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ORIGINAL ARTICLE
Anuja Bhargava, Mohammad Shakeel, Amit P Srivastava, Prasoon Varshney, Shikhar Saxena, Ekta Agarwal

Role of Reflux Symptom Index and Reflux Finding Score in Evaluation of Treatment Outcome in Patients with Laryngopharyngeal Reflux

[Year:2017] [Month:July-December] [Volumn:7 ] [Number:2] [Pages:38] [Pages No:39-43][No of Hits : 805]


ABSTRACT

Introduction: Laryngopharyngeal reflux (LPR) is defined as the reflux of gastric content into the larynx and pharynx with symptoms like foreign body sensation in the throat, cough, heartburn, chest pain, difficulty in swallowing, and hoarseness.

Study design: Prospective study.

Study duration: April 2015 to March 2016.

Materials and methods: Patients with suspected LPR were evaluated using reflux symptom index (RSI) and reflux finding score (RFS) and treated with proton pump inhibitors (PPIs). Pre- and posttherapeutic RSI and RFS were compared.

Results: A total of 120 patients were included over a period of 12 months. Median total score of RSI and RFS before therapy was 23.37 ± 7.26 and 10.36 ± 3.11 respectively, and had reduced to (RSI and RFS) 5.24 ± 2.51 and 4.31 ± 2.00 (p < 0.001) respectively.

Conclusion: Implementation of RFS and RSI in daily use may reduce cost-intensive and time consuming examination, thus helping in early diagnosis of LPR and reducing serious complications of LPR.

Keywords: Gastroesophageal reflux disease, Laryngopharyngeal reflux, Reflux finding score, Reflux laryngitis, Reflux symptom index.

How to cite this article: Bhargava A, Shakeel M, Srivastava AP, Varshney P, Saxena S, Agarwal E. Role of Reflux Symptom Index and Reflux Finding Score in Evaluation of Treatment Outcome in Patients with Laryngopharyngeal Reflux. Int J Phonosurg Laryngol 2017;7(2):39-43.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Manju E Issac

Effect of Kashima’s Surgery in Bilateral Abductor Vocal Cord Palsy

[Year:2017] [Month:January-June] [Volumn:7 ] [Number:1] [Pages:38] [Pages No:10-12][No of Hits : 741]


ABSTRACT

Introduction: Bilateral abductor palsy is treated by tracheostomy or any lateralization procedure. Kashima’s surgery is a lateralization procedure introduced by Kashima in 1989.

Objective: To evaluate the effect of Kashima’s surgery using subjective measures of breathing quality in patients with bilateral abductor palsy.

Materials and methods: This is a prospective study with 31 patients (3 men, 28 women) who underwent Kashima’s surgery between January 2013 and December 2015 in the Laryngology department. Subjective evaluation was done by using dyspnea index score in the pre- and postoperative periods. Dyspnea index score is calculated based on answers given to a 7-point questionnaire and assessed by Likert scale, a self-assessment scale. For each point, the scores range from 0 to 3, and the maximum score is 21. Patients who already had tracheotomy were given a score of 14. This score was calculated again using the same questionnaire in the pretracheostomy scenario.

Results: There is significant reduction in the dyspnea index score with a median reduction score of 9 and improvement of quality-of-life after Kashima’s surgery.

Conclusion: Dyspnea index score is easy to administer. Considering the cost of treatment and high success rate of decannulation, it is obvious that Kashima’s surgery is effective and affordable in bilateral abductor palsy.

Keywords:

How to cite this article: Issac ME. Effect of Kashima’s Surgery in Bilateral Abductor Vocal Cord Palsy. Int J Phonosurg Laryngol 2017;7(1):10-12.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Bhaskar Dey, Rajanikanta Pradhan, Susmita Ghosh, Samriddha Kumar, Abhijit Das, Jayanta Roy

Successful Treatment of Dysphagia in a Case of Lateral Medullary Syndrome

[Year:2017] [Month:July-December] [Volumn:7 ] [Number:2] [Pages:38] [Pages No:63-65][No of Hits : 671]


ABSTRACT

Background: Lateral medullary syndrome is a known cause for apraxia, dysarthria, and dysphagia. It is caused by lesion in the posterolateral area of the medulla oblongata. Dysphagia, being a life-threatening condition, deserves immediate attention of the medical team and is of prime concern to Speech Language Pathologists (SLPs).

Aim: The aim of the study was to document a successful case of dysphagia management in lateral medullary syndrome (LMS).

Case report: This study documents a successful management of dysphagia in an individual with LMS. Assessment (perceptual and instrumental) showed reduction of peripheral capillary oxygen saturation (SpO2) during feeding, slow laryngeal elevation with pooling of food and saliva in bilateral pyriform fossa, along with a high risk of penetration followed by aspiration. Weak tongue movement and improper lip closure were observed. Combinations of manual therapy and compensatory techniques were used for treating dysphagia. Oromotor exercises and respiratory exercises were used along with supraglottic maneuver, Masako maneuver, chin-tuck with effortful swallow, and Shaker’s exercise. Within 2 weeks of initiation of swallow therapy, the subject could start safe oral intake with pureed food and maintain normal SpO2 level during feeding.

Conclusion: This case report demonstrates that dysphagia in LMS can be successfully treated with appropriate selection of combination of techniques in swallow therapy. Supraglottic swallow, Masako maneuver, chin-tuck, and Shaker’s exercise were found effective in this case study. We further conclude that early initiation of therapy is the key to faster recovery.

Clinical significance: It is often seen in many of the patients with LMS that they end up with either Rhyle’s tube or percutaneous endoscopic gastrostomy (PEG) tube feeding until complete recovery. This case report highlights the importance of early initiation of therapy and combination of swallowing therapy techniques in order to avoid prolonged artificial tube feeding in these patients.

Keywords: Chin-tuck, Flexible endoscopic evaluation for swallowing, Lateral medullary syndrome, Masako maneuver, Shaker’s exercise, Supraglottic maneuver.

How to cite this article: Dey B, Pradhan R, Ghosh S, Kumar S, Das A, Roy J. Successful Treatment of Dysphagia in a Case of Lateral Medullary Syndrome. Int J Phonosurg Laryngol 2017;7(2):63-65.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Priyanka J Hardikar, Jyoti P Dabholkar, Ramprasath Vasan, Nilam Sathe

Management of Unilateral Vocal Cord Palsy: Case Series with Review of Literature

[Year:2017] [Month:July-December] [Volumn:7 ] [Number:2] [Pages:38] [Pages No:52-58][No of Hits : 662]


ABSTRACT

Aim: To find out the vocal outcome of conservative management and temporary medialization in unilateral vocal cord palsy (UVCP) and their effectiveness in reducing the need for permanent medialization.

Materials and methods: Thirty adult patients with UVCP, without structural vocal cord lesion or laryngeal malignancy were initially treated conservatively, and those without adequate response at 3 months were treated with temporary medialization. They were followed up for 6 months. Pre- and posttreatment voice was compared using grade, roughness, breathiness, asthenia, strain (GRBAS) scale, Voice Handicap Index (VHI), and maximum phonation time (MPT).

Results: The results show 40% cases were idiopathic, whereas 33.33% had iatrogenic cause, majority, following thyroidectomy; 66.67% responded well to the conservative management. Ten patients (33.33%) did not show satisfactory improvement in the first 3 months and were treated with temporary medialization. Both the groups were comparable at the first visit. At 6 months, the improvement in all parameters was significantly more in the temporary medialization group than the conservative management group compared with their values at 3 months. Two of the 10 patients treated with injection laryngoplasty were considered for permanent medialization. The final outcome was similar in both the groups.

Conclusion: Conservative management of UVCP is the standard of care. Injection laryngoplasty at 3 months achieves better voice outcome in those not fully improved by conservative management. Medialization thyroplasty should be suggested in patients failing to show the desired improvement after injection laryngoplasty.

Clinical significance: The study guides in the management of UVCP, in terms of its likely cause and approach to treatment.

Keywords: Conservative management, Injection laryngoplasty, Prospective study, Unilateral vocal cord palsy.

How to cite this article: Hardikar PJ, Dabholkar JP, Vasan R, Sathe N. Management of Unilateral Vocal Cord Palsy: Case Series with Review of Literature. Int J Phonosurg Laryngol 2017;7(2):52-58.

Source of support: Nil

Conflict of interest: None


 
RESEARCH ARTICLE
Sri Lekha Bodepudi, KASSN Kalyan, Ramarao Peddi

Study of Correlation of Preoperative Fine Needle Aspiration Cytology with Histopathological Examination in Thyroid Swellings

[Year:2017] [Month:January-June] [Volumn:7 ] [Number:1] [Pages:38] [Pages No:16-19][No of Hits : 558]


ABSTRACT

Introduction: Though fine needle aspiration cytology (FNAC) for thyroid is acclaimed as a gold standard before going for intervention, there are some limitations with respect to tissue availability, technique, skill of performer, etc. So, a crosssectional study was conducted to determine the accuracy of FNAC in diagnosis of thyroid swelling and to assess the correlation between preoperative cytopathological diagnosis and postoperative histopathological diagnosis.

Materials and methods: Data collected from records in the time period of 3 years, i.e., from August 2012 to August 2015, were evaluated and analyzed.

Results: A total number of 93 cases were included in the study of which majority were females with frequency of 84.94%, most of the incidence of thyroid swellings occur in the age group of 40 to 50 years. Overall mismatch between histopathological examination and FNAC was 43 out of 93 and of which 7 were major and 36 were minor mismatch. Sensitivity of patients having malignancy with positive FNAC is 82.35% from the study and specificity of patients with nonmalignant thyroid disease and positive cytology is 95.18%.

Conclusion: It was observed that FNAC is a reliable, safe, and accurate method as a first line of evaluation in thyroid swelling before the surgery. Fine needle aspiration cytology is more sensitive in detecting thyroid gland malignancy but still correlation is always necessary and therefore, histopathological analysis still remains essential for final diagnosis.

Keywords: Fine needle aspiration cytology, Follicular adenoma, Histopathological examination, Malignancy, Thyroid swelling.

How to cite this article: Bodepudi SL, Kalyan KASSN, Peddi R. Study of Correlation of Preoperative Fine Needle Aspiration Cytology with Histopathological Examination in Thyroid Swellings. Int J Phonosurg Laryngol 2017;7(1):16-19.

Source of support: Nil

Conflict of interest: None


 
RESEARCH ARTICLE
Anagha Joshi, Varun J Dave, Renuka Bradoo, Deepti Sapkale

Evaluation of Validity of Voice Handicap Index among Indian Population

[Year:2017] [Month:July-December] [Volumn:7 ] [Number:2] [Pages:38] [Pages No:59-62][No of Hits : 552]


ABSTRACT

Introduction: The field of voice disorders has seen numerous advances in diagnostic and therapeutic modalities in the recent past. Unfortunately, none of these assessments reflects the “true” suffering of the patients or the level of handicap that a patient is suffering from as a result of the voice disorder.

Aims and objectives: (1) To compare Voice Handicap Index (VHI) of normal person with VHI of patient with change in voice. (2) To compare VHI of different conditions of change in voice.

Materials and methods: The study is a prospective cohort study with 100 subjects enrolled in the cases or the dysphonic group and 100 patients enrolled as controls. Both the study groups were then asked the VHI questionnaire. The VHI consists of questions on how the voice change has affected the patient’s daily routine life and how the functional, physical, and emotional aspect of voice is impaired is checked.

Results: Among gender analysis, females had high VHI scores along with VHI subscales in both dysphonics and control group. Among the vocal cord lesions, the VHI scores and subscores were compared. The mean VHI score was maximum in patients with Reinke’s edema, then in case of vocal cord polyp, followed by vocal cord palsy, vocal cord cyst, vocal cord nodules, vocal sulcus, and least was in cases of vocal cord varix.

Conclusion: The VHI questionnaire is a brief, relevant, and valid self-rating questionnaire to add to the routinely used clinicians’ assessment battery to contribute to the complex decisionmaking process (diagnosis, therapy, counseling) and outcome.

Keywords: Dysphonias, Laryngology, Phonosurgery.

How to cite this article: Joshi A, Dave VJ, Bradoo R, Sapkale D. Evaluation of Validity of Voice Handicap Index among Indian Population. Int J Phonosurg Laryngol 2017;7(2):59-62.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Ruta V Shah, Rajesh Vishwakarma

Laryngopharyngeal Reflux: Is It the Real Culprit in Patients with Laryngeal Complaints?

[Year:2017] [Month:January-June] [Volumn:7 ] [Number:1] [Pages:38] [Pages No:6-9][No of Hits : 548]


ABSTRACT

Aim: The aim of this study is to evaluate the role of laryngopharyngeal reflux (LPR) in patients with laryngeal complaints and study the correlation between reflux symptom index (RSI) and reflux finding score (RFS).

Materials and methods: This is a study of 104 patients, who presented in the ear, nose, and throat outpatient department at the Civil Hospital, Ahmedabad, India, from April 2015 to April 2016, with complaints like change of voice, chronic cough, foreign body sensation, throat clearing, difficulty swallowing, and regurgitation.
All the patients were examined with 90° endoscope by a single examiner, and an RSI ≥13 was considered as indicative of reflux.

Observation and discussion: The mean age of the 104 patients was 47.2 years. The male:female ratio was 1:1.8. The RSI ranged from 5 to 44, with a mean of 22.99 and standard deviation (SD) of 7.43. The RFS ranged from 4 to 22, with a mean of 11.04 and SD of 3.07. Both the parameters showed high correlation (correlation coefficient 0.98).

Conclusion: The LPR plays an important contributory role in patients with laryngeal complaints. The RFS and RSI can be used as routine parameters in establishing the diagnosis of reflux.

Keywords: Laryngopharyngeal reflux, Reflux finding score, Reflux symptom index.

How to cite this article: Shah RV, Vishwakarma R. Laryngopharyngeal Reflux: Is It the Real Culprit in Patients with Laryngeal Complaints? Int J Phonosurg Laryngol 2017; 7(1):6-9.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Ramesh G Babu, Krishna V Chaitanya, Lokesh P Kumar

Combined Endoscopic and External Surgical Approach for Lateralization of Vocal Cord in Bilateral Abductor Palsy using Suture Technique: Our Experience

[Year:2017] [Month:July-December] [Volumn:7 ] [Number:2] [Pages:38] [Pages No:44-47][No of Hits : 534]


ABSTRACT

Introduction: Bilateral vocal cord paralysis is a rare but dangerous condition which results in shortness of breath and poor quality of voice. Only patients with severe bilateral vocal cord immobility require surgical intervention. In the present study, we describe the procedure of combined endoscopic and external surgical approach for lateralization of vocal cord in bilateral abductor palsy.

Objective: The objective of this study is to analyze the surgical outcome of combined endoscopic and external surgical approach for lateralization of vocal cord using suture technique in bilateral abductor palsy.

Materials and methods: An observational study was conducted on 17 patients presenting in ENT Department during May 2014 to July 2016 with laryngeal lesions of bilateral abductor palsy with posterior glottic chink of 3 mm or less, stridor at rest, and significant limitation of physical activity due to airway narrowing.

Observations: In the present study, we have performed suture lateralization of vocal cords in 17 patients. Of these, 11 (64.70%) were female and 5 (29.41%) were male with slight female preponderance. Mean age of performing procedure was 39 years with the patients in age group of 18 to 60 years. When clinical etiology of the patients leading to bilateral vocal cord palsy was observed, patients presenting with postsurgical causes appeared to develop bilateral vocal cord palsy in 47.05% of patients. During the study, it was observed that improvement in respiration was adequate in 16 (94.11%) patients, and voice quality was socially acceptable in 16 (94.11%) patients.

Discussion and conclusion: Surgery of laterofixation can provide immediate and long-lasting adequate airway and can be considered as minimally invasive with minimal alterations to laryngeal mucosa and subsequent preservation of laryngeal functions. This procedure appears efficient in management of bilateral vocal cord palsy.

Keywords: Bilateral, Laterofixation, Tracheostomy, Vocal cord paralysis.

How to cite this article: Babu RG, Chaitanya KV, Kumar LP. Combined Endoscopic and External Surgical Approach for Lateralization of Vocal Cord in Bilateral Abductor Palsy using Suture Technique: Our Experience. Int J Phonosurg Laryngol 2017;7(2):44-47.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Nitin Arora, Jyoti Singh, Jai L Davessar

Epidemiological Profile of Larynx Cancer at a Tertiary Care Center in Faridkot, Punjab, India

[Year:2017] [Month:July-December] [Volumn:7 ] [Number:2] [Pages:38] [Pages No:48-51][No of Hits : 533]


ABSTRACT

Introduction: Head and neck cancer constitutes about 5 to 50% among all the cancers found in the world. In India, head and neck cancer constitutes about 30% of all the cancers, and laryngeal cancer is the second among all head and neck cancers. A high percentage of laryngeal cancers have been linked to tobacco and alcohol use. Smoking is considered as a major risk factor for laryngeal carcinoma, with alcohol use having synergistic effect. The purpose of our study is to highlight the incidence according to age and sex, site of distribution, risk factors involved, and clinical stage at presentation of the laryngeal cancer.

Materials and methods: It is a cross-sectional study conducted from January 2014 to November 2014. Patients in the age group 21 to 70 years, of either gender, with a histologically proven malignancy of larynx presenting to the ear, nose, and throat (ENT) outpatient department were enrolled in the study. Patients were observed for age and sex distribution, tumor staging, location and metastasis, commonly associated risk factors, and most common site involved by the disease.

Results: Laryngeal cancers are seen more commonly in males than females. It is seen most commonly in the age group of 51 to 60 years. Supraglottis is the commonest site involved. Synergistic history of smoking and alcohol intake was the most significant risk factor associated. T1 and T2 is the most common primary T stage. Neck metastasis occurs most commonly at N2 stage. The most commonly involved lymph node level is level 2.

Conclusion: We conclude that laryngeal cancers most commonly involve supraglottic region, present at advanced age with synergistic smoking and alcohol intake being the most common risk factor involved, and mostly presents with advanced neck metastasis due to late case presentation, subsequently decreasing the 5-year survival rate by about 50%. Hence, there is a great need to create awareness about the signs and symptoms of laryngeal cancers, especially among local doctors practicing in villages so that the patients can be referred to a qualified ENT doctor as soon as possible.

Keywords: Early referral, Larynx cancer, Risk factors.

How to cite this article: Arora N, Singh J, Davessar JL. Epidemiological Profile of Larynx Cancer at a Tertiary Care Center in Faridkot, Punjab, India. Int J Phonosurg Laryngol 2017;7(2):48-51.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
KVS Kumar Chowdary, N Srikanth, Feroz B Shaik

A Clinical Study of Laryngeal Cysts

[Year:2016] [Month:July-December] [Volumn:6 ] [Number:2] [Pages:39] [Pages No:53-56][No of Hits : 1488]


ABSTRACT

Aim: To study cases of cysts of larynx and review the literature regarding precipitating factors and methods of treatment.

Materials and methods: A retrospective study of eight cases of cysts of larynx in our hospital was carried out from July 2012 to December 2015. In all cases, diagnosis was made by video laryngoscopy and was treated by microlaryngeal surgery under general anesthesia (GA).

Results: Eight patients with laryngeal cysts were identified, of which five were male and three were female. The mean age was ranging from 40 to 60.
On examination, two were diagnosed with cysts from epiglottis, three from aryepiglottic folds, two from false vocal cords, and one from the ventricle.

Conclusion: As saccular cysts are identified to be associated with neoplastic transformation, it is important to recognize the laryngeal saccular cyst and manage appropriately in its early stages and to differentiate it from other laryngeal cysts. Thorough diagnostic evaluation and surgical intervention necessitates the appropriate management.

Keywords: Ductal cysts, Laryngeal cysts, Microlaryngeal surgery, Saccular cysts.

How to cite this article: Kumar Chowdary KVS, Srikanth N, Shaik FB. A Clinical Study of Laryngeal Cysts. Int J Phonosurg Laryngol 2016;6(2):53-56.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Suma Kaza, T Jaya Mastan Rao, Anupama Mikkilineni, G Venkata Ratnam, D Ranga Rao

Ki-67 Index in Salivary Gland Neoplasms

[Year:2016] [Month:January-June] [Volumn:6 ] [Number:1] [Pages:51] [Pages No:1-7][No of Hits : 1301]


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


 
ORIGINAL ARTICLE
Syamji V Rao, Varanasi S Sharma, MV Subba Rao, GS Keerthi, Sheeba I Deta, Pravin T Seepana, Vijay Kumar

Etiopathology of Hoarseness of Voice: A Clinical Study

[Year:2016] [Month:July-December] [Volumn:6 ] [Number:2] [Pages:39] [Pages No:64-67][No of Hits : 1175]


ABSTRACT

Aim: Hoarseness of voice is generally due to change in quality of voice. The etiology of hoarseness of voice varies from benign conditions to malignant disease, hence should not be ignored. All cases of hoarseness of voice persisting for more than 3 weeks should be investigated for the underlying disease. It may indicate either malignancy of larynx or silent bronchogenic carcinoma. A retrospective study of cases of hoarseness of voice was done in MediCiti Institute of Medical Sciences for a period of 5 years. The etiopathological factors, age and duration of presentation, and type of condition were analyzed to arrive at different etiopathological conditions responsible at different age groups.

Keywords: Hoarseness of voice, Etiology, Predisposing factors.

How to cite this article: Rao SV, Sharma VS, Rao MVS, Keerthi GS, Deta SI, Seepana PT, Kumar V. Etiopathology of Hoarseness of Voice: A Clinical Study. Int J Phonosurg Laryngol 2016;6(2):64-67.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Myle Mahesh Babu, Ramabhadraiah Anil Kumar, Revathy Thirugnanamani

Montgomery T-tube for Management of Tracheal Stenosis: A Retrospective Analysis in a Government Hospital of South India

[Year:2016] [Month:July-December] [Volumn:6 ] [Number:2] [Pages:39] [Pages No:73-77][No of Hits : 1098]


ABSTRACT

This study investigated the outcome of patients who developed tracheal stenosis after tracheostomy or intubation using Montgomery T-tube. We reviewed 21 patients who had experienced tracheal stenosis at a single institution, over 7 years from January 2008 to January 2015. Majority were in the age group of 20 to 30 years and a male preponderance was noted. The duration between extubation and appearance of respiratory symptoms ranged from 32 to 96 days. Location of stenosis was more common in subglottic region (61.9%), followed by tracheal (33.33%) and laryngotracheal stenosis (4.7%). At the end of 6 months, 18 of 21 patients were decannulated successfully and 3 were decannulated at the end of 9 months. Our study showed that use of Montgomery T-tube for laryngotracheal stenosis gave complete improvement in all the patients. Tracheal resection and anastomosis is the definitive surgical treatment of choice in tracheal stenosis but when surgical management is not feasible T-tube is a good alternative and T-tube as front line of management has produced complete improvement in airway patency and restoration of voice in our study.

Keywords: Endotracheal intubation, Laryngotracheal stenosis, Montgomery T-tube, Tracheostomy.

How to cite this article: Babu MM, Kumar AR, Thirugnanamani R. Montgomery T-tube for Management of Tracheal Stenosis: A Retrospective Analysis in a Government Hospital of South India. Int J Phonosurg Laryngol 2016;6(2):73-77.

Source of support: Nil

Conflict of interest: None


 
CASE SERIES
Nupur K Nerurkar, Ankit A Jain, Binhi H Desai

Lipoma of the Larynx: Our Experience

[Year:2016] [Month:July-December] [Volumn:6 ] [Number:2] [Pages:39] [Pages No:89-92][No of Hits : 1000]


ABSTRACT

Objective: Four cases of laryngeal lipoma are presented with a discussion of their differential diagnoses and management.

Materials and methods: Case report and literature review.

Results: Laryngeal lipomas, though a fairly rare entity, are occasionally the cause of persistent hoarseness of voice. An accurate diagnosis is important and the management may vary from surgical excision to only wait and watch policy, as these tumors are usually slow growing. A discussion of the presentation and management of four cases of laryngeal lipoma managed by us is documented with a review of literature.

Conclusion: Laryngeal lipomas have no set management protocol. A custom-made plan for each patient should be charted out depending on the symptoms of the patient and extent of the lipoma.

Keywords: Benign laryngeal tumor, Laryngeal lipoma, Larynx, Lipoma.

How to cite this article: Nerurkar NK, Jain AA, Desai BH. Lipoma of the Larynx: Our Experience. Int J Phonosurg Laryngol 2016;6(2):89-92.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Nitish Virmani, Arpit Sharma, Jyoti Dabholkar

Outcome Analysis in Patients with Benign Vocal Fold Lesions

[Year:2016] [Month:January-June] [Volumn:6 ] [Number:1] [Pages:51] [Pages No:8-13][No of Hits : 939]


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


 
ORIGINAL ARTICLE
Nirupoma Moran

Subglottic Carcinoma: Treatments and Outcomes

[Year:2016] [Month:January-June] [Volumn:6 ] [Number:1] [Pages:51] [Pages No:14-16][No of Hits : 807]


ABSTRACT

Background and objective: Subglottic malignancies are rare. Most of these are predominantly squmous cell carcinoma and common in male. It is usually advanced when initially presented. This study was to analyze the clinical presentation, treatments, and outcomes of subglottic carcinoma.

Materials and methods: The study was conducted in the Department of Otorhinolaryngology and Head Neck Surgery, Assam Medical College, Dibrugarh, Assam, India, between March 2014 and September 2015.

Results: Of the three patients, two had lymph node metastasis and intralaryngeal involvements. The patients have been followed up till date. All the patients were tracheostomized and received radiotherapy and chemotherapy.

Conclusion: Subglottic carcinoma is relatively rare in comparison with supraglottic and glottic carcinoma. It is presented at advance stage and tend to spread larynx and other organs too.

Keywords: Chemotherapy and radiotherapy, Malignancies, Squmous cell carcinoma, Subglottic, Tracheostomized.

How to cite this article: Moran N. Subglottic Carcinoma: Treatments and Outcomes. Int J Phonosurg Laryngol 2016;6(1):14-16.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Nupur Kapoor Nerurkar, Shraddha Singh, Rajeev Nerurkar

Tubercular Laryngitis: A Rebirth?

[Year:2016] [Month:January-June] [Volumn:6 ] [Number:1] [Pages:51] [Pages No:17-19][No of Hits : 801]


ABSTRACT

Objective: The aim of this study is to highlight the changing clinical patterns of laryngeal tuberculosis (TB) and to increase the awareness of this uncommon manifestation of extrapulmonary TB which will help the clinician in early diagnosis and appropriate management of this condition.

Materials and methods: A retrospective analysis was done of 34 suspected cases of tubercular laryngitis who presented to our institution from January 2009 to December 2011. All of these patients were subjected to hematological tests, sputum microscopy, and radiological investigations.

Results: Out of these 34 patients, hematological profile, sputum testing, and radiological profile was positive for TB in 13 patients who were started on antitubercular treatment. Out of 13, 1 patient had resolution of cough but persistent hoarseness and was diagnosed as having severe epithelial dysplasia. Twentyone patients were tested negative for TB and were diagnosed as chronic laryngitis (11), histoplasmosis (1), amyloidosis (2), sarcoidosis (1), and invasive squamous cell carcinoma (4). Primary laryngeal TB was diagnosed in two cases.

Conclusion: Laryngeal TB, though rare, is increasingly presenting to the otolaryngologists nowadays due to increase in the number of immunocompromised hosts and development of resistant microorganisms. It presents with nonspecific symptoms and can often be missed leading to delay in diagnosis and treatment. Starting empirical steroids without diagnosis may flare up the TB. It often mimics and occasionally may coexist with laryngeal malignancy. Thus the clinician should be vigilant and should always consider laryngeal TB as an important differential for laryngeal lesions.

Keywords: Hoarseness, Larynx, Tuberculosis.

How to cite this article: Nerurkar NK, Singh S, Nerurkar R. Tubercular Laryngitis: A Rebirth?. Int J Phonosurg Laryngol 2016;6(1):17-19.

Source of support: Nil

Conflict of interest: None


 
RESEARCH ARTICLE
Unnikrishnan Menon, Suresh K Radhakrishnan, KR Sundaram

Reliability and Validity of a Questionnaire to Assess Swallowing Disorders in Parkinson’s Disease Cases

[Year:2016] [Month:July-December] [Volumn:6 ] [Number:2] [Pages:39] [Pages No:78-82][No of Hits : 782]


ABSTRACT

Introduction: Swallowing problems have significant subjective component. Their evaluation necessitates the use of questionnaires to know both extent of symptoms and effect on quality of life. These should be designed to get maximum information with minimum trouble to the patient. Parkinson’s disease (PD) involves swallowing disorder as a symptom, often unreported. Hence, this needs to be assessed separately.

Aim: To develop a questionnaire, in the vernacular, to check for the presence of swallowing problems in PD patients and to study its reliability and validity.

Materials and methods: We developed an 11-item questionnaire in English, modeled on the Tel Aviv swallowing disturbance questionnaire (SDQ), chosen for its brevity. This was translated into the vernacular (Malayalam, native tongue of the state of Kerala in India) and administered to patients (n = 106) attending the weekly PD clinic of a tertiary care center, in consultation with the attending n in charge of movement disorder patients. The same questionnaire was also administered to age-matched controls (patients without any swallowing disorders) (n = 63) attending the ear, nose, and throat (ENT); neurology; and geriatric clinics. The scores were documented and statistical analysis done, to check for internal reliability and validity.

Results: Comparison of mean total scores between cases (2.89) and controls (1.51) showed a statistically significant difference, indicating statistical validity (p = 0.009). Guttman’s split-half correlation showed fairly good reliability for both cases (0.812) and controls (0.851).

Conclusion: The present questionnaire to assess dysphagia in PD patients has been found to be reliable and valid for use. We recommend it as a screening tool in the neurology outpatient department (OPD).

Keywords: Deglutition, Deglutition disorders, Parkinson’s disease, Questionnaire, Reliability and validity.

How to cite this article: Menon U, Radhakrishnan SK, Sundaram KR. Reliability and Validity of a Questionnaire to Assess Swallowing Disorders in Parkinson’s Disease Cases. Int J Phonosurg Laryngol 2016;6(2):78-82.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Hitesh Verma, Arjun Dass, Rajpal S Punia, Surinder K Singhal, Nitin Gupta, Mohit Bhutani

Adenoid Cystic Carcinoma of Larynx: A Case Report and Rare Experience

[Year:2016] [Month:July-December] [Volumn:6 ] [Number:2] [Pages:39] [Pages No:86-88][No of Hits : 584]


ABSTRACT

Adenoid cystic carcinoma (ACC) accounts for less than 1% of laryngeal tumors. Surgery is the treatment of choice which can be combined with adjuvant radiotherapy. We present a rare case of ACC of glottis and subglottis presented to us with respiratory distress.

Keywords: Adenoid cystic carcinoma, Perineural, Subglottis, Surgery.

How to cite this article: Verma H, Dass A, Punia RS, Singhal SK, Gupta N, Bhutani M. Adenoid Cystic Carcinoma of Larynx: A Case Report and Rare Experience. Int J Phonosurg Laryngol 2016;6(2):86-88.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Nupur K Nerurkar, Shraddha Deshmukh

Our Approach for Optimizing Vocal Outcomes in Transoral Laser Microsurgical Resection of Early Glottic Carcinoma

[Year:2016] [Month:July-December] [Volumn:6 ] [Number:2] [Pages:39] [Pages No:68-72][No of Hits : 553]


ABSTRACT

Objectives: To assess oncologic and functional outcomes of early glottic cancer cases treated with transoral laser microsurgical resection (TLMR) and to outline the principles for optimizing vocal outcomes in these cases.

Materials and methods: Sixty six patients with early glottic cancer (7 CIS, 43 T1a, 15 T1b, 1 T2) underwent TLMR. Postoperatively, voice quality was assessed by Oates Russell Voice Profile.

Results: Local control was achieved in 95.08% of the cases and larynx was preserved in 98.3%. Residual disease developed in 3 patients. There were eight local recurrences. Single patient of T1b lesion was lost to follow-up and came back with stridor and underwent total laryngectomy.

Conclusion: Early glottic cancers can be effectively treated by TLMR with good oncologic outcome. Depth of infiltration of lesion is the most critical factor affecting the postoperative vocal outcome. In our study near-normal conversational voice to moderate change in voice was found after type I, II, and III cordectomies. Surprisingly, type VI cordectomy also gave a serviceable vocal outcome with moderate change in voice. In our opinion, type IV cordectomy does not give a serviceable vocal outcome even if performed unilaterally. Thus radiotherapy should be strongly considered in such cases for better vocal outcome.

Keywords: Carcinoma, Glottic, Laser, Voice.

How to cite this article: Nerurkar NK, Deshmukh S. Our Approach for Optimizing Vocal Outcomes in Transoral Laser Microsurgical Resection of Early Glottic Carcinoma. Int J Phonosurg Laryngol 2016;6(2):68-72.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Apoorva K Pandey, Sharad Gangrade, Ankur Malhotra, Arvind Varma, Tripti Maithani

Computerized Tomographic Assessment of Vocal Cord Palsy: Otolaryngologist’s Purview

[Year:2016] [Month:July-December] [Volumn:6 ] [Number:2] [Pages:39] [Pages No:57-63][No of Hits : 544]


ABSTRACT

Aims and objectives: Vocal cord palsy (VCP) can be definitely depicted on computed tomograpy (CT) scan by identifying key points at the level of true vocal cords and aryepiglottic folds. There are various VCP mimics and imaging shortcomings, and these can usually be circumvented by thoughtfully assessing the scan plan and level, and a diligent search for additional characteristics.

Materials and methods: This retrospective study consisted of 10 cases of unilateral VCP, who all had been clinically diagnosed of VCP and further evaluated by CT. Pre- and postcontrast enhanced axial CT from skull base to aorto-pulmonary window were done and multiplanar three-dimensional reconstruction of images in coronal and sagittal planes along with volumerendered imaging was done.

Results: Most consistent findings in VCP were thickening of ipsilateral aryepiglottic fold and medialization of ipsilateral aryepiglottic fold (100%), followed by dilation of ipsilateral pyriform sinus (90%) and dilatation of ipsilateral laryngeal ventricle (80%). Etiologic causes were ascertained in three cases: Thyroid malignancy, tuberculosis, and pyriform sinus malignancy. The last etiology was probably a VCP mimic.

Conclusion: Radiologic evaluation is inarguably useful for determining the etiology of VCP, particularly for lesions within neck and thoracic cavity. Most crucial objective in assessing a case of VCP is to exclude the presence of a life-threatening primary lesion as the cause of VCP.

Keywords: Chest radiograph, Computed tomography, Idiopathic, Recurrent laryngeal nerve, Superior laryngeal nerve, Vocal cord palsy.

How to cite this article: Pandey AK, Gangrade S, Malhotra A, Varma A, Maithani T. Computerized Tomographic Assessment of Vocal Cord Palsy: Otolaryngologist’s Purview. Int J Phonosurg Laryngol 2016;6(2):57-63.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Arvind Varma, Alok Kumar Agrahari

An Unusual Presentation of Syringomyelia

[Year:2016] [Month:January-June] [Volumn:6 ] [Number:1] [Pages:51] [Pages No:40-41][No of Hits : 520]


ABSTRACT

Sudden onset stridor due to bilateral vocal cord paralysis in an adult patient with undiagnosed syringomyelia as a sole presenting symptom is rare. Here we are presenting a case of a 40-year-old female with undiagnosed syringomyelia due to Chiari type I malformation presenting with sudden onset stridor. Even 1 year after decompression surgery, her vocal cord functions did not improve.

Keywords: Chiari type I malformation, Syringomyelia, Vocal cord paralysis.

How to cite this article: Varma A, Agrahari AK. An Unusual Presentation of Syringomyelia. Int J Phonosurg Laryngol 2016;6(1):40-41.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Sachender Pal Singh, Smrity Rupa Borah Dutta

Voice Therapy in Muscle Tension Dysphonia Cases

[Year:2015] [Month:January-June] [Volumn:5 ] [Number:1] [Pages:38] [Pages No:20-24][No of Hits : 4708]


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


 
Original Article
Anuja Bhargava, Meenu Cherian, Tambi A Cherian, Sanjay Gupta

Gastroesophageal Reflux Disease in Patients with Eustachian Tube Catarrh

[Year:2015] [Month:July-December] [Volumn:5 ] [Number:2] [Pages:33] [Pages No:61-66][No of Hits : 3201]


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


 
Original Article
Anagha Atul Joshi, Bhagyashri Ganesh Chiplunkar, Renuka Anil Bradoo, Kshitij Dhaval Shah

Posterior Commissure Hypertrophy as Diagnostic and Prognostic Indicator for Laryngopharyngeal Reflux

[Year:2015] [Month:July-December] [Volumn:5 ] [Number:2] [Pages:33] [Pages No:57-60][No of Hits : 1323]


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


 
ORIGINAL ARTICLE
Arvind Varma, Alok Kumar Agrahari, Raj Kumar, Vijay Kumar

Role of Voice Therapy in Patients with Mutational Falsetto

[Year:2015] [Month:January-June] [Volumn:5 ] [Number:1] [Pages:38] [Pages No:25-27][No of Hits : 1226]


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


 
Original Article
Nupur Kapoor Nerurkar, Harsh Karan Gupta, Ajay Eknath Shedge

Diagnostic Challenge of Sulcus Vocalis Made Easier

[Year:2015] [Month:July-December] [Volumn:5 ] [Number:2] [Pages:33] [Pages No:39-41][No of Hits : 1145]


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


 
CASE REPORT
Santosh Kumar Swain, Sidarth Mohanty, Neha Singh, Jashashree Choudhury, Mahesh Chandra Sahu

Suspecting Airway Foreign Body in Agenesis of the Lung: A Rare Incidence of Misdiagnosis

[Year:2015] [Month:January-June] [Volumn:5 ] [Number:1] [Pages:38] [Pages No:32-34][No of Hits : 991]


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


 
ORIGINAL ARTICLE
Anand Acharya

Elongated Styloid Process Revisited

[Year:2015] [Month:January-June] [Volumn:5 ] [Number:1] [Pages:38] [Pages No:15-16][No of Hits : 923]


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


 
ORIGINAL ARTICLE
Shamik Paresh Mehta

Innovations in Flexible Endoscopic Evaluation of Swallowing and Laryngeal Sensation Testing

[Year:2015] [Month:January-June] [Volumn:5 ] [Number:1] [Pages:38] [Pages No:17-19][No of Hits : 804]


ABSTRACT

The larynx plays a crucial part in swallowing to prevent aspiration. The present available clinical tools to assess this function of larynx are ‘flexible endoscopic evaluation of swallowing’ (FEES) and ‘laryngeal sensory tests’. The author has made certain changes to make these tests equally effective and economical.

Keywords: Aspiration, FEES, Laryngeal sensations, Penetration, Swallowing.

How to cite this article: Mehta SP. Innovations in Flexible Endoscopic Evaluation of Swallowing and Laryngeal Sensation Testing. Int J Phonosurg Laryngol 2015;5(1):17-19

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Mahdi Al-Dujaily, Sanàa J Abu Nabàa

Age and Sex Distribution of Speech Disorders

[Year:2015] [Month:January-June] [Volumn:5 ] [Number:1] [Pages:38] [Pages No:7-14][No of Hits : 798]


ABSTRACT

Background: Speech-language pathology is a specialty in the study, assessment, and rehabilitation of speech-language disorders (or communication disorders) which are common problems that may affect both sexes and all age groups.

Aim: The aim of this study is to raise the attention in Iraq about the role of certified speech pathologists (or speech therapists) in the treatment of patients with communication disorders according to their age and sex distribution, as seen in the phonetic center of University of Jordan.

Patients and methods: Subjects with speech problems, who visited the phonetic center in Jordan University for treatment by certified speech-language pathologists, were analyzed retrospectively during 3 years (1996 to 1998), and it included 731 subjects with speech disorders, consisted of 213 females and 518 males, with a minimum age of 2 years and a maximum age of 72 years.

Results: The most common age presentation of communication disorders varies, and it was found that the major speech and language disorders and their distribution were as follows: delayed language development occurred mainly in age group 3 to 4 years (about 57%), stuttering occurred in 3 to 5 years (about 24%), and in articulation disorder occurred in age group 4 to 6 years with about 42%, and in hearing impaired patients occurred mainly in age group of 2 to 4 years with about 45%, in children with mental retardation occurred in age group of 6 to 8 years with about 29%, voice disorders occurred in age 20 to 29 (25%), nasality problems in age group 3 to 5 years (25%), dyslexia in age group 8 to 10 years (40%), and the cases of apraxia, aphasia, and autism were low in number.

Conclusion: The age and sex distribution of communication disorders varies according to the type of disorder. The speechlanguage pathologists have very important role in the evaluation and treatment of speech language disorders. There is great deficiency of this specialty in this country, and the aim of this article is to ring the bell of attention to these common disorders.

Keywords: Communication disorders (or speech-language disorders), Speech-language pathologist, Speech therapy.

Abbreviations: SLP: Speech-language pathologist; CDs: Communication disorders; DLD: Delayed language development; HIP: Hearing impaired patient; MR: Mental retardation; CP: Cerebral palsy.

How to cite this article: Al-Dujaily M, Nabáa SJA. Age and Sex Distribution of Speech Disorders. Int J Phonosurg Laryngol 2015;5(1):7-14.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Sampan S Bist, Shivanjali Sandhirr, Nadia Shirazi, Vinish Agrawal, Bhartendu Bharti

Primary Histoplasmosis of Larynx Mimicking as Laryngeal Carcinoma

[Year:2015] [Month:January-June] [Volumn:5 ] [Number:1] [Pages:38] [Pages No:28-31][No of Hits : 707]


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


 
Original Article
Dhanya Monnappa, Radish Kumar Balasubramanium

Estimation of Spectral Amplitude Measures in Healthy Aged Individuals

[Year:2015] [Month:July-December] [Volumn:5 ] [Number:2] [Pages:33] [Pages No:42-47][No of Hits : 690]


ABSTRACT

Introduction: The anatomical and physiological changes in the phonatory system due to aging have a major impact on voice. Widely researched parameters of voice like fundamental frequency and the perturbation measures have strong correlation with age. However, these measures depend on the location of the exact pitch pulses and it may yield unreliable results in case of a severely aperiodic voice. Also, harmonic measures of voice in healthy aging are scanty in the literature.

Aim: The present study focused on determining the changes in harmonic-related measures in healthy aging individuals using spectral amplitude measures.

Materials and methods: The participants were classified into three groups as young, middle-aged, and elderly adults based on their age. All the participants were required to sustain three different types of vowels. Voice samples were analyzed using CSL software to obtain the spectral amplitude measures.

Results: This showed that there was a decrease in spectral amplitude measures with aging.

Discussion: Thus, suggesting that the harmonic structure of voice is not affected in healthy aged individuals. Vowel type and gender also influences the harmonic-related measures in the healthy aging population.

Conclusion: The results of the present study could be used by the voice clinicians while assessing adults with voice disorders. It will also help the clinicians in delineating the age and gender differences in the vocal parameters.

Keywords: Healthy aging, Spectral amplitude measures, Voice quality.

How to cite this article: Monnappa D, Balasubramanium RK. Estimation of Spectral Amplitude Measures in Healthy Aged Individuals. Int J Phonosurg Laryngol 2015;5(2):42-47.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Ragahvendra G Prasad

Is it Time to Shift to Total Thyroidectomy for Benign Thyroid Disease: An Analysis of 77 Redo Thyroidectomies

[Year:2015] [Month:January-June] [Volumn:5 ] [Number:1] [Pages:38] [Pages No:4-6][No of Hits : 666]


ABSTRACT

Aims and objectives: To analyze redo thyroidectomies so as to get a possible answer to the controversy surrounding thyroidectomy for benign disease.

Materials and methods: This is a retrospective observational cohort. From 1996 to 2010, a total 77 cases of redo thyroidectomies were performed. The data of all patients in the department were maintained on a self developed MS access-based software. The data of redo thyroidectomies were reviewed. These patients were from five districts of Andhra Pradesh, 42 were women and 35 men, 51 underwent subtotal thyroidectomy, 21 had hemithyroidectomy and 5 patients had excision procedure; all were benign. The condition varied from multinodular goiter (MNG) and solitary nodule to follicular neoplasm. There were 44 right-sided, and 43 left-sided surgeries. Recurrence occurred in seven in less than 1 year, in 49 in less than 5 years, in 11 of them in less than 10 years and 10 had recurrence after 10 years. A total thyroidectomy was performed in all. Seventy-five had benign disease. Two had suspected neoplasm; one papillary and one Hurthle cell. One patient had transient recurrent laryngeal nerve palsy.

Results: Seventy-seven redo surgeries for benign thyroid disease were performed. The high rate of referrals for recurrence probably suggests inadequacy of subtotal and hemithyroidectomies for benign thyroid diseases.

Conclusion: The present series of 77 redo thyroidectomies clearly suggests inadequacy of initial subtotal thyroidectomy. Evidence-based analysis of complication rates and surgical feasibility supports total thyroidectomy as the complete safe, scientifically acceptable choice of primary surgical treatment for benign thyroid disease.

Keywords: Benign goiters, Parathyroid sparing PBC surface thyroidectomy, Total thyroidectomy.

How to cite this article: Prasad RG. Is it Time to Shift to Total Thyroidectomy for Benign Thyroid Disease: An Analysis of 77 Redo Thyroidectomies. Int J Phonosurg Laryngol 2015;5(1):4-6.

Source of support: Nil

Conflict of interest: None


 
Original Article
Raghavendra G Prasad, JV Subba Rao, Mohammed Abdul Rahman Hameed

Pinch, Burn, Cut Parathyroid-sparing Thyroidectomy Saves Recurrent and Superior Laryngeal Nerves Conventional Thyroidectomy, Pinch, Burn, Cut Surface Thyroidectomy and Harmonic Scalpel Compared

[Year:2015] [Month:July-December] [Volumn:5 ] [Number:2] [Pages:33] [Pages No:48-52][No of Hits : 551]


ABSTRACT

Introduction: Recurrent laryngeal nerve (RLN) and superior laryngeal nerve (SLN) have been and continue to be the Achilles tendon of thyroidectomy. Many anatomical landmarks described and taught.

Keywords: Burn, Conventional thyroidectomy, Cut parathyroidsparing thyroidectomy, Goiter, Pinch.

How to cite this article: Prasad RG, Rao JVS, Hameed MAR. Pinch, Burn, Cut Parathyroid-sparing Thyroidectomy Saves Recurrent and Superior Laryngeal Nerves (Conventional, PBC and Harmonic Scalpel Techniques Compared). Int J Phonosurg Laryngol 2015;5(2):48-52.

Source of support: Nil

Conflict of interest: None


 
Case Report
Jaini Lodha, Arpit Sharma, Jyoti Dabholkar, Nitish Virmani

Unusual Presentation of Laryngeal Cavernous Hemangioma

[Year:2015] [Month:July-December] [Volumn:5 ] [Number:2] [Pages:33] [Pages No:67-69][No of Hits : 538]


ABSTRACT

Cavernous hemangioma is a rare tumor of the adult larynx. These hemangiomas are confined to the larynx and generally asymptomatic. We present a rare case of a huge cavernous hemangioma in a 22-year-old patient who presented with stridor and a huge swelling in the neck, of acute onset. Detailed evaluation including 70° Hopkins laryngoscopy, contrastenhanced computed tomography (CT) scan and magnetic resonance imaging (MRI) revealed a vascular malformation with both intra- and extralaryngeal components. The typical findings of hemangioma with its management are highlighted in this article. Postoperatively, patient’s voice improved and the stridor was relieved.

Keywords: Cavernous hemangioma, CO2 Laser, Stridor.

How to cite this article: Lodha J, Sharma A, Dabholkar J, Virmani N. Unusual Presentation of Laryngeal Cavernous Hemangioma. Int J Phonosurg Laryngol 2015;5(2):67-69.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Inita Matta, Sunita Chhapola Shukla, Prabodh Karnik

Endolaryngeal Excision of Recurrent Laryngeal Nerve Neurofibroma

[Year:2015] [Month:January-June] [Volumn:5 ] [Number:1] [Pages:38] [Pages No:35-38][No of Hits : 528]


ABSTRACT

Vagal schwannomas, compromising 1% of head and neck neoplasms, are the commonest neurogenic tumors of the neck. Recurrent laryngeal nerve neurofibromas are even rarer. We report such a case, excised totally by an endolaryngeal approach. New trends in diagnosis and immunohistochemistry are discussed.

Keywords: Calretinin, CD 34, CD 56, Endolaryngeal surgery, Factor XIII a, Ki-67, Neurofibroma, Recurrent laryngeal nerve, S-100 protein, Schwannoma.

How to cite this article: Matta I, Shukla SC, Karnik P. Endolaryngeal Excision of Recurrent Laryngeal Nerve Neurofibroma. Int J Phonosurg Laryngol 2015;5(1):35-38.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Ragahvendra G Prasad

Congenital Isolated Agenesis of Epiglottis Presenting with Acute Life-threatening Event Successfully Managed by Temporary Supraglottic Closure and Tracheostomy

[Year:2015] [Month:January-June] [Volumn:5 ] [Number:1] [Pages:38] [Pages No:1-3][No of Hits : 528]


ABSTRACT

Isolated agenesis of epiglottis is extremely rare. The exact incidence is unknown. Anecdotal presentations associated with Pierre Robbin syndrome maxillary hypoplasia have been reported. Agenesis of epiglottis has also been published in an adult. Isolated agenesis of epiglottis with acute life-threatening event (ALTE) has not been specifically dealt with in the literature. Hence, this is the report of six contiguous cohort of isolated agenesis of epiglottis with ALTE.

Materials and methods: After the first case of isolated agenesis of epiglottis was diagnosed 2 years ago, five more such cases were treated by the group. These formed the index cases of the cohort.
Decision for surgery was based on an arbitrary 3 ALTEs in 24 hours. All the patients were initially intubated. Supraglottic space was closed using interrupted unabsorbable sutures. Tracheostomy was added. At 3 to 6 months of follow-up, glottis was restored by Nd-YAG laser knife. Five out of six children are alive and thriving well. One child died before he could be actively managed.

Conclusion: Isolated agenesis of epiglottis with ALTE is extremely rare. Supraglottic closure saves lives and gives enough time for pharyngoesophageal coordination to develop.

Keywords: Agenesis of epiglottis, ALTE, Temporary supraglottic closure.

How to cite this article: Prasad RG. Congenital Isolated Agenesis of Epiglottis Presenting with Acute Life-threatening Event Successfully Managed by Temporary Supraglottic Closure and Tracheostomy. Int J Phonosurg Laryngol 2015;5(1):1-3.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Baisakhi Bakat, Abhishek Gupta, Arunima Roy, Amitabha Roychoudhury, Barin Kumar Raychaudhuri

Does Voice Therapy Cure All Vocal Fold Nodules?

[Year:2014] [Month:July-December] [Volumn:4 ] [Number:2] [Pages:38] [Pages No:55-59][No of Hits : 3217]


ABSTRACT

Introduction: Vocal nodules are known to be one of the most common benign lesions, commonly situated at the junction of anterior one third and posterior two third of vocal folds. Voice therapy is considered to be the gold standard of treatment of vocal fold nodule.

Objectives: To determine the efficacy of voice therapy in the treatment of vocal fold nodules and to identify any possible reason for failure to voice therapy in managing vocal fold nodules.

Materials and methods: A prospective study, conducted over a period of 6 months. Eighteen adult patients diagnosed with vocal fold nodules at a tertiary care hospital were subjected to 6 weeks of voice therapy. Pre and post therapy subjective (Voice Handicap Index-10) and objective (Rigid fiber optic laryngoscopy) evaluation was done. Patients with no improvement after 6 weeks of voice therapy underwent micro laryngeal surgery. All patients were followed up at 3 months and 6 months.

Results: In majority of patients, objective and subjective voice outcome parameters were significantly improved after voice therapy. Although a few cases showed no significant improvement after therapy, they recovered completely after microlaryngoscopic surgery. It was found that patients who required surgery even after voice therapy had hard nodules.

Keywords: Vocal fold nodule, Voice therapy, Microlaryngoscopic surgery.

How to cite this article: Bakat B, Gupta A, Roy A, Roychoudhury A, Raychaudhuri BK. Does Voice Therapy Cure All Vocal Fold Nodules? Int J Phonosurg Laryngol 2014;4(2):55-59.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Swapna Sebastian, Arif Ali Kolethekkat, John Mathew, Mahasampath Gowri

Laryngopharyngeal Reflux in Dysphonics-Understanding the Significance and the Efficacy of Clinical Diagnosis: A Case-based Study

[Year:2014] [Month:January-June] [Volumn:4 ] [Number:1] [Pages:44] [Pages No:5-9][No of Hits : 1729]


ABSTRACT

Objective: To determine the prevalence of laryngopharyngeal reflux (LPR) in patients with voice disorders and to find out the efficacy of reflux symptom index (RSI) and reflux finding score (RFS) in the diagnosis.

Methods: This prospective analytical study was conducted on 554 patients who presented with dysphonia and symptoms suspicious of LPR. They were then subjected to clinical work up based on symptomatic history based RSI and video stroboscopic RFS scoring criteria. The results were analyzed statistically. The differences between RSI and RFS were calculated by Fisher’s two sided test and the comparison between the two is calculated using kappa statistics to check the strength of agreement.

Results: Among 554 patients, 457 (82.4%) patients were diagnosed to have LPR based on RSI score of more than 13. Among 448 (80.8%) patients RFS score was positive. Vocal nodule (23.64%), laryngitis (22.38%) and the vocal polyp (20.03%) constitute the majority, with a female preponderance in vocal nodule. Both RSI and RFS were poor or almost absent in conditions such as spasmodic dysphonia, tremors, vocal cord palsy, hemorrhage, functional aphonia and traumatic conditions. The Pearson correlation coefficient showed a good correlation and agreement between RSI and RFS was statistically significant.

Conclusion: The association of LPR in patients with voice disorders is significantly high. The RSI and RFS based clinical diagnosis is reliable and valid in the diagnosis of LPR as revealed in our study.

Keywords: Dysphonia, Laryngopharyngeal reflux, RSI, RFS, Agreement.

How to cite this article: Sebastian S, Kolethekkat AA, Mathew J, Gowri M. Laryngopharyngeal Reflux in Dysphonics- Understanding the Significance and the Efficacy of Clinical Diagnosis: A Case-based Study. Int J Phonosurg Laryngol 2014;4(1):5-9.

Source of support: Nil.

Conflict of interest: None


 
CASE SERIES
Sanjeev Mohanty, Shameena Shinaz, Gopinath Maraignanam, John Samuel

Salvaging a Shattered Larynx: A Challenge in Clinical Otorhinolaryngology

[Year:2014] [Month:January-June] [Volumn:4 ] [Number:1] [Pages:44] [Pages No:13-16][No of Hits : 1703]


ABSTRACT

Laryngotracheal trauma is a life-threatening clinical scenario at times. Although considered rare, it is on the rise due to high speed vehicular accidents. Failure to recognize such injuries and promptly secure an airway may have fatal consequences.1 We are reporting three cases of laryngotracheal blunt trauma, all of whom subsequently developed absolute dysphagia, difficulty in breathing and difficulty in phonation. These patients were appropriately managed in the critical time period. Two patients were surgically managed and one patient was treated conservatively. They are on regular follow-up and are physiologically stable. In this report, the treatment strategies adopted leading to good clinical outcomes are highlighted.

Keywords: Laryngeal trauma, Dysphonia, Emphysema, Odynophagia, Counter tracheostomy, False passage, Laryngeal stabilization.

How to cite this article: Mohanty S, Shinaz S, Maraignanam G, Samuel J. Salvaging a Shattered Larynx: A Challenge in Clinical Otorhinolaryngology. Int J Phonosurg Laryngol 2014;4(1):13-16.

Source of support: Nil.

Conflict of interest: None


 
CASE REPORT
Santosh Kumar Swain, Maitreyee Panda, Nibedita Patro, Mahesh Chandra Sahu

A Rare Cause of Hoarsness of Voice: Lipoid Proteinosis of the Larynx

[Year:2014] [Month:January-June] [Volumn:4 ] [Number:1] [Pages:44] [Pages No:23-26][No of Hits : 1677]


ABSTRACT

Lipoid proteinosis (LP) is a rare genetic disease with autosomal recessive inheritance. It most often involves deposition of periodic acid Schiff positive hyaline material in skin, oral mucosa, larynx and other tissues. But it also involves the central nervous system, lungs, lymph nodes and striated muscles. Hoarseness, small papules on the eyelid border (moniliform blepharosis), enlarged tongue, waxy skin, and diffuse verrucous skin colored or yellowish papules and plaques on traumatized areas and oral mucosa are the most common features leading to the clinical diagnosis of LP. We present the case report of a 12-year-old boy with significant hoarseness, inability to protrude the tongue, beaded papules along the eyelid margins, and scarring of the skin. Of his two sisters, one had the same symptoms but with less clinical severity and the other had no features of LP.

Keyword: Consanguinity, Laryngeal manifestation, Hoarseness, Lipoid proteinosis, Urbach-Wiethe disease.

How to cite this article: Swain SK, Panda M, Patro N, Sahu MC. A Rare Cause of Hoarseness of Voice: Lipoid Proteinosis of the Larynx. Int J Phonosurg Laryngol 2014;4(1):23-26.

Source of support: Nil.

Conflict of interest: None


 
CASE REPORT
S Gnanatilakan, Vishal Prasad, R Jeyalakshmi

A Rare Case of Arytenoid Cyst presenting as Dysphagia

[Year:2014] [Month:July-December] [Volumn:4 ] [Number:2] [Pages:38] [Pages No:80-82][No of Hits : 1621]


ABSTRACT

Objective: To report a rare benign condition of larynx in a very rare subsite. To emphasize on the role of coblator in the treatment of laryngeal cysts and to highlight the fact that arytenoid cyst should be considered in the differential diagnosis of dysphagia and hoarseness.

Case report: A 76-year-old adult male, Resident of Trichy, Tamil Nadu, Presented with Discomfort in throat-2 years, Change of voice-2 months and Dysphagia-2 months. Indirect Laryngoscopy and Flexible Laryngoscopy revealed a mass in the right arytenoid which was pedunculated and filling the supraglottis. The airway was however adequate. Contrast Enhanced CT scan of the neck revealed a cystic soft tissue mass arising from Right arytenoids extending into supraglottis. A provisional diagnosis of Arytenoid cyst was made. The patient underwent Direct Laryngoscopy and coblator assisted excision of the cyst under General Anesthesia.

Conclusion: This case report highlights the fact that an arytenoid cyst, although rare, must be considered in the differential diagnosis of any case presenting with dysphagia and/or hoarseness.
It also explains the role of coblation in the management of such lesions.

Keywords: Arytenoid cyst, Laryngeal cyst, Coblation, Dysphagia.

How to cite this article: Gnanatilakan S, Prasad V, Jeyalakshmi R. A Rare Case of Arytenoid Cyst presenting as Dysphagia. Int J Phonosurg Laryngol 2014;4(2):80-82.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Anuradha Shastry, Radish Kumar Balasubramanium, Preetam R Acharya

Voice Analysis in Individuals with Chronic Obstructive Pulmonary Disease

[Year:2014] [Month:July-December] [Volumn:4 ] [Number:2] [Pages:38] [Pages No:45-49][No of Hits : 1555]


ABSTRACT

Background: Chronic obstructive pulmonary disease (COPD) is a respiratory condition that can affect voice as respiration is the source for voice production. There are very few studies available on the analysis of voice in individuals with COPD (asthma, chronic bronchitis and emphysema).

Purpose of the study: The aim of this study was to analyze the acoustic and perceptual characteristics of voice in individuals with COPD.

Method: The study followed a comparative cross-sectional study design. Sixty-four participants were considered, and they were divided into two groups (group 1: individuals with COPD, n = 32; group 2: normal individuals, n = 32). Acoustic analysis was performed using CSL software. The perceptual analysis was done using CAPE-V.

Results: The results showed that there was significant difference between the two groups on acoustic measures (lower fundamental frequency, reduced frequency range, increased pitch and amplitude perturbation measures and increased noise measures), and perceptual measures (presence of increased roughness, breathiness, strain).

Conclusion: We can conclude that COPD has an impact on voice measures as assessed through acoustic and perceptual parameters. These voice deviations may be due to COPD itself or due to the effects of the medication.

Clinical implication: The findings of this study provide valuable information regarding voice problems in the individuals with COPD so that an appropriate intervention plan can be designed.

Keywords: Chronic obstructive pulmonary disease, Chronic asthma, COPD, Acoustic measures, Perceptual measures, Voice analysis.

How to cite this article: Shastry A, Balasubramanium RK, Acharya PR. Voice Analysis in Individuals with Chronic Obstructive Pulmonary Disease. Int J Phonosurg Laryngol 2014;4(2):45-49.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Sudarshan Loka Reddy, Nagendra Kadapa

Worm in the Throat: Hamartoma Larynx

[Year:2014] [Month:January-June] [Volumn:4 ] [Number:1] [Pages:44] [Pages No:33-35][No of Hits : 1484]


ABSTRACT

Hamartomas of larynx are rare benign lesions which can be a rare cause for respiratory obstruction. This report highlights the case of a young female who presented with foreign body sensation and worm-like mass in throat of 10 years duration. On videolaryngoscopy, a pinkish polypoidal worm like mass was seen arising from the right side of epiglottis on the laryngeal surface. Endoscopic guided excision with cautery was done and the mass revealed hamartoma on histopathology.

Keywords: Hamartoma, Videolaryngoscopy, Epiglottis.

How to cite this article: Reddy SL, Kadapa N. Worm in the Throat: Hamartoma Larynx. Int J Phonosurg Laryngol 2014;4(1):33-35.

Source of support: Nil.

Conflict of interest: None


 
ORIGINAL ARTICLE
Akanksha Saxena, Madhumita Kumar, Bini Faizal

Aryepiglottoplasty for Severe Laryngomalacia

[Year:2014] [Month:January-June] [Volumn:4 ] [Number:1] [Pages:44] [Pages No:10-12][No of Hits : 1412]


ABSTRACT

Laryngomalacia is the most common cause of stridor in children below the age of 1 year. In majority of the cases it can be managed conservatively, but in severe cases intervention becomes necessary.

Objectives: To evaluate the outcome of aryepiglottoplasty (Cold steel method) in cases of severe laryngomalacia.

Methods: Retrospective. Review of medical records of 8 cases treated in Department of ENT, Amrita Institute of Medical Sciences from 2006 to 2011.

Results: Seven out of eight children had a favorable outcome.

Conclusion: Aryepiglottoplasty (Cold steel method) is an efficient, simple and low cost method for treating severe cases of laryngomalacia.

Keywords: Laryngomalacia, Pediatric stridor, Aryepiglottoplasty, Failure to thrive, Tracheostomy.

How to cite this article: Saxena A, Kumar M, Faizal B. Aryepiglottoplasty for Severe Laryngomalacia. Int J Phonosurg Laryngol 2014;4(1):10-12.

Source of support: Nil.

Conflict of interest: None


 
CASE REPORT
Arjun Dass, Surinder K Singhal, Nitin Gupta, Hitesh Verma

Near-total Laryngectomy: An Oncologically Safe Alternative

[Year:2014] [Month:January-June] [Volumn:4 ] [Number:1] [Pages:44] [Pages No:30-32][No of Hits : 1363]


ABSTRACT

Traditional treatment for advanced transglottic laryngeal and hypopharyngeal cancers is wide field laryngectomy. Patients who undergo wide field laryngectomy must also undergo voice rehabilitation with a prosthesis, electrolarynx or esophageal speech. These are associated with complications, such as bloating of the stomach, stenosis, aspiration and difficulty with hygiene of the TEP prosthesis. Near-total laryngectomy is a surgical treatment modality, where speech is maintained by way of a dynamic myomucosal shunt. It was specially designed to overcome the serious complications of adynamic tracheoesophageal shunt methods.

Keywords: Near-total laryngectomy, Myomucosal shunt, Interarytenoid area.

How to cite this article: Dass A, Singhal SK, Gupta N, Verma H. Near-total Laryngectomy: An Oncologically Safe Alternative. Int J Phonosurg Laryngol 2014;4(1):30-32.

Source of support: Nil.

Conflict of interest: None


 
CASE REPORT
Surendra Kumar Kanaujia, Annanya Soni

A Rare Benign Tumor of Vocal Cord: Myxofibrolipoma

[Year:2014] [Month:July-December] [Volumn:4 ] [Number:2] [Pages:38] [Pages No:67-68][No of Hits : 1229]


ABSTRACT

Laryngeal lipomas are rare. Most of these arise from the aryepiglottic folds of which intrinsic tumors most frequently originate from the false vocal cords. The present case report describes a giant tumor arising from true vocal cord, and that too with a rare histopathology which revealed lipoma with myxomatous degeneration and fibrous changes. Clinical features, management and relevant literature are discussed.

Keywords: Myxofibrolipoma, Vocal cord, Airway obstruction.

How to cite this article: Kanaujia SK, Soni A. A Rare Benign Tumor of Vocal Cord: Myxofibrolipoma. Int J Phonosurg Laryngol 2014;4(2):67-68.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Santosh Kumar Swain, Sanghamitra Mishra, Mrutunjay Dash

An Unusual Asymptomatic Foreign Body at Tracheobronchial Tree

[Year:2014] [Month:January-June] [Volumn:4 ] [Number:1] [Pages:44] [Pages No:40-42][No of Hits : 1215]


ABSTRACT

Inhalation of foreign body is usually seen in children which should be promptly and immediately removed otherwise it leads to complications and death. Early detection of foreign bodies is essential to safe removal. Management approach has to be systematic. Preoperative history taking, radiological assessment followed by rapid intervention by skilled bronchoscopist usually results in favorable outcome. We here report an interesting and an unusual presentation of a sharp and long iron nail in trachea and right bronchus, which was expelled spontaneously after coughing.

Keywords: Foreign body, Tracheobronchial tree, Iron nail.

How to cite this article: Swain SK, Mishra S, Dash M. An Unusual Asymptomatic Foreign Body at Tracheobronchial Tree. Int J Phonosurg Laryngol 2014;4(1):40-42.

Source of support: Nil.

Conflict of interest: None


 
ORIGINAL ARTICLE
Mohan HM Kumar, Rijo M Jayaraju

Laryngotracheoplasty with T-tube Stenting by Modification of Shiann Yann Lee's Technique

[Year:2014] [Month:July-December] [Volumn:4 ] [Number:2] [Pages:38] [Pages No:60-62][No of Hits : 1201]


ABSTRACT

Background: Laryngotracheal stenosis is a challenging problem in laryngology which is often misdiagnosed and improperly treated. It is also on the rise due to increase in the number of accidental trauma, prolonged intubations or tracheostomy. Laryngotracheoplasty by Shiann Yann Lee’s technique with T-tube stenting is a common accepted surgical procedure these days.

Materials and methods: Ours is a retrospective study of 14 cases of laryngotracheal stenosis over a period of 20 years from 1993 to 2014, who underwent laryngotracheoplasty with T-tube stenting by a modification of Shiann Yann Lee’s technique.

Results: In our study of 14 patients, the incidence of laryngotracheal stenosis was found to be maximum in the age group of 21 to 30 years with a male preponderance. The commonest etiological factor was prolonged endotracheal intubation or cuffed tracheostomy. The commonest site of the stenosis in our study was cervical trachea. The average time for removal of T-tube was 18 months. All the 14 patients had an uneventful period between insertion and removal of T-tube without any complications. The success rate of our study was hence 100%.

Conclusion: Laryngotracheoplasty with T-tube stenting by our modification of Shiann Yann Lee’s technique is an effective and successful method in the management of laryngotracheal stenosis with a success rate of 100%.

Keywords: Laryngotracheoplasty, T-tube, Laryngotracheal stenosis.

How to cite this article: Kumar MHM, Jayaraju RM. Laryngotracheoplasty with T-tube Stenting by Modification of Shiann Yann Lee’s technique. Int J Phonosurg Laryngol 2014;4(2):60-62.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Gautam Khaund, Debika Baruah, Vivek Agarwal, Surajit Barman

Invasive Fungal Laryngitis in an Immunocompetent Person

[Year:2014] [Month:July-December] [Volumn:4 ] [Number:2] [Pages:38] [Pages No:73-75][No of Hits : 1193]


ABSTRACT

Fungal laryngitis is common in immunocompromised patients. But it is rarely seen in a immunocompetent person. Only around 40 cases have been reported in world literature so far. This condition is often confused with premalignant conditions like leukoplakia, dysplasia. Our patient, a 35 years old immunocompetent male, presented with hoarseness, who later on developed stridor and had to be tracheostomized. Laryngoscopy was done under general anesthesia and biopsy taken. Histopathological examination revealed fungal laryngitis (Aspergillus). The patient recovered completely after antifungal treatment.

Keywords: Invasive fungal laryngitis, Immunocompetent person, Laryngitis, Fungal laryngitis.

How to cite this article: Khaund G, Baruah D, Agarwal V, Barman S. Invasive Fungal Laryngitis in an Immunocompetent Person. Int J Phonosurg Laryngol 2014;4(2):73-75.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Radish Kumar Balasubramanium, Jayashree S Bhat

Cepstral Characteristics of Voice before, during and after Menopause: A Cross-sectional Study

[Year:2014] [Month:July-December] [Volumn:4 ] [Number:2] [Pages:38] [Pages No:50-54][No of Hits : 1154]


ABSTRACT

Background: Previous studies on effects of menopause on voice characteristics have not compared the voice characteristics before, during and after menopause. It is also possible that these voice changes cannot be captured by traditional acoustic measures such as frequency and amplitude perturbation measures. Hence a robust acoustic tool such as cepstrum was chosen to capture these vocal changes before, during and after menopause and hence the present study was attempted.

Method: The present study followed a cross-sectional study design. The participants consisted of 25 premenopausal women, 25 perimenopausal women and 25 postmenopausal women. Sustained production of/a/ and narration was recorded using Z tool and cepstral peak prominence (CPP) and smoothened cepstral peak prominence (CPPS) was analyzed.

Results: The results of one-way ANOVA revealed that there was a significant main effect of the group at p < 0.05 for all the cepstral measures targeted in the study. Post hoc analysis indicated that there was no significant difference between pre and perimenopausal women for all the cepstral measures at p < 0.05. However, there was a significant difference between pre and postmenopausal women and peri and postmenopausal women at p < 0.05. These results suggests that postmenopausal women had overall good voice quality than pre and perimenopausal women.

Conclusion: Results indicated that post menopausal women had increased cepstral measures when compared to pre and perimenopausal women. Further, studies are required to correlate laryngeal examination and hormonal levels with that of the voice changes before, during and after menopausal women.

Keywords: Menopause, Voice, Analysis, Cross-sectional study.

How to cite this article: Balasubramanium RK, Bhat JS. Cepstral Characteristics of Voice before, during and after Menopause: A Cross-sectional Study. Int J Phonosurg Laryngol 2014;4(2):50-54.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Vinay S Bhat, Yanamadala Sobhan, KS Ravi

A Rare Case of Internal Laryngopyocele presenting with Stridor

[Year:2014] [Month:January-June] [Volumn:4 ] [Number:1] [Pages:44] [Pages No:20-22][No of Hits : 1090]


ABSTRACT

A laryngocele is an abnormal elongation and expansion of the saccule of the laryngeal ventricle. When the neck of the laryngocele is obstructed, it becomes filled with mucus of glandular secretion and is altered to a laryngomucocele. When this lesion becomes infected, laryngopyocele is formed. In view of the general rarity of laryngopyoceles and even more so, one causing acute airway obstruction, it was decided to report an instance of the latter type. The clinical features and management of this rare case has been described.

Keywords: Laryngopyocele, Microlaryngeal surgery, Stridor.

How to cite this article: Bhat VS, Sobhan Y, Ravi KS. A Rare Case of Internal Laryngopyocele presenting with Stridor. Int J Phonosurg Laryngol 2014;4(1):20-22.

Source of support: Nil.

Conflict of interest: None


 
ORIGINAL ARTICLE
Manish D Shah, Sarah K Wise, Melissa R Rotella, Avani P Ingley, Michael M Johns

Prevalence of Laryngeal and Pharyngeal Symptoms in Patients with Environmental Allergy

[Year:2014] [Month:January-June] [Volumn:4 ] [Number:1] [Pages:44] [Pages No:1-4][No of Hits : 1086]


ABSTRACT

Background: The effect of environmental allergy on laryngeal and pharyngeal complaints is not well understood. The goal of this study was to determine the prevalence of laryngeal and pharyngeal symptoms in patients with environmental inhalant allergy.

Methods: A retrospective review was conducted of all patients undergoing allergy skin testing between 2006 and 2009. Patients with positive skin tests were included and were classified as ‘mild’ or ‘extensive’ reactors based on skin testing results. Data regarding laryngeal and pharyngeal complaints, as well as ocular and nasal symptoms, had been systematically documented for all patients. The prevalence of these complaints was calculated in each group of reactors and overall.

Results: The prevalence of laryngeal and pharyngeal complaints was 42.0% overall, 45.5% among the mild reactors, and 39.3% in the extensive reactors. No patients complained of hoarseness or were felt to have dysphonia. There was no statistically significant difference between the mild and extensive reactors (p = 0.78). The prevalence of ocular and/or nasal symptoms was 96.0, 90.9 and 100%, respectively.

Conclusion: The prevalence of laryngeal and pharyngeal complaints in allergy sufferers was low in this study. Given the conflicting literature on this topic, there is insufficient evidence to establish a causal link between environmental allergy and laryngeal and pharyngeal symptoms.

Keywords: Allergy, Dysphonia, Environmental, Allergy testing.

How to cite this article: Shah MD, Wise SK, Rotella MR, Ingley AP, Johns MM. Prevalence of Laryngeal and Pharyngeal Symptoms in Patients with Environmental Allergy. Int J Phonosurg Laryngol 2014;4(1):1-4.

Source of support: Nil.

Conflict of interest: None


 
CASE REPORT
Santosh Kumar Swain, Sidhartha Mohanty, Ishwar Chandra Behera

An Unsafe Foreign Body at an Unsafe Site of Airway

[Year:2014] [Month:January-June] [Volumn:4 ] [Number:1] [Pages:44] [Pages No:17-19][No of Hits : 1076]


ABSTRACT

Aspiration of foreign bodies into the airway is a serious problem in childhood. Children with less attention at an early age are more prone to ingest or inhale foreign bodies. Diagnosis is often difficult due to parental ignorance and lack of a clear history. The present authors have come across a rare case of an open safety pin with its blunt end inside the larynx and sharp end penetrating the interarytenoid membrane and entering the upper part of esophagus. The foreign body was removed successfully without any complications.

Keywords: Foreign body, Direct laryngoscope, Larynx, Open safety pin, Esophagus.

How to cite this article: Swain SK, Mohanty S, Behera IC. An Unsafe Foreign Body at an Unsafe Site of Airway. Int J Phonosurg Laryngol 2014;4(1):17-19.

Source of support: Nil.

Conflict of interest: None


 
CASE REPORT
Rashu Mittal, Hitesh Verma, Navneet Mathur, Harjinder Singh Bhuie

Glottic Papilloma in Pregnancy

[Year:2014] [Month:January-June] [Volumn:4 ] [Number:1] [Pages:44] [Pages No:43-44][No of Hits : 1045]


ABSTRACT

Respiratory papilloma (RP) is the most common benign neoplasm of the larynx, both in children and in adult. The etiology of recurrent respiratory papilloma is human papilloma virus (HPV), which has propensity to lay in normal epithelium, hence the high rate of recurrence. We report a case of an adult onset large glottic papilloma seen in a female with 3rd trimester pregnancy, which was excised under microscope under local anesthesia. The effect of pregnancy and latest modalities of treatment are discussed in this article.

Keywords: Respiratory papilloma, Human papilloma virus, Pregnancy, Microlaryngeal surgery.

How to cite this article: Mittal R, Verma H, Mathur N, Bhuie HS. Glottic Papilloma in Pregnancy. Int J Phonosurg Laryngol 2014;4(1):43-44.

Source of support: Nil.

Conflict of interest: None


 
CASE REPORT
Gautam Khaund, Vivek Agarwal, Surajit Barman, Debika Baruah, Biswajit Gogoi

Papillary Carcinoma in Thyroglossal Cyst

[Year:2014] [Month:July-December] [Volumn:4 ] [Number:2] [Pages:38] [Pages No:69-70][No of Hits : 1033]


ABSTRACT

Thyroglossal duct cysts are not uncommon but malignancy in such a cyst is infrequent. Two patients of thyroglossal duct cyst papillary carcinoma are presented here. Both of these patients had different risk profiles and were managed differently. Both the patients have been followed up for 5 years and have shown no recurrences.

Keywords: Papillary carcinoma, Thyroglossal cyst, Malignancy.

How to cite this article: Khaund G, Agarwal V, Barman S, Baruah D, Gogoi B. Papillary Carcinoma in Thyroglossal Cyst. Int J Phonosurg Laryngol 2014;4(2):69-70.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Nupur Kapoor Nerurkar, Shraddha Deshmukh, Priyanka Agrawal, Pradnya Kulkarni

An Unusual Presentation of Bilateral Vocal Fold Paralysis due to Spinal Muscular Atrophy

[Year:2014] [Month:January-June] [Volumn:4 ] [Number:1] [Pages:44] [Pages No:27-29][No of Hits : 971]


ABSTRACT

Background: Spinal muscular atrophy is a rare autosomal recessive neurodegenerative disorder. We report a case of 62-year-old female of spinal muscular atrophy presenting with bilateral vocal fold paralysis, her diagnosis and management.

Objective: Case report of a case of spinal muscular atrophy presenting with bilateral vocal fold paralysis.

Conclusion: Spinomuscular atrophy though rarely associated with laryngeal symptoms should be kept in mind as a possible etiology of bilateral vocal fold paralysis. The surgical decision and the postoperative sequeale will be affected due to the presence of this disease and thus a high index of suspicion is required.

Keywords: Vocal fold, Palsy, Spinal, Muscular atrophy.

How to cite this article: Nerurkar NK, Deshmukh S, Agrawal P, Kulkarni P. An Unusual Presentation of Bilateral Vocal Fold Paralysis due to Spinal Muscular Atrophy. Int J Phonosurg Laryngol 2014;4(1):27-29.

Source of support: Nil.

Conflict of interest: None


 
CASE REPORT
Kalpana Sharma

Solitary Jejunal Metastasis from Carcinoma Pyriform Fossa presenting as Intestinal Obstruction

[Year:2014] [Month:January-June] [Volumn:4 ] [Number:1] [Pages:44] [Pages No:36-39][No of Hits : 968]


ABSTRACT

Metastatic involvement of small intestine from a head and neck primary is a rare occurrence and carries an unfavourable prognosis. Small bowel metastases usually present with obstruction, perforation or bleeding. Small bowel obstruction due to a metastatic stricture is uncommon and mostly occurs as part of generalized carcinomatosis. Rarely, it selectively affects in the form of a solitary malignant stricture.
We report the first case in medical literature of a patient presenting with small bowel obstruction due to a solitary malignant jejunal stricture caused by metastasis from a primary squamous cell carcinoma of the pyriform fossa, four years after the primary tumor was diagnosed and treated with radiotherapy. To the best of our knowledge, there are no reports of primary tumors of hypopharynx metastasizing to jejunum and presenting antemortem. The rarity of intestinal obstruction as an initial manifestation of metastatic dissemination of a hypopharyngeal malignancy as well as its poor prognosis has been discussed.

Keywords: Small intestinal metastasis, Carcinoma pyriform fossa, Malignant jejunal stricture, Squamous cell carcinoma.

How to cite this article: Sharma K. Solitary Jejunal Metastasis from Carcinoma Pyriform Fossa presenting as Intestinal Obstruction. Int J Phonosurg Laryngol 2014;4(1):36-39.

Source of support: Nil.

Conflict of interest: None


 
Guest Editorial
B Rajashekhar

Role of Speech-Language Pathologists in Voice Therapy

[Year:2014] [Month:January-June] [Volumn:4 ] [Number:1] [Pages:44] [Pages No:v-vi][No of Hits : 898]


ABSTRACT

Role of Speech-Language Pathologists in Voice Therapy

Voice disorders refer to problems in voice production, primarily caused by disturbances or loss of normal laryngeal functions. They can result from a variety of pathological conditions. Voice therapy is defined as ‘an effort to return the voice to a level of adequacy that can be realistically achieved and which will satisfy the patient’s occupational, emotional and social needs’.4 It involves a patientcentered treatment method to modify vocal behaviors and eliminate voice misuse, manage voice disorders nonsurgically and allow for improved voice use and often recommended after a thorough examination of the vocal folds and assessment of the functional use of the voice.


 
Editorial
PSN Murthy

Editorial

[Year:2014] [Month:January-June] [Volumn:4 ] [Number:1] [Pages:44] [Pages No:iv][No of Hits : 868]


ABSTRACT

The Association of Phonosurgeons of India, who officially sponsors the International Journal of Phonosurgery and Laryngology, is growing by leaps and bounds. The last conference was held at Bhubaneswar, Odisha and was well-attended. Prof. Paul Castellanos from USA was the international faculty. Several national faculties joined him to make the precon workshop and the conference a grand success. The next conference is slated to be at Nagpur.


 
CASE REPORT
G Raghavendra Prasad, Madhavi Nori, MD Naseeruddin, JV Subba Rao, SS Quadri

Giant Thoracocervical Lymphangioma with Multivisceral Involvement: A Different Concept

[Year:2014] [Month:July-December] [Volumn:4 ] [Number:2] [Pages:38] [Pages No:63-66][No of Hits : 827]


ABSTRACT

Background: Lymphangiomas are benign lymphatic malformations frequently seen in head and neck region. Most reported cases are cervical lesions with mediastinal extension.1, 2
Most are conceived as due to failure of fetal lymph sacs. Synchronous or metachronus lymphangiomatosis with cystic hygroma of the neck is also reported.3

Case details: Massive multicompartmental mediastinal lymphangioma with cervical extension and concomitant visceral involvement is presented. It is proposed as a hamartomatous tumor rather than malunion of fetal jugular lymphatic sacs.2 Solid intrathoracic component with cystic neck extension supports mediastinal origin. Cell culture lines at 4 months were positive for endothelial cell lines positive for factor VIII antigen.

Conclusion: Giant thoracocervical lymphangioma is more likely to be a tumor rather than simple fetal failure of lymphatic sac fusion. Surgical excision is curative.

Keywords: Giant thoracocervical lymphangioma, Multivisceral involvement, Magnetic resonance imaging.

How to cite this article: Prasad GR, Nori M, Naseeruddin MD Rao JVS, Quadri SS. Giant Thoracocervical Lymphangioma with Multivisceral Involvement: A Different Concept. Int J Phonosurg Laryngol 2014;4(2):63-66.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Nupur Kapoor Nerurkar, Shraddha Deshmukh

Therapeutic challenges in Management of Subglottic Stenosis in Wegener's Granulomatosis

[Year:2014] [Month:July-December] [Volumn:4 ] [Number:2] [Pages:38] [Pages No:76-79][No of Hits : 728]


ABSTRACT

Aims and objectives: To report our experience on the treatment of subglottic stenosis (SS) in patients with Wegener’s granulomatosis (WG).

Materials and methods: We endoscopically treated five patients with SS due to WG. Out of 5, two patients were treated with endoscopic balloon dilatation, two patients underwent CO2 laser resection and dilatation and 1 patient underwent a cold steel resection and dilatation. Outcomes were assessed based on improvement in preoperative symptoms, complications, and need for additional procedures.

Results: Balloon dilatation was done in two patients. They are asymptomatic at follow-up and the one with tracheostomy is in the process of decannulation. The other two patients were treated with CO2 laser. Favorable outcome was obtained in one of the patient who is in the process of decannulation, the other developed recurrent stenosis at 3 years and is on tracheostomy. Cold steel resection was used to treat one patient. After undergoing multiple interventions, she developed severe stenosis and underwent an open procedure and is currently on tracheostomy.

Conclusion: Both use of balloon and laser resection are safe and successful method to manage soft, subglottic stenosis due to WG and avoids the need of open procedure. In our series balloon dilatation gave better outcomes as compared to Laser resection and dilatation. Regular follow-up is necessary to rule out recurrence.

Keywords: Larynx, Carcinoma, Voice.

How to cite this article: Nerurkar NK, Deshmukh S. Therapeutic challenges in Management of Subglottic Stenosis in Wegener’s Granulomatosis. Int J Phonosurg Laryngol 2014;4(2):76-79.

Source of support: Nil

Conflict of interest: None


 
Editorial
PSN Murthy

Voice Matters!

[Year:2014] [Month:July-December] [Volumn:4 ] [Number:2] [Pages:38] [Pages No:iv][No of Hits : 688]


ABSTRACT

Voice Matters!
The voice provides the main tool for both semantic and emotional communication and is therefore relevant to auditory perception, psychology, neurology, cognition, linguistics and phonetics. It is a crucial tool not only in education but also in the daily work for about 30% of the entire working population.


 
CASE REPORT
Preethy Mary, Mathew Dominic

An Elusive Submucosal Laryngeal Malignancy

[Year:2014] [Month:July-December] [Volumn:4 ] [Number:2] [Pages:38] [Pages No:71-72][No of Hits : 669]


ABSTRACT

Submucosal laryngeal tumors, though uncommon, are not rare. Though the symptomatology may suggest a laryngeal malignancy, a routine direct laryngoscopy may not reveal the lesion. Obtaining tissue biopsy may also prove to be a challenge. Radiological modality becomes mandatory in these cases to get a representative biopsy.
The present report describes a case with an unusually high number of negative biopsies. The course of management and related literature are discussed.

Keywords: Submucosal laryngeal malignancy, Biopsy, CT scan.

How to cite this article: Mary P, Dominic M. An Elusive Submucosal Laryngeal Malignancy. Int J Phonosurg Laryngol 2014;4(2):71-72.

Source of support: Nil

Conflict of interest: None


 
CASE REPORTS
Lakshmi Shantharam, KG Somashekara, NS Priya

Saccular Cyst of Larynx

[Year:2013] [Month:January-June] [Volumn:3 ] [Number:1] [Pages:33] [Pages No:21-23][No of Hits : 6350]


ABSTRACT

A saccular cyst is a mucous-filled dilatation of the laryngeal saccule which can be congenital or acquired. The management of these cysts has changed over the period of time. An adult patient was presented with hoarseness of voice. Videolaryngoscopy showed a well-defined pedunculated mass. Endoscopic-guided excision of the cyst was done. Histopathology showed features of saccular cyst of larynx. Laryngeal saccular cyst should be excised to relieve voice change, respiratory obstruction and for possible carcinomatous change. This article aims at management of saccular cyst along with review of literature.

Keywords: Saccular cyst, Larynx, Laryngeal cyst.

How to Cite this article: Shantharam L, Somashekara KG, Priya NS. Saccular Cyst of Larynx. Int J Phonosurg Laryngol 2013;3(1):21-23.

Source of support: Nil

Conflict of interest: None declared


 
CASE REPORT
Padmavathi Devi Chaganti, YVS Prabhakar, KA Seetaram, Kalyan Babu

Caseating Granulomatous Inflammation: Think beyond Tuberculosis

[Year:2013] [Month:July-December] [Volumn:3 ] [Number:2] [Pages:38] [Pages No:51-54][No of Hits : 3962]


ABSTRACT

A 33 years old male human immunodeficiency virus (HIV) positive patient on antiretroviral therapy developed caseating granulomatous inflammation of lymph nodes. He did not respond to antituberculous treatment. Subsequently, he developed gastrointestinal tract lesions. Special stains show positivity for histoplasmosis.
The case is presented because of its resemblance to tuberculosis.

Keywords: Caseation, Granulomatous Inflammation, Tuberculosis, Histoplasmosis.

How to cite this article: Chaganti PD, Prabhakar YVS, Seetaram KA, Babu K. Caseating Granulomatous Inflammation: Think beyond Tuberculosis. Int J Phonosurg Laryngol 2013;3(2):51-54.

Source of support: Nil

Conflict of interest: None declared


 
CASE SERIES
GSN Murthy, R Bhimeswar, M Veera Kumar, P Krishna Prasad

Resurgence of Diphtheria: Are We ready to treat?

[Year:2013] [Month:July-December] [Volumn:3 ] [Number:2] [Pages:38] [Pages No:42-45][No of Hits : 3104]


ABSTRACT

Objectives: To create awareness amongst the medical faculty about a forgotten fatal disease (diphtheria). To determine the age distribution, immunization status, presenting features, prognosis with respect to duration after which they took medication and effect of ADS on recovery in cases of faucial and laryngeal diphtheria. To stress on the importance of DTP immunization to control diphtheria.

Study method: In this study, 15 patients who presented to the Government general hospital between July and September 2013 with membranous tonsillitis were enrolled. In every diphtheriaproven case, we administrated antidiphtheric serum (ADS) as early as possible along with injection crystalline penicillin (CP) and oral erythromycin. Tracheostomy was done in two cases who presented with stridor. Patient variables and their correlation with recovery were studied.

Results: Out of 15 cases of membranous tonsillitis, nine tested positive for diphtheria; eight, smear positive and one, culture positive. Of these nine cases, eight were between 9 and 13 years old and one was a 50-year-old man. While tracing immunization status, it was found that three children (33%) were not immunized, four children (22%) had not taken booster doses, and in one child and the adult, immunization history was unknown. Clinical presentation of two of the unimmunized cases was late (on 8th day of fever), with stridor due to laryngeal diphtheria. The third child presented with bull neck, and developed myocarditis. These three cases proved fatal. Six cases which presented early and were managed in time recovered fully.

Conclusion: Unimmunized children as well as adults are susceptible to diphtheria. High immunization coverage is the only tool to control this infection. Booster doses are needed to control disease in adults. It was found that early diagnosis with high index of suspicion and early administration of ADS along with good supportive therapy carried good prognosis. Every otolaryngologist, pediatrician as well as general practitioner should be ready to manage the cases of diphtheria. Government should be prepared to manage and control epidemics effectively.

Keywords: Faucial diphtheria, Laryngeal diphtheria, Immunization (DPT), Antidiphtheric serum.

How to cite this article: Murthy GSN, Bhimeswar R, Kumar MV, Prasad PK. Resurgence of Diphtheria: Are We ready to treat? Int J Phonosurg Laryngol 2013;3(2):42-45.

Source of support: Nil

Conflict of interest: None


 
CASE REPORTS
Po-Han Chiu, Chun-Wen Shih, Yih-Jeng Tsai, Rayleigh Ping-Ying Chiang

Laryngeal Ultrasound for Assessment of Supraglottic Laryngitis with Abscess

[Year:2013] [Month:January-June] [Volumn:3 ] [Number:1] [Pages:33] [Pages No:24-27][No of Hits : 2880]


ABSTRACT

Here we report a rare case, for this era, of supraglottic laryngitis with abscess formation after antibiotics use. Laryngeal ultrasound for abscess detection and follow-up has advantages over neck computed tomography. This modality can assess vocal cord movement noninvasively with the benefits of cost effectiveness, easy availability, freedom from radiation, and high resolution-factors that are superior to other modalities. Although laryngeal abscesses are rare, clinicians should be aware of their myriad presentations. Acute supraglottitis with abscess formation may cause potentially fatal obstruction of the airway. Early recognition and intervention to prevent morbidity and mortality is thus very important.

Keywords: Laryngeal abscess, Laryngeal ultrasound, Supraglottic laryngitis.

How to Cite this article: Chiu PH, Shih CW, Tsai YJ, Chiang RPY. Laryngeal Ultrasound for Assessment of Supraglottic Laryngitis with Abscess. Int J Phonosurg Laryngol 2013;3(1): 24-27.

Source of support: Nil

Conflict of interest: None declared


 
CASE REPORT
Rohan Gupta, Sachin Gupta, Arshad Bhat, Parmod Kalsotra, KP Singh, Om Prakash, Saurabh Gupta

Bilateral Mixed Laryngocele

[Year:2013] [Month:July-December] [Volumn:3 ] [Number:2] [Pages:38] [Pages No:69-72][No of Hits : 2828]


ABSTRACT

Laryngocele is a rare, benign dilatation of the laryngeal saccule that may extend internally into the airway or externally through the thyrohyoid membrane. The incidence of laryngocele is 1 per 2.5 million people per year. It may be asymptomatic or sometimes may present with cough, hoarseness, stridor, sore throat and as a swelling on one or both sides of the neck. We are reporting a case of bilateral mixed laryngocele in a 41 years old male, its clinical presentation and investigations along with a review of literature.

Keywords: Laryngocele, Saccule, Neck swelling, Computed, Tomography.

How to cite this article: Gupta R, Gupta S, Bhat A, Kalsotra P, Singh KP, Prakash O, Gupta S. Bilateral Mixed Laryngocele. Int J Phonosurg Laryngol 2013;3(2):69-72.

Source of support: Nil

Conflict of interest: None declared


 
ORIGINAL ARTICLES
Sudhir M Naik, Purshottam Chavan, Rajshekar Halkud, Ashok M Shenoy, A Nanjundappa, Sumit Gupta

Crushed Muscle Tissue Graft: A Efficient Repair Technique for Intraoperative Chylous Fistulas

[Year:2013] [Month:January-June] [Volumn:3 ] [Number:1] [Pages:33] [Pages No:1-5][No of Hits : 2651]


ABSTRACT

Background/objectives: Chylous fistula is an uncommon but serious complication of radical neck dissections and is a complication which can be better avoided than treated. Presence of amber colored lymph in the postoperative closed wound suction drainage is defined as chylous fistula.

Materials and methods: Materials and methods: The study was done over 18 months analyzing neck dissections done for 245 cases for complications of chyle leak. Six cases of chyle leak were identified during the course of the study.

Results: All the six cases were repaired with crushed muscle tissue graft harvested from the remaining portion of the sternocleidomastoid muscle was spread out and sealed. No chyle leak complications were seen in the drains after the repair.

Conclusion: The use of crushed local muscle tissue grafts offers better chances of success for closure of chylous fistulae in the neck, especially when the fistulous opening was difficult to ligate and the site of leak was only packed with sponge gel or Surgicel®. This complication should be better avoided than repaired.

Keywords:Chylous fistula, Thoracic duct, Crushed muscle, Surgicel.

How to Cite this article: Naik SM, Chavan P, Halkud R, Shenoy AM, Nanjundappa A, Gupta S. Crushed Muscle Tissue Graft: A Efficient Repair Technique for Intraoperative Chylous Fistulas. Int J Phonosurg Laryngol 2013;3(1):1-5.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLES
Kanika Rana, Praveen Kumar Rathore, Vikram Wadhwa, Surinder Kumar

Deep Neck Infections: Continuing Burden in Developing World

[Year:2013] [Month:January-June] [Volumn:3 ] [Number:1] [Pages:33] [Pages No:6-9][No of Hits : 2600]


ABSTRACT

Deep neck infections (DNIs) continue to burden the health care system in developing countries like India. Aim of our study was to determine clinical features, diagnostic and therapeutic aspects of DNIs, various microorganisms involved in DNIs and their antibiotic sensitivity and to study the outcome of described treatment response. Fifty patients with DNIs were managed at the department of ENT in our hospital from September 2009 to September 2010. There were 29 male (58%) and 21 female (42%) patients with age ranging from 6 months to 75 years. Maximum patients presented in emergency department with complain of neck swelling and pain. Most common abscess encountered was of submandibular region. Odontogenic cause was found to be the most common cause of DNIs. Surgical intervention was required in 39 patients. No major complications were seen. It was observed that the low socioeconomic status along with illiteracy and lack of adequate management of early infection at primary health care level lead to prevalence of these infections in developing countries like ours.

Keywords:Deep neck infections, Odontogenic, Socioeconomic status.

How to Cite this article: Rana K, Rathore PK, Wadhwa V, Kumar S. Deep Neck Infections: Continuing Burden in Developing World. Int J Phonosurg Laryngol 2013;3(1):6-9.

Source of support: Nil

Conflict of interest: None declared


 
CASE REPORTS
Janhvi J Bhate, Unnikrishnan K Menon, K Madhumita

A Stitch in Time

[Year:2013] [Month:January-June] [Volumn:3 ] [Number:1] [Pages:33] [Pages No:31-33][No of Hits : 2266]


ABSTRACT

Bilateral vocal cord paralysis is the one of the common childhood laryngeal lesions. The treatment modalities include interim tracheostomy and, where needed, permanent irreversible procedures.
We report a case of idiopathic bilateral vocal cord palsy in a child, which was managed effectively by the procedure of suture lateralization of the vocal cord. The procedure, its rarity and follow-up of our case is described.

Keywords: Bilateral vocal cord paralysis, Tracheostomy, Suture lateralization.

How to Cite this article: Bhate JJ, Menon UK, Madhumita K. A Stitch in Time. Int J Phonosurg Laryngol 2013;3(1):31-33.

Source of support: Nil

Conflict of interest: None declared


 
CASE REPORT
Deepthi Koganti

Urbach-Wiethe Disease: A Rare Cause of Hoarseness of Voice

[Year:2013] [Month:July-December] [Volumn:3 ] [Number:2] [Pages:38] [Pages No:61-64][No of Hits : 2262]


ABSTRACT

Urbach-Wiethe disease is a rare, autosomal recessive disorder, characterized by infiltration of periodic acid-Schiff positive hyaline material into the skin, oral cavity, larynx and internal organs. The clinical manifestations include hoarseness of voice, beaded papules along the eyelid margins, skin scarring and an inability to protrude the enlarged and thickened tongue. Laryngeal involvement is typical and causes hoarseness of voice. In this paper, we present a case of a middle-aged female with clinical features suggestive of Urbach-Wiethe disease. This entity is of interest to the otolaryngologist as it is a rare cause of hoarseness of voice.

Keywords: Urbach-Wiethe disease, Lipoid proteinosis, Hyalinosis cutis et mucosae.

How to cite this article: Koganti D. Urbach-Wiethe Disease: A Rare Cause of Hoarseness of Voice. Int J Phonosurg Laryngol 2013;3(2):61-64.

Source of support: Nil

Conflict of interest: None


 
CASE REPORTS
Bipin Thomas Varghese, Paul Sebastian

Near Total Pharyngolaryngectomy and Reconstruction with Interpositional Tubed Pectoralis Major Myocutaneous Flap

[Year:2013] [Month:January-June] [Volumn:3 ] [Number:1] [Pages:33] [Pages No:15-17][No of Hits : 2207]


ABSTRACT

Near total laryngectomy can be safely combined with partial or subtotal pharyngectomies when the disease is lateralized rendering the interarytenoid joint and the contralateral cricoarytenoid joint free of tumor. A case of post radiotherapy recurrent carcinoma of the posterior pharyngeal wall which could be salvaged by a circumferential pharyngectomy combined with a near total laryngectomy is reported with a discussion about its potential advantages.

Keywords: Near total laryngectomy, Circumferential pharyngectomy, Tubed pectoralis major myocutaneous flap.

How to Cite this article: Varghese BT, Sebastian P. Near Total Pharyngolaryngectomy and Reconstruction with Interpositional Tubed Pectoralis Major Myocutaneous Flap. Int J Phonosurg Laryngol 2013;3(1):15-17.

Source of support: Nil

Conflict of interest: None declared


 
CASE REPORTS
Raghavendra Suresh, AM Balasubramanya, Vidya Bhushan Rangappa

Angioleiomyoma of the Hypopharynx: A Rare Entity

[Year:2013] [Month:January-June] [Volumn:3 ] [Number:1] [Pages:33] [Pages No:28-30][No of Hits : 2130]


ABSTRACT

Leiomyomas are benign soft tissue neoplasms that arise from smooth muscle. Cases have been reported in the gastrointestinal tract, brain, oral cavity and other sites. Laryngeal angioleiomyomas are infrequently reported. Literature search revealed no case reported in the hypopharynx. We report a case of 40-year-old female with angioleiomyoma of the hypopharynx. External approaches have been described in the literature for laryngeal leiomyomas. We discuss the endolaryngeal approach for removal of these tumors.

Keywords: Angioleiomyoma, Hypopharynx, Leiomyoma .

How to Cite this article: Suresh R, Balasubramanya AM, Rangappa VB. Angioleiomyoma of the Hypopharynx: A Rare Entity. Int J Phonosurg Laryngol 2013;3(1):28-30.

Source of support: Nil

Conflict of interest: None declared


 
CASE REPORTS
R Anil Kumar, J Niveditha, M Mahesh Babu

An Unusual Case of Bull Gore Injury to the Neck Presenting with Internal Jugular Vein Thrombosis and Retropharyngeal Emphysema

[Year:2013] [Month:January-June] [Volumn:3 ] [Number:1] [Pages:33] [Pages No:18-20][No of Hits : 2103]


ABSTRACT

Injuries to the head and neck region are less common than genitourinary, abdominal, inguinal region but are more severe and more likely to cause death.1 A 22-year-old patient presented with dysphagia and swelling in left lower part of the neck secondary to bull gore injury. The injury had caused a retropharyngeal hematoma, emphysema of the neck along with internal jugular vein thrombosis and with air in the lumen of the vein. Pulmonary embolism resulted in sudden death of the patient.

Keywords: Bull gore injury, Internal jugular vein thrombosis, Retropharyngeal hematoma, Retropharyngeal emphysema, Pulmonary embolism.

How to Cite this article: Kumar RA, Niveditha J, Babu MM. An Unusual Case of Bull Gore Injury to the Neck Presenting with Internal Jugular Vein Thrombosis and Retropharyngeal Emphysema. Int J Phonosurg Laryngol 2013;3(1):18-20.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Nupur Kapoor Nerurkar, Gauri Kapre

Plexiform Neurofibroma of the Larynx: A Challenging Management Dilemma

[Year:2013] [Month:July-December] [Volumn:3 ] [Number:2] [Pages:38] [Pages No:55-57][No of Hits : 2094]


ABSTRACT

Introduction: Among the many causes responsible for stridor in the pediatric population, tumors of the larynx are relatively rare. Rarer still is the presence of endolaryngeal neurofibromas. Plexiform neurofibromas are associated with type I neurofibromatosis (NF1). Their typical characteristic is that they are diffuse tumors with indistinct margins, which makes complete resection a challenge and the chances of recurrences higher.

Objective: To document our experience with endolaryngeal neurofibromas and to discuss the treatment options available for this rare condition.

Methods: We present two cases of plexiform neurofibromas in pediatric patients. Both children presented with large supraglottic masses which interfered with breathing and swallowing. They also fulfilled the criteria for type I neurofibroma. Endolaryngeal approach with microdebrider and laser-assisted surgical excision was performed in both cases.

Result: Following surgery, both patients had uneventful recovery and no subsequent breathing or swallowing difficulties.

Conclusion:The dilemma in the management of endolaryngeal neurofibroma is the choice between endolaryngeal laser and aggressive external approach surgery. A short review of the limited existing literature shows that it is wiser to limit the surgery to as complete a resection as is possible endoscopically.

Keywords: Larynx, Plexiform neurofibroma, Surgery.

How to cite this article: Nerurkar NK, Kapre G. Plexiform Neurofibroma of the Larynx: A Challenging Management Dilemma. Int J Phonosurg Laryngol 2013;3(2):55-57.

Source of support: Nil

Conflict of interest: None declared


 
ORIGINAL ARTICLE
Poorva K Athavale, Bhagyashree D Bokare, Vipin R Ekhar, Devendra Meghraj Mahore

Identification and Preservation of External Branch of Superior Laryngeal Nerve in Thyroidectomy

[Year:2013] [Month:July-December] [Volumn:3 ] [Number:2] [Pages:38] [Pages No:39-41][No of Hits : 1953]


ABSTRACT

The basic principle of head and neck surgery is based on the identification and preservation of important structures, rather than avoidance. This principle is also applicable to identification and preservation of external branch of the superior laryngeal nerve (EBSLN) as a standard routine in all thyroid surgeries. During thyroid surgery, the EBSLN is clearly at risk due to its close proximity to the superior thyroid artery (STA) and its branches that need to be ligated during dissection of the superior pole of the thyroid gland. Injury is detrimental to the patient by causing paralysis of the cricothyroid muscle which is the main tensor and pitch controlling mechanism of the vocal folds. Injury to the EBSLN during surgery can result in the voice changes, loss of upper range and easy fatigability of voice, the severity of which varies according to the vocal demand of the patient.
Total 45 cases of thyroid swellings were treated with surgery, in the Department of ENT at a tertiary care hospital during the period from 1st October 2009 to 30th October 2010. Hemithyroidectomy was the most common operative procedure implemented in 24 patients (53.33%) in which right sided was common. Next common procedure performed was that of total thyroidectomy in 14 patients (31.11%). Four patients underwent total thyroidectomy with neck dissection. The position of EBSLN was classified according the Cernea et al classification. In our study we found the EBSLN to be type I in 46.66%, type IIa in 73.33% and type IIb in 02.22%. The anatomical landmark taken into consideration to identify EBSLN was the Joll’s triangle with its relation to the superior pole of the thyroid gland and STA.

Keywords: External branch of the superior laryngeal nerve, Thyroidectomy, Professional voice.

How to cite this article: Athavale PK, Bokare BD, Ekhar VR, Mahore DM. Identification and Preservation of External Branch of Superior Laryngeal Nerve in Thyroidectomy. Int J Phonosurg Laryngol 2013;3(2):39-41.

Source of support: Nil

Conflict of interest: None declared


 
CASE SERIES
GSN Murthy, R Bhimeshwar, M Veera Kumar, PSN Murthy, S Udaya Chanukya

Management of Laryngotracheal Stenosis by Laryngoplasty

[Year:2013] [Month:July-December] [Volumn:3 ] [Number:2] [Pages:38] [Pages No:46-50][No of Hits : 1893]


ABSTRACT

This is a prospective study done on six cases of laryngotracheal stenosis. They were operated by laryngoplasty with mucoperichondrial grafting stenting (temporary and permanent).
The purpose of the study was to determine the role of laryngoplasty in the treatment of acquired subglottic stenosis.
In this study, six patients who presented to the Government General Hospital from March 2011 to April 2012, with subglottic stenosis were enrolled. The details of their etiology, time period with endotracheal intubation, duration between extubation and onset of symptoms, treatment and postoperative recovery on follow-up were recorded and analyzed. It was found that laryngoplasty with cartilage grafting along with T-tube or Dumonts silicone stent placement carries good success rate, with no recurrence.

Keywords: Laryngotracheal stenosis, Subglottic stenosis, Acquired subglottic stenosis, Laryngoplasty, Montgomery T-tube, Dumonts stent, Laryngotracheal resection, Laryngotracheal reconstruction.

How to cite this article: Murthy GSN, Bhimeswar R, Kumar MV, Murthy PSN, Chanukya SU. Management of Laryngotracheal Stenosis by Laryngoplasty. Int J Phonosurg Laryngol 2013;3(2):46-50.

Source of support: Nil

Conflict of interest: None declared


 
ORIGINAL ARTICLE
UP Santosh, MC Anup Kumar, Lavanya Karanam

Upper Gastrointestinal Endoscopy in ENT Practice: How Worth is It?

[Year:2013] [Month:July-December] [Volumn:3 ] [Number:2] [Pages:38] [Pages No:35-38][No of Hits : 1836]


ABSTRACT

Objective: The need for upper gastrointestinal (GI) endoscopy in the evaluation of hoarseness.

Study design: Prospective study, conducted during the period from June 2012 to February 2013.

Setting: Tertiary referral center.

Results: A total of 125 patients were selected for the study and they were evaluated with appropriate history and clinical examination. Out of 125 patients, 41 (32.8%) patients showed laryngeal findings leading to hoarseness, 13 (10.4%) patients showed features of suspected malignancy in other adjacent regions which was confirmed later, two (1.6%) patients showed phonetic gap and 69 (55.2%) patients showed normal laryngeal inlet on indirect laryngoscopy examination. Of the 69 normal patients which were treated conservatively and since they did not show any response they were subjected to upper GI endoscopy. Out of 69 patients, 41 (60%) patients showed features of gastritis, 28 (40%) patients showed features of duodenitis.

Conclusion: It is estimated that more than 50% of patients presenting to the ENT OPD for hoarseness are because of GI problems. We strongly advise upper GI endoscopy for the symptomatic otorhinolaryngological patients with a normal laryngeal finding on indirect laryngoscopy for treating the condition accurately or near accurately. Adding to this upper GI endoscopy has the additional advantages of documentation and medicolegal aspect in the present day scenario.

Keywords: Hoarseness, Upper gastrointestinal endoscopy, Duodenitis.

How to cite this article: Santosh UP, Kumar MCA, Karanam L. Upper Gastrointestinal Endoscopy in ENT Practice: How Worth is It? Int J Phonosurg Laryngol 2013;3(2):35-38.

Source of support: Nil

Conflict of interest: None declared


 
CASE REPORT
Prafulla Sakhare, Binhi Desai, Bhagyashree Bokare, Seema Patel, Apurva Pawde

Killian Jamieson Pouch: A Rarer Cervical Diverticulum

[Year:2013] [Month:July-December] [Volumn:3 ] [Number:2] [Pages:38] [Pages No:65-68][No of Hits : 1664]


ABSTRACT

Killian Jamieson diverticulum (KJD) is lesser common than Zenker’s diverticulum (ZD). Various treatment modalities have been recommended but traditional surgical treatment has been recommended for a symptomatic KJD.
Recently, traditional open surgery for a symptomatic KJD is being challenged by the development of new endoscopic techniques and devices.
We document a rare report of a left KJD diagnosed on barium esophagogram and flexible endoscopy. Diverticulum excision and an esophagomyotomy was done and following treatment the patient’s symptoms resolved and he recovered well.

Keywords: Killian Jamieson Diverticulum, Zenker’s Diverticulum,Cricopharyngeus, Recurrent laryngeal nerve, Surgical excision,Esophagomyotomy.

How to cite this article: Sakhare P, Desai B, Bokare B, Patel S, Pawde A. Killian Jamieson Pouch: A Rarer Cervical Diverticulum. Int J Phonosurg Laryngol 2013;3(2):65-68.

Source of support: Nil

Conflict of interest: None declared


 
CASE REPORT
TK Joseph, Reshmi M Nair

Combined Recurrent Laryngeal and Phrenic Nerve Paralysis due to Aortic Arch Aneurysm

[Year:2013] [Month:July-December] [Volumn:3 ] [Number:2] [Pages:38] [Pages No:58-60][No of Hits : 1469]


ABSTRACT

Idiopathic left recurrent laryngeal nerve palsy is a relatively common entity. However, very occasionally, a sinister mediastinal cause is diagnosed on investigation. Even more rare is the situation where the same lesion also causes a phrenic nerve palsy.
We present such an interesting case where an aortic arch aneurysm, in an elderly male with renal disease, led to both recurrent laryngeal and phrenic nerve palsies. The clinical features, management options and related literature are discussed.

Keywords: Recurrent laryngeal nerve palsy, Phrenic nerve, Aortic aneurysm.

How to cite this article: Joseph TK, Nair RM. Combined Recurrent Laryngeal and Phrenic Nerve Paralysis due to Aortic Arch Aneurysm. Int J Phonosurg Laryngol 2013;3(2):58-60.

Source of support: Nil

Conflict of interest: None declared


 
HOW I DO IT
Bipin T Varghese

Stapler Laryngectomy

[Year:2013] [Month:January-June] [Volumn:3 ] [Number:1] [Pages:33] [Pages No:10-11][No of Hits : 1419]


ABSTRACT

Closed stapling of the pharynx after careful separation of the laryngeal frame work from the adjacent pharynx is a viable option in total laryngectomy for endolaryngeal cancers. Author describes his experience and improvization that ensures success in stapler laryngectomy.

Keywords:Closed stapling, Total laryngectomy, Technique.

How to Cite this article: Varghese BT. Stapler Laryngectomy. Int J Phonosurg Laryngol 2013;3(1):10-11

Source of support: Nil

Conflict of interest: None declared


 
CASE REPORTS
John Samuel, Sanjeev Mohanty, Gopinath Maraignanam

Surgical Management of Recurrent Laryngeal Glomus

[Year:2013] [Month:January-June] [Volumn:3 ] [Number:1] [Pages:33] [Pages No:12-14][No of Hits : 1268]


ABSTRACT

A 51-year-old male presented to the ENT outpatient department with complaints of pain, irritation and foreign body sensation in the throat for 3 months. There was history of being diagnosed to have laryngeal paraganglioma for which the patient had undergone microlaryngeal surgical excision twice during the preceding 9 years. Clinical examination revealed a reddish proliferative mass of about 2 cm involving the laryngeal surface of the epiglottis and extending to the right aryepiglottic fold. Vocal cords were normal in structure and function.
With the previous history of endolaryngeal excision of the tumor and its recurrence, the patient underwent laryngofissure approach with median thyrotomy and left lateral pharyngotomy. The tumor was excised in toto and histopathologically confirmed as paraganglioma. Postoperative period was uneventful. Patient is on continued follow-up with no recurrence till date.

Keywords:Laryngeal glomus, Median thyrotomy, Lateral pharyngotomy.

How to Cite this article: Samuel J, Mohanty S, Maraignanam G. Surgical Management of Recurrent Laryngeal Glomus. Int J Phonosurg Laryngol 2013;3(1):12-14.

Source of support: Nil

Conflict of interest: None declared


 
Editorial
Unnikrishnan Menon

Editorial

[Year:2013] [Month:July-December] [Volumn:3 ] [Number:2] [Pages:38] [Pages No:iv][No of Hits : 600]


ABSTRACT

The vocal cords, dysphonia and phonosurgery may arguably be the glamour areas in laryngology. However, let us not forget the other physiologic function subserved at the same anatomic level. The larynx is situated at the crossroads of the passages for air and food. A wrong turn can lead to aspiration. This and other issues can lead to the spectrum of swallowing disorders.


 
Editorial
PSN Murthy

Editorial

[Year:2013] [Month:January-June] [Volumn:3 ] [Number:1] [Pages:33] [Pages No:iv][No of Hits : 560]


ABSTRACT

Larynx, as an organ of phonation, is an accepted fact and the vocal folds are synonymous with the production of the voice. Several other functions of the 'Voice Box' are known but not much importance has been given. Not many otolaryngologists are taught or even aware of the anatomy and physiology of larynx beyond the phonation.


 
ORIGINAL ARTICLES
Yusuf Kizil, Utku Aydil, Metin Yilmaz, Ozgur Ekinci, Osman Tugrul Guzeldir, Veysel Akif Savas, Ahmet Koybasioglu

Vocal Cord Leukoplakia: Characteristics and Pathological Significance

[Year:2012] [Month:January-June] [Volumn:2 ] [Number:1] [Pages:51] [Pages No:9-13][No of Hits : 19104]


ABSTRACT

Leukoplakia is a nonspecific clinical term used to describe a mucosal white patch or plaque that cannot be easily scraped off. Leukoplakia of vocal cord represents a chronic inflammation or exposure to irritants which can also stimulate development of precancerous conditions or cancer. This study aimed to determine clinical and histopathological characteristics of vocal cord leukoplakia. A total of 66 patients were included. All patients with a clinical diagnosis of vocal cord leukoplakia who had undergone direct laryngoscopic examination and biopsy were analyzed retrospectively. The most common pathological finding was mild dysplasia (25.8%). Cancer was detected in 18.2% of cases. Malignancy was more frequent in cases with unilateral vocal cord involvement (23.4%) when compared with bilateral cases (5.2%) and in patients with localized lesions (19.3%) when compared with lesions involving whole cord (11.1%), but the differences were not statistically significant (p > 0.05). Smoking history was found to be related with cancer diagnosis (p < 0.001). In the presence of a serious smoking history, there is high-risk for malignancy and leukoplakia should be sampled immediately for histopathological examination. Although statistically not proven, cancer rates are higher in more localized and unilateral lesions.

Keywords:Vocal cords, Leukoplakia, Larynx, Laryngeal epithelium, Preneoplastic condition.

How to Cite this article: Kizil Y, Aydil U, Yilmaz M, Ekinci O, Güzeldir OT, Savas VA, Köybasioglu A. Vocal Cord Leukoplakia: Characteristics and Pathological Significance. Int J Phonosurg Laryngol 2012;2(1):9-13.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLES
Owais Mattoo, Rahil Muzaffar, Anees Mir, Aamir Yousuf, Aakib Hamid Charag, Rauf Ahmad

Laryngopharyngeal Reflux: Prospective Study Analyzing Various Nonsurgical Treatment Modalities for LPR

[Year:2012] [Month:January-June] [Volumn:2 ] [Number:1] [Pages:51] [Pages No:5-8][No of Hits : 7961]


ABSTRACT

Objective: To compare the outcomes of various medical treatment modalities for laryngopharyngeal reflux (LPR).

Study design: Prospective study design.

Materials and methods: One-hundred and fifty patients were divided into three groups (A, B, C) based on the mode of intervention used for the control of LPR. Each study group enrolled 50 patients using random tables.

  • Group A: These patients were put on a twice daily dosage of esomeprazole (20 mg bd) and domeperidone (10 mg bd) for 4 months
  • Group B: These patients were put on bd dosage of esomeprazole (20 mg) and domeperidone (10 mg) and also received counseling for dietary and lifestyle changes. The duration of treatment was for 4 months.
  • Group C: These patients received, in addition to above, 10 mg of amitriptyline (tricyclic antidepressant) bid, again for 4 months.
Results:The success achieved in controlling LPR was defined as greater than 50% improvement in baseline symptoms. The success achieved in group A was 46%, in group B was 54% and in group C was 40%.
The relative change in reflux symptom index (RSI) over any given period of time was significantly higher than the relative change in reflux finding score (RFS). The relative change in RSI over first month was 30.99%, which is significantly higher than the relative change of RFS (6.39%) over the same period.
The mean RSI scores during 4 months of treatment fell from 20.67 to 8.9 (p <0.01) in group A, from 23.3 to 8.6 (p <0.01) and from 21.3 to 10.8 (p <0.05) in group C.
The mean RFS during 4 months fell from 15 to 6.5 (p <0.05) in group A, from 16 to 6.4 (p <0.05) and from 15 to 6.4 (p <0.05) in group C.

Conclusion:
  • All the three interventions had a statistically significant impact on the signs and symptoms of LPR.
  • However, higher success rates were achieved in group B where patients were put on a bid dosage esomeprazole and domeperidone nad counseled for lifestyle and dietary changes. Paradoxically, success rates achieved in group C was lower than other groups, possibly because of the anticholinergic effects of amitriptyline causing dry mouth and dry throat.
  • The symptomatic improvement was seen much earlier than the improvement in laryngoscopic findings. This was evidenced by the fact that relative change in RSI was much higher than the relative change of RFS over a given period of time.
  • If diagnosed with enough surety and certainty, patients of LPR do not need any antidepressant medications as these medications may not have any role in the treatment of same and may, however, worsen the condition owing to their anticholinergic side effects.
Keywords:Laryngopharyngeal reflux, Esomeprazole, Domeperidone, Amitriptyline, Reflux symptom index.

How to Cite this article: Mattoo O, Muzaffar R, Mir A, Yousuf A Charag AH, Ahmad R. Laryngopharyngeal Reflux: Prospective Study Analyzing Various Nonsurgical Treatment Modalities for LPR. Int J Phonosurg Laryngol 2012;2(1):5-8.

Source of support: Nil

Conflict of interest: None declared


 
CASE REPORTS
Yong Cheol Koo, Hyo Jin Chung, Michelle J Suh, Hong-Shik Choi

The Efficacy of Treatment for Vocal Fold Bowing with Pulsed Dye Laser

[Year:2012] [Month:January-June] [Volumn:2 ] [Number:1] [Pages:51] [Pages No:46-48][No of Hits : 7896]


ABSTRACT

Bowing of the vocal folds can result from aging, atrophy or idiopathic causes, such as an injudicious vocal cord surgery. Bowing results in dysphonia due to inadequate approximation of the vocal folds.
A number of treatments have been proposed for this condition. Intracordal injection of biological materials including liquid silicon and Teflon and various types of thyroplasty have been utilized. However, full voice recovery has never been fully achieved.
We present a case involving a 64-year-old Asian man with dysphonia for 30 years. The patient’s vocal fold bowing was examined on laryngoscopy. The disease was effectively treated with pulsed dye laser (PDL) followed by speech therapy. Observation of the patient over 1 year did not show any signs of recurrence. Our analysis revealed voice quality improvement.

Keywords:Vocal cords, Laser therapy, Male, Voice disorders.

How to Cite this article: Koo YC, Chung HJ, Suh MJ, Choi HS. The Efficacy of Treatment for Vocal Fold Bowing with Pulsed Dye Laser. Int J Phonosurg Laryngol 2012;2(1):46-48.

Source of support: Nil

Conflict of interest: None


 
CASE REPORTS
Israfil Orhan, Fahrettin Yilmaz, Mehmet Eken

Laryngeal Ulceration in Behcet’s Disease

[Year:2012] [Month:January-June] [Volumn:2 ] [Number:1] [Pages:51] [Pages No:49-51][No of Hits : 4381]


ABSTRACT

Behcet’s disease is a multisystem inflammatory disorder of unknown origin, characterized by recurrent oral and genital ulcerations, ocular and cutaneous lesions, arthritis, central nervous system and vascular disease. There is no pathognomanic laboratory test, but there are clinical criteria to assist in establishing the diagnosis.
There are only a few study about the laryngeal manifestation of Behcet’s disease in the literature. We describe the case of a patient in whom epiglottic ulcers developed 7 years after the diagnosis of Behcet disease.

Keywords:Behcet’s disease, Larynx, Epiglottic ulcers.

How to Cite this article: Orhan I, Yilmaz F, Eken M. Laryngeal Ulceration in Behcet’s Disease. Int J Phonosurg Laryngol 2012;2(1):49-51.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLES
Nupur Kapoor Nerurkar, Sunita Chhapola Shukla

Subepithelial Vocal Fold Cyst: A Pearl on a String?

[Year:2012] [Month:July-December] [Volumn:2 ] [Number:2] [Pages:38] [Pages No:53-56][No of Hits : 4050]


ABSTRACT

Objective: Subepithelial vocal fold cyst (SEVFC) is an epithelium lined sac within the lamina propria. These cysts are of two histologic types: Mucous retention cyst and epidermoid cyst. Rupture of the cyst during surgical excision and incomplete cyst wall removal with consequent recurrence of the cyst is not an infrequent problem. While performing cold-steel blunt microflap surgery for SEVFC, the first author observed thick fibrotic bands at the 12 and 6 o’clock position in all the cases, giving the appearance of a ‘pearl (cyst) on a string (fibrotic bands)’. In most cases of cyst rupture, it took place during dissection of these bands. The aim of our study was to see if there was any significant difference in rupture and recurrence rate by sharp versus blunt dissection of these fibrotic bands.

Study design: Retrospective nonrandomized cohort comparison.

Materials and methods: Fifty-nine subepithelial cysts were operated by microflap technique. The first 26 cysts were taken in alternation for blunt vs sharp dissection of the fibrotic bands. As the results of sharp dissection were better, the subsequent 33 cysts were operated with sharp dissection of the anterior and posterior bands.

Results: Sharp dissection of the anterior and posterior bands during microflap dissection reduced the incidence of cyst rupture (p = 0.006) and recurrence (p = 0.007) of cyst formation.

Conclusion: SEVFC are anchored by thick fibrotic bands at the 12 and 6 o’clock position giving it the appearance of a ‘pearl (cyst) on a string (fibrotic bands)’. Sharp dissection of these bands during microflap dissection reduces the incidence of cyst rupture and recurrence.

Keywords:Subepithelial vocal fold cyst, Mucous retention cyst, Epidermoid cyst, Microflap dissection, Cyst rupture, Cyst recurrence.

How to cite this article: Nerurkar NK, Shukla SC. Subepithelial Vocal Fold Cyst: A Pearl on a String? Int J Phonosurg and Laryngol 2012;2(2):53-56.

Source of support: Nil

Conflict of interest: None declared


 
ORIGINAL ARTICLE
Unnikrishnan Menon, VS Sheejamol, Meera P Cherian

Validation of Malayalam Version of the Voice Handicap Index

[Year:2012] [Month:January-June] [Volumn:2 ] [Number:1] [Pages:51] [Pages No:1-4][No of Hits : 3527]


ABSTRACT

Background: It is important to have a subjective measure of hoarseness. This can be best achieved if the questionnaire is in the patient’s own language.

Objective: To translate the voice handicap index (VHI) into the Malayalam language, and to evaluate its clinical validity and internal consistency.

Materials and methods: One hundred and six patients with dysphonia and 20 asymptomatic subjects were included in the study. Internal consistency was analyzed through Cronbach’s alpha coefficient. For the clinical validity assessment, the scores obtained in the patient group were compared with those found in asymptomatic individuals through the Mann-Whitney U-test. Also, comparison between the VHI scores before and after phonomicrosurgery on 14 out of the studied 106 patients was done using the nonparametric Wilcoxon signed ranks test. Spearman rank correlation was used to find the effect of patient’s age on VHI scores. Finally, the gender-wise average VHI score and its three subsets was analyzed using Wilcoxon signed ranks test.

Results: The internal consistency was found to be excellent (α= 0.946). The control group scored significantly lower than the patients group (p < 0.001). Similarly, significant improvement was seen in the postoperative average VHI scores (p < 0.004). All of the preceding proves the validity of the translated questionnaire. Age showed a significant negative correlation for the overall VHI and their three domains (p < 0.001) in the dysphonic patients. There was no such correlation between male and female patient groups.

Conclusion: This Malayalam language version of the VHI questionnaire is a valid instrument for use in the voice clinic.

Clinical implication: Encouragement to all voice clinicians in India to develop and use the VHI in their native tongues.

Keywords:Dysphonia, Voice handicap index, Validation study.

How to Cite this article: Menon U, Sheejamol VS, Cherian MP. Validation of Malayalam Version of the Voice Handicap Index. Int J Phonosurg Laryngol 2012;2(1):1-4.

Source of support: Nil

Conflict of interest: None declared


 
CASE REPORTS
Sudhir M Naik

Aspirated Voice Prosthesis: A Unique Complication of Post Total Laryngectomy Voice Rehabilitation

[Year:2012] [Month:January-June] [Volumn:2 ] [Number:1] [Pages:51] [Pages No:41-45][No of Hits : 3311]


ABSTRACT

Background/objectives: Prosthetic voice rehabilitation after total laryngectomy has proven to be successful in restoring proper speech function in over 90% of patients. The possibility of achieving effective speech using the voice prosthesis is superior to esophageal speech and electrolarynx.

Setting: Department of Head and Neck Oncosurgery, Kidwai Memorial Institute of Oncology, Bengaluru.

Case report: A 75-year-old female who had undergone wide field laryngectomy 14 months back came with history of lost voice prosthesis which was later found aspirated. It was removed by the bronchoscopic forceps under topical anesthesia by visualizing it by a nasal 0° wide angle endoscope. The puncture site was cleaned and allowed to cicatrize and narrow down. The fistula was closed by topical application of silver nitrate.

Conclusion: Tracheoesophageal puncture and prosthesis rehabilitation has emerged as the standard voice rehabilitation of laryngectomized patients. Patient education regarding maintenance of the prosthesis and the care for the tracheostoma is important in reducing the complications.

Keywords:Voice prosthesis, Total laryngectomy, Tracheoesophageal puncture, Aspiration.

How to Cite this article: Naik SM. Aspirated Voice Prosthesis: A Unique Complication of Post Total Laryngectomy Voice Rehabilitation. Int J Phonosurg Laryngol 2012;2(1):41-45.

Source of support: Nil

Conflict of interest: None declared


 
CASE REPORTS
Nupur Kapoor Nerurkar, Sunita Chhapola Shukla

Stridor due to Bilateral Implant Migration 5 Years after Bilateral Medialization Laryngoplasty

[Year:2012] [Month:July-December] [Volumn:2 ] [Number:2] [Pages:38] [Pages No:82-84][No of Hits : 3081]