Endoscopic aspects and associated factors in paradoxical vocal fold movement.

INTRODUCTION: Paradoxical vocal fold movement (PVFM) is a respiratory disorder related to inadequate movement of vocal folds during inspiration or expiration. Its epidemiology and pathogenesis are unknown. The present study describes the standardization of the examination performed in our service and the main endoscopic changes found, evaluating the prevalence of PVFM in patients with suggestive symptoms and describing the association of PVFM with asthma and other diseases. MATERIALS AND METHODS: Retrospective observational study of a series of cases over a 13-year period - adult patients referred for outpatient bronchoscopy due to suspected PVFM. RESULTS: We analyzed 1131 laryngoscopies performed on patients referred for suspicion of PVFM from May 2006 to June 2019. Of these, 368 cases were excluded from the study. A total of 255 patients (33%) had a confirmed diagnosis of PVFM, 224 women (88%). The most frequent comorbidities found were asthma (62%), rhinitis (45%), gastro-oesophageal reflux disease (45%), obesity (24%), and psychiatric disorders (19%). Among the endoscopic findings concomitant with the diagnosis of PVDM, we highlight posterior laryngitis (71%), diseases of the nasal septum (18%), nasal polyps (7%). DISCUSSION: Female sex is more affected. There are several associations with other diseases, the main one being asthma, followed by rhinitis and psychiatric disorders. Obesity appears as a comorbidity in 24% of patients, as does sleep apnoea in 13%. Posterior laryngitis was the most common endoscopic finding. PVFM is an underdiagnosed disease, little known as it is a rare entity that still needs prospective studies. Exam standardization is important.

Safety of office-based flexible endoscopic procedures of the pharynx and larynx under topical anesthesia.

INTRODUCTION: Flexible endoscopic procedures (FEP) using a working channel allowed otolaryngologists to perform more procedures on the pharynx and the larynx under local anesthesia. The purpose of this work is to demonstrate the feasibility and safety of this technique by studying the adverse effects of this practice in an office-based setting. METHODS: This is a monocentric retrospective cohort study. We searched the database using the French procedural code for FEP performed in an outpatient setting between January 2005 and December 2020. Data regarding the patient's characteristics, indications, and periprocedural complications were extracted. RESULTS: In total, we included 231 patients with a total of 308 FEP: 36% biopsy, 20% hyaluronic acid injection (including 3.5% at the level of the cavum), 20% injection of other substances (in descending order: botulinum toxin, cidofovir, physiological serum, cortisone), 20% exploration for an occult tumor, 3% samples for microbiological analysis, 1% other procedures. Of the 308 FEP included in this study, 24 patients (10.3%) had complications corresponding to 7.8% of the procedures performed. During the procedures, reported complications include minor laryngeal bleeding (n = 5), vasovagal syncope (n = 5), laryngospasm (n = 1) or nausea (n = 3), dysphagia (n = 3), and voice disorders (n = 3). Post-procedural complications were hypertensive crisis (n = 1), asthma attack (n = 1), pneumonia (n = 1), laryngitis (n = 1). Using the Clavien-Dindo classification system, these complications could be defined as grade I (laryngeal bleeding, vasovagal syncope, laryngospasm, dysphagia, nausea, voice disorders, and laryngitis) and grade II (hypertensive crisis, asthma attack, pneumonia) in 9.1% and 1.2% of cases, respectively. Most of these complications were self-limiting, while asthma attacks, pneumonia, laryngitis, and voice disorders required a medical intervention. All complications were managed without sequelae. There was no serious complication grade (no grade III, IV or V). CONCLUSIONS: FEP, which is now well standardized in our institution, makes it possible to carry out a wide range of interventions with little morbidity. These results are in line with those of literature but this technique remains out of nomenclature in France. Our experience led to the development of an evidence-based standard of care that can serve as a framework for practitioners on a nationwide level, while the work to establish official guidelines by the French society of phoniatrics and laryngology is in progress.

An unusual extranodal natural killer/T-cell lymphoma presenting as chronic laryngitis: A case report.

RATIONALE: Nasal-type, extranodal natural killer (NK)/T-cell lymphoma is a rare lymphoma. The tumor usually shows ulcerative and necrotic lesions in the nasal cavities and sinuses. Tissue involvement outside the nasal cavity is uncommon. PATIENT CONCERN: We describe a 30-year-old man with a 2-month history of hoarseness, weight loss, and dyspnea. DIAGNOSIS: Magnetic resonance image (MRI) showed edema of the larynx with obliteration of the airway. Laryngoscopic examination described necrotic tissue in the glottis and larynx. The biopsy showed chronic, necrotizing laryngitis, with no granulomas, vasculitis, or atypical cells. The immunologic and microbiologic study was negative. Later, after immunosuppressive therapy, the patient presented erythema and diffuse enlargement of the right arm. MRI showed myositis of the biceps and brachial muscles. Infection was rule out, and direct microscopy showed an extensive muscle infiltration by mononuclear cells and abundant mitosis. Immunohistochemistry was positive for CD3, CD8, Ki 67 (90%), and CD56 compatible with extranodal NK/T cell lymphoma. INTERVENTIONS: The patient initially received immunosuppression treatments (corticoids, cyclofosfamide, and Rituximab) with relapsing episodes. When lymphoma was diagnosed, chemotherapy was started. OUTCOMES: The patient died during chemotherapy. LESSONS: Nasal-type, extranodal NK/T-cell lymphoma should be suspected even when there are no classical findings of neoplasms on histology. Immunohistochemistry is mandatory to rule it out.

Association of mRNA Expression Levels of LRP1 and Actin-Binding Proteins with the Development of Laryngeal and Laryngopharyngeal Squamous Cell Carcinoma.

We analyzed the association of the level of mRNA expression of the main endocytosis receptor LRP1 and actin-binding proteins (ezrin, profilin-1, cofilin-1, and adenylyl cyclase-associated protein 1) with the development and metastasis of laryngeal and laryngopharyngeal squamous cell carcinoma. The mRNA expression was evaluated in paired tissue samples using quantitative reverse transcription real-time PCR (RT-qPCR) and SYBR Green reagents. The study included 38 patients with stage T1-4N0-1M0 laryngeal and laryngopharyngeal squamous cell carcinoma and 10 patients with chronic hyperplastic laryngitis or grade II-III epithelial dysplasia. The expression of LRP1 in patients with laryngeal and laryngopharyngeal squamous cell carcinoma depended on the stage of the tumor process. Against the background of low expression of LRP1 mRNA, the relationship between cofilin 1 and profilin 1 expression became stronger (r=0.08; p=0.05) and a correlation between cofilin 1 and esrin expression (r=0.7; p=0.05) appeared. Studies on a larger patient cohort are required to make a definite conclusion on the role of LRP1 in the development of laryngeal and laryngopharyngeal squamous cell carcinoma.

Smoking Cessation Improves the Symptoms and the Findings of Laryngeal Irritation.

Smoking is known to increase laryngeal inflammation and laryngopharyngeal reflux (LPR), which cause laryngeal irritation. Thus, the aim of this study is to evaluate the changes in the symptoms and the findings of laryngeal irritation in smokers after a smoking cessation period. The reflux symptom index (RSI) and the reflux finding score (RFS) were used for evaluating the symptoms and findings of laryngeal irritation in smokers. Endoscopic examination of the laryngeal structures for RFS and symptom inquiry for RSI were performed at the beginning of the study and after a 2 months of cigarette cessation period. This study was carried out in 24 volunteers (14 female and 10 male), between the ages of 24 and 62 years. When we compared the results of RSI and RFS that were performed before and after the cigarette cession period, we found that there was a significant improvement both in RSI and in RFS (P < .001 and P < .001, respectively). Also, there was significant correlation between the cigarette smoking period and RFS score that was determined at the beginning of the study (P = .006, r = .54). A significant improvement was found both in RSI and in RFS after smoking cessation period, which might be the evidence of improvement in laryngeal irritation possibly caused by inflammation due to smoking and LPR. A significant positive correlation was found between smoking period and RFS, especially with vocal fold edema and posterior commissure hypertrophy.

A case report of Talaromyces marneffei Oro-pharyngo-laryngitis: a rare manifestation of Talaromycosis.

BACKGROUND: The incidence of Taralomyces marneffei infection in HIV-infected individuals has been decreasing, whereas its rate is rising among non-HIV immunodeficient persons, particularly patients with anti-interferon-gamma autoantibodies. T. marneffei usually causes invasive and disseminated infections, including fungemia. T. marneffei oro-pharyngo-laryngitis is an unusual manifestation of talaromycosis. CASE PRESENTATION: A 52-year-old Thai woman had been diagnosed anti-IFNÉ£ autoantibodies for 4 years. She had a sore throat, odynophagia, and hoarseness for 3 weeks. She also had febrile symptoms and lost 5 kg in weight. Physical examination revealed marked swelling and hyperemia of both sides of the tonsils, the uvula and palatal arches including a swelling of the epiglottis, and arytenoid. The right tonsillar biopsy exhibited a few intracellular oval and elongated yeast-like organisms with some central transverse septum seen, which subsequently grew a few colonies of T. marneffei on fungal cultures. The patient received amphotericin B deoxycholate 45 mg/dayfor 1 weeks, followed by oral itraconazole 400 mg/day for several months. Her symptoms completely resolved without complication. CONCLUSION: In patients with anti-IFN-É£ autoantibodies, T. marneffei can rarely cause a local infection involving oropharynx and larynx. Fungal culture and pathological examination are warranted for diagnosis T. marneffei oro-pharyngo-laryngitis. This condition requires a long term antifungal therapy.

Perceptual, Aerodynamic, and Acoustic Characteristics of Voice Changes in Patients with Laryngopharyngeal Reflux Disease.

Laryngopharyngeal reflux (LPR) is an inflammatory condition suspected to be associated with dysphonia. In this study, we investigated multidimensional perceptual, aerodynamic, and acoustic voice changes in patients with clinically diagnosed LPR compared to healthy participants. We prospectively included 80 outpatients with Reflux Finding Score (RFS) >7 and Reflux Symptom Index (RSI) >13 from September 2013 to April 2016 and we compared clinical and voice quality assessments of these patients with 80 healthy participants. Statistically significant differences were found between groups with regard to Voice Handicap Index, perceptual voice quality (grades of dysphonia, roughness, strain, breathiness, asthenia, and instability), phonatory quotient, percentage jitter, percentage shimmer, peak-to-peak amplitude variation, standard deviation of fundamental frequency, and noise to harmonic ratio. Granulation score of RFS was found to affect the highest number of acoustic parameters. We did not identify significant correlation between vocal fold edema and objective voice quality measurements. This study supports that patients with LPR have significant deterioration of both subjective and objective voice quality compared to healthy participants.

Establishment of a novel and effective reflux laryngitis model in rabbits: a preliminary study.

PURPOSE: To establish a novel and effective reflux model with a modified nasogastric aspiration tube and to investigate the association between different types of nasogastric aspiration tubes and reflux laryngitis, we conducted this study. METHODS: Thirty-eight healthy New Zealand albino rabbits (2.5-3.5 kg) were divided into three groups: control (CTR, n = 6)-non-intubated; normal nasogastric intubation (NNI, n = 16)-intubated with 4#, 6#, 8#, and 10# normal nasogastric aspiration tubes; and modified nasogastric intubation (MNI, n = 16)-intubated with 4#, 6#, 8#, and 10# modified nasogastric aspiration tubes. The laryngoscopy, body weight, and pH values at the esophageal entrance were recorded before and 1, 2, and 4 weeks after intubation. After the final laryngoscopy, the animals in groups with a pH below 4 were sacrificed to obtain histological and gene expression analysis results. RESULTS: The reflux finding score (RFS) after 4 weeks showed that there was a statistically significant difference in the 8# NNI group (7 ± 0.816, P < 0.001), the 8# MNI group (11.5 ± 2.517, P < 0.001) and the 10# MNI (12.75 ± 1.893, P < 0.001) group compared with the control group (1.83 ± 1.602). The pH values of these three groups were lower than 4. However, the weight loss of the rabbits in the 10# NNI and 10# MNI groups was more obvious. Submucous gland hyperplasia and inflammation were significantly increased in the 8# NNI group, 8# MNI group and the 10# MNI group, but in the level of some pro-inflammatory cytokines and COX-2, the MNI group was significantly higher than the NNI group (8# NNI × 8# MNI, P < 0.01; 8# MNI × 10# MNI, P < 0.01). CONCLUSION: This study showed that 8# modified nasogastric intubation (MNI) produces effective reflux laryngitis in the rabbits.

Post-transplantation laryngeal actinomycosis.

A case of laryngeal actinomycosis occurred after bone marrow transplantation was reported. The patient was a 14-year-old girl who had a history of bone marrow transplantation for the treatment of acute lymphocytic leukemia 4month before the onset of the disease. She was referred to our hospital complaining persistent sore throat since 2weeks ago. Fiberscopic observation proved the presence of white tumor-like mass on her right arytenoid of the larynx. As CT image demonstrated that the mass was localized at the arytenoid region with central low-density area surrounded by granulation tissue, we underwent biopsy under local anesthesia. Excision of the mass proved it to be a soft granulation including sulfur granules. Oral administration of amoxicillin 750mg per day was initiated as a postoperative medication. On day 17, histological study confirmed that the tumor-like mass was Actinomyces granuloma, and therefore amoxicillin administration continued. The medication was effective to subside the disease and the arytenoid lesion healed on day 31. Amoxicillin was further administered until day 70 to prevent recurrence. At 6month after the biopsy, she was free from the disease.

Intralesional Cidofovir for Treatment of Acyclovir-Resistant Laryngeal Herpes Manifesting as Supraglottic Mass.

INTRODUCTION:: Laryngopharyngeal herpes simplex virus infection is rare and presents typically in the supraglottis. Findings on presentation can range from small mucosal lesions to fungating obstructive masses mimicking neoplasm. Laryngopharyngeal herpes is a medically treated disease. OBJECTIVES:: Identify potential treatment in cases that are refractory to antiviral medications. METHODS:: Individual case with treatment adapted from other case report. CASE PRESENTATION:: We report a case of bulky, obstructive supraglottic and glottic herpes virus laryngitis that presented with dysphonia, dysphagia, and airway complaints resistant to acyclovir analogues that was treated effectively with intralesional cidofovir injection. CONCLUSIONS:: Our promising initial response suggests a potential novel treatment for this unusual condition.

Use of a national identification database to determine the lifetime prognosis in cattle with necrotic laryngitis and the predictive value of venous pCO2.

BACKGROUND: Necrotic laryngitis, caused by Fusobacterium necrophorum, frequently requires surgical intervention (laryngostomy) in the chronic stage. HYPOTHESIS/OBJECTIVES: To determine survival until slaughter of cattle surgically treated for necrotic laryngitis and to identify predictors of mortality. ANIMALS: A total of 221 cattle diagnosed with necrotic laryngitis by laryngoscopy and surgically treated METHODS: Retrospective cohort study. Clinical records were matched with the national cattle identification, registration, and movement database. Information on possible predictors including clinical examination, biochemistry, and surgery was collected. A multivariable Cox proportional hazard model was used to identify predictors of mortality. RESULTS: The overall survival rate was 65.2% and 58.6% of the animals with a completed life cycle could be slaughtered. Animals <6 months old experienced significantly higher mortality risk (hazard ratio [HR], 2.0; 95% confidence interval [CI], 1.1-3.5). The venous partial pressure of carbon dioxide (pCO2 ; HR, 2.4; 95% CI, 1.4-4.2) at a 64.5 mm Hg cut-off was most significantly associated with mortality. Sensitivity and specificity of the final model consisting of age and pCO2 were 49.1 and 86.4%, respectively. Instead of pCO2 , total carbon dioxide (TCO2 ) could also be used, with similar diagnostic accuracy. CONCLUSIONS AND CLINICAL RELEVANCE: The lifetime prognosis for chronic necrotic laryngitis in cattle with surgical intervention appears fair. Age, venous pCO2 and TCO2 are easily accessible predictors of survival to support owners and veterinarians in their decision process of whether or not to operate and to identify high risk animals that require more intensive follow-up.

[The clinical and functional condition of the larynx in the patients of the elder age group presenting with chronic oedematous polypoidal laryngitis]. / Kliniko-funktsional'noe sostoianie gortani u patsientov starshei vozrastnoi gruppy s khronicheskim otechno-polipoznym laringitom.

This article was designed to report the results of the evaluation of the clinical and functional condition of the larynx in the patients of the elder age group presenting with chronic oedematous polypoidal laryngitis before and after their surgical treatment. A total of 60 patients at the age from 60 to 72 years were available for the examination; all of them had a concomitant somatic or ENT pathology. The clinical and functional conditions of the larynx in the patients of the elder age group were studied, with special reference to those suffering from chronic oedematous polypoidal laryngitis before the surgical intervention, that determined the overall clinical picture of the disease characterized in the first place by the predominance of the severe polypoid process with the combination of the organic and functional laryngeal pathology. The specific clinical and functional features of the larynx were identified after the surgical treatment that exerted the appreciable influence on the postoperative course of the disease and the duration of dysphonia. The peculiarities of postoperative laryngitis are described. Its catarrhal form was diagnosed in 42% of the patients. The strong inflammatory reaction with exudation and formation of fibrin films was documented in 58% of the patients while 83% of them exhibited formation of the functional component of dysphonia that required the application of the additional therapeutic measures for the complete restoration of the vocal function taking into consideration the age-related alteration of the larynx together with the long-term postoperative observation of the patients.

Insulin Resistance is Associated with Chronic Laryngitis in Korean Women.

OBJECTIVES: The aim of this study was to investigate the association between chronic laryngitis (CL) and insulin resistance (IR) in South Korea using data from the 2010 Korea National Health and Nutrition Examination Surveys (KNHANES). DESIGN, SETTING AND PARTICIPANTS: Cross-sectional data of 4,261 adults who completed KNHANES were analyzed. CL was considered when participants experienced a voice change and demonstrated flexible laryngoscopic findings of diffuse laryngeal inflammation. All participants were assessed for IR using the homeostasis model assessment of insulin resistance (HOMA-IR). RESULTS: Among the Korean population older than 19 years, the prevalence of chronic laryngitis was 3.8±0.7%. Univariate analysis demonstrated that CL was significantly associated with smoking and systolic and diastolic blood pressure in men and with age, diastolic blood pressure, HDL cholesterol, insulin, and HOMA-IR in women. Multiple regression analysis demonstrated that the mean value of HOMA-IR was significantly associated with CL in women only. In addition, CL was more prevalent in the highest compared with the lowest HOMA-IR quartile (OR [95% CI]: 2.268 [1.053-4.884] after adjusting for age, OR [95% CI]: 2.235 [1.040-6.181] after adjusting for confounding factors of age, body mass index, smoking status, alcohol intake, regular exercise, education, and income). CONCLUSIONS: These findings indicate that IR characterized by HOMA-IR is significantly associated with CL in Korean women only. Our results suggest that HOMA-IR could be an early predictive factor of increased risk of CL in Korean women.

Effects of Smoke Generated by Electrocautery on the Larynx.

OBJECTIVE: The aim of this study was to investigate effects of smoke produced by electrocautery on the laryngeal mucosa. MATERIALS AND METHODS: We used 16 healthy, adult female Wistar albino rats. We divided the rats into two groups. Eight rats were exposed to smoke for 60 min/d for 4 weeks, and eight rats were not exposed to smoke and served as controls. The experimental group was maintained in a plexiglass cabin during exposure to smoke. At the end of 4 weeks, rats were sacrificed under high-dose ketamine anesthesia. Each vocal fold was removed. An expert pathologist blinded to the experimental group evaluated the tissues for the following: epithelial distribution, inflammation, hyperplasia, and metaplasia. Mucosal cellular activities were assessed by immunohistochemical staining for Ki67. Results taken before and after effect were compared statistically. RESULTS: There was a significant difference in the extent of inflammation between the experimental group and the control group. Squamous metaplasia was detected in each group, but the difference was not significant. None of the larynges in either group developed hyperplasia. CONCLUSIONS: We showed increased tissue inflammation due to irritation by the smoke.

Validation of the laryngopharyngeal reflux color and texture recognition compared to pH-probe monitoring.

OBJECTIVE/HYPOTHESIS: The objective of this study was to determine the validity of our laryngopharyngeal reflux (LPR) diagnostic system from our previous study (Witt et al.) against the results of a standard pH probe monitoring. We hypothesized that subjects with abnormal pH probe results demonstrate color and texture abnormalities that would be classified as LPR according to artificial neural network (ANN) analysis. STUDY DESIGN: Retrospective analysis. METHODS: Eighty-two subjects, including 18 pH-positive, 11 pH-negative, and 53 control subjects were tested for LPR through multichannel intraluminal impedance 24-hour pH (MII-24pH) monitoring. Laryngoscopic images of all subjects were obtained. The hue and texture values of seven areas of interest, including true vocal folds, false vocal folds, arytenoids, and interarytenoid, were quantified using a hue calculation and two-dimensional Gabor filtering. These served as inputs for the ANN. This was used to classify images through pattern recognition, and a receiver operating characteristic (ROC) analysis was performed to determine the effectiveness of the diagnosis. RESULTS: Classification accuracy for the combined hue and texture was 87.40%, with an area under the ROC curve of 0.910. CONCLUSION: Although a previous study conducted classification based on RFS, this study suggests that color and texture analysis may be used to classify images based on the results of pH probing, a more objective approach for diagnosis. Additional studies should include more subjects to produce an even more accurate reading, and will use the color/texture analysis tool to test and confirm this application in a clinical setting. LEVEL OF EVIDENCE: 3B. Laryngoscope, 127:665-670, 2017.