Intra-operative lymphatic mapping and sentinel node biopsy in laryngeal carcinoma using radiotracer injection.

OBJECTIVE: The purpose of this study was to determine the value of sentinel lymph node biopsy (SLNB) in the laryngeal SCC, using intra-operative peri-tumoral injection of Tc-99m-phytate. METHODS: Patients with biopsy-proven squamous cell carcinoma of the larynx were included. On the day of surgery, after anesthesia induction, suspension laryngoscopy was performed to inject 74 MBq/0.4 ml Tc-99m-phytate in four aliquots into the sub-mucosal peri-tumoral location. After a 10-min wait, a portable gamma probe was used to locate sentinel nodes. Subsequently, all patients underwent laryngectomy and neck dissection. Both sentinel nodes and non-sentinel nodes were examined using hematoxylin and eosin (H&E) staining. RESULTS: Twenty-six patients with a diagnosis of laryngeal carcinoma were included in the study. The SLN detection rate was 65.4%, with a 100% detection rate in the supraglottic region and a 52.6% detection rate for glottis/transglottic patients. Permanent pathology results showed lymph node involvement in four patients, but only one patient had a negative result in the SLNB, resulting in an overall false negative rate of 25%. The sensitivity of the SLN technique was 75% overall, 100% in the supraglottic region, and 67% in the glottis/transglottic region. CONCLUSION: The accuracy and feasibility of SLNB may be related to the location of the tumors in the larynx. For supraglottic tumors, the technique seems to be feasible with a low false negative rate. For glottis/transglottic tumors, both the detection rate and false negative rate seem to be suboptimal. Further studies are needed to validate our results.

Comparative Investigation of Laryngeal Palpation Scale Between Primary and Secondary Muscle Tension Dysphonia.

OBJECTIVES: Muscle tension dysphonia (MTD) is a condition that is often assessed through palpation examination. The laryngeal palpation scale (LPS) is a reliable and valid tool developed to evaluate patients with MTD. MTD is classified into primary (without tissue reactions) and secondary (with tissue reactions). Primary MTD is caused by muscle hyperfunction, while maladaptive compensation typically leads to secondary MTD. The objective of this study was to compare the LPS scores between primary and secondary MTD. METHODS: This study is a cross-sectional analytical comparative study. It included 39 participants (10 men and 29 women) who were divided into two groups: primary MTD and secondary MTD with mass lesions (20 with primary MTD and 19 with secondary MTD). Each type of MTD was diagnosed by a qualified otolaryngologist. The participants were assessed using the LPS, which comprises 45 variables evaluated across three subscales. RESULTS: The results of the current study showed that there is a difference between the primary MTD and secondary MTD in the subscale of patients with symptomatic complaints of the item pain at rest/speaking (Pv = 0.001) and pain level (Pv = 0.019) and the subscale of palpation the item cricothyroid (left) in dynamic conditions (tenderness; Pv = 0.013). In other LPS items, no difference was observed between primary MTD and secondary MTD in all three subscales (Pv ≥ 0.05). CONCLUSIONS: The LPS scores for pain items during rest/speaking and the pain level, as well as the left cricothyroid (tenderness) item, were different between the primary MTD and secondary MTD groups. However, the other LPS items did not show any difference between the primary MTD and secondary MTD groups. Further investigation on palpation findings with LPS in larger samples in both groups and with objective measurements such as electromyography are recommended.

The acoustic voice quality index, version 2.06 and 3.01, for the Persian-speaking population.

INTRODUCTION: Dysphonia assessment includes approaches like acoustic analysis, which is non-invasive and easy to use and provides an understandable numerical output. The Acoustic Voice Quality Index (AVQI) is an acoustic model that can detect dysphonia. The Persian language is spoken by around 70,000,000 native speakers. Since AVQI versions 2.06 and 3.01 have not been validated for the Persian yet, this study investigated their concurrent validity and diagnostic accuracy among the Persian-speaking population. METHODS: This scale development study was conducted from 2020 to 2021 on 180 normophonic and dysphonic native Persian-speaking residents of Mashhad, Iran. Five raters rated the samples by auditory-perceptual-judgments, including Grade from the Grade-Rough-Breathy-Asthenic-Strained (an ordinal scale) and the overall dysphonia severity from the Persian version Consensus Auditory Perceptual Evaluation of Voice (a continuous scale) to investigate both versions' concurrent validity. The intra- and inter-rater reliability and concurrent validity were evaluated for both scales. Both versions' diagnostic accuracy was assessed by the receiver operating characteristic, and the optimal thresholds were determined. RESULTS: AVQI-version-2-Persian thresholds of 3.47 and 4.04 provided sensitivity of 88.30% and 85.53% and specificity of 79.07% and 85.58% by the ordinal and continuous scales, respectively. AVQI-version-3-Persian thresholds of 3.07 and 3.03 also rendered sensitivity of 74.47% and 85.53%, and specificity of 97.67% and 91.35% by the ordinal and continuous scales sequentially. CONCLUSION: The significant values of concurrent validities and diagnostic accuracies of both versions of AVQI-Persian confirmed that it can discriminate between normal and pathological voices among the Persian-speaking population. Hence, it can be used for screening or diagnosis purposes.

Allergic rhinitis and chronic suppurative otitis media.

Allergic inflammation in upper airways can act as a predisposing factor for infectious ear diseases. There are some evidences about the role of allergic rhinitis in chronic otitis media with effusion, but its role in establishing chronic suppurative otitis media (CSOM) has not been clearly shown. 68 adult patients with established CSOM, who were candidates for ear surgery, and 184 age- and sex-matched controls were evaluated for the presence of allergic rhinitis. Standard questionnaire was filled out for all participants. All patients and controls underwent skin prick test for 28 common regional aeroallergens, and serum total IgE was measured by means of ELISA method. Allergic rhinitis were defined as a positive responses to the questionnaire, positive skin prick test to at least one allergen, and/or high level of serum total IgE. Allergic rhinitis was diagnosed in 20 (29.41%) and 41 (22.28%) of patients and controls, respectively (P = 0.241) (OR = 1.28, CI = 0.69-2.36). Outdoor allergens, especially grass pollen, were the most prevalent allergens among both groups, but indoor allergens like mites and molds have a low prevalence. The study did not show a significant difference in the prevalence of AR in the CSOM patients compared to the controls. The intermittent nature of allergy and other less known intervening factors in the etiopathogenesis of CSOM make such a conclusion difficult.

The Vocal Fold Dysfunction Questionnaire: Validity and Reliability of the Persian Version.

OBJECTIVES: The aim of this study was to develop, validate, and assess the reliability of the Persian version of Vocal Cord Dysfunction Questionnaire (VCDQP). STUDY DESIGN: The study design was cross-sectional or cultural survey. MATERIALS AND METHODS: Forty-four patients with vocal fold dysfunction (VFD) and 40 healthy volunteers were recruited for the study. To assess the content validity, the prefinal questions were given to 15 experts to comment on its essential. Ten patients with VFD rated the importance of VCDQP in detecting face validity. Eighteen of the patients with VFD completed the VCDQ 1 week later for test-retest reliability. To detect absolute reliability, standard error of measurement and smallest detected change were calculated. Concurrent validity was assessed by completing the Persian Chronic Obstructive Pulmonary Disease (COPD) Assessment Test (CAT) by 34 patients with VFD. Discriminant validity was measured from 34 participants. The VCDQ was further validated by administering the questionnaire to 40 healthy volunteers. Validation of the VCDQ as a treatment outcome tool was conducted in 18 patients with VFD using pre- and posttreatment scores. RESULTS: The internal consistency was confirmed (Cronbach α = 0.78). The test-retest reliability was excellent (intraclass correlation coefficient = 0.97). The standard error of measurement and smallest detected change values were acceptable (0.39 and 1.08, respectively). There was a significant correlation between the VCDQP and the CAT total scores (P < 0.05). Discriminative validity was significantly different. The VCDQ scores in patients with VFD before and after treatment was significantly different (P < 0.001). CONCLUSIONS: The VCDQ was cross-culturally adapted to Persian and demonstrated to be a valid and reliable self-administered questionnaire in Persian-speaking population.

Outcomes of Autologous Fat Injection Laryngoplasty in Unilateral Vocal Cord Paralysis.

INTRODUCTION: Unilateral vocal cord paralysis (UVCP) is not an uncommon finding. Several procedures are available to manage glottal insufficiency. We conducted a clinical trial to evaluate the outcome of fat injection laryngoplasty. MATERIALS AND METHODS: Liposuctioned lower abdomen fat was injected for augmentation of paralyzed vocal cord in 20 patients with UVCP. Autologous fat was harvested with an 18G needle and a 20-ml disposable syringe using a liposuction technique. Clinical follow-up after the injection was carried out from 1 to 6-21 months. RESULTS: Voice and glottal protective function were significantly improved after the surgery. Vocal elements were immediately improved after the surgery, and after 1 year of follow-up. CONCLUSION: Fat injection laryngoplasty by liposuction is simple, safe, effective and has a low cost for patients with UVCP with aspiration and breathy voice dysphonia.

Evaluation of the Distance Between Anterior Commissure of True Vocal Folds and the First Tracheal Ring and Related Laryngeal Indices in 40 Human Cadavers.

OBJECTIVE: Distorted anatomy in laryngotracheal pathologies expresses the need to determine a quantitative mean of the distance between the anterior commissure of true vocal folds and the first tracheal ring to better define whether a lesion is in the subglottis or has extended toward the trachea. STUDY DESIGN: This is a descriptive cross-sectional study. METHODS: In 40 cadavers, the larynx was exposed with an apron cut. The laryngofissure cut opened the larynx via the lateral aspect so that the anterior commissure was exposed. A needle was passed through the thyroid cartilage to reach the anterior commissure. The second needle was crossed over the first tracheal ring. The distance between the two needles was measured. RESULTS: The mean distance between the anterior commissure of true vocal folds and the first tracheal ring was 26.82 ± 4.28 mm (21.3-42.5 mm) in our subjects. This distance was 27.27 ± 4.45 and 25.05 ± 3.2 mm, in men and women, respectively. There was no statistically significant correlation between this distance with body mass index (BMI), age, and sex. CONCLUSIONS: The distance between the anterior commissure and the first tracheal ring in patients with laryngotracheal pathologies helps in determining the best therapeutic plan for patients.

Is Sudden Hearing Loss Associated with Atherosclerosis?

INTRODUCTION: Sudden sensorineural hearing-loss (SSNHL) patients constitute approximately 2-3% of referrals to ear, nose and throat (ENT) clinics. Several predisposing factors have been proposed for this condition; one of which is vascular disorders and perfusion compromise. In this research the atherosclerotic changes and their known risk factors are studied in SSNHL patients. MATERIALS AND METHODS: Thirty SSNHL patients and 30 controls were evaluated with regard to cardiovascular risks including history, heart examination, blood pressure, body mass index, waist circumference, electrocardiogram, blood sugar, triglycerides, cholesterol, high-sensitivity C-reactive protein (HSCRP); also, carotid artery color Doppler study was undertaken to measure intima media thickness(IMT). RESULTS: IMT and HSCRP showed an increased risk in the case group compared with the controls (P= 0.005 & P=0.001). However, waist circumference, history of smoking, fasting blood sugar, lipid profile, and electrocardiogram revealed no significant difference between the two groups. Interestingly, blood pressure and body mass index were higher in the controls in this study. CONCLUSION: Sudden sensorineural hearing loss may be associated with subclinical atherosclerosis.

Distance between Anterior Commissure and the First Tracheal Ring: An Important New Clinical Laryngotracheal Measurement.

INTRODUCTION: The distance between the anterior commissure of the larynx and the first tracheal ring (AC.T. distance) is of great importance in laryngotracheal surgeries. The amount of narrowing of the subglottic airway is used as a quantitative mean to determine whether the lesion is subglottic or has extended to the trachea and therefore helps in the prediction of the final prognosis. MATERIALS AND METHODS: In this study, the larynx was exposed by direct laryngoscopy under general anesthesia. The case was considered to be difficult because the exposure did not optimally reveal the anterior commissure, therefore a cricoid tape or anterior commissure laryngoscope was used. A zero degree Hopkins lens was used to view the anterior commissure and the first tracheal ring. Special markers were used to mark the two points with the distance between those being considered as the AC.T. distance. The relationship between AC.T. distance and the patient's age, sex, BMI, and laryngeal exposure condition during laryngoscopy was also studied. RESULTS: Eighty-two patients participated in this study. The mean AC.T. distance was measured and was found to be 32.67±3.34 mm in males and 29.80± 3.00 mm in females. This difference was statistically significant between the two groups (P<0.05). There was no statistically significant relationship between BMI, age, laryngeal exposure condition, and the AC.T. distance. CONCLUSION: The AC.T. distance was measured to be around 3 cm; with males measuring greater than females. However, future studies may lead to a more accurate practical scale for laryngotracheal surgeries due to possible technical or human errors, in addition to racial differences.

Intra-Operative Lymphatic Mapping and Sentinel Node Biopsy in Laryngeal Carcinoma: Preliminary Results.

INTRODUCTION: Sentinel node mapping has been used for laryngeal carcinoma in several studies, with excellent results thus far. In the current study, we report our preliminary results on sentinel node mapping in laryngeal carcinoma using intra-operative peri-tumoral injection of a radiotracer. MATERIALS AND METHODS: Patients with biopsy-proven squamous cell carcinoma of the larynx were included in the study. Two mCi/0.4 cc Tc-99m-phytate in four aliquots was injected on the day of surgery, after induction of anesthesia, in the sub-mucosal peri-tumoral location using a suspension laryngoscopy. After waiting for 10 minutes, a portable gamma probe was used to search for sentinel nodes. All patients underwent laryngectomy and modified radical bilateral neck dissection. All sentinel nodes and removed non-sentinel nodes were examined by hematoxylin and eosin (H&E) staining. RESULTS: Ten patients with laryngeal carcinoma were included. At least one sentinel node could be detected in five patients (bilateral nodes in four patients). One patient had pathologically involved sentinel and non-sentinel nodes (no false-negative cases). CONCLUSION: Sentinel node mapping in laryngeal carcinoma is technically feasible using an intra-operative radiotracer injection. In order to evaluate the relationship of T-stage and the laterality of the tumor with accuracy, larger studies are needed.

Pharyngeal Packing during Rhinoplasty: Advantages and Disadvantages.

INTRODUCTION: Controversy remains as to the advantages and disadvantages of pharyngeal packing during septorhinoplasty. Our study investigated the effect of pharyngeal packing on postoperative nausea and vomiting and sore throat following this type of surgery or septorhinoplasty. MATERIALS AND METHODS: This clinical trial was performed on 90 American Society of Anesthesiologists (ASA) I or II patients who were candidates for septorhinoplasty. They were randomly divided into two groups. Patients in the study group had received pharyngeal packing while those in the control group had not. The incidence of nausea and vomiting and sore throat based on the visual analog scale (VAS) was evaluated postoperatively in the recovery room as well as at 2, 6 and 24 hours. RESULTS: The incidence of postoperative nausea and vomiting (PONV) was 12.3%, with no significant difference between the study and control groups. Sore throat was reported in 50.5% of cases overall (56.8% on pack group and 44.4% on control). Although the severity of pain was higher in the study group at all times, the incidence in the two groups did not differ significantly. CONCLUSION: The use of pharyngeal packing has no effect in reducing the incidence of nausea and vomiting and sore throat after surgery. Given that induced hypotension is used as the routine method of anesthesia in septorhinoplasty surgery, with a low incidence of hemorrhage and a high risk of unintended retention of pharyngeal packing, its routine use is not recommended for this procedure.

An unusual cause of dysphonia with hemoptysis: a laryngeal live leech.

INTRODUCTION: Foreign bodies in the upper airway are one of the most challenging otolaryngology emergencies and have various presentations depending on their physical properties and location. Leeches are blood-sucking hermaphroditic worms that vary in color, length, and shape. They usually reside in fresh-water streams and lakes. When rural untreated water is drunk, leeches may localize in the nose, pharynx, and esophagus, or rarely in the larynx. CASE REPORT: This case is a man who was referred to our otolaryngology clinic with a complaint of hemoptysis and mild respiratory distress. The patient's symptoms were all relieved post operatively and he was discharged on the second day following the procedure. CONCLUSION: Leeches should be suspected as an airway foreign body in patients with a recent history of drinking stream water.

Nasal Septum Perforation due to Methamphetamine abuse.

INTRODUCTION: Spontaneous Perforation of the nasal septum is an uncommon condition. Nasal inhalation of substances such as cocaine has long been linked to this Perforation. CASE REPORT: This report describes the case of a 46-year-old woman who was addicted to methamphetamine and who presented with perforation of the nasal septum.This is the first reported case of nasal septal necrosis linked to nasal inhalation of methamphetamine. CONCLUSIONS: Patient history and assurance regardingillegal drug consumption and abuse is a key point for fast and accurate diagnosis. The pathophysiology of drug-induced sinunasal disease and a review of the literature are also presented.

Outcome of surgical treatment for proximal long segment post intubation tracheal stenosis.

BACKGROUND: Post intubation long segment tracheal stenosis is a serious problem which usually requires multiple methods of treatment. The aim of this study was to evaluate the results of surgical treatment in long segment post intubation tracheal stenosis. METHODS: Between 2004 to 2008, 20 patients with proximal long segment tracheal stenosis and resection of over 40% of tracheal length, were analyzed in terms of age, sex, clinical symptoms, etiology of stenosis, length of stenosis and resection, role of suprahyoeid release with bilateral hyoeid bone cutting maneuver, post operative complications and life quality 3 year after surgery. RESULTS: M/F was 2/5, with the average age of 23.5 ± 0.5 years. Average length of stenosis was 4.2 ± 0.4 cm and the average length of resected segment was 5.2 ± 0.4 cm. Early postoperative complications occurred in 4 patients (20%), 5 patients (25%) had late stenosis and 4 of them were treated with multiple dilation and one patient needed tracheostomy and prolonged T. tube. We didn't have any mortality. 80% of patients had excellent surgical results in follow up period. CONCLUSION: Surgery is the best method of treatment in long and multi segment tracheal stenosis.

The effect of local injection of epinephrine and bupivacaine on post-tonsillectomy pain and bleeding.

INTRODUCTION: Tonsillectomy is one of the most common surgeries in the world and the most common problem is post-tonsillectomy pain and bleeding. The relief of postoperative pain helps increase early food intake and prevent secondary dehydration. One method for relieving pain is peritonsillar injection of epinephrine along with an anesthetic, which has been shown to produce variable results in previous studies. Study Deign: Prospective case-control study. SETTING: A tertiary referral centers with accredited otorhinolaryngology-head & neck surgery and anesthesiology department. MATERIALS AND METHODS: Patients under 15 years old, who were tonsillectomy candidates, were assigned into one of three groups: placebo injection, drug injection before tonsillectomy, and drug injection after tonsillectomy. The amount of bleeding, intensity of pain, and time of first post-operative food intake were evaluated during the first 18 hours post operation. RESULTS: The intensity of pain in the first 30 minutes after the operation was lower in the patients who received injections, but the difference was not significant during the first 18 hours. The intensity of pain on swallowing during the first 6 hours was also lower in the intervention groups as compared with the placebo group. The amount of bleeding during the first 30 minutes post operation was lower in the two groups who received injections, but after 30 minutes there was no difference. CONCLUSION: Injection of epinephrine and bupivacaine pre- or post- tonsillectomy is effective in reducing pain and bleeding. The treatment also decreases swallowing pain in the hours immediately after surgery.

Laryngeal leiomyosarcoma, a case report and review of articles.

INTRODUCTION: Laryngeal leiomysarcoma is an extremely rare malignancy originating from smooth muscle cells. Its rarity is due to the fact that only less than 50 cases of pure laryngeal leiomyosarcoma and less than 10 cases of hypopharyngeal leiomyosarcaoma have been reported in modern medical literature. Even though the clinical presentation mimics that of a laryngeal carcinoma forming the major bulk of the laryngeal malignancies, the difference in management, warrants an accurate diagnosis. CASE REPORT: We reported a case of this very rare malignancy presenting in the supraglottic region by highlighting the clinical features, histological and radiological diagnosis and management of this extremely rare malignant entity. CONCLUSION: An accurate histological diagnosis may be difficult; but supplementing by electron microscopy and immunohistochemical staining, the diagnosis can be reached certainly.

Bilateral submandibular duct rerouting: assessment of results on drooling in cerebral palsy cases.

OBJECTIVES: Drooling is a physiological phenomenon in infants which becomes unusual and even pathologic after 18 months of age. Cerebral palsy (CP), the most common etiology for physical disability, mostly occurs in cases of normal-intelligence kids who are socially active and therefore their disorders require special attention. One of the major problems kids with CP face is excessive drooling and several therapeutic methods have been suggested to treat this problem. In this study described herein, bilateral submandibular duct rerouting (BSMDR) surgery was performed to investigate its effect on drooling in children with CP. METHODS: From March 2007 to April 2011, 16 children aged 6-16 years old with cerebral palsy who suffered from excessive drooling were recruited. A thorough physical examination was performed and a questionnaire was completed for each case. Those who met the inclusion criteria and provided an informed consent were selected for BSMDR surgery. They were followed-up twice, 10 days and 6 months after the operation to evaluate the degree of drooling or other possible side effects of the surgery. RESULTS: Sixteen patients entered the study and underwent surgery. On the first follow-up visit 87.50% presented overall improvement, of which 56.25% showed good to excellent improvement in contrast to 31.25% who exhibited fair improvement. On the second follow-up an overall improvement was observed in 81.25%, of which 43.75% showed good to excellent improvement compared to 37.50% with fair improvement. CONCLUSION: Considering that during both the first and second follow-up visit only two cases (12.5%) did not respond to treatment, it could be concluded that BSMDR surgery is an effective treatment for reducing drooling in CP children.

Detection of helicobacter pylori in benign laryngeal lesions by polymerase chain reaction: a cross sectional study.

BACKGROUND: Although Helicobacter Pylori (HP) was detected in some cases of chronic laryngitis, the results were not confirmed by polymerase chain reaction (PCR). By this time, it has not been found in laryngeal lesions by in house PCR, the most sensitive method for detecting the genome tracks. Regarding the previous results and also few numbers of studies about the presence of HP in benign laryngeal lesions, specifically by PCR, we aimed to investigate the presence of HP in benign laryngeal lesions by in-house PCR. METHODS: The samples were taken from 55 patients with benign laryngeal lesions and frozen in -20°C. One milliliter (ml) of lysis buffer was added to 100 mg (mg) of each sample and the tube was placed in 56°C overnight. Then DNA extraction was carried out. RESULTS: To find HP DNA, in-house PCR was performed that revealed 5 positive results among 55 patients with benign laryngeal lesions. Of them, 3 were polyp, 1 was nodule and 1 was papilloma. CONCLUSION: Although the number of positive results was not a lot in this study, it was in contrast with previous studies which could not find any HP tracks in benign laryngeal lesions by other methods. More studies about the prevalence of HP in benign laryngeal lesions improve judging about the effect of this infection on benign laryngeal lesions.

Gabapentin effectiveness on the sensation of subjective idiopathic tinnitus: a pilot study.

This prospective, placebo-controlled, double-blind clinical trial evaluated the effectiveness of gabapentin in decreasing subjective features of idiopathic subjective tinnitus in the patients. Pure-tone audiograms, laboratory test and personal histories were used to exclude any particular etiology of tinnitus. Participants were restricted to those with moderate to severe idiopathic subjective tinnitus for at least 6 months. A total of 30 participants received gabapentin in a graduated ascending dose series extending over 4 weeks (peak dose of 900 mg/day). There was not a significant subjective improvement in tinnitus annoyance for the patients (37%) versus controls (42%). Comparison between the results before and after intervention for patients and controls according to subjective response, tinnitus questionnaire, tinnitus severity index and the loudness perception by the patient showed no significant differences (P > 0.05). There is insufficient evidence to support the effectiveness of gabapentin in the treatment of tinnitus up to now.