성대에 발생한 과립세포종 1예

Granular cell tumor is a rare, usually benign neoplasm that can occur in various parts of the body. Half of all granular cell tumors occur in the head and neck, with 33% of these occurring in the tongue. The larynx is relatively an uncommon location, accounting for approximately 7% to 10% of all reported cases. Typically, the most common presenting symptom is hoarseness, with some patients also presenting stridor, hemoptysis, dysphagia, and otalgia. But the tumor may be asymptomatic and discovered only incidentally during a routine examination. The diagnosis is usually made on the histopathological findings, characterized by abundant eosinophilic cytoplasm filled with granules of varying sizes. Complete excision with an attempt to maintain normal structures generally results in cure. We experienced a 16-year-old man with laryngeal granular cell tumor, which involves the right true vocal fold. He was successfully treated with local excision under laryngomicroscopic fine dissection. So we present this case with a review of literature.ope

Clinical Usefulness of Laryngeal Electromyography for Patients with Vocal Cord Palsy

BACKGROUND AND OBJECTIVE: Vocal cord palsy is a complex disorder which may result from numerous causes. Laryngeal electromyography is a valuable adjunct in the study of vocal cord dysfunction. It yields objective and reproducible data, and may establish the pathophysiology and prognosis of laryngeal nerve pathology. We investigated the clinical usefullness of laryngeal electromyography for patients with vocal cord palsy. MATERIAL & METHOD: Laryngeal EMG was performed for 35 patients diagnosed as vocal cord palsy. RESULTS: We defined complete denervation when electrical silence, fibrillation potential or positive sharp waves were seen. We defined partial denervation when motor unit potential with low amplitude and low frequency was seen. We planned treatment modality according to the laryngeal EMG findings. In case of complete denervation, phonosurgery was recommended, whereas voice therapy and observation were recommended when partial denervation was noted. CONCLUSION: Laryngeal EMG is clinically valuable for the evaluation of vocal cord palsy and can serve as a guideline for determining the treatment plan. It is also useful in anticipating the prognosis of laryngeal nerve palsy.ope

The effect of the Modified Voiced Lip Trill (MVoLT) training on vocal changes of musical theater students

The Modified Voiced Lip Trill (MVoLT) training is a variant of voiced lip-till training characterized by increased loudness, lowered laryngeal position, and lip contact facilitated with fingers. The purpose of the current study was to assess the effect of the MVoLT training program on vocal changes of musical singing theater students. A total of 32 musical theater students (17 males and 15 females, age ranging from 18 to 29) participated in the study. For about three months, each participant was tutored using a systematic program focussing on the MVoLT training, accompanied by certain facilitating strategies. Pre- & post-training multi-dimensional vocal characteristics were assesed and compared. Results showed that cepstral peak prominence during vowel phonation increased after training, while its standard deviation and Cepstral Spectral Index of Dysphonia decreased. When an aerodynamic assessment was performed, maximum phonation time, subglottal pressure, mean airflow rate increased, while electroglottographic measures did not change. In addition, decreased psychometric measures, higher maximum pitch, and increased vocal range were noted after training. In conclusion, the MVoLT was proven to have a potential as an effective and safe training method for musical theater singing.ope

Pharyngolaryngeal Closure after Supraglottic Partial Laryngectomy

BACKGROUND AND OBJECTIVES:Although the various methods of pharyngolaryngeal closure after supraglottic partial laryngectomy(SPL) have been reported, the difference of postoperative function and complications has not been adequately analyzed. Therefore, We investigated the relationship between different pharyngolaryngeal closure methods and postoperative function and complications. PATIENTS AND METHODS: According to the methods of pharyngolaryngeal closure, postoperative complications, decannulation day and postoperative day when to start oral feeding were retrospectively investigated on 22 patients who underwent SPL. We divided the patients into two groups according to the methods of pharyngolaryngeal closure. In cartilage group(13 cases), the closure of pharyngolaryngeal defect was done with direct suture between the thyroid cartilage and base of the tongue. In perichondrial group(9 cases), the closure was done between preserved thyroid perichondrium and base of the tongue. RESULTS: There was no case requiring either a gastrostomy or a persistent tube feeding in our series. Fistula occurred more often in perichodrial group(3 cases) than cartilage group(0 case). In one case of perichondrial group, total laryngectomy was performed because of a fistula. Also, aspiration pneumonia occurred more often in perichodrial group(2 cases) than cartilage group(0 case). Decannulation could be performed relatively earlier in cartilage group than in perichondrial group. Also, oral feeding could be performed relatively earlier in cartilage group than in perichondrial group. CONCLUSION: Direct approximation between cut margin of the thyroid cartilage and base of tongue was safe, time-saving and reliable method of pharyngolaryngeal closure after SPL.ope

The Aspect of Voice Characteristics Change after Botulinum Toxin-A Injection in Patients with Adductor Spasmodic Dysphonia according to Vocal Tremor

As BTX-A, which has been known to be the most effective treatment for ADSD, is not effective in treating vocal tremors, voice assessment must be employed to perform differential diagnosis of SD and vocal tremor in an accurate fashion. In this study, the characteristics of vocal changes after botulinum toxin injection were compared by analyzing the voice characteristics resulting from the presence of vocal tremors using objective analysis devices, with the aim of helping to provide prognoses and to determine remedial effects in clinical cases comprising patients with adductor spasmodic dysphonia accompanied by voice tremors. Respiratory function tests, aerodynamic analysis, electroglottography (EGG), acoustic analysis, auditory perception tests, and K-VHI had been conducted at intervals of four, eight, and twelve weeks before and after injection, targeting a group of 17 ADSD female patients (a ADSD group of four with vocal tremor and a ADSD group of 13 without voice tremor). For average FVC and FEV1, the T group showed statistically significant low averages compared with the NT group, whereas the T group showed statistically significant high average ATRI compared with the NT group. In addition, the T group showed a statistically significant Fatr, lower than that of the NT group. For the ADSD group of patients with voice tremor, their vocal tremor remained unchanged despite noticeable decrease in wringing voices. In other words, as the vocal tremor and wringing voices are two distinctive features, there is a need for the two features to be targeted separately for differential diagnosis.ope

Perturbation and Perceptual Analysis of Pathological Sustained Vowels according to Signal Typing

In this paper, we investigate a signal typing on the basis of visual impression of distinctive spectrogram. Pathological voices are classified into signal type 1, 2, 3, or 4 to estimate perturbation parameters and to mark perceptual rating based on Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V). The results suggest that perturbation analysis can be applied to only type 1 and 2 signals and the perceptual ratings of overall grade increase with each signal type, overall. A good inter-rater reliability is showed among three raters. We recommend that pathological voices should be marked the signal typing and CAPE-V, together, to definitely describe the characteristics of pathological voices.ope

Botox Injection for the Management of Spasmodic Dysphonia

Spasmodic dysphonia is a chronic, focal, movement-induced, action-specific dystonia of the laryngeal musculature during speech. It can have a profound effect on quality of life, severely limiting people's communication, especially via telephone and in noisy backgrounds. Spasmodic dysphonia (SD) is usually of the adductor type characterized by glottic contractions causing tightness and voice breaks with forced-strangled voice, but it may also be abductor type or, much less commonly, mixed. Treatment options for adductor spasmodic dysphonia (ADSD) include voice therapy, surgical procedures, and botulinum toxin injections (Botox). The use of Botox injected into the laryngeal muscles remains the "gold standard" treatment for reducing the vocal symptoms of ADSD and Botox induces a temporary paresis of the laryngeal muscles and provides short-term relief of symptoms. Repeated injections of the laryngeal muscles, generally every 3-4 months, are required for continuous relief of symptoms. Improvement in vocal function has been reported after use of Botox injections, though a completely normal voice is rarely achieved. In this hospital, 1,030 patients have been enrolled for Botox injection therapy so far (May, 2012). In this review article, I'd like to present my personal experience of management of spasmodic dysphonia mainly by Botox injection.ope

Voice Analysis after the Vertical Partial Laryngectomy

Background and Objectives：It is generally believed that reconstruction of the glottic region after vertical partial laryngectomy (VPL) can improve glottic and supraglottic function. But reports on secondary healing without glottic reconstruction after VPL are lacking. This study attempts to obtain an objective phonatory data after VPL without glottic reconstruction. Materials and Method：From 1993 to 2001, 13 patients, who had been treated with VPL without glottic reconstruction, and 44 patients who underwent VPL were included in this study. Patients who had been followed up postoperatively less than 12 months were excluded from this study. Seven lesions were classified as T1 glottic cancer and six as T2 glottic cancer ; classic VPL (11 cases) and frontolateral VPL (2 cases). For the evaluation of voice, acoustic (fundamental frequency (Fo), jitter, shimmer, noise to harmonic ratio (NHR)), aerodynamic (maximal phonation time (MPT), mean flow rate (MFR)) analysis and videostroboscopy were done. Results：There were significant differences in Fo, jitter, shimmer, NHR, MPT and MFR between VPL group and the normal control group. In videostroboscopy, the following tendencies were observed in many cases : incopmplete glottic closure, decreased and irregular mucosal wave and amplitude, supraglottic voicing, abnormal arytenoid movement and anterior commissure blunting. Conclusion：We had objective phonatory data after VPL without glottic reconstruction, which showed that voice quality after VPL without glottic reconstruction were somewhat unsatisfactory. Further studies on other surgical techniques of VPL would help to elucidate better ways of improving voice quality in these patients.ope

Case Report：Parotid Sialolithiasis

Salivary duct lithiasis is a condition characterized by the obstruction of a salivary gland or its excretory duct due to the formation of calcareous concretions or sialoliths resulting in salivary ectasia and even provoking the subsequent dilation of the salivary gland. It most commonly involves submandibular gland (80 to 90%) and less frequently parotid (10 to 20%). The authors report 2 cases of parotid sialolithiasis. The first case involved a 46-year-old male patient complaining of the left parotid area pain and swelling, and presenting with a salivary calculus in the left parotid duct. When the patient was diagnosed, he refused surgical removal. The second case involved a 41-year-old male patient complaining of the right parotid area pain and swelling, and presenting with a salivary calculus in the right parotid duct. The sialolith was surgically removed under general anesthesia. In this paper, we also reviewed a series of concepts related to the etiology, diagnosis and treatment of sialolithiasis.ope

Preliminary Results of Mitomycin-C Application in the Treatment of Laryngeal Stenosis and Granuloma

Background and Objectives：Mitomycin-C is an antibiotic, antineoplastic agent that inhibits DNA and protein synthesis, and fibroblast proliferation. It has been successfully used in adjunction to glaucoma surgery, dacryocystorhinostomy, pterygium surgery, and middle meatal antrostomy. The purpose of this study is to evaluate the efficacy and safety of intraoperative Mitomycin-C application as an adjunct therapy in the endoscopic treatment of laryngeal stenosis and granulation. Materials and Method：A total 13 subjects, of whom 2 had anterior glottic web, 4 posterior laryngeal stenosis, and 7 laryngeal granuloma were included. All underwent stroboscopy and were treated with endoscopic laryngomicrosurgery with CO2 laser. Then, 1 cc of 0.4 mg/mL Mitomycin-C was directly applied for 4 minutes on the surgical site. The patients' symptoms were assessed, and the size of the airway was graded on a scale of I (≤50%) to IV (total occlusion) after a mean follow-up period of 5 months. The recurrence of the laryngeal granuloma was checked. Results：There was a significant improvement in postoperative symptoms in the group of posterior laryngeal stenosis. Two with tracheotomy underwent decannulation. The postoperative size of airway was markedly increased and restenosis was not noted. There was only one case of recurrence in the granuloma group. Conclusion：According to these preliminary results, it is suggested that application of Mitomycin-C can be used as a beneficial adjunct therapy in the endoscopic COc laser excision for laryngeal stenosis and granuloma.ope