A Study on the Outcome of Treatment among Patients with Hoarseness in a Tertiary Care Centre

Hoarseness is defined as the perceived rough, harsh or breathy quality of voice. Since both benign and malignant lesions can produce hoarseness, timely evaluation is very important because delay in the diagnosis of malignancy can adversely affect the outcome. We wanted to study the treatment and its outcome in patients with hoarseness of various aetiologies, and compare the response to treatment between various groups.METHODSThis was a longitudinal study conducted in the Department of ENT in a tertiary care centre in south India. In patients with hoarseness, history was elicited, clinical examination was done, and perceptual evaluation of voice was made using GRBAS (Grade, Roughness, Breathiness, Asthenia, Strain) scale. Direct laryngoscopy and biopsy were done whenever suspicious lesions were seen. Early laryngeal cancer was treated with radiotherapy, while advanced cases were treated with chemoradiation. Other cases were treated with medications, Video Laryngeal Surgery (VLS) or voice therapy, according to the diagnosis. Patients were kept under follow up; reassessment was done after six months regarding improvement/ persistence/ deterioration of previous symptoms. Laryngoscopy and perceptual evaluation of voice were repeated, and the data collected was analysed.RESULTSOn treatment, the lesion subsided completely, and hoarseness got relieved in all the cases of laryngitis, trauma, vocal nodule, vocal polyp and cyst, while the lesion subsided partially, and hoarseness improved in vocal cord palsy, papilloma and carcinoma of glottis. The response to treatment was better in benign lesions when compared to malignant lesions (P value < 0.0001) and better in glottic malignancies when compared to malignancies at other nearby sites (P value <0.001).CONCLUSIONSMost of the benign conditions that caused hoarseness subsided and voice became normal with medications, video laryngeal surgery and voice therapy, while hoarseness persisted to some extent after treatment with radiotherapy or chemoradiation in most of the patients with malignancy.

Correlation between vascular endothelial growth factor expression and presence of lymph node metastasis in advanced squamous cell carcinoma of the larynx / Correlação entre expressão do fator de crescimento endotelial e presença de metástase linfática nos carcinomas epidermoides avançados de laringe

Introduction: Squamous cell carcinoma is the most common neoplasm of the larynx, and its evolution depends on tumor staging. Vascular endothelial growth factor is a marker of angiogenesis, and its expression may be related to increased tumor aggressiveness, as evidenced by the presence of cervical lymphatic metastases. Objectives: To evaluate the expression of the vascular endothelial growth factor marker in non-glottic advanced squamous cell carcinoma of the larynx (T3/T4) and correlate it with the presence of cervical lymph node metastases. Methods: Retrospective clinical study and immunohistochemical analysis of vascular endothelial growth factor through the German scale of immunoreactivity in products of non-glottic squamous cell carcinomas. Results: This study analyzed 15 cases of advanced non-glottic laryngeal tumors (T3/T4), four of which exhibited cervical lymphatic metastases. There was no correlation between vascular endothelial growth factor expression and the presence of cervical metastases. Conclusion: Although vascular endothelial growth factor was expressed in a few cases, there was no correlation with the spread of cervical lymph metastases. .

Introdução: O carcinoma de células escamosas é a neoplasia mais frequente da laringe e seu prognóstico depende do estadiamento. A progressão da doença está relacionada a fatores intrínsecos celulares do câncer, não conhecidos. O VEGF (vascular endothelial growth factor) é um marcador de angiogênese e sua expressão pode estar relacionada a uma maior agressividade tumoral, evidenciada pela presença de metástases linfáticas cervicais. Objetivos: Avaliar a expressão do marcador VEGF em carcinoma de células escamosas da laringe avançados (T3/T4), não glóticos e correlacionar quanto à presença de metástases linfáticas cervicais. Método: Estudo clínico retrospectivo de análise imunohistoquimica do VEGF através da escala Germânica de imunorreatividade em produtos de carcinomas epidermóides não glóticos. Resultados: Analisados 15 casos de tumores avançados de laringe (T3/T4) não glóticos, sendo sete com presença de metástases linfáticas cervicais. Não houve correlação entre a expressão do VEGF e a presença de metástases cervicais. Conclusão: O VEGF foi pouco expressado nos casos estudados e não foi observada sua correlação com a disseminação de metástase linfática cervical. .

Correlation between expression of TIAM1 gene and carcinomas of larynx / 临床检验杂志

Objective To study the relation between Tiam1 gene(T lymphoma invasion/metastasis 1)and carcinomas of larynx metastasized to lymph node.Method Using reverse transcription polymerase chain (RT-PCR) mRNA overexpression of Tiam1 gene in 30 cases of carcinoma of larynx tissue,12 lymph nodes and 10 cases of normal larynx tissue was studied.Result The frequency of TIAM1 overexpression was 75% (6/8) in primary carcinomas of larynx with metastasis but only 18.7%(4/22) in those without metastasis(P=0.0072).Overexpression of TIAM1 in metastasized lymph nodes was observed in 100% (8/8) of lymph nodes with metastasis but in only 25%(1/4) of the lymph nodes without metastasis of carcinoma(P=0.0182).The frequency of TIAM1 overexpression was 33.3% (10/30) in primary carcinomas of larynx.Conclusion Our data suggest that the overexpression of the TIAM1 gene correlates with lymph node metastasis of carcinomas of larynx.

Inhibitory Effects of Celecoxib and Sc-58125 on Proliferation of Human Carcinoma of Larynx Hep-2 In Vitro / 华中科技大学学报（医学）（英德文版）

The inhibitory effects of two kinds of selective cyclooxygenase-2 inhibitors on the proliferation of human carcinoma of larynx Hep-2 in vitro and their corresponding mechanisms were investigated. Hep-2 cells were cultured with two kinds of selective cyclooxygenase-2 inhibitors (Sc58125 and Celecoxib) at various concentrations for 24 h. Morphological changes were observed under the phase microscopy and the growth suppression was detected by using MTT colorimetric assay. Apoptotic DNA fragments were observed by agarose gel electrophoresis, and the cell cycle andapoptotic rate were detected by flow cytometry (FCM) respectively. Hep-2 cells became roundedand detached from the culture dish after being treated with Celecoxib for 24 h, however, they remained morphologically unchanged with Sc-58125. Sc-58125 could increase G2 phase cells, whereas, Celecoxib rose G1 phase cells. Both of the two effects were dose-dependent. Moreover, the Hep-2 cells cultured with 50μmol/L and 100 μmol/L Celecoxib showed obvious apoptosis, with the nuclear DNA of cells exhibiting characteristic DNA ladder. So Sc-58125 could inhibit the proliferation of Hep-2 cells by altering the G2 phase cells. However, Celecoxib had the same effect by changing the G1 phase cells and inducing apoptosis at higher concentration.