Heterotopic Gastric Mucosa in the Proximal Esophagus: Prospective Study and Systematic Review on Relationships with Endoscopic Findings and Clinical Data.

Cervical inlet patches (CIP) are common endoscopic findings with uncertain pathogenesis and clinical significance. We aimed to perform a systematic review and prospective study of clinical data and endoscopic findings related to CIP. It was a prospective single-center study conducted between 10/01/2017 and 9/01/2018. Forty patients with histopathologically confirmed CIP were compared with 222 individuals in the reference group. The systematic review was executed in accordance with the PRISMA guideline. Alcohol consumption tended to be higher among patients with CIP (3.0 ± 4.6 vs. 1.9 ± 5.0 standard drinks/week CIP patients and reference group, respectively; p < 0.001). Dysphagia was more frequent among patients with CIP (25% vs. 1.4%, CIP patients and reference group, respectively; p < 0.001), and sore throat and hoarseness were less frequent in patients with CIP (17.5% vs. 26.6% CIP patients and reference group, respectively; p < 0.01). In the multivariate regression analysis, the only risk factor of CIP occurrence was dysphagia (OR 21.9, 95%CI 4.9-98.6; p < 0.001). Sore throat and hoarseness were a reverse-risk factor of CIP diagnosis (OR 0.3, 95%CI 0.1-0.93; p = 0.04). Clinical data and coexisting endoscopic findings were not related to CIP. In the presented study, dysphagia was related to CIP occurrence, and sore throat and hoarseness tended to be less frequent among patients with CIP.

[Results of a prospective observational study of the effectiveness of the complex drug Homeovox in adult patients with various types of dysphonia]. / Rezul'taty prospektivnogo nablyudatel'nogo issledovaniya effektivnosti kompleksnogo lekarstvennogo preparata gomeovoks u vzroslykh patsientov s razlichnymi vidami disfonii.

The voice as the most important means of communication is of great importance in a person's life. Every year the number of specialties for which voice and speech are a key tool of professional activity increases. Diseases of the vocal apparatus reduce the ability to work, and for some people pose a threat of professional unfitness. The relevance of the study is determined not only by the significant prevalence of dysphonia, but also by the insufficient effectiveness of existing methods of treating voice disorders. OBJECTIVE: To evaluate the clinical efficacy and safety of the use of the drug Homeovox in patients with acute and chronic catarrhal laryngitis as monotherapy. To fulfill the set goal of the study, the following tasks were solved: evaluation of the clinical effectiveness of the drug Homeovox as monotherapy for various types of dysphonia; evaluation of the effectiveness of the drug Homeovox as monotherapy from the 1st day of use. MATERIAL AND METHODS: The basis for the implementation of the tasks was the analysis of the results of the examination and treatment of 60 patients with voice disorders aged 18 to 75 years. Among them, 10 (17%) patients with acute laryngitis and 50 (83%) patients with chronic laryngitis. To establish the diagnosis, a comprehensive examination was carried out, involving examination, videolaryngostroboscopy, acoustic analysis of the voice. The study design included three patient visits, during which the functional state of the vocal apparatus was examined by subjective and objective methods. RESULTS: As a result of the treatment with the use of the drug Homeovox, the efficacy and safety of this drug in the treatment of dysphonia in adult patients with acute and chronic laryngitis from the first days of therapy has been proven, which is confirmed by the method of videolaryngostroboscopy and acoustic analysis of the voice. CONCLUSION: The drug Homeovox is an effective, safe remedy and can be included in the complex treatment of laryngeal pathology in order to increase its effectiveness and achieve a therapeutic effect in a shorter time, manifested by an improvement in the clinical and functional state of larynx.

Vocal fold hyalinosis in Urbach-Wiethe disease, a rare cause of hoarseness.

BACKGROUND: Lipoid proteinosis is an autosomal recessive disorder characterized by hyalin deposits in the skin and mucosa of the upper aerodigestive tract; currently, no treatment exists. Nearly all patients experience hoarseness and speech difficulties, due to hyalin deposition in the vocal folds and diminished mobility in infiltrated lips, tongue, and palate. METHODS: We describe a patient with extensive hyalin plaques on the vocal folds, which resulted in near-aphonic hoarseness. Hyalin deposits in the vocal folds and skin were treated with laser resection. RESULTS: Both the vocal folds and skin improved in appearance, with smoother surface epithelium. However, the patient's speech remained impaired, due to extensive hyalin plaques in the mouth, tongue, and lips. The voice improved only temporarily. CONCLUSIONS: Laser resection of hyalin plaques in the vocal folds and skin is a feasible treatment for lipoid proteinosis. However, speech may remain severely limited, due to impaired tongue and lip movement.

Extramedullary plasmacytoma of the larynx - Case report.

Extramedullary plasmacytoma of the larynx is an extremely rare entity accounting for 0.04-0.45% of malignant tumours of the larynx. The objective of this clinical case report is to highlight the diagnosis and management of a unique case such as this. A 77-year-old gentleman presented with complaints of hoarseness for 1 year. Computed tomography image revealed a soft tissue mass lesion involving the right true vocal cord. Direct laryngoscopic biopsy was performed and subjected to histopathological examination, which showed collection of plasma cells. Immunohistochemistry confirmed the presence of Kappa and Lambda cells. Multiple myeloma (MM) was ruled out. The patient received radical intent radiation therapy using 3DCRT technique with a dose of 50Gy in 25# over 5 weeks. He experienced improvement in hoarseness on subsequent follow-up visits. At 1-year follow up, positron emission tomography computed tomography showed near total resolution of disease with no progression to MM. Radiation therapy alone is known to achieve good local control, recurrence free survival, and organ preservation in such cases.

Inflammatory Myofibroblastic Tumor of the Larynx: Report of a Case.

PURPOSE: Inflammatory myofibroblastic tumor (IMT) is a rare tumor composed of mesenchymal myofibroblastic spindle cells enveloped by an inflammatory infiltrate. Historically, this tumor sparked debate regarding whether it was a true malignancy with metastatic potential or merely a locally destructive physiologic inflammatory response. Few reports of IMT exist in the recent literature, with the majority of cases occurring in the pediatric population and favoring the lungs. Here we present an exceedingly rare case of IMT involving the larynx of a 22-year-old female. RESULTS: A hemorrhagic and solid mass of the right true membranous vocal fold was excised and sent for histopathological assessment. Features of the surgical specimens were diagnostic for IMT. Intralesional steroid therapy was selected for additional treatment. Panendoscopy facilitated surveillance for any additional or recurrent lesions, of which there were none. At 11 months post-excision, follow-up MRI revealed symmetric vocal cords without evidence of any masses. CONCLUSIONS: Although rare, laryngeal IMT should be considered in any patient presenting with hoarseness due to a vocal fold mass. Based on the successful treatment of our patient, we suggest that our approach of surgical excision followed by intralesional corticosteroid injection may be an efficacious treatment approach for this rare tumor. However, more research is warranted to elucidate the most effective, safe, and cost-effective treatment approach.

The Evaluation of Beck Anxiety Scale, Voice Handicap Index, and Brief Symptom Inventory on Treatment of Patients With Vocal Fold Nodules.

INTRODUCTION: Vocal fold nodules are benign lesions that cause hoarseness in all age groups including children, adolescents, and adults. These nodules may be caused either by singing or other causes of tension in vocal activity. OBJECTIVE: The aim of this study was to evaluate the psychological symptoms of adult patients with hoarseness and to investigate the relationship in psychological symptoms before and after voice therapy. METHODS: 23 Patients who were admitted with a voice complaint and diagnosed with vocal fold nodules and a matched control group were evaluated. Two inventories recommended by our psychiatrist (The Beck Anxiety Inventory, Brief Symptom Inventory) and Voice Handicap Index-10 (VHI-10), were completed to evaluate the treatment outcomes and psychosocial properties of the patients before and after voice therapy. RESULTS: A significant difference was observed in the BAI and BSI scores between the nodule (+) group and the control group at the beginning of the study, before voice therapy. A significant difference was found between the mean scores on the BAI and the BSI before and after therapy in the vocal fold nodules group. CONCLUSION: Patients with vocal fold nodules should be evaluated more extensively using psychological assessment scales, such as the BSI, and a psychiatric consultation should be added in cases of abnormal findings.

Ruptured innominate artery pseudoaneurysm presenting as hoarseness in Behçet's syndrome: a case report.

BACKGROUND: Vascular involvement is an infrequent clinical manifestation of Behçet's syndrome. Owing to the rarity of arterial involvement in Behçet's syndrome, there is limited experience in managing this phenomenon. CASE PRESENTATION: Here, we report a 28-year-old Iranian man with a Behçet's syndrome background, who presented with shoulder pain and hoarseness. Chest computed tomography angiography was conducted with a suspicion of a vascular pathology causing pressure on the recurrent laryngeal nerves. The patient was diagnosed with a ruptured innominate artery pseudoaneurysm. An innominate artery to the right common carotid artery bypass was performed, and the pseudoaneurysm was excised and replaced with an expandable polytetrafluoroethylene graft. Eventually, the patient was discharged after an uneventful hospital course. CONCLUSION: It appears that we are still a long way from finding the optimal treatment for Behçet's syndrome vascular involvement, and a combination of surgical and medicinal treatments is required.

A complex phenotype of peripheral neuropathy, myopathy, hoarseness, and hearing loss is linked to an autosomal dominant mutation in MYH14.

Both peripheral neuropathy and distal myopathy are well-established inherited neuromuscular disorders characterized by progressive weakness and atrophy of the distal limb muscles. A complex phenotype of peripheral neuropathy, myopathy, hoarseness, and hearing loss was diagnosed in a large autosomal dominant Korean family. A high density single nucleotide polymorphism (SNP)-based linkage study mapped the underlying gene to a region on chromosome 19q13.3. The maximum multipoint LOD score was 3.794. Sequencing of 34 positional candidate genes in the segregating haplotype revealed a novel c.2822G>T (p.Arg941Leu) mutation in the gene MYH14, which encodes the nonmuscle myosin heavy chain 14. Clinically we observed a sequential pattern of the onset of muscle weakness starting from the anterior to the posterior leg muscle compartments followed by involvement of intrinsic hand and proximal muscles. The hearing loss and hoarseness followed the onset of distal muscle weakness. Histopathologic and electrodiagnostic studies revealed both chronic neuropathic and myopathic features in the affected patients. Although mutations in MYH14 have been shown to cause nonsyndromic autosomal dominant hearing loss (DFNA4), the peripheral neuropathy, myopathy, and hoarseness have not been associated with MYH14. Therefore, we suggest that the identified mutation in MYH14 significantly expands the phenotypic spectrum of this gene.

Hoarseness.

Hoarseness is a common problem, typically of transient nature. When hoarseness does not resolve, or when it is associated with concerning symptoms, it is important to consider a wide differential and refer to an otolaryngologist. This article discusses the physiology of the voice and possible causes of dysphonia, and explores when it warrants further work-up by ENT. A discussion of diagnostic techniques and the myriad of tools to treat hoarseness follows. Additionally, the role of reflux in dysphonia is examined with a critical eye to aid in accurate assessment of the patient's complaint.

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.

Clinical and histopathologic examination of ulcerating vocal fold lesions in an immunosuppressed patient.

We present the unique opportunity to correlate videostroboscopic findings with histologic examination. An immunocompromised patient with hoarseness because of ulcerative lesions of both vocal folds of uncertain cause died within a few weeks of initial presentation, and the larynx was donated for postmortem examination. Relevant history, as well as endoscopic and histopathologic findings, is presented.

Reflux-associated laryngitis and laryngopharyngeal reflux: a gastroenterologist's point of view.

Laryngopharyngeal reflux of liquid and gaseous gastric contents should be considered in every patient with unexplained hoarseness. Pathophysiology and treatment of reflux-associated laryngitis are different from those of reflux esophagitis and therefore remain an unsolved puzzle. The laryngeal mucosa is considerably more sensitive to acid and pepsin than the mucosa of the esophagogastric junction. Therefore definitions of acid and nonacid reflux used for gastroesophageal reflux disease may not be helpful for explaining pathophysiologic mechanisms in the larynx or pharynx. A reflux symptom index and reflux finding score may be useful in helping to select the minority of patients who may benefit from acid-suppressive therapy; however, further research is needed. Further research is also needed to identify those patients who may require higher doses or prolonged duration of proton pump inhibitors or alternative treatments like prokinetics or alginate, or those patients who may benefit from surgical treatment of gastroesophageal reflux. Since symptoms of laryngopharyngeal reflux may predict esophageal adenocarcinoma, every patient with laryngopharyngeal reflux should have an upper gastrointestinal endoscopy, even if no classical symptoms of gastroesophageal reflux disease are present.

Recurrent hoarseness due to inflammatory vocal fold lesions in a patient with Crohn's disease.

Crohn's disease is a chronic inflammatory bowel disease characterized by discontinuous chronic inflammation that may affect virtually all organs, including the head and neck. Laryngeal involvement in Crohn's disease is very rare, and only 9 cases have been reported. All 9 patients complained of difficulty in breathing due to edema and ulceration from the larynx to the hypopharynx. The present patient was a 31-year-old woman who had experienced the intestinal symptoms of Crohn's disease starting 20 months earlier and complained of hoarseness, sore throat, and odynophagia. The hoarseness worsened gradually because of limited ulceration of the vocal fold without edema. We describe the first case in which limited ulceration occurred on the vocal fold without airway involvement.

Metastatic calcification involving the true vocal cord.

Metastatic calcification (MC) commonly results secondary to phosphorus and calcium dysregulation in end-stage renal disease (ESRD). Only once before has MC been reported to involve a true vocal cord. A 35-year-old man with ESRD and secondary hyperparathyroidism was evaluated for hoarseness. Three years ago, he underwent a total parathyroidectomy with parathyroid autograft to the forearm. Simultaneously, he had a left lobe thyroidectomy that displayed a papillary thyroid carcinoma. Since that time, he continued to have hyperphosphatemia and hypocalcemia. Laryngoscopy displayed a small papillomatous lesion on the right true vocal cord. He underwent excision of the vocal cord lesion; histologic examination demonstrated benign squamous epithelium with extensive submucosal calcification. In patients with ESRD with secondary dysregulation of serum phosphorus to calcium level balance, MC may involve variable anatomical locations, including the true vocal cords. Regarding histologic findings, pathologists must consider malignancies associated with calcification, mimicking a benign process.

Bamboo Nodes on a Series of 15 Patients: Vocal Fold Lesion as a Sign of Autoimmune Disease and Microphonotrauma.

OBJECTIVES: Bamboo nodes are band-like submucosal deposits of the middle third of the vocal fold. They are often related to connective tissue disorders, but can also precede them. The aim of this study was to report our experience with conservative treatment of those rare lesions. METHODS: This is a retrospective series of 15 patients consulting for hoarseness and presenting bamboo nodes from 2010 to 2016. RESULTS: All patients were women of mean age of 38 years with a moderate or high degree of daily vocal effort. Nine patients (60%) presented with known autoimmune disease at the phoniatric appointment. The other patients (40%) benefited from a systematic biological research for autoimmune disease, which retrieved two poorly symptomatic connective tissue disorders. Patients were clinically improved by speech therapy (53%) or by an optimization or introduction of immunosuppressive treatment (46%). A spontaneous improvement was observed for three patients after voice rest (one after retirement, one after professional change, and last one after resuming professional singing). In our series, no phonosurgery was performed. The vocal profile at last appointment found a moderate Voice Handicap Index at 35.3/120, a low maximum time of phonation at 13.6 seconds, and a high jitter at 1.4, sign of instability of the vibrator. CONCLUSION: This series emphasizes the importance of diagnosing bamboo nodes in middle-aged female presenting an autoimmune disease. Vice versa for each patient with bamboo nodes, a systematic autoimmune check-up has to be realized to detect a biological asymptomatic autoimmune disease.

Lipoid Proteinosis: A Rare Cause of Hoarseness.

Lipoid proteinosis is a rare cause of voice problems. Hoarseness is often the first clinical manifestation of this disorder and can present years before any other symptom. Therefore, it is very important as an otorhinolaryngologist to be familiar with the main characteristics of this disease. We present a case report and a review of current literature to provide a concise overview of this frequently missed diagnosis.

Voice disorders: abuse, misuse and functional problems.

Having a vocal complaint is not uncommon, especially among professional voice users. Medically managing hoarseness is often delayed because the physician or patient fails to understand the vocal behavior that precipitated the voice disorder. Improper breathing and/or abusive vocal patterns are the main predisposing factors to functional voice disorders, the most common category of vocal pathology. Successful management of functionalvoice disorders includes identifying and then modifying aberrant vocal and breathing patterns. Unless these changes are made, a vocal disorder will either persist or commonly recur.

[Role of psychological factors in pathogenesis of disturbances of voice caused with vocal nodules]. / Rola czynników psychologicznych w patogenezie zaburzen glosu spowodowanych guzkami glosowymi.

INTRODUCTION: Hoarseness is most frequent complaint notified by ill in phoniatric outpatient clinics. Looking of causes notified of disturbances of voice often we ascertain in larynx existence of vocal nodules. Changes these come into being in consequence of excessive or irregular phonations. Single incident of disturbances of voice caused with oedema changes nascent of in consequence of inappropriate work with voice does not wake of our trouble, instead returns this of type of complaint provoke to other researches coexisting of etiological factors this diseases. AIM: Estimation of influence of individual personality trait of ill on formation of vocal nodules. MATERIAL AND METHODS: One examined 20 patients with vocal nodules classified to treatments operating and 20 without disturbances of voice. All patients were subjected to otolaryngological and stroboscopic examinations. Character created of voice one examined at help of scale GRBAS, instead influence of disturbances of voice on quality of life ill at help of test VHI. Psychological examinations one executed using questionnaire State-Trait-Anxiety-Inventory (STAI), questionnaire NEO-FFI and questionnaire of aggression Buss-Perry. RESULTS: Obtained results showed, that persons with returning vocal nodules, both during of research as in different situations everyday lives characterizes with higher level of fear and have greater inclination to worry oneself. Ill from groups examined in greater degree are extroverts, show greater activity and more are contagious socially in comparison to persons of comparative group. Attitude this in situations extorting rivalry will be able to be ruthless, are well organized guided, scrupulous and consistently endeavour to aim. CONCLUSIONS: Wanting efficiently to treat persons with returning vocal nodules we should subject to ill psychological examination and in once of ascertainment of irregularity to correct it, what at simultaneous correct treatment of organic changes should diminish frequency or to eliminate returns of disease. Skill psychological looks on patient by therapists treating disturbances of voice and speeches in case not large emotional instabilities probably would be able to improve results of treatment ill not only with functional disturbances of voice but also with disturbances of voice caused with organic changes in larynx.

Effect of hemodialysis on the thickness of vocal folds: a possible explanation for postdialysis hoarseness.

BACKGROUND: Determining the dry weight of chronically hemodialysed patients is a common problem. Patients on intermittent hemodialysis often experience transient hoarseness at the end of dialysis. The vocal folds may be affected by the hydration state. AIM: To test the hypothesis that postdialysis hoarseness may be related to changes in the thickness of the vocal folds. METHODS: Twenty-five stable chronic hemodialysis patients underwent endoscopic nasopharyngeal laryngoscopy before and after dialysis. Pictures of the vocal folds were taken and the folds were measured using computer software. Eighteen vocal folds from 16 patients were technically adequate for analysis. The change in the width/length ratio of the vocal folds (W/L) was used as a measurement of the folds' thickness. RESULTS: W/L decreased from 0.175 +/- 0.011 before dialysis to 0.152 +/- 0.009 after dialysis (p < 0.01, mean reduction 10.9 +/- 3.8%). Patients' weight decreased by 4.7 +/- 0.3% (p < 0.0001), systolic blood pressure decreased by 15.0 +/- 3.1% (p < 0.001), diastolic blood pressure decreased by 13.0 +/- 3.6% (p < 0.01), and mean blood pressure decreased by 14.1 +/- 3.1% (p < 0.001). Sixty percent of the patients had postdialysis hoarseness, and in 72% of the patients a decrease in the vocal folds' thickness was observed. CONCLUSIONS: Chronic hemodialysis patients may experience transient postdialysis hoarseness, and a decrease in the vocal folds' thickness. The latter may result from dehydration.