Evaluation of voice and quality of life after transoral endoscopic laser resection of early glottic carcinoma.

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.

Vocal fold paralysis: role of bilateral transverse cordotomy.

OBJECTIVE: Although modern endoscopic laser techniques aim to avoid a permanent tracheostomy by augmenting the glottic aperture in cases of bilateral vocal fold palsy, loss of tissue from the posterior glottis risks compromising voice quality and swallowing function. The objective of this study was to describe our experience with bilateral transverse posterior cordotomy. METHODS: This was a retrospective analysis of functional outcomes in a series of consecutive patients undergoing a simple modification of the classical laser cordectomy procedure, which avoids tissue loss. The procedure was confined to the complete release of the vocal ligament from the arytenoid cartilage on both sides, while avoiding any significant loss of mucosa or cartilage. RESULTS: Post-operative voice quality and quality of life were rated as good by most patients, which makes bilateral transverse cordotomy an attractive treatment option for bilateral vocal fold paralysis. CONCLUSION: Bilateral transverse cordotomy is a reliable treatment option for patients with bilateral vocal fold paralysis, and aims to avoid the morbidity associated with a permanent tracheostomy.

A prospective single-blind randomized-controlled trial comparing two surgical techniques for the treatment of snoring: laser palatoplasty versus uvulectomy with punctate palatal diathermy.

The aim of this study was to compare laser palatoplasty with uvulectomy with punctate palatal diathermy as treatment modalities for snoring. The study design was a prospective, single-blind, randomized-controlled trial. Eighty-three patients entered the trial. After a mean follow-up period of more than 18 months there was no statistically significant difference between the two groups regarding the patient perception of benefit from surgery or the subjective improvement in snoring. However, there was a statistically significant difference in the degree of pain in the immediate postoperative period (mean difference = 22.14, 95% CI = 7.98-36.31, P = 0.003), with the pain being worse in the laser palatoplasty group. Relative risk of complications for laser palatoplasty was 1.42 (95% CI = 0.93-2.17). The snoring scores and Glasgow Benefit Inventory scores decreased with time in both the groups but there was no statistically significant difference between the two groups.

Spontaneous carotico-cavernous fistula presenting as pulsatile tinnitus.

A patient with sudden onset pulsatile tinnitus resulting from a spontaneous carotico-cavernous fistula is presented. The case is discussed and illustrated to highlight the clinical features and natural history of a condition rarely seen by ENT surgeons.

Adenocarcinoma arising in an oesophageal colonic interposition graft.

This case report describes the rare complication of an adenocarcinoma developing in a colonic interposition graft 20 years following surgical resection of a postcricoid squamous carcinoma. A free jejunal graft was used for further oesophageal reconstruction following resection of the colonic graft.

Silver tracheostomy tube obturator in the tracheobronchial tree.

An unusual incident of aspiration of a silver tracheostomy tube obturator is described. Common sense advice to patients performing home tracheostomy care may help avoid similar occurrences in the future.

Aural suction without vertigo.

Vertigo induced by aural suction was abolished by maintaining a constant temperature in the mastoid cavity during the procedure. This was achieved using humidified air at 38 degrees C at the wider end of the aural speculum. The cavity temperature fell by a maximum of 0.2 degrees C (average) in 24 patients, none of whom experienced rotatary vertigo despite prolonged suction. This contrasted with a maximum temperature drop of 8.9 degrees C (average) in the same group of patients, 18 of whom then suffered vertigo and nystagmus, when the cavity temperature was not controlled during suction.

Adenosquamous carcinoma of the thyroid gland.

A case of adenosquamous carcinoma of the thyroid gland is presented. This rare form of cancer behaves in an aggressive manner similar to anaplastic carcinoma and is characterized histologically by the intimate blending of the squamous and glandular elements. The prognostic significance of identifying areas of malignant squamous epithelium within papillary carcinoma as opposed to the much more common benign squamous metaplasia, is highlighted. The pathogenesis, differential diagnosis and management of the condition are discussed.

Vertigo following aural suction: can it be prevented?

Suction toilet of mastoid cavities leads to unpleasant vertigo in many patients. We have shown that suction causes cooling within the cavity, in a series of 20 patients. This is of the same order of magnitude as a cold air caloric, showing the temperature drop to be an important factor. The relevant physical principles are examined. During suction a flow of cold, dry room air replaces the warm, moist cavity air, causing cooling both directly and by vaporization of water. Introducing humidified air at near body temperature should eliminate these effects and a study is being set up to evaluate the potential clinical applications of the method in the ENT Outpatient Department.