[Pyogenic granuloma on the epiglottis].

In this case report, a 78-year-old man presented with dyspnoea, globus sensation and haemoptysis. CT scan and fibre-optic laryngoscopy revealed a 2 × 3 cm tumour on the laryngeal surface of the epiglottis. The tumour was surgically removed by direct laryngoscopy and debulking. Histology showed a pyogenic granuloma with large amounts of yeasts and bacteria. Six months later the tumour recurred. Treatment with fluconazole and removal with CO2 laser was effective. After a year and a half there were no signs of recurrence.

Vocal cord paralysis as primary and secondary results of malignancy. A prospective descriptive study.

OBJECTIVE: Vocal cord paralysis (VCP) may be caused by a primary malignancy and associated immune cross-reactivity. We aimed to illuminate underlying causes of VCP and to assess if onconeural antibodies occur in association to VCP as an early predictor of cancer. METHODS: A prospective study was performed in patients with newly diagnosed VCP from 2014 to 2016. All patients underwent fiberoptic laryngoscopy, ultrasound of the neck and computed tomography (CT) of the neck and thorax. Patients with idiopathic VCP underwent neurological examination, positron emission tomography/CT, and serum analysis for onconeural antibodies. All patients were offered a one-year clinical follow-up. RESULTS: In total 53 patients fulfilled the inclusion criteria. Left VCP occurred in 37 (70%), right in 15 (28%), and bilateral in one patient (2%). The cause of VCP was cancer in 27 (51%) patients, of those 15 (56%) had VCP as the primary symptom, including all cases with laryngeal and esophageal cancer. Median time interval between VCP and cancer was 7 days (range 1-30). In 12 (23%) VCP was a secondary symptom. Lung cancer was the most common etiology, 14 of 27 (52%), 12 patients (86%) with non-small cell lung cancer. Idiopathic VCP was diagnosed in 18 (34%) patients, of those nine patients had a neurological examination and were screened for well-known onconeural antibodies, which were not detected. Reactions against Purkinje cell nuclei were seen in three patients, none showed symptoms or signs of cancer at follow-up. CONCLUSIONS: The causes of VCP were described. VCP was frequently the primary symptom, and also occurred as a secondary symptom of cancer. Exclusion of malignancy is important in patients with VCP. LEVEL OF EVIDENCE: 1b.

[Mediastinal abscesses caused by a fish bone].

A 72-year-old man presented with left-sided neck pain after eating fish. A flexible fiberolaryngoscopy showed no signs of fish bone or wounds. At the follow-up two days later the patient had developed fever. Direct laryngoscopy and oesophagoscopy revealed no abnormalities. A computed tomography of the neck and thorax showed subcutaneous emphysema and abscesses in the neck and mediastinum originating from the oesophagus. Treatment included incision of the neck, drainage tubes and broad-spectrum IV antibiotics. Although not found, the cause of perforation is strongly believed to have been a fish bone.