Evaluation of laryngeal vascular changes with image1 s enhancement system in reference to the European laryngological society guideline.

OBJECTIVES: To assess the feasibility of using Image1 S™ endoscopic enhancement system for discrimination of the vascular patterns in laryngeal lesions. DESIGN: Forty patients presenting with benign, dysplastic and malignant laryngeal lesions were examined with Image1 S system. The vascular patterns were classified by a group of authors according to the European Laryngological Society (ELS) guideline, as perpendicular or longitudinal, in all lesions. The relationship between the vascular patterns and the pathological results was statistically analysed. Endoscopic images of the lesions were evaluated through an online survey by a group of otolaryngologists with different levels of clinical expertise and asked them to choose a diagnosis and a vascular pattern. The vascular pattern evaluations of the participants were compared to the authors' evaluations to determine the interobserver reliability. The final diagnostic judgements of the participants were compared with the definitive histopathological diagnoses. SETTING: Tertiary university hospital. PARTICIPANTS: Forty patients with laryngeal lesions and thirty otolaryngologists with different clinical experience levels. MAIN OUTCOME MEASURES: The study evaluates the usefulness of the Image1 S system for the detecting the vascular patterns associated with benign, dysplastic, and malignant lesions and measures the level of accuracy and inter observer agreement in detecting the final histopathology. RESULTS: Histopathological examination diagnosed 12 patients as benign, 12 dysplastic and 16 malignant. Using Image1 S, the vascular patterns were longitudinal in 11 lesions, perpendicular in 28 lesions and undetectable in 1 lesion. With white light, longitudinal pattern was observed in 14 lesions, perpendicular in 21 lesions and undetectable in 5 lesions. The correlation between the vascularisation pattern and the pathological diagnosis was found to be significant (p < .001). The qualitative evaluation of the vascular patterns by the two groups of observers showed significant reliability (κ = 0.63, p < .001). The agreement with the final diagnoses was also significant (κ = 0.56, p < .001). CONCLUSIONS: Image1 S endoscopic enhancement system with spectral modes provides an improved visibility of the vascular patterns defined by the ELS in laryngeal lesions. ELS classification can reliably distinguish benign lesions from suspected ones and can be applied even by less-experienced clinicians but the final diagnosis needs experience and should be confirmed with histopathology.

Validity and Reliability of the Turkish Version of the Glottal Function Index.

OBJECTIVES: A comprehensive evaluation is necessary for voice-related complaints, as it can benefit both the patient and physician in busy clinical settings. This study aimed to examine the Turkish adaptation of the Glottal Function Index (GFI-T), which can be quickly administered. STUDY DESIGNS: Phase 1 methodological, phase 2 prospective cohort. METHODS: This study was conducted in two phases. Firstly, the GFI was translated into Turkish, and its content validity was examined. The GFI-T was administered to 40 participants with voice disorders (M=41.3, SD=10) in the study group and 40 participants without voice disorders (M=37.5, SD=11.3) in the control group. Then GFI-T was readministered 2weeks later. The collected data were used for structural and convergent validity [correlation with Turkish version of the Voice Handicap Index-10 (VHI-10)], internal consistency, and test-retest reliability analyses. Secondly, 24 participants with vocal nodules were recruited separately from the first phase and were randomly divided into three groups. The first group underwent lax-vox therapy+vocal hygiene, the second group underwent resonance therapy+vocal hygiene, and the third group was provided only with vocal hygiene recommendations. The discriminative ability and construct validity of the GFI-T were examined by comparing pre- and post-assessments. RESULTS: The results indicated that the content validity indexes were 0.98 in the experts and 0.99 in the participants. Confirmatory factor analysis of the scale confirmed that a single-factor structure and goodness-of-fit indices were suitable. The GFI-T correlated 0.92 with the Turkish version of the VHI-10. The internal consistency was 0.96, and the test-retest value was 0.99. Significant differences (P < 0.001) and correlations with the Turkish version of VHI-10 were found in intragroup comparisons. CONCLUSIONS: The GFI-T is a reliable and valid tool for the self-assessment of voice disorders. The adaptation of this study to the pediatric population is recommended.

Pediatric Voice Disorders from the Perspective of Rare Diseases.

OBJECTIVE: This study aims to present rare pediatric voice disorders, which are usually reported as case reports in the literature, with their clinical features, treatment options, and prognosis, and to emphasize clinical findings that may be associated with rare diseases. METHODS: The clinical records of the pediatric patients presented with dysphonia were reviewed between 2014 and 2019. The terminology "rare disease" is used to describe diseases where the average prevalence thresholds are between 40 to 50 cases/100,000 people. Age, gender, symptoms, laryngeal examination findings, histopathological results, treatment modalities and follow-up results of rare laryngeal pathologies were reviewed. RESULTS: 274 children were diagnosed with and treated for voice disorders at our institution. Seven patients were identified with rare laryngeal pathologies. Four patients diagnosed with lipoid proteinosis, two patients with neurofibroma and one patient with amyloidosis. One patient was known to have neurofibromatosis type-1, while the others did not have any previously diagnosed diseases, dysphonia was the initial clinical presentation. CONCLUSION: There are some clues that bring to mind rare entities. Firstly, these patients generally present with various systemic manifestations. Secondly, if there is any discrepancy between voice quality and endoscopic laryngeal examination, the diagnosis should be reconsidered. Thirdly, in the case of the prolonged dysphonia recalcitrant to treatment, the clinician should reassess the treatment or the diagnosis.

The Effect of Vocal Hygiene Training Via Videoconference in Teachers' Voices.

PURPOSE: Voice disorders are frequently seen among teachers. Intense and inappropriate use of the voice is the most frequent reason. In the literature, studies supporting the positive effect of voice hygiene behaviors to the voice in teachers exist. In the v pandemic era that we pass through, it's being observed that teaching via videoconference is becoming widespread all around the world. The primary aim of this study is to evaluate the risk factors for self-assessed "not normal" voice in teachers, in the light of their demographic and vocational information and voice hygiene behaviors. Our second aim in this study is to evaluate the effect of voice hygiene training via videoconference on teachers' voice. We believe this will contribute in shaping today's therapy modalities in vocal training. MATERIALS AND METHODS: One hundred nine teachers, working as primary, secondary or high school teacher actively in different cities in Turkey, between 25 and 55 years of age participated and self-assessed their voice by filling the survey including demographic, occupational, medical history and voice symptoms and vocal behaviors data as well as Voice Handicap Index (VHI)-10 ve voice self rating scale (VSRS). The teachers with VHI-10 score below 5 and VSRS score "normal" were assumed to have "Normal Voice." The teachers with VHI-10 score 5 or above and VSRS "Not Normal" (mild, moderate or severe) (N = 52) were assigned to "Voice Hygiene Group" and were invited to videoconference for a voice hygiene session. Four weeks after this session, the survey, VHI-10 and VSRS were repeated and the results were compared. RESULTS: In the first phase of the study, risk factors for not being in "Normal Voice" group for the teachers have been assessed. "Having chronic disease" and "having experienced voice problem before" have been found to be risk factors. In the second phase of the study, 52 teachers have been invited to online "Voice Hygiene" videoconference session; only 18 teachers have attended in total of three attempts of sessions. When vocal behaviors before and after the videoconference were compared, positive changes have been observed in five vocal behaviors including "avoiding smoking," "drinking enough water daily," "eating healthy food," "avoiding excessive meals," "avoiding frequent throat clearing," however VHI-10 and VSRS scores have not showed a meaningful change. Only one teacher has progressed to "normal voice" from "Voice Hygiene Group." CONCLUSION: We believe further controlled studies with more participants adherent to videoconference sessions will be needed in order to shape today's therapy modalities.

The Effect of Masks and Respirators on Acoustic Voice Analysis During the COVID-19 Pandemic.

OBJECTIVES: World Health Organization declared the coronavirus disease (COVID-19) as a global pandemic on March 11, 2020. The aim of this study was to determine the effectiveness and reliability of voice analysis performed with surgical masks and respirators during the pandemic and to discuss its routine applicability. METHODS: This prospective study included 204 patients who applied to our clinic between the ages of 18 and 55, whose preoperative SARS-Cov-2 PCR tests were negative. Voice analyses were performed on each patient without a mask, with a surgical mask and with a valved face-filtering piece-3 (FFP3) respirator respectively. The F0, shimmer, jitter, s/z ratio, maximum phonation time and harmonic/noise ratio (HNR) values obtained from the voice analyses were compared with each other. RESULTS: No significant difference was found in terms of F0, Jitter, Shimmer, HNR, s/z and maximum phonation time values in the voice analyses performed without a mask and with a surgical mask. With an FFP3, a significant difference was found in only the Shimmer and HNR values compared to the other analysis values. When we look at the data with sex distinction, in the group of female and male patients, when the data of voice analysis obtained in three situations were compared, different results were obtained from the female and male group. CONCLUSION: In conclusion, it should be decided by the physician to perform the voice analysis with a surgical mask or with an FFP3, considering the clinically desired parameters.

Characteristics of Otorhinolaryngological Emergencies in the Elderly.

OBJECTIVE: This study was designed to characterize the distribution of otorhinolaryngological emergencies seen in the geriatric population in one year. In this article we present our results and discuss the differences between our results and those reported in the current literature. METHODS: The study was carried out in a tertiary care university hospital. All patients aged 65 years or over that were referred by the general emergency department (ED) to the otorhinolaryngology emergency room in a one-year period were retrospectively reviewed. Demographic characteristics (age, gender), findings of physical examination, accompanying systemic diseases, diagnosis, and treatment methods were documented. Hospitalization and referral needs were also analyzed. RESULTS: In the one-year period from April 2017 to April 2018, a total of 12,780 patients aged 65 or older presented to the ED and the otorhinolaryngology physician was consulted for 195 (1.5%) of these patients. The age range of the patients was 65-96 years, with a mean age of 75 years. The most common cause for presenting to the ED was maxillofacial trauma (31.7%), followed by epistaxis (18.7%). Dyspnea (9.7%) and peripheral facial paralysis (9.7%) were the third most frequent causes. The outcome analysis revealed that 9.7% of the patients were hospitalized. CONCLUSION: Identifying the characteristics of the geriatric patients presenting to EDs is important for developing proper management algorithms. Maxillofacial traumas were the most frequently seen ORL emergencies in our cohort of geriatric patients, followed by epistaxis. The distribution and the prevalence of the cases could differ according to the institutional protocols.

Preliminary report of laryngeal phonation during mechanical ventilation via a new cuffed tracheostomy tube.

OBJECTIVE: To study the safety, efficacy, patient tolerance, and patient satisfaction of the Blom Tracheostomy Tube and Speech Cannula (Pulmodyne, Indianapolis, Indiana), a new device that allows the patient to speak while the tracheostomy tube cuff is fully inflated. METHODS: With 10 tracheostomized mechanically ventilated patients we recorded ventilator settings and physiologic variables at baseline with patient's usual tracheostomy tube, then with the Blom Tracheostomy Tube and the Blom standard (non-speech) cannula, and then during three 30-min trials of the Blom Speech Cannula. During the Blom Speech Cannula trials we assessed the subjects' success in phonation (eg, sentence length and volume). RESULTS: Nine of the 10 subjects achieved sustained audible phonation and were very satisfied with the device. CONCLUSIONS: The Blom Speech Cannula appears to be safe, effective, and well tolerated in tracheostomized mechanically ventilated patients while maintaining full cuff inflation.

[Management of laryngeal hemangioma in adults: a case report]. / Eriskinlerde larengeal hemanjiyoma yaklasim: Olgu sunumu.

Hemangiomas are the most common vascular tumors mostly (60%) seen in the head-neck region. Head-neck hemangiomas are seen frequently in the oral cavity, rarely in the larynx. Adult laryngeal hemangiomas are rare and often seen in the supraglottic region, therefore causing dysphagia/dysphonia. We presented two-cases with laryngeal hemangioma, discussed the diagnosis, treatment and follow-up of adult cavernous hemangiomas. A forty-one-year-old female patient applied to hospital with hoarseness and breathing difficulty lasting for three years. A cavernous hemangioma located on laryngeal surface of the epiglottis was excised through a transoral endoscopic approach. The patient had no symptoms after the operation but on the postoperative 34th month follow-up she was admitted to our clinic again because of difficulty during swallowing. Relapsed hemangioma was diagnosed and reoperated by open surgery (laryngofissure). After reoperation the patient had symptomatic relief in three months and videolaryngoscopic examination showed granulation tissue. The patient's regular follow-up was continued. A forty-year-old female other patient was applied to hospital with hoarseness and swallowing difficulty worsening in three months. Hemangioma located in the postcricoid area with extensive to hypopharynx-esophagus junction was diagnosed. The location of the lesion in imaging techniques was evaluated with the thoracic surgery and gastroenterology department and we decided not to do any operation and follow-up patient by considering the severity of symptoms, location of lesion and complications of operation.

Voice Disorders in Islamic Religious Officials: Is It Any Different Than Those of the Teachers, Another Well-Known Professional Voice Users?

OBJECTIVES: This study explores Islamic religious officials' voice use, disorders, and treatment methods by comparing the officials with teachers, the largest group of voice professionals. STUDY DESIGN: This is a nonrandomized retrospective study. METHODS: This study included 85 patients with voice disorder complaints; 42 were religious officials and 43 were teachers. We compared the two groups of patients in terms of demographic information, job descriptions, years in their professions, smoking histories, alcohol consumption, allergies and other systemic disorders, average weekly vocal loads, voice training, vocal abuse-misuse, reflux symptom index and voice handicap index scores, and voice disorder diagnosis and treatment methods. RESULTS: The study compared 39 male (92.85%) and three female (7.14%) religious officials with five male (11.62%) and 38 female (88.37%) teachers. The alcohol use, systemic diseases, and vocal loads were found to be statistically higher in the teachers than the religious officials (P < 0.05), while the vocal abuse-misuse, vocal hygiene knowledge, and voice handicap indices were determined to be statistically higher in the religious officials than the teachers (P < 0.05). A statistically significant difference in the distribution of the diagnoses exists between the two groups (P < 0.005). Voice therapy is the most common treatment method in both groups. CONCLUSIONS: Like teachers, Islamic religious officials appear to be at high risk of developing voice disorders. Because of the lack of research on the frequency of voice disorders among Islamic religious officials, it is important to raise awareness of the prevalence of voice disorders.

Functional and Oncological Outcomes of Open Partial Laryngectomy vs. Transoral Laser Surgery in Supraglottic Larynx Cancer.

OBJECTIVE: The aim of the presented study was to evaluate the outcomes of open partial laryngectomy (OPL) versus transoral laser surgery (TLS) in patients operated on for supraglottic laryngeal carcinoma based on functional parameters (duration of hospitalization, oral nutritional status and duration of transition to oral feeding, weaning status and duration after tracheotomy, and postoperative voice results) and oncological results (overall survival rate, disease-specific survival rate, recurrence, and presence of second primary tumors) in both groups. METHODS: All laryngeal carcinoma patients who had undergone either OPL or TLS in the period from January 2012 to March 2017 in our center and were followed-up at least for 36 months were included in the study. Statistical analyses were carried out using the t-test and the Mann-Whitney U test to compare the means, and the Kaplan-Meier test for survival analysis. RESULTS: Fifty patients (44 males and 6 females) met the study criteria, of whom 31 had undergone OPL and 19 TLS. Patients that underwent TLS had less tracheotomy needs, needed shorter hospitalization periods, and transitioned to oral feeding earlier, compared to those that underwent OPL. There were no significant differences between the two groups based on oral feeding rates and voice outcomes. The impact of TLS and OPL on organ preservation in supraglottic laryngeal cancer were comparable. For local recurrences, repeated endolaryngeal laser surgeries and adjuvant treatments could be used in the TLS patient group. There were no significant differences between the two groups based on overall survival rate and disease specific survival rate. CONCLUSION: Although no significant differences were found in our study between the two surgical procedures in terms of oncological outcomes, TLS appeared to produce better functional outcomes in supraglottic laryngeal carcinoma than OPL.

Melkersson-Rosenthal syndrome revisited as a misdiagnosed disease.

PURPOSE: We aimed to attract our college's attention to the Melkersson-Rosenthal syndrome (MRS), which has been an infrequently encountered subject in otolaryngology journals during the last 10 years. MATERIALS AND METHODS: A retrospective review of the last 10 years' patient database was performed to find patients with MRS. The medical files, treatment charts, and radiological and histopathological records of these patients were reviewed. RESULTS: The study group consisted of 3 MRS patients who had been misdiagnosed for 9, 10, and 16 years. Two of them have had the symptoms since adolescence. All of them presented orofacial edema and fissured tongue, whereas first two also had recurrent facial paralysis. Characteristic histopathological features were noted in 1 patient. Electromyography (EMG) was done in 1 patient who underwent facial decompressiom. All patients responded to either systemic or intralesional corticosteroid treatment. CONCLUSIONS: In the daily practice of an otolaryngologist, it is not usual to diagnose a patient as having MRS. We consider that this is partly because of misdiagnosis. We therefore believe that this study will supply an additional aspect to otolaryngologists, in the scope of recurrent facial paralysis and orofacial edema in both children and adults.

Vascular lesions of the vocal fold.

The aim of the study was to present symptoms, laryngological findings, clinical course, management modalities, and consequences of vascular lesions of vocal fold. This study examined 162 patients, the majority professional voice users, with vascular lesions regarding their presenting symptoms, laryngological findings, clinical courses and treatment results. The most common complaint was sudden hoarseness with hemorrhagic polyp. Microlaryngoscopic surgery was performed in 108 cases and the main indication of surgery was the presence of vocal fold mass or development of vocal polyp during clinical course. Cold microsurgery was utilized for removal of vocal fold masses and feeding vessels cauterized using low power, pulsed CO(2) laser. Acoustic analysis of patients revealed a significant improvement of jitter, shimmer and harmonics/noise ratio values after treatment. Depending on our clinical findings, we propose treatment algorithm where voice rest and behavioral therapy is the integral part and indications of surgery are individualized for each patient.

Changes after voice therapy in objective and subjective voice measurements of pediatric patients with vocal nodules.

The aim of this study was to analyze the efficiency of the voice therapy in children with vocal nodules by using the acoustic analysis and subjective assessment. Thirty-nine patients with vocal fold nodules, aged between 7 and 14, were included in the study. Each subject had voice therapy led by an experienced voice therapist once a week. All diagnostic and follow-up workouts were performed before the voice therapy and after the third or the sixth month. Transoral and/or transnasal videostroboscopic examination and acoustic analysis were achieved using multi-dimensional voice program (MDVP) and subjective analysis with GRBAS scale. As for the perceptual assessment, the difference was significant for four parameters out of five. A significant improvement was found in the acoustic analysis parameters of jitter, shimmer, and noise-to-harmonic ratio. The voice therapy which was planned according to patients' needs, age, compliance and response to therapy had positive effects on pediatric patients with vocal nodules. Acoustic analysis and GRBAS may be used successfully in the follow-up of pediatric vocal nodule treatment.

Clinical Features of Psychogenic Voice Disorder and the Efficiency of Voice Therapy and Psychological Evaluation.

OBJECTIVES: The aim of this study was to define the clinical features of psychogenic voice disorder (PVD) and explore the treatment efficiency of voice therapy and psychological evaluation. METHOD: Fifty-eight patients who received treatment following the PVD diagnosis and had no organic or other functional voice disorders were assessed retrospectively based on laryngoscopic examinations and subjective and objective assessments. Epidemiological characteristics, accompanying organic and psychological disorders, preferred methods of treatment, and previous treatment outcomes were examined for each patient. A comparison was made based on voice disorders and responses to treatment between patients who received psychotherapy and patients who did not. RESULTS: Participants in this study comprised 58 patients, 10 male and 48 female. Voice therapy was applied in all patients, 54 (93.1%) of whom had improvement in their voice. Although all patients were advised to undergo psychological assessment, only 60.3% (35/58) of them underwent psychological assessment. No statistically significant difference was found between patients who did receive psychological support concerning their treatment responses and patients who did not. Relapse occurred in 14.7% (5/34) of the patients who applied for psychological assessment and in 50% (10/20) of those who did not. There was a statistically significant difference in relapse rates, which was higher among patients who did not receive psychological support (P < 0.005). CONCLUSION: Voice therapy is an efficient treatment method for PVD. However, in the long-term follow-up, relapse of the disease is observed to be higher among patients who failed to follow up on the recommendation for psychological assessment.

Current diagnosis and treatment of laryngocele in adults.

OBJECTIVE: To evaluate the treatment outcome of a series of laryngoceles and to comment on the current diagnosis and management of laryngoceles. STUDY DESIGN AND SETTING: A retrospective review of charts, radiological and histopathological notes, videolaryngostroboscopic records, and acoustic voice analyses of patients with laryngocele treated over a 10-year period was undertaken. RESULTS: Seven patients had internal laryngoceles; one had external; another one had combined laryngocele. Patients with internal laryngocele underwent endoscopic CO2 laser resection, while those with external or combined laryngocele were treated via external approach. Quality of voice was improved and no recurrences were encountered during the follow-up. No evidence of laryngeal cancer was found on the histological examinations. CONCLUSION: Endoscopic CO2 laser resection of internal laryngocele provides a reliable and cost-effective method that minimizes hospitalization and the need for tracheotomy. We believe that advances in the applications of laser in microlaryngosurgery will alter the traditional management of all type of laryngoceles.

Influence of long-term airflow deprivation on the dimensions of the nasal cavity: a study of laryngectomy patients using acoustic rhinometry.

We conducted a prospective study to investigate the long-term effect of nasal airflow deprivation on nasal dimensions after total laryngectomy. We evaluated 48 patients who had an initial diagnosis of laryngeal cancer; 6 were disqualified during follow-up, leaving us with data on 42 patients for our final analysis. Acoustic rhinometry was used to measure the minimum cross-sectional area (MCSA) and the volume of the nasal cavity on both the left and right sides before and after laryngectomy. In addition, patients underwent endoscopic nasal examinations and answered questionnaires pre- and postoperatively. At both the 1- and 2-year follow-ups, the mean MCSAs and the mean nasal volumes of both the left and right nostrils were significantly smaller than the preoperative values (p < 0.001). The endoscopic examinations revealed only a mild deterioration in the appearance of the nasal mucosa over the long term. Questionnaire responses obtained at the 2-year follow-up visit revealed that all 42 evaluable patients were experiencing a moderate degree of nasal obstruction while inhaling through the nose. Our data indicate that the dimensions of the nasal cavity appear to be substantially and permanently reduced after total laryngectomy. Our study had two important advantages over other similar studies. First, because ours was a prospective study, we were able to obtain preoperative data and use it to make postoperative comparisons of the same patients rather than using healthy controls as comparators. Second, we used acoustic rhinometry, while most other studies relied on anterior rhinoscopy or rhinomanometry, which are inferior methods ofmaking the evaluations in question. We believe that our findings represent a substantial contribution to our knowledge of the physiologic and functional alterations of the nasal cavity that occur as a result of a complete cessation of nasal airflow.

Amyloidosis of the larynx: a case report.

A 75-year-old female patient presented with hoarseness and foreign body sensation in the back of her throat of one-month history. Direct laryngoscopy showed bilateral, yellow, hyperemic masses on the left false vocal fold and laryngeal ventricle. Both true vocal folds were mobile. Excisional biopsies of the right false vocal fold and ventricle showed extracellular, insoluble, fibrillar protein accumulation, consistent with amyloidosis. There was no evidence for neoplasm. Serum and urine electrophoreses were negative. The work-up for systemic amyloidosis and multiple myeloma were negative. Treatment was limited to surgical excision. No complications developed within a six-month follow-up period.

Laryngeal Verruca Vulgaris Presenting with Dysphonia: A Case Report.

Verruca vulgaris is a common skin lesion that is associated with human papilloma virus and is observed on the surface of skin. Verruca vulgaris is rarely seen in mucosal membranes. Atypical locations may be confused with verrucous carcinoma. The incidence of laryngeal verruca vulgaris has not yet been reported in the literature. Differential diagnoses in histopathological examinations include keratosis, squamous papilloma, verrucous hyperplasia, and verrucous carcinoma. Distinguishing disease from verrucous carcinoma is particularly important because the treatment approach can be altered. In this report, we present a rare case of laryngeal verruca vulgaris that was diagnosed on the basis of histopathological features.

Aerodynamic, acoustic and functional results of posterior transverse laser cordotomy for bilateral abductor vocal fold paralysis.

Bilateral abductor vocal fold paralysis (BAVFP) is a rare but life-threatening condition which may require an emergency tracheotomy procedure. The ideal surgical technique for this condition should improve quality of life by relieving the airway obstruction while preserving laryngeal functions such as phonation and deglutition. Posterior transverse laser cordotomy (PTLC) was first described by Dennis and Kashima as a technique for providing an airway at the posterior glottis without pre-operative tracheotomy; they reported it as a successful method with satisfactory functional results. The aim of this prospective study was to evaluate long term acoustic, aerodynamic and functional results of the primary bilateral PTLC technique in 22 BAVFP patients. Severity of dyspnoea was evaluated using a five-level subjective symptom scale graded according to the limitation in daily activity and level of respiratory difficulty. Aerodynamic and acoustic analyses were performed pre-operatively and prospective changes in aerodynamic and acoustic parameters were collected after one post-operative year.

Life-Threatening Respiratory Distress in a Total Laryngectomy Patient: Aspirated Voice Prosthesis or Lung Tumor?

Laryngectomy patients usually have poor pulmonary functions due to long-term smoking. Their lungs can easily be decompensated. Hence, meticulous evaluation and timely management of severe respiratory distress in laryngectomy patients can be life savers. Here we present an interesting case of a laryngectomy patient with two different clinical presentations of life-threatening respiratory distress at the same time (aspiration of voice prosthesis and a second primary lung cancer). Marked or persistent respiratory distress in a laryngectomy patient deserves thorough clinical evaluation and may require urgent intervention. We consider that the presentation and course of respiratory distress in our laryngectomy patient will provide an additional aspect for emergency room doctors and airway specialists dealing with such a patient.