Search

Introduction. Modern diagnostics of laryngeal diseases is based on the use of video endoscopic technologies. The authors of the article, having almost thirty years of experience with various methods of video endoscopy, proposed a classification of video endoscopic methods of laryngeal examination. Objective. To develop an algorithm for the application of various video endoscopic methods of laryngeal examination in voice professionals with functional and organic dysphonia. Materials and methods. From 2020 to 2022, 2308 patients aged 18 to 80 years (43.2 ± 11.5) were examined in the phoniatric department of the St. Petersburg Research Institute of ENT. There were 1424 women (61,7 %), 884 men (38,3 %) people. Functional dysphonia was detected in 705 (30,5 %) people, acute and chronic laryngitis in 668 (28,9 %), tumor-like formations in 436 (18,9 %), the remaining nosological forms were diagnosed in 499 (21,7). All the patients turned out to be representatives of voice-speaking professions and complained of dysphonia.For videolaryngoscopy, videolaryngostroboscopy, autofluorescence endoscopy, NBI–endoscopy, equipment from various manufacturers was used. Results. An algorithm for the application of video endoscopic research methods in persons of voice-speech professions with dysphonia has been developed. Overview videolaryngoscopy and videostroboscopy were mandatory research methods for all patients with complaints of voice function. The use of these two methods proved to be sufficient for the diagnosis of functional dysphonia, paresis and paralysis, congenital malformations of the larynx, scar stenosis. In-depth diagnostics and differential diagnostics of tumor-like formations, various forms of chronic laryngitis, benign and malignant formations, in addition to videolaryngoscopy and videostroboscopy, included autofluorescence endoscopy or NBI endoscopy, which revealed the earliest stages of the pathological process. Conclusions. Only the complex application of various methods of video endoscopy of the larynx provided timely diagnosis and early treatment of dysphonia, maximum restoration of voice function, and, consequently, the preservation of professional longevity by persons of voice-speech professions.

Introduction. Today the high prevalence of benign vocal fold lesions is shown (up to 55-70%). The possibilities of surgical management of this pathology are very extensive. Laser technologies are becoming more and more popular among high-tech treatment methods. However the comprehensive postoperative management of these patients is equally important.The aim of the study was to assess the features of the postoperative period in patients undergoing the endolaryngeal surgery using a semiconductor laser with a wavelength of 445 nm.Material and methods. On the basis of Saint-Petersburg Research Institute of Ear, Throat, Nose and Speech from February to June 2021 20 patients with benign vocal fold lesions 6 women and 14 men from 24 to 67 years old were examined and treated. All the patients underwent endolaryngeal surgery with direct microlaryngoscopy using a new semiconductor 445 nm laser in an inert gas atmosphere (intraoperative helium supply). After surgical treatment, the patients observed vocal rest, received antiinflammatory, antibacterial therapy, inhalations, as well as the drug Homeovox® according to the standard scheme.Conclusion. Endolaryngeal surgery with the removing of benign vocal fold lesions using a semiconductor laser with a wavelength of 445 nm has been proven to be safe and effective. According to the results of video laryngostroboscopy, acoustic analysis of the voice (the questionnaire “Voice handicap index-30”) it was noted that the laryngeal functions were restored in a short time. The inclusion of Homeovox® in the complex postoperative treatment had a favorable effect on the restoration of the phonatory function.

The aim of the study was to improve the efficiency of diagnosis of various forms of chronic hyperplastic laryngitis, which is referred to as precancerous conditions of the larynx, video laryngostroboscopy was performed in 249 patients. All patients have occupational hazards: increased voice load, smoking, working capacity in a hospital state during acute respiratory viral infections, laryngitis, bronchitis. In case of detection of areas of dyskeratosis of mucous membrane of vocal folds (leukoplacia, hyperkeratosis) biopsy followed by histological examination was carried out. The results of a histological study of leukoplakia showed the presence of metaplasia of stratified squamous epithelium in 100% of the examined. Among patients with vocal fold hyperkeratosis, metaplasia of stratified squamous epithelium was detected in 20,8%, grade II and III dysplasia – 15,1% of observations. 64,1% of patients were diagnosed with laryngeal cancer. The video laryngostroboscopic picture of the larynx in various forms of chronic hyperplastic laryngitis was studied. According to the results of the study, pathological changes in the mucosa of the vocal folds with possible malignation include hyperkeratosis. During video laryngostroboscopy, asymmetric, irregular, mucous waves oscillate in the hyperkeratosis area in 60,4% of patients, and in 39,6% of patients the absence of vibrations of the vocal fold in the area of hyperkeratosis is diagnosed.

Diagnosis and treatment of larynx diseases in voice professionals are an important task of otorhinolaryngology. 244 voice professionals have visited Phoniatric Department of Saint Petersburg Research Institute of Ear, Throat, Nose and Speech. The condition of larynx was assessed by videoendolaryngoscopic and videoendolaryngostroboscopy methods. Larynx pathology was found in 212 patients, 32 persons were healthy. The main causes of dysphonias were the continuous vocal stress, work in sick condition, the diseases of endocrine, gastroduodenal, respiratory, neural system. 77 patients with voice disorders were diagnosed with functional dysphonia, 61 patients – with acute or chronic laryngitis. The cause of hoarseness in 46 persons were the vocal fold nodules, and in 28 patients – the vocal fold polyps. The article describes the clinical manifestations of pathological changes of the larynx. Based on the studied voice disorder etiological factors and clinical picture of the larynx, the authors developed a clinical and diagnostic algorithm of otorhinolaryngologist’s work with voice professionals.

The objective of the present study was to evaluate the effectiveness of the application of homeovox for the combined treatment of small vocal cord nodules and acute laryngitis in the professional voice users. A total of 40 subjects presenting with dysphonia were examined after they were divided into two study groups and two groups of comparison depending on the nosological form of the pathological condition. The subjects comprising the study groups were given traditional therapy in the combination with the intake of homeovox whereas the patients included in the two groups of comparison received the traditional treatment alone. The outcome of the treatment was evaluated on days 1, 5, and 10 after the initiation of therapy based on the analysis of the changes in the videoendostroboscopic picture of the larynx and the acoustic characteristics obtained by the computer-assisted analysis of the voice. The analysis of the results of the combined treatment has demonstrated the statistically significant differences in some acoustic parameters of the voice between the subjects with small vocal cord nodules and acute laryngitis belonging to the study groups and the groups of comparison. It is concluded that the introduction of homeovox in the combined treatment of the patients presenting with the small nodules in the vocal cords and acute catarrhal laryngitis accelerates the recovery of the acoustic characteristics of the voice within various periods after the onset of the treatment in comparison with the patients treated with the use of traditional therapy alone.Цель исследования - изучение эффективности применения препарата Гомеовокс в комплексном лечении мягких узелков голосовых складок и острого ларингита у профессионалов голоса. Были обследованы 40 пациентов с дисфониями, которых распределили по нозологическим формам на две группы исследования и две группы сравнения. В группах исследования больные получали традиционную терапию в сочетании с препаратом Гомеовокс, а в группах сравнения - только традиционную терапию. Результаты оценивали на 1, 5, 10-й дни лечения по изменению видеоэндостробоскопической картины гортани и акустических показателей компьютерного анализа голоса. Анализ результатов проведенного комплексного лечения выявил статистически значимые различия для ряда акустических показателей голоса между группами исследования и сравнения у пациентов с узелками голосовых складок и острым ларингитом. Включение препарата Гомеовокс в комплексное лечение пациентов с мягкими узелками голосовых складок и острым катаральным ларингитом приводит к более быстрому восстановлению акустических показателей голоса в различные сроки наблюдения по сравнению с пациентами, получавшими только традиционную терапию.

Laryngeal cancer still occupies the leading position among malignant neoplasms of the upper respiratory tract. The detection of laryngeal cancer in situ occurs only in 2.3–6% of cases. It is explained by the complexity of differential diagnosis between dyskeratosis and cancer in situ of the vocal folds. The objective of the study was to identify pathognomonic differential-diagnostic signs of videoendostroboscopic and auto-fluorescent larynx picture in the patients with premalignant diseases and early stages of the vocal folds cancer. The study included 110 patients with premalignant diseases and suspected for early stage of laryngeal cancer. All the patients underwent biopsy of mucosa areas that caused oncological alertness. As a result, squamous cell carcinomas in situ and T1 have been detected in 58 (52.7%) patients, chronic hyperplastic laryngitis with stage 2-3 mucosa dysplasia – in 32 (29.1%), chronic hyperplastic laryngitis with metaplasia sections – 12 (10.9%) patients, benign neoplasms– 4 (3.6%), tumor-like diseases – 4 (3.6%) patients. According to videoendostroboscopy results, most of 58 patients with cancer, 46 (79.3%) people, had no vocal fold vibrations and mucotic waves. Less frequently they were preserved, but had reduced amplitude and were irregular. During auto-fluorescent endoscopy the decrease in fluorescence intensity was observed in almost all cases – in 57 (98.3%) patients. In 32 patients with stage 2–3 dysplasia videoendostroboscopy showed lower amplitude of the vocal folds vibration, they were irregular in 30 (93.7%) observations, mucosal wave stopped at the lesion site in 27 (84.4%) observations. Vocal folds vibrations were absent in 2 (6.3) patients. In auto-fluorescent endoscopy, the increase in fluorescence intensity was observed in most cases – in 25 (78.1%) patients. Timely performed videoendostroboscopy in combination with auto-fluorescent larynx endoscopy provides the increase of efficacy of diagnostics of premalignant changes and early vocal folds cancer.

Laryngitis is one of the commonest causes of dysphonia in the subjects engaged in the voice and speech professions. This condition can be either associated with the professional activities or related to voice fatigue. It is a common practice to distinguish between acute and chronic forms of occupational laryngitis. The main factors responsible for development of both conditions include the non-observance of directions concerning the protection and hygiene of the speaking and singing voice. The present study included 478 (100%) subjects engaged in the voice and speech professions presenting with the diagnosis of acute or chronic occupational laryngitis who applied for medical assistance to our Phoniatric Care Department. The clinical state of their larynx was evaluated with the use of the videoendostroboscopic technique. Acute laryngitis was diagnosed in 103 (21.5%) of the examined subjects while the remaining 375 (78.5%) ones presented with chronic laryngitis. A characteristic feature of acute occupational laryngitis documented in 38 (36.9%) examined professional voice users with this condition (practically healthy in all other respects) was the development of this disorder as a result of overloading the speech organs. On the contrary, viral and/or bacterial laryngitis revealed in 65 (63.1%) of the patients was preceded by acute respiratory symptoms. A total of 62 (16.5%) patients suffered from chronic occupational laryngitis attributable to overloading of the organs of speech during protracted periods. The remaining 313 examined professional voice users were found to present with various forms of chronic laryngitis including catarrhal laryngitis in 175 (46.7%) of them, edematous-polypoid and atrophic forms in 32 (8.5%) and 19 (5.1%) subjects respectively. The main etiological factors underlying the development of all the tree forms of chronic laryngitis were smoking, chronic tonsillitis, gastroesophageal reflux disease, bronchial asthma, and diabetes mellitus.Одной из частых причин дисфоний у лиц голосо-речевых профессий являются ларингиты, которые могут быть обусловлены профессиональной деятельностью или не быть связаны с голосовой нагрузкой. Выделяют острую и хроническую формы профессиональных ларингитов. Основной причиной их развития является несоблюдение правил охраны и гигиены певческого и речевого голоса. Было обследовано 478 (100%) профессионалов голоса с диагнозом 'острый или хронический ларингит', обратившихся в фониатрическое отделение. Клиническое состояние гортани оценивали с использованием метода видеоэндостробоскопии. Острый ларингит диагностировали у 103 (21,5%) пациентов, хронический - у 375 (78,5%) больных. Характерным для острого профессионального ларингита, выявленного у 38 (36,9%) человек, являлось его развитие после большой голосовой нагрузки на фоне полного здоровья. Напротив, вирусному или вирусно-бактериальному ларингиту у 65 (63,1%) пациентов предшествовали острые респираторные явления. Хроническим профессиональным ларингитом страдали 62 (16,5%) пациента, которые испытывали длительные голосовые перегрузки. У остальных 313 больных выявлены различные формы хронического ларингита: катаральная в 175 (46,7%) случаев, гиперпластическая - в 87 (23,2%), отечно-полипозная - в 32 (8,5%), атрофическая - в 19 (5,1%). Основными этиологическими факторами развития этих форм были курение, хронический тонзиллит, гастроэзофагеальная рефлюксная болезнь, бронхиальная астма, сахарный диабет.

This article presents the results of analysis of observation of 390 patients which underwent thyroid surgery: the frequency of the recurrent laryngeal nerve dysfunction, significant predictive factors, frequency and timing of vocal folds mobility restoration. The authors provide evaluation of the dynamics of laryngostroboscopic pattern in compliance with the voice computer analysis and specify the reasons of dysphonia after thyroid surgery.

The article is devoted to a rare ENT disease. The introduction deals with pathogenesis, classification, and clinical course of AL­amyloidosis, which is in most cases diagnosed in the larynx diseases. The article presents three authors’ own clinical cases of vestibular, vocal and sub-vocal larynx amyloidosis.