[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.

Pulsed dye laser treatment of primary cryptococcal laryngitis: A novel approach to an uncommon disease.

An 82-year-old supplemental oxygen dependent woman with severe COPD presented with an eight month history of worsening hoarseness and stridor. Office laryngoscopy revealed laryngeal edema and ulcerative masses throughout the larynx. In-office biopsies were positive for Cryptococcus neoformans. This report details a novel approach to the treatment of cryptococcal laryngitis, a combination of in-office pulsed-dye laser (PDL) ablation and medical therapy. Despite treatment with oral fluconazole, the recommended treatment for cryptococcal laryngitis the patient continued to be symptomatic with dysphonia and throat discomfort. Repeated laryngeal exam demonstrated persistent cryptococcal nodules. The patient was subsequently effectively treated with an in-office PDL laser. This case demonstrates the efficacy of in-office laser treatment for residual laryngeal Cryptococcus. For patients like this one, who have failed medical therapy and are unfit for general anesthetic, the in-office laser provides an excellent alternative treatment approach.

Human laryngitis caused by Clinostomum complanatum.

A 64-year-old Japanese man visited our outpatient department complaining of an irritable sensation in the throat, occurring two days after eating raw freshwater fish (carp sashimi) at a Japanese-style inn. During laryngeal endoscopy, a slow-moving worm (fluke) was found attached to the surface of the right aryepiglottic fold. After inhalation of 4% lidocaine, the fluke was removed using endoscopic forceps. Patient's throat symptoms immediately improved. The worm was microscopically identified as Clinostomum complanatum. C. complanatum is a digenetic trematode that usually infects fish-eating water birds. Clinostomum infections in humans are rare, and only 21 cases have been described in Japan and Korea. C. complanatum infection is known to occur after eating raw freshwater fish, which is a secondary intermediate host. In humans, the metacercariae are released into the stomach and migrate through the esophagus before lodging in the throat. Primary therapy involves endoscopic removal of the worm.

An unusual presentation of herpes infection in the head and neck.

Herpes simplex virus (HSV) is among a spectrum of viruses known to affect the upper aerodigestive tract. Gingivostomatitis and pharyngitis are the most common clinical manifestations of first-episode HSV infection, whereas recurrent herpes labialis is the most common clinical manifestation of reactivation HSV infection. Herpetic viral infections seldom attack the larynx. Laryngeal disorders provoked by the herpes virus are characterised by a large spectrum of presentations and polymorphisms, and can simulate mucous lesions such as an extensive laryngeal neoplasm (supraglottic tumour). We report a case of a 69-year-old woman, smoker, who presented with a large ulcerated supraglottic mass mimicking laryngeal cancer, requiring emergency tracheostomy for worsening stridor, which turned out to be an HSV laryngitis superimposed onto an underlying Streptococcus A lower respiratory tract infection. The patient was treated for Streptococcus A infection and her symptoms resolved following treatment. Patient's tracheotomy tube was removed on follow-up appointment.

Membranous laryngitis in a child.

The most common etiologies for acute infectious airway obstruction include epiglottitis, croup, and bacterial tracheitis. We present a unique cause of upper airway obstruction in a child not previously described. To our knowledge this is the first case in the literature of membranous laryngitis in a child due to Methicillin-resistant Staphylococcus Aureus (MRSA). The diagnosis was made by endoscopy and culture and treated with culture directed antibiotics and debridement of membranes from the larynx. The patient did not present with clinical symptoms consistent with epiglottitis as the disease course was not abrupt, and the patient did not present with classic posturing and drooling. Croup-like symptoms were described, but there was no evidence of subglottic involvement radiographically or on endoscopy. Additionally, there was no evidence of membranous plaques within the trachea or subglottis which would be suggestive of bacterial tracheitis. This unique finding is likely the result of MRSA superinfection in a child with Influenza type B.

Long-term outcomes after laparoscopic Nissen fundoplication for reflux laryngitis.

BACKGROUND: The surgical treatment of gastroesophageal reflux-induced reflux laryngitis remains controversial. The aim of this study was to determine both long-term objective endoscopic findings and subjective symptomatic outcomes after laparoscopic Nissen fundoplication in patients operated on for reflux laryngitis. METHODS: 40 consecutive patients with pH-proven reflux laryngitis underwent laparoscopic Nissen fundoplication between 1998 and 2002. 68% (n = 27) of these patients underwent an endoscopic evaluation and 90% (n = 36) were available for the subjective long-term outcome (personal interviews). RESULTS: At a median follow-up of 91 months there were no disrupted plications, none of the patients had esophagitis but 3 recurrent hiatal hernias were detected. 61% of the patients reported no or only mild reflux laryngitis symptoms postoperatively and 69% of the patients evaluated their voice quality improved after surgery. 94% of the patients were satisfied with their surgical result. With benefit of hindsight, 11% of the patients would not choose surgical treatment and 42% had reinitiated antireflux medications postoperatively. CONCLUSION: The majority of pH-proven gastroesophageal reflux-induced reflux laryngitis patients attain long-term symptomatic benefit and satisfaction on the surgical outcome, and with proper patient selection laparoscopic Nissen fundoplication provides a feasible long-term treatment option for reflux laryngitis.

Severe laryngitis following chronic anabolic steroid abuse.

The effects of anabolic steroids on the quality of voice have been well documented; however, no study has established significant structural changes in the larynx as a direct result of anabolic steroid use. We report a unique case of a 47-year-old male smoker and professional body builder who presented with progressive stridor and hoarseness following abuse of anabolic steroids over a period of two years. Conservative management failed to resolve his symptoms and a planned tracheostomy was performed to secure his airway. Subsequently he was treated with multiple laser resections and eventually decannulated. No case of severe laryngitis in association with anabolic steroid usage has been reported previously in the literature.

Diphtheroid necrotic laryngitis in three calves - diagnostic procedure, therapy and post-operative development.

Diphtheroid necrotic inflammation of the larynx in calves in its advanced stage mostly requires surgical therapy. Diagnostic procedure, surgery and post-operative care were described for three calves (aged 3-8 weeks). The clinical diagnosis was confirmed by laryngoscopy. In all three cases, a laryngotomy with resection of necrotic tissue was performed. After surgery two calves showed complications (tracheal stricture, mucosal hyperplasia). Both were cured in further surgery. In cases of post-operative complications, further surgical intervention can be very promising.

Reflux laryngitis: a feasible indication for laparoscopic antireflux surgery?

Laparoscopic fundoplication is a routine surgical approach in the treatment of moderate or severe gastro-esophageal reflux disease. However, there are still contradictions regarding supraesophageal symptoms as an indication for surgery. The aim of this study was to determine the subjective symptomatic outcome and objective laryngeal findings after antireflux surgery in patients with pH monitoring proven reflux laryngitis. Between 1998 and 2002, 40 patients with reflux laryngitis underwent laparoscopic Nissen fundoplication. Patients were referred to surgery and followed-up by a specialist in otorhinolaryngology. Subjective symptoms were collected by a structured questionnaire at a median follow-up of 42 months. The objective laryngeal findings improved from the preoperative situation; at 12 months after surgery, the otorhinolaryngeal status was improved in 92.3% (n=24) of the patients. However, only 38.5% (n=10) of these patients evaluated an improvement in their voice quality. Of all, 62.5% (n=25) of the patients reported no or only mild cough or voice hoarseness symptoms postoperatively, 22.5% (n=9) had moderate symptoms, and 15.0% (n=6) suffered from difficult supraesophageal symptoms. Ninety-five percent of the patients regarded the result of their surgery excellent, good, or satisfactory. Of all, 82.5% (n=33) of the patients would still choose surgery, 7.5% (n=3) would abstain from surgery, and 10% (n=4) of the patients were hesitant about their choice. For patients suffering from supraesophageal symptoms of gastro-esophageal reflux disease with objective evidence of pharyngeal acid exposure, laparoscopic Nissen fundoplication provides a good and alternative adding to current treatment.

[Videostroboscopy assessment in patients with vocal fold hypertrophy underwent microsurgery]. / Ocena wideostraboskopowa w przewleklych stanach przerostowych krtani leczonych chirurgicznie.

Chronic hypertrophic laryngitis concerns many people in our population. Their aetiopathogenesis is complicated and usually connected with exogenous harmful factors like occupational or environmental exposure. The basic aim of this research was to asses phonation function of the larynx after microsurgery on the basis of videostroboscopy examination. The second aim was to estimate the surgical treatment effectiveness depending on vocal fold hypertrophy extensiveness. The research was conducted on 50 subjects chosen from the population of patients with vocal fold hypertrophy treated at the Department of Laryngology Silesian Medical Academy in Zabrze from January to December 2003. All the examined patients underwent classical microsurgery. Videostroboscopy examination was done just before microsurgery and 3 months after operation. Examination results in two groups with different extensiveness of vocal fold hypertrophy were compared. The first group consist of patients with minor vocal fold lesions (limited to I of vocal fold length), the second group consist of patients with extensive vocal fold lesions (above I of vocal fold length). The control group presented 30 subjects without any voice disorders who did not use their voice for professional purposes. In both groups (with minor and extensive vocal fold lesions) significant improvement in videostroboscopy parameters was observed. The functional results in the group with minor vocal fold lesions were better after microsurgery, but it turned out that results were not statistically significant.

[Vocal function of benign vocal fold lesions and outcomes assessment after CO2 phonomicrosurgery].

OBJECTIVE: To investigate the nature of benign vocal fold lesions and its outcomes assessment after CO2 phonomicrosurgery. METHOD: Vocal function of 292 cases of benign vocal fold lesions (vocal nodules, Reinke's edema, vocal fold cyst, vocal fold polyp and chronic laryngitis) and their outcomes assessment after CO2 phonomicrosurgery were evaluated. Vocal function was examined by acoustic analysis, aerodynamic analysis and videostroboscopic examination. RESULT: Young women with professional occupation were predominant in vocal nodules and the higher age showered in Reinke's edema. Vocal function of vocal nodules and vocal fold polyps had improved distinctly only one month after operation. For Reinke's edema, vocal function can recover three months after operation steadily. Although vocal function of vocal cyst also had improved distinctly only one month after operation, there was depression instead of cyst, the outcome of vocal quality would be affected by that. Vocal function of chronic laryngitis did not change so much after operation. However, ventricular dysphonia did not changed any more. CONCLUSION: Benign vocal fold lesion was located in the cover layer of the vocal fold. According to different lesions, the degree of voice disorder were differently. CO2 phonomicrosurgery can control the range of the operation and protect the cover layers delicately. Vocal function can recover three months after operation steadily. The localized lesions recovered only one month after operation. As the supraglottal hyperfunction remained post-operation, it is regarded as incorrect vocalization and effect on the prognosis.

[Chronic hyperplastic laryngitis following treatment of hypertension with angiotensin converting enzyme-inhibitor]. / Chronisch-hyperplastische Laryngitis. Nach antihypertensiver Therapie mit einem ACE-Inhibitor.

We report the case of a 42 year old patient who developed chronic hyperplastic laryngitis during treatment with the angiotensin converting enzyme-inhibitor Cibacen 10. A severe cough and vocal restrictions with hoarseness were only incompletely cured after changing this anti-hypertensive medication to a adrenergic blocker, combined with a vocal rest and anti-inflammatory inhalation. Therefore we performed a laryngoscopy under general anesthesia and excised the swelling of the vocal cords. Additionally, voice therapy was prescribed and complete restitution achieved. Although hoarseness is documented as a potential side effect of angiotensin converting enzyme-inhibitors, morphological alterations in the vocal cords have not been linked to this type of drug. In our case, prolonged medication with Cibacen 10 led to chronic hyperplastic laryngitis. Initial coughing might have induced the trauma of the epithelium of the vocal cords. Due to the morphological alterations to the vocal cords the patient developed additional functional dysphonia.

[Newborn tracheotomy without tracheal intubation].

OBJECTIVE: To approach the tracheotomy in newborn without tracheal intubation in emergency. METHOD: Five cases hospitalized between March 1998 and March 2002 were reviewed retrospectively. The mean age was 19 days from 5 hours to 24 days after born. All patients accepted the operation without tube insertion in trachea because of the primary disease. RESULT: The operation was performed successfully in all cases. One case died of severe respiratory and circulatory failure. Four cases were decannulated with the primary disease cured. CONCLUSION: Preoperative evaluation and ideal timing of tracheotomy are very important for the newborn infant. Intensive postoperation nursing are recommended.

[Paraglottic laryngeal abscesses]. / Abscesos laríngeos paraglóticos.

We present 2 cases of laryngeal abscesses in the paraglottic space. We revise the existing literature in relation with this nowadays rare entity that requires a quick diagnosis and treatment as it is a fast life threatening disease.

An initial assessment of the optical properties of human laryngeal tissue.

The optical properties of human laryngeal tissue have been examined over the whole wavelength range from 400 to 2,200 nm to facilitate the development of new laser applications. Tissue samples were taken from healthy vocal fold and from vocal fold of patients with papillomatosis and with chronic, nonspecific laryngitis. The transmission and scattering properties of the tissue samples were recorded with a computer-guided integrating-sphere system. From the measured data the optical properties were calculated by means of the inverse Monte Carlo simulation. In the 500- to 600-nm range papilloma tissues had a considerably higher absorption than healthy vocal fold. When applying the optical tissue properties as a possible influencing factor of the effectiveness of laser systems, laser applications at this wavelength range may be useful in the ablation of papilloma tissue.