Idiopathic ulcerative laryngitis causing midmembranous vocal fold granuloma

Idiopathic ulcerative laryngitis (IUL) is characterized by bilateral midmembranous vocal fold ulceration, which follows upper respiratory infection with cough. In contrast, granuloma of the membranous vocal fold can occur rarely following microlaryngoscopy, presumably secondary to surgical violation of deep tissue planes. We report a novel case of noniatrogenic membranous vocal fold granulation developing in a patient with IUL. Although the presence of granulation implied injury to the entire microstructure of the vibratory portion of the vocal fold, the lesion resolved with conservative management without adverse sequelae.     

Plasma cell polyp of the vocal fold

Plasma cell polyps of the vocal fold (plasma cell granulomas) are rare inflammatory polyps of the larynx. They should be included in the clinical and histological differential diagnosis of laryngeal polyps. Histologically they are polyclonal aggregates of plasma cells. It is essential to distinguish them from monoclonal, neoplastic plasma cell proliferations. The treatment of choice is surgical resection, although radiotherapy, laser ablation, antibiotics and steroids have been used successfully. We present a case of plasma cell granuloma presenting as a vocal fold polyp, treated surgically.     

CO2激光联合质子泵抑制剂治疗复发性声带突肉芽肿的疗效观察

目的 探讨CO₂激光联合质子泵抑制剂治疗复发性声带突肉芽肿的疗效。 方法 对复发性声带突肉芽肿患者28例,采用全麻支撑喉镜下CO₂激光手术,其中有胃食管反流症状16例,胃食管反流症状不明确12例,术后应用质子泵抑制剂抗胃酸反流治疗8~12周,术后随访1年观察疗效。 结果 28例术后声嘶、咽异物感等症状均有明显改善,病理证实均为肉芽组织。术后随访1年复查电子喉镜复发2例,给予埃索美拉唑40 mg/d口服1个月,肉芽肿明显缩小1例,肉芽肿未见进一步增大1例,无声嘶及异物感等喉部症状,未予再次手术治疗。 结论 胃食管反流是声带突肉芽肿术后复发的一个重要因素;CO₂激光手术联合质子泵抑制剂是治疗复发性声带突肉芽肿的一个有效方法,创伤小、复发率低。     

Vocal function after vertical partial laryngectomy with glottic reconstruction by false vocal fold flap: durational and frequency measures.

OBJECTIVE: Compare vocal function following vertical partial laryngectomy (VPL) with or without glottic reconstruction by false vocal fold (FVF) mucosal flap. STUDY DESIGN: Twenty-seven patients with Tla squamous cell carcinoma (SCC) of the glottis were included in a prospective randomized clinical study. All patients were treated by frontolateral partial laryngectomy (FLPL). Glottic reconstruction with FVF mucosal flap was performed in 14 patients at the time of the FLPL, whereas 13 patients had standard FLPL. METHODS: Objective voice assessment was based on computerized acoustic recordings performed before and 1 year after surgery. When possible, additional recordings were performed at 3 months, 6 months, and 2 years postoperatively. Incidence of postoperative granuloma and anterior neoglottic web were noted. Repeated analysis of variance (ANOVA) was used to compare the durational (maximum phonation time, speech rate) and frequency measurements (average fundamental frequency [Fo], standard deviation of Fo, jitter, shimmer, noise-to-harmonics ratio, degree of voice breaks) between patients with or without glottic reconstruction, postoperative granuloma, and anterior neoglottic web. Linear regression was used to study the evolution over time of the durational and frequency measurements. RESULTS: Frequency measurements improved with time and were significantly better in patients treated with glottic reconstruction. In addition, glottic reconstruction decreased incidence of postoperative granuloma and anterior neoglottic web. CONCLUSIONS: The FVF mucosal flap technique can improve vocal results in selected cases of Tla SCC of the glottis when FLPL is the adequate surgical treatment. false vocal folds; glottic reconstruction; vertical partial laryngectomy; vocal function.     

Fiberoptic laryngeal surgery for vocal process granuloma

We developed a technique of fiberoptic laryngeal surgery for the treatment of vocal process granulomas. In this system, the granuloma can be removed relatively easily and repeatedly under topical anesthesia on an outpatient basis. We treated 27 patients for a total of 4 intubation granulomas and 23 contact granulomas. Ten of the 23 contact granulomas recurred after the initial surgery, but the intubation granulomas did not recur. Most of the recurrent lesions were resolved by fewer than 3 procedures, and all patients were finally cured. Although conservative therapies such as voice therapy and proton pump inhibitors have recently prevailed, surgical removal remains useful in treating vocal process granulomas. Fiberoptic laryngeal surgery facilitates repeated surgical procedures.     

Surgery and proton pump inhibitors for treatment of vocal process granulomas

The aim of this study was to analyze the outcomes of vocal process granulomas treated with surgery and proton pump inhibitors and to specify related factors of recurrence. The medical records of patients with diagnosis of vocal process granuloma between 2000 and 2012 were reviewed. All patients were treated with surgery and proton pump inhibitors for at least 1 month. Forty-one patients were reviewed; mean follow-up time was 45 months. There was no recurrence among the patients who had a recent history of intubation. The recurrence rates of contact granuloma was 38.7 %, and significantly related to the frequency of surgery (P = 0.042), but was not significantly associated with the history of acid reflux (P = 0.676) and vocal abuse (P = 0.447), lesion size (P = 0.203) or surgical techniques (P = 0.331). Surgery combined with proton pump inhibitors was partially effective for the vocal process granulomas, especially with intubated patients. However, repeat surgery for recurrent contact granuloma should be preceded with caution due to high recurrence rates.     

Anterior and posterior medialization (APM) thyroplasty

OBJECTIVE: In unilateral vocal fold paralysis with dysphonia, most of the paralyzed vocal folds may be medialized effectively by medialization laryngoplasty. However, if the posterior glottal gap is wide, these procedures may sometimes have a limit to medialize the posterior glottis and cannot be effective for acceptable voice quality. The objective of this study is to introduce a new surgical technique for medializing the membranous and cartilaginous portions of the paralyzed vocal fold: anterior and posterior medialization (APM) thyroplasty. METHOD: Six patients underwent APM thyroplasty. They completed preoperative and postoperative evaluation with acoustic analysis and video laryngoscopy. RESULTS: All patients satisfied their voice subjectively after surgery. The paralyzed vocal folds, membranous and cartilaginous parts, were medialized well, and the paralyzed arytenoid showed less anterior tipping postoperatively. On voice analysis all patients showed prolonged phonation times and decreased perturbations after surgery. CONCLUSION: The advantages of this procedure are to medialize the membranous and cartilaginous portions of the paralyzed vocal fold directly and to correct vertical mismatch between two vocal folds. This procedure might be especially indicated in the lateralized position of the paralyzed vocal fold but not in the higher paralyzed vocal fold compared with the normal vocal fold.     

In vivo engineering of the vocal fold extracellular matrix with injectable hyaluronic acid hydrogels: early effects on tissue repair and biomechanics in a rabbit model

OBJECTIVES: A prospective, controlled animal study was performed to determine whether the use of injectable, chemically modified hyaluronic acid (HA) derivatives at the time of intentional vocal fold resection might facilitate wound repair and preserve the unique viscoelastic properties of the vocal fold extracellular matrix. METHODS: We performed bilateral vocal fold biopsies on 33 rabbits. Two groups of rabbits were unilaterally treated with 2 different HA derivatives--Carbylan-SX and HA-DTPH-PEGDA--at the time of resection. Saline was injected as a control into the contralateral fold. The animals were painlessly sacrificed 3 weeks after biopsy and injection. The outcomes measured included histologic fibrosis level, tissue HA level, and tissue viscosity and elasticity. RESULTS: The Carbylan-SX-treated vocal folds were found to have significantly less fibrosis than the saline-treated controls. The levels of HA in the treated vocal folds were not significantly different from those in the controls at 3 weeks as measured by enzyme-linked immunosorbent assay. The Carbylan-SX-treated vocal folds had significantly improved biomechanical properties of elasticity and viscosity. The HA-DTPH-PEGDA injections yielded significantly improved viscosity, but not elasticity. CONCLUSIONS: Prophylactic in vivo manipulation of the extracellular matrix with an injectable Carbylan-SX hydrogel appears to induce vocal fold tissue regeneration to yield optimal tissue composition and biomechanical properties favorable for phonation.     

Videoendoscopic laryngeal surgery

This paper introduces videoendoscope-assisted laryngeal surgery with office-based equipment. With this technique, a patient is seated and the nose, pharynx, and larynx are topically anesthetized. A flexible videoendoscope with a light-sensitive charge-coupled device chip built into the tip is transnasally inserted by an assistant. Specially designed fine-tipped forceps and scalpels were developed for removal of laryngeal lesions. Videoendoscopic laryngeal surgery was undertaken in 114 cases of laryngeal lesions such as polyps, granuloma, and cancer. For benign vocal fold lesions, postoperative vocal function was shown to be improved on aerodynamic and perceptual analyses. For laryngeal tumors, biopsy of the lesion was easily undertaken. Videoendoscopic laryngeal surgery presents the following advantages. It is applicable to outpatients not requiring general anesthesia, it enables functional monitoring of the patient's voice and vocal fold during phonation, it allows for delicate manipulations with both hands, and it gives high-resolution images in comparison to conventional fiberscopy.     

Contact granulomas of the larynx

Ten cases of intubation granulomas and eight cases of contact granulomas not related to intubation were reviewed for the purpose of clinical analysis and pathological investigation. Granulomas were located primarily at the vocal process of the arytenoid cartilage. Additionally, 58 hemilarynges obtained from 37 cadavers with intubation granulomas were evaluated grossly and histopathologically. The intubation granulomas had no side predilections. All eight contact granulomas occurred in males and had a higher incidence of recurrence (three of eight cases) despite complete removal with laser surgery. In an attempt to explain recurrences of these contact granulomas, all three cases were studied clinically and pathologically. Results indicated that they recurred in singers and vocal abusers, and presumably resulted from the continued hammering of one vocal process against the other. Analysis also demonstrated that vocal rehabilitation was essential prior to or immediately after removal of the granuloma to prevent its recurrence. Pathological evaluation of the contact granulomas revealed focal ulceration and a covering of necrotic tissue with desquamating epithelium. The propria mucosa was edematous and infiltrated by chronic inflammatory cells and neutrophils forming focal granulation tissue in a stroma containing proliferated capillaries. Pathological features around local ulcerations were typical of a secondary granuloma while underlying arytenoid cartilage was partially necrotic.This paper was adapted from an extraordinary meeting of Colloquia and Workshops on Laryngeal Disorders, Johns Hopkins Medical Institutions, Baltimore, Md., USA, 10–12 September 1992     

硫酸锌治疗声带突肉芽肿的疗效分析

目的探讨硫酸锌治疗声带突肉芽肿的疗效。方法2007-2012年对15例声带突肉芽肿患者给予饭后服用硫酸锌口服液100 ml（含硫酸锌200 mg）,3次/d,服药直至声带突肉芽肿消失。此后每月复查电子喉镜,3个月后每3个月定期复查,随访1年。根据喉部声带突肉芽肿的标准对患者进行分类,对比治疗前后图像,观察疗效。结果12例1个月内肉芽肿消失;3例1个月内肉芽肿缩小,其中2例2个月内消失,1例3个月内消失。治疗后所有患者声嘶、咽痛、咽异物感、咳嗽不适等症状均有明显改善。15例随访1年未见复发及并发症。结论硫酸锌是治疗声带突肉芽肿的一种安全有效的方法,尤其对手术后复发者疗效显著,不失为一种有效的治疗及补救措施。     

成人气管插管后喉肉芽肿的临床分析

目的探讨成人气管插管后喉肉芽肿的形成原因及诊疗方法。方法回顾性研究1996年1月-2006年12月诊治的8例气管插管后喉肉芽肿成人患者，分析其气管导管口径和留置时间与发生插管后喉肉芽肿的关系，总结诊疗经验体会。结果所有患者所用气管导管均为F28-F30；导管留置2-23h，平均7．4h。全部病例均有拔管后的迟发性声嘶发生；喉肉芽肿物多位于声带突处，6例为单侧，2例双侧。均先予以保守治疗，2例经保守疗法治疗而痊愈，另6例经手术切除而治愈。肉芽肿组织病理学表现为炎性肉芽肿。经随访观察1年以上，所有病例的喉肉芽肿均完全消失而无复发。结论结合气管插管史，综合分析咽喉部症状特别是迟发性声嘶和喉镜检查所见，即可确诊。保守治疗或手术切除均可获得良好疗效。     

低温等离子射频技术治疗双侧声带突肉芽肿

目的：探讨低温等离子射频消融技术治疗声带突肉芽肿的方法及疗效。方法回顾性分析2012年9月收治的声带突肉芽肿1例,采用全麻支撑喉镜下低温等离子射频消融技术治疗。结果患者手术安全,病变切除完全,术后恢复顺利,随访1年无复发。结论低温等离子射频消融治疗声带突肉芽肿创伤小,患者痛苦小,喉功能保存好。     

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.     

CO2激光在喉部手术后并发声带粘连的相关因素分析及预防

目的　探讨CO2激光喉显微手术后发生声带粘连的影响因素。方法　选择2012年10月～2016年12月我科采用CO2激光治疗219例喉部病变患者作为研究对象,就性别、年龄、病变性质、病变部位、激光功率和术后肉芽增生等相关因素,分析其与声带粘连的关系,并进行统计学分析。结果　219例患者中发生声带粘连31例,发生率为14.16%。术后声带粘连与病变性质、病变部位、激光功率、术后是否有肉芽增生等因素有关。结论　喉部病变CO2激光应根据不同的病变性质及病变部位,采取适当的手术方式和切割功率,术中、术后采取必要的综合措施,有助于减少术后声带粘连的发生。     

Voice function following CO2 laser microsurgery for precancerous and early-stage glottic carcinoma

CONCLUSIONS: With the cover layer injured, vocal function of mucosal ablation could be protected and even return to normal after surgery and vocal function of mucosal stripping was slightly affected with extensive mucosal injury. Once the body layer was injured, the compensatory mechanism would play an important role in phonation. OBJECTIVES: To investigate voice function following CO2 laser microsurgery for precancerous and early-stage glottic carcinoma. PATIENTS AND METHODS: Vocal function was examined by acoustic analysis, aerodynamic analysis and videostroboscopic examination. RESULTS: For mucosal ablation, vocal quality recovered 1 month after surgery. For mucosal stripping, although vocal quality was steady 3 months after surgery, slight hoarseness persisted in this group. The contour of the treated fold recovered postoperatively. There were no complications in recovery. For cordectomies, vocal quality became steady 6 months after the surgery. The supraglottal hyperfunction with supraglottal structure squeezing played an important role in phonation. The affected vocal fold mucosal wave was absent instead of a regular ventricular fold wave or mucosal wave of the vocal process during phonation. In comparison with the type III-IV cordectomy, the results of extended cordectomies (type Va and Vc) were worse; however, the difference was not statistically significant. Granulomas and anterior commissure webs were present. All granulomas resolved spontaneously 3 months postoperatively.     

Vocal fold granuloma induced by rigid bronchoscopy

Vocal fold granulomas secondary to endotracheal intubation, vocal abuse, and laryngopharyngeal reflux are a well-described cause of hoarseness, generally in the adult population. The mean age of onset is usually in the fourth or fifth decade, and the position is most commonly on the vocal process or one of the arytenoids. We present an atypical case involving a pediatric patient with a large, anterior, true vocal fold granuloma following rigid endoscopy of the upper conductive airway.     

支撑喉内镜联合喉吸切割系统在喉微创手术中的应用观察

目的：观察支撑喉内镜联合喉吸切割动力系统在喉良性增生性病变切除术中的应用效果。方法回顾性分析2009年12月～2013年8月本院在支撑喉内镜下联合使用美敦力喉吸切割动力系统完成的喉良性增生性病变切除术178例,总结其应用效果。所有患者于术后均适当禁声,并予以雾化吸入及中药甘桔冰梅片口服等综合治疗。结果本术式操作简便,视野清晰精确,所有手术均一次成功,治愈率高达95.5%,仅1例声带白斑患者2个月后出现病变复发并发生癌变,改行一侧声带激光切除术,其他均痊愈。结论支撑喉内镜联合喉吸切割系统切除喉的良性增生性病变,具有视野清晰、无盲区、操作便捷、精确度高、并发症少、疗效肯定等优点,值得临床推广。     

Vocal process granuloma and glottal insufficiency: An overlooked etiology?

Objectives/Hypothesis:

Vocal process granuloma has been attributed to intubation, laryngopharyngeal reflux, and phonotraumatic/hyperfunctional vocal behaviors. Vocal process granuloma has recurrence rates following surgical excision approaching 92%. We hypothesize that a portion of persistent or idiopathic cases of vocal process granuloma result from underlying glottal insufficiency (GI) caused by paresis, scar, or atrophy. Our goal was to examine our vocal process granuloma population and determine the incidence of GI, treatment interventions, and outcomes.

Study Design:

Retrospective chart review.

Methods:

Thirty‐four patients with vocal process granuloma were divided into surgically or conservatively managed groups. Patients were identified if they carried a diagnosis of GI. The time to resolution and number of recurrences within the overall treatment period was recorded and compared between subgroups. Pre‐ and post‐treatment Voice Handicap Index‐10 (VHI‐10) and Reflux Symptom Index (RSI) scores were compared.

Results:

Eighteen of 34 patients (53%) carried an underlying diagnosis of GI, 13/34 (38%) were treated surgically, and 8/13 (62%) surgical patients had underlying GI. VHI‐10 and RSI scores significantly improved after disease resolution (P < .05).

Conclusions:

The incidence of GI among patients with vocal process granuloma was 53%. Conservative therapies including treatment of laryngopharyngeal reflux and voice therapy may lead to resolution despite underlying glottal incompetence. If conservative measures fail, recognizing and treating glottal incompetence with true vocal fold augmentation may lead to a shorter surgical treatment course. Laryngoscope, 2010