Abductor spasmodic dysphonia (AbSD) is characterized by voice breaks, an involuntary breathy voice quality and difficulty coordinating respiration with phonation. The phenomenon is caused by the involuntary abduction of the bilateral vocal folds with inadequate and excessive activity of the bilateral posterior cricoarytenoid muscle (PCA). We herein report 2 patients (a 29- and 39-year-old woman) with AbSD whose condition was improved surgically by hemilateral thyroplasty type III (shortening of the thyroid lamina and rendering the vocal folds relaxed). The effects of the surgery on their voice quality were conserved for a long time (2 years in the 29-year-old and 5.5 years in the 39-year-old). Shortening the vocal fold through this surgery might suppress the excessive sensitivity of the muscle spindles of the PCA, thereby enabling control of the abnormal abductor movement of the vocal folds during speech.
We herein report two cases of laryngeal tuberculosis.
Case 1: A 61-year-old woman presented to our clinic with a chief complaint of hoarseness for 2 months. She had no history of tuberculosis. Based on her subjective symptoms and the findings on laryngeal fiberscopy, a laryngeal granuloma induced by gastroesophageal reflux was suspected. Since her symptoms and laryngeal findings did not improve on treatment with a proton pump inhibitor for one month, she was hospitalized to undergo laryngeal granuloma resection. A pre-operative chest X-ray revealed abnormal lung shadows suggestive of pulmonary tuberculosis. A polymerase chain reaction (PCR) examination was positive for Mycobacterium tuberculosis DNA. A diagnosis of pulmonary tuberculosis was confirmed.
Case 2: An 87-year-old man presented to our clinic with a chief complaint of coughing. He did not report a history of tuberculosis. Based on the findings on laryngeal fiberscopy, we initially suspected bacterial laryngitis or a laryngeal tumor. His symptoms and laryngeal findings did not improve on treatment with antibiotics for 11 days. Since we had already encountered Case 1, we ordered a chest X-ray study and a bacteriological examination under suspicion of laryngeal tuberculosis. The patient’s chest X-ray showed evidence of pulmonary tuberculosis, and a diagnosis of pulmonary tuberculosis was confirmed by a positive PCR finding of Mycobacterium tuberculosis DNA.
Based on these two cases, we propose the following algorithm: When a patient presents with symptoms and findings on laryngeal fiberscopy making it difficult to determine whether it is a laryngeal tumor or laryngitis, we should initially perform conservative treatment with drugs. If symptoms do not improve, a diagnosis of laryngeal tuberculosis should be suspected. In such cases, for the early diagnosis and to prevent the further spread of infection, we should perform an imaging study such as chest X-ray, and a bacteriological examination before performing a biopsy in order to rule out a laryngeal tumor.
Aspiration pneumonia is a common complication during the management of head and neck cancer, especially with chemoradiotherapy (CRT)． Once aspiration pneumonia develops, it can lead to the deterioration of the general condition of the patient and forced interruption of therapy. Thus, the early detection and management of aspiration pneumonia is important. In this retrospective study, 121 patients who were hospitalized to undergo CRT for head and neck cancers in our department between 2010 and 2016 were divided into two groups: the aspiration pneumonia group and a control group. The purpose of this study was to identify the risk factors related to the onset of aspiration pneumonia. We compared the two groups with respect to 14 variables, including the patients’ age and sex. We identified five significant risk factors: multiple cancers, pre-treatment anemia, sleeping-pill use, high Brinkman index, and a low albumin level. It is important to establish the risk of aspiration pneumonia in patients with head and neck cancers before CRT is administered. The swallowing function should be assessed, especially in high-risk patients, and aspiration pneumonia should be prevented by swallowing rehabilitation and alternative methods of food preparation during hospitalization.
Laryngeal chondroma is rare benign tumor. A 73 -year-old male patient was referred to Saga University Hospital with a diagnosis of class V malignancy based on fine-needle aspiration cytology. The patient complained of a moving cervical mass when he swallowed. Computerized tomography showed a mass at the cricoid cartilage with cartilage destruction. Malignancy was suspected; thus, we attempted to remove the tumor completely. During surgery, we found that the mass had arisen from the upper edge of the cricoid arch and extended to the endolarynx. However, the tumor was well defined with a capsule and no invasion of surrounding tissue was observed. The histopathological diagnosis, based on the examination of frozen sections, was chondroma.We removed the mass with part of the cricoid cartilage. The histological examination of the excised tumor confirmed that there was no evidence of malignancy. The postoperative course was good and neither laryngeal stenosis nor dysphagia was observed. No recurrence was observed in the year after the tumor was removed. The examination of intraoperative frozen tissue specimens is useful for diagnostic purposes; however, we must be aware that it is difficult to distinguish chondroma from low-grade chondrosarcoma in a histological examination.