RESUMEN
OBJECTIVE: This study aimed to evaluate voice and quality of life after transoral laser resection of early glottic carcinoma. METHODS: We studied 19 patients undergoing transoral laser resection of tumour stage (T) one or T2 glottic carcinoma. Laryngeal function was evaluated by video-stroboscopy, vocal function by the Voice Symptom Scale, the grade-roughness-breathiness-asthenia-strain scale and objective phoniatric assessment, and quality of life by the University of Washington Quality of Life questionnaire. RESULTS: Patients' glottic carcinoma tumour-node-metastasis (TNM) staging was T1 N0 M0 in 14 patients and T2 N0 M0 in five. Overall voice grade, roughness and breathiness were mild to moderate in 84 per cent; asthenia and voice strain were more uniformly distributed, with 15 per cent of patients having normal voice quality. Eight patients developed a glottic web post-operatively; anterior commissure web was significantly associated with worse voice grade (p = 0.05). Seven patients (47 per cent) had a 'mucosal wave' on the operated vocal fold; this was significantly associated with less strain on phonation (p = 0.05). Voice Symptom Scale score was low overall (15 patients (78.9 per cent) scored less than 30). The fundamental frequency and frequency irregularity were normal in nine patients (47.3 per cent); the closed quotient was normal in six (31.5 per cent). The averaged quality of life score was ≥ 90 in 14 patients (73.7 per cent); 18 (94.7 per cent) felt their health-related quality of life was either the same or better post-operatively; and overall quality of life was positive in all. CONCLUSION: Transoral laser resection of T1 and T2 glottic carcinoma enables adequate tumour tissue excision with preservation of acceptable vocal function. Most patients' post-operative quality of life is very good. Anterior commissure web formation is associated with poorer vocal function.
Asunto(s)
Carcinoma/cirugía , Glotis/cirugía , Neoplasias Laríngeas/cirugía , Calidad de Vida , Encuestas y Cuestionarios , Trastornos de la Voz/diagnóstico , Anciano , Anciano de 80 o más Años , Carcinoma/patología , Carcinoma/fisiopatología , Estudios Transversales , Humanos , Neoplasias Laríngeas/patología , Neoplasias Laríngeas/fisiopatología , Laringoscopía , Terapia por Láser/métodos , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Evaluación de Resultado en la Atención de Salud/métodos , Índice de Severidad de la Enfermedad , Estroboscopía , Trastornos de la Voz/fisiopatología , Trastornos de la Voz/psicología , Calidad de la Voz/fisiologíaRESUMEN
We describe a series of four patients who presented with 'high globus pharyngeus', who all had an abnormally curled epiglottis tip touching and indenting the tongue base. The actual incidence of 'curling epiglottis', as well as the potential impact of this variation in persistent globus symptoms, is not known. We therefore describe for the first time a series of patients with this anatomical variant of the epiglottis, each of whom experienced unresolved globus symptoms despite receiving intensive medical treatment. In the literature, the success rate for improvement in symptoms following medical treatment ranges from 68 to 80 per cent. Following CO2 laser partial epiglottectomy, all four patients experienced complete relief of their symptoms. We advocate consideration of this treatment for high globus pharyngeus that fails to respond to conservative treatment, in cases with proven curled epiglottis on endoscopic examination.
Asunto(s)
Epiglotis/anomalías , Adulto , Anciano , Diagnóstico Diferencial , Epiglotis/cirugía , Femenino , Humanos , Laringoscopía , Persona de Mediana Edad , Embarazo , Resultado del TratamientoRESUMEN
The sensation of a foreign body in the throat when swallowing is a common and very discomforting symptom for those who experience it. Common causes are gastroesophageal reflux disease and possibly upper oesophageal dysmotility. This complaint may be dismissed as psychogenic when a cause for the problem is not readily apparent. We present two cases in which the patient had a foreign body sensation in the throat, associated with a dry swallow. The most helpful diagnostic procedure was careful examination of the hypopharynx and neck and flexible fibre-optic rhinolaryngoscopy. One case was treated with surgery of the neck and larynx to trim the medially projecting superior cornu of the thyroid cartilage. Surgery was successful in eliminating the symptoms. Although an uncommon finding, our experience is that symptoms due to a medially displaced thyroid cornu should be considered in the differential diagnosis as an important and surgically correctable cause of persistent foreign body sensation at the hyoid level in the neck.
Asunto(s)
Cuerpos Extraños/diagnóstico , Enfermedades de la Laringe/diagnóstico , Cartílago Tiroides , Trastornos de Deglución/etiología , Trastornos de Deglución/cirugía , Diagnóstico Diferencial , Esofagoscopía , Humanos , Enfermedades de la Laringe/cirugía , Masculino , Persona de Mediana Edad , Cartílago Tiroides/cirugía , Resultado del TratamientoRESUMEN
Cystic lesions of the larynx are most commonly benign. However, we report a case of non-Hodgkin's lymphoma (NHL) of the larynx which presented as a supraglottic cyst. This form of presentation has not been previously described in the medical literature.
Asunto(s)
Quistes/etiología , Enfermedades de la Laringe/etiología , Neoplasias Laríngeas/complicaciones , Linfoma de Células B/complicaciones , Linfoma de Células B Grandes Difuso/complicaciones , Anticuerpos Monoclonales/uso terapéutico , Anticuerpos Monoclonales de Origen Murino , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Ciclofosfamida/administración & dosificación , Diagnóstico Diferencial , Doxorrubicina/administración & dosificación , Humanos , Inmunosupresores/uso terapéutico , Neoplasias Laríngeas/tratamiento farmacológico , Metástasis Linfática , Linfoma de Células B/tratamiento farmacológico , Linfoma de Células B Grandes Difuso/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Prednisona/administración & dosificación , Rituximab , Tomografía Computarizada por Rayos X , Vincristina/administración & dosificaciónRESUMEN
Spontaneous rupture of the oesophagus is a rare event. Most have been reported in association with oesophageal carcinoma, peptic ulceration and alcohol abuse followed by forceful episode of vomiting. We, however, report a case of spontaneous rupture of the oesophagus in an otherwise healthy individual with no history of alcohol intake, as a consequence of blowing of the nose.