小儿声带沟的研究

目的：探讨小儿先天性声带沟的临床特征、诊断、治疗方法。方法：对56例声带沟患儿术前行电子喉镜检查,应用声带沟切开整复术治疗,不附加缝合及用组织或其他外物充填。结果：声带沟占同期嗓音障碍患儿的5．09％（56/1100）,5岁以前占80．04％。总有效率96．40％。结论：声带沟在小儿嗓音障碍中不罕见;出生时即有嗓音异常;多呈裂隙型和凹陷型,常有声带表皮样囊肿或息肉共存;声带沟切开整复术不失为一安全、有效、简捷的手术方式。     

Voice handicap evaluation of patients with pathologic sulcus vocalis

OBJECTIVES: The purpose of this study was to characterize the psychosocial impact of dysphonia on patients with pathologic sulcus vocalis by use of the Voice Handicap Index (VHI). METHODS: The VHI was administered to 15 patients (11 women and 4 men) with pathologic sulcus vocalis. The VHI subscale and total scores were compared with previously published data from individuals with no history of dysphonia and from patients with vocal fold scar. Additional comparisons were performed for patients with unilateral sulcus versus bilateral sulci, type II sulcus versus type III sulcus, and sulcus with concomitant vocal fold scar versus sulcus without concomitant scar. RESULTS: The VHI scores for patients with pathologic sulcus vocalis were significantly greater than those for individuals with no history of dysphonia and for patients with vocal fold scar. In addition, significantly greater VHI scores were observed for patients with sulcus vocalis with concomitant scar versus those with sulcus alone. CONCLUSIONS: These data suggest that pathologic sulcus vocalis can be a severely handicapping condition, particularly in the presence of concomitant scar.     

Anatomical study of minor alterations in neonate vocal folds

IntroductionMinor structural alterations of the vocal fold cover are frequent causes of voice abnormalities. They may be difficult to diagnose, and are expressed in different manners. Cases of intracordal cysts, sulcus vocalis, mucosal bridge, and laryngeal micro-diaphragm form the group of minor structural alterations of the vocal fold cover investigated in the present study. The etiopathogenesis and epidemiology of these alterations are poorly known.ObjectiveTo evaluate the existence and anatomical characterization of minor structural alterations in the vocal folds of newborns.Methods56 larynxes excised from neonates of both genders were studied. They were examined fresh, or defrosted after conservation via freezing, under a microscope at magnifications of 25× and 40×. The vocal folds were inspected and palpated by two examiners, with the aim of finding minor structural alterations similar to those described classically, and other undetermined minor structural alterations. Larynges presenting abnormalities were submitted to histological examination.ResultsSix cases of abnormalities were found in different larynges: one (1.79%) compatible with a sulcus vocalis and five (8.93%) compatible with a laryngeal micro-diaphragm. No cases of cysts or mucosal bridges were found. The observed abnormalities had characteristics similar to those described in other age groups.ConclusionAbnormalities similar to sulcus vocalis or micro-diaphragm may be present at birth.     

声带沟的诊断及治疗

目的探讨声带沟的分型及治疗方法。方法29例声带沟患者按有无声嘶及沟的形态分为3型：Ⅰ型：生理型，11例(无声嘶)；Ⅱ型：裂线型，13例；Ⅲ型：局凹型，5例；后两种为病理型声带沟，有声嘶。对有声嘶18例进行了手术及术后嗓音训练治疗，手术方法有：①黏膜下分离自体脂肪注射术(Ⅱ型9例，Ⅲ型2例，其中1例为术式②疗效不佳再手术者)；②黏膜切开挖槽自体脂肪注射术(Ⅱ型4例、Ⅲ型1例)；③声带沟切除术(Ⅲ型4例，包括1例术式①疗效不佳再手术者)。所有患者均随访6个月以上，平均为15．3个月。结果喉镜及嗓音分析发现，13例Ⅱ型患者中10例(其中6例为黏膜下分离自体脂肪注射术，占该术式6／9；4例为黏膜切开挖槽自体脂肪注射术，占该术式4／4)，术后3个月声带沟消失，发音良好，声带振动恢复；另3例单行黏膜下分离自体脂肪注射术者，术后声带沟变浅，仍稍声嘶。5例Ⅲ型患者中3例行声带沟切除术后4～5个月声带沟消失，发音时声门闭合好，声带振动恢复；另2例先单行黏膜下分离自体脂肪注射术或黏膜切开挖槽自体脂肪术者，术后10d～3个月声带沟再现，再次手术后好转。结论对声带沟患者应分型后采用不同治疗方法，黏膜切开挖槽自体脂肪注射术对Ⅱ型治疗效果最好，声带沟切除术对Ⅲ型治疗最合适。     

Patients’ perceptions of vocal problems: results from a survey in the Tokyo area

Laryngoscopy in cases of sulcus vocalis reveals bowed vocal folds, resulting in a spindle-shaped chink with glottal incompetence. The anatomic and functional problems and resulting incomplete glottal closure during phonation lead to the presenting symptoms of breathy hoarseness, decrease in maximum phonation time (MPT), and vocal fatigue. These symptoms, however, have been reported from the physician’s viewpoint, not the patient’s. Furthermore, no standardized guidelines for the treatment of sulcus vocalis have been established. Because the general attitude toward sulcus vocalis appears to have become ‘It is only a vocal problem and does not significantly affect the patient’s well-being,’ knowledge of sulcus vocalis has decreased and knowledge about choices of therapy remain limited. We therefore conducted an epidemiological questionnaire survey on this pathological condition in voice clinics in seven hospitals in the Tokyo area to establish preliminary guidelines for the management of sulcus vocalis, in reference to the opinion of the patients. Here we report the summary of our preliminary study ‘a survey for sulcus vocalis’ and suggest guidelines for the management of such pathological conditions. Although these management guidelines may result in improvement in the symptoms of sulcus vocalis, patients and physicians should be aware that treatment of this condition is difficult and improvement is not guaranteed.     

Laryngeal electromyography: a useful technique for the investigation of vocal cord palsy

Percutaneous needle laryngeal electromyography was used in 22 patients with an established vocal cord palsy of non-laryngological cause. Recordings of action potentials from both vocalis and cricothyroid muscles produced expected results in 8 patients with skull base lesions. In 6 patients with known lesions below the clavicles, ipsilateral cricothyroid activity was found to be normal despite the vocal cord lying in the lateral (or cadaveric) position. In 2 patients electromyography helped establish the site of the lesion. Eight patients with idiopathic cord palsies showed varying cricothyroid function but in all vocalis activity was absent.     

Fat augmentation for nonparalytic glottic insufficiency

While autogenous fat augmentation for glottic insufficiency has been used before, relatively little information is currently available on the effectiveness of fat injection in patients with nonparalytic glottic insufficiency resulting from problems such as various defects of vocal atrophy or sulcus vocalis. This paper compares retrospectively the efficiency of fat injection after surgery in patients with vocal atrophy (n = 16) and sulcus vocalis (n = 8). The perceptual acoustic and phonatory functions and videolaryngostroboscopic data were evaluated before and after fat augmentation in 24 patients. The mean follow-up time was 19.5 months. Fifteen patients displayed excellent results; 1 showed some improvement; 6 experienced postprocedure failure, and 2 were not available for follow-up analysis. Perceptual rating showed significant improvement in grade, roughness and breathiness (p < 0.05). The videolaryngostroboscopic rating showed significant improvements in vocal fold edge linearity, vocal fold vibration amplitude and mucosal wave excursion (p < 0.05). More improvement in vocal atrophy was observed compared with sulcus vocalis following fat injection procedures. Our research showed that middle defects improved more compared to those in the anterior and posterior area. Fat injection is an effective autogenous implant and may be considered as an option in the treatment of patients with vocal atrophy or sulcus vocalis. Although fat reabsorption was a problem, repeating the procedure could be considered.     

Impact of radiotherapy on laryngeal intrinsic muscles

Ionizing radiation as a cancer therapy is associated with a variety of undesirable side effects. Consequently, radiotherapy can negatively affect neuromuscular function. Clinical observations have identified problems with swallowing and voice function. Our study aims to evaluate the impact of radiotherapy on laryngeal soft tissues using image analysis to quantify its effect on the structure of the vocalis and thyroarytenoid muscles. Case control study, retrospective analysis. We collected total laryngectomy specimens from six patients with persistent or recurrent cancer who had received preoperative radiotherapy (60–66 Gy). The control group consisted of total laryngectomy specimens from six patients who underwent surgery as primary treatment. Sampling of the specimens only included non-cancerous laryngeal tissue. Laryngeal histological slices were evaluated using digital morphometric analysis system. Percentage of fibrosis and density of muscle fibers within the thyroarytenoid muscle were evaluated in both groups. We found no significant quantitative differences in muscle fibrosis (7.92% vs. 7.52%, P > 0.1). Changes were rather qualitative and included changes in the organization of the muscular fibers. A significant reduction in muscle fibers, however, was observed in the samples from irradiated larynges (66.45% vs. 42.03%, P < 0.01). Our analysis suggests that radiotherapy is responsible for a significant reduction in muscle fibers in the thyroarytenoid muscle and that these changes occur during treatment or relatively early after its completion. Loss of muscle mass after irradiation correlates with clinical observations of muscle weakness and decreased function in patients who undergo radiotherapy.     

Combination of fascia transplantation and fat injection into the vocal fold for sulcus vocalis: long-term results

Fat injection and fascia transplantation alone have been used to treat patients with sulcus vocalis. No information is available on the effectiveness of these two procedures used in concert to treat sulcus vocalis. The objectives of this study were to conduct the two procedures together and report the long-term results. This article assesses, retrospectively, the effectiveness of the combination treatment of fascia transplantation and fat injection (FTFI) in patients with sulcus vocalis (n = 22). Perceptual acoustic, phonatory function, and videolaryngostroboscopic data were evaluated before and after FTFI treatment in 18 patients. The mean follow-up time was 16.6 months. Sixteen patients had excellent results, 3 reported improvement, and 3 indicated no change. Phonatory function improved significantly in terms of phonation time, grade, roughness (p < .05), and breathiness (p < .001). The videolaryngostroboscopic rating showed significant improvement in vocal fold vibration amplitude and excursion of the mucosal wave (p < .05). Type 3 sulcus responded better to this treatment than did type 2 (sulcus vergeture). No postoperative complications were noted. The FTFI technique consists of an autogenous implant and delivers positive results. It may be considered as an option for patients with sulcus vocalis. It has been demonstrated to achieve excellent results in a majority of patients and to deliver a better prognosis than fat injection alone. Although resorption of fat and fascia is associated with FTFI, the FTFI procedure may be repeated multiple times.     

Testosterone--an etiological factor in the development of laryngeal carcinoma?

To evaluate the etiological connection between the development of hyperplastic lesions of the laryngeal mucosa (including cancer) and the male sex hormones, the authors determined the level of testosterone in the serum of patients with cancer of the larynx (25 women and 25 men) and patients with hyperplastic lesions of the mucous membrane of the larynx (15 women and 15 men). In patients who suffered from cancer of the larynx the serum level of testosterone was significantly increased compared to the control group. In the patients who had hyperplastic lesions (including precancerous lesions) of the laryngeal mucosa the differences in the concentration of the serum testosterone were not statistically significant from the control group. The same was also true of the testosterone-estradiol index. The results of the study do not help to explain the success of hormonal therapy for hyperplastic lesions of the laryngeal mucosa. The authors consider that endogenous factors, especially the male sex hormones, should be taken more into account, alongside exogenous factors, in the genesis of laryngeal cancer.     

Communication disorders associated with motor neuron disease: MND

The aim of the paper was to present voice and speech disorders associated with motor neuron disease-MND. Two cases of MND were described. Communication problems--dysphonia and dysartria were one of their early manifestations. It is supposed that sulcus vocalis, which is the result of the degeneration process of the vocal muscle, is the laryngeal presentation of MND.     

Is there any association between esophagogastric endoscopic findings and laryngeal cancer?

Purpose

The aim of the study was to survey the association between prevalence of acid-related inflammation in the upper digestive tract and laryngeal cancer.

Materials and Methods

A case-control study was done in an otolaryngology ward at an academic university. Totally, 65 patients with laryngeal cancer and 65 cancer-free matched controls underwent esophagogastroduodenoscopy, and endoscopic findings were collected.

Results

In the case group, positive endoscopic findings were significantly higher than the control group (87.7% vs 58.5%; P < .001). Laryngeal cancer patients had erosive esophagitis, and gastritis ± other findings more than the control group (48 vs 29 cases) and the difference was statistically significant.

Conclusion

The difference between endoscopic findings in cases and controls was statistically significant. Severe inflammation and erosion existed in patients with laryngeal cancer that could be due to increased acid secretion. Our study supported the hypothesis that gastric acid and pepsin play a role in laryngeal cancer.     

Laryngeal findings and acoustic changes in hubble-bubble smokers

The purpose of our investigation was to evaluate the laryngeal findings and acoustic changes in hubble-bubble smokers. A total of 42 subjects with history of hubble-bubble smoking were recruited for this study. A corresponding group with a history of cigarette smoking and controls were matched. All subjects underwent laryngeal video-endostroboscopic evaluation and acoustic analysis. In the hubble-bubble smoking group, 61.9% were males. The average age was 30.02 ± 9.48 years and the average number of years of smoking was 8.09 ± 6.45 years. Three subjects had dysphonia at the time of examination. The incidence of benign lesions of the vocal folds in the hubble-bubble group was 21.5%, with edema being the most common at 16.7% followed by cyst at 4.8%. The incidence of laryngeal findings was significantly higher in the hubble-bubble group compared to controls. In the cigarette-smoking group, the most common finding was vocal fold cyst in 14.8% followed by polyps in 7.4%, and edema, sulcus vocalis and granuloma. These findings were not significantly different from the hubble-bubble group except for the thick mucus, which was significantly higher in the latter. There were no significant changes in any of the acoustic parameters between hubble-bubble smokers and controls except for the VTI and MPT, which were significantly lower in the hubble-bubble group. In comparison with the cigarette-smoking group, hubble-bubble smokers had significantly higher Fundamental frequency and habitual pitch (p value 0.042 and 0.008, respectively). The laryngeal findings in hubble-bubble smokers are comparable to cigarette smokers. These laryngeal findings are not translated acoustically, as all the acoustic parameters are within normal range compared to controls.     

喉部增生性病变患者幽门螺杆菌感染情况的初步调查

目的快速检测喉部增生性病变患者幽门螺杆菌(HP)感染情况,预测HP感染与喉癌发生的关系,为喉增生性病变的多方干预治疗提供依据,为患者进行快捷、客观的HP感染诊断方法。方法采用胃HP快速检测试纸,检测喉增生性病变组织及其患者牙垢HP的感染情况。结果 175例喉增生性病变患者的牙垢及其190份组织样本中,HP感染阳性率分别为100%和71%。结论 HP感染与喉癌及癌前期病变的发病可能有密切的相关性。     

Sulcus configurations of vocal folds during phonation

Conclusion: A detailed understanding of clinical and voice characteristics will help to differentiate sulcus configuration and plan rational management strategies for each type. Objectives: To investigate the clinical and voice characteristics of patients with sulcus configuration of vocal folds during phonation. Patients and methods: A total of 146 patients with bilateral sulcus configuration of vocal folds were enrolled in this study. Based on videostroboscopic findings, patients were classified into three groups: physiologic sulcus configuration group (type I), pathologic sulcus configuration group, including sulcus vergeture (type II), and sulcus vocalis (type III). Voice analyses were obtained from a recorded speech sample. Results: Thirty-two patients (21.9%) were type I, 61 (41.8%) were type II, and 53 (36.3%) were type III. Different sulcus configuration groups had significantly different roughness and mean fundamental frequency. Type III was significantly different from type I and type II in grade, breathiness, mean flow rate, subglottic pressure, maximum phonation time, Jitter%, and harmonics to noise ratio. The pathologic sulcus showed distinctive features in electroglottograph waveform.     

Human papillomavirus and risk of laryngeal cancer

We determined the relationship between human papillomavirus (HPV) infection and the HPV types detected in 44 patients with squamous cell carcinoma, 10 laryngeal leukoplakia patients, and 12 patients evaluated for benign laryngeal conditions (controls). The sources of HPV DNA were from brushings from the upper respiratory tract and lesion (benign or malignant), oral rinses, and biopsies of patient lesions. Polymerase chain reaction (PCR) and DNA sequencing were used to identify and type HPV. We detected HPV in 25.0% (11/44) of patients with laryngeal cancer, in 30.0% (3/10) of patients with laryngeal leukoplakia, and in 16.7% (2/12) of noncancer controls. Patients with cancer were not more likely to be identified with oncogenic HPV types ( 18.2%) than either the leukoplakia group (20%) or the control group (16.7%). An increased risk of disease was associated with current tobacco use and former alcohol drinking in cancer patients versus controls and in leukoplakia patients versus controls (all p < .05). After we controlled for tobacco and alcohol effects on the risk of disease, exposure to oncogenic HPV types was associated with an increased risk of laryngeal cancer (odds ratio = 3.0) and of laryngeal leukoplakia (odds ratio = 6.0) compared to controls, although the results were not statistically significant. This study suggests that although HPV infection and HPV oncogenic types are not found at a higher frequency in laryngeal cancer or laryngeal leukoplakia as compared to controls, infection is associated with an increased risk of disease after controlling for the effects of alcohol and tobacco use.     

New operation for sulcus vocalis--laser vaporization of the sulcus with fat injection

Although several treatments for sulcus vocalis have been reported, the condition continues to be known as an extremely intractable vocal disorder even now. We report the good outcome of a new treatment for sulcus vocalis. The operation was performed under intubated general anesthesia. We aspireted abdominal fat using an 18-gauge needle and a 20 = cc disposal syringe first. After collection of the fat, laryngomicrosurgery and laser vaporization of the sulcus bilaterally was performed using a KTP laser. Then, the collected fat was injected into the thyroarytenoid muscle bilaterally (about 1cc on each side). Seven patients underwent this surgery. The voice, as evaluated auditorily, improved in all the cases and the maximum phonation time increased in 6 of the 7 cases. We attribute the vocal improvement to the formation of new free edges of the vocal folds after this surgery.     

Sulcus vocalis in monozygotic twins

Sulcus vocalis is the presence of a groove extending along the vibratory surface of a vocal fold and may result in dysphonia. Depending on the level of severity, this condition may require treatment involving complicated surgical techniques. Cases of sulcus vocalis are classified as physiological, vergeture, or pouch type. A clear explanation of the etiology has not been established, and the currently proposed congenital origin, as described in the literature, remains controversial. This paper presents findings from monozygotic twin sisters with bilateral sulcus vocalis; these patients had similar morphologies, vibratory characteristics, and vocal quality measurements, which support the theory of a congenital etiology.     

咽喉反流对声门型喉癌中COX-2mRNA表达的影响

目的：探讨咽喉反流对环加氧酶2（COX-2）mRNA在声门型喉癌病变黏膜中表达的影响。方法：对40例声门型喉癌患者行电子鼻咽喉镜检查、反流检查计分量表（RFS）和反流症状指数量表（RSI）评分，将其分为声门型喉癌反流阳性组（20例）和声门型喉癌反流阴性组（20例），另取10例癌旁2cm以上黏膜组织作为对照组。采用Real—timePCR方法，测定各组黏膜中COX-2tuRNA的表达情况。结果：声门型喉癌组COX-2mRNA的表达明显高于对照组（P〈O．05）；声门型喉癌反流阳性组的表达高于声门型喉癌反流阴性组（P〈0．05）。结论：咽喉反流因素可能通过组织损伤、炎症及细胞恶性转化使声门型喉癌的COX-2mRNA的表达升高。