Vocal Cord Lesions Research Articles

Diagnostic accuracy of deep learning-based algorithms in laryngoscopy: a systematic review and meta-analysis.

Laryngoscopy is routinely used for suspicious vocal cord lesions with limited performance. Accumulated studies have demonstrated the bright prospect of deep learning in processing medical imaging. In this study, we perform a systematic review and meta-analysis to investigate diagnostic utility of deep learning in laryngoscopy. The study was performed according to the Primary Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. We comprehensively retrieved articles from the PubMed, Scopus, Embase, and Web of Science up to July 14, 2024. Eligible studies with application of deep learning algorithm in laryngoscopy were assessed and enrolled by two independent investigators. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio with 95% confidence intervals (CIs) were calculated using a random effects model. We retained 9 eligible studies adding up to 106,175 endoscopic images for the meta-analysis. The pooled sensitivity and specificity to diagnose laryngeal cancer were 0.95(95% CI: 0.85-0.98) and 0.96 (95% CI: 0.91-0.98). The area under the curve of deep learning was 0.99 (95%CI: 0.97-0.99). Deep learning demonstrated excellent diagnostic efficacy in assessing laryngeal cancer with laryngoscope images in current studies, which manifests its potential of aiding endoscopist for laryngeal cancer diagnosis and clinical decision making.

Transoral Laser Microlaryngeal Surgery with MLT Tubes: A Retrospective Case Series.

To evaluate effectiveness of using MLT tubes for transoral laser MLS in terms of surgical visualization, complete excision of vocal cord lesions, maintenance of adequate oxygenation and ventilation and the occurrence of any airway related complications. In a retrospective case series study, review of electronic medical records was conducted for 64 patients who underwent transoral laser MLS over an 18-month period. The collected data included vital parameters, mode of ventilation, ET tube details, surgical field of vision, perioperative adverse events and postoperative ventilation requirements. Among the 64 patients, 82.8% of the time, 5 size MLT tubes were used, fixed at meanlengths of21.6cm in females and 23.07cm in males respectively. A good surgical field of exposure was achieved in 92.2% of patients, with an average FiO2 of 0.29 during laser useand pressure control ventilation mode being the majority choice. 98.4% were extubated on table. The incidence of cuff rupture and bronchospasm was 4.7% and 1.6% respectively with no instances attributable to laser relatedevents. Even though Laser resistant tubes are considered gold standard, MLT tubes can be used by taking adequate precautions to reduce Laser related complications when there is limited availability of laser tubes. Level of evidence Case series.

Anesthetic management of a rare case of mobile vocal cord polyp causing dynamic airway obstruction: A case report

We report the anesthetic management of a patient presenting with a mobile vocal cord lesion in combination with restricted mouth opening. Fiber-optic laryngoscopy revealed a highly mobile vocal cord lesion, moving in and out of the vocal cords with respiration. A very small tracheal lumen was visible posteriorly during expiration. ASA difficult airway algorithm was applied, and the patient was successfully intubated awake with a # 5 microlaryngeal tube loaded over a pediatric bronchoscope. We aim to highlight the importance of detailed preoperative evaluation, adopting difficult airway algorithms and utilization of devices, with which we have maximum expertise with some modification as the key to avoid airway-related adverse events in such patients.

Non-Hodgkin lymphoma of vocal cord causing “pseudo-palsy”

Non epithelial lesion of vocal cord is identified as vocal cord palsy/ impaired movement without obvious mucosal ulceration. There are several nonepithelial lesions of vocal cord. Lymphoma, plasmacytoma, liposarcoma, lipoma, myxofibrolipoma, hemangioma, rhabdomyosarcoma are amongst the important differential diagnosis. These tumors occur in the submucosal layer of larynx and hence the mucosa appears intact at endoscopy. The lesions are typical non circumscribed, and invasion of adjoining structures helps in differentiating benign from malignant lesions. Presented here is a case of vocal cord (pseudo) palsy who underwent an 18F-fluorodeoxyglucose positron emission tomography computed tomography (18F-FDG PET CT) scan which revealed a hypermetabolic trans glottic soft tissue lesion. Histology confirmed the diagnosis of Extra-nodal High Grade Diffuse Large B Cell Non-Hodgkin lymphoma (DLBCL NHL).

Videostroboscopic Evaluation of Patients with Benign Vocal Cord Lesions Following Micro Laryngeal Surgery in a Tertiary Care Centre

Videostroboscopic Evaluation of Patients with Benign Vocal Cord Lesions Following Micro Laryngeal Surgery in a Tertiary Care Centre

Direct Microlaryngoscopy and Excision of Vocal Cord Lesion

In this case, Dr. Brown and Dr. Cohen perform a direct microlaryngoscopy and excise a vocal cord lesion.

Analysis of Th1/Th2 cytokine profile and clinical characteristics of patients with head and neck squamous cell carcinoma.

Immune system biomarkers in cancer pathogenesis offer new therapeutic avenues, as seen in cytokine (CK) profiles of laryngeal and hypopharyngeal tumors. A retrospective analysis was conducted on 58 patients with laryngeal and hypopharyngeal tumors and 27 patients with benign vocal cord lesions to explore the role of serum CKs in these diseases' characteristics and immunotherapy. The differences in the levels of 12 cytokines were measured. Additionally, the study examined the correlation between T helper cells (Th)1/Th2 cytokine levels and the clinical characteristics and immunotherapy efficacy of laryngeal and hypopharyngeal cancers. The results show that the balance of Th1/Th2 is biased towards Th2 in patients with laryngeal and hypopharyngeal tumors. Among these, interleukin (IL)-6 (P = 0.021) was highly expressed in laryngeal tumors, and the expression levels of IL-1β (P = 0.008), IL-6 (P = 0.005), and IL-8 (P = 0.05) were higher in patients with poorly differentiated laryngeal tumors. The level of IL-4 (P = 0.0048) was significantly correlated with tumor location. The expression levels of IL-2 (P = 0.010), IL-4 (P = 0.028), IL-10 (P = 0.011), IL-12p70 (P = 0.034), IL-17 (P = 0.024), tumor necrosis factor (TNF)-α (P = 0.003), and interferon (IFN)-γ (P = 0.007) were related to lymph node metastasis. The level of IFN-γ (P = 0.016) was correlated with the efficacy of neoadjuvant therapy, while the level of IFN-α (P = 0.013) was significantly correlated with programmed death ligand 1 (PD-L1) expression. The Principal Component Analysis (PCA) results showed that patients with tumors, poor differentiation, and lymph node metastasis had higher levels of Th1 and Th2 cytokine separation. In conclusion, the shift in the balance of Th1 and Th2 cytokine expression indicates higher tumor invasiveness, and IFN has potential as a circulating molecular marker for immunotherapy of head and neck squamous cell carcinoma.

A Vocal Cord Polyp: An Atypical Case of Molluscum Contagiosum.

A 44-year-old patient presented with hoarseness of voice and a polypoidal lesion on the left vocal cord. Complete excision was done. To our knowledge, this is the second reported case of molluscum contagiosum of the vocal cords. It should be considered as a differential diagnosis of a vocal cord lesion.

Correlation Between the Effects of CO2 Laser and Histopathological Analysis in Vocal Cord Lesions: An Observational Study.

Lasers are based on the principle of light amplification by empowering atoms to store and emit light in a coherent form. Through their effect on tissues, lasers reduce hemorrhage allowing the surgeon to work in a clear field with precise removal of the tissues. Irradiation of the soft tissues by lasers produces thermal effects on the surrounding healthy tissues which can make histopathological examination difficult. Hence this study was done to find a correlation between adjustable parameters of CO2 laser and the extent of collateral thermal damage in the excised vocal cord lesions on histopathological examination and diagnosis. In this study, we enrolled 80 patients who were divided into 4 groups with different combinations of laser power and mode, used during transoral laser micro laryngeal surgery for the excision of vocal cord lesions and subsequent histopathological analysis to objectively measure the extent of thermal damage zone and subjectively assess histo-morphological effects of thermal damage in terms of grade of carbonization. The extent of the thermal damage zone is directly related to the power of the laser, but the mode of the laser had no relation with the thermal damage zone in our study. On subjective histo-morphological examination of excised lesions showed that both power and mode of laser have significant effects on tissue morphology. Continuous mode causes a significantly higher grade of carbonization as compared to the superpulsed mode of the laser. However, in our study it was seen that charring in no way affected the diagnosis in any of the biopsies examined whatever the power or mode of the laser used. The depth and width of the tissue thermal damage zone are mainly dependent upon the laser parameters (power and mode). Although considering the limitations of this study carried out in terms of sample size, it would be pertinent to mention here that further studies with larger cohorts need to be done to authenticate these results.

Office Rigid Laryngoscopy as a Predictor for Glottic Exposure in Microlaryngoscopy.

Good glottic exposure is a prerequisite for a good microlaryngeal surgery. Often this is difficult to predict preoperatively. This study aims to evaluate the utility of office-based rigid laryngoscopy (70°) as a screening tool to predict laryngeal exposure during micro laryngoscopy. Sixty-nine patients underwent office-based rigid laryngeal examination followed by micro laryngoscopic surgery for benign vocal cord lesions. Office-based laryngoscopy was classified as grade 1 when the entire glottis with anterior commissure (AC) was visualized without undue traction of tongue; grade 2 when AC was visualized only during phonation and with some traction of tongue and grade 3 when there is an inability to visualise the glottis adequately despite moderate traction of tongue and the examination was completed using a flexible scope. These were correlated with laryngeal exposure during micro laryngoscopy. 42 patients were categorized as grade 1 out of which 39 (93%) had a favourable laryngeal exposure (class 1) while only 3 (7%) had a partially favourable exposure (class 2). 18 patients were categorized as grade 2 out of which 12(66%) had a favourable exposure (class 1) as against 6 (33%) who had a partially favourable exposure (class 2). Nine of our patients were categorized as grade 3 out of which all 9 (100%) had an unfavourable exposure (class 3) requiring angled tele laryngoscopy to complete the surgery. A strong correlation between office-based laryngoscopic grading and exposure during operative laryngoscopy was obtained statistically (Cramer's V test, V = 0.746). Office examination with a 70° telescope is a good predictor of glottic exposure during micro laryngoscopy. We believe that the ease of performing a micro laryngoscopy in the operating room is directly proportional to the ease of doing laryngoscopy in the office.

Spindle cell carcinoma of the larynx: a rare entity

Squamous cell carcinoma (SCC) is the commonest malignancy encountered in the larynx in the Indian population. Spindle cell carcinoma is an extremely rare malignant tumor and is a variant of SCC with a mesenchymal like malignant cell component. This is a case report of a 58 years old patient who presented with hoarseness of voice of 7 months duration. He was diagnosed to have a right vocal cord polypoidal growth with mobile vocal cords. He underwent direct laryngoscopy and biopsy of the lesion which was reported as spindle cell neoplasm/inflammatory myofibroblastic tumor (IMT). Immunohistochemistry (IHC) was carried out and confirmed the diagnosis of inflammatory myofibroblastic tumor. He was doing well and the follow up videolaryngoscopic examinations and PET CT were normal. At subsequent follow-up 19 months later, he was found to have a recurrent right vocal cord lesion. Direct laryngoscopy and biopsy was repeated along with laserization of the right vocal cord. Histopathology was reported as spindle cell malignant neoplasm. Immunohistochemistry was reported as spindle cell carcinoma. He was then sent for radiation therapy. The patient responded well to radiation and is tumor free at last follow-up. He has been advised regular follow-ups. Spindle cell carcinoma is an extremely rare laryngeal malignancy. It typically originates in the glottis. The treatment for spindle cell carcinoma includes surgery, radiation or a combination of these modalities. Its prognosis is worse than squamous cell carcinoma and patients require close follow-ups.

A Comparative Study of Fiberoptic Laryngoscopy (FOL) and Indirect Laryngoscopy in the Diagnosis of Patients with Vocal Cord Lesions

Background: Change of voice is one of the common complaints in ENT practice and hoarseness of voice is the commonest symptom of changed voice quality. Hoarseness is invariably the earliest manifestation of conditions directly or indirectly affecting the voice apparatus. Though most common causes of hoarseness are benign and vocal abuse is the commonest among them, but we should always investigate for more sinister pathology like malignancy. The aim of this study was to compare the diagnostic yields of fibreoptic laryngoscopy (FOL) with that of indirect laryngoscopy in the diagnosis of vocal cord lesions. Objectives: To compare fibreoptic laryngoscopy (FOL) and indirect laryngoscopy in the diagnosis of vocal cord lesions as the cause of voice change. Methods: This is a cross-sectional study which has been conducted in the Department of ENT and Head Neck Surgery, SSMC Mitford Hospital with a sample size of 87 cases for a period of six months from 10th February’ 2020 to 9th August’ 2020. The patients with vocal cord lesions were selected according to the eligibility criteria by purposive sampling. Results : On indirect laryngoscopic examinations, 29.89% were vocal cord polyp, 16.09% suspected vocal cord neoplasm, 14.94% vocal cord edema, 11.49% vocal cord nodule, 5.74% vocal cord palsy and 2.61 were ulcerative lesion of vocal cords whereas poor view were in 18.39% cases. On fibreoptic laryngoscopy (FOL), 29.89% were vocal cord polyp, 19.54% suspected vocal cord neoplasm, 17.24% vocal cord edema, 16.09% vocal cord nodule, 8.04% vocal cord palsy and 6.90% were ulcerative lesion of vocal cord. 2.30% revealed normal study. Study showed that fibreoptic laryngoscopic examination is superior to indirect laryngoscopy in diagnosing vocal cord lesions. Conclusion : Fibreoptic laryngoscopy (FOL) is significantly superior to indirect laryngoscopy in the diagnosis of vocal cord lesions. Indirect laryngoscopy sometimes may miss to diagnose a sinister disease like malignancy. Bangladesh J Otorhinolaryngol 2023; 29(1): 24-31

PROSPECTIVE STUDY OF THERAPUETIC EFFECTS OF VOICE THERAPY IN BENIGN VOCAL CORD LESIONS

Objective: To analyse the treatment outcomes of patients undergoing voice therapy in terms of maximum phonatory duration (MPD),Voice Handicap Index-10(VHI-10), indirect laryngoscopy. Methods: 44 patients who had benign lesions of vocal cord, who underwent voice therapy were studied. Detailed proforma was filled. Pre-treatment VHI-10, MPD and VLS were noted. Post treatment VHI-10, MPD and indirect laryngoscopy (I/L) findings were noted at 1 month and 3months. Results: 44 patients were studied. Majority 36 (81%) were females and 8 (18%) were males. 15(34%) of patients werein the age group 31-40 years. The mean pre-treatment baseline VHI-10 was 21.10 which was reduced to 10.77 at the end of 1 month and to 8.23 at the end of 3 months. The mean pre-treatment MPD was 8.5 which was increased to 11 after 1 month and 11.72 after 3 months. 27(61.36%) had excellent prognosis, 9 (20.45%) had better prognosis and 8(18.18%) had worse or same (group III) prognosis at the end of 3 months. In our study 40 (91 %) were extroverts, 39(88.6%) had voice abuse, 32 (72 %) patient had acid reflux symptoms, 17 (38%) patients gave history of allergic symptoms Conclusion: Extrovert personality and voice abuse are the most common risk factors for benign lesions of vocal cord.There is significant reduction in the VHI-10 scores and improvement in the MPD after voice therapy.

Detection of laryngeal carcinoma during endoscopy using artificial intelligence.

The objective of this study was to assess the performance and application of a self-developed deep learning (DL) algorithm for the real-time localization and classification of both vocal cord carcinoma and benign vocal cord lesions. The algorithm was trained and validated upon a dataset of videos and photos collected from our own department, as well as an open-access dataset named "Laryngoscope8". The algorithm correctly localizes and classifies vocal cord carcinoma on still images with a sensitivity between 71% and 78% and benign vocal cord lesions with a sensitivity between 70% and 82%. Furthermore, the best algorithm had an average frame per second rate of 63, thus making it suitable to use in an outpatient clinic setting for real-time detection of laryngeal pathology. We have demonstrated that our developed DL algorithm is able to localize and classify benign and malignant laryngeal pathology during endoscopy.

Visual Gaze Patterns in the Analysis of Glottic Lesions: Does Experience Increase Diagnostic Accuracy?

The purpose of this study was to evaluate visual gaze patterns and the ability to correctly identify cancer among participants of different experience levels when viewing benign and malignant vocal cord lesions. Thirty-one participants were divided into groups based on level of experience. These included novice (medical students, PGY1-2 otolaryngology residents), intermediate (PGY3-5 otolaryngology residents, gastroenterology fellow), advanced practice providers (physician assistants, nurse practitioners, and speech language pathologists), and experts (board-certified otolaryngologists). Each participant was shown 7 images of vocal cord pathology including glottic cancer, infectious laryngitis, and granuloma and asked to determine the likelihood of cancer on a scale of certain, probable, possible, and unlikely. Eye tracking data were collected and used to identify the area of interest (AOI) that each participant fixated on first, fixated on the longest, and had the greatest number of fixations. No significant differences were seen among groups when comparing AOI with first fixation, AOI with longest fixation, or AOI with most fixations. Novices were significantly more likely to rate a low likelihood of cancer when viewing infectious laryngitis compared to more experienced groups (P < .001). There was no difference in likelihood of cancer rating among groups for the remaining images. There was no significant difference in gaze targets among participants of different experience levels evaluating vocal cord pathology. Symmetric appearance of vocal cord lesions may explain differences seen in likelihood of cancer rating among groups. Future studies with larger sample sizes will better elucidate gaze targets that lead to accurate diagnosis of vocal cord pathology.

Oncocytic Cystic Lesions of False and True Vocal Cords: An Uncommon Occurrence

Introduction: Oncocytic cysts of the larynx are benign, uncommon, and slow-growing lesions that usually occur in elderly people, especially in those with a history of smoking and chronic irritation. These lesions cause various clinical symptoms depending on their location and size, requiring physicians to consider a wide range of symptoms. Case Presentation: Here we present two men who were referred to us because of prolonged voice hoarseness. Conclusions: Medical assessments led us to the diagnosis of oncocytic cysts in the false and true vocal cords. Both patients were followed up after removing their laryngeal cysts and have had no clinical complaints since then.

Acoustic analysis and video-stroboscopic evaluation of voice disorders

Background: The presence of pathologies of vocal folds cause significant changes in their normal vibratory patterns, which impact the resulting voice. Accurate and early diagnosis is needed for proper and timely management of the underlying vocal cord pathology. Diagnostic assessment in dysphonic patients should comprise both clinical aspects and voice-related problems experienced by the patients in their daily life. A combination of video-stroboscopy, acoustic analysis and Voice handicap index (VHI) helps in detailed evaluation of vocal cord abnormalities. Methods: This was a prospective, observational study. A total of 134 patients with voice disorders were included in the study. The VHI-10 questionnaire was filled by the patients. Acoustic analysis of their voice samples and Video-stroboscopic evaluation of their larynx was done. Results: A VHI-10 score of &gt;11 was noted in 102 patients. Fundamental frequency, jitter and shimmer were significantly related to the type of lesion. All the video-stroboscopic parameters were significantly related with the vocal cord lesions. Conclusions: Acoustic analysis along with video-stroboscopy serve as a better diagnostic tool for quantification and categorisation of vocal cord pathologies. VHI-10 helps in assessing the limitations/the impact on quality of life (QOL) (caused by the various vocal cord pathology).

Sulcus Vocalis and Benign Vocal Cord Lesions: Is There Any Relationship?

Sulcus vocalis (SV) is a longitudinal groove in the free edge of the true vocal cord. It may impair phonation with incomplete glottic closure, phonasthenia and hoarseness. This study aims to detect a correlation between benign vocal cord lesions and the incidence of the SV. A retrospective study was carried out on patients who underwent transoral surgery due to benign vocal fold lesions and were selected according to strict criteria. Patients were divided into a group with sulcus vocalis (Group wSV) and a group without sulcus vocalis (Group w/oSV). The possible correlations between variables were assessed by the Pearson chi-square test (p < 0.05). The study included 232 vocal cord lesions in 229 patients: 62.88% were females whose mean age was 46.61 ± 14.04. The most frequent diseases were polyps (37.94%), nodules (18.53%) and Reinke's edema (21.12%). Statistically significant relationships were found between age and SV (p-value 0.0005) and between mild dysplasia and SV (p-value 0.03). This study did not detect a cause-effect relationship between SV and benign vocal fold lesions. SV within vocal fold lesions is more common in younger patients, suggesting a congenital nature of SV. In conclusion, in the case of a benign vocal fold lesion, a possible SV should be considered and researched to provide the patient the best healthcare.

A Study on Efficacy of Differences in Speech Therapy Duration in Vocal Outcomes of Benign Lesions of Vocal Cords After Conventional Microlaryngeal Surgery.

The online version contains supplementary material available at 10.1007/s12070-023-03780-8.

Sarcomatoid Squamous Cell Carcinoma of Vocal Cord: An Uncommon Malignancy

AbstractSarcomatoid squamous cell carcinoma is a rare variant of laryngeal carcinoma, which comprises 1.3% of all laryngeal malignancies. It is mainly seen in elderly individuals, with smoking and alcohol being common risk factors. The tumor is most common on true vocal cords; hence, patients especially present with dysphonia. We present a case of an elderly male patient who presented with dysphonia due to a vocal cord lesion. During microlaryngoscopy, a firm, exophytic lesion with a narrow stalk was attached to the anterior one-third of the right vocal cord, excised, and sent for histopathology. Histopathology was suggestive of sarcomatoid squamous cell carcinoma. The patient was successfully treated with radiotherapy. We conclude that benign-appearing laryngeal lesions need to be evaluated and histopathological examination to be performed so that rare entities such as sarcomatoid carcinoma, which mimics benign lesions, can be managed appropriately.