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.

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.

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.

[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.

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.

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.

Laryngeal inflammatory myofibroblastic tumor (IMT): a case report and review of the literature.

BACKGROUND: This case report is interesting as cases of children with laryngeal inflammatory myofibroblastic tumor are not common and previously had been presented as isolated case reports. This is the first case report in Asia describing a laryngeal inflammatory myofibroblastic tumor and its removal using an endoscopic approach. CASE PRESENTATION: Our patient is a 12-year-old Malay girl from Singapore who presented with hoarseness without respiratory distress. The initial impression was that of a granuloma or a papilloma. We did a biopsy, which confirmed the histology to be inflammatory myofibroblastic tumor, and a magnetic resonance imaging scan showed a contrast-enhanced lesion. The lesion was excised completely using an endoscopic approach. The child was discharged well on the first postoperative day and she has been on follow-up for a year in the clinic. CONCLUSIONS: This report highlights the importance of understanding the differential diagnosis for a child with hoarseness. It is not uncommon for a pediatrician, a general practitioner, and a pediatric otolaryngologist to see a child presenting with hoarseness. In most cases, the diagnosis made would be screamer's nodules, which is commonly seen in children. In a small group, recurrent respiratory papillomatosis form the diagnosis. Over the past few years, the cases of recurrent respiratory papillomatosis have decreased significantly. Laryngeal tumors are not common in children. However, we must maintain a high index of suspicion when we have a child with hoarseness who does not improve with speech therapy and watchful waiting. In such situations, a stroboscope is usually necessary to diagnose the voice problems and to rule out pathological conditions such as laryngeal tumors. If left untreated, the lesion can grow with time and result in a life-threatening airway condition. We also demonstrate our endoscopic technique in this report, and it has proven to be safe with no increased recurrence and much lower morbidity.

Effects of Vocal Fold Nodules on Glottal Cycle Measurements Derived from High-Speed Videoendoscopy in Children.

The goal of this study is to quantify the effects of vocal fold nodules on vibratory motion in children using high-speed videoendoscopy. Differences in vibratory motion were evaluated in 20 children with vocal fold nodules (5-11 years) and 20 age and gender matched typically developing children (5-11 years) during sustained phonation at typical pitch and loudness. Normalized kinematic features of vocal fold displacements from the mid-membranous vocal fold point were extracted from the steady-state high-speed video. A total of 12 kinematic features representing spatial and temporal characteristics of vibratory motion were calculated. Average values and standard deviations (cycle-to-cycle variability) of the following kinematic features were computed: normalized peak displacement, normalized average opening velocity, normalized average closing velocity, normalized peak closing velocity, speed quotient, and open quotient. Group differences between children with and without vocal fold nodules were statistically investigated. While a moderate effect size was observed for the spatial feature of speed quotient, and the temporal feature of normalized average closing velocity in children with nodules compared to vocally normal children, none of the features were statistically significant between the groups after Bonferroni correction. The kinematic analysis of the mid-membranous vocal fold displacement revealed that children with nodules primarily differ from typically developing children in closing phase kinematics of the glottal cycle, whereas the opening phase kinematics are similar. Higher speed quotients and similar opening phase velocities suggest greater relative forces are acting on vocal fold in the closing phase. These findings suggest that future large-scale studies should focus on spatial and temporal features related to the closing phase of the glottal cycle for differentiating the kinematics of children with and without vocal fold nodules.

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.

Ortner's syndrome: a case report and review of the literature.

We present a case of a 67-year-old man who was an active smoker, with a clinical history of ischaemic cardiopathy, hypertension, who presented to the emergency room with hoarseness of voice of 2 weeks duration. No other neurological or cardiorespiratory symptoms were found. Physical examination revealed an aortic regurgitation murmur with radial pulse difference between the upper limbs and femoral pulse difference on lower limbs. Laryngoscopy examination revealed a left vocal cord paralysis in the paramedian position, without signs of malignancy. Thoracoabdominal CT angiography was performed to rule out an aortic dissection. CT revealed a dissection in the descending thoracic aortic arch and abdominal aorta. Cardiovascular surgery was consulted and decided to place endoprosthesis at the thoracic and abdominal aortic area. Hoarseness eventually resolved during the following weeks. Ortner's syndrome is described as hoarseness of voice caused by compression of the left recurrent laryngeal nerve of cardiovascular origin.