Laryngeal preneoplastic lesions and cancer: challenging diagnosis. Qualitative literature review and meta-analysis

Background: The treatment of laryngeal cancer and its precursor lesions has a great impact on important laryngeal basic functions, thus, early detection and preoperative assessment are important for a curative and function-preserving therapy. Furthermore, delayed diagnosis, leads to loco-regional failure and a high incidence of second primary tumor, reasons for poor outcome. In this setting, there are two basic clinical problems in the management of premalignant and malignant laryngeal lesions. First, small and thin lesions are difficult to evaluate by the histopathologic examination and initial biopsies are often not sufficient for a conclusive diagnosis. Second, margins of the specimens from surgical excisions are difficult to evaluate due to tissue damage from the device, leaving us in doubt whether the excision is radical or not. From these observations, it is obvious that an instrument offering the possibility to detect pre-cancerous-early cancerous lesions, and satellite foci or second primaries would be the key to improving the survival rate in head and neck cancer. But, despite the high number of more advanced diagnostic techniques and methods, unfortunately, it is not uncommon for different clinicians to use different nomenclature or to identify different stage for the same laryngeal lesion. Object. Different modalities of diagnostic techniques of laryngeal lesions exist. Rather than difference between benign and obvious malignant diseases, more difficult is to detect the presence of precancerous epithelial alterations. Not all tests achieve the same diagnostic accuracy and that all tests must be considered against a gold standard, hence this meta-analysis of literature aimed to synthesise the validity of each single diagnostic technique in identifying and staging laryngeal diseases. Methods: A systematic review of literature was led searching for articles mentioning the following terms including their various combinations to maximize the yield: larynx, laryngeal cancer, white light (WL) endoscopy, contact endoscopy (CE), stroboscopy, autofluorescence (AF), ultrasound (US), narrow band imaging (NBI), computers assail tomography (CAT), magnetic resonance imaging (MRI), positron emission tomography (PET). A quantitative analysis was carried on for paper published after 2005 onward, reporting a minumun series of 10 patients each study, declaring sensitivity and specificity of each diagnostic system. Results: The search identified 7215 publications, of which 3616 published after 2005, with a final results of a total of 214 articles stratified and included by our selection criteria. 58 out of 214 articles were selected for quantitative synthesis. 35 out of 58 studies had a quality score of ≥ 6 (good), 15 presented a score between 4 and 5 (fair), the remaining 8 had a score between 2 and 3 (poor). While objections can be raised about the pooling of different diagnostic procedures under the same group and the high level of heterogeneity in the meta-analyses, the inclusion of over 2500 patients makes the results fairly robust. Conclusions: A comprehensive overview of the most recent advances in laryngeal imaging technology combined with all of the information needed to interpret findings and successfully manage patients with voice disorders can be found herein. With these data, clinicians can risk-stratify patients and select proper examination modalities in order to provide appropriate care. Moreover, study limitations, together with possible clinical and research implications have been counted, as well

Models and analysis of vocal emissions for biomedical applications: 5th International Workshop: December 13-15, 2007, Firenze, Italy

The MAVEBA Workshop proceedings, held on a biannual basis, collect the scientific papers presented both as oral and poster contributions, during the conference. The main subjects are: development of theoretical and mechanical models as an aid to the study of main phonatory dysfunctions, as well as the biomedical engineering methods for the analysis of voice signals and images, as a support to clinical diagnosis and classification of vocal pathologies. The Workshop has the sponsorship of: Ente Cassa Risparmio di Firenze, COST Action 2103, Biomedical Signal Processing and Control Journal (Elsevier Eds.), IEEE Biomedical Engineering Soc. Special Issues of International Journals have been, and will be, published, collecting selected papers from the conference

Models and Analysis of Vocal Emissions for Biomedical Applications

The International Workshop on Models and Analysis of Vocal Emissions for Biomedical Applications (MAVEBA) came into being in 1999 from the particularly felt need of sharing know-how, objectives and results between areas that until then seemed quite distinct such as bioengineering, medicine and singing. MAVEBA deals with all aspects concerning the study of the human voice with applications ranging from the neonate to the adult and elderly. Over the years the initial issues have grown and spread also in other aspects of research such as occupational voice disorders, neurology, rehabilitation, image and video analysis. MAVEBA takes place every two years always in Firenze, Italy. This edition celebrates twenty years of uninterrupted and succesfully research in the field of voice analysis

Models and analysis of vocal emissions for biomedical applications

This book of Proceedings collects the papers presented at the 3rd International Workshop on Models and Analysis of Vocal Emissions for Biomedical Applications, MAVEBA 2003, held 10-12 December 2003, Firenze, Italy. The workshop is organised every two years, and aims to stimulate contacts between specialists active in research and industrial developments, in the area of voice analysis for biomedical applications. The scope of the Workshop includes all aspects of voice modelling and analysis, ranging from fundamental research to all kinds of biomedical applications and related established and advanced technologies

The Montgomery Thyroplasty Implant System: A 360° Assessment

This thesis provides a 360° assessment of one thyroplasty implant called the Montgomery Thyroplasty Implant System (MTIS).The author made an effort to use alternative and innovative research techniques. The originality lies in the choice of the Pareto technique as literature review, in the technique of the e-mail survey as to the use of voice indicators by practitioner, in a proof-of-concept study of an innovative (perhaps even disruptive) endoscopic measuring technique, and finally in the development of a new concept, the α -ratio with the use of virtual CT scan reconstruction to study the interactions between thyroid cartilage morphology and post-operative voice results.Thesis results can be summarized as follows:Most commonly used Voice Outcome Indicators (VOIs) to determine the effectiveness of surgical Unilateral Vocal Fold Palsy (UVFP) treatment are: Maximum Phonation Time and Voice Handicap Index. Mean Airflow is a VOI deserving further investigations.MTIS is a simple technique, offering permanent results with the possibility of treating posterior glottal gaps in most UVFP configurations.MTIS provides excellent results for male individuals. Female patients have a lower benefit after MTIS. The depth of the implant, as well as cartilage fenestration location, are factors influencing this gender discrepancySoluvos b.v. BESS Group Inc. XION-Medical GmbHLUMC / Geneeskund

Glottic Width and Respiratory Flow in Patients With Various Lung Diseases

Um die Frage zu beantworten, welche Stimmbandbewegungsmuster physiologisch sind, wenn eine Lungenerkrankung vorliegt und wann eine Vocal Cord Dysfunction (VCD) diagnostiziert werden kann, wurde in dieser Arbeit die Stimmbandbewegung bei 52 Patienten mit unterschiedlicher Lungenfunktion untersucht. Eine Videolaryngoskopie und der Atemfluss wurden synchron aufgezeichnet und später Frame für Frame analysiert. Der Winkel zwischen den Stimmbändern und die Öffnungsfläche wurden als Maß für die Glottisweite gemessen. Sowohl der maximale inspiratorische als auch der minimale exspiratorische Winkel zeigen eine sehr breite Streuung. Die Glottisöffnung unterscheidet sich signifikant zwischen Patienten mit unterschiedlichen Lungenfunktionsstörungen. Bei Patienten mit obstruktiver Lungenfunktionsstörung war die Stimmbandadduktion bei der Exspiration stärker ausgeprägt. Außerdem kann ein Zusammenhang zwischen Glottisweite und Lungenfunktionsparameter nachgewiesen werden. Am deutlichsten korreliert eine geringe Einsekundenkapazität in % des Sollwertes mit einer größeren Stimmbandbewegungsamplitude. Diese Ergebnisse unterstützen die Hypothese, dass eine verstärke Stimmbandadduktion in Exspiration insbesondere bei Patienten mit obstruktiver Lungenfunktionsstörung auftritt als ein physiologischer Mechanismus, um ein intrinsischer positiv-endexpiratorischer Druck sicherzustellen. Da die Stimmbandbewegung eine sehr breite Streuung zeigt und unter anderem durch die Lungenfunktion beeinflusst zu werden scheint, schlussfolgern wir, dass die Glottisweite allein für die Diagnose und den Schweregrad einer VCD ein unzureichendes Kriterium ist. Die exemplarische Analyse des zeitlichen Zusammenhangs zwischen Stimmbandbewegung und Atemfluss zeigt tendenziell gleichläufige Kurven bei allen Patienten. Bei einem Patienten mit dem klinischen Bild einer VCD zeigt sich hingegen eine komplette Phasenverschiebung zwischen der Stimmbandbewegung und dem Atemfluss. So lässt sich vermuten, dass der zeitliche Zusammenhang zwischen Stimmbandbewegung und Atemfluss für die Beurteilung der Relevanz und des Schweregrads einer VCD der entscheidende Faktor ist