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Bang JH, Lee SG, Kwon KJ, Lee SA, Eun YG, Lee YC. Effect of Proton Pump Inhibitor on the Outcome of Laryngeal Microsurgery in Patients With Vocal Fold Mucosal Disease With Reflux Symptoms. J Voice 2024; 38:931-935. [PMID: 35153121 DOI: 10.1016/j.jvoice.2022.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 01/05/2022] [Accepted: 01/06/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To evaluate the effect of proton pump inhibitor (PPI) after laryngeal microsurgery (LMS) in patients with benign vocal fold (VF) mucosal disease and in patients with overt reflux symptom according to subjective and objective voice assessment. METHODS The improvement of voice handicap index-10 (VHI-10) score, reflux symptom index (RSI) score, grade, roughness, breathiness, asthenia, and strain (GRBAS) score, Jitter, Shimmer, noise to harmonics ratio (NHR), maximum phonation time of acoustic voice analysis RESULTS: A total of 47 patients (PPI group [n = 24] and non-PPI group [n = 23]) completed the study. The scores for VHI-10, RSI, GRBAS, and acoustic parameters significantly improved in both groups after surgery. In the subgroup analysis of patients with overt reflux symptoms (RSI ≥ 13; non-PPI group [n = 12], PPI group [n = 15]), significant between-group differences were observed in terms of the improvement in NHR and the strain factor. CONCLUSION Postoperative PPI administration in patients with VF benign mucosal disease with reflux symptoms might improve subjective and objective voice outcomes after LMS.
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Affiliation(s)
- Je Ho Bang
- Department of Otolaryngology - Head and Neck Surgery, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Sun Gyu Lee
- Department of Otolaryngology - Head and Neck Surgery, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Ki Jin Kwon
- Department of Otolaryngology - Head and Neck Surgery, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Seul Ah Lee
- Department of Otolaryngology - Head and Neck Surgery, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Young-Gyu Eun
- Department of Otolaryngology - Head and Neck Surgery, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Young Chan Lee
- Department of Otolaryngology - Head and Neck Surgery, School of Medicine, Kyung Hee University, Seoul, Republic of Korea.
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Cui N, Dai T, Liu Y, Wang YY, Lin JY, Zheng QF, Zhu DD, Zhu XW. Laryngopharyngeal reflux disease: Updated examination of mechanisms, pathophysiology, treatment, and association with gastroesophageal reflux disease. World J Gastroenterol 2024; 30:2209-2219. [PMID: 38690022 PMCID: PMC11056915 DOI: 10.3748/wjg.v30.i16.2209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 02/02/2024] [Accepted: 03/29/2024] [Indexed: 04/26/2024] Open
Abstract
Laryngopharyngeal reflux disease (LPRD) is an inflammatory condition in the laryngopharynx and upper aerodigestive tract mucosa caused by reflux of stomach contents beyond the esophagus. LPRD commonly presents with sym-ptoms such as hoarseness, cough, sore throat, a feeling of throat obstruction, excessive throat mucus. This complex condition is thought to involve both reflux and reflex mechanisms, but a clear understanding of its molecular mechanisms is still lacking. Currently, there is no standardized diagnosis or treatment protocol. Therapeutic strategies for LPRD mainly include lifestyle modifications, proton pump inhibitors and endoscopic surgery. This paper seeks to provide a comprehensive overview of the existing literature regarding the mechanisms, patho-physiology and treatment of LPRD. We also provide an in-depth exploration of the association between LPRD and gastroesophageal reflux disease.
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Affiliation(s)
- Na Cui
- Department of Otorhinolaryngology Head and Neck Surgery, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
| | - Ting Dai
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
| | - Yang Liu
- Department of Otorhinolaryngology Head and Neck Surgery, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
| | - Ya-Yu Wang
- Department of Otorhinolaryngology Head and Neck Surgery, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
| | - Jia-Yu Lin
- Department of Otorhinolaryngology Head and Neck Surgery, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
| | - Qing-Fan Zheng
- Department of Gastroenterology, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
| | - Dong-Dong Zhu
- Department of Otorhinolaryngology Head and Neck Surgery, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
| | - Xue-Wei Zhu
- Department of Otorhinolaryngology Head and Neck Surgery, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
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Cantarella G, Lechien JR, Pignataro L, Aldè M, Battilocchi L, Barillari MR. Laryngopharyngeal reflux and idiopathic vocal fold scars. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2024; 44:68-70. [PMID: 37814979 PMCID: PMC10914356 DOI: 10.14639/0392-100x-n2625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 05/18/2023] [Indexed: 10/11/2023]
Affiliation(s)
- Giovanna Cantarella
- University of Milan, Department of Clinical Sciences and Community Health, Milan, Italy
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Department of Specialist Surgical Sciences, Otolaryngology Unit, Milan, Italy
| | | | - Lorenzo Pignataro
- University of Milan, Department of Clinical Sciences and Community Health, Milan, Italy
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Department of Specialist Surgical Sciences, Otolaryngology Unit, Milan, Italy
| | - Mirko Aldè
- University of Milan, Department of Clinical Sciences and Community Health, Milan, Italy
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Department of Specialist Surgical Sciences, Audiology Unit, Milan, Italy
| | - Ludovica Battilocchi
- University of Milan, Department of Clinical Sciences and Community Health, Milan, Italy
| | - Maria Rosaria Barillari
- Department of Mental and Physical Health and Preventive Medicine, “L. Vanvitelli” University, Naples, Italy
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Lechien JR, Hans S, Crevier-Buchman L. Influence of age on voice quality after transoral CO 2 laser microsurgery. J Otolaryngol Head Neck Surg 2023; 52:59. [PMID: 37697412 PMCID: PMC10496204 DOI: 10.1186/s40463-023-00664-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 08/28/2023] [Indexed: 09/13/2023] Open
Abstract
OBJECTIVE To study the post-operative evolution of voice quality of patients treated by transoral CO2 laser microsurgery (TLM) according to the age. METHODS Patients treated by type I to VI TLM and post-operative speech therapy were prospectively recruited from our hospital. The voice quality was assessed pre-, 1-, 3- 6- and 12-month posttreatment with voice handicap index (VHI), dysphonia, roughness, breathiness, asthenia, strain (GRBAS), maximal phonation time (MPT), F0, F0 standard deviation (STD), percent jitter, percent shimmer, noise-to-harmonic ratio (NHR), vocal fold vibration assessment and speech fluency. Evolution of voice outcomes was analyzed considering age of patients (< 60 vs. ≥ 60 years). RESULTS Seventy-five patients completed the evaluations. Thirty-four and forty-one patients were < 60 or ≥ 60 yo, respectively. Subjective and objective voice parameters (VHI, G, R, B), jitter and fluency significantly improved from 1- to 6-month post-TLM in < 60 yo individuals. The voice parameters improved 12-month post-TLM in the ≥ 60 yo group at the exception of VHI that improved 3-month post-TLM. There were positive associations between age and 12-month NHR, G and A parameters. CONCLUSION The post-operative evolution of voice quality parameters may vary between patients according to the age. Preoperative VHI is predictive of 12-month subjective and objective voice outcomes.
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Affiliation(s)
- Jerome R Lechien
- Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France.
- Department of Otolaryngology-Head & Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, Brussels, Belgium.
- Department of Otolaryngology, Polyclinic of Poitiers, Elsan Hospital, Poitiers, France.
- Faculty of Medicine, Department of Human Anatomy and Experimental Oncology, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium.
- Phonetics and Phonology Lab, CNRS UMR7018, Univ. Sorbonne University, Paris, France.
| | - Stephane Hans
- Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
- Phonetics and Phonology Lab, CNRS UMR7018, Univ. Sorbonne University, Paris, France
| | - Lise Crevier-Buchman
- Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
- Phonetics and Phonology Lab, CNRS UMR7018, Univ. Sorbonne University, Paris, France
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Dewan K, Chhetri DK, Hoffman H. Reinke's edema management and voice outcomes. Laryngoscope Investig Otolaryngol 2022; 7:1042-1050. [PMID: 36000026 PMCID: PMC9392404 DOI: 10.1002/lio2.840] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 06/07/2022] [Indexed: 11/15/2022] Open
Abstract
Objectives Reinke's edema is a chronic disease of the respiratory tract that occurs in adults with a history of chronic smoke exposure. Also known as polypoid corditis, polypoid laryngitis, and polypoid degeneration of the vocal fold, it is strongly associated with smoking, frequently with vocal misuse/abuse, and occasionally with laryngopharyngeal reflux. Reinke's edema remains a cause of chronic dysphonia that is difficult to manage. This review provides perspectives on current and future management of Reinke's edema. Results Reinke's edema impacts <1% of the population. The excessive mass is seen in polypoid degeneration results in a loss of pitch control and a rough voice. Women are more likely to present for treatment as the characteristic lowering of vocal pitch is more noticeable in women than men. Multiple grading systems have been proposed within the literature. The current standard of care is surgical excision, after smoking cessation. The microflap technique remains the approach of choice for bulky lesions. Surgical management of Reinke's edema has evolved with the introduction of various lasers into otolaryngologic practice; some which can now be used in the office setting. While many management approaches have been described within the literature, there is a little direct comparison and no obvious superior method of Reinke's edema management. Conclusion To date, the biology of Reinke's edema is not well understood. Additional research is needed further elucidate the role of uncontrolled reflux in the development and recurrence of Reinke's edema.
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Affiliation(s)
- Karuna Dewan
- Department of Otolaryngology—Head and Neck Surgery Louisiana State University Shreveport Louisiana USA
| | - Dinesh K. Chhetri
- Department of Head and Neck Surgery David Geffen School of Medicine at University of California Los Angeles Los Angeles California USA
| | - Henry Hoffman
- Department of Otolaryngology—Head and Neck Surgery University of Iowa Hospitals and Clinics Iowa City Iowa USA
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Meng L, Zhang Q, Meng J, Liu Y, Wang D. Correlation Between Detection Results of Pepsin in Vocal Fold Polyp Tissues and the Postoperative Efficacy. J Voice 2022:S0892-1997(22)00064-9. [PMID: 35450736 DOI: 10.1016/j.jvoice.2022.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 02/23/2022] [Accepted: 02/28/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE To explore the correlation between detection results of pepsin in vocal fold polyp tissues and the postoperative efficacy. METHODS The clinical data of 112 patients with vocal fold polyp who received surgical procedures in our hospital from June 2019 to March 2021 were retrospectively analyzed. The vocal fold morphology and vocal acoustic function were assessed at postoperative week 12. Using binary logistic regression, we explored whether the factors, ie, detection result of pepsin in vocal fold polyp tissue, microscopic suturing, the use of CO2 laser, and the history of smoking, affected the postoperative morphological repair of vocal fold polyps. Then, to observe and compare the influence of the detection results of pepsin on the recovery of vocal acoustic function, we divided the enrolled patients into the pepsin group and the pepsin-free group based on the postoperative detection results of pepsin in the polyp tissues by immunohistochemistry, RESULTS: In the 112 patients with vocal fold polyps, positive staining of pepsin in the postoperative samples was found in 76 patients (67.86%) and negative in 36 (32.14%). Totally 80 patients returned to normal in vocal fold morphology, among whom 32 (88.89%) were in pepsin-free group and 48 (63.16%) in pepsin group. Binary logistic regression showed that pepsin was a clinically significant indicator that affected the postoperative morphological recovery of the vocal fold (P = 0.003). Although hoarse voice was improved in all patients at postoperative week 12, the differences were statistically significant in the proportion of patients with grade, roughness, breathiness, asthenia, strain class G, voice handicap index, maximum phonation time, Jitter, Shimmer and noise-to-harmonic ratio between the pepsin group and the pepsin-free group (P < 0.05), with the pepsin-free group being superior to the pepsin group in the improvement of vocal acoustic function. CONCLUSION Pepsin in vocal fold polyps is a clinically significant indicator affecting the postoperative morphological recovery and acoustic efficacy, and patients with negative pepsin are superior to those with positive pepsin in the postoperative recovery of vocal fold morphology and function.
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Affiliation(s)
- Lingli Meng
- Department of Pathology, Ningbo Diagnostic Pathology Center, Ningbo, China; Department of Histopathology, Ningbo Clinical Pathology Diagnosis Center, Ningbo, China
| | - Qingxiang Zhang
- Department of Otolaryngology Head and Neck Surgery, Nanjing Tongren Hospital, School of Medicine, Southeast University, Nanjing, China.
| | - Jie Meng
- Department of Otolaryngology Head and Neck Surgery, Nanjing Tongren Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Yaqun Liu
- Department of Otolaryngology Head and Neck Surgery, Nanjing Tongren Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Dewang Wang
- Department of Pathology, Nanjing Tongren Hospital, School of Medicine, Southeast University, Nanjing, China
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Presence of pepsin in laryngeal tissue and saliva in benign and malignant neoplasms. Biosci Rep 2021; 40:226780. [PMID: 33103719 PMCID: PMC7670575 DOI: 10.1042/bsr20200216] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 10/08/2020] [Accepted: 10/23/2020] [Indexed: 12/15/2022] Open
Abstract
Objectives: The current study was performed to determine the presence of pepsin in saliva and laryngeal tissue among participants with benign and malignant laryngeal neoplasms. Study design: Case–control study included three groups of patients with: (1) benign laryngeal neoplasms, (2) malignant laryngeal neoplasms and (3) control subjects without symptoms or signs of laryngopharyngeal reflux (LPR). Methods: Eighty-one voluntary participants were included into study. They were recruited from a group of patients with histologically proven benign and malignant laryngeal neoplasms and in case of control subjects among patients with nasal septum deformation without symptoms of LPR. Morning saliva samples were collected preoperatively. Tumor biopsies were collected by directoscopy of larynx and the control samples from interarytenoid unit of larynx. All samples were analyzed by Enzyme-Linked Immunosorbent Assay (ELISA) and Immunohistochemistry. Results: Pepsin was found in all samples of saliva and tissue biopsies in groups with malignant and benign neoplasms. The highest concentration of pepsin was found in a group of patients with malignant laryngeal neoplasms. Patients with benign laryngeal neoplasms had lower concentrations and the control subjects presented with the lowest concentration of pepsin measured from their saliva. Differences were not statistically significant. Immunohistochemical (IHC) analysis showed the largest number of high positive samples in the group of malignant lesions. Conclusion: These results suggest that pepsin and LPR can contribute to the development of benign and malignant laryngeal neoplasms. Further prospective studies, with far more patients, are necessary to prove the role of pepsin in multifactorial etiology of laryngeal neoplasms.
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8
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Does Pepsin Play a Role in Etiology of Laryngeal Nodules? J Voice 2019; 33:704-707. [DOI: 10.1016/j.jvoice.2018.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 04/13/2018] [Indexed: 12/13/2022]
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9
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Lechien JR, Saussez S, Nacci A, Barillari MR, Rodriguez A, Le Bon SD, Crevier-Buchman L, Harmegnies B, Finck C, Akst LM. Association between laryngopharyngeal reflux and benign vocal folds lesions: A systematic review. Laryngoscope 2019; 129:E329-E341. [PMID: 30892725 DOI: 10.1002/lary.27932] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 01/14/2019] [Accepted: 02/25/2019] [Indexed: 01/05/2023]
Abstract
OBJECTIVES To investigate the role of laryngopharyngeal reflux (LPR) in the development of benign lesions of the vocal folds (BLVF). METHODS PubMed, Cochrane Library, and Scopus were searched by three independent investigators for articles published between January 1990 and November 2018 providing substantial information about the role of LPR in the development of nodules, polyps, cysts, Reinke's edema, and sulcus vocalis. Inclusion, exclusion, diagnostic criteria and clinical outcome evaluation of included studies were analyzed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. RESULTS Of the 155 relevant publications, 42 studies were included. Thirty-five were clinical studies and seven were experimental research studying the impact of reflux on vocal fold tissue. Only seven clinical studies utilized objective LPR diagnoses (pH monitoring), suggesting an association between LPR and the development of nodules, polyps, and Reinke's edema. These studies were characterized by a substantial heterogeneity due to discrepancies in inclusion/exclusion criteria, diagnostic methods, and clinical outcome evaluation. The few basic science studies on this topic support that LPR creates an environment that may predispose to BLVF through changes in defense mechanisms of the vocal folds, cell-to-cell dehiscence, inflammatory reaction of the vocal folds, and reaction to phonotrauma. CONCLUSIONS Caustic mucosal injury from LPR could cause increased susceptibility of the vocal fold mucosa to injury and subsequent formation of nodules, polyps, or Reinke's edema. However, the heterogeneity and the low number of high-quality studies limit the ability to draw definitive conclusions. Future clinical and experimental studies are needed to better identify the role of reflux in development of BLVF. Laryngoscope, 129:E329-E341, 2019.
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Affiliation(s)
- Jerome R Lechien
- Laryngopharyngeal Reflux Study Group of the Young Otorhinolaryngologists of International Federation of Otorhinolaryngological Societies (YO-IFOS), Marseille, France.,Laboratory of Anatomy and Cell Biology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium.,Laboratory of Phonetics, Faculty of Psychology, Research Institute for Language Sciences and Technology, University of Mons, Mons, Belgium.,Department of Otorhinolaryngology-Head and Neck Surgery, CHRU de Lille, Université de Lille, Lille, France.,Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Sven Saussez
- Laryngopharyngeal Reflux Study Group of the Young Otorhinolaryngologists of International Federation of Otorhinolaryngological Societies (YO-IFOS), Marseille, France.,Laboratory of Anatomy and Cell Biology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium.,Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Andrea Nacci
- Laryngopharyngeal Reflux Study Group of the Young Otorhinolaryngologists of International Federation of Otorhinolaryngological Societies (YO-IFOS), Marseille, France.,ENT Audiology and Phoniatric Unit, University of Pisa, Pisa, Italy
| | - Maria Rosaria Barillari
- Laryngopharyngeal Reflux Study Group of the Young Otorhinolaryngologists of International Federation of Otorhinolaryngological Societies (YO-IFOS), Marseille, France.,Division of Phoniatrics and Audiology, Department of Mental and Physical Health and Preventive Medicine, University of Luigi Vanvitelli, Naples, Italy
| | - Alexandra Rodriguez
- Laryngopharyngeal Reflux Study Group of the Young Otorhinolaryngologists of International Federation of Otorhinolaryngological Societies (YO-IFOS), Marseille, France.,Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Serge D Le Bon
- Laryngopharyngeal Reflux Study Group of the Young Otorhinolaryngologists of International Federation of Otorhinolaryngological Societies (YO-IFOS), Marseille, France.,Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Lise Crevier-Buchman
- Laryngopharyngeal Reflux Study Group of the Young Otorhinolaryngologists of International Federation of Otorhinolaryngological Societies (YO-IFOS), Marseille, France.,Department of Otorhinolaryngology-Head and Neck Surgery, Foch Hospital, Paris, France
| | - Bernard Harmegnies
- Laryngopharyngeal Reflux Study Group of the Young Otorhinolaryngologists of International Federation of Otorhinolaryngological Societies (YO-IFOS), Marseille, France.,Laboratory of Phonetics, Faculty of Psychology, Research Institute for Language Sciences and Technology, University of Mons, Mons, Belgium
| | - Camille Finck
- Laryngopharyngeal Reflux Study Group of the Young Otorhinolaryngologists of International Federation of Otorhinolaryngological Societies (YO-IFOS), Marseille, France.,Laboratory of Anatomy and Cell Biology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium.,Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Liège, Faculty of Medicine, University of Liège, Liège, Belgium
| | - Lee M Akst
- Laryngopharyngeal Reflux Study Group of the Young Otorhinolaryngologists of International Federation of Otorhinolaryngological Societies (YO-IFOS), Marseille, France.,Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Hospital, Johns Hopkins School of Medicine, Baltimore, Maryland, U.S.A
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Aksakal C, Karaca I. Isolated vocal cord hematoma developing after blunt neck trauma. Turk J Emerg Med 2018; 19:30-32. [PMID: 30793063 PMCID: PMC6370999 DOI: 10.1016/j.tjem.2018.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 08/27/2018] [Accepted: 08/31/2018] [Indexed: 11/07/2022] Open
Abstract
Introduction Blunt laryngeal trauma is a rare causes of emergency applications. Early diagnosis and treatment are important. Case presentations A 62-year-old woman applied to emergency department with pain over the larynx, hoarseness and dysphagia that starting after blunt laryngeal trauma. The patient had no respiratory distress. There was no ecchymosis and edema in the laryngeal area. Computed tomography showed no thyroid and cricoid cartilage fractures. Isolated hematoma was seen in the left vocal cord at the endoscopic view. Conclusion Endoscopic examination is important when there is no obvious physical examination finding on the in blunt neck trauma.
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Affiliation(s)
- Ceyhun Aksakal
- Ear Nose Throat Department, Tokat State Hospital, Tokat, Turkey
| | - Ilgıt Karaca
- Emergency Department, Tokat State Hospital, Tokat, Turkey
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11
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Wang H, Zhuge P, You H, Zhang Y, Zhang Z. Comparison of the efficacy of vocal training and vocal microsurgery in patients with early vocal fold polyp. Braz J Otorhinolaryngol 2018; 85:678-684. [PMID: 29784620 PMCID: PMC9443021 DOI: 10.1016/j.bjorl.2018.03.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 03/13/2018] [Accepted: 03/29/2018] [Indexed: 02/03/2023] Open
Abstract
Introduction Vocal fold polyp is a benign proliferative disease in the superficial lamina propria of the vocal fold, and vocal microsurgery can improve the voice quality of patients with vocal fold polyp. In preliminary studies, we found that vocal training could improve the vocal quality of patients with early vocal fold polyp. Objective This study aimed to compare the efficacies of vocal training and vocal microsurgery in patients with early vocal fold polyp. Methods A total of 38 patients with early vocal fold polyp underwent 3 months of vocal training (VT group); another 31 patients with early vocal fold polyp underwent vocal microsurgery (VM group). All subjects were assessed using laryngostroboscopy, voice handicap index, and dysphonia severity index, and the efficacies of vocal training and vocal microsurgery were compared. Results The cure rates of vocal training and vocal microsurgery were 31.6% (12/38) and 100% (31/31), respectively. The intragroup paired-sample t-test showed that the post treatment vocal handicap index, maximum phonation time, highest frequency (F0-high), lowest intensity (I-low), and dysphonia severity index in both the VT and VM groups were better than those before treatment, except for the jitter value. The intergroup independent-sample t-test revealed that the emotional values of vocal handicap index (t = − 2.22, p = 0.03), maximum phonation time (t = 2.54, p = 0.013), jitter (t = − 2.11, p = 0.03), and dysphonia severity index (t = 3.24, p = 0.002) in the VT group were better than those in the VM group. Conclusions Both, vocal training and vocal microsurgery could improve the voice quality of patients with early vocal fold polyp, and these methods present different advantages.
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Affiliation(s)
- Hanqing Wang
- Jinhua Central Hospital, Department of Otolaryngology, Jinhua, China
| | - Pan Zhuge
- Jinhua Central Hospital, Department of Otolaryngology, Jinhua, China.
| | - Huihua You
- Jinhua Central Hospital, Department of Otolaryngology, Jinhua, China
| | - Yulan Zhang
- Jinhua Central Hospital, Department of Otolaryngology, Jinhua, China
| | - Zhifeng Zhang
- Jinhua Central Hospital, Department of Otolaryngology, Jinhua, China
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12
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Lechien JR, Huet K, Khalife M, Fourneau AF, Finck C, Delvaux V, Piccaluga M, Harmegnies B, Saussez S. Gender differences in the presentation of dysphonia related to laryngopharyngeal reflux disease: a case-control study. Eur Arch Otorhinolaryngol 2018; 275:1513-1524. [DOI: 10.1007/s00405-018-4951-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 03/22/2018] [Indexed: 12/31/2022]
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13
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Zhuge P, You H, Wang H, Zhang Y, Du H. An Analysis of the Effects of Voice Therapy on Patients With Early Vocal Fold Polyps. J Voice 2016; 30:698-704. [DOI: 10.1016/j.jvoice.2015.08.013] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 08/19/2015] [Indexed: 11/29/2022]
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Lee Y, Na S, Kim H, Yang C, Kim S, Byun Y, Jung A, Ryu I, Eun Y. Effect of postoperative proton pump inhibitor therapy on voice outcomes following phonomicrosurgery for vocal fold polyp: a randomized controlled study. Clin Otolaryngol 2016; 41:730-736. [DOI: 10.1111/coa.12611] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2015] [Indexed: 02/04/2023]
Affiliation(s)
- Y.C. Lee
- Department of Otolaryngology-Head & Neck Surgery; School of Medicine; Kyung Hee University; Seoul Korea
| | - S.Y. Na
- Department of Otolaryngology-Head & Neck Surgery; School of Medicine; Kyung Hee University; Seoul Korea
| | - H.J. Kim
- Department of Otolaryngology-Head & Neck Surgery; School of Medicine; Kyung Hee University; Seoul Korea
| | - C.W. Yang
- Department of Otolaryngology-Head & Neck Surgery; School of Medicine; Kyung Hee University; Seoul Korea
| | - S.I. Kim
- Department of Otolaryngology-Head & Neck Surgery; School of Medicine; Kyung Hee University; Seoul Korea
| | - Y.S. Byun
- Department of Otolaryngology-Head & Neck Surgery; School of Medicine; Kyung Hee University; Seoul Korea
| | - A.R. Jung
- Department of Otolaryngology-Head & Neck Surgery; School of Medicine; Kyung Hee University; Seoul Korea
| | - I.Y. Ryu
- Department of Otolaryngology-Head & Neck Surgery; School of Medicine; Kyung Hee University; Seoul Korea
| | - Y.G. Eun
- Department of Otolaryngology-Head & Neck Surgery; School of Medicine; Kyung Hee University; Seoul Korea
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15
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Abstract
Radiation-induced dysphonia can develop after radiation for primary laryngeal cancer or when the larynx is in the radiation field for nonlaryngeal malignancy. The effects are dose dependent and lead to variable degrees of dysphonia in both short- and long-term follow-up. Rehabilitation of the irradiated larynx can prove frustrating but can be facilitated through behavioral, pharmacologic, or surgical interventions.
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Affiliation(s)
- Craig R Villari
- Department of Otolaryngology-Head and Neck Surgery, Emory University Hospital, Midtown Medical Office Tower, Suite 1135, Atlanta, GA 30308, USA
| | - Mark S Courey
- Department of Otolaryngology-Head and Neck Surgery, University of California - San Francisco, 2330 Post Street, 5th Floor, San Francisco, CA 94115, USA.
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16
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Ruiz R, Achlatis S, Sridharan S, Wang B, Fang Y, Branski RC, Amin MR. The Effect of Antireflux Therapy on Phonomicrosurgical Outcomes: A Preliminary Retrospective Study. J Voice 2014; 28:241-4. [DOI: 10.1016/j.jvoice.2013.09.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 09/19/2013] [Indexed: 10/25/2022]
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17
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Schaefer SD. Management of acute blunt and penetrating external laryngeal trauma. Laryngoscope 2013; 124:233-44. [PMID: 23804493 DOI: 10.1002/lary.24068] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Revised: 01/22/2013] [Accepted: 01/31/2013] [Indexed: 01/27/2023]
Abstract
OBJECTIVES/HYPOTHESIS Improve the care of acute external laryngeal trauma by reviewing controversies and the evolution of treatment. DATA SOURCE Internet-based search engines, civilian and military databases, and manual search of references from these sources over the past 90 years. REVIEW METHODS Utilizing the above-mentioned sources, electronic and manual searches of primary topics such as laryngeal trauma or injury, emergency tracheotomy, airway trauma, intubation versus tracheotomy, cricothyrotomy, esophageal trauma, and emergent management of airway injuries in civilian and combat zones. Citations were reviewed, selected reports analyzed, and the most relevant articles referenced. RESULTS Optimal treatment of acute laryngeal trauma includes early identification of injuries utilizing a directed history and physical examination. Timely management of the wounded airway is essential. The choice of intubation, tracheotomy, or cricothyrotomy must be individualized. Computed tomography (CT) may assist in differentiating patients who can be observed versus those who require surgical exploration. In selected patients, laryngeal electromyography and stroboscopy may also be useful. Surgery should begin with direct laryngoscopy and rigid esophagoscopy to evaluate the hard and soft tissues of the larynx, and to visualize the pharynx and esophagus. Minor endolaryngeal lacerations and abrasions may be observed, whereas more significant injuries require primary closure via a thyrotomy. Laryngeal skeletal fractures should be reduced and fixated. Endolaryngeal stenting is reversed for massive mucosal trauma, comminuted fractures, and traumatic anterior commissure disruption. CONCLUSIONS Acute external injury to the larynx is both life threatening and a potential long-term management challenge. Although a rare injury, sufficient experience now exists to recommend specific treatments, and to preserve voice and airway function.
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Affiliation(s)
- Steven D Schaefer
- New York Head and Neck Institute, Department of Otolaryngology-Head and Neck Surgery, Lenox Hill Hospital of the North Shore Long Island Jewish Health System and New York Medical College, New York, New York, U.S.A
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18
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Impact of laryngopharyngeal and gastroesophageal reflux on asthma control in children. Int J Pediatr Otorhinolaryngol 2013; 77:341-5. [PMID: 23277300 DOI: 10.1016/j.ijporl.2012.11.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Revised: 11/15/2012] [Accepted: 11/17/2012] [Indexed: 12/23/2022]
Abstract
OBJECTIVE A prospective study was carried out to determine the sensitivity and specificity of reflux symptoms and laryngeal findings to diagnose laryngopharyngeal reflux (LPR) and gastro-esophageal reflux (GER) in children with asthma by comparing the results of double probe pH monitorization and to determine the difference between controlled and uncontrolled asthma in terms of GER and LPR coexistence. METHODS A total of 50 patients (23 girls, mean age 10.8±0.4 years) with mild to moderate persistent asthma were included in this study. The patients were divided in two groups according to the asthma control status as controlled (n=27) vs. uncontrolled asthma (n=23). All patients completed the reflux symptom questionnaire and then they underwent flexible fiberoptic laryngoscopy and 24h double probe (pharyngeal and esophageal) pH monitorization. Laryngopharyngeal and gastroesophageal reflux were defined according to the double probe pH meter results. RESULTS The prevalences of LPR and GER were 70% and 46% in asthmatic patients, respectively. The reflux symptom score and LPR disease index were not useful to predict LPR or GER. There was no association between asthma control status and LPR and GER. Vocal nodule seems to be a valuable sign to evaluate LPR in asthmatic children. CONCLUSIONS The reflux symptom score and LPR disease index do not seem reliable to diagnose LPR and GER in children with asthma. The frequency of LPR and GER are independent of asthma control, atopy and long acting beta agonist usage.
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19
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El Uali Abeida M, Fernández Liesa R, Vallés Varela H, García Campayo J, Rueda Gormedino P, Ortiz García A. Study of the influence of psychological factors in the etiology of vocal nodules in women. J Voice 2011; 27:129.e15-129.e20. [PMID: 22088305 DOI: 10.1016/j.jvoice.2011.08.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2010] [Accepted: 08/18/2011] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The role placed by certain psychological factors such as stress and personality on the development of vocal nodules has not yet been established. The aim of this case-control type study is to analyze the relationship between these psychological factors and the presence of vocal nodules while also considering the professional and social aspects of the subjects suffering from this pathology. METHODS The case group is made up of 50 patients diagnosed with vocal nodules and with at least 6 months of evolution. The control group is made up of 50 patients diagnosed with nasal respiratory insufficiency. All the patients were examined by laryngeal stroboscopy. For the personality study, the perceived stress, and the voice use, the Minnesota Multiphasic Personality Inventory-2, Levenstein Perceived Stress Questionnaire, and Goldman Voice Use Survey were used, respectively. RESULTS The subjects with vocal nodules presented a mean perceived stress score of 0.41±0.09, which was higher than that of the control group (0.35±0.06), the differences observed being statistically significant (P<0.001). In the personality study (MMPI-2), the only scale that was associated with the presence of the vocal nodules was that of psychomotor acceleration. The mean score obtained for the scale was 51.64±8.25 in the vocal nodule group and 45.02±0.06 in the control group (P<0.001). In the analysis of voice use, the subjects with vocal nodules scored 9.31±1.36, which was significantly higher than the score of the control group (8.07±1.24; P<0.001). In addition, other variables were associated with the presence of vocal nodules, such as being young and working in professions considered to be of vocal risk. CONCLUSIONS Perceived stress and personality features of hyperactivity and impulsivity are independent factors related to vocal nodules.
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20
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Beltsis A, Katsinelos P, Kountouras J, Kamarianis N, Zavos C, Pournaras A, Kapetanos D, Fasoulas K, Zamboulis C, Eugenidis N. Double probe pH-monitoring findings in patients with benign lesions of the true vocal folds: comparison with typical GERD and the effect of smoking. Eur Arch Otorhinolaryngol 2011; 268:1169-1174. [DOI: 10.1007/s00405-011-1572-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2010] [Accepted: 03/08/2011] [Indexed: 12/18/2022]
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21
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Martins RHG, Defaveri J, Domingues MAC, de Albuquerque e Silva R. Vocal polyps: clinical, morphological, and immunohistochemical aspects. J Voice 2010; 25:98-106. [PMID: 20097524 DOI: 10.1016/j.jvoice.2009.05.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2009] [Accepted: 05/05/2009] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To study the clinical, morphological, and immunohistochemical characteristics of vocal polyps. STUDY DESIGN Prospective and retrospective. METHODS Clinical study: 76 medical charts from patients with polyps were reviewed. Histology study: in 42 slides from surgical specimens, the following were analyzed: epithelium, basal membrane, and lamina propria. In the transmission and scanning electron microscopy (TEM and SEM) studies, eight new cases of polyps were included. An immunohistochemical study was carried out in the 42 specimens, using antibody antifibronectin, antilaminin, and anticollagen IV. RESULTS Genders--43% males and 57% females; age range--between 21 and 40 years (36.85%); and between 41 and 60 years of age (51.31%); smoking and drinking-reported by 39 and 15 patients, respectively; associated symptoms-vocal abuse (61%), gastroesophageal (47%), and nasosinusal symptoms (32%); occupation--teachers (24.0%) and maids (18.0%). Histology--epithelial hyperplasia (31.71%), hyperkeratosis, (14.28%), edema (100%), vessel proliferation (92.86%), and congestion (83.33%). SEM--reduction in mucous lacing and increase in desquamating cells. TEM--hyperplastic epithelium, enlargement of the intercellular junctions, dense subepithelial network of collagen and basal membrane with adhesion loss. Immunohistochemistry--greater immunoexpression of fibronectin, laminin, and collagen IV around the vessels. CONCLUSIONS In vocal polyps, the morphological analyses show lamina propria with edema, vessel proliferation and inflammation, basement membrane with adhesion loss in some areas and dense network of subepithelial collagen. Immunohistochemistry techniques identify pigmentation of the antibodies anti-fibronectin, anti-laminin, and anti-collagen IV in the endothelium of blood vessels.
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Affiliation(s)
- Regina Helena Garcia Martins
- Department of Otorhinolaryngology, Ophthalmology and Head and Neck Surgery, School of Medicine, São Paulo State University, Botucatu, São Paulo, Brazil.
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23
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Current Opinion in Otolaryngology & Head & Neck Surgery. Current world literature. Curr Opin Otolaryngol Head Neck Surg 2009; 17:494-8. [PMID: 19907224 DOI: 10.1097/moo.0b013e32833385d7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Martins RHG, Defaveri J, Custódio Domingues MA, de Albuquerque E Silva R, Fabro A. Vocal fold nodules: morphological and immunohistochemical investigations. J Voice 2009; 24:531-9. [PMID: 19853410 DOI: 10.1016/j.jvoice.2009.01.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2008] [Accepted: 01/06/2009] [Indexed: 11/18/2022]
Abstract
The objective of this study was to investigate the morphological and immunohistochemical characteristics of vocal fold nodules. The study design was prospective and retrospective. For the histological study, we reviewed 15 slides from the surgical cases of vocal fold nodules, in which we analyzed epithelium, basal membrane (bm), and lamina propria. For the transmission and scanning electron microscopy (TEM, SEM) studies, five new cases on vocal fold nodules were included. Immunohistochemistry study was carried out in the 15 specimens, using antifibronectin, antilaminin, and anticollagen IV antibodies. The main histological alterations were epithelial hyperplasia (73.33%), basement membrane thickening (86.66%), edema, and fibrosis (93.33%). SEM--reduction in mucous lacing and increase in the desquamating cells, without epithelial erosion. TEM--hyperplasia of the epithelium, enlargement of the intercellular junctions, which was filled by fluid, subepithelial thickening of the lamina reticularis, and break points in the basal membrane. Immunohistochemistry--we identified greater immunoexpression of fibronectin on the basal membrane, on the lamina propria, and around the vessels. Antilaminin and anticollagen IV antibodies showed higher pigmentation on the endothelium of the vessels than that on the basal membrane. In vocal fold nodules, combined assessment using light microscopy, electron microscopy, and immunohistochemistry can reveal important morphological details useful in characterizing these lesions.
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Affiliation(s)
- Regina Helena Garcia Martins
- Department of Otorhinolaryngology, Ophthalmology and Head and Neck Surgery, School of Medicine, São Paulo State University, Botucatu, São Paulo, Brazil.
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Schwartz SR, Cohen SM, Dailey SH, Rosenfeld RM, Deutsch ES, Gillespie MB, Granieri E, Hapner ER, Kimball CE, Krouse HJ, McMurray JS, Medina S, O'Brien K, Ouellette DR, Messinger-Rapport BJ, Stachler RJ, Strode S, Thompson DM, Stemple JC, Willging JP, Cowley T, McCoy S, Bernad PG, Patel MM. Clinical Practice Guideline: Hoarseness (Dysphonia). Otolaryngol Head Neck Surg 2009; 141:S1-S31. [DOI: 10.1016/j.otohns.2009.06.744] [Citation(s) in RCA: 203] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2009] [Accepted: 06/26/2009] [Indexed: 12/27/2022]
Abstract
Objective: This guideline provides evidence-based recommendations on managing hoarseness (dysphonia), defined as a disorder characterized by altered vocal quality, pitch, loudness, or vocal effort that impairs communication or reduces voice-related quality of life (QOL). Hoarseness affects nearly one-third of the population at some point in their lives. This guideline applies to all age groups evaluated in a setting where hoarseness would be identified or managed. It is intended for all clinicians who are likely to diagnose and manage patients with hoarseness. Purpose: The primary purpose of this guideline is to improve diagnostic accuracy for hoarseness (dysphonia), reduce inappropriate antibiotic use, reduce inappropriate steroid use, reduce inappropriate use of anti-reflux medications, reduce inappropriate use of radiographic imaging, and promote appropriate use of laryngoscopy, voice therapy, and surgery. In creating this guideline the American Academy of Otolaryngology—Head and Neck Surgery Foundation selected a panel representing the fields of neurology, speech-language pathology, professional voice teaching, family medicine, pulmonology, geriatric medicine, nursing, internal medicine, otolaryngology–head and neck surgery, pediatrics, and consumers. Results The panel made strong recommendations that 1) the clinician should not routinely prescribe antibiotics to treat hoarseness and 2) the clinician should advocate voice therapy for patients diagnosed with hoarseness that reduces voice-related QOL. The panel made recommendations that 1) the clinician should diagnose hoarseness (dysphonia) in a patient with altered voice quality, pitch, loudness, or vocal effort that impairs communication or reduces voice-related QOL; 2) the clinician should assess the patient with hoarseness by history and/or physical examination for factors that modify management, such as one or more of the following: recent surgical procedures involving the neck or affecting the recurrent laryngeal nerve, recent endotracheal intubation, radiation treatment to the neck, a history of tobacco abuse, and occupation as a singer or vocal performer; 3) the clinician should visualize the patient's larynx, or refer the patient to a clinician who can visualize the larynx, when hoarseness fails to resolve by a maximum of three months after onset, or irrespective of duration if a serious underlying cause is suspected; 4) the clinician should not obtain computed tomography or magnetic resonance imaging of the patient with a primary complaint of hoarseness prior to visualizing the larynx; 5) the clinician should not prescribe anti-reflux medications for patients with hoarseness without signs or symptoms of gastroesophageal reflux disease; 6) the clinician should not routinely prescribe oral corticosteroids to treat hoarseness; 7) the clinician should visualize the larynx before prescribing voice therapy and document/communicate the results to the speech-language pathologist; and 8) the clinician should prescribe, or refer the patient to a clinician who can prescribe, botulinum toxin injections for the treatment of hoarseness caused by adductor spasmodic dysphonia. The panel offered as options that 1) the clinician may perform laryngoscopy at any time in a patient with hoarseness, or may refer the patient to a clinician who can visualize the larynx; 2) the clinician may prescribe anti-reflux medication for patients with hoarseness and signs of chronic laryngitis; and 3) the clinician may educate/counsel patients with hoarseness about control/preventive measures. Disclaimer: This clinical practice guideline is not intended as a sole source of guidance in managing hoarseness (dysphonia). Rather, it is designed to assist clinicians by providing an evidence-based framework for decision-making strategies. The guideline is not intended to replace clinical judgment or establish a protocol for all individuals with this condition, and may not provide the only appropriate approach to diagnosing and managing this problem.
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Abstract
PURPOSE OF REVIEW Laryngopharyngeal reflux is a widely recognized disorder. Yet, decades after its initial description, debate persists regarding pathophysiology, diagnosis, and treatment. This review addresses current literature on laryngopharyngeal reflux and identifies areas of controversy and future opportunities for research. RECENT FINDINGS Despite numerous research efforts, the diagnosis and treatment of laryngopharyngeal reflux remain elusive and unproven. Acid-induced changes in laryngopharyngeal mucosa have been confirmed by histologic evidence. However, the implications of this for laryngeal symptoms and signs are unclear. Diagnosis remains controversial, confounded by lack of standardization and accepted, evidence-based norms. Whereas treatment is generally believed by clinicians to be effective in alleviating symptoms and signs attributed to laryngopharyngeal reflux, incontrovertible data confirming efficacy are scarce. Confounding the issues further, there are numerous studies that purport to show that various widely used treatments are not effective, although the scientific merit of virtually all of these studies has been challenged. SUMMARY Laryngopharyngeal reflux remains a controversial diagnosis. Treatment with proton pump inhibitors persists despite weak evidence supporting or refuting their utility, and well designed studies are needed to understand diagnosis, treatment, pathyophysiology, and long-term health consequences of laryngopharyngeal reflux and its treatment.
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