Laryngeal Secretion Research Articles

Gardasil Vaccination for Recurrent Laryngeal Papillomatosis in Adult Men Second Report: Negative Conversion of HPV in Laryngeal Secretions

In our first report on antibody levels in middle-aged and older men with recurrent laryngeal papillomatosis (RLP), we reported increases in human papillomavirus (HPV) antibody levels similar to those seen in adult women and young men. We posited that HPV antibodies produced in laryngeal mucus by Gardasil would prevent postoperative reinfection in patients with RLP. This is a case series study. The purpose of this study was to examine whether Gardasil injection effectively inhibits recurrence of RLP. Specifically, in this second report, whether HPV antibodies produced in laryngeal secretions by Gardasil are capable of causing negative conversion of HPV-DNA (deoxyribonucleic acid) in laryngeal mucosa was investigated. A total of 11 patients for whom antibodies were measured in the first report were studied. Before vaccination and after 1 year Post-vaccination, HPV screening tests were performed on laryngeal secretions, and whether HPV-DNA negative conversion had occurred was evaluated. At the time of collection of laryngeal secretions, the presence or absence of laryngeal papillomas was examined. Before vaccination, all patients were HPV low-risk positive on laryngeal secretion screening tests. After vaccination, three patients were positive. Laryngeal papillomas remained in five patients. The HPV-DNA test showed negative conversion in eight of 11 (72.7%) patients after vaccination. Residual laryngeal papillomas were found in five of 11 (45.5%) patients. The serum HPV antibody titer did not differ significantly between the group in which laryngeal secretions showed HPV negative conversion and the group in which conversion did not occur. The serum antibody titer did not differ significantly as a function of whether there were residual tumors.

Role of steroids in acute phonotrauma: A basic science investigation

Steroids are used for the treatment of laryngitis in vocal performers and other individuals despite the absence of evidence demonstrating their impact on vocal fold inflammation. Our objective was to examine laryngeal secretion cytokine inflammatory profile changes associated with corticosteroid treatment in a human phonotrauma model. Prospective, individual, randomized, double-blinded, controlled trial. Participants included 10 healthy females who were randomized to either treatment with oral hydrocortisone or placebo, each given in three doses over 20 hours after the experimental induction of acute phonotrauma. Cytokines associated with inflammation and healing (interleukin [IL]-1β, IL-6, IL-10) were measured in laryngeal secretions before and after vocal loading and at 4 and 20 hours after treatment. Proinflammatory mediators IL-1β and IL-6 were doubled in the controls versus the steroid treatment group at 21 hours following induction of acute vocal fold inflammation. Anti-inflammatory cytokine IL-10 showed a 6.3-fold increase in the steroid treatment group versus the controls, indicating anti-inflammatory modulation by steroid treatment. This study provides biologic evidence supporting the use of steroids for acute vocal fold inflammation associated with phonotrauma. 1b.

Localization and regulation of aquaporins in the murine larynx

Conclusion: Expression of aquaporins (AQPs) in the vocal folds and the parasympathetic regulation of AQPs in the laryngeal glands may be important for controlling laryngeal secretion and vocal fold hydration. These findings are thought to be an initial step towards understanding potential mechanisms of water flow through the vocal fold surface. Objectives: Lubrication of the vocal folds is important for phonation and laryngeal defense. However, the system of water transport in the laryngeal epithelium has not yet been clarified. We investigated the expression of AQP water channnels (AQP1–9) in the murine larynx and examined the neural regulating mechanisms of these subtypes. Methods: The distribution of AQPs (AQP1–9) in the murine larynx was examined by immunohistochemistry. Next, the neural mechanism regulating AQPs in the larynx was investigated using unilaterally vagotomized mice. Results: AQP1, 4, and 5 were expressed in the laryngeal epithelium including the vocal folds. Vocal fold AQP expression was minimal at the vocal process. AQP2, 3, 5, 6, 7, and 8 were localized to the submucosal glands. Expression of AQPs in the vagotomized region was significantly decreased compared with the contralateral intact side. The expression in the laryngeal glands was also decreased in the aged mice.

Immunological responses against human papilloma virus and human papilloma virus induced laryngeal cancer

This study aimed to clarify the local immune status in the larynx in the presence of infection or carcinogenesis associated with human papilloma virus. Cytological samples (for human papilloma virus detection) and laryngeal secretions (for immunoglobulin assessment) were obtained from 31 patients with laryngeal disease, during microscopic laryngeal surgery. On histological examination, 12 patients had squamous cell carcinoma, four had laryngeal papilloma and 15 had other benign laryngeal disease. Cytological samples were tested for human papilloma virus DNA using the Hybrid Capture 2 assay. High risk human papilloma virus DNA was detected in 25 per cent of patients (three of 12) with laryngeal cancer. Low risk human papilloma virus DNA was detected only in three laryngeal papilloma patients. The mean laryngeal secretion concentrations of immunoglobulins M, G and A and secretory immunoglobulin A in human papilloma virus DNA positive patients were more than twice those in human papilloma virus DNA negative patients. A statistically significant difference was observed between the secretory immunoglobulin A concentrations in the two groups. Patients with laryngeal cancer had higher laryngeal secretion concentrations of each immunoglobulin type, compared with patients with benign laryngeal disease. The study assessed the mean laryngeal secretion concentrations of each immunoglobulin type in the 12 laryngeal cancer patients, comparing human papilloma virus DNA positive patients (n = 3) and human papilloma virus DNA negative patients (n = 9); the mean concentrations of immunoglobulins M, G and A and secretory immunoglobulin A tended to be greater in human papilloma virus DNA positive cancer patients, compared with human papilloma virus DNA negative cancer patients. These results suggest that the local laryngeal immune response is activated by infection or carcinogenesis due to human papilloma virus. The findings strongly suggest that secretory IgA has inhibitory activity against infection or carcinogenesis associated with human papilloma virus in the larynx.

Local immune status and tumour marker expression in the human larynx

This study examined the local immune status and tumour marker expression in secretions and related tissue specimens from the laryngeal ventricle, comparing individuals with and without head and neck cancer. Laryngeal secretion and mucosal tissue specimens were collected during laryngeal microsurgery or surgical laryngectomy. The laryngeal secretions were found to contain immunological factors such as immunoglobulins G and A and secretory immunoglobulin A. A high level of the tumour marker Cyfra 21-1 was also detected in laryngeal secretions and mucosal tissue. Lows levels of secretory immunoglobulin A and Cyfra 21-1 were seen in the laryngeal mucosal tissue of controls and patients who had previously undergone radiation therapy. The level of secretory immunoglobulin A in laryngeal secretions closely correlated to the level of this immunoglobulin in mucosal tissue. These results indicate that local immunity is present in the human larynx; furthermore, it is strongly affected both by the presence of malignancy and by laryngeal cancer treatments such as irradiation.

Absence of bacterial infection in the mucosal secretion in chronic laryngitis.

To examine whether an infectious process is present in the laryngeal secretion in patients with chronic laryngitis. Mucosal secretion from vocal cords and ventricular folds from 14 patients with chronic laryngitis was examined. Twelve patients with healthy larynxes served as control subjects. Secretion from the laryngeal mucosa was sampled with an imprint technique during general anesthetic. The samples were stained and examined by light and fluorescence microscopy. The numbers of leukocytes and bacteria and the extension of phagocytosis were estimated. In the secretion from eight of the patients with chronic laryngitis we could observe huge numbers of bacteria, whereas only few bacteria were seen in the secretion from the control subjects. However, in both groups, only a few neutrophils were observed and phagocytosis was not present, indicating that the bacteria were present as colonizers. No infectious process is present in the secretion in chronic laryngitis. Further studies concerning the pathogenesis should focus on the pathological processes or conditions of the mucosa.

Pathways and mechanisms involved in neural control of laryngeal submucosal gland secretion

The purpose of this study was to define the pathways and mechanisms involved in the neural regulation of laryngeal mucosal gland functions. In anesthetized, paralyzed, and artificially ventilated dogs, the responses of laryngeal submucosal glands to stimulation of laryngeal mechanoreceptors and peripheral chemoreceptors were examined by measuring the number of hillocks and volume of secreted fluid before and after activation of sensory nerve endings. Compared with a control period, the number of hillocks and volume of secreted fluid significantly increased (P < 0.05) with mechanical stimulation of the vocal folds (n = 13) and with chemical activation of peripheral chemoreceptors by systemic administration of sodium cyanide (100 micrograms/kg; n = 11). The reflex responses induced by vocal fold stimulation and activation of peripheral chemoreceptors were slightly decreased by interrupting transmission in the recurrent laryngeal nerves (P > 0.05) and were abolished by subsequent sectioning of superior laryngeal nerves or prior intravenous administration of atropine methylnitrate (P < 0.05). In denervated animals, topical application of nicotine on laryngeal epithelium caused significant activation of submucosal glands (P < 0.05). We conclude that laryngeal secretion can be significantly altered reflexly by stimulation of laryngeal sensory nerve endings and peripheral chemoreceptors, that both superior and recurrent laryngeal nerves convey cholinergic outflow to laryngeal submucosal glands, and that nicotine acting locally activates laryngeal submucosal glands.

Control of airway caliber.

Tracheobronchial smooth muscle tone may be affected by 4 nervous mechanisms: (1) Vagal cholinergic parasympathetic nerves, which are the main agents for resting tone and most reflex bronchoconstrictions. Their activity is blocked by atropinic drugs. (2) Sympathetic adrenergic dilator nerves, which may act mainly on beta-adrenoceptors in the pulmonary bronchi; alternatively, they may inhibit ganglionic transmission in the vagal constrictor pathway. (3) Vagal nonadrenergic dilator nerves (NAIS). The neurotransmitter at these nerves is probably vasoactive intestinal polypeptide (VIP), although purines could be involved. The role of this system in physiologic and pathologic conditions has not been established. (4) Local axon constrictor reflexes in afferent nerves. These respond to mucosal irritation and cause local smooth muscle contraction by release of substance P. Their importance has not yet been assessed. The motor innervation of the airways is activated reflexly by many stimuli, some of which cause constriction and others dilation. Most of the reflexes are blocked by atropine, which suggests that the cholinergic constrictor pathway is dominant. Other responses include changes in laryngeal caliber and secretion of mucus. Aspirations into the airways will lead to bronchoconstriction, laryngospasm, and secretion of mucus, as well as to respiratory and cardiovascular reflexes. The balance, effectiveness, and development of these responses requires much further study.

Laryngeal Mucous Gland Excess in Victims of Sudden Infant Death

Larynges from 13 victims of sudden infant death syndrome (SIDS) and from ten controls of comparable age were subjected to serial histological transverse section and examined for structural differences that bear on functional performance. The cross-sectional area of mucous glands in the vestibular fold, expressed as a percent of the total cross-sectional area of the fold was 19.52 +/- 8.56 (mean +/- SD in the SIDS specimens), and 12.56 +/- 6.25 in the controls. The difference is statistically significant and suggests that excess mucous laryngeal secretion may be present in at least some cases of the syndrome.

Laryngeal Secretions:An Immunochemical and Immunohistological Study

This study was designed to investigate properties of laryngeal secretion and secretory activity of IgA in the larynx. Laryngeal secretions were collected by adsorption method on filter paper during laryngomicrosurgery from 20 patients having an inflammatory lesion in the larynx. Contents of IgG, IgA, IgE, secretory component (SC), and lactoferrin in the laryngeal secretions were determined and compared with results of those in nasal secretions, tracheobronchial washings, and serum samples obtained from the same subjects. The laryngeal mucosae of 8 laryngectomized materials for cancer lesion were subjected to immunofluorescence studies including the cytoplasmic SC affinity test. Results of this study indicate that laryngeal secretions are characterized by exocrine secretion, resembling nasal and tracheobronchial secretions in the electrophoretic pattern and immunoglobulins content. The immunofluorescence studies and SC affinity test found that the larynx possesses secretory activity of IgA, particularly in the ventricle and subglottis.

SJOEGREN'S SYNDROME AND LUPUS ERYTHEMATOSUS: A CASE REPORT.

THE SYNDROME of Henrick Sjogren was classically described by him in 1933, 1 when he published the case records of 19 patients presenting inflammation of the cornea and conjunctiva associated with dryness (keratoconjunctivitis sicca), diminished salivary and laryngeal gland secretion (xerostomia), and associated arthritis. The principal clinical manifestations of this syndrome, as originally described, were dryness of the eyes, with lack of or diminution of tearing, but rarely lacrimal gland enlargement; dryness of the mouth, with associated parotid gland enlargement; and polyarthritis of the rheumatoid type. In adition, other signs, symptoms, and clinical features were often, but not always, seen including acrodermatitis, purpura, alopecia, achylia, Raynaud's phenomenon, dry atrophic vaginitis, and pernicious anemia. 2 Sjogren pointed out originally, 2 however, that one or two of the initial triad of symptoms may be lacking in a given case. Since the original description, additional features have been reported as occurring in or