Life-Threatening Respiratory Distress in a Total Laryngectomy Patient: Aspirated Voice Prosthesis or Lung Tumor?

Laryngectomy patients usually have poor pulmonary functions due to long-term smoking. Their lungs can easily be decompensated. Hence, meticulous evaluation and timely management of severe respiratory distress in laryngectomy patients can be life savers. Here we present an interesting case of a laryngectomy patient with two different clinical presentations of life-threatening respiratory distress at the same time (aspiration of voice prosthesis and a second primary lung cancer). Marked or persistent respiratory distress in a laryngectomy patient deserves thorough clinical evaluation and may require urgent intervention. We consider that the presentation and course of respiratory distress in our laryngectomy patient will provide an additional aspect for emergency room doctors and airway specialists dealing with such a patient

Demographics and coexisting tremor, cervical dystonia and vocal fold disorders in a group of patients with spasmodic dysphonia

Dati demografici e presenza di tremore, distonia cervicale e patologie delle corde vocali in un gruppo di pazienti con disfonia spasmodica. Riassunto: L’obiettivo principale di questo studio è quello di descrivere le caratteristiche demografiche e cliniche di un gruppo di pazienti affetti da disfonia spasmodica (SD). Come obiettivo secondario, abbiamo valutato l’età dei pazienti al momento della diagnosi associandola al sesso e tremore non cordale. Sono stati valutati retrospettivamente settantaquattro pazienti consecutivi, trattati per SD alla Mayo Clinic di Jacksonville dall’1 ottobre 2015 al 31 marzo 2018. Sono stati raccolti dati riguardanti sesso, età alla diagnosi, BMI, tipo di SD, storia personale di stress maggiore/depressione, recenti infezioni delle vie aeree superiori (URTI), presenza di patologie neurologiche o delle corde vocali coesistenti. La maggioranza dei pazienti è risultata di sesso femminile con un’età media alla diagnosi di 61 anni (17-80). Il BMI medio è 25,7 (16,9-63,7). le associazioni diagnostiche più comuni sono state disfonia da iperadduzione e MTD (18,9%); disfonia da iperadduzione e tremore (17,6%). La disfonia da iperadduzione isolata è stata trovata nel 52,7% dei casi. Il 36,6% dei pazienti era affetto da tremore mentre il 15,5% da distonia cervicale. Sono state identificate patologie delle corde vocali come paresi/paralisi (3,1%), cisti (3,1%), neoformazioni (4,7%), polipi (1,6%), sinechie glottiche anteriori (1,6%). Non è stata riscontrata alcuna associazione fra sesso e distonia o tremore non cordale. L’età avanzata alla diagnosi ha mostrato un’associazione statisticamente significativa con la distonia cervicale (P = 0,049) ma non con il tremore non vocale (P = 0,22). In questo gruppo di pazienti affetti da SD la maggior parte dei casi non mostra contestuali patologie neurologiche o patologie delle corde vocali. I pazienti più anziani alla diagnosi di SD hanno più probabilità di essere affetti da distonia cervicale

Successful treatment of a case with cervical lymphatic malformation: Repeated bleomycin sclerotherapy

Lymphatic malformations (LM) are benign congenital malformations of the lymphatic system. They are frequently seen in the neck and sometimes can be life-threatening due to compression to the airway. Treatment modalities are widespread including surgical excision, radiotherapy, laser therapy, and application of intralesional sclerosing agents. We report the successful treatment of cervical LM in a 3-year-old boy who presented with a sudden onset of a large cystic mass in the posterior cervical triangle and was treated with repeated injections of intralesional bleomycin

Risk factors for dysplasia in recurrent respiratory papillomatosis in an adult and pediatric population

Aim: Recurrent respiratory papillomatosis (RRP) is classically described as a benign neoplasm of the larynx caused by the low-risk human papillomavirus (HPV) viral subtypes. Nevertheless, transformation to dysplasia and invasive carcinoma can occur. We aimed to assess the prevalence of dysplasia and carcinoma-ex-papilloma in both adult-onset and juvenile-onset RRP and identify patient risk factors for this dysplastic transformation. Material and Methods: Ten-year retrospective chart review of a tertiary otolaryngology referral center. Patients with papilloma were identified from a review of a pathology database and clinical records. Patient demographics, pathologic data, and treatment history, including use of cidofovir as an adjunctive therapy for papilloma, were extracted from electronic medical records. Results: One hundred fifty-nine RRP patients were identified, 96 adult-onset (AORRP) and 63 juvenile-onset (JORRP) cases. Of this cohort, 139 (87%) had only benign papilloma as a pathologic diagnosis. In the AORRP cohort, 10 patients (10%) were diagnosed with dysplasia or carcinoma in situ in addition to papilloma, and 5 patients (5%) had malignant transformation to invasive carcinoma-ex-papilloma. There was a significantly higher age of disease onset for those with dysplasia or carcinoma versus those without dysplasia or carcinoma (56 vs 45 years old; P = .0005). Of the 63 JORRP patients, there were no cases of dysplasia but 3 (5%) cases of invasive carcinoma-ex-papilloma, all involving pulmonary disease. The JORRP patients with carcinoma-ex-papilloma had a younger average disease onset (2 vs 6 years old; P = .009) and a higher rate of tracheal involvement than those without carcinoma. Gender, smoking history, number of operations, or use of cidofovir showed no association with the development of dysplasia or carcinoma-ex-papillomatosis in either the AORRP or JORRP population. Conclusion: In a large series of RRP, age of disease onset is the strongest predictor of dysplastic transformation in the adult and pediatric population. Carcinoma-ex-papillomatosis was uniformly associated with pulmonary disease in the JORRP population in this series. No other demographic or behavioral factors, including adjunctive therapy with cidofovir, were statistically associated with dysplasia or carcinoma-ex-papilloma

Successful Treatment of a Case with Cervical Lymphatic Malformation: Repeated Bleomycin Sclerotherapy

Lymphatic malformations (LM) are benign congenital malformations of the lymphatic system. They are frequently seen in the neck and sometimes can be life-threatening due to compression to the airway. Treatment modalities are widespread including surgical excision, radiotherapy, laser therapy, and application of intralesional sclerosing agents. We report the successful treatment of cervical LM in a 3-year-old boy who presented with a sudden onset of a large cystic mass in the posterior cervical triangle and was treated with repeated injections of intralesional bleomycin

Malignant salivary gland tumours of the larynx: a single institution review

Malignant salivary gland tumours of the larynx are very rare, with limited reports of clinical outcomes. We present the decade-long experience of a single institution. A 10-year retrospective chart review of a tertiary head and neck cancer centre was performed. Index patients were identified from a review of a pathology database, and reviewed by a head and neck pathologist. Patient demographics, presenting signs and symptoms, treatment modalities and clinical outcomes were extracted from electronic medical records. Six patients were included, with an age range of 44 to 69. All six had malignant laryngeal salivary gland tumours. Pathologies included: three adenoid cystic carcinoma (2 supraglottic, 1 subglottic), one mucoepidermoid carcinoma (supraglottic), one epithelial-myoepithelial carcinoma (supraglottic) and one adenocarcinoma (transglottic). All were treated with surgery (2 endolaryngeal, 4 open) and five of six with the addition of adjuvant therapy (4 radiotherapy, 1 concurrent chemoradiation). One patient had smoking history; no patients had significant alcohol history. With 4.5 years of median follow-up, none of the patients has had recurrence or local/distant metastasis. Salivary gland tumours of the larynx present in mid to late-age, and can be successfully managed with a multi-modality approach, resulting in excellent local and regional control rates

Non-epithelial tumors of the larynx: a single institution review

Non-epithelial tumors of the larynx are rare and encompass a wide range of pathology. We present the decade-long experience of a single institution to define clinical presentations and outcomes. MATERIAL AND METHODS: This is a ten year retrospective chart review of a tertiary head and neck cancer center. Index patients were identified from a review of a pathology database, and patient demographics, presenting signs and symptoms, treatment modalities, and clinical outcomes were extracted from electronic medical records. Epithelial tumors (squamous cell carcinoma, spindle cell carcinoma, and salivary tumors), granulomas, sarcoidosis, papilloma, and amyloidosis were all excluded. RESULTS: Twenty-four patients with ages ranging from 2months-old to 84years were identified. Malignant lesions (11) included chondrosarcoma (6), Kaposi's sarcoma (2), metastatic melanoma, synovial cell sarcoma, and T cell neoplasm. Six were operated upon endolaryngeally, but four required either upfront or salvage total laryngectomy. Two received adjuvant therapy. Benign lesions (13) included hemangioma (4), granular cell tumor (3), myofibroblastic tumor (2), schwannoma (2), chondroma, and ossifying fibromyxoid tumor. Nine underwent endolaryngeal operations, and four were managed medically or with observation. None have required aggressive open resection or total laryngectomy. CONCLUSION: Treatment approach of non-epithelial tumors of the larynx depends on the site and extent of the tumor, histology, and sensitivity of adjuvant therapy. Benign tumors can be managed without need for aggressive resection thereby sparing laryngeal function

Histopathologic evaluation of hyaluronic acid and plasma-rich platelet injection into rabbit vocal cords: an experimental study

Objective: Various materials are used by otolaryngologists for vocal cord injections in the management of vocal cord paralysis. An ideal injection material should be long-term effective, readily available, cheap, easy to prepare, have no donor morbidity, easy to use, biocompatible, resistant to resorption or migration, and easy to extract during revision. In this study, we aimed to see the histopathological effects of hyaluronic acid (HYA) and platelet-rich plasma (PRP) injections into the vocal cords of New Zealand rabbits. Methods: PRP was injected into the right vocal cords of twelve rabbits, which was prepared from their serum (PRP group). HYA was injected into the left vocal cords of first six rabbits (numbered 1-6) (HYA group), and the left vocal cords of the other six rabbits (numbered 7-12) were followed with no intervention (control group). Two months later, histomorphological findings in the vocal cords were assessed by two experienced pathologists in seven parameters: chronic inflammation, mucosal atrophy, necrosis, neovascularization, fibrosis, foreign body reaction, and muscular atrophy. They were scored double-blinded as negative (0), mild (+ 1), moderate (+ 2), and severe (+ 3). Fisher's chi-square test was used to evaluate any statistical significance among the three groups. Results: Chronic inflammation, mucosal atrophy, necrosis, foreign body reaction, and muscular atrophy parameters were scored as 0 for each preparate by both pathologists. For neovascularization and fibrosis, a stasistically significant difference was seen among the three groups (p<0.05). Neovascularization was increased in the PRP and HYA groups compared with the control group. No significant difference was observed in fibrosis when the groups were compared separately. After two months, two of the six vocal cords injected with HYA revealed HYA; however, none of the PRP-injected vocal cords showed PRP. Conclusion: HYA and PRP can be safely injected into vocal cords. Our findings show that HYA is a biocompatible and safe injection material for clinical use. Only two of the six vocal cords showed HYA at the end of two months, suggesting that HYA is a short-term effective material. Similarly, PRP was also shown to be a short-term effective material and can be used in patients for testing purpose before using a long-term effective material. The advantages of PRP are that it is inexpensive, readily available, and completely inert as it is prepared from the subject itself

Laryngoscopic examination during the COVID-19 pandemic Turkish voice speech and swallowing disorders society and Turkish professional voice society recommendations

COVID-19 is highly transmissible and spreads rapidly in the population. This increases the occupational risk for health care workers. In otolaryngology clinic practice, patients with upper respiratory tract infection symptoms are common. Also, routine head and neck examinations such as oral cavity examination, nasal/nasopharyngeal examination, or video laryngostroboscopic evaluation are highly risky because of the aerosol formation. To emphasize this issue, two leading otolaryngology organizations in Turkey; 'Voice Speech and Swallowing Disorders Society', and 'Professional Voice Society' gathered a task force. This task force aimed to prepare a consensus report that would provide practical recommendations of the safety measurements during routine clinical care of laryngology patients. To fulfill this, universal aim, on the 2nd and 9th of May 2020, two web-based meetings were conducted by 20 expert physicians. This eighteen items list was prepared as an output

Laryngoscopic Examination During the COVID-19 Pandemic: Turkish Voice Speech and Swallowing Disorders Society and Turkish Professional Voice Society Recommendations

COVID-19 is highly transmissible and spreads rapidly in the population. This increases the occupational risk for health care workers. In otolaryngology clinic practice, patients with upper respiratory tract infection symptoms are common. Also, routine head and neck examinations such as oral cavity examination, nasal/nasopharyngeal examination, or video laryngostroboscopic evaluation are highly risky because of the aerosol formation. To emphasize this issue, two leading otolaryngology organizations in Turkey; 'Voice Speech and Swallowing Disorders Society', and 'Professional Voice Society' gathered a task force. This task force aimed to prepare a consensus report that would provide practical recommendations of the safety measurements during routine clinical care of laryngology patients. To fulfill this, universal aim, on the 2nd and 9th of May 2020, two web-based meetings were conducted by 20 expert physicians. This eighteen items list was prepared as an output