Laryngotracheal mucormycosis: Report of a case.

Airway mucormycosis is a deadly opportunistic infection that affects immunocompromised persons, particularly diabetics and those undergoing chemotherapy. Although it is typically a pulmonary or sinonasal infection, mucormycosis can affect the larynx and trachea, with devastating results. We report the case of a 46-year-old man with human immunodeficiency virus infection, hepatitis C infection, neurosyphilis, and recently diagnosed Burkitt lymphoma who presented with dysphonia and stridor after receiving one dose of intrathecal chemotherapy. Flexible laryngoscopy detected the presence of fibrinous material that was obstructing nearly the entire glottis. Surgical debridement revealed a firm mucosal attachment; there was little bleeding when it was removed. After debridement, the patient's dyspnea improved only to recur 2 days later. After an awake tracheotomy, laryngoscopy and bronchoscopy identified necrosis extending from the supraglottic area to the carina tracheae. Biopsies demonstrated hyphal architecture consistent with mucormycosis. Despite continued debridements, the fibrinous material reaccumulated. The patient was placed in hospice care; his airway remained patent, but he died from other causes several weeks after presentation. The management of airway mucormycosis is challenging and complex. Fungal airway infections should be considered in the differential diagnosis of an immunosuppressed patient who presents with dyspnea, dysphonia, and vocal fold immobility. Timely diagnosis and management are critical for a successful outcome, although the prognosis is poor if the infection is widespread, even with the best of efforts.

A Comparison of Initial and Subsequent Follow-Up Strobovideolaryngoscopic Examinations in Singers.

OBJECTIVES: Previous studies have identified abnormal findings in up to 86.1% of singers on initial screening strobovideolaryngoscopy (SVL) examinations. No studies have compared the prevalence of abnormalities in singers on their subsequent follow-up SVL. Our study evaluates the frequency of these findings in both the initial and subsequent examinations. METHODS: Retrospective charts and SVL reports were reviewed on students from an opera conservatory from 1993 to 2014. All students had initial screening SVL, but only students who later returned with acute voice complaints were included in the study (n = 51, 137 follow-up visits). Normal SVL was defined as an examination without structural or functional abnormalities and reflux finding score ≤7. Data were analyzed using the chi-square test. RESULTS: For initial examinations, 90.2% (including reflux) and 88.2% (excluding reflux) were abnormal. In follow-up examinations, 94.9% (including reflux) and 94.2% (excluding reflux) had abnormal findings, which included muscle tension dysphonia (40.1%), vocal fold (VF) masses (unilateral 48.9%, bilateral 30.7%), vascular abnormalities (unilateral 27.0%, bilateral 5.8%), sulcus (unilateral 17.5%, bilateral 5.1%), VF hypomobility (unilateral 36.3%, bilateral 5.9%), phase (30.6%) and amplitude (44.8%) asymmetries, and glottic insufficiency (49.3%). Follow-up examinations revealed a significant increase in laryngopharyngeal reflux (χ(2) = 7.043; P < 0.05). CONCLUSIONS: We found a higher prevalence of abnormal findings compared with previous studies, which we attributed to a more inclusive definition of abnormal pathologies, improvements in SVL technology, and possibly increased experience with SVL interpretation. This high prevalence of abnormal findings in asymptomatic singers further supports the importance of baseline examinations.

Sulcus Vocalis (Type III): Prevalence and Strobovideolaryngoscopy Characteristics.

OBJECTIVES: The reported prevalence of sulcus vocalis (SV)/type III, a pathologic groove in the vibratory margin of the vocal fold, varies greatly in the literature. Difficulties in visualizing the defect and a variety of descriptions have complicated the evaluation of SV. The objective of this study was to determine the prevalence of SV by reviewing strobovideolaryngoscopy (SVL) examinations in subjects with and without dysphonia. STUDY DESIGN: Retrospective chart review. METHODS: Charts and SVL images were reviewed for subjects with and without dysphonia and analyzed using standard statistical techniques. RESULTS: SVL images were reviewed for 94 nondysphonia subjects and 100 dysphonia subjects. For all subjects, 19.6% had type I, 2.1% had type II, and 5.7% had type III/SV. Per vocal fold, 14.7% had type I, 1.3% had type II, 3.1% had type III/SV and 13.1% had scar. The prevalence of SV per subject was not significantly different between the two groups (8% of dysphonia subjects, 3.2% of nondysphonia subjects). Male gender, decreased amplitude, decreased waveform, and hypodyamic motion were significantly higher in the dysphonia SV subjects compared with the non-SV subjects. All other SVL characteristics were not significantly different in subjects with SV compared with non-SV subjects. CONCLUSIONS: We report a prevalence of SV/type III at 3.1% (per vocal fold) and 5.7% (per subject). Higher frequencies of male gender and waveform abnormalities were seen in the dysphonia SV subjects only. There were no significant differences in nondysphonia subjects with or without SV.

Management of supraglottic stenosis using a novel stent design.

OBJECTIVES: To present a novel design for a stent for management of a traumatic supraglottic web. METHODS: Case report and literature review (PubMed 1964-2013). RESULTS: A 48-year-old man was presented after penetrating laryngeal trauma. He had severe dysphonia and was tracheotomy dependent. He had been treated previously with open reduction and fixation of laryngeal fracture. On examination, we identified an avulsed left vocal fold and a supraglottic web. He initially underwent reapproximation of the avulsed left vocal fold, and subsequently, the supraglottic web was treated using a stent designed by the senior author (R.T.S.). In addition, he underwent later resection of scar tissue to improve dysphonia and then he was decanulated. CONCLUSIONS: There are a few techniques presented in the literature and mostly are adaptations of subglottic stenosis management techniques. Individualized treatment is needed for these difficult cases. We present our experience with supraglottic web treatment to expand the literature on this uncommon disorder.

The effect of oral topical anesthesia on the characteristics of voice.

OBJECTIVES/HYPOTHESIS: Although oral topical anesthesia is used routinely before rigid laryngeal endoscopy, no study has determined whether oral topical anesthesia changes voice quality. Our goal was to determine the effects of topical anesthesia on voice. STUDY DESIGN: Prospective cohort study. METHODS: Adult patients presenting to a laryngology practice who required rigid laryngeal endoscopy as part of the routine clinical visit were eligible for the study. Voices were recorded before and after oral topical benzocaine (14%)/butamben (2%)/tetracaine (2%) (ie, cetacaine) spray. Consensus auditory perceptual evaluation of voice (CAPE-V) protocol was used for the voice recordings and was the primary outcome measure. Recordings were presented randomly to two blinded speech-language pathologists specialized in voice. Secondary outcome measures were fundamental frequency (F0), jitter, shimmer, and noise-to-harmonics ratio (N/H) on sustained /i/ and speaking F0. RESULTS: One hundred two patients participated in the study. There was no significant difference in CAPE-V measurements before and after topical anesthesia for all six attributes: overall severity (P = 0.145), roughness (P = 0.214), breathiness (P = 0.761), strain (P = 0.053), pitch (P = 0.301), and loudness (P = 0.320). There was no significant difference in jitter (P = 0.315), shimmer (P = 0.942), N/H (P = 0.128), and speaking F0 (P = 0.320). F0 /i/ decreased by a mean of 4.8Hz, which was statistically significant (P = 0.003), but probably not clinically significant. CONCLUSION: There was no clinically significant voice change after oral topical anesthesia.

Degrees of dysplasia based on viral typing in patients with cidofovir use and recurrent respiratory papillomatosis.

OBJECTIVES/HYPOTHESIS: To evaluate the degree of dysplasia following cidofovir injections while documenting human papillomavirus (HPV) type in patients with recurrent respiratory papillomatosis (RRP). STUDY DESIGN: Retrospective chart review. METHODS: Demographic data, operative reports, and pathology results were reviewed from 25 patients with RRP who had had cidofovir injections. All patients included had adult onset RRP, no history of immunosuppression, well-controlled laryngopharyngeal reflux, and no current smoking history. Eight patients were excluded because they did not meet the inclusion criteria. RESULTS: Seventeen patients had adequate data for analysis and 40 subsites were identified with sufficient data for analysis. Patients negative for both low and high risk did not have progressive dysplasia at the conclusion of the study. Of the patients with positive viral typing, 70% had progressive disease at the conclusion of the study. No patients progressed to carcinoma or carcinoma in situ. The average pre- and post-treatment dysplasia scores were analyzed using a Student paired t test. There was no difference in mean dysplasia score, indicating that there was no increased risk of dysplasia following cidofovir treatment. CONCLUSIONS: To our knowledge, this is the first study looking at the degree of dysplasia while documenting HPV types in RRP. Our study suggests that HPV type appears to be relevant in the disease progression of RRP and that cidofovir does not increase the risk of dysplasia.