Dedifferentiated chondrosarcoma of the larynx: Radiological, gross, microscopic and clinical features.

Laryngeal chondrosarcoma is an uncommon malignancy with a predilection for the cricoid cartilage of adult male patients. Although rare, identification of aggressive chondrosarcoma variants, such as dedifferentiated chondrosarcoma (DDCS) may influence preoperative patient counseling, definitive surgical management, potential implementation of post-operative adjuvant therapy and prognosis. Herein we describe clinical and imaging features of laryngeal DDCS, the unique perspective of fresh and formalin fixed macroscopic examination, a spectrum of histopathologic findings, and detail the full course of the patient's disease.

Management of Dysphonia After Radiation Therapy.

Radiation-induced dysphonia can develop after radiation for primary laryngeal cancer or when the larynx is in the radiation field for nonlaryngeal malignancy. The effects are dose dependent and lead to variable degrees of dysphonia in both short- and long-term follow-up. Rehabilitation of the irradiated larynx can prove frustrating but can be facilitated through behavioral, pharmacologic, or surgical interventions.

The role of laryngoscopy in the diagnosis of spasmodic dysphonia.

IMPORTANCE: Spasmodic dysphonia (SD) can be difficult to diagnose, and patients often see multiple physicians for many years before diagnosis. Improving the speed of diagnosis for individuals with SD may decrease the time to treatment and improve patient quality of life more quickly. OBJECTIVE: To assess whether the diagnosis of SD can be accurately predicted through auditory cues alone without the assistance of visual cues offered by laryngoscopic examination. DESIGN, SETTING, AND PARTICIPANTS: Single-masked, case-control study at a specialized referral center that included patients who underwent laryngoscopic examination as part of a multidisciplinary workup for dysphonia. Twenty-two patients were selected in total: 10 with SD, 5 with vocal tremor, and 7 controls without SD or vocal tremor. INTERVENTIONS: The laryngoscopic examination was recorded, deidentified, and edited to make 3 media clips for each patient: video alone, audio alone, and combined video and audio. These clips were randomized and presented to 3 fellowship-trained laryngologist raters (A.D.R., A.T.H., and A.M.K.), who established the most probable diagnosis for each clip. Intrarater and interrater reliability were evaluated using repeat clips incorporated in the presentations. MAIN OUTCOMES AND MEASURES: We measured diagnostic accuracy for video-only, audio-only, and combined multimedia clips. These measures were established before data collection. Data analysis was accomplished with analysis of variance and Tukey honestly significant differences. RESULTS: Of patients with SD, diagnostic accuracy was 10%, 73%, and 73% for video-only, audio-only, and combined, respectively (P < .001, df = 2). Of patients with vocal tremor, diagnostic accuracy was 93%, 73%, and 100% for video-only, audio-only, and combined, respectively (P = .05, df = 2). Of the controls, diagnostic accuracy was 81%, 19%, and 62% for video-only, audio-only, and combined, respectively (P < .001, df = 2). CONCLUSIONS AND RELEVANCE: The diagnosis of SD during examination is based primarily on auditory cues. Viewing combined audio and video clips afforded no change in diagnostic accuracy compared with audio alone. Laryngoscopy serves an important role in the diagnosis of SD by excluding other pathologic causes and identifying vocal tremor.

Case report of orbital violation with placement of ethmoid drug-eluting stent.

BACKGROUND: Delivery of topical therapy is a mainstay in the treatment of chronic rhinosinusitis (CRS). Ethmoid sinus stenting has recently been introduced as a minimally invasive mechanism to deliver medication. We review available literature on ethmoid stenting and present a case report involving orbital violation and a fixed, dilated pupil. METHODS: Case report and literature review. RESULTS: A 37 year-old female underwent endoscopic placement of bilateral ethmoid sinus drug-eluting stents for CRS at an outside facility. Postoperatively she complained of right-sided ocular pain and pressure. She was seen in the emergency setting on post-operative day (POD) 2 and had a dilated right pupil. A computed tomography (CT) scan was performed and read as normal. The left stent was removed successfully on POD 19; the right could not be removed in the outpatient setting secondary to pain. The patient was transferred to our facility on POD 21. The CT from POD 2 was reviewed and demonstrated violation of the lamina papyracea and orbit with the stent abutting the lateral orbital wall. On POD 24, the patient underwent medial orbital decompression and successful stent removal but continues to have a dilated pupil in the affected eye. CONCLUSION: This is the first reported case of orbital violation with placement of an ethmoid drug-eluting stent. The literature shows feasibility in cadaveric studies but the practitioner must be diligent in placement. Ethmoid sinus stenting is an option for topical treatment of ethmoid sinusitis but practitioners must be cognizant of potential risks when counseling patients.

Comparison of outcomes and complications between awake and asleep injection laryngoplasty: a case-control study.

OBJECTIVES/HYPOTHESIS: To compare clinical outcomes and complication rates in patients undergoing injection laryngoplasty (IL) under local versus general anesthesia. STUDY DESIGN: Retrospective case-control review METHODS: Charts of 141 consecutive patients undergoing IL were reviewed. Subjects who underwent IL with local anesthesia were grouped as experimental cases. Subjects who underwent IL with general anesthesia were grouped as controls. The voice-related quality of life (VRQOL) measure was employed to determine outcomes before and after IL. All undesirable events resulting from an IL were recorded as complications. RESULTS: One hundred sixty-six ILs were performed in 141 patients (83 males, mean age = 58.9 years). Unilateral vocal fold immobility was diagnosed in 60.9%. One hundred five (63.3%) ILs were performed under local anesthesia, and 61 were performed under general anesthesia. Pre- and postinjection VRQOL data was available for 78 ILs (50 cases, 28 controls). Average VRQOL in the awake patient improved by 25.05 points, whereas average VRQOL in the asleep patient improved by 20.81 points (P = .42). There were 24 complications (14.5% of all injections), which included 19.1% of cases and 6.6% of controls (odds ratio = 2.9). Six ILs had to be aborted. All complications were minor and self-limited. CONCLUSIONS: Both awake and asleep IL offer comparable VRQOL results. Although having the benefit of avoiding general anesthesia, IL in the awake patient has a slightly higher complication rate.