International Journal of Phonosurgery & Laryngology

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2017 | July-December | Volume 7 | Issue 2

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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] [Volume:7] [Number:2] [Pages:5] [Pages No:39 - 43]

   DOI: 10.5005/jp-journals-10023-1141  |  Open Access |  How to cite  | 


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.



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] [Volume:7] [Number:2] [Pages:4] [Pages No:44 - 47]

   DOI: 10.5005/jp-journals-10023-1142  |  Open Access |  How to cite  | 


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.



Jyoti Singh, Jai L Davessar, Nitin Arora

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

[Year:2017] [Month:July-December] [Volume:7] [Number:2] [Pages:4] [Pages No:48 - 51]

   DOI: 10.5005/jp-journals-10023-1143  |  Open Access |  How to cite  | 


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.



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] [Volume:7] [Number:2] [Pages:7] [Pages No:52 - 58]

   DOI: 10.5005/jp-journals-10023-1144  |  Open Access |  How to cite  | 


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



Deepti Sapkale

Evaluation of Validity of Voice Handicap Index among Indian Population

[Year:2017] [Month:July-December] [Volume:7] [Number:2] [Pages:4] [Pages No:59 - 62]

   DOI: 10.5005/jp-journals-10023-1145  |  Open Access |  How to cite  | 


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.



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

Successful Treatment of Dysphagia in a Case of Lateral Medullary Syndrome

[Year:2017] [Month:July-December] [Volume:7] [Number:2] [Pages:3] [Pages No:63 - 65]

   DOI: 10.5005/jp-journals-10023-1146  |  Open Access |  How to cite  | 


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.



Arundhatee P Sapre, Rahul S Gosavi

Fungal Laryngitis in Immunocompetent Individuals: Not so Uncommon

[Year:2017] [Month:July-December] [Volume:7] [Number:2] [Pages:6] [Pages No:66 - 71]

   DOI: 10.5005/jp-journals-10023-1147  |  Open Access |  How to cite  | 


Fungal laryngitis (FL) in immunocompetent individuals has been described as a rare entity. Management of 11 cases of suspected isolated FL in immunocompetent patients is discussed. Fungal laryngitis was suspected if white smooth plaques with surrounding inflammation were seen on the larynx. Suspected patients were given 200 mg OD oral fluconazole for 3 to 4 weeks. In those who showed no improvement at 2 weeks, complete excision of the lesion was performed (five patients). Eight patients gave history of having received a course of oral steroids, one of inhaled steroids. The average erythrocyte sedimentation rate (ESR) of the patients was 42.



Divya Khosla, Hitesh Verma, Shilpi Budhiraja, Phiza Agrawal

Pleomorphic Sarcoma of Larynx

[Year:2017] [Month:July-December] [Volume:7] [Number:2] [Pages:3] [Pages No:72 - 74]

   DOI: 10.5005/jp-journals-10023-1148  |  Open Access |  How to cite  | 


Background: Malignant fibrous histiocytoma (MFH) is a malignant type of sarcoma with uncertain origin and it may arise from bone and soft tissue. In 3% cases it involves head and neck and it is rare in larynx. Case report: We present a rare case of a 55-year-old male diagnosed as pleomorphic sarcoma (PS) of larynx. Conclusion: Plemorphic sarcoma, commonest subtype of MFH, should be kept in mind as a differential diagnosis in aggressive tumors of larynx. Clinical significance: Pleomorphic sarcoma of larynx may be diagnosed as rare tumor of larynx and may need aggressive treatment.



Nitty Mathew, Raghavendra K Suresh, Ganamukhi M Shivaputra, Suhel Hasan

A Rare Case of Herpes Zoster with Pharyngolaryngeal, Facial, and Vestibulocochlear Nerve Involvement

[Year:2017] [Month:July-December] [Volume:7] [Number:2] [Pages:3] [Pages No:75 - 77]

   DOI: 10.5005/jp-journals-10023-1149  |  Open Access |  How to cite  | 


Herpes zoster virus (HZV) infection can present as various symptoms according to site of involvement. We present a case of herpes zoster with multiple cranial nerve palsies. Patient presented with initial symptoms of otalgia, dysphagia and odynophagia. Her condition progressed to herpetic rashes over the ear, facial nerve palsy,sensorineural hearing loss and vocal cord paresis. All the lesions tended to lateralize to the right side.


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