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The Annals of Otology, Rhinology, and... Aug 2023Laryngeal abscesses are rare in the modern antibiotic era. Historically, they were associated with systemic infections including typhoid fever, measles, gonorrhea,... (Review)
Review
OBJECTIVE
Laryngeal abscesses are rare in the modern antibiotic era. Historically, they were associated with systemic infections including typhoid fever, measles, gonorrhea, syphilis, and tuberculosis. More recent authors have described cases resulting from iatrogenic injury and immunosuppression. This report presents a novel case of laryngeal abscess in the setting of uncontrolled diabetes and a detailed review of modern, reported cases of spontaneous laryngeal abscess.
METHODS
Report of a single case. Also, PubMed was queried for cases of laryngeal abscess since 1985.
CASE REPORT
A 58-year-old male with poorly controlled diabetes presented with odynophagia, dysphagia, and dyspnea. He had biphasic stridor, and flexible laryngoscopy showed reduced mobility of bilateral vocal folds and narrowed glottic airway. He was taken urgently for awake tracheostomy and microdirect laryngoscopy. Laryngoscopy demonstrated fullness and fluctuance of the right hemilarynx. The abscess cavity was entered endoscopically via paraglottic incision extending into the subglottis. The patient was treated with an 8-week course of ampicillin-sulbactam with resolution of infection.
RESULTS
Seven additional cases of spontaneous laryngeal abscesses published after 1985 were identified. In total, 6 of 8 had some form of immunodeficiency (75%). The most common presenting symptoms were dysphonia (8/8, 100%), odynophagia (5/8, 62.5%), and dyspnea/stridor (4/8, 50%). All cases were treated with surgical incision and drainage.
CONCLUSIONS
Laryngeal abscesses are rare in the era of modern antibiotics. This review confirms that the majority of recent episodes occurred in the setting of immunodeficiency and are caused by non-tubercular bacteria. These infections are commonly associated with impaired vocal fold mobility which may contribute to dyspnea, stridor, and airway compromise. Surgical intervention is necessary for treatment and culture-directed antimicrobial therapy. Poorly controlled diabetes is a newly described context for development of spontaneous laryngeal abscess.
Topics: Male; Humans; Middle Aged; Abscess; Respiratory Sounds; Vocal Cords; Laryngoscopy; Anti-Bacterial Agents; Dyspnea
PubMed: 35923122
DOI: 10.1177/00034894221115757 -
The Laryngoscope Oct 2018Idiopathic subglottic stenosis (iSGS) is a rare disease in which patients develop airway narrowing and dyspnea from relapsing subglottic and tracheal granulation and...
OBJECTIVES
Idiopathic subglottic stenosis (iSGS) is a rare disease in which patients develop airway narrowing and dyspnea from relapsing subglottic and tracheal granulation and scar tissue that narrows the airway. Definitive management has involved surgical resection and reconstruction of the subglottis and trachea. However, treatment options remain highly variable at different institutions. Here, we present our outcomes and experience after cricotracheal resection (CTR) for iSGS at a high-volume tertiary care center.
METHODS
A review of one surgeon's experience with a population of iSGS patients who underwent CTR between the years 1999 and 2017. The diagnosis of iSGS was one of exclusion and was based on history and microlaryngoscopy and bronchoscopy exams. Recurrence of subglottic stenosis was evaluated using Kaplan-Meier survival estimate analysis.
RESULTS
Sixty-one patients met criteria for iSGS and underwent CTR. Our population was 97% female and had an average of 4.3 balloon dilations prior to CTR. Mean follow-up time after CTR was 7.14 years. Eight (13%) patients developed recurrence of subglottic stenosis after CTR. Mean and median time to recurrence after CTR was 12.5 years and 14.1 years, respectively.
CONCLUSION
Cricotracheal resection is associated with a small, long-term recurrence rate of stenosis. It remains an important option for individuals with refractory iSGS. It may be reasonable to consider early CTR in the management of certain patients with iSGS. Further research should investigate risk factors that predispose patients to recurrence after CTR.
LEVEL OF EVIDENCE
4. Laryngoscope, 128:2268-2272, 2018.
Topics: Adult; Aged; Cricoid Cartilage; Dilatation; Female; Humans; Laryngoscopy; Laryngostenosis; Male; Middle Aged; Otorhinolaryngologic Surgical Procedures; Postoperative Complications; Recurrence; Retrospective Studies; Survival Analysis; Tertiary Care Centers; Trachea; Treatment Outcome; Young Adult
PubMed: 29756352
DOI: 10.1002/lary.27263 -
The Laryngoscope Feb 2021Idiopathic subglottic stenosis (iSGS) is an inflammatory process leading to fibrosis and narrowing of the laryngotracheal airway. There is variability in patient...
OBJECTIVES
Idiopathic subglottic stenosis (iSGS) is an inflammatory process leading to fibrosis and narrowing of the laryngotracheal airway. There is variability in patient response to surgical intervention, but the mechanisms underlying this variability are unknown. In this pilot study, we measure expression of candidate targets at the mucosal surface of the subglottis in iSGS patients. We aim to identify putative biomarkers for iSGS that provide insights into the molecular basis of disease progression, yield a gene signature for the disease, and/or predict a response to therapy.
STUDY DESIGN
In vitro comparative study of human cells.
METHODS
Levels of candidate transcripts and proteins were measured in healthy and stenotic laryngotracheal tissue specimens taken from the mucosal surface in 16 iSGS patients undergoing endoscopic balloon dilation. Pre- and post-operative pulmonary function test and patient reported voice and breathing outcomes were also assessed. Unsupervised clustering was used to define patient subgroups based on expression profile.
RESULTS
Pulmonary function and voice and breathing outcome metrics demonstrated significant post-operative improvement. Transcript levels of αSMA, CCL2, COL1A1, COL3A1, FN1, IFNG, and TGFB1 and protein levels of CCL2, IFNG, and IL-6 were significantly upregulated in stenotic as compared to healthy tissues. Marked heterogeneity was observed in the patterns of expression of candidate markers across individuals and tissue types. Patient subgroups defined by expression profile did not show a statistically significant difference in dilation interval.
CONCLUSION
Pro-inflammatory and pro-fibrotic pathways are significantly upregulated along the mucosal surface of stenotic laryngotracheal tissues, and CCL2 and IFNG merit further investigation as potential iSGS biomarkers.
LEVEL OF EVIDENCE
4 Laryngoscope, 131:342-349, 2021.
Topics: Adult; Aged; Biomarkers; Dilatation; Disease Progression; Endoscopy; Female; Fibrosis; Humans; Laryngeal Mucosa; Laryngostenosis; Larynx; Male; Membrane Proteins; Middle Aged; Pilot Projects; Predictive Value of Tests; Respiratory Function Tests; Trachea; Transcriptome
PubMed: 32369195
DOI: 10.1002/lary.28712 -
Indian Journal of Surgical Oncology Mar 2016Adenoid cystic carcinoma is very rare, with an incidence of 0.1 to 0.26 per one lakh people. It is the second most common primary malignancy of the trachea. The...
Adenoid cystic carcinoma is very rare, with an incidence of 0.1 to 0.26 per one lakh people. It is the second most common primary malignancy of the trachea. The etiology, clinical manifestation and prognosis of ACC trachea in Indian scenario has not been discussed so far. We evaluated the clinical presentation, treatment and follow up details of six patients with ACC of trachea, who were treated in our Institute from January, 2006 to October,2014. Cough with expectoration, exertional dyspnoea and haemoptysis were the most frequent presentations. Proximal trachea was involved in five patients with lesion extending to subglottis in two patients. The male: female ratio was equal and most patients presented in the 4th decade of their life. Two patients were treated with total laryngectomy with proximal tracheal resection, two with tracheal resection and anastomosis and one with window resection. Four patients who were treated surgically received post operative radiation. One patient with inoperable disease was treated with radical radiotherapy. All the patients are doing well with a median follow up period of 42.8 months.
PubMed: 27065684
DOI: 10.1007/s13193-015-0453-5 -
European Archives of... Oct 2019Laryngeal neoplasms are almost always epithelial in origin and squamous cell carcinoma is the most common tumor of the larynx. Non-epithelial tumors make a small subset...
PURPOSE
Laryngeal neoplasms are almost always epithelial in origin and squamous cell carcinoma is the most common tumor of the larynx. Non-epithelial tumors make a small subset of laryngeal neoplasms. We present the experience of a single institution to define clinical presentations and outcomes.
MATERIALS AND METHODS
The pathology archives and clinical records of our center with the diagnosis of laryngeal tumors between the 2005 and 2018 were reviewed. Age, gender, symptoms, location of the tumor, histopathological diagnosis, treatment modality and disease status were discussed.
RESULTS
657 patients were diagnosed with laryngeal tumor between 2005 and 2018 and 13 patients with non-epithelial tumors were identified. The majority of the patients were male. The age ranged between 13 and 93 years. The most common tumor localizations were vocal cords and subglottis. Seven patients were diagnosed with malignant tumors and six patients had benign tumors. Chondrosarcoma was the most common malignant mesenchymal tumor. Others were leiomyosarcoma, fibrosarcoma and liposarcoma. The most common benign non-epithelial tumors were schwannoma and hemangioma. Plexiform neurofibroma and granular cell tumor were the other benign tumors. Eleven patients underwent excisional biopsy. One patient underwent partial laryngectomy and one had total laryngectomy. Three cases presented with recurrent tumor. Among the recurrent cases, two were malignant tumors.
CONCLUSION
Non-epithelial tumors of the larynx are rare and have a wide histological diversity. Immunohistochemical studies are of great importance in the diagnosis of these tumors. Primary mesenchymal tumors of the larynx should be kept in mind in differential diagnosis.
Topics: Aged; Biopsy; Chondrosarcoma; Female; Humans; Laryngeal Neoplasms; Laryngectomy; Liposarcoma; Male; Middle Aged; Neoplasm Recurrence, Local; Neurilemmoma; Outcome Assessment, Health Care; Retrospective Studies; Turkey; Vocal Cords
PubMed: 31256243
DOI: 10.1007/s00405-019-05527-0 -
The Laryngoscope Sep 2020Idiopathic progressive subglottic stenosis (IPSS) predominantly affects females in perimenopause. It has, therefore, been hypothesized that estrogen is involved in its...
BACKGROUND/OBJECTIVES
Idiopathic progressive subglottic stenosis (IPSS) predominantly affects females in perimenopause. It has, therefore, been hypothesized that estrogen is involved in its pathogenesis. There are two main types of estrogen receptors: ER-α and ER-β. Abnormal variants of ER-β have previously been shown to be associated with poor wound healing. Estrogen receptors have recently been identified in subglottic tissue samples, with elevated levels of ER-α and progesterone receptors, and no expression of ER-β, in stenotic specimens reported in one study. The objective of this study was to confirm the presence of estrogen receptors in the subglottis and investigate levels of expression and types of estrogen receptors in normal and stenotic subglottic tissue.
METHODS
Subglottic tissue was obtained from three female and one male cadaver without laryngotracheal pathology to serve as controls. Subglottic tissue specimens from five female patients with IPSS were also analysed. Immunofluorescence stains for ER-α and ER-β were performed on specimens. Staining patterns were compared qualitatively and semi-qualitatively between control and IPSS specimens.
RESULTS
Immunofluorescence stains demonstrated the presence of both ER-α and ER-β in subglottic tissue. IPSS specimens demonstrated significantly greater staining intensity of ER-α in the epithelium and ER-β in glands and ducts compared to controls.
CONCLUSIONS
This study confirms the presence of estrogen receptors in the subglottis. Increased expression of ER-α in the epithelium and ER-β in glands and ducts in IPSS compared to controls may help to explain the predisposition to stenosis in these individuals.
LEVEL OF EVIDENCE
3b Laryngoscope, 130:2186-2191, 2020.
Topics: Adult; Aged; Cadaver; Case-Control Studies; Estrogen Receptor alpha; Estrogen Receptor beta; Female; Fluorescent Antibody Technique; Humans; Laryngostenosis; Larynx; Male; Middle Aged; Sex Factors; Trachea; Tracheal Stenosis
PubMed: 31643093
DOI: 10.1002/lary.28364 -
Indian Journal of Otolaryngology and... Sep 2016Laryngeal stenosis is one of the most complex and challenging problems in the field of head and neck surgery. The management involves a multidisciplinary approach with...
Laryngeal stenosis is one of the most complex and challenging problems in the field of head and neck surgery. The management involves a multidisciplinary approach with multiple complex procedures. In this study we discuss our experience of laryngeal stenosis with regards to patient characteristics, cause and management. A retrospective analysis of 35 patients of laryngeal stenosis treated at a tertiary care centre was evaluated. Inclusion criteria were all patients with laryngeal stenosis who required surgical intervention. Exclusion criteria were patients with associated tracheal stenosis and laryngeal stenosis due to cancer. Demographic data was recorded and findings relating to aetiology, characteristics of stenosis and the various aspects of therapeutic procedures performed are discussed with review of literature. Among 35 patients, 24 were males and 11 females of the age group 2-79 years. 2 (5.7 %) patients had supraglottic stenosis, 11 (31.4 %) had glottis stenosis, 16 (45.7 %) had subglottic stenosis and 6 (17.1 %) had combined multiple sites stenosis. Each patient underwent an average of 3.22 surgical procedures like microlaryngoscopy and excision with cold instrument, CO2 laser excision or open procedures like laryngofissure and excision and laryngoplasty. Montgomery t tube insertion was a common procedure in 17 patients (48.6 %). Of the total 35 patients with severe LS, 27 (77.1 %) patients were successfully decanulated. The results of glottic (100 %) and supraglottic stenosis (100 %) are excellent as compared to subglottic (68.8 %) and combined stenosis (50 %) of multiple sites. Laryngeal stenosis with airway compromise causes significant morbidity to the patients and is a difficult condition to treat in both adult and pediatric population. The need for multiple surgical procedures is common in the treatment of laryngeal stenosis with the t-tube being an important aid in the management of this condition. Trauma especially post intubation trauma is the commonest cause of laryngeal stenosis and the involvement of subglottis has poor outcome as compared to other subsites.
PubMed: 27508129
DOI: 10.1007/s12070-015-0936-2 -
The Annals of Otology, Rhinology, and... Feb 2016To discuss the presentation and management of a rare neoplasm in a previously unreported laryngeal subsite.
OBJECTIVES
To discuss the presentation and management of a rare neoplasm in a previously unreported laryngeal subsite.
METHODS
Case report and literature review.
RESULTS
An 89-year-old woman presented with a subglottic mass, biopsy of which was consistent with basal cell adenocarcinoma. She was successfully treated with surgical intervention and remains disease free 29 months postoperatively.
CONCLUSIONS
Basal cell adenocarcinoma is a rare salivary gland tumor, the laryngeal variant of which is even scarcer. Herein we describe the presentation and successful surgical management of the first reported case of subglottic basal cell adenocarcinoma. We additionally provide a histologic review followed by approaches to treatment.
Topics: Adenocarcinoma; Aged, 80 and over; Bronchoscopy; Female; Humans; Laryngectomy; Laryngostenosis; Neoplasm Staging; Salivary Gland Neoplasms; Treatment Outcome
PubMed: 26346279
DOI: 10.1177/0003489415603720 -
Archivos Argentinos de Pediatria Jun 2022The larynx is at the aerodigestive crossroads; any pathology that involves it will have an impact on breathing, swallowing and/or the voice. It`s divided into three...
The larynx is at the aerodigestive crossroads; any pathology that involves it will have an impact on breathing, swallowing and/or the voice. It`s divided into three regions: supraglottis (includes epiglottis, ventricular bands and laryngeal ventricles), glottis (space limited by the vocal cords) and subglottis (narrowest area of pediatric airway and the only point of larynx completely surrounded by cartilage: the cricoid ring). Laryngeal obstruction can present as a potentially fatal acute condition or as a chronic process. The main symptom is inspiratory or biphasic stridor. The etiology varies widely according to age and it may be of congenital, inflammatory, infectious, traumatic, neoplastic or iatrogenic origin. We describe the pathologies that cause laryngeal obstruction, either those that occur very often or those which are important for their severity, their guiding symptoms to the presumptive diagnosis, additional studies and treatment.
Topics: Airway Obstruction; Algorithms; Child; Humans; Laryngeal Diseases; Larynx; Pediatrics
PubMed: 35533130
DOI: 10.5546/aap.2022.209 -
Otolaryngology--head and Neck Surgery :... Dec 2023Determine the ideal head position to optimize visualization of the subglottis using flexible laryngoscopy.
OBJECTIVE
Determine the ideal head position to optimize visualization of the subglottis using flexible laryngoscopy.
STUDY DESIGN
Prospective cohort study.
SETTING
Outpatient multidisciplinary airway clinic at a tertiary care center.
METHODS
Patients presenting to a multidisciplinary airway clinic undergoing nasoendoscopic airway examination were enrolled. Three head positions were utilized to examine the subglottis during laryngoscopy: "sniffing," chin tuck, and stooping positions. In-office reviewers and blinded clinician participants evaluated views of the airway based on Cormack-Lehane (CL) scale, airway grade (AG), and visual analog scale (VAS). Demographic data were obtained. Statistical analysis compared head positions and demographic data using Student's t test, analysis of variance, and Tukey's post hoc analysis.
RESULTS
One hundred patients participated. No statistical differences existed among in-clinic or blinded reviewers for the CL score in any head position (p = .35, .5, respectively). For both AG and VAS, flexed and stooping positions were rated higher than the sniffing positions by both in-clinic and blinded reviewers (p < .01 for all analyses), but there was no statistical difference between these two positions (p = .28, .18, respectively). There was an inverse correlation between age and scores for AG and VAS in the flexed position for both sets of reviewers (p = .02, <.01 respectively), and a higher body mass index was significantly associated with the need to perform tracheoscopy for full airway evaluation (p < .01).
CONCLUSION
Both flexion and stoop postures can be implemented by an experienced endoscopist in awake, transnasal flexible laryngoscopy to enhance visualization of the subglottic airway.
Topics: Humans; Laryngoscopy; Prospective Studies; Intubation, Intratracheal; Larynx; Patient Positioning
PubMed: 37522249
DOI: 10.1002/ohn.419