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PubMed1992

[Contact granuloma: symptoms, etiology, diagnosis, therapy].

Contact ulcer granuloma has a multifactorial etiology but vocal abuse is considered the most important etiological factor. Some other possible factors are well-known: tuberculosis, allergies, hormonal or autonomic imbalance, psychosomatic influences, reflux-esophagitis, pathological conditions of the nose, nasal accessory sinus, tonsils. Constitutional factors play also an important role. The symptoms range from mild huskiness to severe hoarseness with pain extending to the ear, dysphagia, sometimes hemoptysis and chronic cough. Failure to recognize the pathological features of this frequently overlooked lesion leads to diagnosis of larynx cancer, angiosarcoma or hemangioma. Indication for microsurgical removal is only severe dyspnea by size of mass or if the dignity is not clear, because any surgical procedure has only temporary value and does not eliminate the etiological factors. The dignity can normally be proved by stroboscope. Vocal rehabilitation and re-education are an essential appropriate means of treatment for this disease if other causative factors are excluded.

Diagnosis, Differential↗

PubMed1992

[Assessing the quality of the speaking voice after therapy of T1 and T2 vocal cord cancers].

All studies which analysed voice quality after T1 and T2 glottic cancer employed sustained vowels for evaluation. Sustained vowels can often be produced more clearly than expected in a severe degree of hoarseness in running speech. In this investigation voice quality was analysed by measuring the signal-to-noise-ratio (SNRc) in running speech. For evaluation these data were correlated to the scores from an auditive evaluation and from a clinical examination of the larynx considering functional parameters. 39 patients were examined after different therapies (primary radiation, chordectomy, frontolateral partial resection). The grading of the three different methods for characterisation of the voice quality correlated well. Therefore the SNRc is presumed to be a valuable additional method to the psychoacoustic voice evaluation. Comparison of voice quality after different therapies provided no significant difference between radiotherapy and chordectomy. The functional results after frontolateral partial resection were significantly less satisfying as expected.

Aged↗

PubMed1997

[Icelandic moss lozenges in the prevention or treatment of oral mucosa irritation and dried out throat mucosa].

BACKGROUND: Icelandic Moss (Cetraria islandica) has been used to treat inflammation and dryness of the pharyngeal mucosa in the naturopathy for many years. It contains substances with protective and antiinflammatory effects for the oral mucosa. The necessary concentration of Icelandic Moss and its therapeutic effectiveness were analysed in this clinical study. METHODS: Sixty-one patients who recently underwent surgery of nasal septum were evaluated for this randomized study. These patients suffer especially from dryness and inflammation of the oral cavity due to breathing only through the mouth while the nose is permanently closed by a nasal package. Three groups of patients treated with three different concentrations of the active substance were compared, Coating, dryness, and inflammation of the mucosa, lymph nodes, tongue, the tolerance of the drug, and symptoms like hoarseness and sore throat were documented. The oral application was performed from the first to the fifth day after the operation. RESULTS: The treatment with Icelandic Moss caused a direct reduction of the observed pathological changes. There were no significant differences between the three test groups. A dose of 0.48 g per day (10 Isla-Moos lozenges per day) is a sufficient treatment. CONCLUSIONS: Icelandic Moss is an advisable therapeutic opportunity without interactions and side effects for the treatment of inflammation of the oral mucosa occurring after nasal surgery, after intubation, and for simple infections of the throat.

Adolescent↗

PubMed1991

[Coincidental appearance of laryngocele and laryngeal carcinoma].

The authors present a case of a 54-year-old male patient suffering from a laryngocele with concomitant laryngeal cancer. The patient had a three-month history of hoarseness. The clinical examination as well as the endoscopic evaluation did not reveal any signs of malignancy inside the larynx. MR imaging, however, showed an endolaryngeal cystic process surrounded by a soft tissue mass. Resection of the lesion revealed the concomitant occurrence of both laryngocele and laryngeal carcinoma. Etiology, symptoms, diagnostic management and differential diagnosis are presented and discussed according to the relevant literature.

Carcinoma, Squamous Cell↗

PubMed1990

[Diagnosis of para-laryngeal tumors using computerized tomography].

Computed tomography of the larynx is generally recommended for carcinoma, laryngoceles, and laryngeal trauma. On the basis of several case examples, in which dysphagia and hoarseness were caused by a submucosal thickening of the arytenoid and aryepiglottic fold, the authors propose that these unclear symptoms also be regarded as indication for larynx CT. It must be borne in mind that the underlying process may be one of the rare tumors in the space between the thyroid cartilage and elastic cone, often called the paraglottic space (or paralaryngeal space, by many American authors).

Aged↗

PubMed1989

[Hyalinosis cutis et mucosae of the ear-nose-throat].

Hyalinosis cutis et mucosae (HCM) is a rare autosomal recessive disease of unknown aetiology and pathogenesis. In the skin and mucous membranes there is characteristically a deposition of hyaline-like material in the papillary dermis, around the small blood vessels and around skin appendages. Besides the manifold skin lesions, the mucous membranes affected are found in the nasal and oral cavities, pharynx and larynx. The latter causes the most characteristic symptom, namely, hoarseness, from birth. The lesions of the vessel walls are the most significant histopathological alterations. Ultrastructurally, massive deposits of amorphous, hyaline-like material in the dermis, reduction in number and size of the collagen fibrils and, finally, thickening of the basal laminae could be observed. The findings suggest an abnormal production of noncollagenous proteins as well as the alteration of the lysosomal systems of fibroblasts, endothelial cells and pericytes in the pathogenesis of hyalinosis.

Adult↗

PubMed1997

[Development of a thyroid carcinoma after irradiation of the head/neck region].

HISTORY AND CLINICAL FINDINGS: A 73-year-old woman was hospitalised because of increasing dyspnoea and hoarseness after a bout of acute tracheobronchitis. She had been receiving levothyroxine for a growing grade III nodular goitre. At the ages of 26 and 29 she had been treated for cervical lymph node tuberculosis with local excision and percutaneous radiotherapy of 8 Gy each time. On examination she was found to have a bulging neck profile and a hard, practically immobile node in the left lobe of the thyroid. INVESTIGATIONS: Laboratory tests showed a euthyroid metabolic state, while ultrasound demonstrated a mass. 40 mm in diameter, scintigraphically a cold nodule. A fine-needle biopsy was cytologically highly suspicious of neoplasm. TREATMENT AND COURSE: Surgical exploration of the neck and mediastinum revealed an insular follicular carcinoma (10 cm in diameter), involving the right recurrent laryngeal nerve and surrounding the brachiocephalic trunk. The latter had to be removed and a Gore-Tex graft was interposed. Postoperative radiotherapy was given (150 mCurie I131). CONCLUSION: An enlarging nodular goitre, occurring after a latent period of years following radiotherapy to the neck region for benign and (or) malignant disease, especially when it had been administered in childhood or young adulthood, should raise the suspicion of a radiogenic thyroid carcinoma. Definitive diagnosis by fine-needle biopsy is essential.

Adenocarcinoma, Follicular↗

PubMed1997

[The treatment of juvenile laryngeal papillomatosis with argon plasma coagulation].

HISTORY AND CLINICAL FINDINGS: At 3 years of age a girl known for one year to have progressive juvenile laryngeal papillomatosis with involvement of the lower respiratory tract was seen by her general practitioner because of increasing hoarseness. As about 20 sessions of CO2-laser treatment and adjuvant administration of interferon-alpha had failed to prevent increasing glottal stenosis and spread of the tracheal involvement, a tracheostomy had to be performed. Removal of the papilloma became progressively more difficult and at the age of 6 years she was admitted for further treatment. INVESTIGATIONS: She had marked inspiratory and expiratory stridor. Results of laboratory tests were unremarkable. Examination of the respiratory tract with a flexible endoscope revealed obstruction of the tracheal lumen by the papilloma. TREATMENT AND COURSE: The papilloma was removed by argon plasma coagulation (APC) under general anaesthesia during intermittent apnoeic phases. After four treatment sessions no papilloma could be seen endoscopically. There were no side effects or complications. The interval between treatments has become progressively longer. Further removal of papilloma is only rarely necessary nowadays. CONCLUSION: APC via a flexible endoscope is a promising method in the treatment of juvenile laryngeal papillomatosis involving the lower respiratory tract. It achieves precise, circumscribed tissue penetration without carbonisation or steaming-up, while bleeding can be controlled.

Child, Preschool↗

PubMed1994

Papillary (malignant) meningioma of the foramen magnum presenting as a posterior neck mass.

Meningiomas and neurofibromas are the most common extramedullary tumors in the region of the foramen magnum. The clinical symptoms are variable, including headache, occipitocervical pain, and hoarseness. Neurological symptoms are present only in 40% of cases. The age group ranges from 4 to 56 years. A number of patients are misdiagnosed as multiple sclerosis, syringomyelia, and cervical disc disease. The overall incidence of these tumors vary from 1.6 to 2.4%. The majority of meningiomas are histologically benign. Papillary (malignant) meningiomas are even rarer in this location. The present report is that of a 46-year-old man who developed a painless mass in the nape of his neck, without any neurological symptoms. Following initial biopsy at another hospital, a definitive resection was undertaken at Loyola University Medical Center. The diagnosis of a malignant meningioma was made after extensive immunohistochemical and electron microscopic studies. The patient developed a positive cervical lymph node 1 year later, which was excised and showed identical histopathologic features.

Case Reports↗

PubMed1991

[Tuberculosis of the larynx, oral cavity and pharynx].

A 44-year-old man, a heavy smoker over many years, complained of hoarseness for 8 weeks with weight loss and dysphagia. Malignant tumour of the pharynx was suspected. Examination revealed a swelling of the right upper lip, tumorous changes in the right buccal mucosa, about 6 x 6 cm in size, as well as enlargement of the cervical lymph-nodes. Microlaryngoscopy revealed a three-level tumour of the entire side of the right larynx. Histological examination of biopsies of the right false and true vocal cords as well as the buccal mucosa demonstrated numerous, partly caseous epithelioid granulomas with Langhans giant cells. Ziehl-Neelsen staining showed acid-fast rods. Combined tuberculostatic treatment with isoniazid, rifampicin, ethambutol and pyrazinamide achieved regression of all signs and symptoms within two months. This case emphasizes the need for including laryngeal tuberculosis in the differential diagnosis of seemingly malignant laryngeal tumours.

Adult↗

PubMed1990

[Tracheobronchopathia osteochondroplastica].

A 70-year-old woman developed increasing dyspnoea and hoarseness without stridor. Bronchoscopy revealed the characteristic picture of a "rock-garden" with multiple whitish irregularly shaped nodules in the distal two third of the trachea, except the pars membranacea, involving the right-sided bronchial system to the origin of the lower-lobe bronchus, and the left main bronchus. The diagnosis of tracheobronchopathia osteochondroplastica was confirmed histologically: primary tracheobronchial amyloidosis was excluded. Tomography of the tracheobronchial tree demonstrated the findings, but a plain chest X-ray did not. The symptoms in this patient were not, however, caused by tracheobronchopathia osteochondroplastica but by concomitant pulmonary emphysema and acute laryngitis and were improved after symptomatic treatment of the laryngitis.

Aged↗

PubMed1980

Cry analysis of infants with karyotype abnormality.

Sound spectrography was used to analyze 135 pain cries from 14 infants with a karyotype abnormality. At the time of the cry recording the children were from one day to seven months old, except for one child who was 2 years 10 months at the second recording. The cries were compared with 30 pain cries from 15 healthy infants of corresponding age. The children with an abnormality of chromosome 4 or 5 had cries with a significantly higher fundamental frequency than the control infants. Additionally, the cry in the "Cri-du-Chat" syndrome had a flat, monotonous melody type. The cries of infants with 13- or 18-trisomy were hoarse, low-pitched, with the shift parts absent. The cries in karyotype abnormalities were also different from pain cries of infants with other disorders involving the central nervous system. This study suggests that cry analysis can provide a valuable indication of the presence of a chromosome anomaly.

Abnormalities, Multiple↗

PubMed2002

Melioidosis presenting as an infected intrathoracic subclavian artery pseudoaneurysm treated with femoral vein interposition graft.

We present the first case of in situ replacement of an infected subclavian artery using superficial femoral vein and the fourth reported case of an infected arterial pseudoaneurysm caused by pseudomonas pseudomallei. Sepsis and hoarseness developed in a 58-year-old man after recent travel to Borneo, Indonesia. Indirect laryngoscopy revealed a paralyzed right vocal cord. Computed tomography and arteriography revealed a 6.5-cm pseudoaneurysm of the proximal right subclavian artery. Blood cultures grew pseudomonas pseudomallei. An abnormal cardiac stress test prompted a coronary angiography, which revealed severe coronary artery disease.The patient underwent coronary artery bypass and in situ replacement of the infected subclavian artery pseudoaneurysm with a superficial femoral vein, along with placement of a pectoralis major muscle flap to cover the vein graft. Operative cultures of the pseudoaneurysm grew pseudomonas pseudomallei. The patient was treated with a 6-week course of intravenous ceftazidime and oral doxycycline and then continued on oral amoxicillin-clavulanate. One week after discontinuing intravenous antibiotics, the patient presented to the emergency department with a rapidly expanding, pulsatile mass in the right supraclavicular space. He was taken emergently to the operating room. After hypothermic circulatory arrest was accomplished, the disrupted vein graft and aneurysm cavity were resected and the subclavian artery was oversewn proximally and distally. Parenteral ceftazidime was continued for 3 months and oral amoxicillin-clavulanate (augmentin) was continued indefinitely. There was no evidence of infection clinically or by computed tomographic scan 2 years later. Although autogenous vein replacement of infected arteries and grafts may be successful in the majority of cases, this strategy should probably be avoided when particularly virulent bacteria such as the organism in this case are present.

Aneurysm, False↗

PubMed2002

Retrojugular approach for carotid endarterectomy: a prospective cohort study.

The purpose of this study was the examination of the feasibility of the retrojugular approach for carotid endarterectomy and the investigation of its safety and effectiveness. A consecutive prospective cohort of 43 patients who underwent carotid endarterectomy with the retrojugular approach was compared with a retrospective cohort of 43 patients who underwent surgery with the standard antejugular technique. Age, sex, comorbidity, diagnostic investigations, and indications for surgery were comparable in both groups. In the retrojugular group, a carotid shunt was used in 18 patients (42%) and a patch closure in 15 patients (35%), and in the antejugular group, a carotid shunt was used in 43 patients (100%) and a patch closure in 20 patients (47%). There were no perioperative deaths, strokes, nerve injuries, or 30-day postoperative neurologic events. Wound hematomas were equally distributed in both groups (5%). Transient hoarseness was present in two patients in the antejugular group. The mean operative time was 72 +/- 15 minutes for the retrojugular technique and 100 +/- 27 for the antejugular technique (P <.0001). The hospital stay was 2 +/- 1 days in both groups. In conclusion, the retrojugular approach appears to be safe and the operative time may be shorter than with the antejugular approach.

Aged↗

PubMed2001

Aggressive fibromatosis of the larynx: report of a new case in an adult patient and review of the literature.

We describe a case of aggressive fibromatosis of the larynx occurring in a 75-year-old man. The lesion manifested with voice hoarseness and swallowing difficulty. A computerized tomographic scan of the neck revealed distortion of the glottic profile. A malignant tumor was suspected. Although a laryngoscopy-driven biopsy was non-diagnostic, total laryngectomy was done, since the lesion was not deemed amenable to conservative therapy. Grossly, the glottic rim was infiltrated by a hard, grey-white tissue showing a tentacular outline. Tissue sections featured a moderately cellular lesion composed of spindle cells with bland, tapered nuclei, enmeshed in a variably collagenized ground substance. Delicate spindle cell fascicles surrounded the native submucosal seromucous glands and had invaded the thyroid cartilage and the thyroid gland as well. The spindle cells were immunopositive for actins and vimentin, and negative for keratins, epithelial membrane antigen, desmin, and S-100 protein. No further therapy was administered. Periodic follow-up visits were negative. The patient died 5 years after surgery of myocardial infarction with no clinical evidence of lesion recurrence. Based on the available literature, our data confirm that laryngeal fibromatosis in adult patients is a locally infiltrating and progressive disease. Total laryngectomy with clear margins is needed as to avoid the high risk of local recurrence.

Aged↗

PubMed2001

The expression of cathepsins in osteoclast-like giant cells of an anaplastic thyroid carcinoma with tracheal perforation.

Anaplastic carcinoma of the thyroid gland (ACT) is a rapidly growing neoplasm with a very poor prognosis. In this study, we examined an ACT with osteoclast-like giant cells expressing matrix--degrading cysteine proteinases and their endogeneous inhibitor cystatin C. Bronchoscopic evaluation of a 50-year-old man suffering from hoarseness, dysphagia, and dyspnea revealed an irregular tumor mass infiltrating into the trachea and the cricothyroid ligament region. On histological examination, a necrotizing undifferentiated anaplastic carcinoma with osteoclast-like giant cells was detected. An immunohistochemical study of the tumor tissue was performed using a panel of 15 antibodies, including double labeling techniques. Most of the osteoclast-like multinucleated giant cells (MGC) expressed CD68 and cathepsin K. Colocalization of cathepsin B and its endogenous inhibitor cystatin C occurred in the majority of MGC. Mononuclear cells (MC) were positive for cathepsin B, cystatin C, and CD 68, but only faintly for cathepsin K. Expression of cathepsins B and K in the MGC of the ACT might contribute to the invasive behavior of this tumor, thus promoting metastatic ability and destruction of the cartilagenous trachea.

Biomarkers, Tumor↗

PubMed2002

A case of extramedullary plasmacytoma of the larynx.

An 84-year-old male with a complaint of hoarseness was examined. A mass lesion was recognized in the false vocal fold. The tumor was excised and found to consist of atypical plasmacytes. Immunopathological examination revealed that leukocyte common antigen (CD45), UCHLI (CD45RO), CD3 and L26 (CD20) were negative and that CD79 and Vs38C were positive. Neither uric Bence-Jones protein nor serum M-protein were observed. No other bony abnormalities were recognized on X-ray examinations including both bone and Ga scintigraphy. No atypical plasmacyte infiltration was observed in bone marrow. Our final diagnosis was extramedullary plasmacytoma of the larynx. Radiotherapy was performed following surgery. The tumor did not progress to multiple myeloma and no recurrence has been observed after 2 years.

Aged↗

PubMed2004

Laryngeal hamartoma.

OBJECTIVE: Hamartoma is a rare finding in the head and neck area and usually occurs as an age-related tumor in the lung. The aim of this study was to present the results of long-term follow-up of a case of laryngeal hamartoma (LH) and review the relevant literature. MATERIAL AND METHODS: A case of LH is presented which occurred in a 5-year-old child with a previously unreported change in the histologic pattern at recurrence. The relevant literature is critically reviewed with emphasis on histopathological aspects, clinical signs, age and gender. RESULTS: A total of 26 patients matched the search criteria, of whom 17 (65%) were male. LH occurred in 10 children (mean age 1.9 years) and 9 adults (mean age 49.6 years). Stridor, dysphonia and hoarseness were the commonest symptoms, occurring in 14 patients in total. In 18 patients the tumor presented as a supraglottic lesion (69%). Two neonates died shortly after the diagnosis was made. The current patient is the first to have presented with a change in the histological subtype. CONCLUSION: LH should be included in the differential diagnosis of benign laryngeal lesions, particularly in children. Complete surgical removal is the method of choice but should be limited in order to preserve laryngeal function, as the prognosis of patients with LH is excellent.

Adult↗