European white paper: oropharyngeal dysphagia in head and neck cancer.

PURPOSE: To develop a European White Paper document on oropharyngeal dysphagia (OD) in head and neck cancer (HNC). There are wide variations in the management of OD associated with HNC across Europe. METHODS: Experts in the management of specific aspects of OD in HNC across Europe were delegated by their professional medical and multidisciplinary societies to contribute to this document. Evidence is based on systematic reviews, consensus-based position statements, and expert opinion. RESULTS: Twenty-four sections on HNC-specific OD topics. CONCLUSION: This European White Paper summarizes current best practice on management of OD in HNC, providing recommendations to support patients and health professionals. The body of literature and its level of evidence on diagnostics and treatment for OD in HNC remain poor. This is in the context of an expected increase in the prevalence of OD due to HNC in the near future. Contributing factors to increased prevalence include aging of our European population (including HNC patients) and an increase in human papillomavirus (HPV) related cancer, despite the introduction of HPV vaccination in various countries. We recommend timely implementation of OD screening in HNC patients while emphasizing the need for robust scientific research on the treatment of OD in HNC. Meanwhile, its management remains a challenge for European professional associations and policymakers.

New 445 nm blue laser for laryngeal surgery combines photoangiolytic and cutting properties.

BACKGROUND: Photoangiolytic lasers have broadened the surgical armamentarium for many phonosurgical interventions. However, the pulse dye laser and potassium titanyl phosphate (KTP) laser have technical drawbacks and a smaller spectrum of indications. METHODS AND RESULTS: The new 445 nm wavelength laser, the so-called 'blue laser', proves to show tissue effects comparable to the KTP laser and is also capable of treating subepithelial vessels due to its photoangiolytic properties, it can coagulate and carbonize at higher energy levels, and can be used via glass fibers in non-contact and contact mode for in-office procedures. DISCUSSION: In contrast to the KTP, the new 445 nm laser can also be used as a cutting laser, thus combining very much wanted properties of diode or CO2 lasers with photoangiolytic lasers. Further advantages of the new laser are the; (1) portability of the shoe box sized, shock-proof laser machine for in-office and operating room usage, (2) the selection of pulse rates from continuous wave (cw) to less than a millisecond, (3) stronger tissue effects compared to KTP with similar energy and pulse settings, (4) far better cutting properties than the KTP, and thus (5) more possibilities for usage in laryngology as well as in other fields or surgery. CONCLUSION: We demonstrate the feasibility of the 445 nm laser in several laboratory experiments and show clinical cases where photoangiolysis and cutting was possible. However, this is a preliminary report and further systematic studies in greater numbers are warranted.

Differential gene expression profiling of vocal fold polyps and Reinke's edema by complementary DNA microarray.

OBJECTIVES: Our purpose was to determine whether complementary DNA (cDNA) microarray analysis (MA) can establish distinct gene expression profiles for 2 phenotypically similar vocal fold lesions: Reinke's edema (RE) and polyps. Established transcript profiles can provide insight into the molecular and cellular processes involved in these diseases. METHODS: Eleven RE specimens and 17 polyps were analyzed with MA for 8,745 genes. Further MA profiling was attempted within each lesion group to identify molecular markers for reflux exposure and smoking. Prediction analysis was used to predict lesion classification for 2 unclassified samples. A real-time polymerase chain reaction was performed to corroborate MA transcript levels for selected significant genes. RESULTS: Sixty-five genes were found to differentiate RE and polyps (p = .0088). For RE, 19 genes were differentiated for reflux exposure (p = .016). No genes were found to differentiate smokers from nonsmokers. For polyps, no genes were found to differentiate for reflux (p = .16) and smoking (p = .565). Categorization of unclassified lesions was possible with a minimum of 13 genes. CONCLUSIONS: We demonstrate the feasibility of benign lesion classification based on MA. Microarray analysis is useful not only for improving diagnosis and classification of such lesions, but also for potentially generating prognostic indicators and targets for therapy.

Laryngeal framework surgery: current strategies.

PURPOSE OF REVIEW: Laryngeal framework surgery (LFS) is an indispensable surgical approach for the treatment of voice problems. The purpose of this review is to single out some relevant articles published on the topic of LFS from 2015 to mid-2016. Articles referring to injection laryngoplasty (augmentation) are entirely left aside. RECENT FINDINGS: In the vast majority of recent publications, LFS mostly addresses surgery intended to improve vocal function in cases of glottic insufficiency. Here, medialization laryngoplasties remain the most important surgery. Arytenoid adduction remains an important technique within this field. Some clinical studies concerning indications and outcome of LFS are covered in the recent articles, trying to improve decision making for the indication of medialization laryngoplasty to enhance the rate of favorable long-term results. As in the past years, only a few articles report on laboratory research and other aspects of LFS. SUMMARY: Articles published from 2015 to mid-2016 show that further improvements in LFS have been made, both surgically-technically and in respect of patient selection. There is still a debate about the combination of medialization laryngoplasty and arytenoid adduction in patients with unilateral vocal fold paralysis or paresis (UVFP). Although augmentation laryngoplasties are significantly increasing in number, it seems that LFS remains an important procedure within phonosurgery.

Office-based laryngoscopic observations of recurrent laryngeal nerve paresis and paralysis.

OBJECTIVES: To evaluate the endoscopic criteria of recurrent laryngeal nerve disorders, we performed a retrospective evaluation of videolaryngoscopic recordings from 50 patients with recurrent laryngeal nerve disorders. METHODS: The videolaryngoscopic examination was performed with rigid and flexible endoscopes. The range of motion of three laryngeal structures was assessed: the vocal ligament, the vocal process, and the arytenoid "hump" (mainly the corniculate region). RESULTS: Comparison of movement of these three structures revealed discrepancies. In 16 of 45 patients (36%) rigid endoscopy showed movements of the arytenoid hump associated with absence of any mobility of the vocal process and vocal ligament. In 5 patients the extent of movement of the vocal process and vocal ligament was less than that of the arytenoid hump. Only in 24 of 45 cases were the ratings for the vocal process, vocal ligament, and arytenoid hump identical. The findings of fiberscopy were comparable. CONCLUSIONS: In assessing recurrent laryngeal nerve disorders via laryngoscopy, sole judgment of the arytenoid hump movement can mislead. Our interpretation suggests that visible movement of the mucosa covering the arytenoid and accessory cartilages is not always paralleled by movement of the arytenoid cartilage itself. It was shown that the best criterion to rely on in endoscopy is movement of the vocal process or the vocal ligament.

OSBPL2 encodes a protein of inner and outer hair cell stereocilia and is mutated in autosomal dominant hearing loss (DFNA67).

BACKGROUND: Early-onset hearing loss is mostly of genetic origin. The complexity of the hearing process is reflected by its extensive genetic heterogeneity, with probably many causative genes remaining to be identified. Here, we aimed at identifying the genetic basis for autosomal dominant non-syndromic hearing loss (ADNSHL) in a large German family. METHODS: A panel of 66 known deafness genes was analyzed for mutations by next-generation sequencing (NGS) in the index patient. We then conducted genome-wide linkage analysis, and whole-exome sequencing was carried out with samples of two patients. Expression of Osbpl2 in the mouse cochlea was determined by immunohistochemistry. Because Osbpl2 has been proposed as a target of miR-96, we investigated homozygous Mir96 mutant mice for its upregulation. RESULTS: Onset of hearing loss in the investigated ADNSHL family is in childhood, initially affecting the high frequencies and progressing to profound deafness in adulthood. However, there is considerable intrafamilial variability. We mapped a novel ADNSHL locus, DFNA67, to chromosome 20q13.2-q13.33, and subsequently identified a co-segregating heterozygous frameshift mutation, c.141_142delTG (p.Arg50Alafs*103), in OSBPL2, encoding a protein known to interact with the DFNA1 protein, DIAPH1. In mice, Osbpl2 was prominently expressed in stereocilia of cochlear outer and inner hair cells. We found no significant Osbpl2 upregulation at the mRNA level in homozygous Mir96 mutant mice. CONCLUSION: The function of OSBPL2 in the hearing process remains to be determined. Our study and the recent description of another frameshift mutation in a Chinese ADNSHL family identify OSBPL2 as a novel gene for progressive deafness.

Imaging of the larynx--extending the use of stroboscopy-related techniques.

Three methods (I-III) are presented to demonstrate how technical modifications in the use of stroboscopy-related techniques can be applied to further analyze vocal fold vibrations. (I) With double exposure videostroboscopy, dynamic properties of vocal folds can be visualized within one single image. This allows for estimations of horizontal vibratory velocity of the vocal fold margins. (II) Stroboscopic transillumination of the larynx makes it possible to localize initial vocal fold opening in the horizontal glottal plane and to visualize different vibratory opening patterns. Bidirectional color-coded endoscopic imaging of the larynx facilitates a semi-automated, digital measurement of the glottal area. (III) Stroboscopic illumination using four light emitting diodes (LEDs) clipped on a rigid endoscope and triggered by a portable 'pocket-sized', battery-powered electronic control device offers new prospects for performing stroboscopy outside of specialized clinical facilities.

Vocal cord dysfunction: an important differential diagnosis of bronchial asthma.

INTRODUCTION: Intermittent paradoxical closure of the vocal cords can induce major attacks of dyspnea. Such attacks, called "vocal cord dysfunction" (VCD), are an important element in the differential diagnosis of intractable bronchial asthma. METHODS: Selective review of the literature. RESULTS: The etiology of VCD is unclear. Its clinical manifestations can mimic those of bronchial asthma. Standard asthma medication fails to improve the dyspnea of VCD, which is subjectively perceived as life-threatening. Consequently, patients with unrecognized VCD may be treated with very high doses of anti-asthmatic medication, including systemic corticosteroids, leading to major iatrogenic morbidity. No prospective studies are available on this subject to date. Experts estimate that 3% to 5% of persons diagnosed as having bronchial asthma actually suffer from VCD. Because of the brevity of the attacks, which usually last only 1-2 minutes, VCD is difficult to diagnose with the methods generally used to diagnose asthma. Evidence-based therapeutic approaches are still lacking, but speech therapy, including special breathing techniques with relaxation of the throat, seems to control the attacks of dyspnea in most patients. DISCUSSION: An improved knowledge of the clinical manifestations of VCD can help physicians diagnose it correctly. Early diagnosis can prevent prolonged erroneous treatment based on a false diagnosis of bronchial asthma and thereby obviate the iatrogenic side effects of long-term corticosteroid therapy, as well as the resulting economic losses.

Measurements of vocal fold elasticity using the linear skin rheometer.

OBJECTIVE: The linear skin rheometer (LSR), which measures skin visco-elasticity, was adapted for measurements of vocal fold properties. A series of studies was performed on animal and human excised larynges to determine if the LSR technique can be applied to the vocal fold. METHODS: In excised larynges, small patches of mucosa were driven sinusoidally at 0.3 Hz over distances of 1-2 mm using a small probe. Forces in the order of 1 g equivalent gave optimal measurements. Stiffness and viscosity values were derived from stress/strain data. RESULTS: The instrument was able to measure the visco-elasticity of the tissue in a repeatable manner and it could detect areas where the tissue was artificially stiffened. Two-dimensional maps of the mechanical properties of the laryngeal mucosa were obtained showing local variations in elasticity both parallel and perpendicular to the vocal fold edge. Initial studies were undertaken using animal tissue; more recently, the LSR has been successfully used to obtain similar data from human tissue. CONCLUSION: The LSR was been demonstrated to be capable of measuring the elastic properties of the vocal fold in a repeatable and reliable manner. Further studies will now be undertaken to obtain data from a larger sample of human tissue.

Laryngeal morphometry with a new laser 'clip on' device.

BACKGROUND AND OBJECTIVES: Qualitative laryngoscopic investigations belong to diagnostic routine in laryngology. Nevertheless, quantitative morphometric measurements of intralaryngeal structures have been difficult by now. STUDY DESIGN/MATERIAL AND METHODS: The development of a two-point-light projection method for endolaryngeal measurements that works with a double reflecting mirror and green laser light is shown. RESULTS: The laser beams that have a distance of exactly 2 mm are very well visible at the surface of laryngeal structures. The technique can be used during a routine videoendoscopic examination. CONCLUSION: In our opinion this method enables accurate quantitative morphological measurement within the larynx that could be used even in clinical routine. The two-point light projection technique helps to reduce former limitations of endoscopic investigations.