Hyperfunctional Laryngeal Behavior: Is It the Cause or Consequence of Vocal Fold Polyps?

OBJECTIVES: To evaluate the relationship between arytenoid adduction asymmetry (AAA) and the demographic and morphological characteristics of true vocal fold (TVF) polyps and establish the cause and effect relationship between AAA and TVF polyps. METHODS: Videolaryngostroboscopic findings of 163 patients with TVF polyps were retrospectively reviewed and categorized into Group 1 with AAA or Group 2 without AAA. Demographic details, clinicomorphological polyp characteristics, supraglottic phenomena, and AAA attributes were analyzed. RESULTS: Group 1 was younger than Group 2 (fourth vs fifth decade; P = .0066). Polyp characteristics showed no significant intergroup differences. The association between AAA and false vocal fold (FVF) adduction (65.28% vs 47.62% in Group 1 and 2 respectively; P = .0441) was significant. In relation to TVF polyp laterality, contralateral and bilateral AAA and FVF adduction respectively, was significant. CONCLUSION: AAA is a compensatory laryngeal adaptation akin to a FVF adduction muscle tension pattern. With a concomitant laryngeal pathology and high vocal demand, AAA is a consequence and not the cause for underlying laryngeal pathology which hinders glottic closure.

Is Adjunctive Alginate Therapy Beneficial in the Treatment of Laryngopharyngeal Reflux Disease in a Rural Indian Population? A Prospective Randomized Study.

To assess the benefit of adjunctive alginate therapy in the treatment of laryngopharyngeal reflux disease (LPRD) in a rural population in south India, by comparing the outcome of alginate plus proton pump inhibitor (PPI) therapy versus PPI monotherapy. 100 consenting adults of both sexes, with LPRD symptoms for ≥ 1 month, with both Reflux Symptom Index (RSI) > 13 and Reflux Finding Score (RFS) > 7, were included in a randomised prospective analytical clinical study. Patients were randomised into two treatment groups for 8 weeks. Group A received oral pantoprazole (40 mg, twice a day),and Group B received oral pantoprazole (40 mg) and oral alginate (500 mg/10 ml) twice a day each. Treatment outcome was assessed with RSI and RFS at 4 and 8 weeks. On follow-ups, both groups showed significant improvement in RSI. At 4 weeks, significant improvement in RFS was seen in Group B, but not in Group A; both groups showed improvement at 8 weeks. The improvement was significantly better in Group B RSI and RFS on both follow ups. On analysis of each RSI item at 8 weeks, choking sensation showed no significant improvement in Group A. All other items showed significant improvement in both groups, with all items except difficulty swallowing and choking sensation showing significantly better improvement in Group B. Analysis of each RFS item at 8 weeks, showed significant improvement in Group B but not in Group A. The addition of alginate to PPI shows greater definitive improvement in both symptoms and signs of LPRD within a short period of 8 weeks, compared to PPI monotherapy, making it a feasible treatment option with good results in routine practice in a rural set-up. Adjunctive alginate therapy enhances the resolution of clinical features of LPRD and is thus beneficial in its routine treatment in all populations.

"Innocent" arytenoid adduction asymmetry: An etiological survey.

PURPOSE: To estimate the incidence of "innocent" arytenoid adduction asymmetry (AAA) among patients presenting at a laryngology clinic, identify its association with demographic characteristics, symptomatology and various clinical/pathological conditions and thereby determine its clinical significance. METHODS: A prospective comparative observational clinical study was conducted. Group 1 included patients presenting at the Department of Laryngology, identified with a primary diagnosis and coexisting "innocent" AAA i.e., an overriding arytenoid with normal vocal fold mobility on laryngoscopy. Group 2 included an equal number of randomly selected patients fulfilling the same criteria, without AAA. Demographic and clinical details were recorded and analyzed. RESULTS: 110 cases were included in each group. The incidence of innocent AAA was 12.7%. Males were predominant in both Groups, with the gender difference significant in Group 1. Patients in Group 1 were significantly younger than in Group 2. Professional voice users, namely singers, were significantly greater in Group 1. Symptoms associated with Group 1 (i.e. AAA) were high pitch strain while singing (p = 0.01) and unilateral throat pain (p = 0.01), and the associated diagnoses were Singing Voice Dysphonia (p = 0.005), Vocal Process Granuloma (p = 0.04) and Ventricular Band Dysphonia (p = 0.047). As a definitive diagnosis was made in all patients, the presenting complaints were not attributed to AAA. Right sided preponderance of AAA was significant. Among the diagnoses with a laterality (e.g. vocal process granuloma), AAA was observed contralateral to the pathology in 70.7% and ipsilaterally in 29.3% (p = 0.0058). CONCLUSION: Innocent AAA is common among males in the 3rd-4th decades, in singers among professional voice users, and in those with the muscle tension dysphonia spectrum and vocal process granuloma, thereby suggesting that it is an acquired habit/response to greater vocal demand. The observation of AAA contralateral to laryngeal lesions, highlights its compensatory nature, attempting to optimize glottic closure.

Geriatric Dysphonia: Etiological Analysis in a Rural Hospital in India.

To establish the prevalence of etiological factors for dysphonia in elderly individuals in rural India. Hundred adults aged ≥ 65 years, who presented with dysphonia for ≥ 4 weeks and underwent detailed clinical evaluation including videolaryngoscopic assessment and other appropriate investigations/evaluation, were included in a retrospective cohort clinical study. Patients were classified into eight groups for further descriptive statistical analysis based on standard diagnostic criteria/guidelines i.e. benign vocal cord lesions, inflammatory disorders of the larynx, laryngeal and hypopharyngeal neoplasms, isolated vocal cord palsy/paresis, presbylaryngis, central neurological disorders affecting laryngeal function, impaired pulmonary function and non specific dysphonia. Mean age was 70.73 ± 4.29 years. 58% were aged between 65 and 69 years. Overall, the common causes for dysphonia were laryngopharyngeal reflux disease (23%), carcinoma larynx (12%) and presbylaryngis (8%). Inflammatory disorders of the larynx, benign vocal cord lesions and laryngeal/hypopharyngeal malignancies were the commonest causes for dysphonia in individuals aged between 65 and 74 years. Presbylaryngis and systemic causes were the commonest among individuals aged 75-89 years. 63 males and 37 females met the inclusion criteria. The most common cause for dysphonia among females was laryngopharyngeal reflux disease (17%), followed by vocal palsy (5%) and spasmodic dysphonia (4%). Carcinoma larynx (12%) was the most common cause for dysphonia among males, followed by laryngopharyngeal reflux (6%) and presbylaryngis (6%). Geriatric dysphonia is an often overlooked symptom of greater underlying disease as evidenced in this study. With its impact on the quality of life in this age group and life expectancy in the rural population, dysphonia requires early detection, prompt evaluation and appropriate management.

Impact of Septal Correction on the Blood Pressure of Hypertensive Patients with Deviated Nasal Septum.

This study aims to evaluate the effect of septal correction on the blood pressure (BP) of patients with symptomatic nasal septal deviation and to assess whether a positive association exists between deviated nasal septum and hypertension. A prospective observational clinical study was conducted at Kempegowda Institute of Medical Sciences, Bangalore. Hundred adults, aged 18-40 years, with symptomatic nasal septal deviation, newly detected untreated hypertension (mean BP ≥140/90 mmHg), undergoing submucosal resection of the septum and submucosal diathermy of hypertrophied inferior turbinate (when present), were included. Postoperative follow up for ENT examination and BP measurement was done at 1, 6 and 12 months. Seventy five males and 25 females met the inclusion criteria. 48 % were aged 31-35 years (mean = 31.83 ± 5.19 years). 71 % had anterior septal deviation, 13 % posterior deviation and 16 % a combination of both. Preoperatively, mean systolic blood pressure was 141.82 ± 1.70 mmHg and mean diastolic blood pressure was 91.04 ± 1.21 mmHg, which postoperatively decreased by 10-12 mmHg and 4-5 mmHg respectively. 79 % showed a significant (P < 0.001) decrease in BP postoperatively. 13 % showed no change in BP, of which 53.8 % had posterior deviation, demonstrating a significant association (P < 0.001) between type of deviation and response to surgery. In 8 %, a rise in BP over the follow up period was seen; of these, 62.5 % were aged 36-40 years, indicating a significant association (P < 0.001) between age and BP. Surgical correction of septal deviation is thus effective in controlling the BP of patients with anterior deviation, aged <35 years.