A clinical study was carried out on 93 patients with nasal allergic symptoms from birch pollen (birch pollinosis). It is well known that patients with birch pollen nasal allergy frequently have oral symptoms after fruit and vegetable ingestion, which has been termed oral allergy syndrome (OAS). Recently, the number of OAS patients has been gradually increasing in Hokkaido Prefecture. In this study, we have focused on the relationship between birch pollen nasal allergy and laryngeal allergy, especially the difference between the patients with and without OAS. The clinical symptoms of seasonal rhinitis and the presence of the specific anti-birch IgE antibody confirmed the diagnosis by CAP-RAST testing. Oral hypersensitivity to fruits and vegetables was examined by means of interviews and questionnaires. We also examined the symptoms related to laryngeal allergy according to the criteria proposed by the Society of Study for Laryngeal Allergy in Japan (1995). It was found that the birch pollinosis patients with OAS complained of foreign-body sensations in the larynx more frequently than those without OAS. About 60% of the birch pollinosis patients were diagnosed as having laryngeal allergy. Twelve out of 35 (34%) birch pollinosis patients without OAS and 42 out of 58 (72%) patients with OAS were diagnosed as having laryngeal allergy. It is considered clinically important to establish criteria for laryngeal allergy and OAS.
Laryngeal granuloma is a lesion with a great tendency to recur. The optimal treatment of this disease remains controversial. This study evaluates the therapeutic results of voice therapy over a period of three years. The case group consisted of thirteen patients with laryngeal granuloma, 10 male and 3 female with a mean age of 54.1 years. Six patients had undergone one or more microlaryngeal surgical treatments before receiving voice therapy. The accent method of voice therapy was conducted for the patients with a complimentary conservative approach including dietary and medical therapy for gastroesophageal reflux. Ten patiants (77%) had complete resolution of granulomas and the others had partial resolution. No recurrence has been observed in the patients who had achieved complete dissapearance of the granulomas. Phonatory functions were examined before and after the voice therapy. Fundamental frequency showed a decrease following the therapy. Whereas, maximum phonation time, intensity, AC/DC ratio, mean flow rate, and subglottal pressure showed little change. These results support the voice therapy as a mainstay of treatment for laryngeal granuloma.
The purpose of treating an acute injury to the larynx is to maintain airway and voice quality. Three cases of thyroid cartilage fracture without overlying mucosal disruption are reported. The first patient had a single and displaced fracture of the upper portion of the right thyroid lamina and did not require open reduction. The second patient had multiple and non-displaced fractures of the bilateral thyroid lamina and required open reduction. The third patient had a single and displaced fracture of the left thyroid lamina. This third case presented a voice disorder with a limitation in pitch range and required open reduction and fixation by sutures placed through the cartilage. All three cases did not manifest immediate nor delayed airway problem and maintained post-treatment quality of voice. The indication of open reduction for thyroid cartilage fracture without overlying mucosal disruption should be determined by the voice disorder following laryngeal trauma, rather than the type of fracture (single or multiple, displaced or non-displaced).
This article reviews the basics of 3 dimensional computed tomography (3D-CT) and its application for non-neoplastic laryngeal disease. A wide variety of 3D-CT images can be obtained with the use of helical or multislice-helical CT scans. Images that are especially useful are derived from multiplanner reconstruction (MPR) and virtual endoscopy. The combination of both techniques enables us to obtain accurate anatomical information on the basis of virtual reality, and to help plan phonosurgery. Such anatomical information that can be comprehensively evaluated include : severity of vocal fold atrophy, location and extent of laryngeal stenosis, size of the laryngeal ventricle, relative location of vocal folds and arytenoid cartilage to the thyroid cartilage, and the height of the paralyzed vocal fold. These characteristics are not adequately evaluated with only the use of laryngoscope, even though it is a golden-standard for diagnosis of laryngeal disease. At present, there are several limitations with 3D-CT. 3D-image reconstruction takes much time and skill. The movement of vocal folds cannot be evaluated, since time resolution is insufficient. These limitations still prevent 3D-reconstruction to be a widely used modality. However, as a modality for preoperative evaluation of phonosurgery, 3D-reconstruction images are already in practical use, making up for laryngoscope shortcomings.
In order to investigate the usefulness of three-dimensional CT images for assessment laryngeal cancer, we made multi-planar reconstruction (MPR) images and three-dimensional CT images using conventional helical CT and multi-slice CT, and conducted imaging diagnoses of the developmental range of the cancer. Comparisons between conventional helical CT images and multi-slice CT images and with large specimens of the extracted larynx are reported here. (1) MPR images were useful for diagnosis of the developmental range of laryngeal cancer, and the findings were almost identical to the analyses of the large specimens. Coronary and sagittal section images were particulary useful for diagnosis of cancer development in the superior and inferior directions in the glottis. Axial section images were useful for diagnosis of infiltration into the thyroid cartilage and the development to the extra-larynx. (2) Multi-slice CT images improved the ability of spatial resolution over that of conventional helical CT images, and displayed the developmental range of tumors more clearly. The CT time was shorter and MPR images could be extracted while vocalizing, breathing at rest, and holding breath. Dynamic evaluation was possible. (3) Imaging-facilitated understanding of the developmental-range of a tumor three-dimensionally. Multi-slice CT images were especially superior in the quality and three-dimensional condition.
Purpose : The purpose of this study is to assess the value of MR perfusion studies using dynamic MRI and pharmacokinetic analysis for the prediction of patient outcome in head and neck cancers before conventional radiation therapy. Materials and methods : Dynamic MRI of eighteen, until that time clinically untreated, T2 head and neck tumors were performed. The raw data of time/signal intensity curve from each tumor was analyzed and pharmacokinetically defined permeability index (k), and extracellular space/vascular space ratio (f) were estimated. All 41 patients were treated with definitive radiation therapy (60-72 Gy) using 3MV linac X-ray. The initial radiation effect was determined at four weeks after the termination of radiation therapy. MR parameters and initial radiation effects were correlated. Results : Ten tumors showed complete response (CR), three of which showed early recurrence within 6 months, six tumors showed partial response (PR), and two tumors showed no change (NC) after radiation therapy. There was a significant difference in the permeability index (k) between CR group and PR/NC group (CR group; 0.0352±0.0133 vs PR/NC group; 0.0176±0.0078, p<0.05). Conclusions : Pharmacokinetic analysis of pretreatment dynamic MRI scans of head and neck tumors is a non-invasive and potential method to predict tumor radiation response.
A reconstructive procedure was performed after subtotal laryngectomy due to T3 supraglottic carcinoma. An osteomuscular flap was designed to reconstruct the defective larynx in order to preserve the laryngeal function. In the patient, the contralateral hyoid bone, along with the sternohyoid muscle, was used to reconstruct the resulting defect. This osteomuscular flap provided bulk for the posterior glottic to prevent aspiration, while the maintenance of the glottic remnant preserved an adequate airway and phonation. Mobilized pyriform sinus mucosa and neck skin flap covered a new glottis. Early decannulation and satisfactory voice quality were archived in this case. Conservative laryngectomy means complete resection of the tumor and reconstruction of the essential laryngeal function (sphincteric, phonatory, and respiratory). The method of maintaining one movable arytenoid and one normal vocal cord during surgical treatment of T3 supraglottic carcinoma achieves the goal of satisfactorily reconstructing the essential laryngeal function.
Tracheoesophageal anastomosis is a preventive surgical procedure that can be administered for the purpose of improving the quality of life (QOL) for those with continuous dysphagia. Lindeman's tracheoesophageal anastomosis is advantageous in that it facilitates the confirmation of recovery via videofluoroscopy and it is reversible operation. We report our experience with 67-year-old male patient who had been suffering with hypopharyngeal cancer at the T2N1 stage located from the left piriform sinus to the posterior cricoid. Lindeman's tracheoesophageal anastomosis was performed for continuous dysphagia after a partial pharyngo-laryngectomy. This method succeeded in the recovery of natural phonation. Voice was produced by means of false vocal folds.
Mass screening examinations for the detection of early laryngeal cancer were carried out five times in the past 20 years in Fukui prefecture. A total of 1452 people, 1003 male and 449 female, ranging from 30 to over 90 years of age, underwent the examination. 14 glottic laryngeal cancers were detected. Of those 14 cases, 13 were Tis or Tla cases and one was a T3. Thus, approximately 1% of the population studied was identified as having laryngeal cancer. As mentioned in previous reports, this rate was considerably higher than that reported for cancer screening for other organs. Thirteen patients, those diagnosed with Tis or Tla, were cured of cancer by radiation therapy only. Their larynxes were preserved. Therefore, this mass screening contributed to curing patients with laryngeal cancer while preserving their larynxes. On the other hand, this screening process had several weak points, such as the small absolute number of examinees, the high relative number of examinees who were not in a high-risk group and few subsequent checkups for patients with benign laryngeal disease. Taken together, mass screening examinations have proved useful for early detection of laryngeal cancer, and should be continually refined to overcome faults.
We report a case with associated laryngeal paralysis due to a dural arteriovenous fistula near the left jugular foramen. The patient was a 59-year-old male with left-sided recurrent nerve palsy, left-sided glossopharyngeal nerve palsy, left-sided sensorineural hearing loss, pulsating tinnitus and headaches. Although CT examination of the skull base revealed a single mass (φ15mm) near the left jugular foramen, further MRI examination revealed flow void signals at the lesion. The clinical symptoms, such as glossopharyngeal nerve palsy and sensorineural hearing loss, had fluctuated before treatment. MRI findings and symptoms differed from the characteristic progress of head and neck tumors; therefore, we suspected it to be angiectopia. We performed a cerebral angiography. Examination by angiography revealed a dural arteriovenous fistula near the left jugular foramen. We performed the embolotherapy via the artery for the arteriovenous fistula. After the therapy, the arteriovenous fistula disappeared and the clinical symptoms improved.
A 58-year-old woman with diffuse goiter underwent an expansive laminectomy of the spinal canal under general anesthesia in the prone and head down position. Her trachea was intubated uneventfully with a spiral tube (7.0-mm I.D.), and the cuff was filled with air (3 ml). It took 2 hours and 40 minutes to finish the surgical procedure. After extubation, stridor was noticed. Flexible laryngoscopic examination revealed stenosis of the glottis caused by bilateral laryngeal nerve paralysis, and a tracheotomy was performed. The paralysis disappeared within two weeks and the tracheal stoma was closed. The cause of the laryngeal nerve paralysis after endotracheal intubation is usually considered to be a local circulatory disorder produced by the endotracheal tube and cuff. In this case, however, the patient with diffuse goiter condition and the head down position may have been causes of the paralysis, because the other possible factors were negligible.
Cicatricial pemphigoid is a chronic, vesiculobullous disease characterized by blisters or bullae, primarily involving the oral cavity, pharynx, esophagus, conjunctiva, or rectum with a tendency toward scar formation. It is, however, rare for scarring in the larynx to occur. A case of supraglottic stenosis caused by cicatricial pemphigoid, which appeared in a 60-year-old male patient, was reported. Conservative treatment was performed, but trismus caused by scarring of the buccal mucosa and by supraglottic stenosis did not improve. Operative treatment was done with a diode laser under general anesthesia, and the supraglottic stenosis was removed without surgical hazard to the vocal cord. 15 months after the operation there has been no sign of recurrence of stenosis.