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Granular cell tumors are rare benign soft-tissue lesions that most commonly occur in the head and neck. They usually present in adulthood and are rarely seen in children. Here we present a 13-year-old girl who experienced symptoms of hoarseness of voice for most of her childhood and was unsuccessfully treated for asthma, acid reflux, allergies, and bronchitis before direct visualization revealed what was initially thought to be a vocal cord cyst. Surgical excision and pathology revealed the unexpected diagnosis of a vocal cord granular cell tumor. The patient has had resolution of dysphonia and is undergoing voice therapy.

We report a liver transplant patient with disseminated Legionella micdadei infection with pulmonary, laryngeal, and suspected muscle involvement. This organism, which stains weakly acid-fast, primarily affects immunocompromised patients. The diagnosis is difficult to make; in this case, the organism was identified via molecular diagnostics on laryngeal and pulmonary biopsy tissue.

WOS:000643426500001 PMID: 33871141 Background The aim of this study is to compare neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) values, which are inflammatory parameters, in precancerous and cancerous lesions and to determine whether there is a parameter that can be used in the early diagnosis of laryngeal squamous cell carcinoma. Methods In this retrospective study, 174 patients who were benign as a result of pathology, 122 patients who were malignant, 39 patients who were premalignant (335 patients in total) and 117 normal individuals were included. Data groups were divided into 4 groups as benign laryngeal lesion(BLL), precancerous laryngeal lesion (PLL), malignant laryngeal Lesion (MLL) and control group (CG). In addition, the PLL group was subdivided into mild dysplasia (MiD), Moderate Dysplasia (MoD) and severe dysplasia-carcinoma in situ (SeD/CIS). NLR, PLR and other parameters were calculated. Results NLR and PLR values were significantly different between the groups. (P = .000, P = .002) The mean NLR was higher in the MLL and PLL groups, and was lower in the BLL and control groups. The mean PLR was also higher in the MLL and PLL groups. When the groups were compared in pairs, there was a significant difference between BLL and MLL (P = .001) and MLL and CG (P = .006). The PLL group was subdivided into MiD, MoD and SeD/CIS. There was a significant difference in NLR when CG and other subgroups were compared (P = .027). Significant differences were found between CG and SeD when the groups were compared in pairs (P = .007). There was no significant difference between the groups in terms of PLR and dysplasia (P = .516). Conclusion As revealed in this study, these rates were low in the CG and BLL groups and high in the MLL group, so they could be used as markers to differentiate malignant lesions.

Vallecular cyst is uncommon laryngeal lesion and generally asymptomatic. However, when large in size or occur in a small airway like in neonates, it causes respiratory and feeding difficulties. Here we report a rare case of symptomatic vallecular cyst in a neonate.

OBJECTIVE To assess the prevalence of human papillomavirus (HPV) in benign and malignant laryngeal lesions among Egyptian patients. DESIGN Observational analytical cross-sectional study. SETTING Ain Shams University hospital, Otorhinolaryngology department PARTICIPANTS: Formalin-fixed paraffin-embedded specimens of 126 patients (70 benign laryngeal lesions and 56 squamous cell carcinoma lesions) were assessed for the presence of HPV DNA using MY09/11 PCR-based DNA detection. MAIN OUTCOME MEASURES Percentage of positive samples was calculated. RESULTS All 70 benign laryngeal lesion specimens were negative for the HPV DNA, while 2 of the 56 squamous cell carcinoma lesions (3.6%) were positive. CONCLUSIONS The presence of HPV DNA in only two specimens in our study suggests that the proportion of laryngeal squamous cell carcinomas attributable to infection by HPV seems to be very low in Egypt.

Vocal Cord Metastasis A 49-year-old man presented with voice changes and pain with swallowing. Fiberoptic laryngoscopy revealed a laryngeal lesion. Biopsy and imaging were performed, and a diagnosi...

Therapeutic monocolonal antibodies (MAbs) are a new, rapidly growing class of medications that frequently have poorly characterized side-effect profiles. We present a patient who developed inflammatory lesions of the vocal folds in temporal relation to the initiation of alirocumab. Lesions of the vocal folds represent a previously unreported adverse effect of alirocumab therapy, making it the second MAb documented with such a side effect. The potential laryngeal effects of alirocumab specifically, and of MAbs more broadly, warrant investigation. Laryngoscope, 127:1652-1654, 2017.

Objective: The aim of this study is to evaluate the value of high resolution ultrasonography (HRUS) in diagnosis of various laryngeal lesions which already diagnosed with rigid endoscopy. Study design: Prospective study with control group. Patients and methods: Sixty-six patients were suffering from throat symptoms and pre-examined by rigid endoscopy under local anesthesia and diagnosed to have a laryngeal lesion and 32 volunteers compose the control group. All 98 persons (patients and control groups) were examined by HRUS. Results: HRUS was helpful in describing various laryngeal lesions, vocal fold polyps (17) 25.7%, glottic cancer (6) 9.1%, epiglottic enlargement (2) 3.1% and one patient had laryngocele (1.5%). HRUS was highly significant in diagnosis of subglottic lesions (10) 15.2%. Also vocal fold mobility can be demonstrated by HRUS. While interarytenoid lesions (17) 25.8% and small laryngeal lesions as vocal fold nodules (13) 19.6% were difficult to be described. Conclusion: Rigid endoscopy in laryngeal examination gives us large, bright image but it is difficult to diagnose patients with a sensitive gag reflex, patients with neck or jaw diseases or stridor and very difficult in infants and children. HRUS is an alternative method in diagnosis of some laryngeal lesions, and it is superior in the diagnosis of small subglottic lesions.

A histoplasmose com acometimento único de laringe é uma ocorrência rara da doença, com menos de 100 casos relatados na literatura, quando comparada ao número de pacientes diagnosticados com histoplasmose. Tal localização, quando isolada, pode induzir, erroneamente, ao diagnóstico e tratamento de tuberculose ou câncer de laringe, com casos relatados de tratamentos iniciados para essas doenças. Em um paciente com histoplasmose que desenvolva rouquidão, deve-se pensar no acometimento laríngeo da histoplasmose, enquanto que uma massa laríngea produzindo rouquidão deve incluir em seu diagnóstico diferencial a histoplasmose laríngea. Quando se pensa em histoplasmose como causa de uma lesão laríngea, a biópsia deve ser limitada, removendo a menor quantidade de tecido necessária para o diagnóstico O patologista deve ser avisado da possibilidade do diagnóstico, já que podem ser necessários corantes especiais para o diagnóstico.

Objectives: Chronic cough, defined as a cough persisting for more than 8 weeks, is a common chief complaint in the outpatient department. The role of laryngeal lesions in these patients is discussed in this paper. Materials and Methods: Seventy-seven patients (29 men, 48 women) were enrolled retrospectively at my clinics in one regional hospital and two local hospitals located in Taoyuan county and in Hsinchu county, from January to June, 2006. Their ages ranged from 19 to 83 years (mean, 52.7 years). The duration of symptoms was from 8 weeks to over 2 decades (70.1% of the patients: ≤3 years). Before examination with a flexible fiberoptic nasopharyngoscope, obvious bronchopulmonary disease had been ruled out using chest radiography and chest auscultation. Results: Of the patients examined, 61.0% had laryngeal lesions, including vocal fold atrophy (61.7%), vocal fold sulcus (19.1%), vocal nodules (14.9%), vocal polyps (8.5%), vocal corditis (4.3%), unilateral vocal cord palsy (2.1%), and laryngeal neoplasm (2.1%). Of the patients with laryngeal lesions, 48.9% complained of hoarseness. Among patients with hoarseness, 88.5% had laryngeal lesions. There was a statistically significant difference in the presence of hoarseness between patients with and without laryngeal lesions (p＜0.05, x^2 test). Patients without laryngeal lesions had a higher cure rate for chronic cough than patients with these lesions (p＜0.05, x^2 test) after 10 patients who were lost to follow-up were excluded. Conclusion: Both the larynx and its dynamics should be evaluated together when a patient presents with chronic cough because laryngeal lesions are comitant. In addition, laryngeal malignancy needs early diagnosis and early treatment.

We report a case of laryngeal tuberculosis in a 47-year-old Korean man. Laryngeal tuberculosis is rare and currently accounts for less than 1% of all cases of tuberculosis. Clinical features of laryngeal tuberculosis include hoarseness, odynophagia and dyspnoea. Macroscopically, laryngeal tuberculosis may mimic laryngeal carcinoma, chronic laryngitis or laryngeal candidiasis. The diagnosis is often delayed due to a low index of clinical suspicion and hence may pose a significant public health risk. Laryngeal tuberculosis should be considered in the differential diagnosis of patients who present with any form of laryngeal lesion.

長期気管挿管後に抜管困難となる原因と対策を検討した。平均14日間の気管挿管を受けた33症例を対象に,前向き研究として抜管直後にファイバースコープを用いて観察した喉頭所見と抜管後の臨床症状,転帰,挿管期間などとの関係を調べた。抜管後の症状は気道狭窄症状と気道分泌物による症状に分類し,喉頭所見は喉頭浮腫,声帯損傷,声門閉鎖不全に分類した。気道狭窄症状を呈した群には喉頭浮腫が多く,再挿管率も高かった。分泌物による症状は特定の喉頭病変や転帰との相関は認めなかった。狭窄症状への対策としては非侵襲的陽圧換気(non-invasive positive pressure ventilation, NPPV)の有効性が示唆された。分泌症状に対しては再挿管により喉頭病変が恒久的障害へ進展する可能性や早期気管切開による予後改善の報告があることにより,早期の気管切開が適切と思われる。今回は臨床症状や喉頭所見の重症度評価を行えなかったが,挿管期間のみにとらわれず抜管後の臨床症状と喉頭所見から総合的に病態を判断し,それに見合った対処が必要である。

Objective. To compare the surgeon’s evaluation and histopathology for diagnosis of laryngeal lesions. Material. A clinical survey was distributed to laryngeal surgeons, ENT clinicians, and students in 2013 at the Department of Otorhinolaryngology in Rostock. Participants were asked to anonymously identify laryngeal pathologies and to assess the severity of the lesion starting from hyperplasia and inflammation over moderate dysplasia to early laryngeal cancer. Images of similar clinical laryngeal lesions were demonstrated in a multiple-choice modus to assess the surgeon’s intraoperative evaluation. The questionnaires were digitally processed and evaluated. The results were correlated with histopathology and compared between experienced laryngeal surgeons, clinicians inexperienced in laryngeal surgery, and medical students from the Medical Faculty of the University of Rostock. Results. Sensitivity and specificity varied among the various groups, being highest in experienced laryngeal surgeons. In this group, sensitivity, specificity, positive and negative predictive value, and accuracy were 85%, 56%, 44%, 90%, and 65%, respectively. In 4% and 31%, laryngeal disease was underdiagnosed and overdiagnosed, respectively. In this group, Kappa statistics resulted in Kappa 0.32 (P<0.001). Conclusion. This clinical survey clearly demonstrates that conformity between histopathology and evaluation of the laryngeal lesion depends on the surgeon’s experience.

Tonsillar and laryngeal tuberculosis are rare diseases. We report a case with a tonsillar and laryngeal lesion. Histopathological and bacteriological examinations established the diagnosis of tonsillar and laryngeal tuberculosis associated with asymptomatic pulmonary focus.

We performed endoscopic phonosurgery in a patient with a laryngeal lesion using a prototype of the therapeutic rhino-larynx electronic endoscope connected to a video processor (Asahi Optical Co., Ltd.). This therapeutic electronic endoscope differs from the fiberoptic endoscope, because it contains an instrument channel and a miniature television camera attached to the tip of the endoscope, consisting of a small light-sensitive CCD chip. The dynamic image provided by this system is superior in resolution to that obtained by conventional flexible laryngofiberscopes. Using this therapeutic electronic endoscope and flexible forceps, we succeeded in removing a vocal fold polyp. This endoscope can be passed through the nasal passage into the laryngeal cavity. The therapeutic electronic endoscope is introduced and a clinical case is presented.

Direct laryngoscopy is an essential examination for supraglottic and laryngeal pathology. Fibreoptic or videolaryngoscope are not readily available. This study was designed to see the usefulness of Videogastroscope to evaluate laryngeal lesion instead of fibreoptic or videolaryngoscope. Patients with unsuccessful or unsatisfactory indirect laryngoscopic examination referred by ENT surgeons were examined using videogastroscope and anaesthetizing oropharynx and hypopharynx with lidocaine pharyngeal spray. Under direct supervision impressions including still and dynamic images were recorded. Study group comprised of 76 males and 43 females with age varying from 09 to 87 with mean age 44 years. Various abnormalities were detected among 74 (62.2 %) patients. Common pathologies were vocal cord polyps and nodules in 28, laryngitis and laryngeal ulcer in 16, supraglottic growth in 13 and pyriform fossa growth in 10. Direct laryngoscopy using videogastroscope is safe, effective and easily performed newer technique which might be very useful where indirect laryngoscopy is difficult and fibreoptic or videolaryngoscope is not available.

It is well known that hoarse voice can be produced during the course of any laryngeal lesion. One possible cause is recurrent nerve paralysis due to various pathological conditions. Among various etiologies, our clinical statistics indicate that the incidence of hoarseness due to mediastinal pathology is 2.6%. As for treatment, glottal incompetence should be corrected and various methods have been proposed for this purpose. From our experience, arytenoid rotation and intracordal injection give the best results. However indication for each technique should be considered carefully.

ProblemOver expression of Cyclooxygenase II (COX II) is noted in a variety of inflammatory and neoplastic conditions, including laryngeal cancer. Although smoking is a known risk factor for laryngeal carcinoma, non-smokers are occasionally diagnosed. Possible etiologic factors include up regulation of COX II expression. This study compares COX II expression in benign, dysplastic and cancerous laryngeal tissue specimens in smokers and non-smokers.MethodsPathology specimens from consecutive patients who underwent excision of a laryngeal lesion for unrelated reasons from 2003 to 2006 were collected. Patients with severe laryngopharyngeal reflux were excluded. Patients’ smoking history was collected. Immunocytochemical studies were used to detect COX II expression. A blinded pathologist graded the intensity of COX II expression based on a visual analog scale. Statistical analysis was used to determine differences.Results49 samples from 22 smokers and 18 non-smokers were tested. COX II expression was significa...

Optical coherence tomography (OCT) has been previously identified as a promising tool for exploring laryngeal pathologies in adults. Here, we present an OCT handheld probe dedicated to imaging the unique geometry involved in pediatric laryngoscopy. A vertical cavity surface emitting laser-based wavelength-swept OCT system operating at 60 frames per second was coupled to the probe to acquire three-dimensional (3-D) volumes in vivo. In order to evaluate the performance of the proposed probe and system, we imaged pediatric vocal fold lesions of patients going under direct laryngoscopy. Through this in vivo study, we extracted OCT features characterizing each pediatric vocal fold lesion, which shows a great potential for noninvasive laryngeal lesion discrimination. We believe OCT vocal fold examination in 3-D will result in improved knowledge of the pediatric anatomy and could aid in managing pediatric laryngeal diseases.

We report two cases of chronic progressive disseminated histoplasmosis with unusual and rare clinical picture in a patient with no underlying risk factor. One 50-year-old male, presented with hoarseness of voice, chronic cough, with a history of nonresponding anti-tubercular therapy, revealed mucocutaneous lesions on examination. Fungating vocal cord lesions were visualized on bronchoscopy, raised suspicion of carcinoma. The second case, a 22-year-old female, referred to hospital with suspected vasculitis, with complaints of "off and on" fever with decreased oral intake, arthralgia, who later developed generalized nodular skin eruptions. On investigation, human immunodeficiency virus test was found to be negative in both the cases. Histopathological findings of skin biopsy, adrenal and bone marrow aspirates raised suspicion, whereas fungal cultures confirmed Histoplasma infection. Although diagnosis was delayed, but both of them were successfully treated with amphotericin B.

Introdução: O diagnóstico das disfonias na infância tem sido facilitado, nos últimos anos, pelo desenvolvimento de métodos diagnósticos de fácil execução técnica, como a laringoscopia indireta com fibra óptica9. Objetivo: O presente estudo teve o objetivo de avaliar a incidência das diversas lesões laríngeas nos exames de videolaringoscopia de crianças com queixas vocais realizados no Setor de Laringologia do Serviço de Otorrinolaringologia do Hospital do Servidor Público Estadual de São Paulo. Forma de estudo: Retrospectivo clínico não randomizado. Material e método: Realizamos estudo retrospectivo, analisando 34 exames de videolaringoscopia de crianças realizadas neste serviço, no período de março de 1999 a março de 2000. No levantamento realizado, apresentou interesse especial a incidência quanto ao sexo e idade; o tipo de lesão laríngea, se isolada ou associada; a coaptação glótica e a presença de sinais sugestivos de refluxo gastroesofágico (RGE). Resultados: Foram identificadas 18 crianças portadoras de nódulo vocal (53%), 7 de cisto de prega vocal (21%), 1 criança com lesão nodular inespecífica (3%) e 8 crianças apresentaram o exame normal (23%). A idade das crianças com nódulo vocal variou de 4 a 13 anos, com média de 9 anos; não houve correlação da lesão com o gênero. A idade das crianças com cisto vocal variou de 10 a 13 anos, com média de 11,2 anos; também não houve correlação da lesão com o gênero da criança. Achados sugestivos de RGE foram encontrados em apenas 1 criança, sendo esta portadora de nódulo vocal. Conclusão: O nódulo vocal foi a lesão mais comum observada nas crianças avaliadas, sem prevalência quanto ao sexo, com uma média de idade de 9 anos.

As the prevalence of tuberculosis in the U.K. increases, uncommon clinical presentations of the disease may be encountered by the otolaryngologist. We describe just such a case, where a caucasian patient presented with laryngeal lesion, considered to be highly suspicious of a neoplastic process rather than an infective one. We discuss the pathogenesis of tuberculous laryngitis, and review the differential diagnosis and management of the condition.

We report the case of an 82-year old Italian female with laryngeal involvement of classic Kaposi's sarcoma. We obtained a complete regression of laryngeal lesion with low-dose alpha-2b interferon.

A Case report of a laryngeal malignant mesenchymoma, a very rare head and neck and even rarer laryngeal leison, is reported.In this case, an 85-years-old man, who had undergone several panendoscopies and biopsies that were non-diagnostic, subsequently succumbed to pulmonary metastases and died from respiratory failure. At autospy, tumour cells were demonstrated to constiute both bone and straited muscle cell types. As the tumour cells differentiated into two types of specialized cells from one type of embryonal tissue, the diagnosis of maligant mesenchymoma was established.

An unusual case of cervical cystic hygroma with laryngeal extension is reported. A patient with acute upper airway obstruction due to a laryngeal lesion was seen 18 years after the original cervical surgery. Maintenance of an adequate airway has required a partial laryngectomy in addition to repeated endoscopic procedures for removal of recurrent disease. The rationale for this therapy is discussed in light of the current literature.

Occasionally the air flow rate during phonation is inadequetely improved by endoscopic microsurgery for vocal cord polyps, nodules and Reinke's edema. To clarify the factors influencing the air flow rate after surgery, we studied severity of the laryngeal lesion and the improvement of hoarseness in patients with inadequete flow rate.1) In patients with polyps, the large and/or bilateral lesions appeared to cause inadequete improvement of the flow rate. There was no relationship between improvement of the flow rate and hoarseness after surgery.2) A patient with vocal cord nodules and little improvement of the flow rate had red vocal cords before surgery and no reduction of hoarseness.3) In a patient with Reinke's edema, good relief of hoarseness was obtained regard less of little improvement of flow rate which did not relate to severity of the laryngeal lesion.