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PubMed2001

Effect of in vitro irradiation of donor larynges on cyclosporine requirements and rejection rates in rat laryngeal transplantation.

Total lymphoid irradiation is an acknowledged adjunctive immunosuppressant in whole organ transplantation in humans and animals. Local irradiation administered for a similar purpose is at best controversial. We evaluated in vitro donor larynx irradiation immediately preceding laryngeal transplantation as an immunomodulator. Each donor larynx was pretreated with 7.34 Gy of radiation in vitro. After transplantation, cyclosporine was administered in doses of 5 mg/kg per day, 2.5 mg/kg per day, and 1 mg/kg per day for trial lengths of 15 days and 30 days. Each of these 6 groups consisted of 10 rats per group. Earlier data have shown cyclosporine dosed at 5 mg/kg per day, without irradiation, administered for 1 month to have varied efficacy. Established histologic criteria were used to determine rejection patterns. All recipient rats survived the 15-day and 30-day trials. In all 10 rats receiving 5 mg/kg per day of cyclosporine for 15 days, the harvested transplanted larynges were viable without evidence of meaningful rejection (mild rejection). In 9 of the 10 rats receiving 5 mg/kg per day of cyclosporine for 30 days, the transplanted larynges displayed no meaningful rejection (mild rejection). In 9 of the 10 rats receiving 2.5 mg/kg per day of cyclosporine for 15 days, the transplanted larynges displayed no meaningful rejection (mild rejection). One rat receiving 2.5 mg/kg per day of cyclosporine for 15 days had a transplanted larynx that displayed moderate rejection. In all 10 rats receiving 2.5 mg/kg per day of cyclosporine for 30 days, the transplanted larynges displayed no meaningful rejection (mild rejection). At 15 days, 5 rats treated with 1 mg/kg per day of cyclosporine displayed mild rejection, 2 displayed moderate rejection, 2 displayed advanced to moderate rejection, and 1 displayed severe rejection. At 30 days, 4 rats treated with 1 mg/kg per day of cyclosporine displayed moderate rejection, 2 displayed advanced to moderate rejection, and 4 displayed severe rejection. We conclude that pretransplantation in vitro irradiation of donor larynges has immunomodulatory effects, allowing reduced cyclosporine immunosuppression with less rejection.

Animals↗
PubMed1992

Laryngeal paralyses: theoretical considerations and effects on laryngeal vibration.

The neurological causes of vocal fold paralyses have been well documented. However, the effect of these disorders on laryngeal vibration is not well understood. A theoretical four-mass model of the larynx, based on the work of Ishizaka and Isshiki (1976) and Koizumi, Taniguchi, and Hiromitsu (1987), was developed and adapted to simulate laryngeal biomechanical behavior. The model was used to evaluate various states of asymmetric laryngeal vibration. Input parameters that relate observed laryngeal function and model simulation were developed. Laryngeal paralyses were simulated by their predicted effect on these parameters. Simulations were compared with available data on glottal vibration in laryngeal paralyses. Complex modes of vibration were seen with certain combinations of asymmetrical lower mass stiffness and initial glottal gap.

Computer Simulation↗
PubMed1998

[Coincidence of isolated laryngeal sarcoidosis and laryngeal carcinoma].

Isolated sarcoidosis is quite rare, causing non-specific symptoms and possibly not diagnosed because of the large number of other entities with similar presentations. We report the problems of diagnosis of isolated laryngeal sarcoidosis following a localized carcinoma. A 66-year-old patient was seen in the Westpfalz ENT Department after a Le Roux-Robert fronto-latera laryngeal resection for a pT1a N0 M0 vocal cord carcinoma following progressue dyspnea. Laryngoscopy showed laryngeal stenosis due to a neoplastic lesion. However, an epitheloid granulomatosis was found on histopathology with no evidence for recurrent carcinoma. After exclusion of other processes and systemic disease, the diagnosis of isolated laryngeal sarcoidosis was made and long-term corticoid medication was administered, resulting in a rapid regression of the laryngeal stenosis.

Aged↗
PubMed1998

Correlation of laryngeal chemoreflex severity with laryngeal muscle response.

OBJECTIVES: To examine the relationship between the severity of the laryngeal chemoreflex (LCR) and the pattern of laryngeal muscle activity during an LCR-induced apnea. METHODS: The laryngeal mucosa of 20 piglets aged 17 to 20 days was stimulated under both hypoxic and normoxic conditions. Respiration, blood pressure, and activity of the thyroarytenoid (TA) and posterior cricoarytenoid (PCA) muscles were monitored during the LCR-induced apnea. RESULTS: Hypoxemia resulted in a shorter average apnea duration but a greater degree of hypotension. All piglets recovered spontaneously following normoxic LCR stimulation. Hypoxic stimulation resulted in two divergent apneic responses: transient with a spontaneous recovery (17 piglets) or profound requiring resuscitation (three piglets). An increase in TA muscle activity and a decrease in PCA muscle activity was the most common response to LCR stimulation. The response of the TA and PCA muscles was maintained in piglets destined for spontaneous recovery. Decreasing TA activity and increasing PCA activity correlated with the development of a profound response. CONCLUSIONS: The piglet demonstrates two distinct responses to hypoxic laryngeal chemostimulation that correlate with the activity of the intrinsic laryngeal muscles. Failure to maintain the activity of the TA and PCA muscles during a profound response is associated with the development of severe cardiovascular instability. This study suggests that the critical event involving the LCR is the development of complications secondary to hypoxia.

Animals↗
PubMed1990

Electronic control of laryngeal spasm. I. Blockage of orthodromically induced action potentials in intact canine recurrent laryngeal nerves.

Spastic dysphonia is a central nervous system phenomenon of unknown etiology characterized by uncoordinated voice tremor with erratic patterns of laryngeal contraction. Standard treatments have not been entirely satisfactory. The authors propose to apply a concept of selective nerve activity blockage, which leaves normal contractions undisturbed, as the basis for suppression of laryngeal spasticity. Single pulses of constant duration and increasing amplitude were injected into specially designed blocking electrodes placed around six recurrent laryngeal nerves (three dogs). Vocal cord adduction was reduced or arrested within given "windows" of stimulation levels of the blocking electrodes, while it increased with higher amplitudes when the current was injected via standard bipolar electrodes (controls). Although this study demonstrates the feasibility of blocking action potentials passing along recurrent laryngeal nerves, it might eventually allow control of laryngeal spasm from information taken directly from the affected musculature.

Action Potentials↗
PubMed2005

[A comparative analysis of immune status in laryngeal cancer and chronic hyperplastic laryngitis].

Examination of the immune system made in 148 patients with laryngeal cancer and 32 patients with chronic hyperplastic laryngitis has revealed that different laryngeal diseases are associated with immune diseases. Laryngeal cancer, unlike chronic laryngitis, demonstrated prevalent disorders of the effector mechanisms. However, dysgammaglobulinemia related to mucosal immunoglobulin A, can be considered as alteration associated with mucosal problems.

Antigens, CD↗
PubMed1984

[Cytodiagnostic studies of the laryngeal mucosa in chronic laryngitis].

Cytological diagnostic aids in chronic inflammation of the larynx have been rarely employed so far. A study was conducted to prove whether there is any possibility of larnygeal cytological diagnosis and whether there are any premalignant changes. In view of the results obtained by gynaecological exfoliative cytology, attention was focussed on the metaplastic cells. The frequent incidence of metaplasias was highly significant, whereas dysplasias occurred only in chronic laryngitis besides in tumours. One trend occupying higher cytological diagnostic groups in the Papanicolaou pattern was seen in chronic laryngitis. In our opinion, cytological diagnosis in laryngeal investigation is an aid in the followup control in chronic laryngitis, which is a repeatable procedure without unduly stressing the tissue. Recording of cellular changes in chronic laryngitis can enable a prospective appreciation of morphological changes, which can be useful as diagnostic tool for examining suspicious findings.

Chronic Disease↗
PubMed2003

Resistive load of laryngeal mask airway and ProSeal laryngeal mask airway in mechanically ventilated patients.

BACKGROUND: The ProSeal Laryngeal Mask Airway (PLMA) ventilation tube is narrower and shorter than the standard Laryngeal Mask Airway (LMA) and is without the vertical bars at the end of the tube. In this randomized, crossover study, PLMA and LMA resistances were compared. METHODS: Respiratory mechanics was calculated in 26 anesthetized, mechanically ventilated patients with both LMA and PLMA. The laryngeal mask positioning was fiberoptically evaluated. Differences in the respiratory mechanics of the LMA and the PLMA were attributed to the differences between the laryngeal masks. RESULTS: In the total study population the airway resistance was 1.5 +/- 2.6 hPa.l-1.s-1 (P = 0.005) higher with the PLMA than with the LMA. During the PLMA use, the peak expiratory flow reduced by 0.02 +/- 0.05 l min-1 (P = 0.046), the expiratory resistance increased by 0.6 +/- 1.3 hPa.l-1.s-1 (P = 0.022), and the time constant of respiratory system lengthened by 0.09 +/- 0.18 s (P = 0.023). These differences doubled when the LMA was better positioned than the PLMA, whereas they disappeared when the PLMA was positioned better than the LMA. CONCLUSIONS: The standard LMA offers a lower resistive load than the PLMA. Moreover, the fitting between the laryngeal masks and the larynx, as fiberoptically evaluated, plays a major role in determining the resistive properties of these devices.

Adult↗
PubMed1999

Placement of the intubating laryngeal mask is easier than the laryngeal mask during manual in-line neck stabilization.

We have compared in 25 patients ease of placement of the conventional and intubating laryngeal masks while the patient's head and neck were stabilized by a manual in-line method, in a randomized, crossover study. After induction of anaesthesia and neuromuscular block, the masks were placed in turn. Adequacy of ventilation and ease of placement (using a 10-cm visual analogue scale (VAS)) were assessed; time for placement between removal of the face mask and connection of the laryngeal mask to the breathing system was measured. Adequate ventilation was always obtained after placement of the intubating laryngeal mask, whereas ventilation was adequate in 22 of 25 patients after placement of the conventional laryngeal mask. Placement of the intubating laryngeal mask was significantly easier (P < 0.001; 95% confidence intervals (CI) for median difference 8-31 mm in VAS) and faster (P << 0.001; 95% CI for mean difference 3.2-6.2 s) than that of the conventional mask.

Adolescent↗
PubMed2004

A randomized controlled trial comparing the ProSeal Laryngeal Mask Airway with the Laryngeal Tube Suction in mechanically ventilated patients.

BACKGROUND: The ProSeal Laryngeal Mask Airway (PLMA) (Laryngeal Mask Company, Henley-on-Thames, United Kingdom) is a new laryngeal mask with a modified cuff designed to improve its seal and a drain tube for gastric tube placement. Similarly, the Laryngeal Tube Suction (LTS) (VBM Medizintechnik Gmbh, Sulz a.N, Germany) is a new laryngeal tube that also has an additional channel for gastric tube placement. This study compared the placement and functions of these two devices. METHODS: One hundred fifty patients undergoing general anesthesia for elective surgery were randomly allocated to the PLMA (n = 75) or LTS (n = 75). Oxygenation and ventilation, ease of insertion, fiberoptic view, oropharyngeal leak pressure, ventilatory data, ease of gastric tube insertion, and postoperative airway morbidity were determined. RESULTS: After successful insertion of the devices in 96% of patients with the PLMA and in 94.4% with the LTS it was possible to maintain oxygenation, ventilation, and respiratory mechanics during the entire duration of surgery. Successful first and second attempt insertion rates were 57 patients (76%) and 15 patients (20%), respectively, for the PLMA and 60 patients (80%) and 11 patients (14.6%), respectively, for the LTS. Airway placement was unsuccessful with the PLMA in three patients and with the LTS in four patients. Time to achieve an effective airway was 36 +/- 24 s with the PLMA versus 34 +/- 25 s with the LTS. Gastric tube insertion was possible in 97.3% of patients with the PLMA and in 96% with the LTS. CONCLUSIONS: With respect to both physiologic and clinical function, the PLMA and LTS are similar and either device can be used to establish a safe and effective airway in mechanically ventilated anesthetized adult patients.

Adult↗
PubMed2002

Laryngeal adductor reflex and pharyngeal squeeze as predictors of laryngeal penetration and aspiration.

OBJECTIVES: The contribution of laryngopharyngeal (LP) sensory deficits to the outcome of swallowing and the relationship between sensory and motor deficits in the laryngopharynx is unclear. The study purpose is to determine if patients with LP sensory and motor deficits are at increased risk for laryngeal penetration and aspiration during swallowing, and to determine the relationship between pharyngeal motor weakness and LP sensory deficits. MATERIALS AND METHODS: Endoscopic evaluation of swallowing with sensory testing was performed on 122 dysphagic patients who were prospectively divided into two groups. The control group was 76 patients with normal sensitivity, determined by an intact laryngeal adductor reflex (LAR) on air pulse stimulation of the mucosa innervated by the superior laryngeal nerve. The study group was 46 patients with severe sensory deficits, determined by an absent LAR. Each group was given puree followed by thin liquid, noting presence or absence of laryngeal penetration and aspiration. Pharyngeal muscle strength was assessed by noting presence or absence of pharyngeal contraction during voluntary adduction of the vocal folds (pharyngeal squeeze). RESULTS: In control subjects, with purees, 6 of 76 (7.90%) penetrated and 3 of 76 (3.94%) aspirated; with thins, 26 of 76 (34.2%) penetrated and 13 of 76 (17.1%) aspirated. In the absent LAR group, with purees, 39 of 46 (84.8%) penetrated and 32 and 46 (69.6%) aspirated; with thins, 46 of 46 (100%) penetrated and 43 of 46 (93.5%) aspirated. For both consistencies, the differences in prevalence of penetration and aspiration between groups was significant (P <.0001, chi2). In control subjects, pharyngeal squeeze was impaired in 17 of 76 (22.4%), with penetration of puree in 6 of 17 (35.3%) and aspiration in 3 of 17 (17.6%). In the absent LAR group, squeeze was impaired in 41 of 46 (89.1%), with penetration of puree in 39 of 41 (95.1%) and aspiration in 32 of 41 (78.0%). The difference in the prevalence of pharyngeal weakness between groups was significant (P <.0001). The difference in the prevalence of penetration and aspiration was higher in the absent LAR/impaired contraction cohort than in the normal sensation/impaired contraction cohort (P <.0001). CONCLUSION: Absence of the LAR and impaired pharyngeal squeeze puts patients with dysphagia at high risk for laryngeal penetration and aspiration compared with patients with an intact LAR and intact pharyngeal squeeze. There is a strong association between motor and sensory deficits in the laryngopharynx.

Adult↗
PubMed1995

Postoperative laryngeal competence. The laryngeal mask airway and tracheal tube compared.

We investigated the incidence of postoperative laryngeal incompetence in 40 patients undergoing lower limb arthroplasty. Patients were randomly allocated to one of two groups using a standardised general anaesthetic/muscle relaxant technique; in group A the patients' lungs were ventilated via a laryngeal mask airway and in group B via a tracheal tube. Following recovery from general anaesthesia, at a time when patients were considered safe for discharge back to the general ward, they were asked to swallow 20 ml of barium, and an immediate portable chest X ray was taken. The X rays were examined for evidence of tracheopulmonary aspiration. Contrary to previous studies the incidence of aspiration was low, occurring in only one patient. This aspiration was, however, clinically silent. The exact mechanism of this apparent laryngeal incompetence, which occurred in a patient from the tracheal tube group, is unclear. Due to the relatively small numbers of patients studied no conclusions can be drawn about the relative benefits of the use of the laryngeal mask airway with regard to postoperative laryngeal competence.

Aged↗
PubMed1994

Measurement of laryngeal resistance in the evaluation of botulinum toxin injection for treatment of focal laryngeal dystonia.

In the past, there has been no consistent, objective method of following patients undergoing botulinum toxin injections for treatment of laryngeal dystonia. Herein, the application of translaryngeal resistance measurements to 15 dysphonic patients is described. Laryngeal resistance is calculated from analysis of translaryngeal pressure and airflow during the utterance /pi/, and found to fall predictably after successful toxin injection. In our series of patients, laryngeal resistance dropped by 69.1% after initial toxin injection. The changes in resistance over time correlate with subjective impressions of voice quality. Translaryngeal resistance measurements can be used objectively to follow patients longitudinally after injection and to collect objective data for analysis. No previously described measurements have met all these criteria. Laryngeal resistance measurement is an ideal method of documenting the results of botulinum toxin injection for the treatment of focal laryngeal dystonia.

Airway Resistance↗
PubMed2001

Bilateral investigation of the anatomical relationships of the external branch of the superior laryngeal nerve and superior thyroid artery, and also the recurrent laryngeal nerve and inferior thyroid artery.

The relationships of both the external branch of superior laryngeal nerve with the superior thyroidal artery and the recurrent laryngeal nerve with the inferior thyroidal artery were examined on the fixed cadavers of 4 adult women and 26 adult men. A total of 32 external branches of superior laryngeal nerve, 16 on each side, were dissected. When left and right sides were assessed altogether, 71.9% were medial to the artery while 28.1% were in between the branches. No nerve was found to be lateral to the artery. Thus the type in which the nerve is exposed to surgical trauma was found to be present in 28.1% of the cases. Only 12 of the cadavers could be assessed for symmetry and three fourths were found to have bilaterally symmetric relationship. A total of 52 Recurrent Laryngeal Nerves, 27 on the left and 25 on the right side were dissected. When bilateral symmetry was assessed in 21 cadavers, one third of the Recurrent Laryngeal Nerves were found to be bilaterally symmetrical. Inferior Thyroidal Artery was missing in 4 sides; bilaterally in one cadaver and unilaterally in 2 cadavers. Thus, artery-nerve relationship was assessed on 48 sides, 25 on the left and 23 on the right. On the right, 39.2% were in between the branches while 30.4% were anterior to the artery and 30.4% were posterior. On the left, 52% were in between the branches whereas 44% were posterior and 4% was anterior to the artery. Thus the position of the nerve in between the branches had the highest incidence while the anterior position had the lowest, the differences being statistically insignificant.

Arteries↗
PubMed2000

[Operations for laryngeal carcinoma with reservation of laryngeal function].

OBJECTIVE: To study the long term results and functional recovery of partial laryngectomy in the treatment of glottic and supraglottic types of laryngeal carcinoma. METHOD: A series of 70 cases operated on between July 1978 and August 1998 were analysed, of whom 60 were glottic, 10 were supraglottic type laryngeal carcinoma. Among them, 22 cases underwent vocal cord resection, 22 vertical hemilaryngectomy, 17 Majer-Piquet's operation, 7 horizontal hemilaryngectomy, 2 Arslan's operation. RESULT: 1, 3, 5-year survival rates were 98.53%, 87.04% and 78.26% respectively. Decannulation rate was 100%. All patients could finally take food by mouth without inspiration, and could speak as soon as decannulated. Complication and recurrence rates were 15.71% and 13.04% separately. CONCLUSION: Partial laryngectomy is an effective operation on laryngeal carcinoma with reservation of laryngeal function. It not only can totally excise neoplasm and prolong life, but also can better reserve laryngeal function and improve the quality of patient's life.

Adult↗
PubMed2002

[Supracricoid subtotal laryngectomy with laryngeal reconstruction for laryngeal cancers].

OBJECTIVE: To assess the effectiveness of supracricoid subtotal laryngectomy in the treatment of laryngeal cancer and the reconstructed laryngeal functions. METHOD: A retrospective review was made on 411 laryngeal cancer patients in the stage T2 to T4 treated by this surgical procedure form 1985 to 2000. In these cases, 35 were glottic cancers, 6 were supraglottic cancers, 23 patients were performed by supracricoid subtotal Laryngectomy with cricohyoidoepiglottopexy, 18 were performed with cricohyoidopexy. RESULT: Over 3 year and 5 year survival rates were 83.3%(30/36) and 71.4% (20/28). Decannulation rate was 92.7% (38/41). 40 patients resumed normal oral feeding but one was still performed an operation to separate the tracheal from pharynx because of the severe aspiration. All cases were able to speak by the new larynx. CONCLUSION: Supracricoid subtotal laryngectomy with laryngeal reconstruction was not only completely removal of tumors, but also restored the three physiological functions of larynx. It is an effective treatment for laryngeal cancer.

Adult↗
PubMed2004

Improvement in clinical course and laryngeal appearance in selected patients with chronic laryngitis after eight weeks of therapy with rabeprazole.

BACKGROUND: One well-known extraesophageal manifestation of gastroesophageal reflux disease (GERD) is chronic laryngitis. The aim of this study was to estimate the efficiency of eight weeks of treatment with the PPI rabeprazole in a selected group of patients with chronic idiopathic laryngitis without typical GERD symptoms. MATERIAL/METHODS: Seventeen patients (nine men and eight women) aged 35-72 years, with long histories (0.5 to 6 years) of chronic idiopathic laryngitis were included in the study. Larynx appearance was estimated by laryngostroboscopy. This examination, as well as interview and physical examination were performed in all patients at the start of the study and after 8 weeks of treatment with 20 mg rabeprazole taken orally twice a day. RESULTS: There was remarkably good therapeutic outcome, clinical symptoms such as hoarseness and pharyngeal pain resolved, respectively, in 68.7 and 78.5% of patients and laryngeal signs in 50-80%, except for weak tension of the vocal cords which was observed in 12 patients at the start and end of the study. CONCLUSIONS: Treatment with a proton pump inhibitor can be considered as a first-line diagnostic and therapeutic method in patients with idiopathic chronic laryngitis. Weak tension of vocal cords was often seen in these patients and persisted after the 8-week-long treatment.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMedDate not supplied

[Tuberculosis of the otorhinolaryngologic region: laryngeal and extra-laryngeal forms].

BACKGROUND: The aim of the study was to assess all patients with ENT symptoms whose histologic and/or microbiologic diagnosis confirmed tuberculosis. METHODS: All the anatomopathologic studies performed in the ENT unit in the authors' hospital in which the presence of acid-alcohol resistant bacilli were observed. All cases of cervical adenitis were not included. RESULTS: Eighteen patients with the following localizations were studied: 14 laryngeal tuberculosis and 4 extra-laryngeal tuberculosis (2 oropharyngeal, 1 otic and 1 sinusal). In the laryngeal forms, all patients were male except for one, and all were smokers. The duration of the symptoms was greater than 3 months in all the cases. Unilateral cord involvement was most commonly found, and in 2 cases this was associated with carcinoma of the vocal cord. Twenty-nine percent did not present with coincident pulmonary tuberculosis. None of the extra-laryngeal forms showed pulmonary involvement. All the patients were women and only 1 was smoker, the symptomatology was greater than 3 months in all cases and all required biopsy for achieving diagnosis. The evolution with medical treatment was favorable in all cases. During the same time period, 2300 cases of pulmonary tuberculosis were diagnosed in the authors' hospital. CONCLUSIONS: Tuberculosis of the upper respiratory tract is infrequent. Pulmonary involvement is common, although in this series this was only found in 71% of all laryngeal forms. Diagnosis is difficult, except in cases of coinciding pulmonary involvement and usually requires surgery for biopsy. Response to medical treatment is usually good.

Adult↗