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Bacteria are among the important factors that play a role in the balance of human health, and their relationship with some tumors has been well established. However, the association between bacteria colonizing the vocal cords and glottic laryngeal squamous cell carcinoma (GLSCC) remains unclear. Here, we investigated whether bacterial communities of the vocal cord mucous membrane play a role in the development of GLSCC. We collected tumor tissue and normal adjacent tissue (NAT) samples from 19 GLSCC patients, and the bacterial communities were compared with control samples (control) from 21 vocal cord polyps using 16S rRNA high-throughput pyrosequencing. We detected 41 phyla, 93 classes, 188 orders, 373 families, and 829 genera in the vocal cord mucous membrane. A comparison of the bacterial communities in the NAT samples showed higher α-diversity than in the tumor samples. In the tumor samples, seven groups of bacteria, i.e., the phylum Fusobacteria, the class Fusobacteriia, the order Fusobacteriales, the family Fusobacteriaceae, and the genera Fusobacterium, Alloprevotella, and Prevotella, were significantly enriched, as revealed by linear discriminant analysis coupled with effect size measurements (LEfSe). However, bacteria from the phylum Firmicutes were most significantly enriched in the vocal cord polyp tissues. These findings suggest alterations in the bacterial community structure of the vocal cord mucous membrane of GLSCC patients and that seven groups of bacteria are related to GLSCC, indicating that imbalances in bacterial communities increase the risk for the development of GLSCC.

Laryngoscopes are widely used in the clinical diagnosis of laryngeal lesions, but such diagnosis relies heavily on the physician's subjective experience. The purpose of this study was to develop a computer-aided diagnostic system for the detection of laryngeal lesions based on objective criteria. This study used the distinct features of the image contour to find the clearest image in the laryngoscopic video. First to reduce the illumination problem caused by the laryngoscope lens, which could not fix the position of the light source, this study proposed image compensation to provide the image with a consistent brightness range for better performance. Second, we also proposed a method to automatically screen clear images from laryngoscopic film. Third, we used ACM to segment automatically them based on structural features of the pharynx and larynx, using hue and geometric analysis in the vocal cords and other zones. Finally, the support vector machine was used to classify laryngeal lesions based on a decision tree. This study evaluated the performance of the proposed system by assessing the laryngeal images of 284 patients. The accuracy of the detection for vocal cord polyps, cysts, leukoplakia, tumors, and healthy vocal cords were 93.15%, 95.16%, 100%, 96.42%, and 100%, respectively. The cross-validation accuracy for the five classes were 93.1%, 94.95%, 99.4%, 96.01% and 100%, respectively, and the average test accuracy for the laryngeal lesions was 93.33%. Our results showed that it was feasible to take the hue and geometric features of the larynx as signs to identify laryngeal lesions and that they could effectively assist physicians in diagnosing laryngeal lesions.

Background: Vocal cord polyp usually arises from the epithelium and the lamina propria. Minimally invasive dissection procedures are employed to treat these vocal cord polyp for an effective outcome. Two types of microsurgical techniques were developed gradually and practiced namely, the conventional laryngeal microsurgery, which involves the use of cold instruments and the laryngeal laser micro-surgery. Objective: To compare the conventional cold dissection and CO2 laser methods in treatment of vocal cord polyp. Methods: A randomized prospective study was conducted at the Department of Otolayngology- Head & Neck Surgery, at Bangabondhu Sheikh Muzib Medical University (BSMMU) between July 2017 and June 2019. A total of 60 cases were studied on the following parameters: a. Visual analysis on stroboscopy b. Voice analysis –GRBAS (grade, roughness, breathiness, asthenia, strain) indices c. Duration of surgery d. Peroperative bleeding. Results: During first postoperative assessment, both groups had the normal symmetrical waves, while 50% of cases still had aperiodicity but all patients had the near normal periodicity in the second postoperative assessment. Regarding glottic closure, during preoperative assessment, almost all patients had incomplete glottic closure due to mass lesion as polyps. During first postoperative assessment, glottic closure was found to be better in group B (83% of cases) than group A (76% of cases), while during second postoperative assessment, all patients of both groups had around 95% glottic closure. The mean duration oflaser technique (7.1 ± 1.1 minutes) was less than the conventional technique time (15.6 ± 1.9 minutes), also mean of operative bleeding of laser technique (zero pack) is less than the conventional two(2 packs). Conclusion: There is no significant difference between both groups in all parameters except operative time and bleeding, as laser technique has less time and clear field. Bangladesh J Otorhinolaryngol; April 2021; 27(1): 17-24

Background Myxomas are benign tumors of mesenchymal origin that rarely occur in the larynx. Case summary We report a case of a laryngeal myxoma that presented as a right vocal cord mass in a 54-year-old man. Conclusion Laryngeal myxoma is a rare benign tumor in the larynx. It is difficult to distinguish glottis myxoma from vocal cord polyps on laryngoscopy. We recommend that otolaryngologists acquire a better understanding of this disease. If a laryngeal myxoma is suspected, dynamic laryngoscopy, acoustic voice analysis, and pathological biopsy should be performed.

To study the association of Helicobacter pylori (H. pylori) in patients with laryngeal pathologies. Study design: prospective observational study. Tertiary care teaching hospital. One hundred consecutive patients with laryngeal lesions scheduled for microlaryngoscopy were enrolled in the study. Laryngopharyngeal reflux was assessed using the reflux symptom index and reflux finding score. Tissue samples from the laryngeal lesions were taken under general anaesthesia and were screened for the presence of H. pylori using real time polymerase chain reaction (PCR) for ureA genes and histopathological examination. Of the 100 patients, 14 had a significant reflux symptom index score and 35 had significant reflux finding score. The lesions in the study subjects included both benign and malignant laryngeal pathologies. Vocal cord polyps formed more than half of the laryngeal pathology (57%) studied. Our study could not detect H. pylori in any laryngeal lesions by PCR analysis and histopathological examination. H. pylori may not be associated with laryngeal pathologies.

Background: Hoarseness of voice is a common symptom presentation in the Department of ENT. The etiology ranges from benign to malignant causes. Video nasopharyngolaryngoscopy is an effective method of evaluation of the laryngeal pathologies. The aim of the study was to study the different etiological factors of hoarseness of voice presenting in the Department of ENT at Western Regional Hospital, Pokhara. Materials and Methods: A retrospective observational longitudinal study was done in the Department of ENT, Western Regional Hospital after approval from IRC, Pokhara Academy of Health Science. A total of 275 patients presenting to the ENT Department with hoarseness of more than two weeks duration were examined with video nasopharyngolaryngoscopy (NPL) from April 2018 to March 2019. The data were electronically entered and analyzed with SPSS Version 21. Results: Total number of cases were 275 among which 187 (68%) were females whereas 88 (32%) were males. Vocal cord nodules were observed in 107 patients (38.9%), features of laryngopharyngeal reflux were observed in 54 patients (19.6%) muscle tension dysphonia was seen in 49 (17.8 % ), vocal cord polyp in 6 patients (2.2%), left vocal cord palsy in 7 patients ( 2.5%), right sided vocal cord palsy in 2 patients (0.7%). The hemorrhagic polyp, leucoplakia and ventricular dysphonia were observed in 3 patients each. Conclusion: Since causes of hoarseness of voice range from simple benign diseases to malignant diseases, it is mandatory to evaluate every cases of hoarseness of voice replace with of more than 2 weeks duration with history, videolaryngoscopic examination and investigations.

Prior studies have shown that apolipoprotein M (APOM) is involved in the development of some cancers. Here we investigated the effects of APOM on larynx cancer (LC). 20 patients with vocal cord polyps and 18 patients with LC were included in this study. The protein and mRNA levels of the samples were analysed using the Wes-ProteinSimple system (or traditional Western blot) and PCR technology, respectively. APOM protein level in cancer tissues was lower than that in paracarcinomatous (P = 0.0003) and polyp tissues (P P P P P = 0.0215). In addition, matrix metalloproteinase-10 (MMP-10) mRNA level was significantly reduced in the APOM overexpression group (P = 0.0077). However, Western blot analysis showed that APOM overexpression did not change VDR, NFE2L3 and MMP-10 protein levels (P > 0.05). In summary, APOM inhibits the proliferation and migration of LC cells, but may not be related to VDR, NFE2L3 and MMP-10, which needs further study.

Background: Thelarynx is an intricate part of the body which has to perform a very composite function like protection, respiration, phonation. To carry out the function, larynx should be adaptable and flexible. Any structural disorder like vocal cord polyp alter these specialized function and squander the laryngeal pacing, and increasing voice discomfort of the patient like hoarseness, dysphonia, and odynophagia day by day. Phonosurgery is the mainstay of treatment. Methods: It is a cohort retrospective study of 54 cases in the Department of Otolaryngology and Head-Neck Surgery, Comilla Medical College, Bangladesh, from 20 February 2017 to 27 October 2019. Result: Incidence of vocal cord polyp in laryngeal disorder patient was 6.83%, and the laryngeal operative patient was 28.27%. All patients were treated by micro laryngeal surgery with rigid Hopkin’s laryngeal telescope, and setback was 2 (3.70%). Of them, male were 41(75.92%), females were 13(24.08%), below 20 years were 2(3.70%), 20-50 years 39(72.23%,) and above 50 years 13(24.07%), unilateral was 50(92.59%) and 4(7.41%) were bilateral, smoker was 41(75.92%), nonsmoker 13(24.08%), industrial workers were 21(38.89%), professional voice user was 13(24.07%)

Objectives. The purpose of this study was to investigate serum pituitary tumor transforming gene (PTTG1) expression in laryngeal carcinoma and its relationship with the clinical pathological characteristics and prognosis.Methods. Expression of serum PTTG1 was measured by enzyme-linked immunosorbent assay in 110 patients with laryngeal carcinoma and 60 patients with vocal cord polyps. Expression of the serum PTTG1 levels relationship with the clinicopathological characteristics and prognosis were analyzed.Results. In laryngeal carcinoma patients’ serum, the PTTG1 median concentration was 141.43 pg/mL (interquartile range [IQR], 111.387 to 160.837 pg/mL), significantly higher than that of the vocal cord polyp group of 94.01 pg/mL (IQR, 81.26 to 108.59 pg/mL), and the difference was statistically significant (z=–6.715, P

Dynamic airway obstruction is a terrifying situation. Most of the time, the obstruction is intermittent. The situation becomes horrifying and panicky when this intermittent dynamic airway obstruction turns into a total laryngeal obstruction under anaesthesia. Herein, we present a case of a 56-year-old male with vocal cord polyp, who was posted for excision. The difficult airway was anticipated in view of a thick neck. He was also hypertensive and a suggestive case of obstructive sleep apnoea. The patient went to the cannot ventilate, cannot intubate, cannot oxygenate situation because of the polyp taking position between the vocal cords and completely obstructing the central airway gateway. The case was successfully managed by emergency cricothyroidotomy by following the Vortex approach but taught us a few lessons. The case shows us the relevance of clinical findings and the importance of vocal polyp as a cause of inducible laryngeal obstruction and highlights the consequences of intuition and minor lacuna in airway management.

Vocal cord diseases can cause irregular vibration of the vocal cords, resulting in abnormalities. Therefore, it is necessary to study abnormal vocal cords in a vocal cord model. Research that focus...

Patient: Male, 51 Final Diagnosis: Intravascular papillary endothelial hyperplasia Symptoms: Changes in his voice Medication: — Clinical Procedure: Laryngomicrosurgery Specialty: Otorhinolaryngology Objective: Rare disease Background: Intravascular papillary endothelial hyperplasia (IPEH), is a vascular tumor characterized by the proliferation of endothelial cells with papillary formations. It is a rare benign disease; therefore, it is important to exclude malignant vascular neoplasm in order to prevent misdiagnosis and inappropriate overtreatment. Case Report: Herein, we describe the case of a 51-year-old male who reported changes in his voice, and who was preoperatively diagnosed with vocal cord polyp and hemorrhagic change based on laryngoscopy. He underwent laryngomicrosurgery and the lesion was completely excised via the microflap surgical method. Histopathology analysis was consistent with IPEH. Conclusions: Herein, we report an extremely rare case of IPEH arising from the true vocal cord, and we provide a brief review of the relevant literature and a detailed discussion of this rare clinical entity.

Background Currently, high-speed digital imaging (HSDI), especially endoscopic HSDI, is routinely used for the diagnosis of vocal cord disorders. However, endoscopic HSDI devices are usually large and costly, which limits access to patients in underdeveloped countries and in regions with inadequate medical infrastructure. Modern smartphones have sufficient functionality to process the complex calculations that are required for processing high-resolution images and videos with a high frame rate. Recently, several attempts have been made to integrate medical endoscopes with smartphones to make them more accessible to people in underdeveloped countries. Objective This study aims to develop a smartphone adaptor for endoscopes, which enables smartphone-based vocal cord imaging, to demonstrate the feasibility of performing high-speed vocal cord imaging via the high-speed imaging functions of a high-performance smartphone camera, and to determine the acceptability of the smartphone-based high-speed vocal cord imaging system for clinical applications in developing countries. Methods A customized smartphone adaptor optical relay was designed for clinical endoscopy using selective laser melting–based 3D printing. A standard laryngoscope was attached to the smartphone adaptor to acquire high-speed vocal cord endoscopic images. Only existing basic functions of the smartphone camera were used for HSDI of the vocal cords. Extracted still frames were observed for qualitative glottal volume and shape. For image processing, segmented glottal and vocal cord areas were calculated from whole HSDI frames to characterize the amplitude of the vibrations on each side of the glottis, including the frequency, edge length, glottal areas, base cord, and lateral phase differences over the acquisition time. The device was incorporated into a preclinical videokymography diagnosis routine to compare functionality. Results Smartphone-based HSDI with the smartphone-endoscope adaptor could achieve 940 frames per second and a resolution of 1280 by 720 frames, which corresponds to the detection of 3 to 8 frames per vocal cycle at double the spatial resolution of existing devices. The device was used to image the vocal cords of 4 volunteers: 1 healthy individual and 3 patients with vocal cord paralysis, chronic laryngitis, or vocal cord polyps. The resultant image stacks were sufficient for most diagnostic purposes. The cost of the device including the smartphone was lower than that of existing HSDI devices. The image processing and analytics demonstrated the successful calculation of relevant diagnostic variables from the acquired images. Patients with vocal pathologies were easily differentiable in the quantitative data. Conclusions A smartphone-based HSDI endoscope system can function as a point-of-care clinical diagnostic device. The resulting analysis is of higher quality than that accessible by videostroboscopy and promises comparable quality and greater accessibility than HSDI. In particular, this system is suitable for use as an accessible diagnostic tool in underdeveloped areas with inadequate medical service infrastructure.

Clinical methods that assess voice pathologies are typically based on laryngeal endoscopy or audio-perceptual assessment. Both methods have limited accessibility in low-resourced healthcare settings. M-health systems can provide a quantitative assessment and improve early detection in a patient centered care. Automated methods for voice pathologies assessment apply machine learning methods to acoustic, frequency and noise features extracted from sustained phonation recordings and aim to discriminate pathological voices from controls. The machine learning methods in this study are applied to a discriminating between two prevalent vocal pathologies: vocal cord polyp and vocal cord paralysis. The data was acquired by a low-cost recording device in an experiment at a tertiary medical center and the pathologies were clinically labeled. Acoustic and spectral features were extracted and multiple classifiers compared using batched cross validation. The best classifiers were tree-based classifiers, with the Extra Trees classifier providing the best performance with an accuracy of 0.9565 and F1-score of 0.9130. Explainable AI (XAI) and feature interpretability analysis was carried out to allow clinicians to use the features marked as important to clinical care and planning. The most important features were octave-based spectral contrast and MFCCs 0 to 3. The results indicate a feasibility of machine learning to accurately discriminate between different types of vocal cord pathologies.

This paper investigates the relative importance of plosive cues in the effect of vocal cord polyp on Mandarin tones recognition. There are two sections in this research, i.e., acoustic analysis and perceptual analysis. In acoustic analysis, VOTs of plosives were measured in Praat. And in perception analysis, identification results of Mandarin tones before and after the surgeries of vocal cord polyp would be analyzed from the perspective of unaspirated plosive and aspirated plosive. The research results in this research are as follows: first, unaspirated plosives before the surgery of vocal cord polyp have longer VOT than those after the surgery. Second, aspirated plosives before the surgery of vocal cord polyp have shorter VOT than those after the surgery. Third, vocal cord polyp has a significant effect on VOT of aspirated plosives in Tone 2 and Tone 3 before and after the surgeries. Fourth, aspirated plosives are relative important cues in significantly affecting identification rate of Mandarin CV syllables with aspirated plosives in Tone 1 and Tone 2 before and after the surgeries of vocal cord polyp. Fifth, before and after the surgeries of vocal cord polyp, significant difference of VOT in Tone 2 of aspirated plosive is a relative important cue in significantly influencing identification rate of Mandarin CV syllables with aspirated plosives in Tone 2. It is concluded that aspirated plosives are relative important cues in affecting identification rate of Mandarin tones with plosives as their initials before and after the surgeries of vocal cord polyp, but not unaspirated plosives.

This paper investigates effect of unilateral vocal cord polyp on different monophthongs ([-A], [-γ], [-o], [-u]) with Mandarin tones. First, acoustically, Praat was used to extract F0 contour in Mandarin tones to analyze how vocal cord polyp affects F0 contour of different monophthongs with Mandarin tones. Second, perceptually, identification test was used to analyze how vocal cord polyp influences identification rate of different monophthongs with Mandarin tones. In this research, the main findings are as follows: first, vocal cord polyp does not affect tone pitch, F0 contour and identification rate of [-o] with Tone 1. Second, vocal cord polyp has an effect on tone pitch of [-a] with Tone 2 and Tone 3, [-γ] with Tone 2 and Tone 4, [-u] with Tone 4 and [-o] with Tone 4. Third, vocal cord polyp influences F0 contour of [-a] with Tone 1 and Tone 4, and [-γ] with Tone 1 significantly. Fourth, vocal cord polyp has an effect on tone pitch and significantly affects F0 contour of [-γ] with Tone 3, [-u] with Tone 3 and [-o] with Tone 2 and Tone 3. Fifth, vocal cord polyp affects tone pitch and has a significant effect on identification rate of [-u] with Tone 2. Sixth, vocal cord polyp influences tone pitch, and significantly affects F0 contour and identification rate of [-u] with Tone 1. It is concluded that although vocal cord polyp has an effect on tone pitch and F0 contour of monophthongs with Mandarin tones, and has little influence on intelligibility of Mandarin monophthongs except of [-u] with Tone 1 and Tone 2.

Microlaryngoscopy for benign vocal cord lesion excision is a procedure with good outcomes and relatively few complications that is performed worldwide. The anterior one-third of the vocal cords is a relatively common site to find benign polyps, and the excision of cases with adequate laryngeal exposure is relatively easy. However, they can sometimes present a challenge when laryngeal exposure is suboptimal, which leads to trouble in accessing the site. The factors that can lead to difficulties in laryngeal exposure are numerous, such as restricted mouth opening, limited neck extension, large tongue size, and others. The preoperative prediction of difficult laryngeal exposure (DLE) can be obtained by different scoring and grading systems. We have used the Laryngoscore in this case. However, management options for such cases remain limited. Here, we present a case that was managed using channeled cup forceps under fiberoptic endoscopy with the STRIVE-Hi technique used to administer anesthesia.

Correlation between pathological Voice Onset and Voice Quality of Chinese patients based on Vocal Attack Time(VAT) and Multidimensional Voice Parameters is discussed in this paper. The test subjects were divided into three groups, one is normal voice group and the other two are pathologic voice groups, namely, vocal cord polyps and non vocal cord polyps. We recorded the EGG signal for the above subjects and extracted the Jitter, Shimmer, HNR and VAT parameters by the relevant software. The VAT and other voice parameters at /a:/, /i:/ and /u:/ vowels were then compared and analyzed in different groups. The results showed that there was no significant difference in the VAT between the three groups at /a:/, /i:/, and /u:/ vowels. In addition, the analysis of VAT changes in a patient with vocal cord polyps before and after surgery revealed that neither the overall difference in stops nor the difference in manner of aspiration or not was significant, indicating VAT is not a specific indicator of vocal cord polyps.

Intelligent Diagnosis for pathological voice contains two parts. One is intelligent detection, and the other is intelligent comprehension. Before the application of intelligent comprehension, it is important for us to know how human perceive pathological voice. This paper first investigated acoustically a patient who had vocal cord polyp read Chinese characters with Mandarin tones before and after the surgeries. Second, identification test was used to find out the effect of vocal cord polyp on Mandarin tones recognition. The results show that first, the effect of vocal cord polyp on Tone 1 and Tone 3 in F0 contour are statistically significant, but not Tone 2 and Tone 4. Second, vocal cord polyp does not affect identification of Mandarin tone types. Third, vocal cord polyp affects Tone 1 and Tone 2 in identification rate significantly, but not Tone 3 and Tone 4. It is concluded that vocal cord polyp has little influence on the intelligibility of Mandarin tone types. And our research results are referential to intelligent diagnosis for pathological voice.

A laryngoscopically benign lesion with minimal hoarseness may turn out to be mimickers of malignancy or malignancy itself. Histopathological study is mandatory in such cases to rule out malignancy. A descriptive study of histopathological and laryngoscopic findings of benign laryngeal lesions were studies over a period of 4.5 years. Among the thirty-six patients studied, the mean age of the patients was 42 years. The most common presenting complaint was hoarseness of voice seen in 87.5% of cases. Twelve cases of vocal cord polyps were diagnosed based on clinical, laryngoscopical and histopathological features. Seven cases of vocal cord nodules, presenting with hoarseness of voice and laryngoscopic finding of a small nodular growth over the cord. Nine cases of laryngeal papillomas and papillomatosis showed branching papillae, lined by squamous epithelium with fibrovascular cores. A single case of amyloidosis and four cases of granulomatous lesions suggestive of tuberculosis were studied. One case each of rhabdomyoma and granular cell tumour was reported and confirmed by immunohistochemistry. Rare benign tumours and tumour-like lesions mimicking malignancy on laryngoscopy need histopathological evaluation. It is mandatory to study excised biopsies of the larynx as grossly similar lesions can vary from non-neoplastic to frankly malignant.

Benign vocal cord lesion is a benign mass formed in vocal cord in form of vocul nodule, vocal cord polyp, vocal cord cyst and vocal cord granuloma. Voice handicap index (VHI) is one of subjective voice analyses. This study aimed to analyse correlation between VHI score and praat voice analysis in benign vocal cord lesion before and after microscopic laryngeal surgery. This study was carried out from November 2009 to December 2010 at Outpatient Unit of Otorhinolaryngology, Head and Neck Surgery and Integrated Oncology Center of Dr. Soetomo General Hospital, Surabaya, Indonesia. Pearson’s correlation test found a negative correlation between total VHI score with base frequency and harmonic-to-noise ratio (HNR) (r = − 0.186, p = 0.689; r = − 0.650, p = 0.114). On the other hand, there was a positive correlation between total VHI score with jitter and shimmer (r = 0.812, p = 0.027; r = 0.638, p = 0.123). It could be inferred that base frequency, shimmer and HNR after surgery had no significant correlation (p > 0.05), while VHI total score significantly correlated with jitter after surgery (p

Background Molecular evidence suggests that human papillomavirus (HPV) has a role in the etiology of oropharyngeal squamous cell carcinoma. However, the role of HPV in laryngeal squamous cell carcinoma (LSCC) is unclear. Patients and methods We conducted a case–control study using tumor tissue specimens from 300 LSCC patients and vocal cord polyp specimens from 300 cancer-free controls. HPV genotype, HPV16 viral load and viral integration status, and p16 expression were determined. Results The prevalence of HPV (all types) was higher in cases than controls [21 (7.0%) versus 10 (3.3%), adjusted odds ratio (aOR) 2.37, 95% CI 1.08–5.21]. The prevalence of HPV16 was higher in cases than controls [20 (6.7%) versus 8 (2.7%), aOR 2.84, 95% CI 1.21–6.68]. The risk of LSCC associated with HPV16 DNA positivity was even higher in patients aged 55 years or younger (aOR 3.52, 95% CI 1.07–11.54), males (aOR 4.74, 95% CI 1.33–16.90), never-smokers (aOR 5.57, 95% CI 1.41–22.10), and never-drinkers (aOR 3.72, 95% CI 1.09–12.72). HPV DNA was partly or fully integrated in all 20 HPV16-positive cases but was episomal in all 8 HPV16-positive controls; however, the HPV16-positive cases and controls had similar viral loads (P = 0.28). P16 immunostaining was positive in 31 of the 300 cases (10.3%) and negative in all 300 controls. Conclusion These results suggest that prior infection with HPV16 may play a role in the etiology of some LSCC. This larger case–control study will offer for the first time the possibility to address in depth the understanding of a tissue-specific role of HPV in laryngeal carcinogenesis. Further studies with larger samples are needed to confirm these findings.

Aim of Study: To analyze over a period of 2 years, the demographics such as age, sex, distribution, occupation, the site of involvement, symptomatology and prognosis of the most frequent benign lesions of larynx. Materials and Methods: 50 patients presenting with hoarseness of voice and diagnosed with benign lesion of larynx in ENT OPD of Dr. B.R.Ambedkar Medical College and Hospital were included in the study after taking their consent and the study was carried out for a period of 2 years between October 2013 to September 2015. Results: In this study, it was noted that males were predominantly involved, maximum incidence between 31-40 years. Business men among males and housewives among females were commonly involved. Bilateral vocal cord nodule was the most common benign lesion of larynx, others included vocal cord polyp (both unilateral and bilateral) and Reinke’s edema. Most important predisposing factor was being vocal abuse in all the cases. Treatment given included speech therapy, medical management and MLS according to the diagnosis and patients were followed up for six months. 41.18% of patients with bilateral vocal cord nodule, 50% of patients with bilateral vocal cord polyp, 50% of patients with right vocal cord nodule, 75% of patients with left vocal cord polyp, 42.86% of patients with right vocal cord polyp and 100% of patient’s with Reinke’s edema were normal at follow up. Conclusion: It was observed that vocal abuse was the most common predisposing factor for benign lesions of larynx and a multi modality treatment is necessary including medical, surgical and speech therapy to prevent recurrence.

Neurofibromatosis (NF) is a common disorder resulting in tumors on nerve tissue. It rarely affects the larynx and even rarer is an isolated laryngeal neurofibroma. Literature reveals

Introduction Vocal cord polyps commonly occur in those with a history of vocal abuse. Patients with large lesions generally undergo microlaryngeal surgery under general anaesthesia. This unique case report highlights a strange scenario where the patient coughed out a fleshy mass during his morning walk and which was later confirmed as a vocal cord polyp. Case Report A 62 year old male with a history of hoarseness of voice for 3 months presented to the ENT OPD holding a chunk of tissue which was apparently coughed out by him during his morning walk. After the incident, his symptoms had immediately improved. A videolaryngoscopy showed a congested spot on the right vocal cord being the probable site of origin of the lesion. On Histopathological examination, the tissue was reported as a vocal cord polyp. The patient was managed conservatively but the lesion recurred at the same site after a month for which a microlaryngeal excision was performed. Discussion Vocal cord polyps are fairly common in ENT practice and usually present to the clinic with hoarseness of voice. Polyps that are small are usually managed conservatively by voice therapy alone whereas large polyps require surgical excision. This unique case report highlights a strange clinical scenario where the patient coughed out a large vocal cord polyp (Auto-polypectomy) during a bout of acute cough. This event saved him a surgery at the first instance, but eventually had a recurrence and had to undergo an excision under GA.

We report a case of Broken Heart Syndrome in a 56 year old Postmenopausal woman suffered while undergoing simple biopsy procedure for vocal cord polyp that lead to physical, mental and financial burden both for the patient as well as the doctors. A team of cardiologists based on clinical and echocardiographic findings made the diagnosis of this case.

Objective to investigate the effect of traditional Chinese medicine on vocal nodules and vocal polyps. Methods: 102 patients with vocal cord tumors, including 53 patients with vocal cord polyps and 49 patients with vocal cord nodules, were randomly divided into the treatment group and the control group. Both groups had a course of treatment of 65d. Results: The total effective rate was 100% in the treatment group and 52.1% in the control group (P < 0.05). The therapeutic effect of vocal nodules was 92% in the treatment group and 66.6% in the control group (P < 0.05). Conclusion: the treatment of vocal cord tumors with traditional Chinese medicine composition is safe and effective in treating vocal cord nodules and vocal cord polyps, providing a good idea and method for the prevention and treatment of vocal cord tumors with traditional Chinese medicine.

In this study, a next-generation sequencing strategy on 16S ribosomal RNA (16S rRNA) gene was employed to analyze 70 oral samples from 32 patients with throat cancer, nine patients with vocal cord polyp, and 29 healthy individuals (normal controls). Using this strategy, we demonstrated, for the first time, that the salivary microbiota of cancer patients were significantly different from those of patients with a polyp and healthy individuals. We observed that the beta diversity of the cancer group was divergent from both the normal and polyp groups, while alpha-diversity indices such as the Chao1 estimator (P = 8.1e-05), Simpson (P = 0.0045), and Shannon (P = 0.0071) were significantly reduced in cancer patients compared with patients containing a polyp and normal healthy individuals. Linear discriminant analysis (LDA) and Kruskal–Wallis test analyses and real-time quantitative polymerase chain reaction (qPCR) verification test revealed that the genera Aggregatibacter, Pseudomonas, Bacteroides, and Ruminiclostridium were significantly enriched in the throat cancer group compared with the vocal cord polyp and normal control groups (score value >2). Finally, diagnostic models based on putatively important constituent bacteria were constructed with 87.5% accuracy [area under the curve (AUC) = 0.875, 95% confidence interval (CI): 0.695–1]. In summary, in this study we characterized, for the first time, the oral microbiota of throat cancer patients without smoking history. We speculate that these results will help in the pathogenic mechanism and early diagnosis of throat cancer.

A 35-year-old Japanese man who had experienced hoarseness for 10 years presented with a vocal cord lesion. A gross examination revealed a left vocal cord polyp occupying two-thirds of the vocal space. The endoscopically resected lesion contained scattered atypical fibroblastic, stellate, or ganglion-like cells with mucoid stroma. Vacuolated cells were also seen. Lymphoplasmacytic infiltrate was largely undetectable. A vocal cord polyp was first suspected, but well-differentiated liposarcoma and inflammatory myofibroblastic tumor (IMT) were included in the differential diagnoses. The tumor cells were positive for anaplastic lymphoma kinase (ALK), calponin, and vimentin, and negative for other smooth muscle markers by immunohistochemistry. Structures resembling myofibroblasts were not observed by electron microscopy, which confirmed abundant rough endoplasmic reticulum in the tumor cells and accumulated lipid droplets in some tumor cells. ALK gene rearrangement was detected by fluorescence in situ hybridization, and TIMP3-ALK fusion was confirmed by 5' rapid amplification of cDNA ends. We diagnosed the lesion as an IMT, and an ALK-rearranged stellate cell tumor may be postulated. This is the first report of a fusion partner gene of ALK in a case of laryngeal IMT.

The aim of the present study was to investigate the expression levels of Yes-associated protein (YAP) in different grades of laryngeal squamous cell carcinoma (LSCC) tissues and vocal cord polyps tissues, and to investigate any correlations with clinical factors. The expression of YAP in 128 cases of LSCC and 10 cases of vocal cord polyps tissues was tested using immunohistochemistry. YAP was primarily present in the nucleus of LSCC and controls, whereas phosphorylated YAP expression was present in the cytoplasm. The results indicated that YAP expression was upregulated in LSCC samples compared with vocal cord polyps tissues. YAP expression was positively correlated with the malignant degree of LSCC (P

The objective of the study is to investigate the expression of human β-defensin-1 (hBD-1) and human β-defensin-2 (hBD-2) in vocal cord polyps using tissue microarray. Tissue specimens from vocal cord polyps (N = 51), vocal cord nodules (N = 26), and healthy vocal cords (N = 8) were retrieved from the biobank of the Department of Pathology of Tianjin Tianhe Hospital between 2003 and 2006 and immunostained on tissue microarrays for the quantitative analysis of hBD-1 and hBD-2 expression. hBD-1 expression did not differ significantly between healthy vocal cords, vocal cord nodules, and vocal cord polyps (p = 0.904). In contrast, hBD-2 expression was significantly higher in vocal cord polyps compared to vocal cord nodules and healthy vocal cords (p

The study was undertaken to identify the type of laryngeal lesions, the age, sex distribution, symptomatology, sites of involvement, conservative and surgical management, histopathological analysis and outcome of the same. This is a prospective study conducted at a tertiary care centre for one and a half years. A total of 20 patients were included based on symptomatology such as hoarseness of voice, foreign body sensation, throat pain, and respiratory distress. All malignant cases were excluded. Hematological and radiological investigations, along with microlaryngoscopic procedures followed by histopathology, were employed. A male preponderance with an M: F ratio of 3:2 was observed. The majority of the patients were in the age group of 30 to 45 years. Vocal cord polyps were observed to be the commonest type of the lesion. A case of a bilobed concomitant tonsillar cyst of the larynx was the rarest encountered. In this study, hoarseness of voice, cough, foreign body sensation, and throat pain proved to be the commonest symptoms. Early diagnosis with routine clinical examination aided by radiological investigation such as contrast enhanced computed tomography (CECT) has proven to be useful in suspicious lesions of the larynx. Micro laryngeal surgery, voice rest, and postoperative speech therapy together offer a cost-effective and safe method for the management of benign laryngeal lesions.

Objective The aim of the study was to perform a pathohistological and immunohistochemical analysis of squamous cell (SC) carcinogenesis markers on epithelial linings of vocal cord polyps. The vocal box, being a heavily burdened organ with intensive cell renewal and regenerative processes, is therefore a favourable environment for constant epithelial growth and hyperplasia. In our ongoing projects on laryngeal carcinogenesis and research on laryngeal tissue, we encountered atypia on diagnosed nodules and polyps that are usually considered as benign formations, resulting from the above-mentioned cell renewal and regeneration, which lead to further investigation. The purpose was to see if changes in molecular markers of SC carcinogenesis follow, or, may appear in immunohistochemical (IHC) analysis, before histological atypia in standard haematoxylin-eosin (HE) staining, and contribute in early diagnosis of potentially suspect polyps. Methods After classical pathohistological (PH) analysis on HE slides, IHC analysis of EGFR, cyclin D1, p53, Ki-67, and IMP3 was performed on tissue microarrays of laryngeal tissue (50 samples), ranging from normal to hyperplastic lesions with no atypia (34 samples), low-grade atypia (11 samples), and high-grade atypia (5 samples). Results This study established an increase and correlation of EGFR, cyclin D1, p53, Ki-67 and IMP3 IHC expressions with pathohistological findings of dysplasia in glottic polypoid lesions. Low and high-grade dysplasia had statistically higher percentages of EGFR-positive cells than normal epithelium and simple hyperplasia (SH) (low vs. normal/SH P = 0.007; high vs. normal/SH P = 0.001). High-grade dysplasia had statistically more positive cells than low-grade dysplasia (P = 0.004), and low-grade dysplasia had statistically more positive cells than specimens without atypia (P = 0.007). The percentage of positive cells was statistically higher for cyclin D1, p53 and Ki-67 in high-grade dysplasia versus low-grade dysplasia (cyclin D1 P = 0.011, p53 P = 0.002; Ki-67 P = 0.026; respectively) and versus normal epithelium and SH (cyclin D1 P = 0.003; p53 P = 0.001; Ki-67 P = 0.002; respectively). An increase of IMP3-positive cells with an increase of atypical changes in the laryngeal epithelium, from superficial towards basal layers was noticed, contrary to the usually seen positivity pattern of SC carcinogenesis markers from basal to superficial layers. A statistically significant difference of IMP3 IHC staining between the pathohistological groups (P = 0.003) was recorded. Conclusion Only polyps that present with simple hyperplasia as the greatest mucosal change can be considered as benign formations. Pathohistologically detected atypia in polypoid changes of vocal cords, confirmed by molecular atypia with an increase of SC carcinogenesis markers, suggest their inclusion in studies of laryngeal carcinogenesis. Our results suggest that in problematic cases IHC analysis could be of interest in detection of biological aggressiveness in polypoid laryngeal tissue and beneficiary for polyp patients’ follow-up. Further research of laryngeal carcinogenesis markers and their meaning in fibrovascular polyps is of interest.

Background: Voice disorders that affect children and adults have different causes with respect to different age groups. Factors associated with voice disorder ranges from the medical to emotional stress. This study was aimed to analyze the different pathological causes leading to hoarseness of voice in population attending a tertiary care hospital. Methods: Subjects with symptoms of hoarseness of voice visited the tertiary care hospital was included in the study. The etiologies such as vocal nodules, vocal cord polyps, vocal cord cysts, cancer of larynx, vocal cord paralysis and vocal cord oedema were evaluated using the video laryngoscopy. The prevalence was statistically analysed. Results: Ninety nine subjects of both gender (age 10-79 years) were included in the retrospective study. Among the total subjects, 51 subjects were males and 48 were females. Maximum prevalence of hoarseness was 41%, found in the age group of 50-79 years. The most common cause for the hoarseness was due to vocal nodule (22%), vocal polyp (19%) and cancer of larynx (17%). Number of subjects with the vocal nodule was significantly differ from that of vocal polyp (p =0.01, p 0.05) was found among the gender. However, the cancer of larynx was more associated with the age group 50-69 years with male dominance (p>0.05). Phonaesthenia was the minor cause (1%). Conclusions: Among the causes for the hoarseness of voice, vocal nodules were the major. Causes such as vocal cord polyps, laryngeal cancer, chronic laryngitis, were found in a descending order of prevalence.

Background: Upper airway symptoms are quite common. Many of these symptoms underlie serious upper airway pathologies which should be diagnosed at an early stage so that optimum treatment can be given. Often it seems to be difficult to diagnose upper air way pathology by conventional indirect laryngoscopy (I/L), especially when the lesion is at an early stage. In this situation fiber optic laryngoscopy (FOL) is very helpful.Objective: To identify lesions in the larynx in patients with persistent upper airway disorders and to compare the diagnostic yield of FOL over I/L.Method: This was a cross-sectional study conducted partly in department of ENT and Head & neck surgery, BIRDEM General Hospital and partly at the same department of BSMMU during the period of July to December 2012. 100 adult patients were taken having upper airway symptoms. Study subjects were evaluated by history, physical examinations, and ENT examinations. All patients underwent indirect laryngoscopy and FOL. Data were recorded and analyzed.Results: Age of the respondents was between 18-72 years. The mean ± SD was 54 ±11.79 years. Common symptoms among the participants were hoarseness, sore throat, neck swelling, breathless ness, cough, odynophagia, earache etc. On I/L examinations 30% were vocal cord polyps, 14% v. cord edema, 17% v. cord growths, 11% v. cord nodules, 6 % v. cord palsy, 4% ulcerated lesions, 13 % poor vision and 5% were normal. On FOL examinations, 30% were vocal cord polyp, 18% v. cord edema, 21% v. cord growth, 14% v. cord nodule, 8 % v. cord palsy, 5% ulcerated lesion, 2% laryngeal web, 2 % were normal study and there were no poor vision. A comparison was made between the findings of I/L and FOL which showed that FOL is superior to I/L in diagnosing upper airway disorders as evidenced by findings of 2% lesions among 5% patients having normal I/L findings. Chi-square test was done between I/L and FOL findings which was statistically significant; (P value was .002) i.e. FOL procedure is valuable diagnostically in comparison to I/L.Conclusion: In many occasions I/L findings are inconclusive in daily ENT practice. Moreover, in some cases there is poor vision to identify the lesion. Therefore, Routine FOL evaluation is valuable in patients with significant, chronic and progressive upper airway symptoms. It should always be considered in patients with persisting and progressive symptoms even though I/L appeared normal.J Bangladesh Coll Phys Surg 2014; 32: 200-205

Objectives Laryngeal inflammatory myofibroblastic tumors (IMTs) are rarely reported in the literature but may be underrecognized. To better characterize their features, we report a series of six cases. Methods The clinicopathologic findings, including immunohistochemistry, fluorescence in situ hybridization (FISH) analysis, and follow-up, were evaluated and a review of the literature was performed. Results These cases presented as small polypoid vocal cord or ventricular band lesions, with a more advanced mean age at diagnosis (49 years) than typically reported in other localizations. Apart from one secondary revision surgery, no complementary treatment and no recurrences were observed. Histologically, various morphologic features were seen. All tumors were spindle cell proliferations on a myxoid background with more or less atypia and significant inflammatory infiltrate. All six cases showed anaplastic lymphoma kinase (ALK) immunohistochemical expression. FISH rearrangement was present in four of six cases. Only two cases were initially diagnosed as IMT. Conclusions According to our series, laryngeal IMTs are easily misdiagnosed. They have a good prognosis, and ALK immunohistochemistry should be carried out to assess this diagnosis when spindle cell proliferations are observed in this localization.

Laryngocoeles are rare cystic dilatations of the laryngeal ventricle. Obstruction of its outlet can cause entrapment of mucus and superimposed infection causes a laryngopyocoele. Such presentations, although rare, have potential to cause airway obstruction. A 67-year-old lady presented with a one-week history of hoarseness and shortness of breath. On examination, she was stridulous and had fullness of the left side of the neck. Nasendoscopy revealed large bilateral vocal cord polyps and near-complete glottis obstruction. She was taken to emergency theatre for restoration of a viable airway. Upon excision of the polyps, pus was visualised originating from the laryngeal ventricle. Literature proposes that laryngocoeles develop secondary to a one-way valve caused by an obstructing lesion distorting the saccule neck. We propose that the laryngocoele developed secondary to large obstructing polyps. Urgent excision of the polyps allowed decompression of the laryngopyocoele and reestablishment of a patent airway.

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Benign laryngeal lesions, especially laryngeal polyps are very common and they usually only cause hoarseness andrarely develop into dyspnea.This condition is generally attributed to smoking. Cardiorespiratory failure and sudden death due tolarge laryngeal polypwas reported in the literature. The preferred treatment of large polyps is surgical excision using suspension microlaryngoscopy. We present a case of a 60-year-old man presented to the emergency with stridor and severe dyspnea. He had a 4-month history of a neglected inspiratory dyspnea and dysphonia. Fiberoptic laryngoscopy revealed a large laryngeal mass causing airway obstruction. Administration of oxygen, inhalation and intravenous administrationof corticosteroid did not relieved hissymptoms. As intubation was judged impossible, an emergency tracheostomy was performed to salvage the patient. After tracheostomy, the dyspnea ceased. Computed tomography scan showed a homogeneous regular formation of 2.5×1.5 cm obstructing the glottis and the subglottislumen. Direct laryngoscopy under general anesthesia identified a valve-like large polyp attached to the anterior wall of the subglottic region. The polyp wastotally excised with no complication. Decannulation was carried out on the second postoperative day. The masswas histologically diagnosed as normal vocal cord polyp.

Purpose The aim of this study was to evaluate the prevalence of Benign Vocal Fold Lesion (polyp, cysts, nodules) and Leukoplakia in Korea. Materials and methods The data from the 2008 to 2011 Korea National Health and Nutrition Examination Surveys, which were cross-sectional survey of the civilian noninstitutionalized population of South Korea. A survey team that included an otolaryngology residents, nurses, and interviewers moved with a mobile examination unit and performed laryngologic interviews and examinations of vocal folds using rigid telescopic laryngoscopy on survey participants over 19 years old (n=19636). Results Laryngoscopic examination revealed normal results in 19251 (98.04%) of those included in the survey. Abnormal laryngoscopic findings were observed in 1.96% of the population examined, and vocal cord nodules were the most common abnormal finding. The prevalence of vocal cord nodules was 0.99-1.72%, the prevalence of vocal cord polyps was 0.31-0.55%, the prevalence of vocal cysts was 0.04-0.17%, and the prevalence of vocal cord leukoplakia was 0.07-0.21%. There was no significant correlation of linear trend of prevalence by year, and there were no significant differences in prevalence between males and females. Conclusion This is the first nationwide epidemiologic study to assess the prevalence of Benign Vocal Fold Lesion (polyp, cysts, nodules) and Leukoplakia by both the Korean Otolaryngologic Society and the Ministry of Health and Welfare. The results of this large epidemiologic study provide valuable information regarding the prevalence of voice disorders and the management of laryngologic diseases.

Background: Laryngeal disorders are the main culprit for change of voice. Patient presenting with change of voice needs to be assessed for laryngeal disorder. Larynx being part of hypopharynx in the deeper part of cavity has been difficult organ to examine since long, but with technological evolution from artificial light to flexible scopes to stroboscope has made life easier for a laryngologist to evaluate laryngeal disorder thoroughly.Methods: In this study we have included all cases of change of voice coming to department of ENT and head and neck surgery at GMERS Medical College and Hospital, Gotri in last one year with change of voice for more than one month including vocal cord malignancy. A detailed history and thorough examination of ENT and in particular larynx done. Further work up and management was done according to case base need. Results: Out of 50 patients enrolled in the study we found 48% males and 42% females. Most of the patients were adults. Only 4% were in geriatric age group. Most common diagnosis was vocal cord nodules 26% followed by hypertrophy of vocal cords16%. Malignancy of the vocal cords was found to be 14% followed by10% of vocal cord polyp and vocal cord palsy 10%. Other conditions were found to be 6%.Conclusions: Stroboscopy is a great tool for evaluation of vocal cord pathology in particular subtle diseases of vocal cords. Along with diagnosis we can have proper documentation of dynamic movement of vocal folds with help of stroboscopy.

The objective of the present study was to determine the effect of voice training on the vocal rehabilitation of patients with vocal cords polyps following phonomicrosurgery. A total of 60 cases of vocal cord polyps treated by laser phonomicrosurgery were randomly divided into training and control groups with 30 cases in each group. The patients were treated with laser phonomicrosurgery, routine postoperative treatment and nursing. The training group were additionally treated with vocal training, including relaxation training, breathing training, basic pronunciation training, chewing voice training and tone sandhi pronunciation training, and attention was paid to the training steps. Subjective and objective voice evaluations of the two groups were compared three months after the surgery and the differences between groups were statistically significant (P