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Objectives@#. This study aimed to assess predictors of the response to varying durations of proton pump inhibitor (PPI) use and lifestyle modification treatment for laryngopharyngeal reflux disease (LPRD). @*Methods@#. Between October 2014 and June 2016, a prospective, multicenter, open-label, single-cohort, intention-to-treat, observational study was conducted at eight referral hospitals across the Republic of Korea to examine predictors of early and late response to treatment in adult patients (age ≥19 years) with LPRD. Participants underwent standard treatment (PPI [Esomezol] and lifestyle modification) for 3 months. Response to treatment was defined as greater than 50% improvement in reflux symptom index score. The primary outcome was potential predictors of treatment response at 1 and 3 months. The secondary outcome was potential predictors distinguishing early from late responders. @*Results@#. In total, 394 patients were enrolled. Improved sleep habits was a positive predictor (odds ratio [OR], 1.785; 95% confidence interval [CI], 1.06–3.007; P=0.029), while initial alcohol consumption (OR, 0.587; 95% CI, 0.355–0.969; P=0.037) and past medication history (OR, 0.438; 95% CI, 0.215–0.891; P=0.005) were negative predictors of response after 1 month of treatment. High pre-reflux finding score was a positive predictor (OR, 1.187; 95% CI, 1.049– 1.344; P=0.007), while male sex (OR, 0.516; 95% CI, 0.269–0.987; P=0.046), higher depression score (OR, 0.867; 95% CI, 0.784–0.958; P=0.005), and past thyroid hormone medication history (OR, 0.161; 95% CI, 0.033–0.788; P=0.024) were negative predictors of response after 3 months of treatment. Past medication history (OR, 0.438; 95% CI, 0.215–0.891; P=0.023) was the only negative predictor for early responders compared to late responders. @*Conclusion@#. Adult patients with LPRD and a history of prior medication use may require longer treatment durations to achieve a therapeutic response. Future research should explore the incorporation of diverse treatment approaches to improve treatment outcomes for patients exhibiting negative prognostic indicators.
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Background and Objectives@#Vocal fold (VF) scar is known to be the most common cause of dysphonia after laryngeal microsurgery (LMS). Steroids reduce postoperative scar formation by inhibiting inflammation and collagen deposition. However, the clinical evidence of whether steroids are helpful in reducing VF scar formation after LMS is still lacking. The purpose of this study is to determine whether intralesional VF steroid injection after LMS helps to reduce postoperative scar formation and voice quality.Materials and Method This study was conducted on 80 patients who underwent LMS for VF polyp, Reinke’s edema, and leukoplakia. Among them, 40 patients who underwent VF steroid injection after LMS were set as the injection group, and patients who had similar sex, age, and lesion size and who underwent LMS alone were set as the control group. In each group, stroboscopy, multi-dimensional voice program, Aerophone II, and voice handicap index (VHI) were performed before and 1 month after surgery, and the results were statistically analyzed. @*Results@#There were no statistically significant differences in the distribution of sex, age, symptom duration, occupation and smoking status between each group. Both groups consisted of VF polyp (n=21), Reinke’s edema (n=11), and leukoplakia (n=9). On stroboscopy, the lesion disappeared after surgery, and the amplitude and mucosal wave were symmetrical on both sides of the VFs in all patients. Acoustic parameters and VHI significantly improved after surgery in all patients. However, there was no significant difference between the injection and control group in most of the results. @*Conclusion@#There was no significant difference in the results of stroboscopy, acoustic, aerodynamic, and subjective evaluation before and after surgery in the injection group and the control group.
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Neuroendocrine carcinoma (NEC) is a rare form of hormone-secreting tumor. NECs originate from the epithelial cells of the larynx and account for less than 1% of the laryngeal neoplasm. Most cases of NECs are diagnosed by pathological confirmation after surgery. The terminology of laryngeal NEC has been a source of confusion. In 2017, World Health Organization newly categorized laryngeal NEC; as a result, the large cell type, which has been the main target of disagreement, was finally included into a subtype of poorly differentiated NEC. We report a case of a 58-year-old male with a growing granulomatous mass in the posterior supraglottis. The granuloma was removed by surgical excision when the size of the mass increased. He was diagnosed with the large cell type laryngeal NEC by pathological confirmation. He underwent postoperative radiotherapy and is currently being followed up in our outpatient clinic without evidence of recurrence.
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Myofibrosarcoma is a rare malignant tumor originating from myofibroblasts. It is classified into low-grade, intermediate-grade, and high-grade according to the histological characteristics. High-grade myofibrosarcoma is reported very rarely worldwide, and its recurrence and metastasis are known to be more common. Myofibrosarcoma is diagnosed by histopathologic examination, and its treatment is complete surgical excision. With a review of literature, we report a case of myofibrosarcoma originating from the right masseter muscle in a 73-year-old male patient who complained of a right chin mass for 4 months. The MRI findings revealed a 4.8 cm-sized heterogeneous contrast-enhancing mass in the right masseter muscle with direct invasion into the ipsilateral medial pterygoid muscle and the mandible body. The patient was treated with margin-free surgical excision, including marginal mandibulectomy, and a highgrade myofibrosarcoma was finally diagnosed as the pathologic finding. Adjuvant radiation therapy was performed as a subsequent treatment, and no recurrence has been observed during follow-up for 1 year.
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Background and Objectives@#Claudin-1 (CLDN-1) is the major component of tight junctions and functions in controlling cell to cell adhesion. Certain claudins were expressed aberrantly and proved to have prognostic significance in various human cancers. However, its clinical significance has been poorly understood in head and neck squamous cell carcinoma (HNSCC). The aim of this study was to investigate the relationship between CLDN-1 expression and clinicopathologic parameters in HNSCC.Subjects and Method The surgical specimens of primary HNSCCs from a consecutive cohort of 91 patients were retrospectively collected. Immunohistochemical staining for CLDN-1 was performed blindly by two pathologists. CLDN-1 staining intensity was scored semi-quantitatively on a scale of 0 to 3 (0: negative; 1: weak; 2: moderate; 3: strong). For the statistical analysis, the expression levels were classified as low (negative and weak) and high (moderate and strong). Next, the association between CLDN-1 expression and clinicopathological features & clinical outcomes was analyzed. @*Results@#The increased CLDN-1 expression was significantly associated with lymphatic invasion (p=0.019). The expression level of CLDN-1 was not associated with pathological T stage, lymph node metastasis or recurrence. Kaplan-Meier analysis found that 3-year overall survival (OS) rate was 53% in patients with high level CLDN-1 expression and 74% in patients with low level CLDN-1 expression. It also found that 5-year OS rate was 49% in patients with high level CLDN-1 expression and 68% in patients with low level CLDN-1 expression. A significantly poor OS rate was recorded in patients with high level of CLDN-1 expression compared to patients with low level CLDN-1 expression (p=0.022). @*Conclusion@#CLDN-1 may serve as useful prognostic marker in patients with HNSCCs.
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The Korean Society of Laryngology, Phoniatrics and Logopedics appointed a task force to establish clinical practice guidelines for the management of unilateral vocal fold paralysis (UVFP). These guidelines cover a comprehensive range of management-related factors, including the diagnosis and treatment of UVFP, and provide in-depth information based on current, up-to-date knowledge. Detailed evidence profiles are provided for each recommendation. The CORE databases, including OVID Medline, Embase, the Cochrane Library, and KoreaMed, were searched to identify all relevant papers, using a predefined search strategy. When insufficient evidence existed, expert opinions and Delphi questionnaires were used to fill the evidence gap. The committee developed 16 evidence-based recommendations in six categories: initial evaluation (R1–4), spontaneous recovery (R5), medical treatment (R6), surgical treatment (R7–14), voice therapy (R15), and aspiration prevention (R16). The goal of these guidelines is to assist general otolaryngologists and speech-language pathologists who are primarily responsible for treating patients with UVFP. These guidelines are also intended to facilitate understanding of the condition among other health-care providers, including primary care physicians, nurses, and policy-makers.
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Background and Objectives@#OperaVOXTM (Oxford Wave Research Ltd.) is a portable voice analysis software package designed for use with iOS devices. As a relatively cheap, portable and easily accessible form of acoustic analysis, OperaVOXTM may be more clinically useful than laboratory-based software in many situations. The aim of this study was to evaluate the agreement between OperaVOXTM and Multi-Dimensional Voice Program (MDVP; Computerized Speech Lab) to assess voice quality before and after laryngeal microsurgery in patient with vocal polyp.Materials and Method Twenty patients who had undergone laryngeal microsurgery for vocal polyp were enrolled in this study. Preoperative and postoperative voices were assessed by acoustic analysis using MDVP and OperaVOXTM. A five-seconds recording of vowel /a/ was used to measure fundamental frequency (F0), jitter, shimmer and noise-to-harmonic ratio (NHR). @*Results@#Several acoustic parameters of MDVP and OperaVOXTM related to short-term variability showed significant improvement. While pre-operative value of F0, jitter, shimmer, NHR was 155.75 Hz (male: 125.37 Hz, female: 183.37 Hz), 2.20%, 6.28%, 0.16, post-operative values of these parameter was 164.34 Hz (male: 129.42 Hz, female: 199.26 Hz), 2.15%, 5.18%, 0.14 Hz in MDVP. While pre-operative value of F0, jitter, shimmer, NHR was 168.26 Hz (male: 135.16 Hz, female: 201.37 Hz), 2.27%, 6.95%, 0.26, post-operative values of these parameters was 162.72 Hz (male: 128.267 Hz, female: 197.18 Hz), 1.71%, 5.36%, 0.20 in OperaVOXTM. There was high intersoftware agreement for F0, jitter, shimmer with intraclass correlation coefficient. @*Conclusion@#Our results showed that the short-term variability of acoustic parameters in both MDVP and OperaVOXTM were useful for the objective assessment of voice quality in patients who received laryngeal microsurgery. OperaVOXTM is comparable to MDVP and has high intersoftware reliability with MDVP in measuring the F0, jitter, and shimmer.
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Background and Objectives@#OperaVOXTM (Oxford Wave Research Ltd.) is a portable voice analysis software package designed for use with iOS devices. As a relatively cheap, portable and easily accessible form of acoustic analysis, OperaVOXTM may be more clinically useful than laboratory-based software in many situations. The aim of this study was to evaluate the agreement between OperaVOXTM and Multi-Dimensional Voice Program (MDVP; Computerized Speech Lab) to assess voice quality before and after laryngeal microsurgery in patient with vocal polyp.Materials and Method Twenty patients who had undergone laryngeal microsurgery for vocal polyp were enrolled in this study. Preoperative and postoperative voices were assessed by acoustic analysis using MDVP and OperaVOXTM. A five-seconds recording of vowel /a/ was used to measure fundamental frequency (F0), jitter, shimmer and noise-to-harmonic ratio (NHR). @*Results@#Several acoustic parameters of MDVP and OperaVOXTM related to short-term variability showed significant improvement. While pre-operative value of F0, jitter, shimmer, NHR was 155.75 Hz (male: 125.37 Hz, female: 183.37 Hz), 2.20%, 6.28%, 0.16, post-operative values of these parameter was 164.34 Hz (male: 129.42 Hz, female: 199.26 Hz), 2.15%, 5.18%, 0.14 Hz in MDVP. While pre-operative value of F0, jitter, shimmer, NHR was 168.26 Hz (male: 135.16 Hz, female: 201.37 Hz), 2.27%, 6.95%, 0.26, post-operative values of these parameters was 162.72 Hz (male: 128.267 Hz, female: 197.18 Hz), 1.71%, 5.36%, 0.20 in OperaVOXTM. There was high intersoftware agreement for F0, jitter, shimmer with intraclass correlation coefficient. @*Conclusion@#Our results showed that the short-term variability of acoustic parameters in both MDVP and OperaVOXTM were useful for the objective assessment of voice quality in patients who received laryngeal microsurgery. OperaVOXTM is comparable to MDVP and has high intersoftware reliability with MDVP in measuring the F0, jitter, and shimmer.
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Background and Objectives@#Transoral laser microsurgery (TLM) is minimally invasive and has become the standard approach for early and intermediate stage laryngeal cancers. Many studies show that the oncologic results of TLM are equivalent to those obtained by conventional conservative surgery and radiotherapy (RT). The purpose of this study were to analyze the treatment outcome and predictors of local recurrence in glottic cancer patients who underwent TLM.Subjects and Method Sixty-seven patients who received TLM for glottis cancer between 2008 and 2019 were analyzed retrospectively. Patients were predominantly male (98.5%), with a median age of 64.3 years (range 45 to 87 years). There were 35 cases of T1 (52.2%), 15 cases of T2 (22.3%), and 17 cases of T3 (25.3%) in the primary tumor stage. There were no patients with lymph node metastasis (cN0). When classified into types, there were 2 cases of type I (3%), 15 cases of type II (22.3%), 34 cases of type III (50.7%), 4 cases of type IV (5.9%), 12 cases of type V (17.9%). The local control rate and overall survival rate were calculated with KaplanMeier curve analysis. Additionally, multivariate analysis of factors associated with local recurrence used Cox proportional-hazards model. @*Results@#TLM alone was performed in 54 patients (80.5%) whereas 13 patients (19.5%) underwent TLM followed by adjuvant RT. The 5-year local control rate and 5-year overall survival rate were 81.9% and 93.3%, respectively. In the Univariate analysis, the significant factors of local recurrence were difficult laryngeal exposure [odds ratio (OR)=22.8, 95% confidence interval (CI)=1.7-297.4, p-value=0.03], anterior commissure invasion (OR=17.2, 95% CI=1.9-154.7, p-value=0.004, positive lymphovascular invasion (OR=18.0, 95% CI=2.9-109.8, p-value=0.003) and positive resection margin (OR=9.5, 95% CI=1.6-55.6, p-value=0.011). In the multivariate analysis, the independent factors of local recurrence were anterior commissure invasion [hazard ratio (HR)=18.4, 95% CI=1.98-170.99, p-value=0.010] and lymphovascular invasion (HR=7.5, 95% CI=1.49-38.15, p-value=0.015). No major or lethal complications were observed. @*Conclusion@#TLM is a reliable modality to treat early and select cases of moderately advanced glottic cancer. Our study found that independent factors of local recurrence included anterior commissure invasion, and lymphovascular invasion. These findings may be useful to follow-up glottic cancer patients after TLM.
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Background and Objectives@#Vocal polyps are generally caused by phonotrauma such as vocal overuse, and the first line treatment is known as laryngeal microsurgery. The aim of the study is to evaluate the applicability and effectiveness of percutaneous steroid injection via cricothyroid membrane in patients with vocal polyp and to evaluate its advantages and limitations of the technique.Subjects and Method We included in this study 70 patients with vocal polyp managed by vocal fold steroid injection via the cricothyroid membrane from Jan 2008 to July 2018. We compared their medical records of laryngoscopy, stroboscopy, and multi-dimensional voice program analysis at pre and post treatment. Subjective voice improvement was evaluated using Voice Handicap Index-30 (VHI-30). @*Results@#Of the patients, 54.3 percent showed morphological improvement. In acoustic analysis, the pre-treatment mean values of jitter, shimmer, and NHR were 2.20±2.23, 5.09±3.24, 0.15±0.04, respectively. The post-treatment values were 1.54±1.28, 5.00±4.40, 0.13±0.04, respectively, and only jitter was statistically significant. For subjective symptom improvement, 32 (45.8%) patients showed better score on the post-treatment of VHI-30 compared to pretreatment. Ten patients experienced mild complications such as vocal fold atrophy and scar; however, no critical complications such as internal bleeding or dyspnea were reported. @*Conclusion@#According to our study, steroid injection is a safe and effective procedure for patients with vocal polyp. A vocal fold steroid injection via the cricothyroid membrane can be an alternative treatment option for those who are not able to undergo conventional laryngeal microscopic surgery.
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BACKGROUND AND OBJECTIVES@#Reinke's edema is a benign vocal fold disease caused by an edematous laryngeal superficial layer of lamina propria. The first line treatment is cessation of smoking and laryngeal microsurgery. The aim of the study is to evaluate the feasibility and efficacy of percutaneous steroid injection via cricothyroid membrane in patients with Reinke's edema.MATERIALS AND METHOD: From Jan 2010 to July 2018, 33 Patients with Reinke's edema managed by vocal fold steroid injection via the cricothyroid membrane were included in this study. We compared medical records of laryngoscopy, stroboscopy and Multi-Dimensional Voice Program analysis at pre-treatment and post-treatment. Subjective voice improvement was evaluated using Voice Handicap Index-30 (VHI-30).@*RESULTS@#75.7% of the patients showed partial response and 6.06% showed complete response. 93.94% were present smokers and only 4 patients ceased smoking after the treatment. In acoustic analysis, the pre-treatment mean value of jitter, shimmer, and noise to harmonic ratio was 2.30±3.21, 9.34±10.37, 1.11±2.90 each. The post-treatment value was 2.20±1.89, 6.96±5.30, 0.20±0.09 respectively and none of the parameters were statistically significant. For subjective symptom improvement, 25 (75.8%) patients showed a better score on post-treatment VHI-30 compared to pre-treatment.@*CONCLUSION@#According to our study, steroid injection is a relatively safe and effective procedure for patients with Reinke's edema. A vocal fold steroid injection via the cricothyroid membrane can be an alternative treatment option for those who are not able to undergo conventional laryngeal microscopic surgery, however cessation of smoking is necessary for effective treatment.
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BACKGROUND AND OBJECTIVES@#The purpose of this study was to develop the differential diagnosis scale containing items from adductor spasmodic dysphonia (ADSD) to muscle tension dysphonia (MTD) and the determine clinical utility of newly developed items.MATERIALS AND METHOD: The four parts of pitch, redirected phonation, automatic speech and voiced sound were selected for analyzing the characteristics of ADSD in the literature. One part of tense voiceless sound was developed according to the Korean manner of articulation. The content validity was evaluated based on 5 scales (1–5 point) analysis from 30 experts. One hundred patients (50 ADSD and 50 MTD) were recorded in reading a sentence and sustained phonation. The two speech language pathologist evaluated recorded voices through a blind test using 4 scales (0–3 point) for newly developed items.@*RESULTS@#As a result of verifying the content validity of items with experts, it was identified that the differentiated items were valid with 4.2 out of 5. Through the differential diagnosis between two groups according to the items, the correlation between sub-domains and total scores was shown as higher than 0.710. The result of analyzing the reliability on each diagnosis domain was 0.840–0.893, which showed the internal consistency of items was great. Newly developed five parts of ADSD were significantly higher than those of MTD with strong correlation (p<0.01). The reliability among the evaluators was analyzed as high with 0.892.@*CONCLUSION@#In this study, the differential diagnosis scale of ADSD was revealed as having validity and reliability. It is considered that it will be useful for differentiating ADSD and MTD in the clinical field.
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Laryngeal foreign body can be a life-threatening emergency. Respiratory distress, aphonia, and cyanosis may occur in quick succession. However, in case of a non-obstructive laryngeal foreign body, symptoms can be indolent, but the hazardous foreign body can nevertheless put the patient in danger. To prevent life-threatening consequences, early detection based on symptoms is imperative. This case, which presented with usual symptoms of anterior neck pain and throat discomfort without respiratory symptoms and an unusual site of laryngeal foreign body, finally turned out to be an impacted fish bone in the subglottis.
Subject(s)
Humans , Aphonia , Cyanosis , Emergencies , Foreign Bodies , Laryngoscopes , Larynx , Neck Pain , Pharynx , TracheaABSTRACT
A mammary-type myofibroblastoma is a rare benign mesenchymal neoplasm composed of spindle cells initially described to occur in the breast. However, they also arise at extra-mammary sites including the inguinal area, breast, chest wall/axilla, trunk, upper and lower extremities, and head and neck regions. In particular, mammary-type myofibroblastoma of the head and neck are extremely rare and may occur at any age. Immunohistochemically, it is typically CD34 and desmin positive. Currently, complete excision is considered as the first line treatment and recurrence of the tumor is rare. We experienced a 41-year-old man who visited with 1 cm sized firm mass of the tongue. The mass was resected and tissue biopsy revealed a diagnosis of mammary-type myofibroblastoma. Herein we report a rare case of mammary-type myofibroblastoma of the tongue with a review of the literature.
Subject(s)
Adult , Humans , Biopsy , Breast , Desmin , Diagnosis , Head , Lower Extremity , Neck , Neoplasms, Muscle Tissue , Recurrence , Thorax , TongueABSTRACT
A mammary-type myofibroblastoma is a rare benign mesenchymal neoplasm composed of spindle cells initially described to occur in the breast. However, they also arise at extra-mammary sites including the inguinal area, breast, chest wall/axilla, trunk, upper and lower extremities, and head and neck regions. In particular, mammary-type myofibroblastoma of the head and neck are extremely rare and may occur at any age. Immunohistochemically, it is typically CD34 and desmin positive. Currently, complete excision is considered as the first line treatment and recurrence of the tumor is rare. We experienced a 41-year-old man who visited with 1 cm sized firm mass of the tongue. The mass was resected and tissue biopsy revealed a diagnosis of mammary-type myofibroblastoma. Herein we report a rare case of mammary-type myofibroblastoma of the tongue with a review of the literature.
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BACKGROUND AND OBJECTIVES: Adductor type spasmodic dysphonia (ADSD) is neurogenic disorder and focal laryngeal dystonia, while muscle tension dysphonia (MTD) is caused by functional voice disorder. Both ADSD and MTD may be associated with excessive supraglottic contraction and compensation, resulting in a strained voice quality with spastic voice breaks. The aim of this study was to determine the utility of spectrogram analysis in the differentiation of ADSD from MTD. MATERIALS AND METHODS: From 2015 through 2017, 17 patients of ADSD and 20 of MTD, underwent acoustic recording and phonatory function studies, were enrolled. Jitter (frequency perturbation), Shimmer (amplitude perturbation) were obtained using MDVP (Multi-dimensional Voice Program) and GRBAS scale was used for perceptual evaluation. The two speech therapist evaluated a wide band (11,250 Hz) spectrogram by blind test using 4 scales (0–3 point) for four spectral findings, abrupt voice breaks, irregular wide spaced vertical striations, well defined formants and high frequency spectral noise. RESULTS: Jitter, Shimmer and GRBAS were not found different between two groups with no significant correlation (p>0.05). Abrupt voice breaks and irregular wide spaced vertical striations of ADSD were significantly higher than those of MTD with strong correlation (p < 0.01). High frequency spectral noise of MTD were higher than those of ADSD with strong correlation (p < 0.01). Well defined formants were not found different between two groups. CONCLUSION: The wide band spectrograms provided visual perceptual information can differentiate ADSD from MTD. Spectrogram analysis is a useful diagnostic tool for differentiating ADSD from MTD where perceptual analysis and clinical evaluation alone are insufficient.
Subject(s)
Humans , Acoustics , Compensation and Redress , Diagnosis, Differential , Dysphonia , Dystonia , Muscle Spasticity , Muscle Tonus , Noise , Voice , Voice Disorders , Voice Quality , Weights and MeasuresABSTRACT
The anatomy of the voice is not limited to the region of the larynx. Practically all body systems affect the voice. The larynx receives the greatest attention because it is the most sensitive and expressive component of the vocal mechanism, but anatomic interactions throughout the singer's body must be considered in making the singing voice. The physiology of voice production is exceedingly complex. The voice requires interactions among the power source, the oscillator, and the resonator. The review of functional anatomy and physiology in vocal technique would provide information on the terminology, components, and workings of the voice to permit an understanding of practical, every clinical problems and their solutions. The otolaryngologist, speech language pathologist, singing or acting teacher, singer, and actor would have benefit greatly from more extensive study of voice science.
Subject(s)
Electric Power Supplies , Larynx , Physiology , Singing , VoiceABSTRACT
Bronchogenic cysts are rare congenital malformations that result from an abnormal development of the ventral foregut budding of the tracheobronchial tree at the time of organogenesis. They are usually located in the mediastinum and intrapulmonary regions. Localization in the cervical area is unusual, and specially, bronchogenic cysts presenting as thyroid and perithyroid cyst are quite rare. We report a case of bronchogenic cyst mimicking a thyroid colloid cyst. We tried percutaneous ethanol injection at 3 times for treatment of this thyroid cyst, but we failed, because of intractable cough. After cyst excision with thyroid lobectomy, we diagnosed the lesion to bronchogenic cyst. Bronchogenic cyst should be considered in the differential diagnosis of perithyroid cyst, which especially the lesion is intolerable cyst to enthanol injection.
Subject(s)
Bronchogenic Cyst , Colloid Cysts , Cough , Diagnosis, Differential , Ethanol , Mediastinum , Organogenesis , Sclerotherapy , Thyroid Gland , TreesABSTRACT
Laryngopharyngeal reflux (LPR) is a very prevalent condition with a rising incidence. The diagnosis remains challenging and often controversial because the pathophysiology of LPR is often poorly understood and there is currently no diagnostic gold standard for LPR. Pepsin is produced by gastric chief cells in zymogen form as pepsinogen, and subsequently cleaved by the hydrochloric acid in the stomach, generating active pepsin protein. Pepsin is only produced in the stomach, and thus when detected in the laryngopharynx, it can be used as a specific marker for reflux. The carcinogenic properties of the gastric contents may also lead to cancer in target organs especially considering that they do not have intrinsic protective mechanisms as found in the esophagus. Many studies have demonstrated a high prevalence of LPR in patients with laryngeal cancer, but these studies are confounded by the cofactor such as smoking and alcohol consumption. This review focuses on the current studies about pepsin as a specific marker for LPR and putative relationship between pepsin and laryngeal cancer.
Subject(s)
Humans , Alcohol Drinking , Carcinogenesis , Chief Cells, Gastric , Diagnosis , Esophagus , Hydrochloric Acid , Hypopharynx , Incidence , Laryngeal Neoplasms , Laryngopharyngeal Reflux , Pepsin A , Pepsinogen A , Prevalence , Smoke , Smoking , StomachABSTRACT
OBJECTIVES: To introduce a new injection material for vocal fold diseases, which could be readily translated to clinical practice, we investigated the effectiveness of platelet-rich plasma (PRP) injection on the injured vocal fold in terms of histological recovery. METHODS: Blood samples were drawn from New Zealand White rabbits and PRP was isolated through centrifugation and separation of the samples. Using a CO2 laser, we made a linear wound in the 24 vocal fold sides of 12 rabbits and injected each wound with PRP on one vocal fold side and normal saline (NS) on the other. Morphologic analyses were conducted at 2, 4, and 12 weeks after injection, and inflammatory response, collagen deposit, and changes in growth factors were assessed using H&E and masson trichrome (MT) staining and western blot assay. RESULTS: PRP was prepared in approximately 40 minutes. The mean platelet concentration was 1,315,000 platelets/mm3. In morphological analyses, decreased granulation was observed in the PRP-injected vocal folds (P<0.05). However, the irregular surface and atrophic change were not difference. Histological findings revealed significant inflammation and collagen deposition in NS-injected vocal folds, whereas the PRP-injected vocal folds exhibited less (P<0.05). However, the inflammatory reaction and fibrosis were not difference. In western blot assay, increased amounts of growth factors were observed in PRP-injected vocal folds. CONCLUSION: Injection of injured rabbit vocal folds with PRP led to improved wound healing and fewer signs of scarring as demonstrated by decreased inflammation and collagen deposition. The increased vocal fold regeneration may be due to the growth factors associated with PRP.