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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.

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.