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JAYPEE JOURNALS
International Scientific Journals from Jaypee
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1.  ORIGINAL ARTICLE
Ki-67 Index in Salivary Gland Neoplasms
Suma Kaza, T Jaya Mastan Rao, Anupama Mikkilineni, G Venkata Ratnam, D Ranga Rao
[Year:2016] [Month:January-June] [Volume:6 ] [Number:1] [Pages:51] [Pages No:1-7] [No of Hits : 547]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10023-1110 | FREE

ABSTRACT

Assessment of proliferation is a means of predicting local recurrence and metastatic potential of malignancies. A mitotic count is not an ideal marker for proliferation in certain situations, such as salivary gland neoplasms. Ki-67 expression as a proliferation marker has been investigated in many human tumors. In the present study, Mitotic index (MI) and Ki-67 index were studied in pleomorphic adenoma, basal cell adenoma, mucoepidermoid carcinoma, adenoid cystic carcinoma epithelial myoepithelial carcinoma, carcinoma ex Pleomorphic adenoma and adenocarcinoma of salivary glands. The results were compared.
The MI was similar in benign neoplasms, mucoepidermoid carcinoma and epithelial myoepithelial carcinoma, whereas it was high in carcinoma ex pleomorphic adenoma, adenocarcinoma and adenoid cystic carcinoma. The Ki-67 index was different in basal cell adenoma and pleomorphic adenoma. It was helpful in differentiating high grade and low grade mucoepidermoid carcinoma. It highlighted the malignant behavior of epithelial myoepithelial carcinoma.
It was concluded that Ki-67 in benign neoplasms is 5% or less and in malignant ones more than 23% with a few exceptions. In mucoepidermoid carcinoma and epithelial myoepithelial carcinoma, Ki-67 index was found to be a better indicator for aggressiveness. These findings will be presented in this paper, with review of literature.

Keywords: Ki-67 index, Mitotic index, Prognostic marker, Proliferation, Salivary gland neoplasms.

How to cite this article: Kaza S, Rao TJM, Mikkilineni A, Ratnam GV, Rao DR. Ki-67 Index in Salivary Gland Neoplasms. Int J Phonosurg Laryngol 2016;6(1):1-7.

Source of support: Nil

Conflict of interest: None

 
2.  ORIGINAL ARTICLE
Outcome Analysis in Patients with Benign Vocal Fold Lesions
Nitish Virmani, Arpit Sharma, Jyoti Dabholkar
[Year:2016] [Month:January-June] [Volume:6 ] [Number:1] [Pages:51] [Pages No:8-13] [No of Hits : 502]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10023-1111 | FREE

ABSTRACT

Introduction: Benign vocal cord lesions cause significant dysphonia by disrupting the normal vibratory function of the vocal fold mucosa. Multidimensional assessment of voice characteristics allows for an accurate analysis of voice impairment and can be used to assess the outcome of different treatment modalities.

Aims: To evaluate the outcome in patients treated for benign vocal fold lesions using multidimensional voice assessment.

Materials and methods: Thirty adult patients with benign vocal fold lesions were treated according to standard protocols and followed up for 6 months. Voice was evaluated by visual analog scale (VAS), GRBAS (grade, roughness, breathiness, asthenia, strain) scale, maximum phonation time (MPT), S/Z ratio, and acoustic parameters using PRAAT. Pre- and posttreatment voice was compared.

Results: Benign lesions observed were vocal polyps (16), vocal nodules (7), vocal fold cysts (5), vocal cord papilloma (1), and sulcus vocalis (1). Mean VAS rating improved from 7.5 to 2 at 3 months and 1.6 at 6 months. Mean GRBAS score improved from 7.5 to 2.96 at 3 months and 2.3 at 6 months. Maximum phonation time increased from 9.43 seconds to 14.16 seconds at 3 months and 14.46 seconds at 6 months. S/Z ratio reduced from 1.37 to 1.16 at 3 months and 1.15 at 6 months. Jitter reduced from 1.81 to 1% at 3 months and 0.97% at 6 months; shimmer decreased from 6.07 to 2.19% at 3 months and to 2.03% at 6 months. Harmonic-to-noise ratio values improved from 8.01 to 10.78 dB at 3 months and 10.96 dB at 6 months; mean F0 increased from 207.27 to 217.89 Hz at 3 months and 219.65 Hz at 6 months.

Conclusion: A single measurement of voice cannot be used as a reliable outcome measure. Perceptual, aerodynamic, acoustic, and self-analysis together allow a multidimensional assessment of voice characteristics.

Keywords: Benign vocal fold lesions, Dysphonias, Outcome analysis, Phonosurgery, Speech therapy, Voice assessment.

How to cite this article: Virmani N, Sharma A, Dabholkar J. Outcome Analysis in Patients with Benign Vocal Fold Lesions. Int J Phonosurg Laryngol 2016;6(1):8-13.

Source of support: Nil

Conflict of interest: None

 
3.  ORIGINAL ARTICLE
Voice Therapy in Muscle Tension Dysphonia Cases
Sachender Pal Singh, Smrity Rupa Borah Dutta
[Year:2015] [Month:January-June] [Volume:5 ] [Number:1] [Pages:38] [Pages No:20-24] [No of Hits : 1352]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10023-1097 | FREE

ABSTRACT

Muscle tension dysphonia (MTD) is a condition where phonation is associated with excessive muscular tension or muscle misuse. It has multifactorial etiologies. It can be a primary or secondary MTD. While it can affect anyone, sufferers usually belong to a particular group. It has very serious impact on sufferer’s personal, social and professional life.
We are presenting here, our 20 months prospective study done in the department of otorhinolaryngology, Silchar Medical College and Hospital from June 2012 to July 2013.
Voice therapy was given to every patient, whether primary or secondary MTD. Pre-therapy vs post-therapy comparisons were made of self-ratings of voice handicap index, auditoryperceptual ratings as well as visual-perceptual evaluations of laryngeal images.
Outcome of voice therapy results (Graphs 1 and 2) in such patients were found to be very good. As the disease is multifactorial, treatment approach should be broad-based involving multidisciplinary team.

Keywords: Circumlaryngeal massage, Dysphonia plica ventricularis, GRABS score.

Abbreviations: Vocal Cord Nodule (N), Vocal Polyp (P), Laryngopharyngeal Reflux (LPR), Presbylaryngis (PL), Cut Throat injury (CT), Primary Muscle Tension Dysphonia (PMTD), Dysphonia Plica ventricular (DPV).

How to cite this article: Singh SP, Dutta SRB. Voice Therapy in Muscle Tension Dysphonia Cases. Int J Phonosurg Laryngol 2015;5(1):20-24.

Source of support: Nil

Conflict of interest: None

 
4.  Original Article
Diagnostic Challenge of Sulcus Vocalis Made Easier
Nupur Kapoor Nerurkar, Harsh Karan Gupta, Ajay Eknath Shedge
[Year:2015] [Month:July-December] [Volume:5 ] [Number:2] [Pages:33] [Pages No:39-41] [No of Hits : 696]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10023-1102 | FREE

ABSTRACT

Objectives: To introduce a simple diagnostic test performed with white light laryngoscopy for the diagnosis of sulcus vocalis.

Materials and methods: This is a retrospective observational study. A total of 14 patients with voice-related complaints and a phonatory gap on examination were included. Obvious structural and neuromuscular glottic pathologies were excluded. Phonatory gap was measured using white light rigid laryngoscopy with the technique described here. Findings were then correlated with stroboscopy.

Results: All 14 patients (10 U/L and 4 B/L), observed to have an asymmetric phonatory gap on white light rigid laryngoscopy, were diagnosed with sulcus vocalis.

Conclusion: An asymmetric phonatory gap, as seen on white light laryngoscopy and measured with the simple technique mentioned here, should make the laryngologist suspect a sulcus vocalis. However, the diagnosis needs to be confirmed by stroboscopy.

Keywords: Phonatory gap, Stroboscopy, Sulcus.

How to cite this article: Nerurkar NK, Gupta HK, Shedge AE. Diagnostic Challenge of Sulcus Vocalis Made Easier. Int J Phonosurg Laryngol 2015;5(2):39-41.

Source of support: Nil

Conflict of interest: None

 
5.  ORIGINAL ARTICLE
Role of Voice Therapy in Patients with Mutational Falsetto
Arvind Varma, Alok Kumar Agrahari, Raj Kumar, Vijay Kumar
[Year:2015] [Month:January-June] [Volume:5 ] [Number:1] [Pages:38] [Pages No:25-27] [No of Hits : 646]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10023-1098 | FREE

ABSTRACT

Background: Mutational falsetto is the most common mutational voice disorder, found in all ages. Clinicians often miss this diagnosis due to unfamiliarity with the condition. The voice of a person with mutational falsetto is high pitched, weak, thin, breathy, hoarse and monopitched.

Objective: This study was carried out to evaluate the efficacy of voice therapy in persons with mutational falsetto.

Methods: Eleven male patients with ages between 18 and 26 years (mean age 22.18 years, SD 2.52) diagnosed with mutational falsetto underwent acoustical analysis using Praat Software, perceptual analysis using grade, roughness, breathiness, asthenia and strain (GRBAS) scale and psychosocial analysis using emotional component of voice handicap index (VHI). All the components were analyzed pre- and postvoice therapy.

Results: Improvement in acoustic analysis parameters was statistically significant with p-value less than 0.0001(pretherapy mean of fundamental frequency (F0) was 217.45 with SD 8.68, whereas post-therapy mean of F0 was 127.50 with SD 5.32). Significant improvement in perceptual analysis was seen post-therapy on GRBAS scale. Improvement in psychosocial aspect was also statistically significant with p-value less than 0.0001 (pre-therapy mean 26.18, SD 1.72 post-therapy mean 7, SD 1.15).

Conclusion: Voice therapy plays an important role in lowering F0 and alleviation mental agony of the patients with mutational falsetto.

Keywords: Fundamental frequency, Mutational falsetto, Voice therapy.

How to cite this article: Varma A, Agrahari AK, Kumar R, Kumar V. Role of Voice Therapy in Patients with Mutational Falsetto. Int J Phonosurg Laryngol 2015;5(1):25-27

Source of support: Nil

Conflict of interest: None

 
6.  Original Article
Gastroesophageal Reflux Disease in Patients with Eustachian Tube Catarrh
Anuja Bhargava, Meenu Cherian, Tambi A Cherian, Sanjay Gupta
[Year:2015] [Month:July-December] [Volume:5 ] [Number:2] [Pages:33] [Pages No:61-66] [No of Hits : 639]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10023-1107 | FREE

ABSTRACT

Background: Eustachian tube catarrh could be due to laryngopharyngeal reflux besides other causes.

Objectives: To assess gastroesophageal reflux disease (GERD) in patients with Eustachian tube catarrh and the effect of proton pump inhibitors on symptoms of Eustachian tube disease.

Methodology: A total of 50 patients were selected with symptoms of Eustachian tube catarrh and evaluated prospectively in the ENT Outpatient Department of the Pondicherry Institute of Medical Sciences, Puducherry.

Results: The group consisted of 15 (30%) males and 35 (70%) females. The largest group was of the age of 45 years and above (44%). The most common symptom of Eustachian tube catarrh was itching (84%), followed by otalgia (76%) and popping sensation on swallowing (74%). On otoscopic examination, the commonest grade of tympanic membrane retraction was grade I (57%), on tympanometry 90% of cases had middle ear pressure in range -100 to +100. The middle compliance ranged from 0.5 to 1.75 (normal) in 86% of the cases. The tympanomeric curve was type A (normal) in 78% of the cases and type C in 8% of the cases. At the end of 4 and 8 weeks, the response of treatment to proton pump inhibitors was significantly higher (z = 3.53, p < 0.05) in the studied group.

Conclusion: Laryngopharyngeal reflux (LPR) could be an important etiological factor in Eustachian tube catarrh. The treatment, with proton pump inhibitors, of Eustachian tube catarrh with no local identifiable cause, could be very useful to this subsect of patients.

Keywords: Eustachian tube catarrh, Gastroesophageal reflux, Laryngopharyngeal reflux, Proton pump inhibitors.

How to cite this article: Bhargava A, Cherian M, Cherian TA, Gupta S. Gastroesophageal Reflux Disease in Patients with Eustachian Tube Catarrh. Int J Phonosurg Laryngol 2015;5(2): 61-66.

Source of support: Nil

Conflict of interest: None

 
7.  Original Article
Posterior Commissure Hypertrophy as Diagnostic and Prognostic Indicator for Laryngopharyngeal Reflux
Anagha Atul Joshi, Bhagyashri Ganesh Chiplunkar, Renuka Anil Bradoo, Kshitij Dhaval Shah
[Year:2015] [Month:July-December] [Volume:5 ] [Number:2] [Pages:33] [Pages No:57-60] [No of Hits : 606]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10023-1106 | FREE

ABSTRACT

Purpose: To establish posterior commissure hypertrophy as tool to diagnose laryngopharyngeal reflux (LPR) and to determine whether it can be used as a reliable marker for response to treatment.

Materials and methods: A prospective study of 100 patients with voice disorder was conducted. Patients were evaluated using reflux symptom index (RSI) and reflux finding score (RFS) by 70° Hopkins’ rigid laryngoscope. Those patients in whom RFS score was 7 or more were diagnosed to have LPR. These patients were then started on antireflux therapy along with lifestyle modification and were evaluated regularly over a period of 6 months.

Results: The prevalence of LPR in patients with voice disorders was found to be 25%. Mean age was 41.48 years and the male and female ratio was 0.85:1. Posterior commissure hypertrophy was present in 60 out of 100 patients (60%). Among laryngopharyngeal reflux disease (LPRD), 23 out of 25 patients (92%) had posterior commissure hypertrophy, out of which only 2 (8.6%) patients showed complete resolution of posterior commissure hypertrophy after 6 months of treatment. A total of 10 patients (43.47%) did not show any change in grading of posterior commissure hypertrophy. And 11 patients (47.82%) showed downgrading of posterior commissure hypertrophy. Sensitivity of posterior commissure hypertrophy for diagnosis of LPR was found to be 92%, whereas specificity was 50.66%.

Conclusion: Posterior commissure hypertrophy can be used as a screening tool for diagnosis of LPR but cannot be used reliably as a clinical marker for response to therapy.

Keywords: Laryngopharyngeal reflux, Posterior commissure hypertrophy, Reflux finding score.

How to cite this article: Joshi AA, Chiplunkar BG, Bradoo RA, Shah KD. Posterior Commissure Hypertrophy as Diagnostic and Prognostic Indicator for Laryngopharyngeal Reflux. Int J Phonosurg Laryngol 2015;5(2):57-60.

Source of support: Nil

Conflict of interest: None

 
8.  CASE REPORT
Suspecting Airway Foreign Body in Agenesis of the Lung: A Rare Incidence of Misdiagnosis
Santosh Kumar Swain, Sidarth Mohanty, Neha Singh, Jashashree Choudhury, Mahesh Chandra Sahu
[Year:2015] [Month:January-June] [Volume:5 ] [Number:1] [Pages:38] [Pages No:32-34] [No of Hits : 587]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10023-1100 | FREE

ABSTRACT

Agenesis of the lung is an extremely rare condition. Suspecting foreign body in agenesis of the lung is a diagnostic dilemma. We report the case of an 11 months old boy who presented with cough and cold; examination showed decreased air entry on the right side and investigations reported collapse on chest X-ray and plain computed tomography (CT) scan of thorax. Pediatrician suspected airway foreign body. Rigid bronchoscopy was done to confirm the diagnosis, but there was blind end in the right bronchus with no foreign body seen. Contrast-enhanced CT scan (CECT) of the neck and chest confirmed the aplasia of right lung. Agenesis of the lung should be kept in the mind by the clinician when dealing with foreign body in airway. This can prevent unnecessary intervention like rigid bronchoscopy.

Keywords: Agenesis of the lung, Airway foreign body, Bronchoscopy.

How to cite this article: Swain SK, Mohanty S, Singh N, Choudhury J, Sahu MC. Suspecting Airway Foreign Body in Agenesis of the Lung: A Rare Incidence of Misdiagnosis. Int J Phonosurg Laryngol 2015;5(1):32-34.

Source of support: Nil

Conflict of interest: None

 
9.  ORIGINAL ARTICLE
Elongated Styloid Process Revisited
Anand Acharya
[Year:2015] [Month:January-June] [Volume:5 ] [Number:1] [Pages:38] [Pages No:15-16] [No of Hits : 561]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10023-1095 | FREE

ABSTRACT

Elongated styloid process is one of the many causes of pain in throat. Yet, it is often overlooked. When the throat looks normal on examination, the entity should be kept in mind, to clinch the diagnosis. Management and review of literature are discussed.

Keywords: Eagle syndrome, Elongated styloid process, Foreign body sensation, Stylalgia.

How to cite this article: Acharya A. Elongated Styloid Process Revisited. Int J Phonosurg Laryngol 2015;5(1):15-16.

Source of support: Nil

Conflict of interest: None

 
10.  CASE REPORT
Primary Histoplasmosis of Larynx Mimicking as Laryngeal Carcinoma
Sampan S Bist, Shivanjali Sandhirr, Nadia Shirazi, Vinish Agrawal, Bhartendu Bharti
[Year:2015] [Month:January-June] [Volume:5 ] [Number:1] [Pages:38] [Pages No:28-31] [No of Hits : 510]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10023-1099 | FREE

ABSTRACT

Granulomatous diseases caused by infectious agents are being encounted more frequently nowadays. Infection by Histoplasma capsulatum is one such granulomatous disease. Isolated laryngeal histoplasmosis is a rare clinical entity. Because of its simulation with malignancy, it needs to be included in the differential diagnosis of neoplasm, both benign and malignant. We report an extremely rare case of isolated histoplasmosis, presenting as a primary infection of the larynx with no other systemic involvement in a 57 years old immunocompetent male. He presented with progressive hoarseness of voice, difficulty in breathing and mild dysphagia. Indirect laryngoscopy revealed multiple exophytic nodular lesions in endolaryngeal structures. The patient then underwent direct laryngoscopy biopsy under general anesthesia and the histopathological examination of the biopsy revealed chronic granulomatous inflammation, caused by histoplasma which was confirmed by using special Gomori’s methanamine silver stain for fungi. Though it appeared like cancer clinically; biopsy confirmed the final diagnosis. The histopathologist must be informed about the possibility of histoplasmosis, because special dyes have to be used to confirm this diagnosis. The treatment is mainly medical with amphotericin B which remains the gold standard for treatment of this disease, although other drugs have also been used.

Keywords: Granulomatous, Histoplasmosis, Laryngeal malignancy.

How to cite this article: Bist SS, Sandhirr S, Shirazi N, Agrawal V, Bharti B. Primary Histoplasmosis of Larynx Mimicking as Laryngeal Carcinoma. Int J Phonosurg Laryngol 2015;5(1):28-31.

Source of support: Nil

Conflict of interest: None

 
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