International Journal of Phonosurgery & Laryngology

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2018 | July-December | Volume 8 | Issue 2

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Guest Editorial

Kishore Sandu

Guest Editorial

[Year:2018] [Month:July-December] [Volume:8] [Number:2] [Pages:1] [Pages No:0 - 0]

   DOI: 10.5005/IJOPL-8-2-iv  |  Open Access |  How to cite  | 


Original Article

Ushirin Bose, Santosh K Misra

Urinary Nitrosamines: An Underestimated Biomarker in Laryngeal Cancer

[Year:2018] [Month:July-December] [Volume:8] [Number:2] [Pages:4] [Pages No:61 - 64]

Keywords: Combined modality of tobacco consumption, Laryngeal cancer, 4(Methylnitrosoamino)-1-(3-pyridyl)-1butanone, 4-Methyl nitrosoamino-1-3-pyridyl-1 butanol, Urinary nitrosamines

   DOI: 10.5005/jp-journals-10023-1161  |  Open Access |  How to cite  | 


Laryngeal cancer is the ninth and the seventh most common cause of cancer in males in Asia and India, respectively, and enlisted as one of the tobacco-related cancers. The carcinogen in tobacco is the tobacco-specific nitrosamines (TSNAs). Both secondary and tertiary amines can react with nitrite yielding nitrosamines which are excreted in urine. This study aims at quantifying urinary nitrosamines. Aims and objectives: • To quantify urinary nitrosamines in smokers and subjects consuming chewable forms of tobacco. • Correlation of urinary nitrosamine levels with the development of laryngeal cancer. Materials and methods: This study was a retrospective cross-sectional study conducted in adult patients presenting at the outpatient department of ENT in a tertiary care hospital over a period of 2 years. One hundred twenty-six cases were studied in detail. The urine of all adult patients presenting with malignant or premalignant lesions of larynx was analyzed and the sample was then subjected to liquid chromatography followed by mass spectrometry and the final amount of urinary nitrosamines was obtained in picograms/nanoliter (pg/nL). Results: Out of 126 laryngeal lesions that presented at the outpatient department, 107 cases were malignant and 19 cases had premalignant lesions. The mean of quantity of urinary nitrosamines was found to be the highest 843pg/nL among the subjects practicing combined modality (smoke + smokeless) of tobacco consumption. The mean of urinary nitrosamines was significantly higher 778.23 pg/nL in smokers as compared with tobacco chewers 613.45 pg/nL. Out of the 107 patients of carcinoma larynx (Ca larynx), 78 cases were smokers suggesting smoking that has a stronger association in the development of carcinoma larynx. Conclusion: The amount of urinary nitrosamines was higher in smokers, high in cases when more than one modality of tobacco was consumed and was more in cases of malignancy of larynx as compared to benign lesions.


Original Article

Shokouh T Zahir, Koorosh Rahmani, Meisam Mehri, Mohammad Shafiee, Seyed M Reza Mortazavizadeh

Clinicopathological Characteristics and Survival Rate of Patients with Laryngeal Squamous Cell Carcinoma: A Retrospective Study during 2011–2017 in Yazd, Iran

[Year:2018] [Month:July-December] [Volume:8] [Number:2] [Pages:6] [Pages No:65 - 70]

Keywords: Chemotherapy, Larynx, Radiotherapy, Squamous cell carcinoma

   DOI: 10.5005/jp-journals-10023-1162  |  Open Access |  How to cite  | 


Background: The aim of the current study is to determine the clinicopathological characteristics of patients with laryngeal squamous cell carcinoma and evaluation of the effect of prognostic factors on survival rate. Materials and methods: The archives of all patients with laryngeal squamous cell carcinoma (2011–2017) were studied. Patients’ data were extracted using a checklist that included age, gender, tumor stage, treatment methods used, and survival rate in months. All data were analyzed by the SPSS-17 software with the Chi-square test, the Kaplan–Meier test, and the log-rank test at a statistical significance level of p < 0.05. Results: Out of 109 patients with laryngeal cancer, 99 were males and 10 were females. Patients in stages I and II and also in stage III had a longer overall survival compared to patients in stage IV. The mean survival rate was found to be significantly lower in patients in stage IV compared to those in the other stages of the disease. Patients in the age group of 35–59 years had a longer overall survival compared to the older age group (60–89 years). Patients at stage III of the disease who had not undergone chemotherapy had a greater longevity compared to the ones who had undergone the therapy. Patients at stage IV who had not undergone laryngectomy had a much lower survival rate compared to those who had used both surgery and radiotherapy or chemoradiation. Conclusion: Surgery and radiotherapy can positively affect the mean survival rate in patients at stages I and II of laryngeal carcinoma. Together surgery and chemotherapy or chemoradiation have a positive effect on the survival of patients in advanced stages of the disease.



Shreya Venugopal, Deepu Chirayil, Renjitha Bhaskaran

Voice Handicap Index Severity Grading: Do We Need to Recalibrate it for the Indian Population?

[Year:2018] [Month:July-December] [Volume:8] [Number:2] [Pages:3] [Pages No:71 - 73]

Keywords: Statistical analysis, Voice handicap index, Voice analysis

   DOI: 10.5005/jp-journals-10023-1160  |  Open Access |  How to cite  | 


Background: The voice handicap index (VHI 30), used to assess patients’ perception of the severity of their voice disorder, is a standard evaluation parameter in dysphonia cases. The score has conventionally set cut-offs to grade the severity. The latter will be effective only if there are appropriate responses from the patient. If not, then there may be a need to re-set the cut-offs. Objective: The objective of this study is to compare and correlate laryngeal findings and voice analysis parameters with the VHI scores, to see if there is a need to recalibrate the normatives. Materials and methods: Document analysis of VHI forms of patients who have visited and undergone treatment at the voice clinic at Amrita Institute of Medical Sciences. The VHI scores were correlated with the laryngeal findings and voice analysis parameters. Results: As much as 64% of patients were in the normal and mild grades of the VHI score. No statistically significant correlation could be found between VHI scores and Jitter and Shimmer, by any of the attempted methods, although there was a clinical correlation in some cases. The validity of the present cut-offs of VHI severity could not be assessed. Conclusion: There is a need to look at VHI scoring patterns in other population groups in India, as also to consider better statistical methods to approach the problem.



Tejal Patel, Kshitij D Shah

Study of Physical Parameters Used for Preoperative Prediction of Difficult Laryngeal Exposure during Suspension Microlaryngoscopy

[Year:2018] [Month:July-December] [Volume:8] [Number:2] [Pages:5] [Pages No:74 - 78]

Keywords: Difficult laryngeal exposure, Laryngeal exposure prediction, Suspension microlaryngoscopy

   DOI: 10.5005/jp-journals-10023-1164  |  Open Access |  How to cite  | 


Aim: The aim of this study is to analyze the various physical parameters used for the preoperative prediction of difficult laryngeal exposure (DLE) during suspension microlaryngoscopy. Materials and methods: This is a single-center, retrospective study carried out in a tertiary care teaching hospital, comprising 50 patients who underwent suspension microlaryngoscopy at our center from June 2014 to April 2016. We assessed 10 physical parameters that can help in predicting DLE preoperatively. Results: The patients’ ages ranged from 20 to 69 years. The laryngeal exposure was assessed in all the patients and correlated with the 10 physical parameters. Out of the parameters assessed using the student t test, the modified Mallampati's index (MMI) (class II and above), body mass index (BMI) (>27.1 kg/m2), thyroid–mental distance (≤4.9 cm), thyroid–mandibular angle (>122°), and horizontal thyroid distance (HTD) (≤3.8 cm) showed a statistical significance with p < 0.001. The ROC curve analysis showed that the thyroid–mental distance and HTD had the highest sensitivity (100%) and specificity (100%) each among the parameters assessed. Conclusion: Based on our study results, we conclude that the age and the sex of the patient have no role in predicting the risk of DLE during suspension microlaryngoscopy. The MMI, BMI, thyroid–mental distance, thyroid–mandibular angle, and HTD measurements help in the prediction of DLE preoperatively. Clinical significance: These physical parameters can be measured just prior to the surgery using simple measuring aids. The advantage of preoperative prediction of DLE being that it enables the surgeon to be prepared beforehand with additional measures to deal with the same and provide adequate treatment.



Nupur Nerurkar, Sohil Gala, Ruchi Shah, Udbhav Mittal

Extramedullary Plasma Cell Neoplasms with Amyloidosis of the Head and Neck Region: A Series of two Rare Cases and Literature Review

[Year:2018] [Month:July-December] [Volume:8] [Number:2] [Pages:4] [Pages No:79 - 82]

Keywords: Extramedullary plasmacytomas, Plasma cell Neoplasms, Plasmacytoma with amyloidosis

   DOI: 10.5005/jp-journals-10023-1163  |  Open Access |  How to cite  | 


Extramedullary plasmacytomas (EMP) are rare malignant plasma cell neoplasms (PCNs) mainly affecting the head and the neck region. These are more commonly seen in adult males. These have variable outcomes and may even coexist with, or progress to multiple myelomas (MMs). Hence, a systemic examination is a must, to rule out generalized involvement. The presence of monoclonal plasma cells on histopathology explains the relationship of PCNs with amyloidosis. Treatment may be surgical for accessible tumors or low to moderate dose radiation as indicated. Long-term surveillance is a must. We discuss two cases of extramedullary PCNs with amyloidosis involving the head–neck region. Both the patients underwent surgical excision followed by radiation for the residual disease and recurrence prevention. Systemic involvement was ruled out and the patients have been advised regular follow-up.


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