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European Archives of... Jul 2022Pyriform sinus carcinoma with vocal cord fixation is stratified as stage T3 and above, and non-surgical treatment is generally preferred according to the guidelines,...
BACKGROUND
Pyriform sinus carcinoma with vocal cord fixation is stratified as stage T3 and above, and non-surgical treatment is generally preferred according to the guidelines, aiming to preserve laryngeal function. However, long-term survival is often compromised by deep infiltration of the tumor. Vertical hemipharyngolaryngectomy (VHPL) was previously reported to be a feasible surgical approach for organ preservation. The aim of this study was to evaluate the functional and oncological outcomes of VHPL in patients.
METHODS
Patients who underwent VHPL type II (total VHPL, which includes the removal of a vertical section of the thyroid cartilage through the anterior commissure to the upper border of the cricoid cartilage) for pyriform sinus cancer with vocal cord fixation at the authors' institute between 1999 and 2015 were retrospectively analyzed. Functional outcomes concerning swallowing and decannulation were evaluated. Successful functional preservation was defined as laryngeal preservation as well as oral realimentation and decannulation within 6 months after surgery. The oncological outcomes were measured by overall survival (OS) and disease-free survival (DFS) with Kaplan-Meier curves and comparisons were performed between the VHPL-treated patients and patients who underwent non-surgical treatment within the same period.
RESULTS
A total of 23 patients (stage T3, 17 patients; stage T4, 6 patients) whose initial treatment was VHPL type II were studied, and a cohort of 123 patients was selected as the control group. Pedicle and free flap reconstructions were performed on 12 and 11 patients, respectively. Postoperative radiation and chemoradiation was performed on 14 and 3 patients, respectively. Flap failure and pharyngeal fistula were detected in 2 and 5 patients, respectively. Oral realimentation and decannulation within 6 months were achieved in 82.6% (19 patients) and 87.0% (20 patients) of patients, respectively, and the total functional preservation rate of the study cohort at 6 months was similar to that of the control cohort. (78.3% vs. 82.9%, p = 0.28). After a median follow-up period of 49 months, 9 recurrences and 8 deaths had occurred in the study cohort. According to the Kaplan-Meier analysis, the study cohort had superior DFS (5-year DFS 60.3% vs. 44.6%, p = 0.04) and similar OS (5-year OS 63.8% vs 57.0% p = 0.28) compared with those in the control group.
CONCLUSION
VHPL yielded favorable oncological and functional outcomes in patients with unilateral pyriform sinus carcinoma and vocal cord fixation.
Topics: Carcinoma, Squamous Cell; Humans; Hypopharyngeal Neoplasms; Laryngeal Neoplasms; Laryngectomy; Organ Preservation; Pyriform Sinus; Retrospective Studies; Vocal Cords
PubMed: 34825265
DOI: 10.1007/s00405-021-07182-w -
European Archives of... Nov 2019To investigate the presence of sulcus vocalis in patients who underwent phonomicrosurgery due to benign vocal cord lesions.
OBJECTIVE
To investigate the presence of sulcus vocalis in patients who underwent phonomicrosurgery due to benign vocal cord lesions.
METHODS
Between January 2013 and June 2018, the records of 133 patients who underwent operations for benign vocal fold pathology were retrospectively reviewed. Intraoperative findings of the patients were noted. Patients were divided into two groups: patients with only benign vocal fold lesions (BVFL) and patients with benign vocal fold lesions and accompanying sulcus vocalis (SV + BVFL).
RESULTS
In total, 67 patients (50.4%; 38 females, 29 males) had BVFL and 66 (49.6%; 37 females, 29 males) had SV + BVFL. The patients in the SV + BVFL group were significantly younger than those in the BVFL group (p = 0.039). The sulcus was unilateral in 60.6% of the patients. The presence of sulcus vocalis was 49% and 47.6% in patients with a diagnosis of polyps (n = 51) and cysts (n = 42), respectively. A total of 12 of 13 patients with multiple benign vocal fold lesions had accompanying sulcus vocalis.
CONCLUSION
Approximately half of the patients who underwent operations for benign vocal fold lesions had accompanying sulcus vocalis. More than half of the sulcus associated with benign lesions was unilateral.
Topics: Adult; Correlation of Data; Cysts; Female; Humans; Laryngeal Diseases; Laryngeal Muscles; Male; Middle Aged; Polyps; Retrospective Studies; Vocal Cords
PubMed: 31473780
DOI: 10.1007/s00405-019-05623-1 -
Journal of Voice : Official Journal of... Nov 2021Paradoxical vocal fold motion (PVFM) is a disorder in which the vocal folds adduct inappropriately during inspiration resulting in episodic dyspnea and sometimes...
BACKGROUND
Paradoxical vocal fold motion (PVFM) is a disorder in which the vocal folds adduct inappropriately during inspiration resulting in episodic dyspnea and sometimes respiratory distress. Diagnosis is obtained through careful history, physical examination, flexible laryngoscopic examination with provocative maneuvers, and laryngeal electromyography. The pathogenesis and clinical findings of this disorder are not known.
OBJECTIVES
To determine characteristics of patients with confirmed PVFM and to evaluate efficacy of current treatments.
METHODS
A retrospective chart review of the patients with PVFM who presented at a quaternary care laryngology office between January 1, 2007 and August 31, 2019 was performed. Comorbidities, laboratories tests, imaging, 24-hours pH impedance testing, and laryngeal EMG results were analyzed. Dyspnea Index questionnaire before and after treatment was used to evaluate the efficiency of treatments for PVFM.
RESULTS
The average age of the 40 patients was 30.25 years. Forty-five percent of patients were under the age of 18, and 80% were female. Twenty-five percent of patients were serious athletes, and 40% of patients were students. Sixty-five percent had a previous diagnosis of asthma. One third of patients had concurrent psychiatric diagnosis. There was no family history of PVFM in the cohort. There were no other common findings. Treatment for laryngopharyngeal reflux (LPR) was used only when there was evidence of LPR; and 93% of our 40 patients received LPR treatment. Ninety percent of patients who received botulinum toxin, voice therapy (VT), and LPR treatment had subjective improvement. Patients with just VT and LPR treatment had a 43% subjective improvement rate; and the difference was statistically significant at P of 0.021. There was no statistical difference between VT and LPR treatment versus VT or LPR treatment alone.
CONCLUSION
Botulinum toxin, VT, and LPR treatment regimen is currently the most effective management for patients with paradoxical vocal fold movement disorder. More research is needed to determine the etiology of this disorder.
Topics: Adult; Female; Humans; Laryngopharyngeal Reflux; Laryngoscopy; Retrospective Studies; Vocal Cord Dysfunction; Vocal Cords
PubMed: 32418667
DOI: 10.1016/j.jvoice.2020.04.007 -
Advances in Oto-rhino-laryngology 2020We here summarize the structures of the laryngeal vocal fold as well as its insertion structures at the anterior commissure and at the area of the vocal process and... (Review)
Review
We here summarize the structures of the laryngeal vocal fold as well as its insertion structures at the anterior commissure and at the area of the vocal process and place these findings within the context of biomechanical, functional, and clinical implications.
Topics: Humans; Vocal Cords
PubMed: 33166982
DOI: 10.1159/000456678 -
Journal of Speech, Language, and... May 2023The purpose of this study was to determine whether patient voice-related diagnosis, severity of dysphonia, and rater's experience influence the relationship between...
PURPOSE
The purpose of this study was to determine whether patient voice-related diagnosis, severity of dysphonia, and rater's experience influence the relationship between laryngeal oscillation ratings made from videostroboscopic and high-speed videoendoscopic (HSV) exams.
METHOD
Stroboscopy and HSV exams from 15 patients with adductor spasmodic dysphonia (ADSD) and 15 with benign vocal fold lesions were rated for laryngeal oscillation and closure by 10 licensed speech-language pathologists (SLPs). Raters were divided into low- (< 5 years) and high-experience (> 5 years) groups. Ratings of vocal fold amplitude, mucosal wave, periodicity, phase symmetry, nonvibrating portion of the vocal fold, and glottal closure were examined using an online form adapted from the Voice Vibratory Assessment of Laryngeal Imaging (VALI).
RESULTS
Stroboscopy and HSV ratings were more strongly positively correlated for patients with benign vocal fold lesions ( between .43 and .75) than for those with ADSD ( between .40 and .68). Differences between stroboscopy and HSV exams were significantly greater for ratings of amplitude, mucosal wave, and periodicity in patients with ADSD than for patients with benign vocal fold lesions. Raters with < 5 years of experience showed significantly greater differences between stroboscopy and HSV ratings of amplitude and nonvibrating portion of the vocal fold for patients with ADSD only. Significantly greater differences between ratings of periodicity and phase symmetry were observed in patients with more severe dysphonia.
CONCLUSIONS
Differences in laryngeal ratings made between HSV and stroboscopy exams may be influenced by patient diagnosis, severity of dysphonia, and rater experience. Future study is warranted to determine how the differences observed influence clinical diagnosis and outcomes.
Topics: Humans; Dysphonia; Video Recording; Larynx; Vocal Cords; Laryngoscopy
PubMed: 37040690
DOI: 10.1044/2023_JSLHR-22-00649 -
Journal of Evaluation in Clinical... Feb 2020ENT UK released guidelines in 2010 detailing the requisite structure for the creation of a laryngeal intervention clinic. The senior author's practice is the only one... (Review)
Review
INTRODUCTION
ENT UK released guidelines in 2010 detailing the requisite structure for the creation of a laryngeal intervention clinic. The senior author's practice is the only one regionally that offers this service, and our objective was to review this to determine whether vocal cord medialization injections were showing an improvement in quality of voice for patients.
MATERIALS AND METHODS
Patients were reviewed in a specialist voice clinic prior to being offered vocal cord injection under local anaesthetic in a separate dedicated weekly clinic. They would be assessed by the senior author and a dedicated voice specialist speech and language therapist (SALT). This would include a preinjection grade, roughness, breathiness, asthenia, and strain (GRBAS), Voice Handicap Index (VHI)-10, and the measuring of maximum phonation time (MPT) with the aid of Opera Vox Apple iPad application.
RESULTS
Data were available for 186 injections, on patients with a median age of 66 years (interquartile range [IQR]: 51-75), of whom 61% were male. VHI-10 score improved significantly, from a mean of 26.7 to 12.5 (P < .001). A significant improvement in MPT was also observed, from a median of 3.0 to 6.3 (N = 66, P < .001). Improvements in all components of the GRBAS score were also observed (all P < .001), with between 43% and 88% of cases reporting reductions after the procedure. Patients receiving a repeat procedure saw a significantly smaller improvement in VHI-10 than those where it was the primary treatment (mean reduction: 9.8 vs 15.5, P = .018). Analysis of MPT found a significant correlation between the quantity of injection material used and the degree of improvement observed (rho = 0.355, P = .004).
CONCLUSION
Vocal Cord local anaesthetic medialization injection is a swift, safe, and effective short-term method of improving dysphonia.
Topics: Aged; Humans; Laryngoplasty; Male; Retrospective Studies; Surgeons; Treatment Outcome; Vocal Cords
PubMed: 31168894
DOI: 10.1111/jep.13169 -
Ear, Nose, & Throat Journal Nov 2022Leukoplakia is a precancerous lesion considered to be within the spectrum of histopathological results from parakeratosis, through stages of dysplasia to invasive... (Review)
Review
INTRODUCTION
Leukoplakia is a precancerous lesion considered to be within the spectrum of histopathological results from parakeratosis, through stages of dysplasia to invasive cancer. Narrow band imaging (NBI) endoscopy has been introduced to improve early diagnosis of benign and malignant laryngeal lesions. The aim of this literature review was to evaluate the accuracy of preoperative evaluation of vocal fold leukoplakia with NBI endoscopy in comparison with histology.
METHODS
A systematic review of the literature was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, using 3 different databases: PubMed, Embase, and Scopus. The included articles in the systematic review were identified combining each of the following terms: "narrow band imaging" OR "NBI," [AND] with each of these terms: "laryngeal leukoplakia," OR "vocal fold leukoplakia," OR "vocal cord leukoplakia."
RESULTS
The articles that fully met the inclusion criteria were 5 case series, conducted between January 2010 and February 2018, and published between 2017 and 2019. The selected articles included 312 patients (86% males and 14% females), affected by 382 vocal cord leukoplakia, evaluated with NBI endoscopy and that underwent surgical microlaryngoscopy with biopsy. Based on the studies included in the review, accuracy of NBI in predicting malignancy within leukoplakia ranged from 81% to 97.8%, demonstrating to be an accurate method to predict the risk of malignant transformation of vocal fold leukoplakia.
CONCLUSION
Narrow band imaging can help otolaryngologists in the decision-making process on the necessity to perform a biopsy and transoral surgery or long-term follow-up. Larger studies are necessary to confirm the high association of NBI evaluation of the epithelium surrounding the leukoplakia with the histological diagnosis.
Topics: Endoscopy; Endoscopy, Gastrointestinal; Female; Humans; Laryngeal Neoplasms; Leukoplakia; Male; Narrow Band Imaging; Vocal Cords
PubMed: 33213196
DOI: 10.1177/0145561320973770 -
Journal of Voice : Official Journal of... May 2024Vocal fold nodules are the most common etiology of chronic dysphonia in the pediatric population. Voice therapy is an effective first line of treatment, with increasing...
BACKGROUND
Vocal fold nodules are the most common etiology of chronic dysphonia in the pediatric population. Voice therapy is an effective first line of treatment, with increasing evidence supporting the use of telepractice in speech pathology. Despite this, there is limited data on its effectiveness in the pediatric population. The aim of this retrospective study was to investigate the feasibility and efficacy of telepractice in delivering voice therapy to children diagnosed with vocal fold nodules.
METHODS
A retrospective review was conducted of patients treated with virtual voice therapy from April 2020 to June 2021. Patients were included if diagnosed with vocal fold nodules, 2-18 years of age, and completed therapy in a virtual format. Data includes demographics, Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) scores and pediatric Voice Handicap Index (pVHI) scores.
RESULTS
Twenty-three children were included, 17 (74%) male and six (26%) female (with an age range of 2.4-9.9 years at the start of therapy). Prior to treatment, the average CAPE-V Overall Severity score was 37.9 (SD 13.8); the average posttreatment score was 22.4 (SD 10.2). The average pVHI total score prior to treatment was 26.3 (SD 12.1), with an average posttreatment score of 20.2 (SD 11.7). Patients who underwent virtual voice therapy had improved posttreatment CAPE-V severity scores than those prior to treatment (average difference = -15.5 points; 95% CI: -8.3 to -22.7; P < 0.001). An increased number of therapy sessions was associated with both higher initial CAPE-V severity scores (r = 0.72; P < 0.01) and a greater decrease in posttreatment CAPE-V scores (r = -0.55; P < 0.01).
CONCLUSION
Virtual voice therapy may be feasible and efficacious in treating dysphonic children diagnosed with vocal fold nodules. Significant improvements were found in perceptual CAPE-V scores in overall severity; positive changes were also seen in parental measures of quality of life. Delivery of voice therapy in a telehealth format may increase access of care and should be considered as a treatment option.
Topics: Humans; Dysphonia; Female; Male; Child; Retrospective Studies; Voice Training; Child, Preschool; Voice Quality; Treatment Outcome; Adolescent; Telemedicine; Feasibility Studies; Disability Evaluation; Age Factors; Vocal Cords; Recovery of Function
PubMed: 34969557
DOI: 10.1016/j.jvoice.2021.11.007 -
Head & Neck Nov 2022We report outcomes among patients with T2 and select T3 glottic squamous cell carcinoma (SCC) treated with radiotherapy. (Review)
Review
BACKGROUND
We report outcomes among patients with T2 and select T3 glottic squamous cell carcinoma (SCC) treated with radiotherapy.
METHODS
We reviewed T2 and T3 (only paraglottic space invasion) N0 M0 glottic SCC patients treated with curative-intent hypofractionated larynx radiotherapy, with or without concurrent systemic therapy.
RESULTS
Of 71 patients, those who received concurrent chemotherapy (23/71; 32%) had worse prognostic factors, including impaired cord mobility (70% vs. 40%, p = 0.02) and larger median gross tumor volume (3.0 vs. 1.6 cm , p = 0.003). Over a median follow-up of 3.8 years, 2-year local control among patients with impaired cord mobility appeared higher for those who received chemotherapy (88% vs. 61%, p = 0.12), but the difference was not statistically significant. Acute and late toxicity rates were not higher among patients who received chemotherapy.
CONCLUSIONS
The addition of concurrent platinum-based chemotherapy to hypofractionated larynx radiotherapy among patients with early-stage glottic SCC with impaired cord mobility appears safe and worthy of additional investigation.
Topics: Glottis; Humans; Laryngeal Neoplasms; Larynx; Radiation Dose Hypofractionation; Vocal Cords
PubMed: 35950338
DOI: 10.1002/hed.27165 -
The Annals of Otology, Rhinology, and... Sep 2022Evidence demonstrates neurotropism is a common feature of coronaviruses. In our laryngology clinics we have noted an increase in cases of "idiopathic" vocal fold...
OBJECTIVE
Evidence demonstrates neurotropism is a common feature of coronaviruses. In our laryngology clinics we have noted an increase in cases of "idiopathic" vocal fold paralysis and paresis in patients with no history of intubation who are recovering from the novel SARS-Cov-2 coronavirus (COVID-19). This finding is concerning for a post-viral vagal neuropathy (PVVN) as a result of infection with COVID-19. Our objective is to raise the possibility that vocal fold paresis may be an additional neuropathic sequela of infection with COVID-19.
METHODS
Retrospective review of patients who tested positive for COVID-19, had no history of intubation as a result of their infection, and subsequently presented with vocal fold paresis between May 2020 and January 2021. Charts were reviewed for demographic information, confirmation of COVID-19 infection, presenting symptoms, laryngoscopy and stroboscopy exam findings, and laryngeal electromyography (LEMG) results.
RESULTS
Sixteen patients presented with new-onset dysphonia during and after recovering from a COVID-19 infection and were found to have unilateral or bilateral vocal fold paresis or paralysis. LEMG was performed in 25% of patients and confirmed the diagnosis of neuropathy in these cases.
CONCLUSIONS
We believe that COVID-19 can cause a PVVN resulting in abnormal vocal fold mobility. This diagnosis should be included in the constellation of morbidities that can result from COVID-19 as the otolaryngologist can identify this entity through careful history and examination.
Topics: COVID-19; Electromyography; Humans; Paresis; SARS-CoV-2; Vocal Cord Paralysis; Vocal Cords
PubMed: 34643462
DOI: 10.1177/00034894211047829