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HNO Jan 2022Prolonged ulcerative laryngitis is a rare, benign inflammatory alteration of the larynx that persists for months. The laryngoscopic findings suggest a malignant... (Review)
Review
BACKGROUND
Prolonged ulcerative laryngitis is a rare, benign inflammatory alteration of the larynx that persists for months. The laryngoscopic findings suggest a malignant process and can therefore be a challenge for the treating ear, nose and throat (ENT) physician.
OBJECTIVES
Presentation of the current database to provide an overview of the etiology, progress and treatment for everyday clinical practice.
METHODS
Three case studies from the Department of Phoniatrics and Speech Pathology of the ENT Department, University Hospital Zurich, Switzerland, are presented. Analysis and discussion of the current literature base and of case reports in the English literature.
RESULTS
The etiology and predisposing factors for this disease are unclear. Previous respiratory infection with cough and dysphonia seems to be the most common cause. Biopsies should be avoided.
CONCLUSIONS
The typical laryngoscopic findings show corresponding circumscribed lancet-shaped ulcerations in the middle third of the vocal fold. The course of the disease appears to be self-limiting and without permanent structural consequences. Therefore, good patient education and close laryngoscopic follow-up should be performed.
Topics: Dysphonia; Hoarseness; Humans; Laryngitis; Laryngoscopy; Vocal Cords
PubMed: 34170335
DOI: 10.1007/s00106-021-01079-0 -
Current Opinion in Otolaryngology &... Jun 2017This article provides a thorough review of the literature highlighting the articles that have advanced our knowledge about the sensitivity of the larynx to allergens in... (Review)
Review
PURPOSE OF REVIEW
This article provides a thorough review of the literature highlighting the articles that have advanced our knowledge about the sensitivity of the larynx to allergens in the air or ones consumed. This area of inquiry requires continued interest and investigation. As the field of clinical laryngology changes, and more information is discovered about the possible causal association between allergy and vocal pathologies, practicing otolaryngologists, allergists, and other medical professionals may discover more comprehensive methods to evaluate and treat their allergic patients, particularly those who present with complaints of dysphonia, dysphagia, laryngopharyngeal reflux (LPR), and/or dyspnea.
RECENT FINDINGS
There continues to be epidemiological studies designed to describe the relationship of allergy to vocal symptoms and signs. Both population and smaller studies have recently attempted to link these two conditions. Unfortunately, the patient with chronic laryngeal complaints is often tagged by default with the diagnosis of LPR and treated with proton pump inhibitors, which are not always beneficial. The endoscopic assessment may not be as reliable to make the diagnosis of LPR as the examination is subjective and the inter-rater reliability is low. It has been demonstrated by direct laryngeal provocation studies that sticky-viscous endo-laryngeal mucous is the only reliable finding consistently associated with allergy potential allergic tissue reactivity.
SUMMARY
The interrelationship of allergic sensitivity and chronic laryngitis in certain individuals is becoming clearer because our knowledge of inquiry has increased and the available routine technology to diagnose these conditions has remarkably improved. Notwithstanding these advancements, much more research is needed on this subject to reduce the frequency of mis-diagnoses and mis-management of allergic patients.
Topics: Diagnostic Errors; Dysphonia; Dyspnea; Gastroesophageal Reflux; Humans; Hypersensitivity; Laryngitis; Laryngoscopy; Larynx; Observer Variation; Proton Pump Inhibitors
PubMed: 28266945
DOI: 10.1097/MOO.0000000000000354 -
Ear, Nose, & Throat Journal Feb 1993
Review
Topics: Barium; Edema; Erythema; Female; Gastroesophageal Reflux; Humans; Laryngitis; Larynx; Male; Mucous Membrane; Pharyngitis; Vocal Cords
PubMed: 8482250
DOI: No ID Found -
Vestnik Otorinolaringologii 2021The article deals with optimization of treatment policy for singers with chronic catarrhal laryngitis. The survey sample is 51 singers with chronic catarrhal laryngitis...
The article deals with optimization of treatment policy for singers with chronic catarrhal laryngitis. The survey sample is 51 singers with chronic catarrhal laryngitis of the age from 29 to 54 and the length of time worked from 8 to 22 years. The following methods are used: anamnesis, microbiological investigation, voice evaluation according to Visual Analog Scale (VAS), microlaryngoscopy, videolaryngostroboscopy, voice acoustic analysis (MDVP Kay Pentax system), statistical processing of results. It is shown that the cause of chronic catarrhal laryngitis in professional singers is non-bacterial irritants that provoke the appearance of an inflammatory process in the larynx, as well as uncontrolled use of drugs that irritate and dry out the mucous membrane and imperfect vocal technique. Pathogenic flora as an etiologic factor in the occurrence of laryngitis does not play an important role. A comprehensive treatment scheme for chronic catarrhal laryngitis using inhalation therapy and drugs that improve trophic processes in the laryngeal mucosa, which allows to increase the effectiveness of treatment and achieve stable remission of the disease, is suggested.
Topics: Adolescent; Adult; Child; Chronic Disease; Humans; Laryngitis; Laryngoscopy; Larynx; Singing; Voice Disorders; Young Adult
PubMed: 33929149
DOI: 10.17116/otorino20218602133 -
The Annals of Otology, Rhinology, and... Jan 2023To discuss the presentation and management of pill-induced chemical laryngitis by illustrating a rare case.
OBJECTIVE
To discuss the presentation and management of pill-induced chemical laryngitis by illustrating a rare case.
METHODS
We report a unique case of a patient with iron pill-induced laryngitis.
RESULTS
A 71-year-old male presented for evaluation of dysphonia. Five weeks prior, the patient had reportedly aspirated an iron pill. The pill was lodged in his throat for several hours before being coughed up, soft but still intact. Since that event, the patient noted complete voice loss and in clinic was found to have a very breathy and asthenic voice. Stroboscopy revealed aperiodicity with severe false fold compression and significant ulceration of the infraglottic region associated with thick exudate. Vocal folds were mobile but atrophic, with overlying crusted secretions. A sensory deficit was suspected based on scope tolerance. The patient was treated with nebulized ciprodex and humidified air with some improvement in mucosal crusting but had persistent glottic insufficiency and dysphonia, prompting bilateral hyaluronic acid injection.
CONCLUSIONS
Pill-induced laryngitis is an extremely rare phenomenon. While typically associated with bisphosphonates, this condition should be considered in any patient presenting with dysphonia and history of aspiration of a pill, including iron supplements. Regardless of the inciting medication, pill-induced laryngitis may be treated with humidified air, nebulized steroids, and antibiotics. Injection augmentation of the vocal folds may be made considered when glottic insufficiency and weak cough contribute to the presentation.
Topics: Male; Humans; Aged; Laryngitis; Dysphonia; Iron; Stroboscopy; Vocal Cords; Hoarseness; Cough
PubMed: 35100816
DOI: 10.1177/00034894221075115 -
BMJ Case Reports Feb 2022A 79-year-old smoker with a background history of a treated glottic carcinoma and chronic obstructive pulmonary disease presented with progressive hoarseness, symptoms...
A 79-year-old smoker with a background history of a treated glottic carcinoma and chronic obstructive pulmonary disease presented with progressive hoarseness, symptoms of aspiration and shortness of breath for 6 months. Examination revealed an ulcero-fungating mass over the posterior commissure of the larynx. A tracheostomy, direct laryngoscopy and biopsy of the mass was performed to secure his airway and to exclude recurrent glottic carcinoma. Reassuringly, a histopathological examination of the mass revealed numerous fungal yeast bodies. He was then treated with itraconazole for 4 weeks and was followed up as and outpatient with complete resolution and no recurrence of the disease.
Topics: Aged; Carcinoma; Humans; Laryngitis; Laryngoscopy; Larynx; Male; Neoplasm Recurrence, Local
PubMed: 35140081
DOI: 10.1136/bcr-2021-245678 -
The Annals of Otology, Rhinology, and... Mar 1948
Topics: Humans; Laryngeal Diseases; Laryngitis; Larynx
PubMed: 18913522
DOI: 10.1177/000348944805700106 -
Digestive Diseases (Basel, Switzerland) 2009Laryngopharyngeal reflux of liquid and gaseous gastric contents should be considered in every patient with unexplained hoarseness. Pathophysiology and treatment of... (Review)
Review
Laryngopharyngeal reflux of liquid and gaseous gastric contents should be considered in every patient with unexplained hoarseness. Pathophysiology and treatment of reflux-associated laryngitis are different from those of reflux esophagitis and therefore remain an unsolved puzzle. The laryngeal mucosa is considerably more sensitive to acid and pepsin than the mucosa of the esophagogastric junction. Therefore definitions of acid and nonacid reflux used for gastroesophageal reflux disease may not be helpful for explaining pathophysiologic mechanisms in the larynx or pharynx. A reflux symptom index and reflux finding score may be useful in helping to select the minority of patients who may benefit from acid-suppressive therapy; however, further research is needed. Further research is also needed to identify those patients who may require higher doses or prolonged duration of proton pump inhibitors or alternative treatments like prokinetics or alginate, or those patients who may benefit from surgical treatment of gastroesophageal reflux. Since symptoms of laryngopharyngeal reflux may predict esophageal adenocarcinoma, every patient with laryngopharyngeal reflux should have an upper gastrointestinal endoscopy, even if no classical symptoms of gastroesophageal reflux disease are present.
Topics: Gastroesophageal Reflux; Gastrointestinal Agents; Hoarseness; Humans; Hypopharynx; Laryngeal Diseases; Laryngeal Mucosa; Laryngitis; Laryngoscopy; Proton Pump Inhibitors; Treatment Failure
PubMed: 19439955
DOI: 10.1159/000210098 -
Current Opinion in Otolaryngology &... Dec 2015The importance of bacterial biofilm in the human body, both when associated in chronic infections and as the default mode of microbial growth in the normal flora, has... (Review)
Review
PURPOSE OF REVIEW
The importance of bacterial biofilm in the human body, both when associated in chronic infections and as the default mode of microbial growth in the normal flora, has been understood during the last two decades. The word biofilm has recently entered into clinical vocabulary especially in dentistry, and oral hygienists have begun to talk of oral or dental biofilm instead of oral plaque. Biofilm presence has been demonstrated widely in otorhinolaryngology, related to chronic infections of middle ear, paranasal sinuses and lymphoid tissue of adenoids and tonsils and to implanted materials; however, less literature exists considering the implication of biofilm to laryngeal infections or head and neck cancer. The research until now has been mainly descriptive and the mechanisms that lead to biofilm formation are unclear and thus there are limited options for specific treatment of biofilm infection. The focus of this article is to review the recent literature considering the bacterial biofilm in larynx and in head and neck surgery.
RECENT FINDINGS
Bacterial biofilm has now also been implicated in chronic laryngitis. Among head and neck cancer patients, biofilm is the main reason for the short life cycle of indwelling devices such as voice prostheses and tracheal tubes. Recently, bacterial biofilm has been related to dysplasia and malignancies both as an aetiological factor and as a source of complications.
SUMMARY
It has been shown that microbial biofilm is implicated in the mechanisms leading to chronic recalcitrant infections, implant contamination and even to dysplasia. Biofilm has an important role in finding new preventive measures and treatment of these diseases.
Topics: Biofilms; Carcinogenesis; Chronic Disease; Epithelium; Head and Neck Neoplasms; Humans; Laryngitis; Larynx; Larynx, Artificial; Tracheostomy
PubMed: 26371604
DOI: 10.1097/MOO.0000000000000200 -
Journal of Voice : Official Journal of... Nov 2021Idiopathic ulcerative laryngitis (IUL) is a rare disorder characterized by ulceration in the mid-membranous portions of the vocal folds. The etiology and optimal...
OBJECTIVES
Idiopathic ulcerative laryngitis (IUL) is a rare disorder characterized by ulceration in the mid-membranous portions of the vocal folds. The etiology and optimal management of this condition are poorly understood. We aimed to survey laryngologists on their experiences with managing IUL in order to better understand the diagnosis and treatment of this unusual condition.
METHODS
An online survey was sent to 149 laryngologists practicing at academic institutions in the United States. Survey questions assessed respondents' professional backgrounds and clinical experiences with IUL. Individual responses were tallied and calculated as percentages of total responses.
RESULTS
A total of 96 out of 149 academic laryngologists completed the survey, leading to an overall response rate of 64.4%. All respondents reported that they had encountered IUL in practice, including 56.3% who reported having seen 1-10 cases, 22.9% reporting 11-20 cases, and 20.8% reporting greater than 20 cases over their careers. Dysphonia (99.0%) and cough (84.4%) were the two co-occurring primary presenting symptoms reported. Most base diagnosis on laryngeal videostroboscopy (93.8%). Fungal/bacterial cultures and operative biopsy had been performed by approximately 30% of respondents with occasional candidiasis reported but otherwise negative or nonspecific results. Common therapies used were empiric: antireflux therapy (91.7%), modified voice rest (91.7%), and oral steroids (80.2%). Among survey respondents with experience managing more than 10 cases of IUL, many found complete voice rest (60.0%), oral steroids (55.9%), behavioral cough suppression (46.7%), and modified voice rest (46.3%) to be at least moderately effective treatment options. Resolution of symptoms was most commonly reported to occur over the course of 1-3 months (59.4%) and recurrences were seen not very often or never (85.4%). However, permanent sequelae were common, including vocal fold stiffness (89.6%) and dysphonia (81.3%).
CONCLUSIONS
IUL is a rare disorder of unknown etiology. Diagnosis is typically made with laryngeal videostroboscopy and spontaneous resolution occurs over 1-3 months. Laryngologists commonly treat empirically with antireflux therapy, voice rest, antimicrobials, and oral steroids. While no empiric treatment appears to be highly effective for the management of IUL, complete or modified voice rest, oral steroids, and behavioral cough suppression may be the most effective of the currently available options. Further research is necessary to improve the understanding and optimal management of IUL.
Topics: Dysphonia; Hoarseness; Humans; Laryngitis; Ulcer; Vocal Cords
PubMed: 32345504
DOI: 10.1016/j.jvoice.2020.04.009