Practical Application of Culture-Directed Treatment for Chronic Bacterial Laryngitis.

BACKGROUND/OBJECTIVES: Situated at the center of the upper aerodigestive tract, the larynx often is susceptible to a variety of insults including infection. Manifestations of laryngitis include hoarseness, cough, and sore throat, among others. The purpose of this research is to better understand the clinical presentation and patient characteristics of chronic infectious laryngitis. We aim to better understand when culture-directed therapy should be initiated in patients presenting to the otolaryngologist with suspected chronic infectious laryngitis and how this may influence treatment outcomes. METHODS: A single center, retrospective chart review was performed for patients with laryngitis of >3 weeks duration and who had positive laryngeal cultures obtained at a tertiary referral laryngology office from January 2016 through January 2023. RESULTS: Twenty-four patients (ages 36-84 years) with 29 positive cultures of the larynx met inclusion criteria. Ninety percent of patients were already on acid suppression therapy prior to culture acquisition. Fifty-five percent were immunocompromised. The most common species of bacterial growth included Klebsiella sp. (27.5%), Staphylococcus sp. (27.5%), and methicillin-resistant staphylococcus sp. (13.7%). Twelve cultures (41.4%) revealed multiple bacterial species, and 10 cultures (34.5%) had concomitant fungal isolates. The average treatment duration was 10 days. Twenty-one patients (72%) experienced improvement or resolution in symptoms after completion of culture-directed therapy. CONCLUSIONS: The use of culture-directed therapy for chronic bacterial laryngitis was helpful in the determination of appropriate treatment in these cases. More studies are needed to determine the optimal timing of cultures, duration of treatment, and implications of concomitant fungal laryngitis. LEVEL OF EVIDENCE: 4 Laryngoscope, 134:335-339, 2024.

Extruded Screw From Cervical Spine Hardware Causing Vocal Fold Paralysis.

Dysphonia and dysphagia are often observed among patients presenting to the otolaryngology clinic. One of the more common etiologies includes iatrogenic injury to the recurrent laryngeal nerve (RLN) as a known complication of head and neck surgeries such as thyroidectomy or anterior approaches to the cervical spine. Most often, RLN injury occurs in this context due to traction or transection of the nerve. No reports on delayed presentation of RLN injury from the extrusion of cervical spine hardware (screw) could be found in the peer-reviewed literature. We present a case of a 63-year-old woman who presented to the otolaryngology office with a 3-month history of hoarseness and difficulty swallowing. The patient's past medical history was significant for a motor vehicle accident (MVA) 6 years prior resulting in right arm radiculopathy and subsequent anterior cervical discectomy with spinal decompression and fusion (ACDF) at C5-C6 and C6-C7 approximately 3 months after the MVA. Strobovideolaryngoscopy revealed right vocal fold immobility. Computed tomography scan revealed that a screw from the right side of the ACDF hardware migrated approximately 2 cm with compression of the RLN. The patient underwent neck exploration with removal of the extruded hardware and microdirect laryngoscopy with right vocal fold injection laryngoplasty. Intraoperatively, the extruded screw was found embedded within the RLN fibers. This case represents the first report to our knowledge of extrusion of cervical spine hardware screw resulting in delayed RLN injury and vocal fold paralysis.

Acute infectious laryngitis: A case series.

Although acute laryngitis is common, it is often managed by primary physicians. Therefore, video images documenting its signs are scarce. This series includes 7 professional voice users who previously had undergone baseline strobovideolaryngscopy (SVL) during routine examinations or during evaluations for other complaints and who returned with acute laryngitis. Sequential SVL showed not only the expected erythema, edema, cough, and dysphonia, but also new masses in 5 of the 7 subjects. All the signs returned to baseline. This series is reported to highlight the reversible structural changes that can be expected in patients with acute laryngitis and the value of conservative management.

A Comparison of Initial and Subsequent Follow-Up Strobovideolaryngoscopic Examinations in Singers.

OBJECTIVES: Previous studies have identified abnormal findings in up to 86.1% of singers on initial screening strobovideolaryngoscopy (SVL) examinations. No studies have compared the prevalence of abnormalities in singers on their subsequent follow-up SVL. Our study evaluates the frequency of these findings in both the initial and subsequent examinations. METHODS: Retrospective charts and SVL reports were reviewed on students from an opera conservatory from 1993 to 2014. All students had initial screening SVL, but only students who later returned with acute voice complaints were included in the study (n = 51, 137 follow-up visits). Normal SVL was defined as an examination without structural or functional abnormalities and reflux finding score ≤7. Data were analyzed using the chi-square test. RESULTS: For initial examinations, 90.2% (including reflux) and 88.2% (excluding reflux) were abnormal. In follow-up examinations, 94.9% (including reflux) and 94.2% (excluding reflux) had abnormal findings, which included muscle tension dysphonia (40.1%), vocal fold (VF) masses (unilateral 48.9%, bilateral 30.7%), vascular abnormalities (unilateral 27.0%, bilateral 5.8%), sulcus (unilateral 17.5%, bilateral 5.1%), VF hypomobility (unilateral 36.3%, bilateral 5.9%), phase (30.6%) and amplitude (44.8%) asymmetries, and glottic insufficiency (49.3%). Follow-up examinations revealed a significant increase in laryngopharyngeal reflux (χ(2) = 7.043; P < 0.05). CONCLUSIONS: We found a higher prevalence of abnormal findings compared with previous studies, which we attributed to a more inclusive definition of abnormal pathologies, improvements in SVL technology, and possibly increased experience with SVL interpretation. This high prevalence of abnormal findings in asymptomatic singers further supports the importance of baseline examinations.

Laryngeal actinomycosis in an immunocompromised patient.

Actinomycosis of the larynx represents an unusual presentation for a common bacterium comprising the oral and oropharyngeal florae. There are few cases reported in the literature of laryngeal actinomycosis occurring primarily in the immunocompromised population. Here, we present a case in a 74-year-old man that occurred in the setting of neutropenia as a result of chemotherapy. Once the diagnosis was made with biopsy of the larynx, the infection was resolved after a prolonged course of penicillin-based therapy.