Complications including dysphagia following transoral non-robotic surgery for pharyngeal and laryngeal squamous cell carcinoma: A retrospective multicenter study.

OBJECTIVE: Transoral surgery is a minimally invasive treatment but may cause severe dysphagia at a lower rate than chemoradiotherapy. METHODS: We compared clinical information, surgical complications, and swallowing function in patients who underwent transoral nonrobotic surgery for laryngo-pharyngeal squamous cell carcinoma between 2015 and 2021 in a multicenter retrospective study. RESULTS: Six hundred and forty patients were included. Postoperative bleeding was observed in 20 cases (3.1%), and the risk factor was advanced T category. Postoperative laryngeal edema was observed in 13 cases (2.0%), and the risk factors were prior radiotherapy, advanced T stage, and concurrent neck dissection in patients with resected HPC. Dysphagia requiring nutritional support was observed in 29 cases (4.5%) at 1 month postoperatively and in 19 cases (3.0%) at 1 year postoperatively, respectively. The risk factors for long-term dysphagia were prior radiotherapy and advanced T category. Short-term risk factors for dysphagia were prior radiotherapy, advanced T category, and concurrent neck dissection, while long-term risk factors for dysphagia were only prior radiotherapy and advanced T category. CONCLUSION: Prior radiotherapy, advanced T stage, and concurrent neck dissection increased the incidence of postoperative laryngeal edema and short-term dysphagia, but concurrent neck dissection did not affect long-term dysphagia. Such features should be considered when considering the indication for transoral surgery and postoperative management.

Impact of cervical lymph node metastasis on transoral surgery for hypopharyngeal squamous cell carcinoma: A retrospective multicenter study.

BACKGROUND: Hypopharyngeal carcinoma is likely to spread to the lymph nodes, but there is no established strategy for management in transoral surgery. METHODS: We compared oncologic and functional outcomes in a retrospective multicenter study of patients who underwent transoral surgery for hypopharyngeal carcinoma between 2015 and 2021. RESULTS: Two-hundred and thirty-two patients were included. Comparing patients with and without adjuvant radiotherapy, 3-year regional recurrence-free survival (RRFS) was not significantly different in pN2b and pN2c, but was significantly worse in pN3b without adjuvant radiotherapy. In patients without neck dissection, the 3-year RRFS was 85.6%, 76.8%, and 70.0% for T1, T2, and T3 primary lesions, respectively, and was significantly worse for T2 or higher (p = 0.035). CONCLUSIONS: In the absence of extracapsular invasion, regional control did not deteriorate without adjuvant therapy. If prophylactic neck dissection is not performed, careful follow-up is necessary if the primary lesion is T2 or greater.

Local recurrence and metachronous multiple cancers after transoral nonrobotic surgery for pharyngeal and laryngeal squamous cell carcinoma: A retrospective multicenter study.

BACKGROUND: Late laryngopharyngeal cancers after transoral surgery include not only local recurrences but also metachronous multiple cancers. METHODS: We compared clinical information, surgical outcomes, and late laryngopharyngeal cancers in patients who underwent transoral nonrobotic surgery for laryngopharyngeal squamous cell carcinoma without lymph node metastases between 2015 and 2021 in a multicenter retrospective study. RESULTS: Four hundred and fifty-seven patients were included. Positive surgical margins were found in 121 patients (26.5%). Twenty-two patients (4.8%) received additional treatment. Positive horizontal margins of invasive carcinoma (p = 0.003) and positive horizontal margins of carcinoma in situ only (p = 0.032) were independent risk factors for local recurrence, and prior radiotherapy (p = 0.001) for metachronous multiple cancers. Local control was significantly worse without additional treatment (p = 0.049), but there was no significant difference in survival. CONCLUSIONS: Patients with positive margins had an increased frequency of local recurrence, but salvage therapy was effective.

Validation of Cepstral Acoustic Analysis for Normal and Pathological Voice in the Japanese Language.

OBJECTIVES: Cepstral analysis does not require the detection of pitch within waveforms, which makes it suitable for acoustic evaluation of connected speech contexts and severely disordered voice. Although the utility of cepstral measurements, including cepstral peak prominence (CPP) and cepstral spectral index of dysphonia (CSID), has been reported for several languages, it has yet to be demonstrated in the Japanese language. The current study aimed to investigate the utility of cepstral acoustic analysis for the Japanese language as an indicator of dysphonia and the degree of dysphonia severity. METHODS: Ninety-five patients with dysphonia and thirty volunteers without voice complaint uttered the sustained vowel /a/ and read four Japanese sentences designed to elicit different laryngeal behaviors. The recorded voice samples were evaluated perceptually by three raters according to the GRBAS scale (grade) and overall severity (OS) on a visual analog scale. Participants were then divided into four groups based on grade and OS: non-, mildly, moderately, and severely dysphonic groups. For the acoustic analysis, CPP and CSID were computed using the Analysis of Dysphonia in Speech and Voice, while jitter percentage (Jitt), shimmer percentage (Shim), and noise to harmonic ratio were computed using the Multi-Dimensional Voice Program. RESULTS: Statistical analysis revealed that both CPP and CSID differed significantly between all groups, except for grade between the non-dysphonic and mildly dysphonic groups. Pearson correlation analysis between the acoustic measurements and the perceptual ratings revealed that the absolute correlation coefficients for CPP, CSID, and Jitt were greater than 0.7. Specifically, those for CPP and CSID were greater than 0.8 for OS. Receiver operating characteristic curve analysis showed that the AUC for CPP, CSID, Jitt, and Shim was greater than 0.8 for both grade and OS. The cut-off values for CPP and CSID, as determined by the Youden Index, were 6.74-7.18 and 12.16-20.39, respectively. CONCLUSION: The current study demonstrated the validity of CPP and CSID as indicators of dysphonia and indices of dysphonia severity in the Japanese language.

Impact of Thickened Liquids on Laryngeal Movement Velocity in Patients with Dysphagia.

Considering that thickened liquids are frequently used for patients with dysphagia, elucidating their impact on laryngeal dynamics is important. Although studies have investigated the impact of thickened liquids on laryngeal movement velocity among healthy young adults, no study has examined the same among patients with dysphagia. We aimed to elucidate the influence of bolus consistency on laryngeal movement velocity and surface electromyographic activity of the suprahyoid muscles in patients with dysphagia. Participants included 18 male, poststroke patients with dysphagia, whereas patients with true bulbar paralysis, head and neck cancer, neuromuscular disease, or recurrent nerve paralysis were excluded. A video fluoroscopic swallowing study (VFSS) was performed while swallowing 3 mL of moderately thick and thin liquids. Quantitative VFSS analysis, including factors such as laryngeal peak velocity, laryngeal mean velocity, laryngeal movement distance, duration of the laryngeal elevation movement, and the temporal location of laryngeal vestibule closure within the laryngeal elevation movement was performed. Muscle activity was evaluated using integrated muscles activity values obtained from electromyography (iEMG) of the suprahyoid muscle during swallowing. VFSS analysis showed that laryngeal peak velocity and laryngeal mean velocity were significantly faster while swallowing moderately thick than while swallowing thin liquids. Laryngeal movement distance was significantly greater while swallowing moderately thick than while swallowing thin liquids. iEMG was significantly higher while swallowing moderately thick liquids than while swallowing thin liquids. Compared to thin liquids, moderately thick induced an increase in laryngeal movement velocity and in suprahyoid muscle activity among patients with dysphagia, a finding consistent with that of a previous study among healthy adults.

Development and Validation of the Japanese Version of the Consensus Auditory-Perceptual Evaluation of Voice.

PURPOSE: Auditory-perceptual evaluation is essential for the assessment of voice quality. The Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) provides a standardized protocol and assessment form for clinicians to analyze the voice quality and has been adapted into several different languages. The aims of this study were to develop the Japanese version of the CAPE-V and to investigate its reliability and validity. METHOD: The Japanese CAPE-V consisted of the same three speech contexts (vowels, sentences, and conversation) as developed in the original English version. The sentences were designed according to the concepts of the original version and reviewed by Japanese phoneticians. To validate the usefulness of the Japanese CAPE-V, voices of 173 Japanese-speaking subjects (76 subjects with dysphonia and 97 without voice complaints) were evaluated by five experienced judges, according to the Japanese CAPE-V as well as the GRBAS (Grade, Roughness, Breathiness, Asthenia, Strain) scale. RESULTS: The Japanese CAPE-V provided a high interrater reliability (intraclass correlation coefficients [ICCs] > .85 for all the parameters) as well as a high intrarater reliability (ICCs > .85 for all the parameters). In addition, overall severity, roughness, and breathiness in the Japanese CAPE-V were highly correlated with the corresponding dimensions in the GRBAS scale, having Spearman correlation coefficients greater than .8. CONCLUSION: This study demonstrated the reliability and validity of the newly developed Japanese CAPE-V as an auditory-perceptual evaluation instrument.

A summary of the Clinical Practice Guideline for the Diagnosis and Management of Voice Disorders, 2018 in Japan.

OBJECTIVE: To develop a summary of the first version of the Clinical Practice Guideline of Voice Disorders for Diagnosis, Management, and Treatment in Japan by the Clinical Practice Guideline Committee of the Japan Society of Logopedics and Phoniatrics and The Japan Laryngological Association. The 2018 recommendations, based on a review of the scientific literature, are intended to serve as clinical practice guidelines for the diagnosis, management, and treatment of voice disorders in Japan. METHODS: A summary of the original version of the Clinical Practice Guideline of Voice Disorders for Diagnosis, Management, and Treatment in Japan was described. Recommendations for the diagnosis, management, and treatment of voice disorders were prepared. Twelve clinical questions (CQs) regarding the diagnosis, management, treatment, and effectiveness of therapy for voice disorders were also prepared. RESULTS: A summary of the first version of the clinical practice guidelines for the diagnosis, management, and therapy of voice disorders was prepared and is presented. Additionally, answers to the 12 CQs on the diagnosis, management, treatment, and effectiveness of voice disorder therapy were prepared, and include evidence-based recommendations. CONCLUSION: These guidelines present a summary of the standard approaches for the diagnosis and treatment of voice disorders and relevant CQs that consider the medical environments in Japan. We hope that the guidelines will assist physicians in clinical settings for patients with voice disorders.

Intranasal topical estrogen in the management of epistaxis in hereditary hemorrhagic telangiectasia.

CONCLUSION: Application of topical estriol ointment is an effective treatment for hereditary hemorrhagic telangiectasia (HHT) epistaxis. OBJECTIVE: HHT is an autosomal-dominant disease characterized by epistaxis in more than 96% of patients. Management of this major symptom, epistaxis, has not been standardized. This study reports experience with topical application of estriol in patients with HHT. METHODS: Five patients with a confirmed diagnosis of HHT who first visited the hospital between 2012 and 2013 received 0.1% estriol ointment and were guided to apply the ointment twice daily to the anterior part of both nasal cavities. Severity of epistaxis was valued using epistaxis severity score (ESS) before and 3 months after initiating therapy. RESULTS: Five patients (three males, two females) received treatment. After the initiation of treatment, intensity and frequency of epistaxis became moderate in all patients. ESS decreased significantly from pre- to post-treatment (p = 0.043). No adverse events were recorded during follow-up.

[A review of the complications and candida colonization associated with voice rehabilitation using a voice prosthesis].

Between December 2004 and December 2011, we have used the indwelling voice prosthesis for voice rehabilitation in 28 patients after total laryngectomy in our department. To clarify both the complications and safety of voice reconstruction using a voice prosthesis, and the occurrence of candida colonization, we conducted a retrospective study with a review of the Japanese literature. Twenty-six patients who were observed over a period of more than six months at our hospital were enrolled in this study. We examined the interval of prosthesis replacement, types and frequency of complications, candida colonization, and clinical outcomes. The median follow-up time postoperatively was 28.8 months (range 8.1-95.7). The average interval of prosthesis replacement was 147 days (4.9 months). Complications occurred in 14 patients (54%), and 6 patients (23%) of whom were hospitalized. The main complications were periprosthetic leakage, increased granulation around the tracheoesophageal shunt and stenosis of the trachea stoma. There were no significant differences in the frequency of complications in the background factor of the patients as far as age (p = 0.495), radiation therapy (p = 0.686) or reconstruction time (p = 0.257) were concerned. Candida species was detected in 81% of the specimens which we submitted to a culture test and confirmed the pseudohyphae which comfirmed the pathogenicity from the histopathological examination. Moreover, radiation therapy was significantly associated with the detection of candida (p = 0.004). Permanent closure of the tracheoesophageal shunt for periprosthetic leakage was required in one patient, but we were able to deal with the other complications. No patient experienced any life-threatening complications and all are safely using the prostheses. It has been reported that complications will occur over the long-term, thus careful follow-up is necessary.

Acoustic radiation force impulse imaging for reactive and malignant/metastatic cervical lymph nodes.

The aim of this study was to compare lymph node stiffness using acoustic radiation force impulse (ARFI) imaging in patients with cervical lymph node swelling. Forty-two cervical lymph nodes (reactive, n = 22; metastatic, n = 20) from 19 patients (13 men, 6 women; mean age, 63.68 ± 14.9 y; range, 23-85 y) were examined between September 2011 and March 2012. The shear wave velocity (SWV, m/s) of each lymph node was evaluated by ARFI imaging. SWV of reactive lymph nodes was 1.52 ± 0.48 m/s, and that of metastatic/malignant lymph nodes was 2.46 ± 0.75 m/s. A SWV > 1.9 m/s was very useful metastatic lymph node classification, with 95.0% specificity, 81.8% sensitivity and 88.0% overall accuracy. The area under the receiver operating characteristic curve was 0.923 (95% confidence interval, 0.842-1.000). ARFI imaging can be useful in the differentiation of reactive and malignant/metastatic cervical lymph nodes.

Functional results of Reinke's edema surgery using a microdebrider.

OBJECTIVES: We evaluated the functional results of Reinke's edema surgery using a microdebrider. METHODS: In this prospective nonrandomized study from 2004 through 2008, functional surgery using a microdebrider was performed on patients with severe Reinke's edema. Comparisons were conducted for preoperative and postoperative phonatory function using both subjective grade (G), roughness (R), breathiness (B), asthenia (A), and strain (S) scoring and objective Multi-Dimensional Voice Program parameters. Statistical analysis was done by paired t-test, and a p value of less than 0.05 was considered significant. RESULTS: Seventeen patients were enrolled in this study, with a median age of 56 years and a median observation period of 129 days. The male-to-female ratio was 1 to 2.4. No major complications were observed in the perioperative period. Significant improvement was observed in the subjective values of G, R, B, and S. Improvement was also observed in the fundamental frequency, pitch perturbation quotient, and amplitude perturbation quotient calculated by the Multi-Dimensional Voice Program. CONCLUSIONS: The microdebrider is a useful tool in functional surgery for severe Reinke's edema and gives good functional outcomes. Surgeons can swiftly complete the key steps of removing pathological submucosal tissue and preserving the normal epithelium with an excellent surgical view.

Perceptual evaluation of pathological voice quality: a comparative analysis between the RASATI and GRBASI scales.

To provide mutual understanding between different evaluation scales for pathological voice quality, comparative analyses between the GRBASI and the RASATI systems were conducted. A total of 100 voice samples were rated by experienced Brazilian and Japanese listeners. Analysis by factor analysis with varimax rotation identified significant interrelations between the scales, with asthenia, instability, and roughness as the common factors. Grade-of-hoarseness, only included in GRBASI, corresponds to a combination of roughness, breathiness, and instability. Harshness, included only in RASATI, can be predicted by breathiness with strain in the GRBASI scale. Roughness is found to be the most consistent factor and the easiest to identify by evaluators with different linguistic background.