International Journal of Phonosurgery & Laryngology

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2012 | January-June | Volume 2 | Issue 1

EDITORIAL

POSTLARYNGECTOMY SURGICAL VOICE REHABILITATION

[Year:2012] [Month:January-June] [Volume:2] [Number:1] [Pages:1] [Pages No:0 - 0]

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

EDITORIAL

LARYNGOTRACHEAL TRANSPLANTATION

[Year:2012] [Month:January-June] [Volume:2] [Number:1] [Pages:1] [Pages No:0 - 0]

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

RESEARCH ARTICLE

Unnikrishnan Menon, VS Sheejamol, Meera P Cherian

Validation of Malayalam Version of the Voice Handicap Index

[Year:2012] [Month:January-June] [Volume:2] [Number:1] [Pages:4] [Pages No:1 - 4]

PDF  |  DOI: 10.5005/jp-journals-10023-1025  |  Open Access |  How to cite  | 

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.

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.

RESEARCH ARTICLE

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

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

[Year:2012] [Month:January-June] [Volume:2] [Number:1] [Pages:4] [Pages No:5 - 8]

PDF  |  DOI: 10.5005/jp-journals-10023-1026  |  Open Access |  How to cite  | 

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.

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.

RESEARCH ARTICLE

Yusuf Kizil, Utku Aydil, Metin Yilmaz, Özgür Ekinci, Osman Tugrul Güzeldir, Veysel Akif Savas, Ahmet Köybasioglu

Vocal Cord Leukoplakia: Characteristics and Pathological Significance

[Year:2012] [Month:January-June] [Volume:2] [Number:1] [Pages:5] [Pages No:9 - 13]

PDF  |  DOI: 10.5005/jp-journals-10023-1027  |  Open Access |  How to cite  | 

Abstract

How to cite this article

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

RESEARCH ARTICLE

Mohan Kameswaran, Kiran Natarajan, Arpana Shekhar, Raghunandhan Sampath, Sathya Murali

Outcomes in Management of Pediatric Laryngotracheal Stenosis: Our Experience

[Year:2012] [Month:January-June] [Volume:2] [Number:1] [Pages:6] [Pages No:14 - 19]

PDF  |  DOI: 10.5005/jp-journals-10023-1028  |  Open Access |  How to cite  | 

Abstract

Background

Pediatric laryngotracheal stenosis is a difficult entity encountered in clinical practice which manifests with a myriad of etiologies and presentations. Management of pediatric laryngotracheal stenosis is a surgical challenge which requires meticulous preoperative evaluation and planning.

Aim of study

This is a retrospective study of the efficacy of different surgical techniques involved in restoring the airway patency in pediatric laryngotracheal stenosis performed at our institution over 4 years.

Materials and methods

Twenty-four pediatric patients underwent treatment for laryngotracheal stenosis over a 4-year period (June 2006-May 2010). Various surgical modalities, such as anterior cricoid split, costal cartilage interposition, stenting, laser procedures, etc. were used. Hood's stent, Montgomery T-tube, silastic swiss roll, indwelling nitinol tracheal stent were used to stent the airway after resection of the stenotic segment.

Results

Nine patients achieved successful decannulation with single-stage procedure and 14 patients underwent multiple procedures. Of 24 patients, decannulation was possible in 18 patients (75%), one patient had no indication for tracheostomy and five children (20%) have a persisting tracheostomy including two who were lost to follow-up.

Conclusion

It is vital to outline a rational approach to the management of laryngotracheal stenosis in children based on the site and severity of the stenotic segment. No single approach is ideal and often several procedures may be required before decannulation can be achieved. Limitations of study: Patients were followed-up for 1 year. A long-term follow-up is preferable.

How to cite this article

Shekhar A, Natarajan K, Sampath R, Kameswaran M, Murali S. Outcomes in Management of Pediatric Laryngotracheal Stenosis: Our Experience. Int J Phonosurg Laryngol 2012;2(1):14-19.

RESEARCH ARTICLE

Sudarshan L Reddy, Sridhar D Reddy, AVVSL Prasad

A Prospective Study of Total Laryngectomy and associated Complications

[Year:2012] [Month:January-June] [Volume:2] [Number:1] [Pages:3] [Pages No:20 - 22]

PDF  |  DOI: 10.5005/jp-journals-10023-1029  |  Open Access |  How to cite  | 

Abstract

How to cite this article

Reddy SL, Reddy SD, Prasad AVVSL. A Prospective Study of Total Laryngectomy and associated Complications. Int J Phonosurg Laryngol 2012;2(1):20-22.

RESEARCH ARTICLE

Rauf Ahmad, Raja Salman Khurshid, Mukhtar Ahmad Khan

Clinical Profile of Hoarseness and its Management Options: A 2 years Prospective Study of 145 Patients

[Year:2012] [Month:January-June] [Volume:2] [Number:1] [Pages:7] [Pages No:23 - 29]

PDF  |  DOI: 10.5005/jp-journals-10023-1030  |  Open Access |  How to cite  | 

Abstract

Aim

This study was undertaken to study the clinical profile of hoarseness and the role of conservative (nonsurgical) and surgical modes of intervention.

Materials and methods

A prospective cohort analysis was carried out in Department of ENT, Government Medical College, Srinagar, in 145 cases of change in voice for 2 years duration. All cases were analyzed for detailed history and pre- and postoperative fiber optic laryngeal examination. The cases were managed by conventional conservative methods or underwent phonosurgery in nonresolving cases.

Results

Total 145 cases with M:F ratio of 1.37:1 were analyzed. Patients’ age ranged from 5 to 80 years and majority of patients equally presented in 4th and 6th decade and about 75% had duration of hoarseness of more than 3 months. A voice demanding profession was present in 34% of cases. Vocal abuse was the commonest predisposing factor (about 40%) followed by larygopharyngeal reflux disease (26%). Functional voice disorders were found in 15.85% of cases while 62.06% of patients had a definite organic disorder. Conservative treatment (primary) was employed in 103 cases (71%), surgical treatment (primary) in 42 cases (29%) and surgical treatment after failure of conservative was given in 22 cases (15%).

How to cite this article

Khurshid RS, Khan MA, Ahmad R. Clinical Profile of Hoarseness and its Management Options: A 2 years Prospective Study of 145 Patients. Int J Phonosurg Laryngol 2012;2(1):23-29.

CASE REPORT

Ravi C Nayar, Shreekantha B Kakkillaya, Shantanu Tandon

Isolated Primary Subglottic Laryngeal Amyloidosis Presenting as Sudden Airway Obstruction

[Year:2012] [Month:January-June] [Volume:2] [Number:1] [Pages:3] [Pages No:30 - 32]

PDF  |  DOI: 10.5005/jp-journals-10023-1031  |  Open Access |  How to cite  | 

Abstract

How to cite this article

Vamanshankar H, Kakkillaya SB, Tandon S, Nayar RC. Isolated Primary Subglottic Laryngeal Amyloidosis Presenting as Sudden Airway Obstruction. Int J Phonosurg Laryngol 2012;2(1):30-32.

CASE REPORT

Sudhir M Naik

Untreated Cleft Palate a Unique Surgical Contraindication in Carcinoma of the Pyriform Fossa

[Year:2012] [Month:January-June] [Volume:2] [Number:1] [Pages:4] [Pages No:33 - 36]

PDF  |  DOI: 10.5005/jp-journals-10023-1032  |  Open Access |  How to cite  | 

Abstract

Background/objectives

Swallowing problems following total laryngectomy are significantly lesser compared to other partial laryngectomies as a permanent seperation between the trachea and esophagus is seen in the earlier. Sometimes, the patient complains of difficulty in propelling bolus through the oral cavity and pharynx as a result of the loss of hyoid bone, which is the anchor for the tongue. The increased pressure in the narrowed pharyngoesophageal segment following laryngectomy requires the tongue to move with greater force.

Setting

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

Case report

A 52-year-old man with history of difficulty and pain while swallowing and diagnosed as squamous cell carcinoma of the right pyriform fossa extending to the pharyngoepiglottic fold. Incidently, the patient had an old untreated cleft palate. Assessment of the pharyngeal wall involvement on direct laryngoscopy proved that pectoralis major myocutaneous flap patch was needed to reconstruct the pharyngeal lumen. Cleft palate proved a contraindication for surgery as the oral swallowing phase would be affected.

Conclusion

Current management protocols of hypopharyngeal cancers include multifactorial assessment of anatomical and functional outcomes and rehabilitation. Even though no literature is found stating cleft palate as the contraindication for total laryngectomy, chemoradiation was preferred citing swallowing problems.

How to cite this article

Naik SM. Untreated Cleft Palate a Unique Surgical Contraindication in Carcinoma of the Pyriform Fossa. Int J Phonosurg Laryngol 2012;2(1):33-36.

CASE REPORT

NV Deepthi, Janhvi J Bhate, K Madhumita

Rare Benign Tracheal Lesions

[Year:2012] [Month:January-June] [Volume:2] [Number:1] [Pages:4] [Pages No:37 - 40]

PDF  |  DOI: 10.5005/jp-journals-10023-1033  |  Open Access |  How to cite  | 

Abstract

How to cite this article

Bhate JJ, Deepthi NV, Menon UK, Madhumita K. Rare Benign Tracheal Lesions. Int J Phonosurg Laryngol 2012;2(1):37-40.

CASE REPORT

Sudhir M Naik

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

[Year:2012] [Month:January-June] [Volume:2] [Number:1] [Pages:5] [Pages No:41 - 45]

PDF  |  DOI: 10.5005/jp-journals-10023-1034  |  Open Access |  How to cite  | 

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.

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.

CASE REPORT

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] [Volume:2] [Number:1] [Pages:3] [Pages No:46 - 48]

PDF  |  DOI: 10.5005/jp-journals-10023-1035  |  Open Access |  How to cite  | 

Abstract

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.

CASE REPORT

Israfil Orhan, Fahrettin Yilmaz, Mehmet Eken

Laryngeal Ulceration in Behcet's Disease

[Year:2012] [Month:January-June] [Volume:2] [Number:1] [Pages:3] [Pages No:49 - 51]

PDF  |  DOI: 10.5005/jp-journals-10023-1036  |  Open Access |  How to cite  | 

Abstract

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.

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