Clinical Analysis of Laryngeal Tuberculosis: Recent 10 Years’ Experience in a Single Institution

Background and Objectives@#The overall incidence of laryngeal tuberculosis (LT) has generally decreased over the recent years, yet there is still a discrete population of patients newly diagnosed with the disease. This study is aimed to examine the patients with LT over the recent 10 years and to investigate the changes in clinical pattern with respect to the past period.Materials and Method A retrospective review has been performed on 20 patients who have been initially diagnosed with LT between 2005 and 2015. @*Results@#The age of the patients ranged from 25 years to 95 years with an average age of 45.6 years. Seventeen patients (85%) showed hoarseness, which was the most common clinical symptom. Most affected lesion was the true vocal cord. Laryngoscopic examination showed various clinical manifestations: polypoid 30%, granulomatous 25%, nonspecific 25%, ulcerative 20%. A variety of methods were used for diagnostic confirmation of LT [acid-fast bacilli (AFB) smear 45%, AFB culture 40%, polymerase chain reaction 30%, surgical pathology 45%]. Coexisting pulmonary tuberculosis (PT) was detected in 10 patients (50%). Relative to the patients with inactive PT or normal lung status, those with active PT showed higher incidence of laryngeal lesions located in areas other than true vocal cord (p=0.050). @*Conclusion@#Based on the analytic results from this study, laryngologists should recognize the changes in the recent clinical patterns of LT and always be ready for clinical suspicion of this disease on such atypical laryngeal findings which can often mimic laryngeal malignancies to provide the pertinent treatment.

Clinical Analysis of Laryngeal Tuberculosis: Recent 10 Years’ Experience in a Single Institution

Background and Objectives@#The overall incidence of laryngeal tuberculosis (LT) has generally decreased over the recent years, yet there is still a discrete population of patients newly diagnosed with the disease. This study is aimed to examine the patients with LT over the recent 10 years and to investigate the changes in clinical pattern with respect to the past period.Materials and Method A retrospective review has been performed on 20 patients who have been initially diagnosed with LT between 2005 and 2015. @*Results@#The age of the patients ranged from 25 years to 95 years with an average age of 45.6 years. Seventeen patients (85%) showed hoarseness, which was the most common clinical symptom. Most affected lesion was the true vocal cord. Laryngoscopic examination showed various clinical manifestations: polypoid 30%, granulomatous 25%, nonspecific 25%, ulcerative 20%. A variety of methods were used for diagnostic confirmation of LT [acid-fast bacilli (AFB) smear 45%, AFB culture 40%, polymerase chain reaction 30%, surgical pathology 45%]. Coexisting pulmonary tuberculosis (PT) was detected in 10 patients (50%). Relative to the patients with inactive PT or normal lung status, those with active PT showed higher incidence of laryngeal lesions located in areas other than true vocal cord (p=0.050). @*Conclusion@#Based on the analytic results from this study, laryngologists should recognize the changes in the recent clinical patterns of LT and always be ready for clinical suspicion of this disease on such atypical laryngeal findings which can often mimic laryngeal malignancies to provide the pertinent treatment.

Clinical Characteristics and Management of Saccular Cysts: A Single Institute Experience

OBJECTIVES: A saccular cyst is defined as a dilated saccule of the larynx, filled with mucus, and is located between the false vocal cords and the thyroid cartilage. Although this uncommon laryngeal condition is benign in nature, it could lead to dyspnea, stridor, and airway obstruction, depending on its size and location. Furthermore, some saccular cysts have been associated with laryngeal carcinoma. This study aimed to characterize this rather uncommon laryngeal condition to aid in determining the proper management of this pathology. METHODS: Medical records were retrospectively reviewed of all patients with saccular cysts diagnosed and treated between 2006 and 2017 at a tertiary otolaryngologic care center. RESULTS: Seven patients with saccular cysts were identified (male:female=2:5; mean age, 34.1 years); two were pediatric patients. Surgical intervention was performed in all patients by laryngo-microsurgery using CO2 laser. There was no recurrence after the initial surgical treatment. CONCLUSION: Saccular cysts can be managed endoscopically using CO2 laser, without requiring an external approach. Therefore, an endoscopic approach should be actively considered for an optimal treatment outcome.

Two Cases of Mucosal Bridge Crossing the Membrane of Vocal Folds / 대한이비인후과학회지

Mucosal bridges of vocal fold have been described as a parallel band to vocal folds with the presence of sulcus vocalis. However, the type of mucosal bridge crossing each vocal fold has not been well documented in the literature. Herein, we present two cases of mucosal bridge found in the vocal fold connecting the mid-portions of true vocal folds. Two patients who had no history of laryngeal trauma, surgery or oro-tracheal intubation visited our clinic due to voice change. Laryngoscopic examination revealed that they had a mid-portion mucosal band without any other mucosal lesions. Two patients underwent laryngomicrosurgery with pulsed dye laser. After the surgery, they showed significant improvement of voice quality.

Surgical Treatment of Sulcus Vocalis Using KTP Laser

Sulcus vocalis remains a surgical challenge despite many recent advances in laryngomicrosurgeries. We previously reported that 585-nm Pulsed dye laser (PDL) exerts favorable outcome in treatment of sulcus vocalis due to its therapeutic effects of collagen rearrangement and improved wound remodeling. In spite of the usefulness of PDL glottoplasty for treating sulcus vocalis, the device is no more available in the country. It prompted us to focus another angiolytic laser ; 532-nm KTP laser which has similar mechanisms of action and has been used for treatment of other laryngeal lesions elsewhere. Herein, we present a case of sulcus vocalis successfully treated with KTP laser. A patient underwent laryngomicrosurgery with angiolytic KTP laser (KTP glottoplasty) by the same surgical procedure with PDL glottoplasty. After the surgery, the patient presented improved voice outcome in time without complications.

Two Cases of Secondary Sublesional Laryngeal Cyst after Pulsed Dye Laser Glottoplasty / 대한이비인후과학회지

The pulsed dye laser (PDL) has been shown to be effective for hypertrophic scars and keloids in dermatology initially. The fundamentals of PDL are based on photoacoustic, photothermal and photochemical effects. Because of noninvasive and physiologic features of PDL, it is recently used to treat vocal cord diseases. In particualr, treating sulcus vocalis with PDL (PDL glottoplasty) is a recently introduced surgical treatment. The sulcus vocalis irradiated with PDL can induce collagen synthesis and natural mucosal healing without adherent tissue injury. Although PDL glottoplasty is beneficial in the treatment of sulcus vocalis, we experienced two cases of secondary sublesional laryngeal cysts after PDL glottoplasty during long-term follow-up periods. There have been no reported cases of complication after PDL treatment for sulcus vocalis until now. Therefore, these two cases seem to be the first complication of PDL application reported in literature.

Incidental Ignition of a Pulsed Dye Laser Fiber During Laryngomicrosurgery: A Case Report

Surgical fires require an ignition source, oxidizer, and fuel. The pulsed dye laser (PDL) has been shown to be effective in the treatment of hypertrophic scars and keloids in dermatology. With the increasing number of applications of CO2, laser as ignition source has been associated with operating room fires in the otorhinolaryngologic field. There have been many case reports on PDL-induced fires in dermatology, but until now, there were no reports in the larynx. We describe a 57-year-old patient diagnosed with laryngeal hyperkeratosis treated by PDL-assisted laryngomicrosurgery. In this case, we experienced incidental PDL tip flaring during pulsed dye laser vaporization.

A Case Report of Incidental Endotracheal Tube Firing in Operating Room during CO2 Laser-Assisted Laryngomicrosurgery / 대한이비인후과학회지

Operating room fires are a rare but preventable danger in modern operating rooms. But sometimes accidental fires in operating room can be life threatening. Surgical fires require an ignition source, oxidizer, and fuel. Recently, laser as an ignition source in the presence of anesthetic gases has been associated with operating room fires in otorhinolaryngologic field. We describe a 30-year-old patient diagnosed with recurrent laryngeal papillomatosis treated by CO2 laser-assisted laryngomicrosurgery. In this case, we experienced endotracheal tube flaring during CO2 vaporization and then incidental endotracheal tube firing due to CO2 laser under high O2 circumference. Shortly after removal of firing endotracheal tube, the anesthesiologist considered careful re-intubation. To minimize the risk of operating room fires, surgeons must familiarize with the common possibilities where fire is known to occur. Furthermore, the prevention of operating room firing should be strongly considered during all operations using lasers.

Voice Characteristics of Adductor Spasmodic Dysphonia before and after Botulinum Toxin-A Injection / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Botulinum toxin type A (BTX-A) injection is well known for its effectiveness in the treatment of "Spasmodic dysphonia". However, studies on the efficacy of BTX-A injection have not been attempted in Korea. Therefore, this study was carried out to investigate the effects of BTX-A. SUBJECTS AND METHOD: The study examined 12 female patients with 'adductor spasmodic dysphonia'. Objective assesments included aerodynamic analysis and electoroglottography (EGG) of each patient before and after BTX-A. Subjective assessments included using the Korean-version of Voice Handicap Index-30 (KVHI-30) and a patient self-rating scale. RESULTS: Aerodynamic analysis revealed that only maximum phonation time (MPT) was significantly shortened after the injection of BTX-A (p<0.05). In the EGG, the mean frequency distribution was significantly increased, while the mean amplitude and the mean closed quotient distribution were significantly decreased (p<0.05). The KVHI-30 and patient self-rating scale scores were significantly decreased (p<0.01) as well, demonstrating the effects of BTX-A on the quality of life. CONCLUSION: Our results show the effects of BTX-A objectively by comparing voice characteristics, which were measured through EGG before and after BTX-A injection, as well as by determining aerodynamic characteristics. The subjective self-assessment on the quality of life is significant as it may serve as a clinically relevant measure. This study may be helpful in elucidating treatment efficacy of BTX-A in many ways.

Schwannoma in Head and Neck: Preoperative Imaging Study and Intracapsular Enucleation for Functional Nerve Preservation

PURPOSE: In treating schwannoma patients, it is critical to determine the origin of the tumor to preserve nerve function. We evaluated the validity of preoperative imaging studies in distinguishing the neurological origin of the schwannomas of the head and neck, and the efficacy of intracapsular enucleation in preserving nerve function. MATERIALS AND METHODS: In 7 cases of schwannomas in the head and neck region, we predicted whether the tumor originated from the vagus nerve or the cervical sympathetic chain through imaging studies including computed tomography (CT) and magnetic resonance imaging (MRI). All patients were performed intracapsular enucleation, and the function of the vagus nerve and the sympathetic nerve was evaluated preoperatively and postoperatively. RESULTS: Preoperative imaging studies showed 6 cases where the tumor was located between the carotid artery and the internal jugular vein, and 1 case where the tumor was located posteriorly, displacing the carotid artery and the internal jugular vein anteriorly. At the time of operation, we confirmed schwannoma originating from the vagus nerve on the first 6 cases, and schwannoma originating from the sympathetic nervous system on the last case. All patients went through successful intracapsular enucleation, and of the seven schwannoma cases, 6 patients maintained normal postoperative neurological function (85.7%). CONCLUSION: Preoperative imaging studies offer valuable information regarding the location and origination of the tumor, and intracapsular enucleation helped us to preserve the nerve function.

A case of postoperative nasopharyngeal reflux associated with retropharyngeal lymphangioma in newborn infant / 소아과

Lymphangioma is a rare benign congenital tumor of the lymphatic system, which is commonly diagnosed before 2 years of age. In the natronal report, cystic lymphangioma was usually reported as a huge translucent mass located in the head and neck area. It's occurrence in retropharyngeal space with respiratory obstruction and swallowing difficulty in neonate is extremely rare and postoperative nasopharyngeal reflux has rarely been reported. Complete resection is the standard therapy. However, involvement of the upper airway may be determining prognosis in the extensive lymphangiomas because of the difficulty of complete excision. We present a case of cystic lymphangioma in neonate which was initially asymptomatic but gradually progressed to cause respiratory obstruction due to enlargement. After resection, nasopharyngeal reflux developed with dysfunction of the soft palate and gradually improved with conservative care over 5 months.

Successful Treatment of Tracheal Stenosis with Slide Tracheoplasty after the Failure of Resection with End-to-End Anastomosis

The combined effects of inhaled irritant gases and heat in burn patients can result in the development of laryngotracheal strictures. Several factors could adversely affect the development of tracheal stenosis and cause the growth of granulation tissue. Yet the current treatment options for this condition are limited because of the paucity of case reports. We report here on a case of a patient who experienced recurrent upper tracheal stenosis after an inhalation injury. She displayed repetitive symptoms of stenosis even after several laryngomicrosurgeries and resection with end-to-end anastomosis. Finally, 5 yr after the burn injury, slide tracheoplasty was successfully performed and the postoperative check-up findings and the increased airway volume seen on imaging were all satisfactory.

Case Report: Parotid Sialolithiasis / 대한이비인후과학회지

Salivary duct lithiasis is a condition characterized by the obstruction of a salivary gland or its excretory duct due to the formation of calcareous concretions or sialoliths resulting in salivary ectasia and even provoking the subsequent dilation of the salivary gland. It most commonly involves submandibular gland (80 to 90%) and less frequently parotid (10 to 20%). The authors report 2 cases of parotid sialolithiasis. The first case involved a 46-year-old male patient complaining of the left parotid area pain and swelling, and presenting with a salivary calculus in the left parotid duct. When the patient was diagnosed, he refused surgical removal. The second case involved a 41-year-old male patient complaining of the right parotid area pain and swelling, and presenting with a salivary calculus in the right parotid duct. The sialolith was surgically removed under general anesthesia. In this paper, we also reviewed a series of concepts related to the etiology, diagnosis and treatment of sialolithiasis.

Three Cases of Epidermoid Cyst Associated with Sulcus Vocalis / 대한이비인후과학회지

Sulcus vocalis refers to a condition in which a furrow occurs along the upper medial edge of the vocal folds. The etiology of sulcus is controversial. Bouchayer et al. proposed that sulcus vocalis is congenital and there are what appeared to be transition forms between the cyst and sulcus. Sulcus vocalis is frequently associated with epidermoid cyst. Epidermoid cyst may rupture spontaneously. If the resulting opening is as large as the cyst, the resulting empty pocket becomes a glottic sulcus. In addition, mucosal invagination may proceed on the upper and lower margins of the cyst and then sulcus vocalis can be formed. We experienced 3 cases of epidermoid cyst associated with sulcus vocalis on the upper and lower margins of the cyst and thought that presenting them would be helpful to understand the pathogenesis of the sulcus vocalis from the epidermoid cyst.

Xanthoma Disseminatum, a Case with Laryngeal Involvement / 대한이비인후과학회지

Xanthoma disseminatum is a rare benign, normolipemic mucocutaneous xanthomatosis resulting due to the proliferation of non-Langerhans cell histiocytes. Xanthoma disseminatum typically involves the skin, particularly the flexor skin folds. Mucocutaneous involvement develops in 40-60% of patients, most commonly affecting the oropharynx, larynx, or corneae and conjunctivae. Xanthoma disseminatum may also manifest in the central nervous system. While the natural history of xanthoma disseminatum is usually benign, lesions in critical anatomical locations may result in morbidity and mortality. Curative therapy is lacking. We report a case with laryngeal involvement in a female patient. In this patient, xanthomas involved oropharynx and larynx mucosa. Dyspnea occurred due to epiglottis lesion. Tracheotomy was performed, and maintenance of breathing and decanulation were possible after epiglottectomy.

The Current Clinical Propensity of Laryngeal Tuberculosis: Review of 60 Cases / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Although laryngeal tuberculosis is not common, it still occurs with an increasing incidence of pulmonary tuberculosis. The clinical pattern and spread mechanism of this disease have also changed as well. This study was performed to examine the current propensity seen in laryngeal tuberculosis and the clinical characteristics of this disease in patients showing atypical clinical pattern. SUBJECTS AND METHOD: We retrospectively analyzed 60 cases of laryngeal tuberculosis diagnosed from 1994 to 2004 in the department of otorhinolaryngology at Severance Hospital by evaluating clinical and videostroboscopic records. RESULTS: The age of the patients ranged from 25 to 78 years, with their average age being 49.7 years. The ratio between men and women was 1.9 : 1. The major symptom encountered was hoarseness (96.6%). Clinically, granulomatous (n=22) and ulcerative types (n=11) of laryngeal tuberculosis were still prevalent, however, the incidence of atypical types such as polypoid (n=16) and nonspecific (n=11) were on the rise. Among 27 cases that showed polypoid or nonspecific types, unilateral lesion was seen in 20 cases (74%). The most frequently affected area by this disease was true vocal cord, followed by false vocal cord, epiglottis, arytenoids and posterior commissure. Active pulmonary tuberculosis was present in 28 (46.7%), inactive pulmonary tuberculosis in 20 (33.3%), normal lung status in 12 cases (20%). Primary laryngeal tuberculosis was present in 9 cases (15%). Single lesion, polypoid and nonspecific type were the prevalent characteristics found in patients with inactive tuberculosis or normal lung status. CONCLUSION: Physicians should be aware of changes in the clinical pattern of laryngeal tuberculosis, which pose serious complications and risk of spreading.

Electroglottographic Measurement with Vocal and Videostroboscopic Analysis for T1 Glottic Cancer Patients after Curative Radiotherapy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: This study was carried out to analyze voice changes after curative radiotherapy in T1 glottic cancer and the clinical efficacy of electroglottography (EGG) as a new treatment method for voice analysis. MATERIALS AND METHOD: From February 2002 to December 2004, 10 patients with T1 glottic squamous cell carcinoma who underwent a curative radiotherapy were studied prospectively. They received voice quality measurement (Perceptual evaluation, Acoustic analysis) and vocal function test (Aerodynamic study, Videostroboscopy, EGG) one year before and after radiotherapy. RESULTS: Perceptual test showed voice quality improvement after radiotherapy, but 3 cases had still abnormal voices. Acoustic analysis showed that although fundamental frequency, jitter and shimmer changed significantly after radiotherapy, HNR did not change and aerodynamic study had no changes after radiotherapy.On the other hand, in the videostroboscopy, glottic closure, wave and non-vibrating portion had significant changes after radiotherapy. In EGG, %Fx and Qx also showed significant changes whereas %Ax had no changes. CONCLUSION: This study suggests that the voice improves significantly after radiotherapy and multi-dimensional analysis with diverse method is required in voice analysis. In addition, EGG may be used as a reliable method in vocal function test.

Surgical Treatment of Two Cases of Benign Symmetrical Lipomatosis Causing Dyspnea / 대한이비인후과학회지

Benign symmetrical lipomatosis, known as Madelung's disease, is a rare disease characterized by non-encapsulated fat tissue accumulation in a symmetrical manner around the neck, shoulders, and upper extremities, rarely involving the lower limbs and the lower body. To date, there have been approximately 200 cases reported. We experienced two cases of Madelung's disease, 57 and 59 year-old man with neck and shoulder swelling and the symptom of dyspnea. Laryngoscopic and CT scan findings showed severe narrowing of supraglottic and paraglottic area, caused by fat tissue accumulation. The fat tissues were surgically excised, one by external approach and the other by laryngomicrosurgery using LASER under direct laryngoscope, with successful result. We report it with a review of the current literatures.

The Clinical Characteristics and Voice Analysis of Reinke's Edema / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Reinke's edema is characterized by the swelling of the vocal folds, which is bilateral, and is found superficial to the vocal ligament, Reinke's space. However, the etiology of Reinke's edema is not well understood, and voice characteristics are still controvertial. The aim of this study was to evaluate the clinical characteristics of Reinke's edema, and to assess the voice qualities in patients with Reinke's edema before and after a laryngomicrosurgery. Furthermore, this study also determined which parameters were most associated with the improvement of postoperative voice quality in Reinke's edema. SUBJECTS AND METHOD: The clinical records from 61 patients with Reinke's edema were reviewed and telephone questionnaires were carried out about smoking, laryngopharyngeal reflux, voice abuse, and allergy. All the patients were classified according to the stroboscopic findings (Yonekawa's classification). The voice analysis of 61 patients with Reinke's edema were performed and compared with 30 normal controls. Also, the voice analysis of 23 patients, who underwent laryngomicrosurgery, was carried out 2 months after surgery. RESULTS: Smoking, voice abuse and laryngopharyngeal reflux may play important roles in developing Reinke's edema. There were 26, 22, and 13 patients identified as Yonekawa types I, II, and III, respectively. The preoperative voice analysis of 61 patients showed decreased FxM (mean fundamental frequency), and increased subglottic pressure. Furthermore, FxSD (fundamental frequency standard deviation), QxM (mean closed quotient), and QxSD (closed quotient standard deviation) were all higher for the patients than the normal group. The postoperative results showed an increase in the FxM and an improvement in the MFR (mean flow rate), Psub (subglottic pressure), shimmer, and HNR (harmonics to noise ratio). The correlation analysis showed that jitter, HNR, QxM, and CFx (% irregularity of frequency) were the parameters, showing the best correlation with improvement in the postoperative voice quality. CONCLUSION: The fundamental frequency was approximated to normal ranges, and stabilizing of vocal fold vibration, and the improvement of vocal efficiency was also found 2 months after layngomicrosurgery. The parameters which represented voice quality by correlation analysis after surgery were jitter, HNR, QxM, and CFx.

A Case of MALToma Involving the Thyroid Gland / 대한이비인후과학회지

Primary thyroid lymphomas constitute up to 5% of all thyroid malignancies and can be divided into non-Hodgkin's lymphomas of B and T cell types, as well as Hodgkin's lymphomas. Recently, mucosa-associated lymphoid tissue lymphoma (MALToma) are recognized as a B cell subset of non-stomach origin. However, they may also occur in lungs, salivary glands, skin, and other sites, including the thyroid. Thyroid MALTomas make up about 9% of all non-gastrointestinal tract tyroid lymophomas. MALTomas are thought to develop from acquired lymphocytic tissue during the course of a chronic inflammatory or autoimmune process. In the thyroid, which is normally devoid of lymphocytic tissues, chronic autoimmune thyroiditis (Hashimoto's disease) has been associated with an increased risk of lymphoma, including MALT type. We report a case of MALToma of the thyroid.