Larynx

The effect of chronic obstructive pulmonary disease on laryngopharyngeal sensitivity

September 7, 2012     Nicola A. Clayton, MScMed, BAppSc; Giselle D. Carnaby-Mann, MPH, PhD; Matthew J. Peters, MD; Alvin J. Ing, MBBS, MD
article

Abstract

Patients with chronic obstructive pulmonary disease (COPD) may be at increased risk of aspiration secondary to impaired swallow function. One possible cause of this impairment is a reduction in laryngopharyngeal sensitivity. The relationship between COPD and laryngopharyngeal sensitivity has not been previously determined. We conducted a study to investigate the effect of COPD on laryngopharyngeal sensitivity by using laryngopharyngeal sensory discrimination testing (LPSDT). Our study population was made up of 20 adults (mean age: 71.7 yr) with clinically proven COPD and 11 healthy, age-matched controls. All 31 subjects underwent LPSDT with the use of an air-pulse stimulator via a nasendoscope. The threshold of laryngopharyngeal sensation was evaluated by measuring the amount of air pressure required to elicit the laryngeal adductor reflex (LAR). We found that the patients with COPD had a significantly higher LAR threshold than did the controls (p< 0.001). We conclude that patients with COPD have significantly less mechanosensitivity in the laryngopharynx. This sensory change may place patients with COPD at increased risk for aspiration.

Primary laryngeal NK/T-cell non-Hodgkin lymphoma: A case report

July 5, 2012     Draško Cikojević, MD, PhD; Ivo Glunčić, MD, PhD; Valdi Pešutić-Pisac, MD, PhD; Marisa Klančnik, MD, PhD; Zaviša Čolović, MD
article

Abstract

The estimated prevalence of extranodal non-Hodgkin lymphoma ranges from 10 to 35% of all cases; a finding in the larynx is extremely rare. We describe the case of a 77-year-old man who presented for evaluation of a 1-month history of minor swallowing difficulty, cough, and a foreign-body sensation in the throat. Fiberoptic endoscopy detected a tumor mass on the left aryepiglottic fold. Vocal fold mobility was normal. A biopsy specimen was obtained, and microscopic analysis revealed that the stratified squamous epithelium was partially eroded by abundant infiltrate that had occupied the entire submucosa. The submucosal infiltration consisted of lymphatic cells, including small, medium-sized, and large cells with an anaplastic appearance. On immunohistochemical analysis, the lymphoma cell population stained positive for CD3 and CD2, focally positive for CD56, and negative for CD4, CD5, and CD7. In addition, tumor cells expressed TIA-1, perforin, and granzyme B. A complete radiologic, pulmonologic, and hematologic workup found no other tumor. The patient underwent two cycles of chemotherapy followed by radiotherapy, and he experienced complete tumor regression. At the 1-year follow-up, findings on fiberoptic endoscopy of the larynx were normal, and positron-emission tomography found no evidence of a recurrence. The prognosis for this type of tumor is good when the diagnosis is made in the early phase of the disease. Long-termfollow-up is advisable for the timely detection of possible local or distant recurrences, which are common.

Case report: Leiomyosarcoma of the parapharyngeal space

July 5, 2012     Pradipta Kumar Parida, MBBS, MS; Jaimanti Bakshi, MBBS, MS; Sanjeev Bhagat, MBBS, MS; Ramandeep Singh Virk, MBBS, MS
article

Abstract

Leiomyosarcoma is usually found in the female genital tract, the retroperitoneum, the wall of the gastrointestinal tract, and subcutaneous tissues. An appearance of this malignant tumor in the parapharyngeal space is extremely rare and may be difficult to diagnose. Because of its rarity, little information exists on management and prognosis. We report the case of a 50-year-old man with a parapharyngeal space leiomyosarcoma who was treated with total excision of the tumor and postoperative radiotherapy. At follow-up 6 months postoperatively, he was well and free of disease. To the best of our knowledge, this is only the third case of a leiomyosarcoma in the parapharyngeal area to be reported in the literature. We discuss the diagnosis and treatment of leiomyosarcoma in this aspect.

Acute candidal pharyngolaryngitis

July 5, 2012     Andrew Mallon, DO; Rima A. DeFatta, MD; Robert T. Sataloff, MD, DMA, FACS
article

Use of inhaled steroids has been identified as a risk factor for the development of laryngeal candidiasis. Therefore, if dysphonia, cough, and general laryngeal irritation occur in a patient using inhaled steroids, the possibility of laryngeal candidiasis should be considered.

Primary NK/T-cell lymphoma of the larynx

April 30, 2012     Nechama Uri, MD; Yaakov Schindler, MD; Miriam Quitt, MD; Olga Valkovsky, MD; Geva Barzilai, MD
article

Abstract

Laryngeal extranodal non-Hodgkin lymphoma is uncommon, accounting for less than 1% of all laryngeal neoplasms; the B-cell phenotype is predominant. Lymphomas outside the nasal cavity are rare and highly aggressive. We present a case of primary natural killer T-cell (NK/T-cell) lymphoma of the larynx that arose in a 45-year-old man. Because only a limited amount of data is available on laryngeal NK/T-cell lymphoma, the mainstay of treatment remains unclear, although some data suggest that radiotherapy alone is the best option. Our patient was treated with chemotherapy and radiotherapy, and he remained in remission 2 years later.

Laryngeal schwannoma excised under direct laryngoscopy: Case report

April 30, 2012     Iosif Vital, MD; Dan M. Fliss, MD; Jacob T. Cohen, MD
article

Abstract

Laryngeal schwannomas (neurilemmomas) are extremely rare, and they present the otorhinolaryngologist with diagnostic and management challenges. These lesions usually present as a submucosal mass, and they are always a potential threat to the airway. We describe the case of a 75-year-old woman with a laryngeal schwannoma that arose from the left postcricoid area and covered the piriform sinus and arytenoid cartilage on that side. The tumor was completely excised under direct laryngoscopy with the use of a CO2 laser, and preservation of the mucosal lining of the larynx was achieved.

Laryngeal papilloma

April 30, 2012     Rima A. DeFatta, MD; Johnathan B. Sataloff; Grace E. Klaris; Robert T. Sataloff, MD, DMA, FACS

Third branchial anomaly: Endoscopic management revisited

March 31, 2012     Mala Tanna, MD, Monica R. Sharma, DDS, and Bijal Patel, MD
article

Third and fourth branchial apparatus anomalies may be misidentified as a recurrent deep neck abscess that does not respond to appropriate medical or surgical therapy or as recurrent acute suppurative thyroiditis, respiratory distress, or retropharyngeal abscess.

Microbial colonization of Blom-Singer indwelling voice prostheses in laryngectomized patients: An Indian perspective

March 31, 2012     Suhail I. Sayed, MS, Rehan Kazi, MS, PhD, Shubhra Sengupta, MD, Abhay Chowdhari, MD, DM, and Mohan Jagade, MS, MCh
article

Abstract

We analyzed a series of adults with an implanted voice prosthesis that had malfunctioned and required removal as a result of the attachment and growth of microorganisms. Our goal was to determine the characteristics of these colonizing microbes. We swabbed the esophageal side of each prosthesis to obtain microbial flora for analysis with standard culture media. In all, we studied 22 prostheses in 18 patients (3 patients had received multiple prostheses). We found mixed contamination (both yeast and bacteria) in 19 of the 22 cultures (86.4%); the other 3 cultures yielded bacteria only, and there was no instance of yeast only. The most common yeast isolated was Candida albicans (68.2% of cultures), and the most common bacterium was Pseudomonas aeruginosa (63.6%). The average lifetime of the prostheses was 201 days (∼6 mo, 3 wk). This study, which was the first of its kind in India, revealed that the microbial picture here was different from that found in previously reported studies of European populations. We presume the differences are attributable to different lifestyles and dietary habits.

Topical measles-mumps-rubella vaccine in the treatment of recurrent respiratory papillomatosis: Results of a preliminary randomized, controlled trial

March 31, 2012     Jin Lei, MD, Wang Yu, MD, Lin Yuexin, MD, Chen Qi, MD, Sun Xiumin, MD, and Zhang Tianyu, PhD
article

Abstract

We conducted a study to test the hypothesis that the measles-mumps-rubella (MMR) vaccine can either prevent further recurrences of recurrent respiratory papillomatosis (RRP) or prolong its remission. Our study population was made up of 26 children with RRP. All patients underwent surgical excision of their lesions. After the lesions were removed, half of these patients were prospectively randomized to receive a topical coating of the MMR vaccine on the site of their excised lesion (intervention group); the other half were treated with excision alone (control group). The patients in the intervention group experienced a longer period of recurrence-free remission than did those in the control group (median: 160 and 133 days, respectively), but the difference was not statistically significant. Therefore, it appears that topical MMR vaccine as an adjunct to routine surgical management may not be beneficial in preventing or slowing the return of RRP. However, we believe that further studies with larger patient populations are warranted.

The association between Helicobacter pylori and laryngopharyngeal reflux in laryngeal pathologies

March 1, 2012     Engin Çekin, MD, Mustafa Ozyurt, PhD, Evren Erkul, MD, Koray Ergunay, MD, Hakan Cincik, MD, Burak Kapucu, MD, and Atila Gungor, MD
article

Abstract

We conducted a study to determine the presence or absence of Helicobacter pylori and laryngopharyngeal reflux (LPR) in 43 previously untreated patients who had presented with a laryngeal lesion. Our aim was to determine if there was any association among H pylori, LPR, and laryngeal lesions. H pylori status was determined by real-time polymerase chain reaction (PCR) assays of biopsy tissue obtained during direct laryngoscopy. The presence or absence of LPR was determined on the basis of patients' reflux symptom index (RSI) and reflux finding score (RFS), which were based on their questionnaire responses and findings on endoscopic examination of the larynx, respectively. Patients with an RSI of 14 or more and/or an RFS of 8 or more were considered to have LPR. H pylori was present in 24 patients (55.8%) and absent in 19 (44.2%)-not a statistically significant difference. The prevalence of LPR was higher than the prevalence of H pylori; it was present in 30 patients (69.8%) and absent in 13 (30.2%). The difference was statistically significant (p = 0.01). We found no association between H pylori status and LPR status. Additionally, we analyzed two subgroups based on whether their lesions were benign or malignant/premalignant and found a significant relationship between LPR positivity and the presence of malignant/premalignant laryngeal lesions (p = 0.03). We found no association between H pylori status and either of the two subgroup categories.

Ventricular cyst of the larynx

March 1, 2012     Johnathan B. Sataloff, Rima A. DeFatta, MD, Mary J. Hawkshaw, BSN, RN, CORLN, and Robert T. Sataloff, MD, DMA FACS
article

Surgery for supraglottic cysts may not be necessary in patients in whom the cysts do not grow or interfere with phonation, if these patients will comply with follow-up for close observation. If the mass enlarges or causes severe enough symptoms to warrant the risks of surgery, excision is usually safe and effective.

PreviousPage
of 13Next