Search

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.

Objective: To evaluate the curative effect of surgical treatment of vocal cord polyp under selfretaining fibrolaryngoscope and fibrolaryngoscope. Methods: A total of 118 patients with vocal cord polyp who received surgical treatment in our hospital between August 2013 and August 2015 were included in the study, the treatment process was retrospectively analyzed, and according to different operation methods, patients were divided into observation group (n=61) who received surgical treatment under self-retaining fibrolaryngoscope and control group (n=57) who received surgical treatment under fibrolaryngoscope. Differences in voice electroglottography parameters, oxidative stress system indexes, trauma-related indexes and so on were compared between two groups of patients 2 weeks after operation. Results: Jitter, Shimmer and NNE levels of observation group were significantly lower than those of control group while HNR and SNR levels were significantly higher than those of control group; SOD T, SOD Cu-Zn and T-AOC content in serum of observation group were significantly higher than those of control group while H2O2 and AOPP content were significantly lower than those of control group; NPY, β-EP, PGI2, HMGB-1 and HSP72 content in serum of observation group were significantly lower than those of control group. Conclusions: Surgery under selfretaining fibrolaryngoscope can better realize the accurate resection of vocal cord polyp, protect the normal vocal cord function and also reduce the body trauma, and it is a more ideal way of surgery.

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.

Objective: To investigate the expression ofCaspase-3 in laryngeal squamous cell carcinoma (LSCC) and its relationship with cell apoptosis. Methods: The expression of Caspase-3 protein in 43 LSCC tissues and 21 vocal cord polyp tissues was detected using immunohistochemical SP method; the apoptosis of LSCC was measured by in situ end-labeling (TUNEL) assay, and the relationships between Caspase-3 expression and clinicopathological features as well as cell apoptosis in LSCC tissue were analyzed. Results: The positive rate of Caspase-3 expression in LSCC tissue was lower than in vocal cord polyp tissue dramatically, with statistical significance (51.2% vs. 85.7%, P=0.007). Caspase-3 expression in LSCC tissue was closely related to the tumor differentiated degrees, clinical staging and presence or absence of lymph node metastasis (P=0.009, 0.001, 0.018) instead of the gender, age and tumor size (P>0.05). The apoptosis index (AI) of Caspase-3 was (4.31±0.49)% in LSCC tissue, while (24.28±1.07)% in vocal cord polyp tissue. Significant difference was presented between two groups by comparison to the AI (P

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.

n/a

Los pólipos de cuerda vocal son lesiones laríngeas benignas. Se asocian a micro-traumatismos por mal uso vocal que generan remodelación de la lámina propia y el epitelio. Es más frecuente en hombres entre los veinte y cuarenta años. En la gran mayoría de los casos se presenta de manera unilateral. Si bien estas lesiones están bien documentadas en la literatura, es raro encontrar presentaciones bilaterales, por lo que su enfrentamiento y manejo puede ser discutible. Se presenta el caso de una paciente de sexo femenino de 41 años, fumadora, que consulta por disfonía de larga data. Se diagnostican pólipos bilaterales de cuerda vocal, realizando una intervención quirúrgica en un tiempo, con un resultado favorable. Vocal cord polyps are benign Iaryngeal lesions. They are associated to micro traumatisms because ofvocal misuse, generating a remodelation of the lamina propria and the epithelium. It is more common in men between twenty and forty years of age. In the vast majority of cases it unilaterally occurs. While these are well documented injuries in the literature, it is rare to find bilateral presentations, so their confrontation and management may be debatable. We present the case of a female patient, smoker, who consulted for chronic dysphonia. Bilateral vocal cord polyps were diagnosed, performing a bilateral resection with a positive outcome.

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.

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.

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

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.

Objectives/Hypothesis: There is a significant lack of uniform agreement regarding nomenclature for benign vocal fold lesions (BVFLs). This confusion results in difficulty for clinicians communicating with their patients and with each other. In addition, BVFL research and comparison of treatment methods are hampered by the lack of a detailed and uniform BVFL nomenclature. Study Design: Clinical consensus conferences were held to develop an initial BVFL nomenclature paradigm. Perceptual video analysis was performed to validate the stroboscopy component of the paradigm. Methods: The culmination of the consensus conferences and the video-perceptual analysis was used to evaluate the BVFL nomenclature paradigm using a retrospective review of patients with BVFL. Results: An initial BVFL nomenclature paradigm was proposed utilizing detailed definitions relating to vocal fold lesion morphology, stroboscopy, response to voice therapy and intraoperative findings. Video-perceptual analysis of stroboscopy demonstrated that the proposed binary stroboscopy system used in the BVFL nomenclature paradigm was valid and widely applicable. Retrospective review of 45 patients with BVFL followed to the conclusion of treatment demonstrated that slight modifications of the initial BVFL nomenclature paradigm were required. With the modified BVFL nomenclature paradigm, 96% of the patients fit into the predicted pattern and definitions of the BVFL nomenclature system. Conclusions: This study has validated a multidimensional BVFL nomenclature paradigm. This vocal fold nomenclature paradigm includes nine distinct vocal fold lesions: vocal fold nodules, vocal fold polyp, pseudocyst, vocal fold cyst (subepithelial or ligament), nonspecific vocal fold lesion, vocal fold fibrous mass (subepithelial or ligament), and reactive lesion.

The geometric and biomechanical properties of the larynx strongly influence voice quality and efficiency. A physical understanding of phonation natures in pathological conditions is important for predictions of how voice disorders can be treated using therapy and rehabilitation. Here, we present a continuum-based numerical model of phonation that considers complex fluid-structure interactions occurring in the airway. This model considers a three-dimensional geometry of vocal folds, muscle contractions, and viscoelastic properties to provide a realistic framework of phonation. The vocal fold motion is coupled to an unsteady compressible respiratory flow, allowing numerical simulations of normal and diseased phonations to derive clear relationships between actual laryngeal structures and model parameters such as muscle activity. As a pilot analysis of diseased phonation, we model vocal nodules, the mass lesions that can appear bilaterally on both sides of the vocal folds. Comparison of simulations with and without the nodules demonstrates how the lesions affect vocal fold motion, consequently restricting voice quality. Furthermore, we found that the minimum lung pressure required for voice production increases as nodules move closer to the center of the vocal fold. Thus, simulations using the developed model may provide essential insight into complex phonation phenomena and further elucidate the etiologic mechanisms of voice disorders.

A two-year prospective study was conducted from June 2008 to May 2010. A total of 80 patients with benign laryngeal lesions were included in the study based on symptoms, such as hoarseness of voice, foreign body sensation, vocal fatigue, dyspnea and cough and with positive clinical findings on indirect laryngoscopy. Diagnostic and therapeutic laryngoscopic and microlarygoscopic procedures were employed. Vocal cord polyps were observed to be the commonest type of lesions. Out of the 80 patients in the study group, 40% patients got complete relief with voice rest and vocal rehabilitation; 60% patients required surgery, which included endoscopic/microlarygoscopic endolaryngeal surgery and external approaches. There was no recurrence in cases of vocal polyps and nodules during the period of observation. Endolaryngeal surgery and voice rest offer a cost-effective, useful and safe method for the management of benign laryngeal lesions. With the inclusion of lasers, they can be more precisely operated. As such, the standard treatment of choice in all types of benign tumors of the larynx should consist of a triad of approach by microlaryngeal surgery (either microscopic or endoscopic, with or without use of lasers), voice rest and vocal rehabilitation.

Importance In-office angiolytic laser procedures have been used successfully as an alternative treatment for vocal fold polyps; little is known in detail about the treatment outcomes and adverse events. Objective To examine the outcomes and incidence rates of adverse events associated with in-office angiolytic laser procedures with or without concurrent polypectomy as an alternative treatment for vocal fold polyps. Design, Setting, and Participants Retrospective cohort study at a tertiary medical center. We identified 114 consecutive patients with vocal polyps who underwent in-office angiolytic laser treatments between January 1, 2014, and August 31, 2016. After the exclusion of 17 with missing or incomplete data, 97 were enrolled. Interventions In-office 532-nm laser procedures with or without concurrent polypectomy. Main Outcomes and Measures Between 1 and 2 months after the surgical procedures, we collected the following outcome data: videolaryngostroboscopy, perceptual rating of voice quality, acoustic analysis, maximal phonation time, and subjective rating of voice quality using a visual analogue scale and 10-item voice handicap index. Results This study enrolled 97 patients (mean [SD] age, 45.6 [11.3] years; 48 [49%] male). The mean duration of symptoms was 10.1 months (range, 1-60 months). Twenty-nine patients (30%) had angiolytic laser procedures only, while 68 (70%) received laser with concurrent polypectomy. Both treatment modalities offered significant improvements. Only 1 patient (1%) receiving angiolytic laser with concurrent polypectomy underwent another treatment session, so this group had significantly less need for multiple treatments than those receiving laser treatment alone (6 [21%]; effect size, −1.57; 95% CI, −2.77 to −0.36). We identified 8 adverse events (8% of the cases): vocal fold edema (n = 5), vocal hematoma (n = 2), and vocal ulceration (n = 1). Patients treated with laser plus concurrent polypectomy had significantly fewer adverse events than those treated with angiolytic laser alone (2 [3%] vs 6 [21%]; effect size, 1.20; 95% CI, 0.26 to 2.13). Conclusions and Relevance In-office angiolytic laser procedures can be an effective alternative treatment for vocal polyps, although with possible need for multiple treatment sessions and occasional occurrence of minor postoperative adverse events. Concurrent polypectomy following laser coagulation allows less laser energy delivery and reduces the risk of postoperative adverse events and the need for additional treatment sessions.

Summary Introduction The aim of the work was to evaluate effects of the surgical treatment and postoperative rehabilitation of the patients with organic lesions of the larynx using laryngostroboscopy. Material and methods A group of 110 patients of both sex was covered by the studies, aged 19–65, who underwent surgical treatment due to organic lesion in the larynx. The voice was assessed using the perceptive GRBAS scale and the laryngostroboscopic examination following and preceding the surgical treatment and foniatric rehabilitation (30 days after the operation). Direct microlaryngoscopic procedures were performed under local intratracheal anaesthesia, whereas the CO 2 laser was used in the surgery in 18,2% cases and the other cases (81,8%) had the traditional technique applied. Results of the studies In the studied material the following was found: chronic hypertrophic laryngitis in 46,4% of the patients, Reincke's laryngeal oedema in 29,1% of the patients, vocal cord polyp in 22,7% of the patients and laryngeal papilloma in 1,8% of the patients. The voice evaluation based on the GRBAS scale indicated that better voice improvement after the treatment and rehabilitation was found in the patients with Reincke's oedema and vocal fold polyp rather than in those with chronic laryngeal hypertrophy. The majority showed the degree of hoarseness, rough voice, blowing voice, weak and tight voice in the scale of either 0 or 1, contrary to the evaluation preceding the surgery. No better voice improvement was achieved in the GRBAS scale in the patients with laryngeal papilloma. On the grounds of the laryngostroboscopic examination it was found that the best voice improvement occurred after the surgical treatment and rehabilitation of the patients suffering from Reincke's oedema and vocal cord polyps. Conclusions On the basis of the GRBAS scale and laryngostroboscopic examination of the patients after their surgical treatment and rehabilitation the best results in the voice quality were found in the patients with laryngeal polyps and Reincke's oedema whereas the worst results occurred in the patients with laryngeal papilloma.

This study aimed to look at whether a correlation exists between telomerase activity and survival of laryngeal carcinoma patients. Telomerase activity was measured by telomerase repeat amplification protocol in 31 laryngeal carcinomas and adjacent normal tissues, and in21 vocal cord polyps (controls). Follow-up was for at least 60 months. Telomerase activity in tissues adjacent to laryngeal carcinomas was significantly higher than in the carcinomas which was, in turn, significantly higher than in vocal cord polyps. There was no significant difference between telomerase activity in carcinomas or adjacent tissues and clinicopathological characteristics. Patients with high telomerase activity in carcinoma tissue had significantly shorter survival times than those with low activity, but no significance difference was observed between survival time and telomerase status in adjacent tissues. Linear regression showed significant association between telomerase activity levels in carcinoma tissues and survival time, but this was not observed in adjacent tissues. This study suggests that telomerase activation probably takes place before the cancer phenotype develops and has prognostic significance for survival of patients with laryngeal carcinoma.

声帯ポリープは外見や色調などがさまざまであり，腫瘍，嚢胞，結核や肉芽腫などと鑑別を要する。今回われわれは声帯ポリープに混在した声帯嚢胞の1症例を経験したので報告する。症例は53歳，女性。主訴は嗄声。喫煙歴は1日10本，30年。職業は洋服販売員。現病歴は平成16年7月頃より嗄声が出現し，以後改善，増悪を繰り返していた。平成17年1月当院初診。喉頭ファイバースコピーにて左声帯前1/3に黄色の腫瘤を認めた。同年4月全身麻酔下に喉頭微細手術を行った。直達喉頭鏡下では前交連に表面平滑，黄色の腫瘤を認め，左声帯前1/3に茎を有することが判明した。茎の基部を鋏にて切断し腫瘤を摘出した。腫瘤は3×3×6mm大，表面平滑，黄色，弾性軟であった。病理組織学的検査では蛋白液貯留を伴う拡張した嚢胞を認め，嚢胞周囲の間質には浮腫およびフィブリンの析出を認めポリープの所見であった。本症例の発生機序として，喫煙，職業上の音声の酷使によりポリープが発生し，このポリープのため以後改善，増悪を繰り返しつつも依然喫煙，音声の酷使を続けていたため炎症を生じ，声帯の喉頭腺管が閉鎖され貯留嚢胞が発生したのではないかと考えられた。

A case of subarachnoid hemorrhage due to vertebral artery dissection after direct laryngoscopy is reported. The patient, a healthy 61-year-old man with hoarseness, was treated for vocal cord polyp with laryngomicrosurgery. After surgery, he complained of nape pain without neurological symptoms. Six days after the onset of nape pain, he suddenly lost consciousness. CT showed subarachnoid hemorrhage and CT angiography demonstrated enlargement of the right vertebral artery which was suspected to be dissecting aneurysm. The right vertebral artery was occluded proximal to the aneurysmal dilation using detachable coils. Most vertebral artery dissections have been described as showing spontaneous onset. Recently, some cases were associated with minor neck trauma like extension and/or rotation. Direct laryngoscopy is a widely used technique in otolaryngological surgery, but it requires that the patient's neck be placed in hyperextension. This is the first report of vertebral artery dissection as a complication of otolaryngological surgery. Physicians should recognize that a hyperextended neck position during surgery may induce vertebral artery injury.

A rare case of large vocal cord polyp causing dyspnea is reported. A 55-year-old man with thrombocytopenia visited our department complaining of dyspnea and hoarseness. Laryngeal endoscopy showed a large mass located between the vocal cords, which moved up and down in accordance with breathing. The upper airway was very narrow because of the mass. Tracheostomy was performed under local anesthesia and then the mass was resected under general anesthesia using a laryngomicrosurgery technique. The patient's dyspnea and hoarseness disappeared after surgery. The histopathological findings indicated a diagnosis of vocal cord polyp. We consider that tracheostomy is the safest and most useful procedure to guarantee the upper airway in cases of large vocal cord polyp showing dyspnea.

A 65-year-old woman presented to the pulmonary medicine department of Kasturba Hospital with dyspnoea and dysphonia of 3 months duration. She reported that her dyspnoea was aggravated in the supine position. The patient had consulted a local physician at a peripheral centre for the same symptom, and was diagnosed as a case of asthma. She was prescribed oral steroid inhalers and intravenous steroids. She reported being temporarily relieved of her symptoms after administration of the steroid injections. Subsequently, she was referred to the department of pulmonary medicine in our hospital. The patient was carefully examined and referred to the department of ENT and head and neck surgery for …

患者は60歳代女性。呼吸困難を主訴に来院。心電図でI,aVL,V3～6に陰性T波,心臓超音波検査で前壁中隔心尖部に高度低収縮を認めた。来院後短時間で窒息状態となり緊急気管切開術を施行したが,術後肺水腫と皮下気腫を併発した。緊急冠動脈造影では第1対角枝に75%狭窄,左室造影ではたこつぼ型収縮異常を認めた。術後人工呼吸管理を要したが,CPK最高値は131IU・l-1と上昇を認めず,心電図異常,収縮異常は数日の経過で回復し,第5病日ICUを退室した。第7病日の冠動脈造影で多枝冠動脈攣縮が誘発された。第22病日,喉頭微細手術を施行し,有茎性巨大ポリープの嵌頓と診断された。本例の左室低収縮領域は冠動脈1枝の支配領域を越えて存在し,収縮異常も数日の経過で改善した。巨大声帯ポリープ嵌頓を誘因とした,たこつぼ型心筋障害と考えられる。肺水腫は第2病日に改善し,胸腔内異常陰圧による血行動態性肺水腫と推測した。

Background: Hoarseness is a quality of voice that is rough, grating, harsh, more or less discordant and lower than normal in pitch for the individual. Besides affecting useful communication leading to tremendous alterations in daily living, voice problem may also signify the presence of more serious medical illnesses; such as malignancy or airway compromise. Hence this study is undertaken to determine the relative incidence of cases presented at a tertiary hospital, to analyse the hoarseness population based on age, sex, occupation etc, to find out the pathogenesis of hoarseness in the cases and to postulate the risk factors implicated in each. Methods: Descriptive cross sectional study was conducted on patients with hoarseness reported at Government Medical College, Trivandrum for a period of twelve months. Detailed history regarding duration, onset, nature of hoarseness, aggravating and relieving factors, voice fatiguability, diurnal variation, associated symptoms and history of upper respiratory infection were taken. Results: Being the tertiary hospital, the incidence was noted to be 0.7%. Majority of patients are in 4th to 7th decades and the most commonly affected age group was 50-59 years. Male preponderance with 4:1 ratio was observed in which manual labourers constitute the single largest group. Smoking, alcohol intake and vocal abuse are found to be the major etiological factors. Majority of lesions were malignant in nature, commonest being Carcinoma Glottis. In benign lesions, majority was vocal cord polyp. Conclusions: Early detection of pathology and awareness is very important in the management of hoarseness.

Laryngeal sensitivity is crucial for maintaining safe swallowing, thus avoiding silent aspiration. The sensitivity test, carried out by fiberoptic endoscopic examination of swallowing, plays an important role in the assessment of dysphagic patients. The ventricular folds appear to be more sensitive than the epiglottis during the sensitivity test. Therefore, this study aimed to investigate the mechanical sensitivity of the supraglottic larynx. In seven healthy adults undergoing microlaryngoscopy to remove vocal cord polyps, we excised mucosal samples from the epiglottis and ventricular folds. We measured afferent nerve fiber density by immunoelectron microscopy. All of the subjects underwent an endoscopic sensitivity test based on lightly touching the laryngeal surface of the epiglottis and ventricular folds. The discomfort level was self-rated by the subjects on the visual analog scale. Samples were fixed and stored in cryoprotectant solution at 4 °C. Sections were stained with the protein gene product 9.5, a pan-neuronal selective marker. Nerve fiber density was calculated as the number of fibers per millimeter length of section. The mean nerve fiber density was higher in ventricular samples than in epiglottis samples (2.96 ± 2.05 vs 0.83 ± 0.51; two-sided p = 0.018). The mean visual analog scale scores were significantly higher for touching the ventricular folds than for touching the epiglottis (8.28 ± 1.11 vs 4.14 ± 1.21; two-sided p = 0.017). The higher sensitivity of the ventricular region should be considered for further refining clinical endoscopic evaluation of laryngeal sensitivity.

A 47-year-old obese woman with GERD and COPD presents for CO2-laser excision of bilateral vocal fold masses. She had a history of progressive hoarseness and difficulty in breathing. Nasopharyngeal laryngoscopy revealed large, mobile, bilateral vocal cord polyps that demonstrated dynamic occlusion of the glottis. We describe the airway and anesthetic management of this patient with a topicalized C-MAC video laryngoscopic intubation using a 4.5 mm Xomed Laser Shield II endotracheal tube. We examine the challenges of anesthetic management unique to the combined circumstances of a ball-valve lesion and the need for a narrow-bore laser compatible endotracheal tube.

Introdução: O pólipo de prega vocal representa uma lesão benigna comum da laringe e o seu tratamento tem diversas modalidades. O objetivo deste artigo é apresentar aspectos clínicos e cirúrgicos específicos destes pólipos. Forma de estudo: Clínico retrospectivo. Material e Método: Levantamento retrospectivo de todos os casos atendidos no ambulatório de laringe da Faculdade de Medicina do ABC durante 18 meses e análise completa de todos os dados obtidos. Discutimos ainda as possibilidades terapêuticas e os resultados relatados na literatura. Resultados: Foram atendidos 108 pacientes no período acima e o diagnóstico mais prevalente foi pólipo de prega vocal (29,62%; n = 32), sem predileção por sexo. O principal sintoma referido foi disfonia (100%) e em 56,25% o tabagismo estava presente, seguido de abuso vocal (25%). Vinte seis pacientes (81,25%) foram tratados por microcirurgia de laringe com laringoscópio de suspensão sob anestesia geral e fonoterapia pós-cirúrgica, além de higiene vocal e tratamento medicamentoso quando necessário. Em 95% destes houve melhora da qualidade vocal após 60 dias de pós-operatório. Conclusões: O tratamento cirúrgico do pólipo de prega vocal apresenta diversas modalidades, porém o sucesso terapêutico depende da habilidade técnica do cirurgião, dos cuidados pós-operatórios e seguimento completo fonoterápico e medicamentoso. Introduction: Vocal fold polyp is a commom benign lesion of the larynx which can be treated in various ways. This article intends to show how clinical and surgical work can be applied in the event of the vocal fold polyp. Study design: Clinical retrospective. Material and Method: A retrospective research analysing patients was carried out from February 2000 to July 2001 (18 months) by the Department of Larynx at the Faculdade de Medicina do ABC. A complete analysis of the results, as well as therapeutical techiniques applied and the results referred in the medical literature was done. Results: A number of 108 patients underwent the study. Polyp was found to be the most prevalent lesion (29,62%; n=32) among both male and female and the main symptom found was dysphonia (100%). Around 56,25% of the patients were smokers and approximately 25% related vocal abuse. A number of 26 (twenty-six) patients (81,25%) underwent microlaryngeal surgery with a suspension laryngoscope, general anesthesia, postsurgical voice and drugs therapy, whenever needed. As a result, 95% of the patients showed some improvement on their voice, within 60 days after surgery. Conclusions: Although surgical excision of the vocal polyp can be carried out in many ways, therapeutical success depends on the surgeron's skills and standards of postoperative care, such as voice and drugs therapy.

In a retrospective cohort study, conducted in Department of Oto-Rhinolaryngology, Head and Neck Surgery, M.LX Medical College, Allahabad from January 1989 to December 1999, 81 benign laryngeal lesions were evaluated. Majority (69, 85.2%) presented with hoarseness of voice and stridor was the presenting complaint in 12 ( 14.8%) cases. Vocal cord polyp (33, 40.7%) dominated the non-neoplastic group, while squamous papilloma (18, 22.4%) was the most common neoplastic lesion. Adult unset multiple papiUoma of unilateral vocal cord (4, 4.9%) was an unexpected finding in our series. A rare case of pleomorphic lipoma of larynx in a 68-year-old male patient along with its CT characteristics has been presented. Conservative microlaryngeal surgery offered the most satisfactory mode of treatment without any mortality and with minimal recurrence.

This study aims to investigate the correlations between serum apolipoprotein A-I (ApoA-I) and the formation of vocal cord polyps (VCPs).This study used the nonmatched case-control study method.The serum total cholesterol (TC), triglyceride, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol, ApoA-I, apolipoprotein B (ApoB), and ApoA-I/ApoB levels of 89 VCP patients and 87 normal volunteers were compared. Additionally, such VCP-related factors as excessive vocal use, vocal abuse, smoking, drinking, and the size of VCPs were analyzed.The two groups did not significantly differ with regard to triglyceride, low-density lipoprotein cholesterol, ApoB, and ApoA-I/ApoB levels (P 0.05), whereas they did significantly differ with regard to TC, HDL-C, and ApoA-I levels (P 0.05) according to independent t tests. Logistic regression analysis showed that excessive vocal use and vocal abuse were risk factors for VCPs (P 0.05), with odds ratio values of 5.675 and 12.781, respectively. The ApoA-I level was negatively associated with VCPs (P 0.05), with an odds ratio of 0.511; however, TC and HDL-C were not associated with the formation of VCPs (P 0.05). The size of VCPs in females was negatively correlated with the serum ApoA-I level (r = -0.349, P = 0.032), whereas that in males was not (P 0.05).As the serum ApoA-I level was negatively correlated with the formation of VCPs, ApoA-I may reduce the risk of VCPs. These findings may facilitate the prevention and treatment of VCPs.

The anaesthetic management of patients presenting with laryngeal tumours and airway obstruction is difficult. We present the case of a pregnant woman at 30 weeks gestation who underwent surgical removal of two vocal cord polyps under general anaesthesia using jet ventilation

Objective: To present a case of vocal cord polyp in a pediatric patient and discuss its differential diagnosis, assessment and management. Methods: Study Design: Case Report Setting: Tertiary Public Hospital Participant: One Results: A seven-year-old girl presented with hoarseness and a benign, unilateral mass seen at the junction of anterior and middle third of the vocal cord. The hoarseness resolved after excision, and histopathology confirmed an inflammatory vocal cord pseudo polyp. Conclusion: Vocal cord polyps occur infrequently in children and adolescents. These cases are seldomly seen and reported and may arise from chronic abuse of the larynx, vocal cord trauma or phonotrauma. Hoarseness is the most common presenting symptom. Differential diagnoses include recurrent respiratory papillomatosis, laryngeal cyst and laryngeal nodule. The management of vocal cord polyps involves surgical removal followed by speech therapy. Keywords: hoarseness, phonotrauma, vocal cord polyp, recurrent respiratory papillomatosis, vocal cord nodule, vocal cord cyst, flexible laryngoscopy, speech therapy

Purpose The aim of this study was to identify parameters that would differentiate healthy from pathological organic-based vocal fold vibrations to emphasize clinical usefulness of high-speed imaging. Method Fifty-five men ( M age = 36 years, SD = 20 years) were examined and separated into 4 groups: 1 healthy (26 individuals) and 3 pathological (10 individuals with contact granuloma, 12 with polyps, and 7 with cysts). Vocal fold vibrations were recorded using a high-speed camera during sustained phonation. Twenty objective glottal area waveform and 24 phonovibrogram parameters representing spatiotemporal characteristics were analyzed. Statistical group comparisons were performed to document spatiotemporal changes for organic lesions that cannot be determined visually. To look for specific pattern profiles within organic lesions, the authors performed linear discriminant analysis. Results Thirteen parameters showed significant differences between the healthy group and at least 1 pathological group. The differences occurred more in temporal than in spatial parameters. Contact granuloma showed the fewest statistical differences (3 parameters), followed by cysts (9 parameters), and polyps (10 parameters). Linear discriminant analysis achieved accuracy performance of 76% (all groups separated) and 82% (healthy vs. pathological). Conclusion The results suggest that for males, the differences between healthy voices and organic voice disorders may be more pronounced within temporal characteristics that cannot be visually detected without high-speed imaging.

The location of laryngeal lesions sometimes complicates surgical treatment of laryngeal disease using laryngo-microsurgery. For treatment of these cases, laryngeal-fiberscopy via laryngeal mask airway (LMA) was performed. LMA is a very useful device which provides an oropharyngeal airway and offers an alternative to endotracheal intubation and standard mask anesthesia in these cases. Fifteen patients in whom laryngo-microsurgery was seemed difficult, were chosen for this study. Of these 15 patients, 4 were diagnosed with vocal cord polyps, 4 with papilloma, 3 with carcinoma, 2 with leukoplakia, 1 with a cyst and 1 with an angioma. The technique of laryngeal fiberscopy via LMA readily allows full examination of the larynx and trachea. This method facilitates precise biopsy and laser surgery of both the larynx and trachea. Use of the LMA is also recommended for treatment of cases of papilloma or malignancy, because it minimizes the risk of dissemination of malignant cells or papilloma cells to the trachea and lung. We concluded that this procedure is potentially very advantageous when laryngo-microsurgery is difficult to perform.

A 55-year-old male with progressively worsening hoarseness was found to have a vocal cord polyp of >10 mm in diameter on the right true cord. It was necessary to remove the polyp in order to prevent airway obstruction by prolapse. However, the patient was a poor candidate for resection by standard otolaryngologic procedures because of the large size of the polyp and because he had a symptomatic cervical disc herniation. Therefore, endoscopic resection under general anesthesia using a bipolar electrocautery snare was selected. This case was our first attempt to treat a vocal cord polyp using this technique, and we found that polypectomy with the bipolar snare was an efficient and safe method for the treatment of this lesion.

The immunohistochemical expression of p53 and cyclin D1 proteins was evaluated in formalin-fixed, paraffin-embedded surgical specimens from 39 patients with epithelial hyperplasia and dysplasia of the vocal cords. The series for this study consisted of nine patients with hyperplasia, 12 with mild dysplasia, ten with moderate dysplasia, eight with severe dysplasia, eight with vocal cord polyps, and 14 with invasive squamous cell carcinoma (SCC). The following results were obtained. 1) The mean p53 positive rates were 0.81±0.37 (mean±STD%) in mild dysplasia, 5.56±1.18 in moderate dysplasia, 11.81±3.61 in severe dysplasia, and 39.23±12.78 in SCC. The p53 expression was negative in the polyp cases and mild dysplasia. 2) The mean cyclin D1 positive rates were 0.55±0.15 (mean±STD%) in hyperplasia, 5.16±1.53 in mild dysplasia, 8.02±5.25 in moderate dysplasia, 18.34±8.95 in severe dysplasia, and 32.20±17.77 in SCC. The cyclin D1 expression was negative in the polyp cases. In the cases of hyperplasia and dysplasia, the p53 and cyclin D1 positive rates increased significantly as the histological grade advanced (p

Abnormal patterns of expression of the basement membrane type IV collagen are observed in many human cancers. This study examines the immunohistological expression of type IV collagen in the basement membrane in human laryngeal squamous cell carcinomas (SCC) (n = 24). Non-neoplastic vocal cord polyps (n = 4) were used as controls. The formalin-fixed, paraffin-embedded tissues were sectioned and pretreated with protease prior to immunostaining for type IV collagen. There was a statistically significant difference in type IV collagen expression between laryngeal SCC and vocal cord polyps (p = 0.0001; chi 2 test with continuity correction). In laryngeal SCC (n = 24; 100%), type IV collagen distribution was discontinuous and irregular or absent around individual or groups of neoplastic cells. In contrast, all of the cases of vocal cord polyps (n = 4; 100%) displayed a continuous pattern of subepithelial basement membrane type IV collagen. This study has shown that abnormal distribution of type IV collagen occurs in laryngeal squamous cell carcinomas but not in non-neoplastic vocal cord polyps. This may be related to either abnormal synthesis or to the breakdown of the collagen and it may be of use as a potential biological marker in the study of laryngeal carcinogenesis.

We investigated the proliferative activities in epithelial hyperplasia and dysplasia of the human vocal cords as precancerous lesions, using immunohistochemical staining with anti-PCNA and MIB-1 (anti-Ki-67) monoclonal antibody.The series for this study consisted of nine patients with hyperplasia, 12 with mild dysplasia, ten with moderate dysplasia, eight with severe dysplasia, eight with vocal cord polyps, and 14 with invasive squamous cell carcinoma.The following results were obtained:1) The mean PCNA labeling index was 1.12±1.05 (MEAN±STD%) in polyp, 4.88±2.02 in hyperplasia, 2.76±1.76 in mild dysplasia, 3.80±2.03 in moderate dysplasia, 6.12±3.01 in severe dysplasia, and 19.07±10.37 in invasive cancer.2) The mean MIB-1 positive rates were 5.50±2.47 (MEAN±STD%) in polyp, 13.08±6.86 in hyperplasia, 16.55±7.34 in mild dysplasia, 15.94±6.73 in moderate dysplasia, 21.43±8.16 in severe dysplasia, and 41.48±14.05 in invasive cancer.In cases of hyperplasia, dysplasia and invasive cancer, PCNA labeling index values and MIB-1 positive rates increased in proportion to the histological atypical grade increasing. Some lesions which recurred or progressed to cancer were found show high expression of PCNA and MIB-1.In cancer cases, there was no significant correlation between the PCNA labeling index, MIB-1 positive rates and either the degree of tumor cell differentiation or the T-classification.There was a positive correlation between the PCNA labeling index and MIB-1 positive rates among all cases.In this study, those cases showing a high PCNA labeling index and/ or MIB-1 positive rates may indicate the possibility of recurrence or progression to malignancy in precancerous lesions of the vocal cords.