Immunolocalization of aquaporins in vocal fold epithelia

OBJECTIVE: To investigate the presence of aquaporin (AQP) water channels 1, 2, and 3 in stratified squamous vocal fold epithelium. DESIGN: Immunolocalization analysis of excised ovine vocal fold epithelia. SUBJECTS: Sheep. INTERVENTIONS: Ovine vocal fold epithelia were prepared for immunoelectron microscopy using primary antibodies directed against AQP-1, AQP-2, and AQP-3. Photographic profiles of epithelium exposed to each antibody were used to calculate the immunogold labeling density of the plasma membrane and cytoplasm. MAIN OUTCOME MEASURES: Density of immunolabeling was compared across 3 regions that represent cell layers closest to the glottal lumen for the plasma membrane and cytoplasm, respectively. RESULTS: Labeling densities of AQP-1 and AQP-2 were significantly greater for the plasma membrane region of the luminal cells than for deeper cell layers. Cytoplasmic labeling and labeling of circular structures was greatest for cell layers 2 through 5 beneath the vocal fold surface compared with the surface cell layer. Immunogold labeling of AQP-3, an aquaglyceroporin, in vocal fold epithelium was inconclusive. CONCLUSION: Aquaporins 1 and 2, associated with the plasma membrane region of ovine vocal fold epithelial cells, demonstrate the presence of an intrinsic mechanism to permit transcellular water flux in response to osmotic gradients.     

Pediatric vocal cord paralysis

Pediatric vocal cord paralysis accounts for approximately 10% of all congenital laryngeal lesions. Early detection of these neurogenic disorders is based upon a high index of suspicion and is important to prevent catastrophes during periods of acute respiratory embarrassment. This paper reviews the symptoms, etiology and management of unilateral and bilateral vocal cord paralysis as it pertains to this age group. A case is presented of a neonate with vocal cord paralysis and associated hydrocephalous and meningomyelocele to illustrate many of the problems associated with pediatric laryngeal paralysis.     

Hereditary vocal cord palsy

Hereditary vocal cord palsy is an uncommon cause of neonatal stridor that has significant implications for patients, their families, and their future progeny.     

The clinical differentiation between vocal cord paralysis and vocal cord fixation using electromyography

With newer techniques for laryngeal intervention, it becomes a practical necessity to understand whether an immobile cord is due to neurogenic dysfunction or cricoarytenoid fixation. An objective test for this differentiation is laryngeal electromyography, which can be done as an office procedure with a minimum of discomfort. Our experience in a clinical setting has shown laryngeal electromyography to be efficient in accurately assessing the neuromuscular status of the intrinsic laryngeal musculature.     

低温等离子单侧声带离断并同侧杓状软骨切除术治疗双侧声带外展麻痹

目的 探讨在内镜支撑喉镜辅助下, 采用低温等离子消融刀头行单侧声带离断加同侧杓状软骨切除术治疗双侧声带外展麻痹的疗效。方法 对双侧声带外展麻痹的患者19例, 采用低温等离子消融术行单侧声带离断加同侧杓状软骨切除术进行治疗, 术后随访6～42个月, 分析评估该术式的临床效果。结果 19例术后呼吸功能恢复满意, 术后1个月内安全拔管18例, 其中术前已行气管切开8例。术后瘢痕挛缩喉腔狭窄未能拔管者1例, 经再次手术行对侧杓状软骨切除后成功拔管。嗓音评估发声效果满意14例, 轻微下降但患者能接受4例, 行2次手术者声嘶较前明显加重1例。结论 低温等离子单侧声带离断及同侧杓状软骨切除术治疗双侧声带外展麻痹, 术后呼吸困难完全缓解, 拔管率高, 发声功能保留良好。此术式创伤小, 术后愈合快, 安全、有效、微创。     

Premalignant changes in the vocal cord

The subject of premalignant changes in the vocal cords encompasses a very extensive scope; therefore, only two aspects are discussed in this presentation. The two most common clinically identifiable entities that progress to invasive carcinoma are examined, namely, keratosis and carcinoma in situ. The treatment of keratosis and carcinoma in situ is probably the most provocative subject in laryngeal disease. There is a great difference of opinion as to the action or inaction to be taken when these conditions are identified in the larynx. Keratosis may appear in two forms: delineated keratosis and diffuse keratosis. They_have distinct-Glinical appearances and have a different potential for malignant progression. The treatment of carcinoma in situ is a very controversial subject. The value and advisability of treating this disease with irradiation is questioned. The use of microlaryngeal surgery has been a valuable aid in the identification and delineation of both of these diseases of the vocal cords. The second part of this presentation discusses the role of the submucosa in intraepithelial and early invasive carcinoma of the vocal cord. Some interesting investigative studies have been performed in the study of the role of the stroma in epidermal carcinogenesis. These observations suggest the possibility of stromal elements being of pathogenic importance in the origin of epithelial tumors. The very rapid reappearance of carcinoma_ in situ in the regenerated epithelium of the vpcal cord after complete mucosal removal is suggestive of some extra-epithelial stimulus. Both vocal cords being exposed to the same extrinsic irritants, carcinoma in situ will frequently appear only in the regenerated epithelium of the vocal cord that first evidenced the disease. Multicentric foci of carcinoma is mentioned but not discussed in the presentation.     

Bilateral vocal cord paralysis in children

Bilateral vocal cord paralysis in children with its many causes presents a challenging problem to the pediatric otolaryngologist. Traditionally, management of bilateral vocal cord paralysis includes securing the airway with a tracheotomy and waiting for spontaneous recovery. Surgeons have tried a variety of surgical procedures in lieu of or in addition to tracheotomy, but none are perfect solutions to the problem. This article reviews the current surgical procedures for bilateral vocal cord paralysis in the pediatric population with a particular focus on the senior author's experience with the endoscopic posterior costal cartilage grafting procedure.     

Paradoxical vocal cord dysfunction in juveniles

OBJECTIVE: To evaluate demographic and videolaryngoscopic features in a large series of juveniles with paradoxical vocal cord dysfunction (PVCD). DESIGN: Case series data from videolaryngoscopic tapes retrospectively evaluated in a masked, controlled fashion, and demographic data collected via retrospective medical chart review. SETTING: A tertiary care otolaryngology and speech pathology referral center. PATIENTS: Twenty-two patients with PVCD aged 18 years and younger diagnosed as having PVCD at The Ohio State University Voice Institute, Columbus. MAIN OUTCOME MEASURES: Age, sex, social history, and medical history (demographic); epiglottic position, arytenoid and interarytenoid appearance, phase 0 stability, true vocal cord respiratory motion, degree of anteroposterior (AP) constriction, and false vocal cord adduction (videolaryngoscopic). RESULTS: Of 22 patients, 18 were girls, and 12 had significant social stressors, particularly organized sports. Nineteen patients had posterior laryngeal changes commonly found in gastroesophageal reflux disease. Twelve patients demonstrated abnormal true vocal cord adduction during quiet respiration. Seven patients demonstrated supraglottic anteroposterior constriction and false vocal cord approximation during phonation. CONCLUSIONS: Juvenile PVCD is more common in girls and is associatedwith social stresses. Anatomic laryngeal changes typically associated with gastroesophageal reflux disease are extremely common in these patients. Juveniles with PVCD frequently demonstrate abnormal true vocal cord adduction during quiet respiration. We recommend that initial evaluation of juvenile patients for possible PVCD be conducted via transnasal fiberoptic laryngoscopy while the patient is asymptomatic, and that strong consideration be given to empiric pharmacological treatment of gastroesophageal reflux disease in juveniles diagnosed as having PVCD.     

树突状细胞、郎格罕氏细胞在声带息肉中浸润的意义

目的探讨树突状细胞(dendritic cells, DC)、郎格罕氏细胞(Langerhan′s cells,LC)在声带息肉浸润中的意义.方法选择息肉样变性30例和增生型息肉30例石蜡标本重新制备,用免疫组化技术SABC法作S-100单克隆抗体染色和HE染色,进行定量检测.结果息肉样变型组息肉上皮内的DC/LC浸润密度平均为1.40±1.03个/16HP ,间质内的DC浸润密度平均为11.10±4.07个/16HP.增生型组的息肉上皮内的DC浸润密度平均为0.73±1.08个 /16HP,间质内的DC浸润密度平均为3.13±2.78个/16HP.两组息肉内DC/LC浸润密度差异有显著性(P<0.01).结论声带息肉中DC/LC浸润密度与声带息肉的预后及临床分型有关.     

Suture lateralization of vocal cord treating paradoxical vocal cord movement: a case report

Paradoxical vocal cord movement (PVCM) causes inspiratory stridor and extra-thoracic airway obstruction through inappropriate adduction of the vocal cords during the respiratory cycle. We report on a patient with severe PVCM necessitating tracheostomy insertion. Using the technique of endoscopic suture lateralization of a vocal cord, we succeeded in decannulation 22 years after tracheostomy. PVCM of this severity is rare and its management remains unclear. Successful treatment in this manner has not been documented previously. A brief review of current management options for this condition is included.     

单侧声带横断与声带部分切除术治疗双侧声带外展麻痹

目的探讨用单侧声带横断与声带部分切除术治疗双侧声带外展麻痹的疗效与临床应用价值。方法对9例继发性双侧声带外展麻痹的患者,采用支撑喉镜下单侧声带横断与声带部分切除术进行治疗,通过术后的观察随访,对该术式的临床效果进行分析与评估。结果8例患者气管切开后行单侧声带横断与声带部分切除术,其中7例患者术后2个月安全拔管,1例不能拔管的患者经过再次手术2个月后安全拔管;另1例I度呼吸困难患者经口气管内插管后行声带手术。所有患者行单侧声带横断与声带部分切除术后随访半年以上呼吸困难完全缓解;术后声嘶程度均较前加重,但不影响日常的生活交流。结论单侧声带横断与声带部分切除术治疗双侧声带外展麻痹的方法,不需要昂贵器械,简单实用,临床疗效良好,并发症少,值得在基层医院中推广应用。     

Treatment of vocal cord granuloma

Combined surgical and conservative therapy (voice therapy, treatment of infections, allergy, oesophageal reflux, and psychogenic stress) has been used in the treatment of non-specific vocal cord granuloma. Such tumors have a great tendency to recur. The 41 patients with vocal cord granuloma in our study (4 women, 37 men, mean age 56 years) were treated at our hospital during 1980-1986. Nine patients were healed with conservative treatment, 32 were treated by laryngomicrosurgery under general anesthesia and jet-ventilation. The latter group was divided into three treatment groups; 8 of these patients were treated with cryotherapy, 9 with postoperative steroids (Prednisolone 40 mg/day in decreasing doses) and antibiotics, and 15 only with microsurgery. At some phase in their treatment 41% of the patients were able to participate in voice therapy. The most recurrences were found in the group treated with cryotherapy, 2.7 rec./pat.; 1.8 rec./pat. were found in the group that underwent surgery, and 1.7 rec./pat. among the patients treated with steroid-antibiotics. In all three groups, some patients experienced recurrences. In the cryotherapy group, however, recurrent granulomas were large and required reoperation, while those in patients treated with steroid-antibiotics were small and could be cured using conservative therapy. If granuloma does not disturb the voice, cause respiratory obstruction or demand histopathological diagnosis, surgery is contraindicated. Cryotherapy does not help traditional surgery, while steroid-antibiotics administered postoperatively seem to help the healing process.     

Etiology of vocal cord paralysis

OBJECTIVE: Vocal cord paralysis (VCP) is a sign of a certain underlying disease, a diagnosis which can be attributed to various causes. This study intends to analyze the contemporary etiology of VCP in a tertiary medical center. MATERIALS AND METHODS: A retrospective review of medical records from June 2000 to December 2004 of hospitalized patients with VCP was done to determine the etiology. RESULTS: Two hundred and ninety-one patients with a determined etiology were identified, consisting of 176 males and 115 females. Unilateral VCP was present in 259 patients, while 32 presented with bilateral VCP. The causes were surgical in 40.2%, neoplastic in 29.9%, idiopathic in 10.7%, traumatic in 8%, central in 3.8%, radiation-induced in 3.4%, inflammatory in 2%, cardiovascular in 1.7% and other causes in 0.3% of the cases. Thyroidectomy represented the most common surgery for VCP and was the cause in 57 patients. Lung cancer was responsible for 34 cases and was the most common neoplastic etiology. In males, neoplasm was the most common cause occurring in 63 of 176 males, whereas surgery was most frequent in 59 of 115 females. CONCLUSION: Surgical trauma, mainly thyroidectomy, is the most common cause of VCP in hospitalized patients. The possibility of a neoplasm must be ruled out before VCP is labeled idiopathic. A benign thyroid tumor could also cause VCP. Besides, radiation-induced cranial nerve paralysis in head and neck cancer may play a significant role.