Artificial Intelligence for Clinical Research in Voice Disease

Diagnosis using voice is non-invasive and can be implemented through various voice recording devices; therefore, it can be used as a screening or diagnostic assistant tool for laryngeal voice disease to help clinicians. The development of artificial intelligence algorithms, such as machine learning, led by the latest deep learning technology, began with a binary classification that distinguishes normal and pathological voices; consequently, it has contributed in improving the accuracy of multi-classification to classify various types of pathological voices. However, no conclusions that can be applied in the clinical field have yet been achieved. Most studies on pathological speech classification using speech have used the continuous short vowel /ah/, which is relatively easier than using continuous or running speech. However, continuous speech has the potential to derive more accurate results as additional information can be obtained from the change in the voice signal over time. In this review, explanations of terms related to artificial intelligence research, and the latest trends in machine learning and deep learning algorithms are reviewed; furthermore, the latest research results and limitations are introduced to provide future directions for researchers.

Vocal Fold Leukoplakia: Updates in Diagnosis and Management

Vocal fold leukoplakia poses a challenge to otolaryngologists due to its various spectrum of pathologic diagnosis. The degree of dysplasia is associated with malignancy risk and the new 2017 WHO classification system changed from the 3-tier system to a 2-tier system consisting of low and high grades. Infections including candidiasis, cryptococcosis, and tuberculosis should also be included in the differential diagnosis. Efforts have been made to evaluate risks using endoscopic technologies such as narrow band imaging, and surgery is essential for histopathological diagnosis. Regarding management, it is important to make an accurate diagnosis and find a balance between oncologic safety and functional outcome.

Cumulative Sum Analysis of the Learning Curve of Free Flap Reconstruction in Head and Neck Cancer Patients

Objectives@#. Owing to the functional and structural complexity of the head and neck area, the reconstruction of defects in these areas is challenging. Free flap surgery has become standard for the reconstruction of the head and neck with improvements in microvascular surgery. The aim of this study was to use the cumulative sum (CUSUM) method to evaluate the learning curve for free-flap head and neck reconstruction performed by a single surgeon. @*Methods@#. We retrospectively reviewed the medical records of 47 patients who underwent free-flap reconstruction from 2017 to 2021. The clinical demographics and surgical outcomes were analyzed. The total operation time was analyzed using the CUSUM method, which is an analytical approach for visualizing patterns in data by converting raw data into an accumulation of deviations from the average value. @*Results@#. CUSUM analysis showed two phases of the learning curve: phase 1 (cases 1–22) and phase 2 (cases 23–47). The operative time in phase 1 (579.9±128.2 minutes) was significantly longer than that in phase 2 (418.6±80.9 minutes) (P<0.001). The re-exploration rate was higher in phase 1 (31.8%) than in phase 1 (4%) (P=0.018). The flap failure rate was higher in phase 1 (9.1%) than in phase 1 (4%), but this difference was not statistically significant (P=0.593). @*Conclusion@#. The learning curve of free-flap head and neck reconstruction seems to stabilize after approximately 20 cases.

Radiotherapy versus Surgery in Early-Stage HPV-Positive Oropharyngeal Cancer / Journal of the Korean Cancer Association, 대한암학회지

Purpose@#This study aimed to compare the outcomes of primary radiotherapy (RT) versus surgery in early-stage human papilloma virus–positive oropharyngeal squamous cell carcinoma (hpv+OPC), and investigate the preoperative clinical factors that can predict the requirement for postoperative adjuvant treatment. @*Materials and Methods@#This multicenter study included 166 patients with American Joint Committee on Cancer 8th edition-Stages I-II hpv+OPC. Sixty (36.1%) and 106 (63.9%) patients underwent primary (concurrent chemo)radiotherapy [(CC)RT] and surgery, respectively. Seventy-eight patients (73.6%) in the surgery group received postoperative (CC)RT. @*Results@#With a median follow-up of 45.6 months for survivors, the 2-year overall survival (OS), progression-free survival (PFS), and locoregional control (LC) for RT/surgery were 97.8%/96.4%, 91.1%/92.0%, and 92.9%/93.3%, respectively. In multivariate analyses, patients with synchronous radiologic extranodal extension and conglomeration (ENEcong) of metastatic lymph nodes (LNs) showed significantly poorer OS (p=0.047), PFS (p=0.001), and LC (p=0.003). In patients undergoing primary surgery, two or more clinically positive LN metastases (odds ratio [OR], 5.15; p=0.004) and LN metastases with ENEcong (OR, 3.75; p=0.009) were predictors of postoperative chemoradiotherapy. No patient in the primary RT group demonstrated late severe toxicity whereas three (2.8%), one (0.9%), and one (0.9%) patient in the surgery group showed grade 3 dysphagia, grade 3 xerostomia, and fatal oral cavity bleeding. @*Conclusion@#We found no differences in OS, PFS, and LC between upfront RT and surgery in stage I-II hpv+OPC which warrants comparison through a prospective trial in the treatment de-escalation era. However, most early-stage hpv+OPC patients undergoing surgery received adjuvant (CC)RT. Pretreatment LN findings were prognostic and predictive for adjuvant treatment.

Standardization of FEES Evaluation for the Accurate Diagnosis of Dysphagia / 대한연하장애학회지

Objective@#Fiberoptic endoscopic evaluation of swallowing (FEES) is a standard diagnostic tool for swallowing disorders. However, it has not been used frequently in Korea because of the long test time, low cost, and the absence of a standard evaluation system. The purpose of this study was to suggest a standard fill-out form for the FEES result. @*Methods@#From February 2019 to June 2020, a total of 98 FEES tests were performed by an otolaryngologist (JYJ) at the Wonkwang University Hospital. After the exclusion of 68 cases, 30 cases were analyzed twice by 4 raters with over 5 years of experience as otolaryngologists working in various hospitals. The results were measured for the rater’s test-retest reliability and inter-rater consistency. @*Results@#Cohen’s kappa values for measuring the intra-rater consistency of the four raters were 0.984, 0.887, 0.848, and 0.930, respectively, meaning very good alignment of 0.8 or more, respectively. The Fleiss Kappa value for measuring inter-rater consistency was 0.276, meaning ‘fair’ for values of 0.2 or more. To examine consistency, an intraclass correlation coefficient (ICC) analysis conducted by assuming the grading score to be a constant continuous variable gave an ICC value of 0.729 (P＜0.001), showing a very reliable tendency. @*Conclusion@#In this study, all the items of the fill-out form were rated using a three-step grading scale, so the degree of agreement was high when performed twice by the same rater, but the degree of agreement among raters was relatively low. Therefore, our fill-out form for FEES will be useful in evaluating the improvement of a patient over the course of clinical treatment.

Guidelines for the Management of Unilateral Vocal Fold Paralysis From the Korean Society of Laryngology, Phoniatrics and Logopedics

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.

Poor prognostic factors in human papillomavirus-positive head and neck cancer: who might not be candidates for de-escalation treatment?

BACKGROUND/AIMS@#Since patients with human papillomavirus (HPV)-associated head and neck squamous cell carcinoma (HNSCC) have favorable outcomes after treatment, treatment de-escalation for these patients is being actively investigated. However, not all HPV-positive HNSCCs are curable, and some patients have a poor prognosis. The purpose of this study was to identify poor prognostic factors in patients with HPV-positive HNSCC.@*METHODS@#Patients who received a diagnosis of HNSCC and tested positive for HPV from 2000 to 2015 at a single hospital site (n = 152) were included in this retrospective analysis. HPV typing was conducted using the HPV DNA chip assay or liquid bead microarray system. Expression of p16 in the tumors was assessed by immunohistochemistry. To determine candidate factors associated with overall survival (OS), univariate and multivariable Cox regression analyses were performed.@*RESULTS@#A total of 152 patients with HPV-positive HNSCC were included in this study; 82.2% were male, 43.4% were current or former smokers, and 84.2% had oropharyngeal cancer. By univariate analysis, old age, performance status ≥ 1, non-oropharyngeal location, advanced T classification (T3–4), and HPV genotype 18 were significantly associated with poor OS. By multivariable analysis, performance status ≥ 1 and non-oropharyngeal location were independently associated with shorter OS (hazard ratio [HR], 4.36, p = 0.015; HR, 11.83, p = 0.002, respectively). Furthermore, HPV genotype 18 positivity was also an independent poor prognostic factor of OS (HR, 10.87, p < 0.001).@*CONCLUSIONS@#Non-oropharyngeal cancer, poor performance status, and HPV genotype 18 were independent poor prognostic factors in patients with HPV-positive HNSCC. Patients with these risk factors might not be candidates for de-escalation treatment.

Association of FOXP3 Single Nucleotide Polymorphisms With Clinical Outcomes After Allogenic Hematopoietic Stem Cell Transplantation

BACKGROUND: Forkhead box P3 (FOXP3) is an important marker of regulatory T cells. FOXP3 polymorphisms are associated with autoimmune diseases, cancers, and allograft outcomes. We examined whether single nucleotide polymorphisms (SNPs) at the FOXP3 locus are associated with clinical outcomes after allogenic hematopoietic stem cell transplantation (HSCT). METHODS: Five FOXP3 SNPs (rs5902434, rs3761549, rs3761548, rs2232365, and rs2280883) were analyzed by PCR-sequencing of 172 DNA samples from allogenic HSCT patients. We examined the relationship between each SNP and the occurrence of graft-versus-host disease (GVHD), post-HSCT infection, relapse, and patient survival. RESULTS: Patients with acute GVHD (grades II-IV) showed higher frequencies of the rs3761549 T/T genotype, rs5902434 ATT/ATT genotype, and rs2232365 G/G genotype than did patients without acute GVHD (P=0.017, odds ratio [OR]=5.3; P=0.031, OR=2.4; and P=0.023, OR=2.6, respectively). Multivariate analysis showed that the TT genotype of rs3761549 was an independent risk factor for occurrence of acute GVHD (P=0.032, hazard ratio=5.6). In contrast, the genotype frequencies of rs3761549 T/T, rs5902434 ATT/ATT, and rs2232365 G/G were lower in patients with post-HSCT infection than in patients without infection (P=0.026, P=0.046, and P=0.031, respectively). CONCLUSIONS: rs3761549, rs5902434, and rs2232365 are associated with an increased risk of acute GVHD and decreased risk of post-HSCT infection.

Technical Review of How to Determine the Exact Location of Needle Tip During Office-Based Injection Augmentation of the Vocal Folds Via Cricothyroid Approach

The office-based, un-sedated vocal fold injection laryngoplasty has re-emerged in the past decade as an appealing alternative to microsuspension laryngoscopic procedure which is conducted under general anesthesia. The trend toward vocal fold injection laryngoplasty in an in-office setting was possible due to technological evolution for visualization and new injection materials. However, invisibility of the injection needle has been the main shortcomings of cricothyroid approach. The purpose of this review is to provide an up-to-date review of office-based, trans-cricothyroid membrane approach injection laryngoplasty technique under local anesthesia and efforts made to increase the preciseness of amount and location of the injected materials in the management of glottic insufficiency. A review of variable efforts undertaken to maximize the result of cricothyroid approach by technically increasing accuracy of the location of needle tip was done. With the proper patient selection and utilization of the new technologies, office-based and un-sedated vocal fold injection laryngoplasty via cricothyroid approach can be redeem as a main-stay in the management of glottic insufficiency, such as vocal fold paralysis, vocal fold paresis, vocal fold atrophy and vocal fold scar.

Multicenter Evaluation on the Efficacy of N-Acetyl Cystine in Relieving the Symptoms of Laryngopharyngeal Reflux Disease

BACKGROUND AND OBJECTIVES: Laryngopharyngeal reflux disease (LPRD) is relatively common disease. N-acetyl cysteine (NAC) has both mucolytic and antioxidant effect, also may be beneficial in inflammatory airway diseases. The purpose of this study was to evaluate the efficacy and safety of inhaled NAC therapy in LPRD. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 525 LPRD patients at 12 medical centers. Finally 401 patients subjected to inhaled NAC therapy for 2 months were enrolled in the study. We analyzed the change of Reflux Symptom Index (RSI) and Reflux Finding Score (RFS) after use of NAC for 4 weeks and 8 weeks in addition to the patient's compliance of the treatment. RESULTS: The RSI score significantly decreased from 19.87±6.34 to 12.78±6.93 after 4 weeks and to 10.65±7.47 after 8 weeks. The RFS score also significantly decreased from 9.29±3.4 to 7.17±3.41 after 4 weeks and to 6.1±3.73 after 8 weeks (p<0.05). During the treatment periods, 42 patients (10.4%) reported to have 80 episodes of discomfort. Throat discomfort (33%) and nausea (28%) were most common complaints, but the duration of discomfort was usually less than 4 weeks. CONCLUSION: Inhaled NAC treatment is highly effective for the reduction of both subjective and objective findings in LPRD patients. This study will provide the evidence of new treatment option for patients with LPRD. However, further studies will be needs to assess the real effect of inhaled NAC therapy as a standard treatment regimen of LPRD.

VEGF and Ki-67 Overexpression in Predicting Poor Overall Survival in Adenoid Cystic Carcinoma / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The purpose of this study was to evaluate potential prognostic factors in patients with adenoid cystic carcinoma (ACC). MATERIALS AND METHODS: A total of 68 patients who underwent curative surgery and had available tissue were enrolled in this study. Their medical records and pathologic slides were reviewed and immunohistochemistry for basic fibroblast growth factor, fibroblast growth factor receptor (FGFR) 2, FGFR3, c-kit, Myb proto-oncogene protein, platelet-derived growth factor receptor beta, vascular endothelial growth factor (VEGF), and Ki-67 was performed. Univariate and multivariate analysis was performed for determination of disease-free survival (DFS) and overall survival (OS). RESULTS: In univariate analyses, primary site of nasal cavity and paranasal sinus (p=0.022) and Ki-67 expression of more than 7% (p=0.001) were statistically significant factors for poor DFS. Regarding OS, perineural invasion (p=0.032), high expression of VEGF (p=0.033), and high expression of Ki-67 (p=0.007) were poor prognostic factors. In multivariate analyses, primary site of nasal cavity and paranasal sinus (p=0.028) and high expression of Ki-67 (p=0.004) were independent risk factors for poor DFS, and high expression of VEGF (p=0.011) and Ki-67 (p=0.011) showed independent association with poor OS. CONCLUSION: High expression of VEGF and Ki-67 were independent poor prognostic factors for OS in ACC.

Induction chemotherapy in head and neck squamous cell carcinoma of the paranasal sinus and nasal cavity: a role in organ preservation

BACKGROUND/AIMS: The role of induction chemotherapy (IC) for eyeball preservation has not been established in head and neck squamous cell carcinoma (HNSCC) of the paranasal sinus and nasal cavity (PNSNC). Periorbital involvement frequently leads to eyeball exenteration with a margin of safety. We evaluated the treatment outcomes, including survival and eyeball preservation, of patients who received IC for HNSCC of the PNSNC. METHODS: We reviewed 21 patients diagnosed with HNSCC of the PNSNC who were treated with IC. We analyzed response, eyeball preservation rate, and overall survival. RESULTS: Tumors were located in the paranasal sinus (n = 14) or nasal cavity (n = 7). Most patients had stage T4a (n = 10) or T4b (n = 7) disease. More than half of the patients received a chemotherapy regimen of docetaxel, fluorouracil, and cisplatin (n = 11). Thirteen patients (61.9%) achieved a partial response after IC and 15 patients (71.4%) achieved T down-staging. Among 17 patients with stage T4 disease, which confers a high risk of orbital exenteration, 14 (82.4%) achieved preservation of the involved eye. The 3-year overall survival (OS) rate of patients who achieved a partial response to IC was 84.6%. The 3-year OS rate of patients with stable disease or disease progression after IC was 25.0% (p = 0.038). CONCLUSIONS: IC could be considered for down-staging patients with advanced T-stage disease. It could also be a reasonable option for eyeball preservation in locally advanced HNSCC of the PNSNC.

Long-Term Outcome of Definitive Radiotherapy for Early Glottic Cancer: Prognostic Factors and Patterns of Local Failure / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: This study evaluates the long-term results of definitive radiotherapy (RT) for early glottic cancer. Clinical and treatment factors related to local control and patterns of failure are analyzed. MATERIALS AND METHODS: We retrospectively reviewed 222 patients with T1-2N0 squamous cell carcinoma of the glottic larynx treated with definitive RT from 1981 to 2010. None of the patients received elective nodal RT or combined chemotherapy. The median total RT dose was 66 Gy. The daily fraction size was < 2.5 Gy in 69% and 2.5 Gy in 31% of patients. The RT field extended from the hyoid bone to the cricoid cartilage. RESULTS: The median age was 60 years, and 155 patients (70%) had T1 disease. The 5-year rates of local recurrence-free survival (LRFS) and ultimate LRFS with voice preservation were 87.8% and 90.3%, respectively. T2 (hazard ratio [HR], 2.30; 95% confidence interval [CI], 1.08 to 4.94) and anterior commissural involvement (HR, 3.37; 95% CI, 1.62 to 7.02) were significant prognostic factors for LRFS. In 34 patients with local recurrence, tumors recurred in the ipsilateral vocal cord in 28 patients. There were no contralateral vocal cord recurrences. Most acute complications included grade 1-2 dysphagia and/or hoarseness. There was no grade 3 or greater chronic toxicity. CONCLUSION: Definitive RT achieved a high cure rate, voice preservation, and tolerable toxicity in early glottic cancer. T2 stage and anterior commissural involvement were prognostic factors for local control. Further optimization of the RT method is needed to reduce the risk of ipsilateral tumor recurrence.

Patterns of Regional Metastasis in Patients with Periorbital Cancer / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: To identify patterns of regional metastasis according to primary tumor location in patients with malignant periorbital tumor. SUBJECTS AND METHOD: We retrospectively reviewed the medical records of the patients diagnosed with periorbital malignant tumors between 1997 and 2008. We analyzed demographic data, pathologic diagnosis, primary tumor location, lymph node metastasis and recurrences. RESULTS: Ninety-five patients with periorbital cancer were reviewed. Amongst them, 16 patients (M : F=7 : 9, mean age: 57.0 years) had regional metastasis. The follow-up duration of 16 patients was 46.2 months on the average. Nine tumors were located in the medial half, two tumors in the lateral half and five tumors in both halves. The parotid gland was the most common regional metastatic site regardless of primary tumor location, and whether or not medially located. CONCLUSION: The parotid gland lymph node group is crucial for medially located periorbital tumor as well as for laterally located one. Once a malignant periorbital tumor is diagnosed, the whole cervical and parotid lymph nodes should be evaluated carefully.

Human salivary gland stem cells ameliorate hyposalivation of radiation-damaged rat salivary glands

Salivary function in mammals may be defective for various reasons, such as aging, Sjogren's syndrome or radiation therapy in head and neck cancer patients. Recently, tissue-specific stem cell therapy has attracted public attention as a next-generation therapeutic reagent. In the present study, we isolated tissue-specific stem cells from the human submandibular salivary gland (hSGSCs). To efficiently isolate and amplify hSGSCs in large amounts, we developed a culture system (lasting 4-5 weeks) without any selection. After five passages, we obtained adherent cells that expressed mesenchymal stem cell surface antigen markers, such as CD44, CD49f, CD90 and CD105, but not the hematopoietic stem cell markers, CD34 and CD45, and that were able to undergo adipogenic, osteogenic and chondrogenic differentiation. In addition, hSGSCs were differentiated into amylase-expressing cells by using a two-step differentiation method. Transplantation of hSGSCs to radiation-damaged rat salivary glands rescued hyposalivation and body weight loss, restored acinar and duct cell structure, and decreased the amount of apoptotic cells. These data suggest that the isolated hSGSCs, which may have characteristics of mesenchymal-like stem cells, could be used as a cell therapy agent for the damaged salivary gland.

A Case of Negative Pressure Treatment on Necrotizing Fasciitis / 대한이비인후과학회지

Necrotizing fasciitis is an invasive soft tissue infection that progresses rapidly. It rarely occurs in the craniocervical area but when it does, it can be fatal; an early diagnosis and treatment would be thus important. Patients with necrotizing fasciitis are treated with intravenous antibiotics after wide debridement of necrotic tissues and daily dressing with antibiotic solution. Since daily dressing is thought to be a bothering procedure to both patients and medical doctors, we applied negative pressure wound therapy on the necrotizing fasciitis wound after operation. Negative pressure wound therapy has been used broadly in the departments of plastic surgery, orthopedic surgery and urology but rarely in the department of otorhinolaryngology. After applying the negative pressure wound therapy, the wound was successfully healed. We hereby introduce the benefits of negative pressure treatment on necrotizing fasciitis patients.

Research on Construction of the Korean Speech Corpus in Patient with Velopharyngeal Insufficiency / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: We aimed to develop a Korean version of the velopharyngeal insufficiency (VPI) speech corpus system. SUBJECTS AND METHOD: After developing a 3-channel simultaneous speech recording device capable of recording nasal/oral and normal compound speech separately, voice data were collected from VPI patients aged more than 10 years with/without the history of operation or prior speech therapy. This was compared to a control group for which VPI was simulated by using a french-3 nelaton tube inserted via both nostril through nasopharynx and pulling the soft palate anteriorly in varying degrees. The study consisted of three transcriptors: a speech therapist transcribed the voice file into text, a second transcriptor graded speech intelligibility and severity and the third tagged the types and onset times of misarticulation. The database were composed of three main tables regarding (1) speaker's demographics, (2) condition of the recording system and (3) transcripts. All of these were interfaced with the Praat voice analysis program, which enables the user to extract exact transcribed phrases for analysis. RESULTS: In the simulated VPI group, the higher the severity of VPI, the higher the nasalance score was obtained. In addition, we could verify the vocal energy that characterizes hypernasality and compensation in nasal/oral and compound sounds spoken by VPI patients as opposed to that characgerizes the normal control group. CONCLUSION: With the Korean version of VPI speech corpus system, patients' common difficulties and speech tendencies in articulation can be objectively evaluated. Comparing these data with those of the normal voice, mispronunciation and dysarticulation of patients with VPI can be corrected.

Clinical Analysis of Acinic Cell Carcinoma in Parotid Gland

OBJECTIVES: Acinic cell carcinoma (AciCC) is a rarely encountered malignancy in parotid gland. Because AciCC is rare and was recently recognized as the entity of malignancy, AciCC has been difficult to study. We aimed to analyze the diagnosis and treatment experience for this malignancy in our hospital. METHODS: We retrospectively reviewed medical records of the 20 patients with AciCC of parotid gland diagnosed from 1990 to 2009. The preoperative computed tomography scan, preoperative fine needle aspiration cytology (FNAC) and intraoperative frozen section results were compared with the final diagnosis. The survival and recurrence were analyzed with the cancer stages and treatment modalities. RESULTS: There were 10 males and 10 females, with a mean age of 44.4 years, ranging 8-77 years. The AJCC tumor stage distributions of the patients were 70%, 15%, and 15% for stages I, II, and IV, respectively. The sensitivity of FNAC and intraoperative frozen section was 26.7% and 50.0% respectively. The 10-year survival rate was 90.9% with a mean follow-up of 111 months, ranging 17-251 months. The 10-year disease free survival rate was 74.2% and the mean duration of recurrence from initial surgery was 92.3 months. CONCLUSION: AciCC of the parotid gland is a rare malignancy that has features of less aggressive behavior, and good prognosis. Intraoperative frozen section examination may be helpful in the diagnosis of AciCC of the parotid gland because of the low sensitivity of preoperative computed tomography scan and FNAC. Surgery with adjuvant postoperative radiotherapy is satisfactory for disease control.

Pseudocyst of the Vocal Fold: Distinct Disease Entity or Not? / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Koufman described a pseudocyst of the vocal folds for the first time in 2001. A pseudocyst in all parts of the body and that is related to secretory glands is already well known, but such a lesion of the vocal folds has only been mentioned a few times. It is unclear whether or not to define a pseudocyst of the vocal folds as a benign lesion of the vocal folds. The objective of this study was to introduce the demographic and clinical findings of pseudocyst and to discuss our diagnostic and therapeutic strategies. SUBJECTS AND METHOD: We carried out a retrospective review of all the medical records, the preoperative voice lab results and the operation records from 2006 to 2009. All the patients underwent laryngomicrosurgery due to benign vocal folds lesions. We select 11 cases that showed subepithelial lesion without a definite capsule. RESULTS: Seven patients had had the history of voice abuse. One patient has been a smoker, another was an ex-smoker and the others were non-smokers. According to aerodynamic assessment, the maximum phonation time was 14.6 seconds and the mean airflow was typically increased. On laryngoscopy, all were translucent and spherical or fusiform subepithelial lesions. The preoperative stroboscopic findings showed a uniform feature of damping on the vocal fold lesion. Both the unroofing technique and the microflap technique were used. CONCLUSION: A pseudocyst would be a subepithelial lesion without a definite epithelial lining that contains serous discharge. We suggest that a pseudocyst of the vocal fold is a new benign lesion.

Schwannoma Mimicking Laryngocele

A schwannoma of the larynx is a rare benign tumor that usually presents as a submucosal mass in the pyriform sinus and the aryepiglottic space, and this type of schwannoma constitutes a diagnostic and therapeutic challenge for otolaryngologists. We present here two cases of supraglottic schwannomas that were misdiagnosed as laryngoceles. Both were excised through a lateral thyrotomy approach without a tracheostomy, and the laryngeal function was successfully maintained. We discuss the clinical and imaging findings and the management of this rare neoplasm with focusing on the differential diagnosis of laryngeal schwannoma and laryngocele. We also review the relevant medical literature.