We retrospectively reviewed 27 patients with laryngeal granulomas who were surgically treated at the Kurume University Hospital between November 1990 and January 2011. There were 17 men and 10 women whose ages ranged from 23 to 75 years (median : 52.5 years). The chief symptoms were hoarseness in 20 cases (74.1%), dyspnea in 9 (33.3%), pharynx incongruity in 4 (14.8%) and cough in 1 (3.7%). Causes of the disease were intubation in 13 cases (48.1%), voice abuse in 3 (11.1%), gastro-esophageal reflux disease in 2 (7.4%), cough and injury in one, respectively. While the posterior glottis was the most frequent site of granuloma development, as found in 20 cases (74.1%), there were a few cases of development in the membranous potions of the anterior commissure and subglottis. With regard to the size of the granulomas, 10 to 14mm was the most frequent occurrence, thereby indicating surgery. Post operative recurrence was observed in 12 cases (44.4%), but they recovered by conservative treatment in most cases. In the analysis of recurrence according to the cause of granulomas, a “temporary stimulus” such as intubation and injury revealed lower rate than cases where granuloma were caused by a “repetitive stimulus” such as vocal abuse, reflux of stomach acid and cough (p=0.05). Excision with cold instrument (knife or scissors) had a lower rate of recurrence than excision with CO2 laser. Steroid injection into the wound after excision showed a lower rate of recurrence in granulomas by temporary stimulus, and showed a significantly lower rate than CO2 laser vaporization to the wound (p=0.01).
The causes of age-related hoarseness include 1) a decreased amount of mucus covering the vocal cord surface; 2) a decreased content of hyaluronic acid in the superficial layer of the vocal cord lamina propria ; and 3)） age-related atrophy of the vocal cord. Patients with presbyphonia resulting from the second or third causes listed above often show evidence of vocal cord atrophy, such as imperfect closure of the glottis and reduced duration of glottal closure. Some of the middle-aged and older patients with little evidence of vocal cord atrophy have relevant endoscopic findings and/or subjective symptoms, such as sputum sticking sensation during speech and dry mouth. Saliva keeps the vocal cord mucosa moist and serves as a lubricant during speech. Only a limited number of studies have examined the relationship between reduced moisture content of the vocal cord mucosa associated with hyposalivation and the development of presbyphonia. The objective of this study was to evaluate the effectiveness of sialagogue pilocarpine hydrochloride in improving vocal function in patients with vocal disorders considered to be caused by reduced moisture content of the vocal cord mucosa due to hyposalivation. This study included 20 patients aged 60 years and up who were complaining of hoarseness suspected to be the result of reduced secretion of laryngeal mucus and who displayed no apparent space-occupying lesion or vocal cord atrophy. Pilocarpine hydrochloride administered via tablets 1-3 times daily for 4 weeks resulted in increased saliva secretion as well as significant improvement in VHI and acoustic parameters. The results demonstrate the efficacy of pilocarpine hydrochloride for promoting saliva secretion in the treatment of presbyphonia.
Spasmodic dysphonia (SD) is a focal dystonia that affects the larynx. Abductor SD (ABSD) is less common than adductor SD (ADSD). ABSD is typified by breathy breaks in connected speech. A male professional classic baritone singer, age 46, presented with gradually increasing breathy unphonated breaks in singing over the course of three years. He visited various institutions and was said to have incomplete elevation of the soft palate of unknown origin, myasthenia gravis, etc. His symptoms were remarkable in pronouncing vowels following unphonated consonants. He had been exposed to neither vocal abuse nor heavy singing performances. Our diagnosis was ABSD. An injection of Botulinum toxin (BT) into the posterior cricoarytenoid muscles was done via lateral cervical approach. His voice improved remarkably. His daily conversation became smooth; however, he could not regain his previous brilliant singing voice. He was obliged to discontinue his professional singing performances.
In recent years, the occurrence of chronic cough patients with accompanying allergic factor has increased. The main causes of these patients’ symptoms are laryngeal allergy, atopic cough, cough variant asthma and classic bronchial asthma. We observed a case of chronic cough of unknown cause that was initially suspected to be the result of laryngeal allergy. A forty-seven-year-old female complaining of a persistent dry cough for seven months visited our clinic. She had Japanese cedar hay fever with a higher level of serum specific IgE to cedar pollen. No abnormal findings were found in CT and X-ray imaging of her chest. Peroral ingestion of H1 blocker, bronchodilator, proton pump inhibitor, antibiotics, minor tranquilizer and cough remedy were entirely ineffective and the patient was diagnosed as having a cough of unknown cause. Peroral ingestion of Bakumondoto (Mai Men Dong Tang), a Chinese blended medicine and 1% codeine phosphate hydrate powder showed tremendous effectiveness. The combined treatment of the two medicines was found to be an effective therapy for such case of chronic cough of unknown cause.