Larynx Research Articles

Focus on the larynx

Focus on the larynx

Traços laringais em Latundê (Nambikwára do Norte)

Este trabalho reflete o status dos traços laringais na língua Latundê, pertencente ao subgrupo Nambikwára do Norte, da família Nambikwára. Os dados foram coletados in loco pela autora entre os anos 1997-2001. Para a análise, considerou-se também a literatura disponível sobre outras línguas da família. O presente artigo está organizado em cinco seções: na primeira, são fornecidas informações sobre a família Nambikwára e os inventários segmentais de três línguas da família; na segunda, são apresentados os quadros fonológicos (consonantal e vocálico) do Latundê; na terceira, encontram-se dados que evidenciam a realização dos traços laringais existentes em consoantes Latundê (glotalização e aspiração) e o contraste do traço creaky voice, nas vogais; na quarta, são feitas considerações sobre a variação laringal no Latundê; finalmente, na quinta seção, são apresentadas reflexões sobre a correspondência entre segmentos com traço laringal do Latundê e do Mamaindê, outra língua Nambikwára do Norte. Os resultados do estudo evidenciaram que no Latundê as consoantes neutralizaram os traços laringais, enquanto que as vogais os mantêm contrastivamente. No interior do ramo do Norte, a correspondência entre consoantes Latundê e Mamaindê parece indicar que a primeira língua é mais inovadora no processo de mudança histórica.

Efficacy of double-lumen central venous catheter for airway management in children undergoing resection of laryngeal papilloma under inhalation anesthesia with sevoflurane-spontaneous breathing

Objective To evaluate the efficacy of double-lumen central venous catheter (DLCVC) for airway management in children undergoing resection of laryngeal papilloma under inhalation anesthesia with sevoflurane-spontaneous breathing.Methods Twenty-nine ASA physical status Ⅰ or Ⅱ podiatric patients,aged 1-9 yr,weighing 10-35 kg,scheduled for elective resection of laryngeal papilloma under self-retaining laryngoscope,were included in this study.Anesthesia was induced with inhalation of 8 ％ sevoflurane and the children kept spontaneous breathing.The larynx was sprayed with 2％ lidocaine for topical anesthesia.A self-retaining laryngoscope was inserted and a 7F DLCVC was placed below the glottis via the self-retaining laryngoscope.4％-6％ sevoflurance was insufflated via the main lumen of DLCVC (14G) to maintain anesthesia.PETCO2 was monitored through the branch lumen of DLCVC (18G).Before surgery (T1),at 20 min after the beginning of surgery (T2),and at the end of surgery (T3),arterial blood samples was obtained for blood gas analysis,and body movement,hypoxemia (SpO2 ＜ 95 ％ during oxygen inhalation),and airway management failure (SpO2 ＜ 90％ during oxygen inhalation) were also recorded.Results Compared with the baseline value at T1,although there were significant changes in PaCO2,base excess,pH value and PaO2 at T2 and T3 (P ＜ 0.05),they were all within the clinical reference ranges.There were no significant differences between PaCO2 and PETCO2 at T1,T2 and T3 (P ＞ 0.05).The incidence of body movement and hypoxemia was 10％,and the rate of airway management failure was 3％ (due to degree Ⅲ laryngeal obstruction).Conclusion DLCVC can be safely and effectively used for airway management in children with degree Ⅰ or Ⅱ laryngeal obstruction undergoing resection of laryngeal papilloma under inhalation anesthesia with sevoflurane-spontaneous breathing. Key words: Intubation, intratracheal ; Anesthesia, inhalation ; Respiration ; Laryngeal neoplasms; Papilloma; Child

Relationship between level of lymph node metastasis (LNM) and survival in head and neck squamous cell carcinoma (HNSCC).

6087 Background: Evidence from small cohorts suggests that level of LNM predicts survival in patients with HNSCC. This study sought to investigate the prognostic value of level of LNM in a large populational database and contrast it with the current AJCC classification of lymph node involvement. Methods: SEER registry was queried for patients with stage I-IVB HNSCC of oral cavity (OC), oropharynx (OP), larynx (LAR) and hypopharynx (HP) diagnosed from 2004 to 2009 (N=39,699, median follow-up 2.3 years). Each anatomic group was divided into 3 subgroups based on level of LNM (no LNM, LNM to levels 1-3, 4 or 5), and 4 subgroups based on AJCC classification (N0, N1, N2, N3). Overall survival (OS) in each subgroup was computed (Kaplan-Meier method) and compared (log-rank test). Concordance statistics (C-index) were used to assess the accuracy of LNM classification by level vs AJCC in predicting OS. Results: Both AJCC and level of LNM-based classifications predicted OS in patients with OC, LAR, and HP cancers. For OP, neither AJCC nor level of LNM-based classification predicted OS as expected (lower OS for N0 vs N1/2 or levels 1-3/4) (Table). The performance of level of LNM-based classification was comparable to AJCC N staging for OC, LAR and HP. Conclusions: Level of LNM is a prognostic factor for OC, LAR and HP HNSCC. Classification by level of LNM reached similar accuracy as AJCC N staging in predicting OS for OC, LAR and HP. Neither classification is satisfactory for OP, illustrating the need to refine the staging system in this subgroup. [Table: see text]

Imaging of the pharynx and larynx

Imaging of the pharynx and larynx

Treatment of pyriform sinus carcinoma involving the lateral wall

To present and discuss the clinical features, treatment, and efficacy of pyriform sinus carcinoma involving the lateral wall. Seventy-seven patients with pyriform sinus cancer involving the lateral wall (stage I 8, stage II 10, stage III 32, stage IV 27, according to UICC 2002 staging) were treated from Jun 1997 to Jun 2009 in the department of otorhinolaryngology head and neck surgery, Yuhuangding Hospital. The patients were divided into two groups: Group one 17 cases, simply underwent radiation therapy (R group); Group two 60 cases underwent surgery plus postoperative radiation (SR group). All patients underwent radiotherapy 50-75 Gy. In SR group, hyoid area and lateral pharyngeal approaches were taken according to the lesions for resection. To repair the defects and reconstruct the functions of larynx and pharynx, regional roping in suture, fascial flap/muscular- fascial of strap muscles, glosso-flap, musculocutaneous flap of major pectoral muscle, joint split graft or heterologous (bovine) acellular dermal matrix were used respectively. In group R, the primary tumor and neck lymph node metastasis disappeared at the end of radiotherapy in 15 cases. For one case, the N3 cervical lymph nodes shrank, but failed in local control and died of systemic metastases after 7 months. For another case, the N2 neck lymph nodes significantly reduced after the full course of radiation, PET-CT and biopsy did not find the cancer, but the tumor grew again after 6 months, and died of a neck bleeding 11 months later. All repairing materials used were alive in SR group. Two cases developed postoperative wound infection, and 2 cases suffered from pharyngeal fistula. All patients retained laryngeal functions, and all patients in SR group recovered diet 12 - 30 days, the mean time was 15.6 days. Three and 5 year survival rates for all 77 patients were 59.1% and 41.4%. For stage I + stage II cases in SR group and R group, 3 and 5 year survival rates were 63.6%, 53.0% and 66.7%, 50.0% respectively. There was no significant difference between the two groups (χ(2) = 0.021, P = 0.884). For cases of stage III + stage IV of the SR group and R group, 3 and 5 year survival rates were 63.9%, 43.7%, 16.4%, and 0. There was a very significant difference (χ(2) = 20.496, P = 0.000); all cases in SR group and in R group for 3, 5-year survival rates were 63.6%, 45.8%, 41.5%, and 24.9% respectively. There was also a significant stastical difference (χ(2) = 4.644, P = 0.031). Pyriform sinus carcinoma involving the lateral wall is characterized with scattered growth on the surface of mucous or submucously, tending to invade lamina cartilaginis thyroidea. Simple radiotherapy can get better therapeutic effect for early stage cases. The comprehensive therapy measures should be taken in advanced cases, especially those with surgical indications should be taken to surgery plus radiotherapy. For the purpose of excising the tumor thoroughly and preserving good laryngeal functions, proper operative approaches and ways of repairing should be selected.

The phonetics of Yucatec Maya and the typology of laryngeal complexity

Abstract We examine the known typology of laryngeal complexity (SILVERMAN 1997a, b) in light of phonetic research (FRAZIER 2009) showing that Yucatec Maya uses contrastive tone and phonation type. The phonetic patterns in YM suggest that articulatory incompatibility is the most important factor in enforcing the phasing of tone and non-modal phonation, but that perceptual factors account for the distribution of phasing patterns. Furthermore, YM is similar to the unrelated languages Danish and Acoma which show that creaky voice conditions preceding high pitch. We motivate future research on cross-linguistic differences in the production of creak and its interaction with pitch and gender.

Voice quality and tone identification in White Hmong

This study investigates the importance of source spectrum slopes in the perception of phonation by White Hmong listeners. In White Hmong, nonmodal phonation (breathy or creaky voice) accompanies certain lexical tones, but its importance in tonal contrasts is unclear. In this study, native listeners participated in two perceptual tasks, in which they were asked to identify the word they heard. In the first task, participants heard natural stimuli with manipulated F0 and duration (phonation unchanged). Results indicate that phonation is important in identifying the breathy tone, but not the creaky tone. Thus, breathiness can be viewed as contrastive in White Hmong. Next, to understand which parts of the source spectrum listeners use to perceive contrastive breathy phonation, source spectrum slopes were manipulated in the second task to create stimuli ranging from modal to breathy sounding, with F0 held constant. Results indicate that changes in H1-H2 (difference in amplitude between the first and second harmonics) and H2-H4 (difference in amplitude between the second and fourth harmonics) are independently important for distinguishing breathy from modal phonation, consistent with the view that the percept of breathiness is influenced by a steep drop in harmonic energy in the lower frequencies.

Study on decellularized laryngeal scaffold in dogs

To explore the survivorship and character of decellularized laryngeal scaffold in pectoralis major muscle flap in canine. Eighteen donor larynx in experimental group were decellularized by perfusing sodium dodecyl sulphate. Three of them were used to detect the character of histology. The other fifteen ones were embedded in right pectoralis major muscle flap of acceptor canine. Donor larynx in control group were not perfused. Other experimental procedure was the same as experimental group. The specimens were harvested at two weeks, one month and two months after operation, respectively. Macroscopic view, histological examination and trypan blue staining were performed in the experimental group and control group. The size of the specimens decreased remarkably into disappearance in control group, there was statistical significance between the experimental group and the control group (which used least significant difference t test P < 0.05). There was only little neutrophils and lymphocytes infiltrating around the laryngeal scaffold at 2 weeks in the experimental group. One month after operation, loose connective tissue begin to form around the laryngeal scaffold. After two months of transplantation, the connective tissue became thicker and the number of blood vessels increased than before. There was a large number of lymphocytes and neutrophil infiltration around the laryngeal specimens in the control group at 2nd week. The perichondrium in the control group was damaged at one month post operation. The cartilage cells could not be detected two months after surgery. The survival rate of cartilage cell between experimental group (86.8% ± 3.2%) and the control group (88.6% ± 3.1%) did not show statistical significance before implantation (χ(2) = 0.19, P > 0.05). The survival rate of cartilage cell decreased insignificantly in experimental group while the survival rate declined obviously in the control group at two weeks and one month after operation, the difference had statistical significance (χ(2) were respectively 5.52 and 20.55, P were respectively < 0.05 and < 0.01), the survival rate of cartilage cell in experimental group was (65.8% ± 2.6%) at two months after operation, while the cartilage cell all disappeared in control group. Perfused decellularation technique can construct a low immunogenicity laryngeal cartilage scaffold which can survive in the chest muscle package and establish a good blood supplement. The decellularized laryngeal scaffold could be used as a biological scaffold for whole laryngeal reconstruction.

Investigations of the Larynx and Singing

Investigations of the Larynx and Singing

Adult-type rhabdomyoma of larynx: A rare cause of difficult tracheal intubation

Eriskin tipte laringeal rabdomiyom yetiskinlerde gorulen, yavas buyumesine bagli uzun surede semptomatik olan, benign mezenkimal bir tumordur. Genellikle, bas ve boyun duz kaslarindan kaynaklanir. Rabdomiyomlar disfaji, ses kisikligi ve bogazda cisim hissine neden olurlar. Bu yazida, ust hava yolu tikanikliklarinda entubasyon oncesi laringeal kitle acisindan degerlendirmenin onemini, dispne ve zor trakeal entubasyona neden olan piriform sinus kaynakli eriskin tipte laringeal rabdomiyom olgusu uzerinden anlatmaktadir.

Analysis of 155 cases of head and neck cancers seen over a 3-year period at University of Port Harcourt Teaching Hospital

Objective : Head and neck cancers are group of malignancies that affect the head and neck region. They remain a serious public health concern worldwide with more than half a million cases diagnosed annually. The prevalence and presentation vary from one region to the other. The purpose of this study is to determine the pattern of presentation of this lesion in the University of Port Harcourt Teaching Hospital (UPTH). Method : Records of all histologically diagnosed head and neck cancers during the study period were retrieved from the Cancer Registry of UPTH. Information collected were age, sex, histopathological diagnosis and site of primary lesion. The data were analyzed with SPSS version 20 and summary statistics of frequency and central tendency were presented. Result : There were 155 patients comprising 95 (61.3%) males and 60 (38.7%) females, giving a male to female ratio of 1.6:1. The age range of the patients was 1-85 years with a mean age of 37.8±20.6. The highest incidence of HNC was found in the 40-49 (18.7%) age group while least number of patients was found in the 80-89 (2.6%) age group. Carcinomas (44.5%) was the most common malignant lesion with squamous cell carcinoma been the most common. The next most common lesions were the Lymphomas (25.8%). The neck (29.7%) was the most commonly affected site followed by the oral cavity (22.5%) while the parotid region and the larynx with 1.9% respectively were the least affected sites. Conclusion : Squamous cell carcinomas were the most frequent HNC seen in our centre and the patients within the 5th decade were most frequently affected with male predominance. Common sites affected were the neck, oral cavity, eye, and the nasopharynx. Key words : Head and Neck, Cancers, Port Harcourt

Histopathological spectrum of tumours of upper aero digestive tract in Surat - A study of 156 cases

Background: Cancers of the upper aero-digestive tract (UADT) constitute 3.5-4% of all malignancies. Majority of cases are squamous cell carcinomas which are related with various epidemiologic factors. Aims & Objective: The objective of this study is to know the histopathological spectrum of tumours of UADT. Material and Methods: This study comprises of 156 cases of histopathological diagnosed tumours of upper aero digestive tract who attended new civil hospital, government medical college, Surat, from August 2010 to august 2012. All prospective and neoplastic cases were included and retrospective and non- neoplastic cases were excluded. Routine paraffin sectioning and staining was done and immunohistochemistry was applied when required. Results: Out of total 156 cases of UADT, 129 malignant, 19 cases benign and 8 were carcinoma in-situ cases. In malignant cases, 124 (96.00%) cases of carcinomas, 1 (0.80%) case of sarcoma, 2 (1.60%) cases of melanoma, and 2 (1.60%) cases were of lymphomas. Most common site of carcinoma was oral cavity (tongue). Most common carcinoma was Squamous cell carcinoma. Most common site of SCC was hypo pharynx (pyriform Fossa), followed by oral cavity (tongue) and larynx (supra glottis). In benign tumours, most common site was nasal cavity (7 cases) and common varieties were Angiofibroma and Capillary Haemangioma. Conclusion: Tumours of UADT are predominant in males affecting older age group. People with tobacco chewing, smoking, alcoholism, poor socioeconomic background, mixed diet and poor oral hygiene are more vulnerable.

Study on the ultrasonic images and ultrasound anatomy for the larynx

Objective To explore ultrasonic image for the normal anatomy of the larynx,and provide the basis of ultrasonic diagnosis in laryngeal diseases.Methods Ultrasound anatomy for the larynx was established by way of comparing the structures of four corpses and ultrasonic imaging of the larynx of normal control group.Results Ultrasonic image for the normal anatomy of the larynx was established by comparing the anatomy tomography of corpses and ultrasonic imaging of the larynx of normal control group.Conclusions Ultrasonography could be applied in the examination of the laryngeal diseases as it could show unambiguous ultrasonic imagings of the larynx,and adding an important complementary technique to clinical medicine. Key words: Ultrasonography; Larynx

Clinicopathologic study of 9 patients with neuroendocrine carcinoma of the larynx

To evaluate the clinic manifestation, therapy and prognosis of neuroendocrine carcinoma of the larynx. Nine cases with neuroendocrine carcinoma of the larynx treated between May 2005 and June 2011 were analyzed retrospectively. There were six males and three females, with a median age of 58 years (ranging from 35 to 65 years). Five cases were treated by only operation, and four cases by combined treatment (surgery followed by radiotherapy and chemotherapy). Two patients with typical carcinoid tumor had not any recurrence with following up of 28 and 30 months, respectively. Of three patients with atypical carcinoid tumor, one patient recurred in 36 months after the first operation and followed by re-operation, with no recurrence by further 30 month follow-up, and the other two patients did not recur 15 and 20 month follow-up, respectively. Of three patients with small cell neuroendocrine carcinoma, two died after 11 and 14 months, respectively, and another patient was followed up for 18 months, with no recurrence. One patient with paraganglioma showed no recurrence with a follow up of 32 months. Neuroendocrine carcinoma in larynx included typical carcinoid tumor, atypical carcinoid tumor, small cell neuroendocrine carcinoma and paraganglioma. Accurate diagnosis relies on histopathologic and immunohistochemical examination. There is no standard treatment plan and based-surgery combined treatment should be adopted to laryngeal neuroendocrine carcinoma. The prognosis is dependent on tumor types.

Causes of death in patients with laryngeal cancer in stages I and II

Laryngeal carcinoma is one of the most common cancers in the head and neck region and occurs predominantly inmales. The peak of incidence is between 50 and 70 years of life. The glottis is the most affected topography, but in the Mediterranean countries the supraglottic region assumes a particular preponderance. In the early stages of the disease, the survival rate at 5 years is of about 90% (stage I). The most important risk factors for this tumor are alcohol and tobacco consumption and these patients, probably because of their lifestyle, have several associated comorbidities. To frame the survival rates related to the disease, not disease related and also those arising from other malignancies,allowing to criticize some published data. From the analysis of medical records of patients diagnosed with laryngeal cancer in stages I and II, treated from 2000 to 2005, the cause of death in these patients was analysed. A total of 216 clinical records were reviewed. It was observed that the overall survival of patients in the study period was 75%and that 66.7% and 54.5% of the deaths were not related to the disease, respectively, for stages I and II. It was also found that the specific survival rate for stage I was 94.6% and for stage II was 90.3%. The results show that most patients' deaths were not related to laryngeal cancer. Thus, the authors emphasize the importance of a careful analysis of statistical data on rates of survival / mortality for cancers of the larynx, especially in the early stages.

Morphology of cricopharyngeal muscle under suspension laryngeal endoscope

To observe the morphologic features of cricopharyngeal muscle (CPM) under suspension laryngeal endoscope. This prospective study was conducted on a series of 100 consecutive patients who undergone endoscopic microlaryngeal surgery with intubation general anesthesia. The suspension laryngoscope was introduced down to postcricoid area approaching esophageal inlet. By lifting the larynx with the laryngoscope, the mucosa-covered cricopharyngeal muscle was easily identified as the mound of tissue just at the posterior pharyngeal wall. The image of cricopharyngeal muscle under the laryngoscope was saved. In 94 out of 100 patients, CPM could be visualized with laryngoscope. In the other 6 patients, both CPM and glottic could not be exposed because of cervical vertebra stiffness and obesity. According to the image of CPM under the laryngoscope, the shape of the CPM was divided into three types. It was named for flat type in which there was no mound of tissue visible at the posterior pharyngeal wall and esophageal cavity could be visible completely, semi-bar type in which there was a bar at the posterior pharyngeal wall and partial esophageal cavity could be visible and full-bar type in which the bar contact esophageal anterior wall and esophageal cavity could not be visible. There were 14(14.9%) patients as flat type, 59(62.8%) as semi-bar type and 21(22.3%) as full-bar type. No significant difference was found between adults group and the aged (≥ 65 years old) group (χ(2) = 1.224, P = 0.747) and reflux associated group and non-reflux associated group respectively (χ(2) = 5.252, P = 0.072). The CPM could be well exposed in most of the patients with suspension laryngeal endoscope. It provides anatomy basis for endoscopic cricopharyngeal myotomy.

Evaluation of glottal closure instant detection in a range of voice qualities

Recently developed speech technology platforms, such as statistical speech synthesis and voice transformation systems, facilitate the modification of voice characteristics. To fully exploit the potential of such platforms, speech analysis algorithms need to be able to handle the different acoustic characteristics of a variety of voice qualities. Glottal closure instant (GCI) detection is typically required in the analysis stages, and thus the importance of robust GCI algorithms is evident. The current study examines some important analysis signals relevant to GCI detection, for a range of phonation types. Furthermore, a new algorithm is proposed which builds on an existing GCI algorithm to optimise the performance when analysing speech involving different phonation types. Results suggest improvements in the GCI detection rate for creaky voice due to a reduction in false positives. When there is a lack of prominent peaks in the Linear Prediction residual, as found for breathy and harsh voice, the results further indicate some enhancement of GCI identification accuracy for the proposed method.

Voice prostheses – characteristics and application in laryngology

Рехабилитацията на гласа е едно от най-сериозните предизвикателства пред болните с ларингектомия по повод на злокачествено заболяване. Целта на настоящото съобщение е да се анализира литературата върху приложението на гласовите протези при такива болни и да се представят основните им особености, предимства и недостатъци. Проведено е ретроспективно проучване на публикациите върху гласовите протези, реферирани в базата-данни MEDLINE през последните години и е анализирано съдържанието на обзорните статии. Вече са налице над 1900 статии, посветени на рехабилитацията на гласа с гласови протези, като първите от тях са на Е. Mozolewski (Полша) от 1978 г. Съвременните протези са от два типа: „преживяващи“ и „непреживяващи“. Първите се поставят само от специалист. Ползват се от няколко седмици до 2 години, след което се подменят. Описват се конкретните характеристики, начините на поставяне и поддръжка, както и предимствата и недостатъците на отделните модели. Цената им е все още висока, което ще наложи да се реинбурсират от здравната каса. Внедряването на гласовите протези в ларингологичната практика у нас ще допринесе съществено за подобряване на индивидуалното качество на живот на ларингектомираните болни, постигнато в другите страни. -------------------------------------------------------------- Voice rehabilitation is one of the most serious challenges faced by the patients laryngectomized on the occasion of a malignant disease. The purpose of the present communication was to analyze the literature devoted to the application of the voice prostheses in such patients as well as to present their basic peculiarities, advantages, and disadvantages. A retrospective search of the publications on the voice prostheses abstracted in MEDLINE data-base during the recent years was carried out and the content of the review articles was analyzed. There were already more than 1900 articles devoted to voice rehabilitation by means of voice prostheses as the first ones were authored by Е. Mozolewski (Poland) in 1978. Contemporary prostheses are of two types, i. e. ‘indwelling’ and ‘non-indwelling’. The first ones should be placed by a specialist only. They can be used for several weeks up to 2 years and should be changed thereafter. The concrete characteristics, ways of placement and maintenance, as well as the advantages and disadvantages of the single models were described. Their price still remains high which will necessitate their reimbursement by the Health Insurance Fund. Introduction of the voice prostheses into the laryngological practice in our country will substantially contribute to the improvement of the individual quality of life of the laryngectomized patients that has already been achieved in the other countries.

Surgery of the larynx and trachea (part 2) Marc Remacle, Hans Edmund Eckel (editors). 1st ed. Berlin, Heidelberg: Springer-Verlag, 2010. 308 pages. ISBN: 978-3-540-79135-5, suggested price: $161.02

Surgery of the larynx and trachea (part 2) Marc Remacle, Hans Edmund Eckel (editors). 1st ed. Berlin, Heidelberg: Springer-Verlag, 2010. 308 pages. ISBN: 978-3-540-79135-5, suggested price: $161.02