International Journal of Phonosurgery & Laryngology

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2011 | July-December | Volume 1 | Issue 2

EDITORIAL

Editorial

[Year:2011] [Month:July-December] [Volume:1] [Number:2] [Pages:1] [Pages No:0 - 0]

   DOI: 10.5005/ijopl-1-2-v  |  Open Access |  How to cite  | 

EDITORIAL

KK Handa

Lasers in Laryngology; Current Status

[Year:2011] [Month:July-December] [Volume:1] [Number:2] [Pages:1] [Pages No:0 - 0]

   DOI: 10.5005/ijopl-1-2-vi  |  Open Access |  How to cite  | 

RESEARCH ARTICLE

Jayakumar R Menon

Flaring of Ala Nasi: A Reliable Diagnostic Sign for Abductor Spasmodic Dysphonia

[Year:2011] [Month:July-December] [Volume:1] [Number:2] [Pages:3] [Pages No:41 - 43]

   DOI: 10.5005/jp-journals-10023-1010  |  Open Access |  How to cite  | 

Abstract

Objective

To study the reliability of flaring of ala nasi as a diagnostic sign in abductor spasmodic dysphonia.

RESEARCH ARTICLE

Nayla Matar, Georges Lawson, Marc Remacle, Marie-Cécile Nollevaux, Monique Delos, Jacques Jamart

Reliability of Frozen Section Analysis in Transoral Laser Microsurgery of Upper Aerodigestive Tract Advanced Malignant Tumors

[Year:2011] [Month:July-December] [Volume:1] [Number:2] [Pages:3] [Pages No:44 - 46]

   DOI: 10.5005/jp-journals-10023-1011  |  Open Access |  How to cite  | 

Abstract

Objective

Transoral laser microsurgery (TLM) for endoscopic excision of head and neck cancers of the upper aerodigestive tract has become an accepted treatment modality. As in any excision of head and neck tumors, the persistance of tumor at the surgical margins influences the outcome. One of the frequent criticisms of endoscopic resection is that the laser use makes interpretation of the surgical margins difficult due to the thermal effect. The goal of this study is to assess the reliability of frozen section after laser excision in locally advanced tumors.

Methods

The charts of patients with T2 and T3 tumors, who underwent TLM between January 2000 and 2008, using the CO2 laser AcuBlade system were reviewed. Frozen section margin results obtained during TLM were compared with margins after formalin fixation.

Results

Sixty-seven patients fulfilled the inclusion criteria. 20 had supraglottic tumors, 22 had oral cavity tumors, 13 had oropharyngeal tumors and 12 had hypopharyngeal tumors. Fifty-nine had no prior treatment, seven had prior radiation therapy and one had prior open surgery. The mean number of frozen margins per surgery was 4. Histological examination on the formalin-fixed tissue confirmed frozen section in 97% of the cases. In 3% of the frozen sections, the diagnosis of invasive carcinoma was missed. None of these patients had significant locoregional disease progression.

Conclusion

Frozen section analysis of margins is reliable during TLM when performed by an experienced team. It enables a one-stage approach reducing the need of a planned second procedure.

RESEARCH ARTICLE

John Samuel, Shenbagavalli Mahalingam, Subramaniyam Balasubramaniyam, Prakash Boominathan, Ravikumar Arunachalam

Stroboscopic and Multiparametric Acoustic Analysis of Voice after Vocal Loading Task

[Year:2011] [Month:July-December] [Volume:1] [Number:2] [Pages:5] [Pages No:47 - 51]

   DOI: 10.5005/jp-journals-10023-1012  |  Open Access |  How to cite  | 

Abstract

Introduction

Voice overuse may result in roughness, fatigue and pain while speaking. Vocal loading tasks have been used to assess changes in voice quality under different controlled settings. This study was done to document changes in voice characteristics before, immediately and 24 hours post-vocal loading task (VLT) using stroboscopic and acoustic analysis.

Materials and methods

Ten healthy adult males (age range: 20 to 40 years) with no apparent comorbid illness participated in the study. They were instructed to read the standard Rainbow passage at intensity above 75 dB SPL until they perceived any symptoms of fatigue/ strain. Stroboscopy and comprehensive voice assessment were done on all subjects before, immediate post VLT and 24 hours post VLT.

Results

Symptoms of vocal fatigue were noted on an average of 45 minutes of loud reading. Vocal fold edema, ventricular band hyperadduction and arytenoid congestion were noticed in immediate post task. The vocal fold movements were asymmetric and aperiodic with reduced mucosal wave and amplitude. Maximum phonation time (MPT) revealed statistically significant decrease (approximately 7 sec). Multiparametric acoustic analysis revealed a statistically significant increase in fundamental frequency, perturbation measures and lowest intensity with significant decrease in dysphonia severity index (DSI). All parameters (stroboscopic findings, perceptual, aerodynamic and acoustic analysis) showed values within normal limits after 24 hours post-task indicating recovery at 24 hours after vocal loading. Stroboscopy served as an evidence for structural and functional changes in the vocal fold. Changes in voice characteristics and recovery following vocal loading task can be documented using comprehensive voice assessment.

RESEARCH ARTICLE

S Raghunandhan, Kiran Natarajan, S Raghunandhan, Jawahar Nagasundaram, Srividya Prashanth

Videostroboscopy in Laryngopharyngeal Reflux Disorder

[Year:2011] [Month:July-December] [Volume:1] [Number:2] [Pages:5] [Pages No:52 - 56]

   DOI: 10.5005/jp-journals-10023-1013  |  Open Access |  How to cite  | 

Abstract

Introduction

Acid reflux disease of the larynx has been established as a separate clinical entity in the present day, requiring the nuances of a skilled laryngologist for its early diagnosis and appropriate management. Clinical presentations of laryngopharyngeal reflux disorder may vary from very subtle to mammoth proportions, ranging across a panorama of features like chronic laryngitis, indolent laryngeal ulcers or granulomas, onto life-threatening glottic/sub-glottic stenosis and laryngeal malignancies very rarely. With the advent of videostroboscopy, laryngologists have now acquired a ‘cutting-edge’ sensitive tool to look into the intricacies of the larynx and thereby study the pathological effects of laryngopharyngeal reflux in great detail.

Objective

To assess the efficacy of videostroboscopy with voice analysis, as a diagnostic and prognostic tool in a cohort of patients with laryngopharyngeal reflux disorder.

Study method

This prospective study was conducted over a two-year period, among 50 patients with hoarseness of voice and features of reflux laryngitis, who underwent videostroboscopy with voice analysis at initial diagnosis and at routine follow-up, to objectively study the response and outcome of anti-reflux therapy on the larynx.

Observation and result

Videostroboscopy provided a vivid picture of the changes in larynx due to chronic acid reflux and proved efficacious in precisely judging the treatment responses.

Conclusion

Our study reflects the recent concept highlighted in world literature that videostroboscopy is an ideal, sensitive tool for early diagnosis and in prognosis of acid induced laryngeal disorder.

RESEARCH ARTICLE

PH Dejonckere, C Manfredi

Long-term Follow-up of Patients with Spasmodic Dysphonia Repeatedly Treated with Botulinum Toxin Injections

[Year:2011] [Month:July-December] [Volume:1] [Number:2] [Pages:4] [Pages No:57 - 60]

   DOI: 10.5005/jp-journals-10023-1014  |  Open Access |  How to cite  | 

Abstract

Adductor spasmodic dysphonia (SD) is a focal laryngeal dystonia mainly resulting in a strained voice quality with spastic voice breaks and frequency shifts, perturbing fluency and intelligibility. SD-patients report unusually high impairment of their quality of life. The standard treatment is botulinum toxin injection in the thyroarytenoid muscles, in order to interfere with the perturbed sensory feedback loop of kinetic muscle tension regulation. The globally favorable effects are temporary, but the botulinum injections can be repeated. There is a lack of information about long-term effects. This is the first study investigating effects over several years, and comparing self-evaluation of patients with objective multimodal acoustic analysis. Results show that 72% of the individual injections are successful. The effects of botulinum are not reduced after repeated injections. In contrary, the self-perceived improvement increases in average over time. When self-evaluations preinjection are considered, patients tend to evaluate their voice and their handicap as worsening over time. This contrasts with the results of multimodal acoustic analysis. Objective data reveal a relative stability over time for as well pre- as postinjection. This seems to indicate that there is no shift over time in the objective severity of deviance in voice quality.

RESEARCH ARTICLE

Pankaj Kumar Doloi, Swagata Khanna

A Study of Management of Benign Lesions of the Larynx

[Year:2011] [Month:July-December] [Volume:1] [Number:2] [Pages:4] [Pages No:61 - 64]

   DOI: 10.5005/jp-journals-10023-1015  |  Open Access |  How to cite  | 

Abstract

A two-year prospective study was conducted from June 2008 to May 2010. A total of 80 patients with benign laryngeal lesions were included in the study based on symptoms, such as hoarseness of voice, foreign body sensation, vocal fatigue, dyspnea and cough and with positive clinical findings on indirect laryngoscopy. Diagnostic and therapeutic laryngoscopic and microlarygoscopic procedures were employed. Vocal cord polyps were observed to be the commonest type of lesions. Out of the 80 patients in the study group, 40% patients got complete relief with voice rest and vocal rehabilitation; 60% patients required surgery, which included endoscopic/microlarygoscopic endolaryngeal surgery and external approaches. There was no recurrence in cases of vocal polyps and nodules during the period of observation. Endolaryngeal surgery and voice rest offer a cost-effective, useful and safe method for the management of benign laryngeal lesions. With the inclusion of lasers, they can be more precisely operated. As such, the standard treatment of choice in all types of benign tumors of the larynx should consist of a triad of approach by microlaryngeal surgery (either microscopic or endoscopic, with or without use of lasers), voice rest and vocal rehabilitation.

RESEARCH ARTICLE

Suman Kumar, Amitabha Roychoudhury, Indranil Chatterjee, Hindol Halder, Sayani Bari

An Analytical Study of Age and Gender Effects on Voice Range Profile in Bengali Adult Speakers using Phonetogram

[Year:2011] [Month:July-December] [Volume:1] [Number:2] [Pages:6] [Pages No:65 - 70]

   DOI: 10.5005/jp-journals-10023-1016  |  Open Access |  How to cite  | 

Abstract

The study was aimed to analyze the changes in acoustic parameters based upon age and gender effects and to obtain normal voice range profile (VRP) of adult male and female of three different age range. Total no. of 90 subjects were grouped into three groups as per their age (20-30, 40-50 and 60-70 years) consisting 15 males and 15 females in each group. All participants were native Bengla speakers, not reported to have any speech, language, hearing, respiratory, or any other motor/ sensory deficits. Dr. Speech Software Phonetogram (version 4) and SPSS software (version 11.0) were used as tools. VRP parameters such as maximum and minimum fundamental frequency (F0), fundamental frequency range, sound pressure level (SPL), semitone and area were measured. Subjects were asked to phonate /a/ vowel in seven consistent registering in normal loudness. The mentioned parameters were measured by the tools. Responses were statistically analyzed by SPSS software (version 11.0). There was significant difference in fundamental frequency of males and females. But, there were no such significant difference in other parameters. For females endochronological changes results in more massive vocal folds and consequently, reduced F0 in old age group. Elderly males had a significantly higher F0 than young and middle aged due to vocal cord atrophy and tissue stiffening. In daily practice, the clinician prefers to make use of visual tools to treat the patient with voice problem.

CASE REPORT

Childhood Wegener's Granulomatosis with Subglottic Stenosis

[Year:2011] [Month:July-December] [Volume:1] [Number:2] [Pages:3] [Pages No:71 - 73]

   DOI: 10.5005/jp-journals-10023-1017  |  Open Access |  How to cite  | 

Abstract

Our aim is to highlight the possibility of subglottic stenosis caused by Wegener's granulomatosis. The incidence of subglottic stenosis in Wegener's granulomatosis is seen five times more often in children.

We report a case of a 12-year-old female diagnosed as Wegener's granulomatosis who was on medical treatment since six months. She presented to us with stridor. As rigid laryngoscopy revealed a pinhole opening in the subglottic region, an emergency tracheostomy was performed. This was followed by a planned microlaryngoscopy using cold steel instruments. A triradiate incision with dilatation, local steroid injection and topical application of mitomycin-c was performed. In Wegener's granulomatosis, subglottic stenosis is caused due to vasculitis therefore, the use of laser and stent is contraindicated, as this may lead to a further worsening of the stenosis.

Among various causes of subglottic stenosis, the most common cause is use of cuffed tracheostomy tube and endotracheal tube. It is essential to diagnose the etiology of subglottic stenosis to decide on the appropriate modality of treatment.

CASE REPORT

PSN Murthy, Vennela Devarakonda, Bhanuprasad , M Anupama, C Sitalatha

Granular Cell Tumor of Larynx in a Young Boy

[Year:2011] [Month:July-December] [Volume:1] [Number:2] [Pages:2] [Pages No:74 - 75]

   DOI: 10.5005/jp-journals-10023-1018  |  Open Access |  How to cite  | 

Abstract

Granular cell tumors are rare head and neck tumors and not a common presentation in larynx. We present a young boy of 12 years attending with hoarseness of voice. Clinical examination showed a well-defined lesion on the vocal process of the left vocal cord which was excised completely under operating microscope. The biopsy report came as histological surprise as granular cell tumor. The case is presented for its rarity of the lesion in the unusual site of the larynx.

CASE REPORT

PSN Murthy, Sudhakara M Rao, T Satishchandra

Cricopharyngeal Myotomy Revisited

[Year:2011] [Month:July-December] [Volume:1] [Number:2] [Pages:4] [Pages No:76 - 79]

   DOI: 10.5005/jp-journals-10023-1019  |  Open Access |  How to cite  | 

Abstract

Dysphagia due to neuromuscular in coordination is major disability for the patient. Not able to swallow food or liquids inspite of healthy appetite makes the patient most irritable and can lead to psychological problems. Added to the swallowing problem patient also encounters symptoms and signs of laryngeal penetration or aspiration. For these patients, surgical option of cricopharyngeal myotomy offers a very good relief. We describe two cases where CP myotomy could facilitate a good swallow and prevent laryngeal stimulation or penetration and made a significant improvement in the quality of life of the patients.

CASE REPORT

HP Schwarze, LU Scholtz, H Sudhoff

Epstein-Barr Virus Infection associated with Acute Recurrent Laryngeal Nerve Palsy

[Year:2011] [Month:July-December] [Volume:1] [Number:2] [Pages:2] [Pages No:80 - 81]

   DOI: 10.5005/jp-journals-10023-1020  |  Open Access |  How to cite  | 

Abstract

Introduction

Epstein-Barr virus (EBV) belongs to the group of human herpes viruses and can cause the clinical syndrome of infectious mononucleosis. EBV infection has been reported to cause several neurological complications. However, cranial nerve deficits are rare and have been infrequently reported. To our knowledge, recurrent laryngeal nerve palsy in EBV acutely infected patients has been reported only once with a case of bilateral laryngeal nerve palsy.

Case presentation

A case of a 41-year-old female Caucasian patient with a positive serology of active EBV infection developing acute recurrent laryngeal nerve palsy is presented. Fiberoptic rhinolaryngoscopy with stroboscopy showed complete paralysis of the left vocal cord in abduction with abundant secretions, consistent with unilateral recurrent laryngeal nerve paralysis. Full recovery over a 6-month follow-up period has been achieved by starting immediate speech therapy.

Conclusion

Our case report confirms the possible involvement of EBV infection in recurrent laryngeal nerve palsy. This rarely described association should be taken into account as an extremely rare differential diagnosis in patients suffering from recurrent laryngeal nerve paralysis and fatigue symptoms with muscle pain. To minimize the risk of permanent palsy, immediate speech therapy is recommended.

CASE REPORT

Ravi Meher, Tripti Brar, PK Rathore, Virad Aggarwal, Aditi

Benign Corrosive Stricture Excision by Lateral Pharyngotomy

[Year:2011] [Month:July-December] [Volume:1] [Number:2] [Pages:2] [Pages No:82 - 83]

   DOI: 10.5005/jp-journals-10023-1021  |  Open Access |  How to cite  | 

Abstract

Benign corrosive lesion of aerodigestive tract is difficult to treat. We report a case of a 3-year-old male child who accidentally ingested acid and presented to the emergency a few hours later with difficulty in breathing and dysphagia. He was admitted and underwent a tracheotomy. A feeding jejunostomy was also done. The patient was then planned for an endoscopic examination followed by a lateral pharyngotomy. A few weeks later, a bougie dilatation of the esophageal stricture was done and the dysphagia was relieved.

CASE REPORT

M Gopinath, VV Ramachandran, Rohini Jose

Cervical Sympathetic Neurofibroma Masquerading as Obstructive Sleep Apnea Syndrome

[Year:2011] [Month:July-December] [Volume:1] [Number:2] [Pages:4] [Pages No:84 - 87]

   DOI: 10.5005/jp-journals-10023-1022  |  Open Access |  How to cite  | 

Abstract

Obstructive sleep apnea is a chronic condition characterized by frequent episodes of upper airway collapse during sleep. Collapsibility can be increased by underlying anatomic alterations and/or disturbances in upper airway, neuromuscular control, or both, which play key roles in the pathogenesis of obstructive sleep apnea. Neurofibromas of the parapharyngeal space are the second most commonly encountered primary tumor of the nerve sheath origin. A parapharyngeal neurofibroma of the cervical sympathetic chain, presenting as obstructive sleep apnea with all the features mimicking that condition is reported here for its rarity in modern clinical practice. A transcervical approach was adopted to excise the tumor in toto, following which patient was completely relieved of the symptoms, especially those of respiratory distress and features of OSAS.

CASE REPORT

Ravinder Verma, NK Sardana, Ravneet Ravinder Verma

Multiple Myxoid Lipomas of Supraglottic Region

[Year:2011] [Month:July-December] [Volume:1] [Number:2] [Pages:3] [Pages No:88 - 90]

   DOI: 10.5005/jp-journals-10023-1023  |  Open Access |  How to cite  | 

Abstract

Though lipomas are very common tumors occurring in the head and neck region, there are very few case reports of submucosal lipomas of the upper aerodigestive tract. A case of myxoid lipoma of the supraglottic region is reported.

RESEARCH ARTICLE

Arpit Sharma, Priya Shah, Jyoti Dabholkar, Neeti Kapre

Thyroarytenoid Muscle Ablation for Treatment of Spasmodic Dysphonia

[Year:2011] [Month:July-December] [Volume:1] [Number:2] [Pages:2] [Pages No:91 - 92]

   DOI: 10.5005/jp-journals-10023-1024  |  Open Access |  How to cite  | 

Abstract

Adductor spasmodic dysphonia is the most common form of laryngeal dystonia and comprises about 80% of all laryngeal dystonias. It is characterized by strained and strangled voice quality causing significant impairment to the patient. This article focuses on the surgical treatment of adductor spasmodic dysphonia by thyroarytenoid muscle ablation. It provides longlasting control of symptoms and patient satisfaction is very high.

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