Laryngeal Amyloidosis: What is the Role of Imaging?

OBJECTIVE/HYPOTHESIS: To review the imaging findings of laryngeal amyloidosis and to identify radiological findings suggestive of this disease. STUDY DESIGN: Retrospective case series. METHODS: A retrospective chart review of patients with pathologically confirmed laryngeal amyloidosis was performed from 2009 to 2022. Clinical and demographic factors were collected. A fellowship-trained head and neck radiologist reviewed all computed tomography (CT) scans and magnetic resonance imaging (MRI) findings within this cohort. RESULTS: 12 patients were identified and a total of 36 imaging studies analyzed. Localized amyloidosis was found in the supraglottic region (n = 6), glottic region (n = 7), and subglottic region (n = 5); six patients had disease spanning two subsites. The most common finding on the CT scan was a homogeneous and well-defined submucosal soft tissue mass. Punctate calcifications were present in three cases. The presence of contrast enhancement was identified in the majority of patients who underwent MRI (4/5). MRI showed consistent signal intensity, hypointense, or isointense on both T1-weighted and T2-weighted images. Diffusion-weighted sequences were obtained in every patient and did not demonstrate diffusion restriction. CONCLUSION: This is the largest series searching for unifying imaging characteristics of laryngeal amyloidosis. This research suggests that characteristics from CT and MR provide both similar and unique features of laryngeal amyloidosis on imaging. Both modalities identify a submucosal mass. CT is the preferred modality to demonstrate punctate calcifications, while MRI identifies enhancement and altered signal characteristics. The main benefit of serial imaging is the correlation with patient symptoms, identification of the extent of disease, and assisting in delineating appropriate timing for surgery.

Surgical Treatment of Early Glottic Cancer.

The incidence of all head and neck malignancies is rising worldwide, with carcinoma of the larynx constituting approximately 1% of all cancers. Early glottic cancer responds quite favorably to surgical intervention due to its early presentation, coupled with the low rate of regional and distant metastases. This article focuses on various approaches to the surgical treatment of early glottic cancer. Details include the clinical and radiological evaluation of laryngeal cancer, the goals of treatment, current surgical options for early disease, approach to surgical resection margins and management of nodal disease, and complications associated with each treatment modality.

Voice Disorders in the Elderly.

Presbyphonia is more common than appreciated by most physicians, and it is associated with undesirable vocal characteristics such as hoarseness, weakness, breathiness, instability, and tremulousness. Hearing impairment in the patient or his or her friends, family, and associates exacerbates the problem, resulting in depression and social withdrawal, further reducing quality of life. Moreover, voice weakness and instability are all too often misinterpreted as reflecting intellectual instability. Expert diagnosis, medical treatment, voice therapy and training, and occasionally surgery usually can maintain or restore vocal stability and "youth."

Use of fluorescent light in detecting malignant and premalignant lesions in the oral cavity: a prospective, single-blind study.

OBJECTIVE: To determine the usefulness of the VELscope in detecting malignant and premalignant oral cavity lesions. STUDY DESIGN: Prospective clinical study. SETTING: Head and neck oncology clinic at an academic tertiary care centre. SUBJECTS AND METHODS: Eighty-five patients with a history of smoking, alcohol use, and/or head and neck cancer were recruited into the study. The VELscope was used to examine patients' oral cavities after a clinical examination. Biopsies were then taken from suspicious areas. RESULTS: Of the 85 patients included in the study, 33 underwent biopsies prompted by a clinical examination, the VELscope, or both. Biopsy results that showed invasive malignancy or dysplasias were considered positive. Five positive biopsies for premalignant lesions were detected only by the VELscope and were not visible on clinical examination. On the other hand, only one positive biopsy for a premalignant lesion was detected by the clinical examination only and not seen on the VELscope. Seven positive biopsies were detected by both methods. This indicates that the diagnostic yield from a regular examination was 47% (95% CI 23-72) and that the diagnostic yield from the addition of the VELscope was an additional 31% (95% CI 11-59). Sensitivity and specificity for the VELscope were 92% and 77%, respectively. CONCLUSION: The Velscope may add sensitivity to the clinical examination and be a useful adjunct in high-risk patients.

Sclerosing mucoepidermoid carcinoma of the salivary gland: Case report and literature review.

Sclerosing mucoepidermoid carcinoma (SMEC) is an extremely rare variant of mucoepidermoid carcinoma with unique histologic features. To the best of our knowledge, only 14 cases of salivary gland SMEC have been previously reported in the English-language literature since it was discovered in 1987. We report a new case of salivary gland SMEC, and we review the literature. Because of SMEC's distinctive histologic features and rarity, its diagnosis can be difficult. Moreover, no clear treatment strategy has emerged with regard to adjuvant postoperative radiotherapy. We attempt to elucidate a natural course of this disease, and we propose a conservative approach to postoperative management.

A rare but serious entity: nasogastric tube syndrome.

Since its first description by Hunter in 1790, the nasogastric tube has become a frequently used method of alleviating gastrointestinal symptoms. Because the morbidity associated with its use is low the risks of complications are often underestimated. We present a case of bilateral vocal cord paralysis and supraglottic edema following nasogastric tube insertion-also known as Nasogastric Tube Syndrome (NGTS). Although this complication is rare, it can be life threatening. We discuss this phenomenon in the context of a meta-analysis of reported cases, notably: presenting symptoms, time at development and resolution of symptoms in relation to nasogastric intubation and propose treatment options.

Laryngeal inflammation assessed using the reflux finding score in obstructive sleep apnea.

OBJECTIVES: To evaluate the relationships between laryngeal inflammation assessed using the Reflux Finding Score (RFS), laryngeal sensory function, and apnea severity in patients with obstructive sleep apnea (OSA). METHODS: Endoscopic sensory testing (EST) was performed with subsequent blinded scoring from video of RFS. An RFS>7 was indicative of increased inflammatory change. RESULTS: Of 34 patients evaluated, 29 had OSA (apnea-hypopnea index [AHI]>or=15 events/h) at polysomnography. Increased inflammation was present in 26/29 (90%), with changes suggestive of laryngopharyngeal reflux. There were significant correlations between: inflammation and OSA severity (eg, RFS vs AHI, r=0.57, P<0.001); inflammation and laryngeal sensory impairment (EST detection threshold and pressure required to elicit the laryngeal adductor reflex, LAR); and the degree of sensory impairment and OSA severity. CONCLUSIONS: Laryngeal inflammation is prevalent among OSA patients and correlates with laryngeal sensory dysfunction, attenuation of the LAR, and apnea severity. EBM RATING: C-4.

High prevalence of obstructive sleep apnea among patients with head and neck cancer.

OBJECTIVES: To determine the prevalence of obstructive sleep apnea (OSA) in patients with cancer of the oral cavity and oropharynx scheduled for primary surgical resection. To correlate the presence of OSA and the occurrence of postoperative morbidities in this patient population. METHODS: This was a prospective study involving 17 patients with malignancies of the oral cavity and oropharynx scheduled for primary surgical resection. Consecutive patients were approached to undergo overnight polysomnography to determine the apnea-hypopnea index (AHI). OSA was defined by an AHI value > or = 20 events per hour. Postoperative morbidities were evaluated in a blinded fashion for the patients completing surgery. RESULTS: OSA was present in 13 of 17 patients, yielding a striking prevalence of 76% in this patient group. The mean AHI for patients with OSA was 44.7 +/- 3.5 (standard error) events per hour, with a mean nadir oxygen saturation of 88.2 +/- 1.8%, consistent with moderate to severe sleep-disordered breathing. The OSA and non-OSA patients were similar with respect to age and body mass index. The mean size of the primary tumour was 3.3 cm in patients with an AHI < 20 and 3.5 cm in those with an AHI > or = 20 (p = not significant). Overall, postoperative complications, defined as prolonged intensive care unit stay (> 24 hours), need for mechanical ventilation, and cardiopulmonary morbidities, were observed in 67% of OSA and 25% of non-OSA patients. CONCLUSIONS: These findings point to a strong association between OSA and malignancies of the oral cavity and oropharynx. This relationship was independent of the size of the primary malignancy in this patient population with tumours ranging from 1 to 7 cm (p = not significant). When comparing the two groups (AHI < 20 and AHI > or = 20), there was a tendency for the group with OSA to have an increase in postoperative morbidities. Further research is warranted to further evaluate the postoperative morbidities and mortalities associated with OSA in this patient population and to determine the potential roles for preoperative treatment with continuous positive airway pressure and tracheotomy.