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PubMed2004

Detection of laryngeal carcinoma and epithelial hyperplastic laryngeal lesions via a rapid-access dysphonia clinic.

Recent government initiatives in the UK have focused on streamlining oncology services by reducing waiting times between urgent referral, assessment and treatment of patients with possible cancer. The performance of the Quick Early Diagnosis Dysphonia Clinic of the Queen Elizabeth Hospital, Birmingham, between May 1997 and April 2001 was reviewed. Of 721 patients reviewed, 123 (17 per cent) had clinically suspicious laryngeal lesions. Thirteen cases of epithelial hyperplastic laryngeal lesions and 27 laryngeal malignancies were diagnosed. There was no statistical link between early cancer detection and assessment within two weeks of referral. However, rapid-access clinics for dysphonia serve an important role in the reassurance and multidisciplinary management of patients with persistent hoarseness. Greater financial commitments are necessary to achieve compliance with objectives for a maximum two-week wait for patients with suspected laryngeal malignancy.

Female↗
PubMed2005

Vocal fold palsy due to plombage for tuberculosis.

A 67-year-old patient, who had previously undergone Lucite ball plombage for pulmonary tuberculosis, presented with a hoarse voice, intermittent stridor and breathlessness. Direct laryngoscopy confirmed a left vocal fold palsy. A left supraclavicular mass became apparent and a computerized tomograph (CT) scan showed that a Lucite ball had migrated into her supraclavicular fossa. Subsequently she developed left arm pain and weakness. The balls were removed surgically, following which her arm symptoms improved but her voice remained unchanged. Migration of implanted material should be considered when new symptoms appear in patients who have undergone plombage treatment.

Aged↗
PubMed2004

Extraskeletal Ewing's sarcoma of the parapharyngeal space.

Extraskeletal Ewing's sarcoma (EES) is rarely found in the head and neck region. We report here a case of EES of the parapharyngeal space in a 53-year-old man who presented with blurred vision, dysphagia, hoarseness and right facial numbness. CT examination showed a large, seemingly well-defined soft tissue mass in the right parapharyngeal space with skull base destruction and intracranial extension. The patient showed poor response to chemotherapy and radiotherapy and died 6 months after initial presentation. A review of the literature revealed no previous reports of EES occurring in the parapharyngeal space.

Fatal Outcome↗
PubMed1975

Voice following radiotherapy.

This study was undertaken to provide information on the voice of patients following radiotherapy for glottic cancer. Part I presents findings from questionnaires returned by 227 of 235 patients successfully irradiated for glottic cancer from 1960 through 1971. Part II presents preliminary findings on the speaking fundamental frequencies of 22 irradiated patients. Normal to near-normal voice was reported by 83 percent of the 227 patients; however, 80 percent did indicate persisting vocal difficulties such as fatiguing of voice with much usage, inability to sing, reduced loudness, hoarse voice quality and inability to shout. Amount of talking during treatments appeared to affect length of time for voice to recover following treatments in those cases where it took from nine to 26 weeks; also, with increasing years since treatment, patients rated their voices more favorably. Smoking habits following treatments improved significantly with only 27 percent smoking heavily as compared with 65 percent prior to radiation therapy. No correlation was found between smoking (during or after treatments) and vocal ratings or between smoking and length of time for voice to recover. There was no relationship found between reported vocal ratings and stage of the disease. Data on mean speaking fundamental frequency seem to indicate a trend toward lower frequencies in irradiated patients as compared with normals. A trend was also noted in both irradidated and control groups for lower speaking fundamental frequencies in heavy smokers compared with non-smokers or previous smokers. These trends would indicate some vocal cord thickening or edema in irradiated patients and in heavy smokers. It is suggested that the study of irradiated patients' voices before, during and following treatments by means of audio, aerodynamic and acoustic instrumentation would yield additional information of diagnostic value on recovery of laryngeal function. It is also suggested that the voice pathologist could assist in evaluating and guiding patients in vocal usages during and following treatments.

Aged↗
PubMed1975

Restoration of voice after laryngeal surgeries.

Some aspects of speech deficiency in Japanese-speaking patients who had undergone surgeries for laryngeal malignancy were studied. Surgical procedures included reconstructive surgeries after total laryngectomy and conservation surgeries. A series of listener-judgments and some acoustic analyses of speech were made. The recorded voices of the patients were more or less hoarse. The median speaking pitch varied greatly from patient to patient, and often assumed an unusual value. The average articulation score for five Japanese vowels was computed for each subject. The score varied from patient to patient, and was thought to be useful in quantitatively evaluating speech quality. It was shown that certain glottal consonants such as /h/ can be affected by laryngeal surgeries. It was emphasized that the larynx should be regarded not only as a generator or a vibrator, but also as an articulator which produces consonants. The listening tests also revealed that the intonation pattern of Japanese two-syllable nouns can be influenced by laryngeal surgeries, and that distinction among certain words may become impossible as a result. This type of speech problem may require serious consideration in some language environments.

Environment↗
PubMed1975

Reasons for irradiation failure in squamous cell carcinoma of the larynx.

The reasons for irradiation failure in squamous cell carcinoma of the larynx can be: 1. Geographical miss because of undiagnosed extensions is the exception. Almost all of the recurrences were well within the treatment portals. 2. Specific extensions with an unfavorable tumor bed. Extension of disease into poorly vascularized structures and/or deep infiltration with fixation are causes of failure. 3. Low dose for the volume cancer. Higher doses delivered in longer treatment time are necessary for 90 percent control of bulky exophytic supraglottic lesions. 4. Techniques which do not assure daily coverage of the tumor. With carefully drawn and checked anatomical portals, geographical misses should be nonexistent. 5. Sigmoid response curve. There is an 85 percent control of the T1 glottic tumors. The control rate is 90 percent of the T1 and T2 supraglottic tumors, and the 10 percent failures have no obvious explanation except that the plateau of the sigmoid response curve has been reached. A negligible yield would be obtained by increasing doses which would not be justified because of concomitant increase in frequency and severity of complications and lessening of the quality of voice. 6. New cancer. Probably 25 percent of the so-called recurrences on the vocal cords are actually new primary lesions. The ultimate failure rates respectively are 2 percent for T1 lesions and 10 percent for T2 lesions after a rescue surgical procedure. All patients with T1 vocal cord lesions who did not experience a failure or a complication, have a normal voice. In the patients with T2 lesions in whom the cancer had completely replaced the cord(s), some hoarseness is present; but most of these lesions would have been suitable only for a total laryngectomy. In the 15 failures in T1 and T2 supraglottic lesions, surgery was not attempted in only three patients, one of whom was salvaged by re-irradiation. Following 12 laryngectomies there is only one definite failure and two patients died within two years NED locally. Except in the patients who had severe edema and/or necrosis, the voice has been normal or near normal. In patients with lesions of the suprahyoid epiglottis which had amputated the suprahyoid epiglottis swallowing difficulty has not developed.

Carcinoma, Squamous Cell↗
PubMed1976

Chondrosarcoma of the larynx.

Cartilaginous tumors of the larynx are rare, and of those reported, most are chondromas. To date, approximately 157 cartilaginous tumors of the larynx have been reported, but only 37 have been chondrosarcomas. A review of the records of the past 25 years (1948-1974) of the Johns Hopkins University Hospital and the Greater Baltimore Medical Center was made and revealed only two previous cartilaginous tumors, both chondromas. A case of an exceptionally large chondrosarcoma of the larynx which appeared as a neck mass invading the thyroid cartilage in a patient with a six-month history of hoarseness is presented. A complete review of the literature was made which shows that most chondrosarcomas occur in middle-aged males originating most often from the posterior cricoid lamina, next from the thyroid cartilage. Misdiagnosis has been a problem with low-grade tumors, and although wide local excision has been stated as being the treatment of choice, the authors emphasize the need for more aggressive surgery because of the high recurrence rate discovered in the literature.

Age Factors↗
PubMed1976

Arytenoidectomy revisited.

The spectrum of disabilities attendant to laryngeal paralysis range from mild hoarseness to complete upper airway obstruction depending upon the static position of the paralyzed cord or cords. The most distressing disabilities are those of bilateral vocal cord paralysis in which both vocal folds are fixed in the midline resulting in severe upper airway obstruction. Clearly the most acceptable solution to the problem of persistent laryngeal paralysis is through the establishment of normal neuromuscular integrity by vagal repair or neural transfer techniques. While electromyographic evidence of reinnervation and some restoration of cord motion has been described, synchronous neuromuscular activity is, at best, unpredictable and generally unsuccessful. Successful reinnervation procedures depend in part on early repair and herein lies a disparity between experimental work and its clinical applicability. Given the realities of delays in diagnosis and the unpredictability of operative reinnervation of the paralyzed larynx, we rely on alternative methods of improving the compromised glottic airway consequent to bilateral recurrent nerve paralysis of the larynx. During the period 1962 through 1974, 23 patients with complete bilateral paralysis of the larynx have been treated by the posterior extralaryngeal approach originally described by Woodman. The following is a description of the operative technique utilized with technical modifications which we consider important in enhancing operative results.

Adolescent↗
PubMed1977

Contribution to therapy of dysphonia plica ventricularis.

Excision of the hypertrophic ventricular folds was performed in 35 patients by means of laryngomicroscopy. In most of our patients this therapy promptly resulted in a clear voice. Correlating the laryngomicroscopic finding and the histological picture we were able to classify hypertrophy of the ventricular folds into three stages, each of which presents with a characteristical clinical and histological picture and thus requires approapriate therapy. In Stage I the histological changes are reversible and conservative phoniatric therapy leads to success relatively quickly. In the second stage histological changes may also be reversible, and the prolonged and persistent phoniatric therapy leads to success but we prefer microsurgical excision because of the direct effect. In Stage III, however, we found irreversible histological changes in the sense of connective hyperplasia which prompted us to conclude that microsurgical excision alone may lead to regression of the hoarseness.

Humans↗
PubMed1977

Gastro-esophago-pharyngeal reflux.

Reflux of gastric contents into the esophagus, pharynx, and larynx does occur. This phenomenon can produce hoarseness, globus, dysphagia, otalgia and laryngospasm. It may be responsible for the appearance of contact granulomata, esophageal webs, and pachyderma. The key to reflux is the lower esophageal sphincter and the nature of the stomach contents. Multiple factors may be influential including those conditions causing aerophagia. The diagnosis of reflux depends on a high index of suspicion. Physical findings may reveal only subtle changes of arytenoid erythema. Thyrohyoid tenderness is not an infrequent sign. Treatment is usually simple, involving first elimination of those factors which increase intragastric pressure or lower the lower esophageal sphincter pressure. Elevation of the head of the bed and antacids will often prevent further gastric insult to the pharynx and larynx and thus eliminate the patient's discomfort.

Adult↗
PubMed1978

The otolaryngologic manifestations of multiple myeloma.

The purpose of this paper is to present the precursors and complications of multiple myeloma as manifested in Otolaryngology. The modern Otolaryngologist is well aware that systemic disease may manifest itself in our specialty. Multiple myeloma is a distinctive form of plasma cell dyscrasia which often manifests itself in Otolaryngology. For example, patients may present with epistaxis, hoarseness, asymmetry of the face, swelling of the palate, nasal obstruction and a multiplicity of other symptoms. Therefore, the practicing Otolaryngologist must maintain a high index of suspicion that a seemingly simple sign or symptom may represent one small facet of a generalized condition. The paper emphasizes that in many instances a slight extension of our history taking may provide us with information leading to the diagnosis of this systemic disease. Cases seen by the author are reviewed and the relevant clinical features are presented.

Adult↗
PubMed1979

The treatment of subglottic stenosis in children by prolonged dilatation.

Laryngeal stenosis can present with recurrent lower respiratory tract infections, hoarseness, stridor or decreased exercise tolerance. Asphyxia and death may follow. One accepted method of treatment is to perform a tracheostomy, dilate the stricture and insert an obturator for 6 to 9 mo. Ten children with a subglottic stenosis were treated by this technique and 7 completed the treatment. Results in 5 of these children were good, 1 was improved and 1 restenosed. These results compare favorably with those reported by others. This form of treatment is indicated for unyielding but dilatable strictures which have failed to respond to other approaches. The choice, therefore, lies between resection and plastic repair or prolonged dilatation. Results are generally quite good for strictures near the vocal cords, but are variable for those well below the cords. The manufacture and insertion of a prosthesis used in the above cases are described.

Adult↗
PubMed1980

Laryngeal angiomyoma (vascular leiomyoma): clinicopathological findings.

Two cases of laryngeal angiomyoma which developed in 51 and 52-year-old men are reported. One was a tumor found in the supraglottic area of the larynx and the other was in the subglottic space. Each was a spherical tumor with a smooth surface. The chief complaints of these patients were sudden dyspnea, hoarseness, and laryngeal pain. The tumors were removed through direct laryngoscopy under general anesthesia; but in both cases, considerable bleeding occurred during and after surgery. Histological examination showed that the tumor was covered by squamous epithelium and a fibrous capsule. The parenchyma of the tumor was composed of proliferated fibers of smooth muscle, and dilated blood vessels in abundance. The tumor is of benign nature and recurrence is rare. For therapy, therefore, complete extirpation of the tumor is adequate, but the likelihood of profuse bleeding must be considered.

Hemangiosarcoma↗
PubMed1981

Tuberculous laryngitis: a series of 37 patients.

A series of 27 cases of tuberculous laryngitis is reviewed to assess the diagnostic features of the disease. The condition generally presents in males of late middle age who have pulmonary tuberculosis, although the pulmonary disease is seldom advanced. The presenting symptom is usually hoarseness, and the laryngoscopic appearances frequently mimic a tumor or chronic non-specific laryngitis: few patients correspond to the classical descriptions of the disease found in old texts. Histological examination of biopsy material is usually the diagnostic procedure, emphasizing the difficulty of diagnosis in the general population.

Adult↗
PubMed1981

Laryngeal tuberculosis.

Tuberculosis involvement of the larynx is uncommon. However, it is a highly infectious disease and a hazard to both community and hospital staff. It should be considered in the differential diagnosis of patients presenting with chronic hoarseness. Two patients with laryngeal tuberculosis are the objective of the present report. The diagnosis was established by biopsy followed by isolation and identification of Mycobacterium tuberculosis from sputum.

Biopsy↗
PubMed1981

Aerodigestive dysfunction secondary to thyroid tumors.

Although most thyroid tumors first manifest clinically by a neck mass, several patients with thyroid tumor have been treated whose initial complaint was a disturbance of the respiratory and digestive tracts. Because this association is not well recognized, the diagnosis of a thyroid tumor can be delayed, or even missed until the tumor grows much larger causing other symptoms. A series of 269 patients with thyroid tumors seen at UCLA from 1979-1980 was reviewed. Approximately 16% of these patients sought treatment because of aerodigestive dysfunction such as dyspnea, dysphagia, hoarseness, throat discomfort and hemoptysis. Such symptoms often indicate malignancy of substernal extension of tumor. The management of these tumors is discussed.

Deglutition Disorders↗
PubMed1983

Adductor spastic dysphonia: three years after recurrent laryngeal nerve resection.

The voices of 33 patients, ages 44 to 79 years, were assessed after recurrent laryngeal nerve resection for adductor spastic dysphonia. Voice improvement was noted in all patients 24 hours after surgery: in 97% at 1 month, 97% at 6 months, 82% at 1 year, 70% at 1 1/2 years, 58% at 2 years, 52% at 2 1/2 years, and 36% at 3 years. Of the 64% with failed voices by 3 years, 48% were worse than before surgery. Of the 36% whose voices remained improved, 58% were worse than at any previous period and 42% were better. Failures among women (77%) were considerably higher than among men (36%). Except for one patient, none of the patients with improvement achieved a normal voice. Patients with improvement had varied types and degrees of dysphonia: breathiness, hoarseness, diplophonia, and falsetto pitch breaks. The voices of some patients approached normalcy. A high percent of patients had voice tremor and regular voice arrests on vowel prolongation, signaling that the spastic dysphonia may have been related to essential (voice) tremor and that the spastic dysphonia returned because of increased severity of the neurologic tremor. We conclude that recurrent laryngeal nerve surgery for adductor spastic dysphonia has long-term limitations and that the differential diagnosis between neurologic and psychogenic types is imperative prior to therapeutic decision making.

Adult↗
PubMed1983

Plasmacytoma of the larynx.

Plasmacytoma involving the larynx is very rare. To the best of our knowledge there are only 79 cases reported in the world literature. We are adding 3 more cases; 2 cases were associated with multiple myeloma and 1 was considered to be a solitary or extramedullary plasmacytoma. The clinical picture was hoarseness and upper airway obstruction. In plasmacytoma of the larynx multiple biopsies are often nondiagnostic, sometimes revealing only chronic inflammation and amyloid infiltration in the tissues. Most authors agree that the treatment of choice is conservative surgical excision and radiation therapy. Surgery may also be reserved to excise residual scar tissue and fibrosis after treatment mainly to improve the airway and eliminate the tracheostomy tube. To confirm the definitive diagnosis of solitary plasmacytoma of the larynx, long-term follow-up of many years is necessary in order to rule out multiple myeloma.

Aged↗