Laryngeal Metastatic Lesions: A Literature Review.

BACKGROUND: Cancer ravages all aspects of a patient's life. In recent decades, there has been a substantial paradigm shift in the treatment of cancer with an emphasis on quality of life and patient comfort. Patients are treated holistically, a complex task given how multifaceted cancers are. Voice, a subtle indicator of patients' well-being is affected commonly by malignancies. One of the various ways by which voice is disturbed by non-laryngeal cancers is through metastasis to the larynx and adjacent areas. Metastasis to the larynx is rare but well-documented. If not diagnosed in a timely fashion, it can have devastating consequences on patients from life-threatening airway obstruction to progressive dysphonia that erodes their quality of life. Metastatic lesions of the larynx usually appear submucosal with intact overlying mucosa and are located most commonly in the supraglottis. Deep biopsies usually are needed for diagnosis, and management may entail endoscopic resection or other treatments. OBJECTIVES: This paper reviews the literature to identify typical features of laryngeal metastatic lesions of the ten cancers that are among the most common worldwide, ie, skin, renal, breast, colorectal, lung, prostate, thyroid and liver. By summarizing their most prevalent locations in the larynx, type and appearance, the authors hope to aid physicians in their diagnostic process, particularly in cases in which laryngeal involvement is the first presenting sign of a malignancy.

The Effects of Hormonal Contraception on the Voice: History of Its Evolution in the Literature.

OBJECTIVES: Women of reproductive age commonly use hormonal contraceptives, the vocal effects of which have been studied. Otolaryngologists should be aware of this relationship to make recommendations on hormonal contraception as it relates to each patient's voice requirements. METHODS/DESIGN: A comprehensive literature review of PubMed was completed. The terms "contraception," "vocal folds," "vocal cords," and "voice" were searched in various combinations. Articles from 1971 to 2015 that addressed the effects of contraception on the vocal folds were included. RESULTS: In total, 24 articles were available for review. Historically, contraception was believed to affect the voice negatively. However, more recent studies using low-dose oral contraceptive pills (OCPs) show that they stabilize the voice. However, stabilization generally occurs only during sustained vowel production; connected speech appears unaffected. Therefore, singers may be the only population that experiences clinically increased vocal stability as a result of taking hormonal contraceptives. Only combined OCPs have been studied; other forms of hormonal contraception have not been evaluated for effects on the voice. Significant variability exists between studies in the physical attributes of patients and parameters tested. CONCLUSIONS: Hormonal contraception likely has no clinically perceptible effects on the speaking voice. Singers may experience increased vocal stability with low-dose, combined OCP use. Other available forms of contraception have not been studied. Greater consistency in methodology is needed in future research, and other forms of hormonal contraception require study.

Laryngeal lipotransfer: review of a 14-year experience.

OBJECTIVE: To determine the efficacy of lipotransfer for treatment of various vocal fold (VF) pathologies. STUDY TYPE: Retrospective review. METHODS: We reviewed retrospectively the indications for and techniques of laryngeal lipotransfer and its effect on glottic closure and mucosal wave. One hundred four patients treated with lipotransfer between 1997 and 2010 were screened for inclusion in this study. Fifteen patients were excluded. Strobovideolaryngoscopic examinations for the 89 included subjects were reviewed to determine the change in glottic closure and mucosal wave. The degree of improvement, if any, was graded as mild, moderate, or substantial. The population was divided into the following four groups for analysis: (1) single lateral lipoinjection, (2) combination of lipoinjection and thyroplasty, (3) multiple lipoinjections with or without other injection medialization procedures, and (4) lipoimplantation for treatment of VF scar. RESULTS: Lipotransfer was used alone and as an adjunct procedure to treat glottic insufficiency (GI) secondary to VF motion abnormality or vibratory margin pathology. Augmentation was accomplished either by lateral injection or by medial implantation through an access tunnel. Most patients showed a statistically significant improvement in glottic closure because of lipoinjection and in mucosal wave because of lipoimplantation. Few minor and no serious complications occurred. CONCLUSION: Laryngeal lipotransfer is safe and effective for treatment of GI and VF scar.

Self-reported changes in the professional singing voice after surgical intervention treatment for breast cancer: a survey pilot study of female professional singers.

BACKGROUND: The effects of breast cancer surgical treatment on the professional singing voice are unknown. OBJECTIVE: The purpose of this study was to discover whether there are self-perceived changes in the quality and/or process of singing experienced by professional female singers who have undergone surgical intervention for the treatment of diagnosed breast cancer-including any changes perceived from the use of radiation, chemotherapy, and other drug treatments related to those surgeries. METHODS: A voluntary subject pool comprised female professional singers who have undergone surgery for breast cancer was recruited from professional singing networks. Participants underwent evaluation through an anonymous online survey, psychometrically vetted for content and instrument reliability/validity before administration. RESULTS: Valid participants (N=56) responded to 45 questions regarding surgical procedures, related therapies, and self-perceived vocal effects. Analysis of results produced a preliminary description of types of voice change, duration of changes, and qualitative self-perceptions. CONCLUSIONS: This initial report reveals that there are self-perceived singing voice changes experienced by professional singers treated for breast cancer. However, additional research is needed to determine the degree of vocal impact perceived to be attributable to individual surgical interventions and related therapies.

Laryngopharyngeal reflux: current concepts and questions.

PURPOSE OF REVIEW: Laryngopharyngeal reflux is a widely recognized disorder. Yet, decades after its initial description, debate persists regarding pathophysiology, diagnosis, and treatment. This review addresses current literature on laryngopharyngeal reflux and identifies areas of controversy and future opportunities for research. RECENT FINDINGS: Despite numerous research efforts, the diagnosis and treatment of laryngopharyngeal reflux remain elusive and unproven. Acid-induced changes in laryngopharyngeal mucosa have been confirmed by histologic evidence. However, the implications of this for laryngeal symptoms and signs are unclear. Diagnosis remains controversial, confounded by lack of standardization and accepted, evidence-based norms. Whereas treatment is generally believed by clinicians to be effective in alleviating symptoms and signs attributed to laryngopharyngeal reflux, incontrovertible data confirming efficacy are scarce. Confounding the issues further, there are numerous studies that purport to show that various widely used treatments are not effective, although the scientific merit of virtually all of these studies has been challenged. SUMMARY: Laryngopharyngeal reflux remains a controversial diagnosis. Treatment with proton pump inhibitors persists despite weak evidence supporting or refuting their utility, and well designed studies are needed to understand diagnosis, treatment, pathyophysiology, and long-term health consequences of laryngopharyngeal reflux and its treatment.