The role of allergy in the etiopathogenesis of laryngeal mucosal lesions.

The results of this study showed that allergy is an important factor in the etiopathogenesis of laryngeal mucosal lesions. Despite adequate treatment, no other unfavourable factors appeared to have significant influence on the results of the treatment. It seems that hypersensitivity to different inhalatory and nutritional allergens make laryngeal mucosa more susceptible for adverse action of other factors: vocal misuse, gastroesophageal reflux (GER), smoking, irritants in the surrounding microclimate, endocrinologic disorders, etc. Acting together, all these factors cause the development of laryngeal mucosal lesions. In the treatment of noninfectious laryngitis, vocal cord nodules, polyps or Reinke's edema, all the stated adverse factors should be identified and suitably diminished or eliminated. Allergy (Ig-E-mediated and non-IgE-mediated) should be considered as only one of the etiopathogenetic factors.

Alterations in the laryngeal mucosa after exposure to asbestos.

The laryngeal mucosa of 195 workers in an asbestos cement factory (Salonit Anhovo, Yugoslavia) and in a control group was examined. The factory manufactures asbestos cement products containing about 13% of asbestos (8% amosite, 12% crocidolite, and 80% chrysotile) of different provenance. Alterations in the laryngeal mucosa were more frequent in the factory workers than in the control group. The changes, mostly consistent with chronic laryngitis, were closely related to the degree of workplace pollution and less so to the duration of employment Ten workers exhibiting the most severe clinical changes underwent biopsy, the results of which showed histomorphological changes characteristic of hyperplastic chronic laryngitis. Four tissue specimens were examined also by scanning electron microscopy and in three of them asbestos fibres were found on the epithelial surface. No case of laryngeal carcinoma was identified. On the basis of our results it is thought that asbestos related changes of the larynx should receive more attention and that the use of the term "laryngeal asbestosis" is justified. The clinical picture is non-specific but in view of their frequency such changes should be considered a consequence of exposure to asbestos.

[Anatomical markers of Reinke's space and the etiopathogenesis of Reinke edema]. / Die anatomischen Merkmale des Reinke-Raumes und die Atio-Pathogenese des Reinke-Odems.

On the basis of histological examination of normal human larynges, the authors have defined the anatomical and histological features of Reinke's space. It is sharply demarcated by dense fibrous tissue in the anterior commissure, along the vocal process of the arytenoid and beneath the free margin of the vocal cord. The upper limit is not always sharply demarcated, and on the upper surface Reinke's space varies considerably in size. It may include a half of the upper surface of the vocal cord, reaching usually to the bottom of the laryngeal ventricle and occasionally extending to include also the inferior surface of the ventricular fold. The authors suggest that the upper boundary of Reinke's space is functional. On the basis of the morphologic structure of Reinke's space a hypothesis of aetiopathogenesis of Reinke's oedema was set up. The patient's attempt to compensate the hoarseness by the use of the false vocal cords forces the fluid within Reinke's space towards the free edge of the vocal cord.

[The role of the otolaryngologist in the treatment of children with clefts]. / Uloga otorinolaringologa u lijecenju djece sa shizama.

Cheilognathopalatoschises are a complex therapeutic problem not yet completely solved and demanding collaboration of a number of medical and paramedical branches. In a therapeutic team, an otorhinolaryngologist has an important role since he has to deal with impaired hearing, impaired nasal breathing, as well as with disturbed speech development. On the basis of an analysis of the state of hearing in children who were treated at the University Clinic for Otorhinolaryngology and Cervicofacial Surgery in Ljubljana, it was found that more than 76% of them suffered from hearing loss of different levels. Almost in all children with uni-or bilateral cheilognathopalatoschises nasal breathing was disturbed, due to deformities of alae and caudal border of septum. In all these children signs of chronic rhinitis were pronounced. A silent inflammation in the nose and in the epipharynx together with hyperplastic adenoids and disturbed function of the eustachian tube cause conduction hearing loss and recurrent otitis media, which hinders speech training. The authors are of the opinion that additional surgical interventions enabling nasal breathing and function of the middle ear should be implemented more frequently and sooner than up till now. All children with cleft-lip-palate should be permanently followed up by a group of subspecialized otorhinolaryngologists which would lead to a more successful and complete rehabilitation.

[Testosterone--an etiological factor in the development of laryngeal carcinoma?]. / Testosteron--aetiologischer Faktor bei der Entwicklung des Larynxkarzinoms?

To evaluate the etiological connection between the development of hyperplastic lesions of the laryngeal mucosa (including cancer) and the male sex hormones, the authors determined the level of testosterone in the serum of patients with cancer of the larynx (25 women and 25 men) and patients with hyperplastic lesions of the mucous membrane of the larynx (15 women and 15 men). In patients who suffered from cancer of the larynx the serum level of testosterone was significantly increased compared to the control group. In the patients who had hyperplastic lesions (including precancerous lesions) of the laryngeal mucosa the differences in the concentration of the serum testosterone were not statistically significant from the control group. The same was also true of the testosterone-estradiol index. The results of the study do not help to explain the success of hormonal therapy for hyperplastic lesions of the laryngeal mucosa. The authors consider that endogenous factors, especially the male sex hormones, should be taken more into account, alongside exogenous factors, in the genesis of laryngeal cancer.

Acid posterior laryngitis. Aetiology, histology, diagnosis and treatment.

The authors have treated 44 patients with posterior chronic acid laryngitis. Biopsy was performed in all patients. Characteristic changes typical of the hyper-regenerative or atrophic phase of reflux oesophagitis were identified in all specimens. Gastric hypersecretion was proven in all but two patients. The aetiologic factors of acid posterior laryngitis are gastro-oesophageal reflux, with friction of both vocal processes during phonation and vocal abuse. The preferred therapy is removal of circumscribed lesions with a suitable medical regimen.

Topographic anatomy of the external branch of the superior laryngeal nerve. Its importance in head and neck surgery.

The authors have studied the anatomy of the external branch of the superior laryngeal nerve in its entirety on 40 fresh cadavers, and they have drawn the following conclusions: the nerve ramifies from the vagus immediately below the nodose ganglion or in the ganglion itself. The nerve splits into two branches approximately 1.5 cm below the ganglion nodosum. In four cases, both branches originated from the vagus itself. In one case, anastomosis of the external branch of the superior laryngeal nerve with the recurrent nerve was found. The external branch of the superior laryngeal nerve is not usually severed at supraglottic laryngectomy but the nerve is at risk during neck dissections, resection of Zenker's diverticula and thyroidectomy. An accurate knowledge of its course should reduce the incidence of injury to the branches of the superior laryngeal nerve during surgery.

The role of testosterone in laryngeal carcinogenesis.

Testosterone levels in the plasma of 25 women and 25 men with carcinoma of the larynx and of 15 women and 15 men with hyperplastic aberrations in the laryngeal mucosa were determined to evaluate the etiologic relation between hyperplastic aberrations in the laryngeal mucosa (including cancer) and the male sex hormones. Patients with laryngeal cancer showed statistically significant increases in plasma testosterone levels compared with the control group. No statistically significant differences were found in plasma testosterone levels or in the testosterone/estradiol index between patients with hyperplastic aberrations of the laryngeal mucosa (including precancerous conditions) and the control subjects. The authors believe that greater attention should be paid to endogenous factors, particularly the male sex hormones, in further studies of the etiology of laryngeal carcinoma.

Warty dyskeratoma of the vocal cord. First reported case.

Warty dyskeratoma is a tiny, nodular lesion with a characteristic histologic picture that resembles that of Darier's disease. Until now, these changes have been described only on the skin and the mucosa of the oral cavity. To our knowledge, our case includes the first description of this lesion on the vocal cord. This study presents clinical and histologic features in detail, dealing also with the differential diagnosis, which is very important for distinguishing the warty dyskeratoma from the squamous cell carcinoma.

Intubation lesions of the larynx.

One thousand patients were examined immediately after extubation of the trachea at the end of anaesthesia. Severe lesions of the larynx were detected in 62 patients (6.2%). The lesions encountered included haematoma, laceration of the mucous membrane, laceration of the muscle and subluxation of the arytenoid cartilage. In spite of early diagnosis and adequate treatment, it was not possible to avoid an effect on the voice in nine patients.

The influence of cigarette smoke on the pharyngeal mucosa.

The influence of cigarette smoke on the pharyngeal mucosa was investigated in a clinical study and in an experiment on animals. Histologic reports were evaluated according to the Kambic-Lenart classification of hyperplastic aberrations of the throat mucosa. A close dependence of the degree of hyperplasia and the number of cigarettes smoked was revealed. The more cigarettes the patients smoked every day, the more evident were changes on the mucosa, more clearly manifested in male than in female smokers. It was observed that the changes related to the hyperplasia atypica were more evident the longer the patients smoked. They were also more intense the younger the smokers were when they started smoking. In the experiment on animals, a number of factors with additionally noxious influence on the pharyngeal mucosa were excluded. A great interdependence was observed between the number of daily inhaled cigaretes and the changes on the pharyngeal mucosa.

[Laryngeal mucosal changes experimentally produced by endogenous and exogenous factors in mice (author's transl)]. / Veränderungen an der laryngalen Mäusechleimhaut als Folge endogener und exogener Faktoren.

Experimentally an attempt was made to demonstrate the effects of exogenous factors on the hormonally altered laryngeal mucosa of mice. Albany mice were divided into 4 groups of 8. In the first group of males, testosterone was injected daily; in the second group of males, no testosterone was given; in the third group of females with previously removed ovaries, testosterone was given daily; and, in the fourth group of females, no testosterone was given. All 4 groups were exposed to cigarette smoke for one hour daily for six weeks. Histopathological examination of the mucosa showed that the larynx can be considered a "target" organ for male hormones and that exogenous factors produce changes that lead to malignancy.

[Intubation microtraumatic lesions of the larynx (author's transl)]. / Die Mikrotraumen des Larynx bei Intubation

Laryngeal microtrauma and seeding of laryngeal malignancy to the lower respiratory tract after short-term intubation is reported. These findings have been confirmed by cytology of smears taken from the endotracheal tubes used on 40 patients. Dysphonia without macroscopically visible laryngeal changes is caused by microtraumatic lesions. The authors advise very gentle intubation to avoid such consequences. Dissemination of infection and malignancy remains unsolved.