International Journal of Phonosurgery & Laryngology

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2023 | July-December | Volume 13 | Issue 2

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PSN Murthy, Bhagyashree Bokare


[Year:2023] [Month:July-December] [Volume:13] [Number:2] [Pages:1] [Pages No:iv - iv]

   DOI: 10.5005/ijopl-13-2-iv  |  Open Access | 


Original Article

S Vivek, Jayakumar R Menon, Manju E Issac, Basil Varghese

Validation of Ni's Grading and European Laryngological Society Grading for Laryngeal Lesions: A Prospective Cross-sectional Study

[Year:2023] [Month:July-December] [Volume:13] [Number:2] [Pages:5] [Pages No:19 - 23]

Keywords: Histopathological examination, Hoarseness, Laryngeal cancer, Laryngoscopy, Narrow band imaging

   DOI: 10.5005/jp-journals-10023-1251  |  Open Access |  How to cite  | 


Aims and background: Laryngeal carcinomas comprise one-third of all head and neck carcinomas. Early detection of these lesions is pertinent for curative and functional preservation. Narrow band imaging (NBI) is a novel biological endoscopic tool enabling in vivo differentiation of nonmalignant from malignant laryngeal lesions. Ni et al. proposed a classification of laryngeal lesions based on intraepithelial papillary capillary loops (IPCL) patterns from type I to V. The European Laryngological Society (ELS) introduced a simpler classification in 2015, categorizing vascular changes as either longitudinal or perpendicular. The present study is aimed at identifying the angiogenetic pattern of different laryngeal lesions and validating the two different grading systems. Materials and methods: Preoperative flexible laryngoscopy coupled NBI evaluation was done for 30 consecutive patients with laryngeal lesions posted for excision biopsy and graded according to both Ni's and ELS grading. The biopsy results of the lesions were correlated with preoperative NBI gradings. Results: Of the 30 patients, 23 (76.7%) were males, and seven (23.3%) were females. The maximum number of patients, 13 (43.3%) belonged to Ni's grade V, whereas 15 patients (50%) each showed longitudinal and perpendicular pattern blood vessels, respectively in ELS grading. A total of 14 patients (46.7%), five patients (16.7%), and 11 patients (36.7%) were revealed to be benign, dysplastic, and malignant, respectively on biopsy. Both Ni's and ELS grading had a statistically significant association with the benign or malignant nature of the lesion. The sensitivity and specificity of Ni's grading were 84.2 and 90.9%, and of ELS grading were 78.9 and 100%, respectively. Both these gradings had similar measures of agreement with histopathological examination (HPE) (measured by Cohen's κ). Conclusion: The NBI is a useful diagnostic tool in evaluating laryngeal pathologies. Clinical significance: The ELS grading system which is convenient and easy to use than Ni's grading can be reliably used for classifying laryngeal lesions.


Original Article

Nishigandha V Nehete, Anagha A Joshi, Manish A Prajapati

Unveiling the Harmonics of the Singing Voice: A Comparative Evaluation of Voice Handicap Index-10, Singing Voice Handicap Index-10, and Singer Reflux Symptom Score in Singers: A Cross-sectional Observational Study

[Year:2023] [Month:July-December] [Volume:13] [Number:2] [Pages:3] [Pages No:24 - 26]

Keywords: Laryngopharyngeal reflux, Self-perpetual scale, Singers Reflux Symptom Score, Singing Voice Handicap Index-10, Voice Handicap Index-10

   DOI: 10.5005/jp-journals-10023-1252  |  Open Access |  How to cite  | 


Aims and objectives: The purpose of this study is to compare the Voice Handicap Index-10 (VHI-10) with the Singer's Voice Handicap Index-10 (SVHI-10) and assess the Singer Reflux Symptom Score (Singer RSS) with the SVHI-10. Materials and methods: Study design. Type of study—cross-sectional observational study. Sample size (n)—69. Duration of study—4 months. Period of study—March–June 2020. Method—The Google Survey Form™ was designed and created by us and circulated to singers through WhatsApp and Email. VHI-10, SVHI-10, and Singer RSS scores are considered for this study. Results: Comparison of VHI-10 with Singing Voice Handicap Index-10the mean VHI-10 was 3.03 and that of SVHI-10 was 6.80 with a p-value was <0.001, which signifies that singers have very specific singing voice issues. Effect of Singer RSS on SVHI-10 scoreonly the disorder severity scale was considered in the Singer RSS. Singer RSS score was divided into three groups viz 0–15, 16–30, and 31–45 and an average SVHI-10 score was 19.62 in a group of singers having Singer RSS score between 31 and 45, suggesting that laryngopharyngeal reflux (LPR) causes severe singing voice impairment. Conclusion: Singers have more specific singing voice issues along with a speaking voice that can be adequately addressed by voice surgeons. LPR is one of the major factors contributing to vocal problems in singers. Self-perceptual scales like VHI-10, SVHI-10, and Singers RSS can be efficiently used to assess voice impairment in singers. Singers have more specific singing voice issues along with a speaking voice that can be adequately addressed by voice surgeons. Clinical significance: The self-perpetual scales viz VHI-10, SVHI-10, and Singers RSS can be used to assess specific singing voice issues so that they can be adequately addressed by voice surgeons.



Hesti D Palupi, Anisa H Khoiria, Ardhila R Rasyada

A Rare Case of Ductal Laryngeal Cyst and Its Surgical Outcome

[Year:2023] [Month:July-December] [Volume:13] [Number:2] [Pages:5] [Pages No:27 - 31]

Keywords: Case report, Dysphonia, Laryngeal cyst, Microlaryngeal surgery, Steroid injection, Vocal cord cyst

   DOI: 10.5005/jp-journals-10023-1248  |  Open Access |  How to cite  | 


Background: Benign lesions of vocal fold commonly occur in general population, causing significant hoarseness and interfering with routine vocal use. We aim to report a combination of microlaryngeal surgery and steroid injection intralesion in treating vocal fold ductal cyst. Case description: A 46-year-old male presented with chronic and persistent dysphonia for the past 2 years. Flexible laryngoscope examination showed a pale white mass on the one-third anterior of the right true vocal fold. Significant improvement was acquired following microlaryngeal surgery and vocal fold steroid injection. Conclusion: A vocal cord ductal cyst, a rare apparition, manifests clinically similar to other benign laryngeal lesions. Therefore, a common management algorithm can be utilized. Postoperative care is a notable matter in the management of a ductal laryngeal cyst to achieve good vocal outcome.



Nilanjan Bhowmick, Snehpali Bansode, Harshal Jadhao, Sachin Goel, Rajasudhakar Rathinaswamy

Impact of Intralesional Steroid Injections in a Case of Postintubation Subglottic Granuloma

[Year:2023] [Month:July-December] [Volume:13] [Number:2] [Pages:3] [Pages No:32 - 34]

Keywords: Case report, Granuloma, Intralesional injection, Laryngeal granuloma, Postintubation granuloma, Steroid injection, Steroids, Subglottic granuloma

   DOI: 10.5005/jp-journals-10023-1247  |  Open Access |  How to cite  | 


Subglottic granuloma is a rare but life-threatening complication of long-term tracheal intubation. Here, we report a case of an adult female who presented with difficulty breathing. The patient had a history of intubation in the past, and on video laryngoscopy, it was diagnosed as subglottic granuloma and managed with microlaryngeal surgical excision with intralesional steroids. Postoperative systemic and inhaled steroids with prompt anti-reflux medications were advised. Recurrence of the granuloma was treated on outpatient department (OPD)—based procedure of intralesional steroid injections and followed up with no evidence of any lesion for a period of 10 months.



Nupur K Nerurkar, Enu M Kukreja, Jahnavi

Squamous Cell Malignancy Coexisting with Squamous Papilloma in the Larynx: Is This an Entity?

[Year:2023] [Month:July-December] [Volume:13] [Number:2] [Pages:4] [Pages No:35 - 38]

Keywords: Adult-onset recurrent respiratory papillomatosis, Case report, Malignant transformation, No type recurrent respiratory papillomatosis, Recurrent respiratory papillomatosis, histopathology, Squamous papilloma

   DOI: 10.5005/jp-journals-10023-1249  |  Open Access |  How to cite  | 


Background: Recurrent respiratory papillomatosis (RRP) is the most common benign mesenchymal neoplasm of the larynx caused by the human papillomavirus (HPV). This condition has a childhood-onset and adult-onset type, which historically has an inclination toward malignant transformation. Case description: A detailed case discussion of two patients with two clinically distinct and dissimilar lesions on two different subsites of the larynx. Both patients were clinically diagnosed to have laryngeal papilloma, with a second malignant lesion. In case 1, the final histopathology of the malignant lesion was found to have papillomatous fronds with evidence of severe dysplasia. In case 2, histopathology of the malignant lesion revealed invasive squamous cell carcinoma with features of papilloma. Both patients revealed “no type” in viral typing. Conclusion: Malignant transformation in adult laryngeal papilloma may occur as a relatively acute phenomenon that may present at the first surgical intervention. It is often associated with the “no type” HPV entity. The presence of squamous papilloma and carcinoma of the larynx, even at two different subsites, should be histologically confirmed and considered a malignant transformation of the laryngeal papilloma.


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