声带淋巴组织增生1例

患者,女,50岁,因咽部异物感,声音嘶哑3个月就诊。检查见咽部黏膜慢性充血,扁桃体Ⅰ度大,表面无充血。喉内镜下见双侧声带无充血,右侧声带前中1/3表面近边缘处有灰白色颗粒样小米粒大小新生物,左侧声带表面光滑,双侧声带运动好,会厌、杓区、梨状窝未见异常。表面麻醉纤维喉镜下行右侧声带肿物切除术,将肿物完整切除,病理报告为淋巴组织增生,并见碳末沉着（图1）。     

动态喉镜记波图对声带病变的分析

目的 探讨声带不同病变的动态喉镜记波图的特点.方法 对正常声带、声带小结、声带息肉、慢性喉炎、声带白斑、声带癌患者各10例行动态喉镜检查、录像,选择声带的前、中、后1/3作为观察位点,导出记波图,计算开放商、速度商、相位对称指数(PAI),同时观察记波图特征.结果 不同的声带病变均能利用动态喉镜记波图计算出开放商、速度商、相位对称指数,不同病变其记波图表现不同.正常声带振幅相位一致,侧峰角较锐利,声带上、下缘平滑;声带小结声带振幅对称,相位一致,侧峰角较正常变钝,小结前后开放相延长,小结处开放相缩短;声带息肉声带病变前后振动的开放相延长,而病变处明显缩短;慢性喉炎声带中1/3开放相较其他组延长,双侧声带振动相位基本对称;声带白斑病变处振幅减小,侧峰角度变钝;声带癌病变声带各段振动不对称.结论 动态喉镜记波图可以对动态喉镜图像进行进一步观察、分析,并可以对某些指标进行定量分析.     

动态喉镜图像定量分析技术的应用

目的探索图像定量分析技术在声带振动研究中的应用。方法应用计算机软件、分析６０例正常人和２０例单侧声带麻痹患者的动态喉镜图像。结果正常组声带振动均呈规律性,多数声门闭合完全;麻痹组声带振动均不规律,多数声门闭合不全,发声相声门最小面积（Ａｍｉｎ）麻痹组明显大于正常组,而最大面积（Ａｍａｘ）两组间无显著性差异。结论动态喉镜计算机图像分析技术可用于声带振动功能的定量分析。     

喉杓间区神经鞘瘤1例

1临床资料患者女性,56岁,因进行性声音嘶哑5年入院。初起症状为轻度声嘶,无其他不适,声嘶症状缓慢加重,入院前饮水偶有呛咳,发声费力,时有呼吸不畅,无呼吸困难、吞咽困难、痰中带血等。入院查体：颈淋巴结无肿大,心肺腹无异常。喉镜检查示双侧杓间区可见半球形隆起,直径约1.5 cm大小,表面黏膜光滑,黏膜下可见纵行毛细血管,双侧声带活动正常,声带后段闭合差,双侧声带、室带及喉室均未见异常,     

声带恶性纤维细胞瘤1例

患者,男,74岁。以声嘶40d为主诉于2007年11月10日入院。40d前无明显诱因出现声嘶,逐渐加重,偶有咳嗽及少量清痰。电子喉镜示：会厌缘光滑,会厌舌面黏膜光滑,右声带前端见豆粒大、白色、表面光滑新生物,前连合及左声带前端未受累;双声带活动良好、闭合不严;双杓会厌襞、杓间区、双侧杓状软骨及双侧梨状窝处黏膜光滑,活动正常（图1）。入院诊断：右声带肿物。于2007年12月8日全身麻醉下行支撑喉镜激光下右声带肿物切除术。     

喉错构瘤1例并文献复习

患儿,男,6岁,因吸气困难5年于2012年10月入我院治疗。问诊其母知此患儿1岁时发现呼吸费力,夜间明显,5岁时当地诊断“双侧扁桃体肥大”行双侧扁桃体切除术,术后吸气困难无改善。遂行喉部 CT 检查发现杓区一类圆形低密度肿物影,边缘光滑,内部密度不均匀（图1）。进一步查纤维喉镜提示,喉入口处可见一基底位于杓区,向喉入口处突出的新生物,表面光滑,堵塞喉入口处约4／5,双侧声带、室带均未窥及。初步诊断为：先天性喉囊肿。行常规化验检查无手术禁忌,在全麻下行支撑喉镜下喉肿物切除术。术中见杓区新生物,被覆正常黏膜,表面光滑,以喉钳触动肿物呈实性、质硬,稍有一定活动度。双侧声带、室带未受累。镜下以二氧化碳激光沿肿物正中切开被覆黏膜,用喉显微器械和二氧化碳激光将肿瘤完整剥离、摘除、止血,切开伤口以丝线缝合,术中出血少。检查离体肿瘤质地较韧,外观不规则,类球形,直径约2．5 cm,剖检瘤体为实性肿瘤。术后病理诊断为：喉部间叶错构瘤,可见脂肪、平滑肌、纤维组织及血管等（图2～4）。患儿术后恢复好,无并发症。术后1个月复诊,无呼吸困难及声音嘶哑,杓区切口处稍肿胀,双侧声带、室带均正常。目前病例随访3年无复发。     

喉恶性颗粒细胞瘤一例

患者女 ,2 5岁。持续声嘶半年 ,进行性呼吸困难 3个月 ,于 1997年 4月 1日入院。呈ＩＩ度吸入性呼吸困难。纤维喉镜检查 :喉前庭大部分被一直径约3ｃｍ的红色肿物占据 ,声门不可见 ,肿物表面粘膜略显粗糙不平 ,会厌和梨状窝未见异常。气管切开后取活体组织检查 ,报告为良性颗粒细胞瘤。在支撑喉镜下行肿瘤切除并激光烧灼 ,术中发现肿物位于粘膜下 ,呈黄白色 ,质硬 ,双侧杓会厌襞、室带及杓间区均受肿瘤累及 ,但声带色泽正常。术后 1周纤维喉镜检查 ,创面平整 ,声门裂大小正常 ,声带活动好 ,左杓会厌襞仍显饱满 ,带管出院观察。半年后肿瘤复…     

支撑喉镜下CO2激光并环后推进黏膜瓣治疗声门狭窄

声门狭窄特别是声门后部瘢痕狭窄是临床上一个较为棘手的疾病,常常伴有呼吸困难,有时可以见到声带活动受限.Bogdasarian和Olson[1]将其分为4级:1级为杓间区瘢痕,但是后连合正常;2级为杓间区和后连合均粘连瘢痕;3级为后连合瘢痕导致一侧环杓关节固定;4级为后连合瘢痕导敏双侧环杓关节固定.本文介绍了4例患者使用支撑喉镜下CO2激光切除喉狭窄并使用环后前移黏膜瓣修复后嗓音有不同程度提高或保持原样,均拔管.     

反流性喉炎的临床观察

目的探讨胃食管反流病与反流性喉炎（refluxlaryngitis,RL）之间的关系。方法对55例RL患者进行详细的病史采集,分别行电子喉镜、上消化道内镜、x线钡餐拍片,嗓音声学分析等检查,并给予抑-酸抗反流治疗。结果RL患者多表现为咽喉部不适和异物感（89．1％）、慢性咳嗽（36．4％）、声音嘶哑（20％）、喉痛（18．2％）,严重者甚至引起误吸、喉痉挛（10．9％）等症状,电子喉镜下可见杓区充血（67．3％）,杓间区黏膜肿胀或肥厚形成皱襞（43．6％）,声带、假声带水肿（40％）,梨状窝积液（32．7％）,声带后部接触性溃疡或肉芽肿（20％）,声带缘下出现假性声带沟（16．4％）;RL患者可出现轻度的嗓音异常,65．5％表现为紧张性发声障碍,其基频（F0）、频率微扰（jit-ter）、振幅微扰（shimmer）、及标准化噪声能量（NNE）值升高,除女性F0外,与正常组比较差异均有统计学意义（P〈0．05）。经质子泵抑制剂（PPI）治疗症状体征改善或消失。结论反流性喉炎是胃食管反流病（GERD）的主要消化道外表现之一,以声门后部病变为主,质子泵抑制剂（PPI）既可以作为其治疗手段又可用作临床试验性诊断的方法。     

推拿法治疗慢性喉炎13例

本文介绍采用推拿疗法治疗慢性喉炎13例。本组病例均有音哑,间接喉镜检查有喉粘膜弥漫性充血,声带呈浅红色,表面可见舒张血管,重者声带暗红或假声带与声带肥厚。治疗方法:患者正坐(或仰卧位),医者坐于患者对面偏右侧方。医者用右手拇指与食、中二指相对,轻柔着力,拿推夹喉穴(系颈前喉结旁开1.5寸,自上而下的两条线),自上而下     

慢性喉炎局部穴位电刺激治疗前后喉镜观察及声学分析

目的 观察穴位电刺激治疗慢性喉炎的临床疗效并探讨其应用价值。方法 采用韩氏穴位刺激仪对40例慢性喉炎(单纯性：22例;声带小结：18例(早期8例,后期10例)]进行人迎、合谷穴位刺激治疗,治疗前后分别行喉镜检查及声学测试,观察喉部病变及嗓音声学特征变化以评价疗效。结果 14例(35％)痊愈,声带病变消除,声学参数及语图正常;18例(45％)好转,声带病变减轻,声学参数值下降,语图逐渐恢复;8例(20％)无效,声带病变及声学特征无明显变化;总有效率达80％。其中单纯性喉炎有效率为91％,声带小结早期为87．5％,后期为50％。结论 局部穴位电刺激方法主要适用于治疗慢性单纯性喉炎及早期声带小结,具操作简单,无创伤、痛苦及疗效较显著等特点。     

Absence of bacterial infection in the mucosal secretion in chronic laryngitis

OBJECTIVES: To examine whether an infectious process is present in the laryngeal secretion in patients with chronic laryngitis. STUDY DESIGN: Mucosal secretion from vocal cords and ventricular folds from 14 patients with chronic laryngitis was examined. Twelve patients with healthy larynxes served as control subjects. METHODS: Secretion from the laryngeal mucosa was sampled with an imprint technique during general anesthetic. The samples were stained and examined by light and fluorescence microscopy. The numbers of leukocytes and bacteria and the extension of phagocytosis were estimated. RESULTS: In the secretion from eight of the patients with chronic laryngitis we could observe huge numbers of bacteria, whereas only few bacteria were seen in the secretion from the control subjects. However, in both groups, only a few neutrophils were observed and phagocytosis was not present, indicating that the bacteria were present as colonizers. CONCLUSIONS: No infectious process is present in the secretion in chronic laryngitis. Further studies concerning the pathogenesis should focus on the pathological processes or conditions of the mucosa.     

Symptoms, laryngeal findings, and 24-hour pH monitoring in patients with suspected gastroesophago-pharyngeal reflux.

OBJECTIVES: To investigate the laryngeal signs and symptoms associated with gastroesophago-pharyngeal reflux (GEPR). STUDY DESIGN: A prospective controlled study. METHODS: Nineteen healthy control subjects and 43 patients, 26 with posterior laryngitis (PL) and 17 with a normal larynx and suspected GEPR, were examined using videolaryngoscopy and 24-hour ambulatory dual-probe pH monitoring. RESULTS: Pharyngeal acid reflux occurred in 18 (69%) patients with PL, in 9 (53%) patients with a normal larynx, and in 5 (26%) healthy control subjects. Multiple-comparison procedure showed that pharyngeal reflux was significantly more prevalent in patients with PL than in the healthy control subjects (P < .05). The laryngoscopic findings in patients with pharyngeal reflux varied from normal mucosa to thickening or edema of the posterior wall of the glottis, which was the most frequent finding in the PL group. Erythema was uncommon; it was found only in patients with verified pharyngeal reflux. There was no difference in symptom profile between the patients with PL and patients with a normal larynx or patients with or without pharyngeal reflux. CONCLUSIONS: Pharyngeal reflux is significantly more prevalent in patients with posterior laryngitis than in healthy control subjects. Moreover, a certain degree of pharyngeal reflux appears to be a normal phenomenon. The most common laryngeal finding in patients with posterior laryngitis is thickening or edema of the posterior wall of the glottis. GEPR does not yield specific laryngeal symptoms. Thus, it is unreliable to base the reflux diagnosis on symptoms alone.     

Solacy and non-specific chronic laryngitis

Adult subjects, without age or sex distinction, presenting a non-specific chronic laryngitis were treated with SOLACY. The posology of SOLACY administered was: 2 capsules in the morning and 2 at night for four months in a row. The subjects were seen at least twice: one consultation before the treatment and one after the 4 months of treatment. These consultations included an interview and fibroscopic test of the laryngeal mucosa (photographs were taken). The subjects were also requested to quantify the overall discomfort experienced. Ten subjects were recruited for this study. Dysphonia was significantly lower after the 4-month treatment as was the self-evaluation of the overall discomfort brought on by the different symptoms. In addition, it can be noted that SOLACY lessened coughing and laryngeal discomfort in most of the patients treated and it improved the fibroscopic test results, especially concerning the congestive aspect of the laryngeal mucosa, whether limited to vocal chords or spread throughout the entire vestibule. The treatment was tolerated perfectly well. In conclusion, SOLACY, administered in adults presenting non-specific chronic laryngitis improves the state of the laryngeal mucosa and its main symptoms (dysphonia, coughing, laryngeal discomfort).     

Content of protein lactoferrin in precancer laryngeal disease

Lactoferrin was studied in 50 patients with laryngeal precancer: chronic hyperplastic laryngitis (n=28), leukoplakia (n=22). Lactoferrin was measured before the treatment, 10-12 days and 12 months after the treatment. Blood serum concentration of lactoferrin was significantly increased before the treatment. By the authors, it was due to inflammation in laryngeal tissues. Conservative treatment of patients with chronic hyperplastic laryngitis resulted in a considerable reduction in this protein concentration. Surgical removal of leukoplakias stimulated laryngeal inflammation and raised lactoferrin concentration in blood serum. One year after the examination, those patients who had neither exacerbation of chronic hyperplastic laryngitis no recurrent leukoplakia exhibited serum lactoferrin in concentrations close to the baseline but still higher than in healthy individuals. This is explained by chronicity of inflammation in laryngeal tissues. These findings can be used in diagnosis and prognosis of the disease course in patients with laryngeal precancer.     

Chronische Laryngitis und Carcinom

Summary 35 cases of a continuous series of 841 laryngeal cancers were studied separately. Those patients had already been suffering from hoarseness for more than 2 years, in the average for 9 years. Many of these patients had been examined and treated by inhalations, and biopsies were taken because of a chronic laryngitis. Clinically in half of the cases a big carcinoma could be found. In 10 cases a chronic laryngitis had been diagnosed; in spite of the preceeding examination by microlaryngoscopy in 4 cases, however, the carcinoma could only be proved by histologic examination.The histologic examinations of the specimen regularly displayed an extended field of epidermisation of the laryngeal mucosa following chronic laryngitis. In these fields of epidermisation the carcinoma developed multicentrically and — in the early stages — mostly showed a covering-like, minutely infiltrating growth. Disseminated dot-like cancer-focuses in the epidermisation field and cancer buds arising from the basal layers of an intact covering of the hypertrophic epithelium could be observed several times.Chronic-hypertrophic laryngitis seems to favour the development of cancer within some patients (promoting-factor), it even might accelerate it. As in about 6% of all the vocal cord cancers a preexistent chronic laryngitis is proved by history and clinical findings each patient with a chronic hypertrophic laryngitis must be examined by microlaryngoscopy as well as histological examinations and must be constantly observed.

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Auszugsweise vorgetragen von H. Glanz anläßlich der Jahrestagung der deutschen Gesellschaft für Hals-, Nasen-, Ohrenheilkunde, Kopf- und Halschirurgie, Wiesbaden, Mai 1975.     

The use of eurespal for the treatment of chronic laryngitis

The author provides a rationale for the use of eurespal for the treatment of chronic laryngitis based on the pathogenetic concept of pathological condition. The results of a clinical study designed to evaluate the efficiency and safety of eurespal therapy in patients with chronic laryngitis are presented.     

Role of the tumor marker TAG-72 in head and neck neoplasms

The serum glycoprotein TAG-72 level was determined in 34 patients with chronic laryngitis or ENT malignancy. This marker is in widespread use in cases of gynaecological and gastrointestinal malignancy. TAG-72 levels did not differ significantly either from the levels of healthy subjects or in the post-operative follow-up, so that this indicator appears to be of no clinical value in head and neck oncology.     

A comparative analysis of immune status in laryngeal cancer and chronic hyperplastic laryngitis

Examination of the immune system made in 148 patients with laryngeal cancer and 32 patients with chronic hyperplastic laryngitis has revealed that different laryngeal diseases are associated with immune diseases. Laryngeal cancer, unlike chronic laryngitis, demonstrated prevalent disorders of the effector mechanisms. However, dysgammaglobulinemia related to mucosal immunoglobulin A, can be considered as alteration associated with mucosal problems.     

Experiences with 'optical' biopsies of leukoplakia of the vocal folds

BACKGROUND: It is often difficult to distinguish leucoplakia from carcinoma or chronic laryngitis. In this study, we examined if color texture optical biopsies are able to detect leukoplakia reliably and to distinguish this from normal vocal fold tissue. METHODS: 25 images from patients with a normal larynx and 25 images from patients with leucoplakia were analysed retrospectively. The images were recorded with a rigid 90 degrees -laryngoscope (Wolf Typ 4450.571) during a clinical setting and were recorded by a S-VHS-videorecorder. With a software program (InSegT), regions with leucoplakia, normal tissue and suspicious tissue were manually marked. Within each marked region, the use of color texture analysis numeric features were calculated to characterize the surface in texture and color. Color histogramms (HST), Sum- and Difference histogramms (S/D), Statistical Geometric Features (SGF) and Grey-Value-Dependent-Matrix (GLDM) were used. PATIENTS: 29 women and 21 men (age 18 to 81 years, average of 53 years), who were examined in our clinic from 10/1999 - 8/2003, took part in this study. RESULTS: The automatized classification for color texture analysis resulted in 71 % for leucoplakia and 97 % for normal tissue. CONCLUSION: Optical biopsies can contribute to find the correct diagnosis. However, classification results must still get better when optical biopsies should be used in clinical practice.