Laryngeal Stenosis Research Articles

Treatment outcomes of primary surgery versus chemoradiotherapy for T4 oropharyngeal cancers

Concurrent chemoradiotherapy (CCRT) has been the standard of care for locally advanced diseases regardless of human papillomavirus infection status. Other treatment options include surgery followed by adjuvant therapy and induction chemotherapy followed by CCRT or radiotherapy. However, for locally advanced T4 laryngeal or hypopharyngeal diseases, surgery is preferred over CCRT. Given the improvement in the functional outcomes of surgery, examining the oncologic outcomes in OPSCC patients is critical. This study aimed to determine whether differences in overall survival (OS) exist between surgery and CCRT. Oropharyngeal cancer patients included in the cancer registry of our hospital from January 2014 to December 2018 were retrospectively analyzed. Patients with T4 disease who underwent curative treatment were identified. In this study, the primary and secondary outcomes were OS and disease-free survival (DFS), respectively. Potential confounding factors were also evaluated. Details regarding recurrence pattern were listed. From 2014 to 2018, 74 newly diagnosed oropharyngeal cancer patients were identified from our cancer registry database, 60 of whom satisfied our inclusion criteria. Our findings showed an OS of 25.5 months and DFS of 17.5 months. No significant difference in both of OS and DFS were observed between the surgery and CCRT cohorts. Sex, stage, second primary cancer, IC, and primary treatment were not correlated with DFS. Male sex was the only significant factor identified, with an HR of 0.2 for OS (95% confidence interval, 0.06-0.71). No significant difference in both OS and DFS were observed between the CCRT and surgery cohorts. CCRT remains the standard of care for locally advanced disease.

Assessment of survey radiography as a method of diagnosing bilateral laryngeal paralysis in dogs.

The gold standard for diagnosis of laryngeal paralysis is laryngoscopy under light anesthesia. This prospective analytical cross-sectional study aimed to determine whether a radiographic assessment of the larynx could be used as a non-invasive screening tool for diagnosing laryngeal paralysis in non-sedated animals, as the laryngeal ventricles may appear wider in affected animals. The laryngeal ventricles of 18 dogs with bilateral laryngeal paralysis composing the affected group and 25 non-sedated dogs presenting no respiratory abnormality composing the control group were evaluated using right lateral radiography of the larynx. Three observers measured the ratios of the maximal ventricular length and surface to the body length of the third cervical vertebra (MVL/LC3 and VS/LC3, respectively). They also subjectively assessed the ventricular shape as either normal or rounded. The most accurate criterion was found to be MVL/LC3, as the respective areas under the ROC curves were 0.96 (95% confidence interval [CI]: 0.95-0.97), 0.89 (95% CI: 0.87-0.91), 0.80 (95% CI: 0.65-0.95) for MVL/LC3, VS/LC3, and ventricular shape evaluation, respectively. Based on ROC curve analysis, two thresholds of clinical interest were set for the MVL/LC3; bilateral laryngeal paralysis was very unlikely for values<0.3 and very likely for values>0.5. The findings of this study support the use of lateral laryngeal radiography as a screening tool for diagnosing bilateral laryngeal paralysis. However, further diagnostic tests remain required if MVL/LC3 lies between these threshold values or if clinically indicated. Further studies are warranted to explore the use of laryngeal radiography in unilateral paralysis and other laryngeal or oropharyngeal diseases.

A Case of Posterior Glottic Stenosis Caused by Treatment of COVID-19 with Long-term Intubation

Posterior glottic stenosis (PGS), of which the most common cause is tracheal intubation, is often misdiagnosed as bilateral vocal cord paralysis. We herein report a case of PGS that occurred after treatment with COVID-19 with long-term intubation. The patient underwent tracheostomy and endoscopic resection and showed improvement in dyspnea. The COVID-19 epidemic is expected to increase long-term intubation cases and cases of severe laryngeal injury, including PGS. We need tracheostomy in long-term intubated COVID-19 patients, just like other diseases, and an appropriate diagnosis and surgical treatment for PGS should be performed. When otolaryngologists encounter cases of bilateral vocal cord paralysis, it is necessary to keep in mind the possibility of PGS and laryngeal stenosis and pay attention to the history of COVID-19.

Surgical Approach for the Treatment of Laryngeal Stenosis Including Laryngeal Web

Surgical Approach for the Treatment of Laryngeal Stenosis Including Laryngeal Web

Analysis of the Effectiveness of Arytenoidectomy and Posterior Cordectomy with the Use of CFD Airflow Measurements in Patients with BVFP: A Retrospective Study.

Bilateral vocal fold paralysis (BVFP) is a rare larynx disease manifested by dyspnea, which often requires surgical treatment. The aim of the study is to determine the effectiveness of unilateral arytenoidectomy with posterior cordectomy in the treatment of BVFP using the computational fluid dynamics (CFD) method. This study included 33 patients with BVFP who underwent unilateral laser arytenoidectomy with posterior cordectomy. Glottis area measurements and spirometry, as well as a self-assessment of respiratory efficiency were performed before the surgery and after the recovery period. Using the CFD method, computer models of the glottis were made. Then, changes in air pressure gradient and maximum air velocity at the level of glottis were calculated, and local fields of pressure and air velocities were obtained. The values of glottal surface area (S), spirometry parameters (forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and peak expiratory flow (PEF)), inlet air velocity at the glottal level as well as patients self-assessment of respiratory efficiency turned out to be significantly higher after the operation. The values of maximum velocity at the glottal level, pressure gradient at the glottal level turned out to be significantly lower after the surgery. We observed that the greater the increase in glottal surface area, the greater the decrease in self-assessment scales (visual analogue scale (VAS) and Medical Research Council (MRC)). Increased levels of spirometry parameters after the surgery correlated with smaller decrease of PEF-dependent pressure gradient at the glottal level (PEFΔP CFD). Unilateral laser arytenoidectomy with posterior cordectomy is an effective method for the treatment of BVFP. CFD is a useful tool to determine and visualize the effectiveness of surgical treatment in BVFP.

Video endoscopic methods of laryngeal examination in modern phoniatry

Introduction. Modern diagnostics of laryngeal diseases is based on the use of video endoscopic technologies. The authors of the article, having almost thirty years of experience with various methods of video endoscopy, proposed a classification of video endoscopic methods of laryngeal examination. Objective. To develop an algorithm for the application of various video endoscopic methods of laryngeal examination in voice professionals with functional and organic dysphonia. Materials and methods. From 2020 to 2022, 2308 patients aged 18 to 80 years (43.2 ± 11.5) were examined in the phoniatric department of the St. Petersburg Research Institute of ENT. There were 1424 women (61,7 %), 884 men (38,3 %) people. Functional dysphonia was detected in 705 (30,5 %) people, acute and chronic laryngitis in 668 (28,9 %), tumor-like formations in 436 (18,9 %), the remaining nosological forms were diagnosed in 499 (21,7). All the patients turned out to be representatives of voice-speaking professions and complained of dysphonia.For videolaryngoscopy, videolaryngostroboscopy, autofluorescence endoscopy, NBI–endoscopy, equipment from various manufacturers was used. Results. An algorithm for the application of video endoscopic research methods in persons of voice-speech professions with dysphonia has been developed. Overview videolaryngoscopy and videostroboscopy were mandatory research methods for all patients with complaints of voice function. The use of these two methods proved to be sufficient for the diagnosis of functional dysphonia, paresis and paralysis, congenital malformations of the larynx, scar stenosis. In-depth diagnostics and differential diagnostics of tumor-like formations, various forms of chronic laryngitis, benign and malignant formations, in addition to videolaryngoscopy and videostroboscopy, included autofluorescence endoscopy or NBI endoscopy, which revealed the earliest stages of the pathological process. Conclusions. Only the complex application of various methods of video endoscopy of the larynx provided timely diagnosis and early treatment of dysphonia, maximum restoration of voice function, and, consequently, the preservation of professional longevity by persons of voice-speech professions.

Employing Energy and Statistical Features for Automatic Diagnosis of Voice Disorders.

The presence of laryngeal disease affects vocal fold(s) dynamics and thus causes changes in pitch, loudness, and other characteristics of the human voice. Many frameworks based on the acoustic analysis of speech signals have been created in recent years; however, they are evaluated on just one or two corpora and are not independent to voice illnesses and human bias. In this article, a unified wavelet-based paradigm for evaluating voice diseases is presented. This approach is independent of voice diseases, human bias, or dialect. The vocal folds' dynamics are impacted by the voice disorder, and this further modifies the sound source. Therefore, inverse filtering is used to capture the modified voice source. Furthermore, the fundamental frequency independent statistical and energy metrics are derived from each spectral sub-band to characterize the retrieved voice source. Speech recordings of the sustained vowel /a/ were collected from four different datasets in German, Spanish, English, and Arabic to run the several intra and inter-dataset experiments. The classifiers' achieved performance indicators show that energy and statistical features uncover vital information on a variety of clinical voices, and therefore the suggested approach can be used as a complementary means for the automatic medical assessment of voice diseases.

Modulation of mouse laryngeal inflammatory and immune cell responses by low and high doses of mainstream cigarette smoke

Cigarette smoking is a major risk factor for laryngeal diseases. Despite well-documented cigarette smoke (CS) induced laryngeal histopathological changes, the underlying immunopathological mechanisms remain largely unexplored. The goal of this study was to evaluate inflammatory and immune cell responses in a CS-exposed larynx. Specifically, we used a 4-week subacute whole-body CS inhalation mouse model to assess these responses in the laryngeal mucosa upon exposure to low (LD; 1 h/day) and high dose (HD; 4 h/day) CS. Laryngeal tissues were harvested and evaluated using a 254-plex NanoString inflammation panel and neutrophil/macrophage/T-cell immunohistochemistry (IHC). NanoString global and differential gene expression analysis revealed a unique expression profile only in the HD group, with 26 significant differentially expressed genes (DEGs). StringDB KEGG pathway enrichment analysis revealed the involvement of these DEGs with pro-inflammatory pathways including TNF/TNFα and IL-17. Furthermore, inflammatory responses remained inhibited in conjunction with predicted activated states of anti-inflammatory regulators like PPARγ and NFE2L2 upon Ingenuity Pathway Analysis (IPA). Subglottic T-cell levels remained significantly inhibited as corroborated by IPA predictions. Overall, our key findings are consistent with HD exposures being anti-inflammatory and immunosuppressive. Furthermore, the identification of important regulatory genes and enriched pathways may help improve clinical interventions for CS-induced laryngeal diseases.

Effect of socioeconomic status on wait times for patients undergoing treatment for laryngeal conditions in a universal healthcare system.

As one of the world's only fully publicly administered, universal healthcare systems, Canada intends to provide equitable access to services for all patients. Socioeconomic status (SES) can affect treatment wait times with implications on health outcomes; however, this has not been evaluated in the setting of laryngeal disease, which incorporates urgent and elective conditions, in a universal healthcare system. This study aims to identify whether SES-affected treatment wait times for laryngeal therapies in this system. A retrospective review was conducted on a cohort of patients with laryngeal disease at an academic, tertiary center who underwent laryngeal surgery over a three-year period. Data retrieved through medical records; surgical and voice therapy wait times were normalized to each practitioner's average wait time for respective diagnostic categories. Income was used to assess SES and was derived from Statistics Canada census information based on patient postal codes. Data analysis identified 578 patients (59% male). Mean wait time to surgery for all conditions was 123.5 (95% confidence interval 113.1-133.9) days. Analysis of variance analysis found no difference in wait times between different SES groups (p= .28), regardless of laryngeal disease category. Patients with cancer or airway obstruction had shorter wait times compared with benign conditions (p< .0001). SES did not affect treatment wait times for laryngeal therapies in a universal healthcare system. Wait times were shorter for oncologic and obstructive conditions compared with benign conditions, reflecting an ability to accommodate clinical needs without impacting care access at the detriment of different SES statuses. 4.

Retrospective study of 1050 dogs with respiratory symptoms in Japan (2005-2020).

Few studies have investigated the incidence of respiratory diseases based on anatomical sites or the relationship between breed and these diseases. The objective of this study was to investigate the prevalence of canine respiratory diseases among dogs in Japan, with relationship to the breed. We retrospectively reviewed the medical records of dogs with respiratory symptoms and calculated the odds ratio (OR) to evaluate the relationship between breed and disease. A total of 1050 dogs with respiratory symptoms were included in this study. Miniature dachshunds were the most common breed affected by respiratory diseases. Among tracheobronchial diseases, there was a significant association between some small breeds and tracheobronchial collapse, miniature dachshunds (OR: 4.44, 8.43, 95% confidence interval [CI]: 3.17-6.22, 4.33-16.0) and chronic bronchitis and bronchiectasis. Among nasal diseases, miniature dachshunds (OR: 27.2, 95% CI: 16.8-44.8) and golden retrievers (OR: 21.0, 95% CI: 6.43-69.3) were the most affected by non-infectious rhinitis and nasal aspergillosis, respectively. Brachycephalic obstructive airway syndrome was the most common disease among pharyngeal and laryngeal diseases, with a relationship with breed being found in some brachycephalic breeds, and Pomeranians (OR: 2.7, 95% CI: 1.42-5.17). Respiratory diseases in dogs are strongly correlated with popular breeds in Japan. Miniature dachshunds, in particular, are associated with many respiratory diseases, which may differ from international reports. Thus, this result may help in the early detection, prevention, treatment, and elucidation of the pathophysiology of canine respiratory diseases.

OA24 Airway obstruction in an adolescent: relapsing polychondritis

OA24 Airway obstruction in an adolescent: relapsing polychondritis

Effects of surgery on the relationship between subglottic pressure and fundamental frequency in vocal fold dynamics in patients with benign laryngeal diseases.

Subglottic pressure (Ps) and fundamental frequency (F0) play important roles in governing vocal fold (VF) dynamics. Theoretical description, model simulation, excised larynx and animal models have been used in previous studies, yet clinically applicable measurements are still lacking. This study aimed to evaluate the effects of surgery for benign laryngeal lesions by investigating the relationship between F0 and Ps. Patients with benign laryngeal lesions who underwent phonosurgery were prospectively recruited. Participants were instructed to sustain voicing the vowel /o/ at three incremental frequencies four semitones apart in the modal register (F01, F02, F03). F0 was estimated by VF vibration on the accelerometer. Ps change was achieved and measured using the airflow interruption method. Thirteen patients with a mean age (SD) of 43.5 (12.4) years were included. The change in F0 per unit change of Ps, which is the slope (Hz/kPa) of the regression line of the frequency-pressure data pairs, decreased as the tension of the VF increased. The slopes significantly increased after the operation for F01 and F02 (36.43 ± 14.68 preoperatively, 53.91 ± 30.71 postoperatively, p = 0.011 and 26.02 ± 10.71; 34.85 ± 17.92, p = 0.046, respectively). In addition, there was a significant decrease in phonation threshold pressure and improvements in the grade, roughness, breathiness, asthenia, strain scale, and the voice handicap inventory-10. The relationship between F0 and Ps may serve as an objective assessment of the outcomes in the treatment of benign laryngeal diseases with clinical relevance.

A silent laryngeal trauma case: an unexpected late fracture of the superior portion of the thyroid cartilage superior horn.

Attempts to analyze clinical unexpected cases of laryngeal fractures based on mild symptoms and physical findings. Even though a laryngeal fracture is rare in a living patient and when happens it is related to severe airways emergency, this case reported seems important to offer a possible differential diagnosis in patients who present with the same symptoms, if no other causes have been detected, like another one benign laryngeal disease.

Hierarchical dynamic convolutional neural network for laryngeal disease classification

Laryngeal disease classification is a relatively hard task in medical image processing resulting from its complex structures and varying viewpoints in data collection. Some existing methods try to tackle this task via the convolutional neural network, but they more or less ignore the intrinsic difficulty differences among different input samples and suffer from high training complexity. In order to better resolve these problems, an end-to-end Hierarchical Dynamic Convolutional Network (HDCNet) is proposed, which can dynamically process the input samples based on their difficulty. For the easy-classified samples, the HDCNet processes them with a smaller resolution and a relatively small network, while the difficult samples are passed to a large network with a larger resolution for more accurate classification results. Furthermore, a Feature Reuse Module (FRM) is designed to transfer the features learned by the small network to the corresponding block in the deep network to enhance the overall performance of some rather complicated samples. To validate the effectiveness of the proposed HDCNet, comprehensive experiments are conducted on the public available laryngeal disease classification dataset and HDCNet provides superior performances compared with other current state-of-the-art methods.

Glucocorticoid Dose Dependency on Gene Expression in Vocal Fold Fibroblasts and Macrophages.

Glucocorticoids (GCs) modulate multiple cellular activities including inflammatory and fibrotic responses. Outcomes of GC treatment for laryngeal disease vary, affording opportunity to optimize treatment. In the current study, three clinically employed GCs were evaluated to identify optimal in vitro concentrations at which GCs mediate favorable anti-inflammatory and fibrotic effects in multiple cell types. We hypothesize a therapeutic window will emerge as a foundation for optimized therapeutic strategies for patients with laryngeal disease. In vitro. Human vocal fold fibroblasts and human macrophages derived from THP-1 monocytes were treated with 0.03-1000 nM dexamethasone, 0.3-10,000 nM methylprednisolone, and 0.3-10,000 nM triamcinolone in combination with interferon-γ, tumor necrosis factor-α, or interleukin-4. Real-time polymerase chain reaction was performed to analyze inflammatory (CXCL10, CXCl11, PTGS2, TNF, IL1B) and fibrotic (CCN2, LOX, TGM2) genes, and TSC22D3, a target gene of GC signaling. EC50 and IC50 to alter inflammatory and fibrotic gene expression was calculated. Interferon-γ and tumor necrosis factor-α increased inflammatory gene expression in both cell types; this response was reduced by GCs. Interleukin-4 increased LOX and TGM2 expression in macrophages; this response was also reduced by GCs. GCs induced TSC22D3 and CCN2 expression independent of cytokine treatment. EC50 for each GC to upregulate CCN2 was higher than the IC50 to downregulate other genes. Lower concentrations of GCs repressed inflammatory gene expression and only moderately induced genes involved in fibrosis. These data warrant consideration as a foundation for optimized clinical care paradigms to reduce inflammation and mitigate fibrosis. NA Laryngoscope, 133:1169-1175, 2023.

Supraglottic Localization of IgG4-Related Disease—Rare and Challenging Equity

Supraglottic stenosis is a rare symptom, particularly in fibroinflammatory multifocal diseases, such as IgG4-related disease (IgG4-RD). There is still an inconsistency in the diagnosis of less-common locations of IgG4-RD, which causes a delay in the diagnosis and treatment. Our paper aims to analyze different aspects of IgG4-RD presenting as supraglottic stenosis, including the possible overlap with ANCA-associated vasculitis. We compare the usefulness of the recently revised ACR/EULAR and Comprehensive criteria and discuss treatment options. The review was performed according to PRISMA guidelines using the MEDLINE Pubmed and Scopus databases. The analysis includes nine papers describing supraglottic laryngeal stenosis in 13 patients. Furthermore, we present a case of a woman with ongoing supraglottic stenosis presenting with cough, temporary dyspnea and stridor as the symptoms of localized IgG4-RD. At the time of writing, the patient remains in remission while receiving treatment with cyclophosphamide and methylprednisolone. The symptoms of supraglottic localization of IgG4-RD may be severe; however, at that point, clinicians should suspect autoimmune etiology and attempt to modulate the autoimmune response instead of performing dilatation surgery—the effects of which may not result in extended intervals between interventions. The ACR/EULAR criteria show great specificity; however, when IgG4-RD is presumed, the specific treatment should be implemented.

Diagnosis and Surgical Treatment of Laryngeal Stenosis as a Late Complication of Endotracheal Intubation

全身麻酔下手術において, 気管内挿管は日常的に行われているが, 施行医の技量の問題や喉頭展開困難などにより, 挿管操作時に喉頭および気管粘膜の損傷が生じることがある. また, 挿管チューブの不適合や過剰なカフ圧により後部声門や声門下の粘膜に壊死を来し, 抜管時点では多少の出血以外問題はないものの, 緩徐に狭窄し, 結果として呼吸困難に至る例もある. 当院でそのような例を比較的短期間に3例経験し, いずれも良好な臨床経過をたどったので, 症例毎の術前診断と外科的治療法の選択の重要性について報告する. また, 医原性の上気道狭窄としての本疾患の病態および適切な診断・治療の重要性について, 若干の文献的考察を交えて提示する.

Postacute Laryngeal Injuries and Dysfunctions in COVID-19 Patients: A Scoping Review.

Objective: To investigate post-acute laryngeal injuries and dysfunctions (PLID) in coronavirus disease 2019 (COVID-19) patients. Methods: Three independent investigators performed a systematic review of the literature studying PLID in patients with a history of COVID-19. The review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement. Epidemiological, clinical, hospitalization features, laryngeal diseases, and voice outcomes were extracted from the included papers. Results: Eight papers met our inclusion criteria (393 patients) corresponding to five uncontrolled prospective and three retrospective studies. The most prevalent PLID were vocal fold dysmotility (65%), vocal fold edema (35%), muscle tension dysphonia (21%), and laryngopharyngeal reflux (24%). Posterior glottic stenosis (12%), granuloma (14%), and posterior glottic diastasis (12%) were the most common injuries. Most patients with PLID were obese and had a history of intensive care unit hospitalization, and orotracheal intubation. The delay between the discharge and the laryngology office consultation ranged from 51 to 122 days. The mean duration of intubation ranged from 10 to 34 days. Seventy-eight (49%) intubated patients were in the prone position. The proportion of patients requiring surgical treatment ranged from 39% to 70% (mean = 48%). There was an important heterogeneity between studies about inclusion, exclusion criteria, and outcomes. Conclusions: COVID-19 appeared to be associated with PLID, especially in patients with a history of intubation. However, future controlled studies are needed to evaluate if intubated COVID-19 patients reported more frequently PLID than patients who were intubated for other conditions.

Fungal and Bacterial Co-infection of Supraglottis in an Immunocompetent Patient Secondary to Herbal Medicine

Fungal infections are among the major infections among immunocompromised patients. They are becoming more common with the widespread use of antibiotics, steroid therapy, and the increasing number of immunocompromised patients. However, the incidence of laryngeal fungal and bacterial co-infection has rarely been reported. As same as laryngeal fungal infection, it mimics other types of laryngeal disease such as gastroesophageal reflux disease, granulomatous disease, and malignant lesions. There is a high likelihood of misdiagnosis, leading to delayed treatment and morbidity from fungal and bacterial co-infection of the larynx. A high index of suspicion is required to make the diagnosis and one should look for evidence of immunosuppression and predisposing factors to local mucosal barrier impairment. However, herbal medicine is a rare cause. We present a case of fungal and bacterial co-infection of supraglottis in an immunocompetent patient secondary to herbal medicine.

Laryngeal function-preserving of frontolateral vertical partial laryngectomy (FLVPL) for selected T4a glottic cancer with thyroid cartilage invasion adherence to the anterior commissure: an innovative attempt

ObjectiveTo evaluate the feasibility and efficacy in selected T4a glottic cancer (thyroid cartilage invasion adherence to the anterior commissure) treated with frontolateral vertical partial laryngectomy (FLVPL) and laryngeal framework reconstruction using titanium mesh.MethodsSix patients with the limited T4a glottic cancer with thyroid cartilage destruction adherence to the anterior commissure, underwent FLVPL from 2009 to 2016 in Sun Yat-Sen University Cancer Center. All patients were followed up postoperatively.ResultsAll patients comprised radical tumor resection and favorable functional outcomes, and no aspiration and laryngeal stenosis were observed. According to postoperative pathology, four patients should go through postsurgical radiotherapy with a mean dose of 66 Gy. But one of them refused to undergo postoperative radiotherapy, who observed local recurrence in postcricoid area underwent total laryngectomy (TL) and ipsilateral selected neck dissection in post-surgery two year. During follow-up period, all patients were still alive, and five patients without local recurrence and distant metastases.ConclusionFLVPL and laryngeal framework reconstruction using titanium mesh is one viable surgical procedure to obtain adequate oncologic and functional outcomes.