A case of vocal polyps improved with herbal medicine: A case report.

Vocal polyps are benign vocal cord lesions, which mainly manifest as a hoarse voice. Laryngeal microsurgery is the most common treatment. However, because of anxiety regarding invasive treatment, it is necessary to have a non-invasive treatment option. A 43 year old female patient who is a teacher visited a Korean medical hospital for persistent hoarseness with a vocal polyp. After taking herbal medicine for hoarseness (Kyung-Hee-cheong-um-whan) and pharyngitis (cheong-in-li-gyok-tang and cheong-in-ryu-que-whan) for almost 10 weeks, the vocal polyp was reduced and symptoms improved. Herbal prescription for pharyngitis and hoarseness can be applied to vocal polyps as non-invasive treatment.

The Effect of Antioxidant Agents on Cisplatin-Induced Laryngeal Histological Alterations in Rats.

The larynx-related adverse effects that depend on cisplatin decrease patient comfort and many antioxidants have been used to eliminate these side effects. We aimed to identify the laryngeal mucosal changes imposed by cisplatin and investigated whether antioxidants, and their healing effects on these changes, may help reduce laryngeal complications in patients resulting from adverse effects in the larynx. A rat model was designed to evaluate the effects of cisplatin on the larynx and the protective role of antioxidants. Single-dose cisplatin was given both intraperitoneally alone and additionally administered with p-coumaric acid, melatonin, resveratrol, vitamin D, and oleic acid over 5 days. Whole larynges were dissected and evaluated histologically, histochemically, and immunohistochemically. Varying degrees of mucosal changes cisplatin group, but neither erosion nor an ulcer was observed. Numerous variable histological effects of antioxidants were observed on cisplatin exposed laryngeal mucosa. The most obvious effects of cisplatin were edema. The results of the study showed that resveratrol was the most preventive antioxidant agent against cisplatin-dependent mucosal changes. The highest increase in the Ki67 index was in the oleic acid group. Vitamin D increased stromal cyclooxygenase-2 expression that may have an effect on increasing mucosal damage.

[Laryngeal dystonia: novel forms of therapeutic administration of botulinum toxin by direct routes]. / Distonia laringea: nuevas formas de administracion terapeutica de toxina botulinica por via directa.

AIM: To describe our experience in the treatment of laryngeal dystonia (in abduction and adduction), with special emphasis given to the technical aspects (approach procedure, dosage and type of botulinum toxin type A used), as well as treatment response and possible side effects. PATIENTS AND METHODS: We conducted a cross-sectional descriptive study of a sample of patients with laryngeal dystonia treated by means of transoral administration of onabotulinumtoxinA or incobotulinumtoxinA over a period of 10 years (2007-2017). Data collected include demographic and clinical variables, treatment response (based on a self-rating scale), the duration of treatment and the appearance of side effects. SAMPLE SIZE: 15 patients (11 women; mean age: 44.06 years) with laryngeal dystonia (mean time since onset of 40 months; 12 patients with dystonia in adduction) and 174 administrations (92% incobotulinumtoxinA; average dosage of 5 U in each vocal cord). The procedure took an average of 11.7 minutes to perform. Response was good in 31% of the procedures and very good in 57.5%. Side effects were recorded in 14.4% of the procedures, although always mild and transitory, with a predominance of dysphagia and dysphonia. CONCLUSION: In our experience, transoral administration of botulinum toxin type A to treat laryngeal dystonia has proved to be a simple, quick, effective and safe technique.

TITLE: Distonia laringea: nuevas formas de administracion terapeutica de toxina botulinica por via directa.Objetivo. Describir nuestra experiencia en el tratamiento de la distonia laringea (en abduccion y aduccion), destacando los aspectos tecnicos (procedimiento de abordaje, dosis y tipo de toxina botulinica de tipo A utilizada), asi como la respuesta al tratamiento y los posibles efectos adversos. Pacientes y metodos. Estudio descriptivo transversal de una muestra de pacientes con distonia laringea tratados mediante administracion transoral de onabotulinumtoxina o incobotulinumtoxina A durante un periodo de 10 años (2007-2017). Se recogen las variables demograficas y clinicas, la respuesta al tratamiento (a partir de una escala de autoevaluacion), la duracion de este y la aparicion de efectos adversos. Resultados. Tamaño muestral: 15 pacientes (11 mujeres; edad media: 44,06 años) con distonia laringea (tiempo medio de evolucion de 40 meses; 12 pacientes con distonia en aduccion) y 174 administraciones (92% incobotulinumtoxina A; dosis media de 5 U en cada cuerda vocal). La duracion media del procedimiento fue de 11,7 minutos. La respuesta fue notable en el 31% de los procedimientos y alta en el 57,5%. Se registraron efectos adversos en el 14,4% de los procedimientos, siempre de caracter leve y transitorio, con predominio de la disfagia y la disfonia. Conclusion. En nuestra experiencia, la administracion transoral de toxina botulinica de tipo A como tratamiento de la distonia laringea ha demostrado ser una tecnica sencilla, rapida, eficaz y segura.

Upper Airway Obstruction Requiring Emergent Tracheostomy Secondary to Laryngeal Sarcoidosis: A Case Report.

BACKGROUND Laryngeal sarcoidosis is a rare extrapulmonary manifestation of sarcoidosis, accounting for 0.33-2.1% of cases. A life-threatening complication of laryngeal sarcoidosis is upper airway obstruction. In this report we describe our experience in the acute and chronic care of a patient who required an emergent tracheostomy, with the aim to provide further insight into this difficult to manage disease. CASE REPORT A 37-year-old African American female with a 10-year history of stage 1 sarcoidosis presented with severe dyspnea. Laryngeal sarcoidosis was diagnosed three years previously, and she remained stable on low-dose prednisone until six months prior to admission, at which time she self-discontinued her prednisone for the homeopathic treatment Nopalea cactus juice. Her physical examination was concerning for impending respiratory failure as she presented with inspiratory stridor and hoarseness. Laryngoscopy showed a retroflexed epiglottis obstructing the glottis with edematous arytenoids and aryepiglottic folds. Otolaryngology performed an emergent tracheostomy to secure her airway and obtained epiglottic biopsies, which were consistent with sarcoidosis. She was eventually discharged home on prednisone 60 mg daily. Following months of corticosteroids, a laryngoscopy showed the epiglottis continuing to obstruct the glottis. The addition of methotrexate to a tapered dosage of prednisone 10 mg daily was unsuccessful, and she remains on prednisone 20 mg daily for disease control. CONCLUSIONS Laryngeal sarcoidosis, a rare extrapulmonary manifestation of sarcoidosis, uncommonly presents as the life-threatening complication of complete upper airway obstruction. As such, laryngeal sarcoidosis is associated with significant morbidity and mortality, requiring a high index of suspicion for timely diagnosis and treatment.

Cryptococcal infection of the larynx: case report.

OBJECTIVE: Laryngeal cryptococcosis is a rare condition. In this report, we describe the findings for and treatment of a 58-year-old man with Cryptococcus gattii infection of the right vocal fold. METHOD: Case report and review of the relevant English language literature. RESULTS: The patient presented with persistent hoarseness of voice. Laryngoscopy demonstrated an irregular, red lesion on the right vocal fold. Histopathological examination identified cryptococcus. The patient was treated with oral fluconazole 400 mg/day for eight weeks. CONCLUSION: Laryngeal involvement by Cryptococcus gattii can result from prolonged inhaled corticosteroid therapy and proximity to eucalyptus trees. The clinical presentation, laryngoscopic findings and imaging results of laryngeal involvement may mimic a neoplasm. Histopathological examination can demonstrate the causative organism. Management consists of advice from an infectious disease specialist together with adequate treatment by antifungal agents.

Prospective study of voice outcomes and patient tolerance of in-office percutaneous injection laryngoplasty.

OBJECTIVES/HYPOTHESIS: In-office percutaneous injection laryngoplasty is a common treatment for glottal insufficiency. Our objective was to prospectively study voice outcomes and patient tolerance of the procedure. STUDY DESIGN: Prospective case series. METHODS: Consecutive adult patients undergoing awake injection laryngoplasty were recruited. Voice Handicap Index (VHI)-30; Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V); and vocal Grade, Roughness, Breathiness, Asthenia and Strain (GRBAS) were evaluated prior to injection and 2 months postinjection. Visual analog scale (VAS) was completed by the patient before and after the procedure to quantify the amount of discomfort. RESULTS: Thirty-five subjects enrolled; 26 (15 male, 11 female; mean age 61.6 ± 13.2 years) had complete data. All components of VHI improved significantly: functional (P=0.0006), emotional (P=0.0004), physical (P=0.009), and total (P=0.0006). CAPE-V also improved significantly (P=0.003). All components of GRBAS, except for roughness, improved significantly: grade (P=0.004), roughness (P=0.718), breathiness (P=0.023), asthenia (P=0.023), and strain (P=0.03). Patient expectations on the tolerance of the procedure was similar to what they reported immediately afterward (P=0.803). CONCLUSIONS: Injection laryngoplasty is an effective method of treating glottal insufficiency, as measured by voice outcomes. Patients have realistic expectations on the procedure experience and find it tolerable. This is the first prospective study of injection laryngoplasty outcomes.

[Jinsangsanjie capsule for treating vocal fold polyps and vocal nodules].

OBJECTIVE: To investigate therapeutic effects of Jinsangsanjie capsule on vocal fold polyps and vocal nodules. METHOD: Seventy-five patients with vocal fold polyps and vocal nodules were treated by taking Jinsangsanjie capsule orally. After the therapeutic course, they were all followed up for 1 month. RESULT: The effective rate of vocal nodule group was 93.8%, the effective rate of vocal fold polyp group was 89.7%, the effective rate of vocal nodule with acute congestion group was 100%, the effective rate of vocal fold polyp with acute congestion group was 100%, and the effective rate of hypertrophy of vocal cords with chronic congestion group was 66.7%. CONCLUSION: Jinsangsanjie capsule has definite efficacy for treatment of vocal fold polyps and vocal nodules and deserved to be recommended.

Cross-over study of topical anaesthesia with tetracaine solution for transoral rigid laryngoscopy.

BACKGROUND: Transoral rigid laryngoscopy with videostroboscopy is the most practical method to visualise the vocal folds. The optimal topical anaesthesia regimen for transoral rigid laryngoscopy has not yet been established. OBJECTIVE: To compare patient comfort and compliance with various topical anaesthetics for transoral rigid laryngoscopy. METHODS: Each of 10 patients received a random topical administration of either 2 per cent lidocaine gel, 1 per cent tetracaine gel or 1 per cent tetracaine solution, 10 minutes before undergoing rigid laryngoscopy with videostroboscopy. During follow-up laryngoscopies, the agent with the lowest mean visual analogue scale score for discomfort was then used to study the timing of topical anaesthetic application: the agent was given to the patient 5, 10 or 15 minutes before laryngoscopy (with the timing randomly selected). RESULTS: Compared with lidocaine gel or tetracaine gel, laryngoscopy with topical tetracaine solution was more comfortable. There was a statistically significant difference in discomfort score between the 5 and 10 minute application groups, but not between the 10 and 15 minute groups. CONCLUSION: Tetracaine solution, applied topically 10 minutes before transoral rigid laryngoscopy, significantly decreases patient discomfort.

Laryngeal and respiratory patterns in patients with paradoxical vocal fold motion.

The purposes of this study were to determine the differences in spirometric measures obtained from patients with endoscopically-documented paradoxical vocal fold motion (PVFM) and to compare them to a group of normal subjects without endoscopically-documented paradoxical vocal fold motion during non-provocative breathing and following speech. Thirty eight subjects with documented paradoxical vocal fold motion using transnasal flexible laryngoscopy (TFL) and no history of asthma and 21 normal subjects with documented normal breathing patterns and normal findings on endoscopy underwent flow-volume loop studies. Endoscopic judgments of vocal fold motion from three breathing conditions were made by two observers. The results of the endoscopic judgments indicate that paradoxical motion occurs whether breathing through the nose or mouth in the PVFM subjects, mainly after speaking and inhalation. In addition, the spirometry results indicated that the inspiratory measure of FIVC%, FVC% and FIV(0.5)/FIVC were significantly lower in the PVFM group compared to the normal subjects. The data supports the hypothesis that in patients with PVFM, inspiratory spirometric values play a role in identifying patients with PVFM. The finding of vocal fold closure following a speech utterance in the majority of the PVFM subjects but not in the normal control group warrants further investigation.

Respiratory retraining therapy in long-term treatment of paradoxical vocal fold dysfunction.

OBJECTIVES: Paradoxical vocal fold dysfunction (PVFD) is a disorder in the larynx featuring involuntary adduction of the vocal folds during the inspiratory phase of breathing. The symptoms include acute episodes of dyspnea and bouts of coughing. To date, there is no universally acknowledged treatment for PVFD, though respiratory retraining therapy is the treatment of choice. AIMS: The purpose of this work was to evaluate the results of long-term respiratory retraining therapy in cases of PVFD. PATIENTS AND METHODS: We treated 20 patients with PVFD for 2 years: 10 subjects were submitted to a cycle of respiratory retraining therapy every 12 months (receiving a total of 3 cycles) while 10 were given a cycle every 3 months (for a total of 9 cycles) no matter what their clinical conditions were. RESULTS: The results show that long-term respiratory retraining is particularly efficacious if the cycles of treatment are repeated, no matter what clinical conditions are present. In fact, when only one cycle of retraining treatment is given a year, there is initial improvement followed by progressive worsening. CONCLUSIONS: Long-term respiratory rehabilitation is effective, especially if the treatment is given at least once every 3 months.

Silent reflux: ex juvantibus criteria for diagnosis and treatment of laryngeal disorders.

CONCLUSIONS: Some primary laryngeal pathologies with specific clinical presentation may be related to silent laryngeal reflux. An ex adjuvantibus proton pump inhibitor (PPI) treatment may be helpful for showing evidence of such a hidden laryngeal disorder. OBJECTIVE: To assess the validity of PPI as an ex adjuvantibus criterion for diagnosis and treatment of suspected reflux-associated laryngitis. PATIENTS AND METHODS: Sixty patients with clinical suspicion of laryngo-pharyngeal reflux (LPR) were identified on the grounds of laryngeal symptoms (dysphonia, cough, globus sensation, increased throat clearing, bad taste, and laryngeal spasm), laryngeal features (arytenoid edema/erythema, partial or total vocal fold erythema, and posterior glottic edema) with or without gastro-esophageal reflux disorder (GERD). They were consequently subdivided in three groups: type I, with LPR symptoms and features without GERD; type II with LPR symptoms and features with GERD; and type III with LPR features only. Types I and III were randomly treated with omeprazole (group A) or with immunostimulating vaccine (group B) for 3 months. Pre- and post-treatment laryngeal features and symptoms in all groups were evaluated by laryngo-stroboscopy and analyzed for statistical correlation. RESULTS: All omeprazole-treated patients showed improvement of laryngeal features and symptoms. With PPI treatment, a more significant improvement was noticed with respect to nonspecific immunostimulant therapy. Also, patients without LPR symptoms showed improvement of laryngeal features.

Inlet patch of gastric mucosa in upper esophagus causing chronic cough and vocal cord dysfunction.

BACKGROUND: An inlet patch of gastric mucosa in the upper esophagus is usually an incidental, congenital finding found during upper gastrointestinal tract endoscopy. Although it has been reported to cause dysphagia, strictures, adenocarcinoma, and webs, it has never been associated with cough and vocal cord dysfunction. OBJECTIVE: To report the first case of a patient with an inlet patch of gastric mucosa in the upper esophagus as the cause of a particularly troublesome, chronic cough that was initially missed on 2 upper endoscopies. METHODS: The patient is a 50-year-old man with a 7-year history of chronic cough associated with hoarseness, shortness of breath, and globus sensation. For diagnostic evaluation, pulmonary function tests, chest computed tomography, rhinolaryngoscopy, upper gastrointestinal tract endoscopy, and histologic examinations were performed. RESULTS: A multidisciplinary approach revealed several possible causes for the chronic cough, including vocal cord dysfunction, postnasal drip syndrome, allergic rhinitis, and mild gastroesophageal reflux disease that was only partially responsive to therapy. The results of 2 initial upper gastrointestinal tract endoscopies were interpreted as normal. A third endoscopy detected an inlet patch of gastric mucosa in the upper esophagus. Treatment with a high-dose histamine type 2 receptor antagonist and a proton pump inhibitor alleviated the patient's symptoms. CONCLUSIONS: An inlet patch of gastric mucosa in the upper esophagus is not uncommon, but it is often overlooked or believed to be an incidental, congenital finding. This is the first report, to our knowledge, of an inlet patch resulting in a troublesome, chronic cough.

[An analysis of therapeutic effects of jinsangsanjie and jinsangkaiyin pills on polyps and/or nodules of the vocal cords].

OBJECTIVE: To observe the therapeutic effects of Jinsangsanjie and Jinsangkaiyin Pills in treating polyps and/or nodules of the vocal cords. METHOD: Two hundred and fifty cases of vocal polyp and/or nodule including 88 cases of early poly, 115 cases of nodule and 47 eases of postoperative patients of vocal polyp were treated with Jinsangsanjie and Jinsangkaiyin Pills. RESULT: The total effective rate of early polyps and nodules was 94.1% and the total effective rate of postoperative patients of vocal polyp was 100.0. CONCLUSION: The better therapeutic effects of Jinsangsanjie and Jinsangkaiyin Pills in treating vocal polyps and/or nodules are worthy to be popularized.

[Diagnosis and treatment of juvenile recurrent laryngeal papillomatosis].

OBJECTIVE: To evaluate some perplexing problems in the diagnosis and treatment of juvenil recurrent laryngeal papillomatosis (JRLP) and the relationship between juvenile onset recurrent respiratory papillomatosis(JORRP) and infantile laryngeal condyloma accuminatum (ILCA). METHODS: A group of 44 cases with JRLP were analyzed retrospectively from March, 1994 to March, 2002 in the light of literature review. RESULTS: The average age of first visit was 1.6 years. Average 5.3 operations had been performed per patient. There was an interval of average 2.4 months between two surgical excisions. Of 233 operations, the total incidence rate of all the complications was 3.9%. At present, the laryngeal lesion of 18 cases have withered away for over 1 year. 11 cases have being followed up. 10 cases have lost follow-up and 5 cases have died (11.4%). Combined laryngeal lesion excision with tracheotomy aiming at prolonging operative interval or Chinese traditional medicine has received more satisfactory effect than other therapies. There is an extensive similarity between JORRP and ILCA. CONCLUSIONS: To demondrate further whether JORRP and ILCA are the same identical disease has important significance in both theoretical study and clinic practice. The treatment for JRLP is still difficult. The tracheotomy for laryngeal obstruction resulted from the laryngeal lesion of JRLP should be avoided as far as possible. Combined laryngeal lesion excision with tracheotomy aiming at prolonging opertive interval or Chinese traditional medicine shows optimistic prospect.

Paradoxical vocal fold motion: presentation and treatment options.

Paradoxical vocal fold motion is a rare disorder in which adduction of the folds occurs on inspiration. The disorder presents with signs of airway obstruction and often airway distress, so proper diagnosis by the otorhinolaryngologist is critical to subsequent management. We present a retrospective review of 10 patients with the diagnosis of paradoxical vocal fold motion seen over a 6-year period. Eight patients were females, and 6 required an acute airway intervention at presentation; 3 patients eventually underwent tracheotomy for respiratory decompensation. Six patients had a prior diagnosis of asthma, and this was determined to contribute to their respiratory status. Five patients were treated with botulinum toxin and 2 with flexible nasolaryngoscopic biofeedback, which improved the outcome. A review of the literature confirms a female predominance of patients presenting with paradoxical adduction and airway distress, often with a history of asthma and psychopathology. Our experience with botulinum toxin and biofeedback suggests that these procedures are viable treatment options in the management of patients with this disorder.

Effect of Koso-san on globus pharyngeus.

Twenty-three patients with globus pharyngeus were treated with Koso-san (TJ-70) at a dose of 7.5 g/day for at least 14 days. Symptoms disappeared in 18 cases and improved in 3 cases, therefore, the effective rate was 91.3% (21/23). The symptoms disappeared on average within 13.5 days. Terasawa qi-stasis scores were significantly decreased after the treatment. TJ-70 might thus be a remedy for globus pharyngeus with qi-stasis.