Analysis of the clinical efficacy and voice outcomes of CO2 laser resection versus laryngeal microsurgery for vocal cord polyps.

OBJECTIVE: To compare CO2 laser resection and laryngeal microsurgery for vocal cord polyps and provide evidence for the optimal surgical method. METHODS: This was a retrospective cohort study that included 74 patients with vocal cord polyps who underwent either CO2 laser resection or laryngeal microsurgery in our hospital from August 2018 to December 2021. According to their preference, 77 patients were divided into two groups: a CO2 laser resection group (n = 35) and a laryngeal microsurgery group (n = 39). Patients were evaluated two days before surgery, and follow-ups were conducted one, two and four weeks after surgery. The voice handicap index (VHI-10) score, voice acoustic analysis results and electronic laryngoscopy results were collected for each patient, and the differences between the two groups were evaluated. RESULTS: The basic demographic characteristics of the 74 patients were comparable, and all patients completed postoperative follow-up observations. A total of 30 (85.71%) patients in the CO2 laser resection group and 22 (56.41%) patients in the laryngeal microsurgery group were healed. The total effectiveness rate of the CO2 laser resection group (94.29%) was significantly higher than that of the laryngeal microsurgery group (82.05%), and the difference between the two groups was statistically significant (p = .037). Both surgical methods had a positive effect on reducing VHI-10 scores with the effect of CO2 laser resection being more obvious. The difference between the two groups in this regard was statistically significant (p < .001). The effects of each surgical method on the average fundamental frequency perturbation (jitter), amplitude perturbation (shimmer), maximum phonation time and dysphonia severity index were not statistically significant (p > .05). CONCLUSION: CO2 laser resection and laryngeal microsurgery have similar effects on voice quality, but CO2 laser resection has higher clinical efficacy.

A Rare Case of Adult Vocal Cord Hemangioma: A Case Report and Literature Review.

Infantile laryngeal hemangiomas are relatively common. However, adult vocal cord hemangiomas are extremely rare. A 46-year-old woman was referred to our department for hoarseness, which continued for 18 months. A laryngeal fiberscope revealed a small protuberant tumor resembling a polyp on her right vocal cord, and the narrow-band imaging showed abundant vascularity. Laryngeal microsurgery with a cold instrument under general anesthesia completely resected the tumor on the vocal cord. Histopathologically, the resected tumor consisted of vessels with thick walls and was diagnosed as a cavernous hemangioma of the vocal cord. After the surgery, she has never complained of hoarseness and has had no local recurrence for six months.

Role of mepolizumab in severe allergic asthma with vocal cord polyp.

Interleukin (IL)-5 plays an important role in development, recruitment, and survival of eosinophils, thereby causing debilitating signs and symptoms associated with severe eosinophilic asthma. Mepolizumab is a humanized monoclonal antibody (mAb) against IL-5 which selectively inhibits eosinophilic inflammation and reduces the amount of eosinophils. This reduction is seen in both sputum and blood, resulting in a reduction in exacerbations and in time the need for using systemic steroids. The role of mepolizumab and its effect is still not fully known as there are less real-life studies available. We herewith present a case of severe eosinophilic asthma with vocal polyp managed by mepolizumab.

Vocal cord inflammatory myofibroblastic tumor with mucoid deposits harboring TIMP3-ALK fusion: A potential diagnostic pitfall.

A 35-year-old Japanese man who had experienced hoarseness for 10 years presented with a vocal cord lesion. A gross examination revealed a left vocal cord polyp occupying two-thirds of the vocal space. The endoscopically resected lesion contained scattered atypical fibroblastic, stellate, or ganglion-like cells with mucoid stroma. Vacuolated cells were also seen. Lymphoplasmacytic infiltrate was largely undetectable. A vocal cord polyp was first suspected, but well-differentiated liposarcoma and inflammatory myofibroblastic tumor (IMT) were included in the differential diagnoses. The tumor cells were positive for anaplastic lymphoma kinase (ALK), calponin, and vimentin, and negative for other smooth muscle markers by immunohistochemistry. Structures resembling myofibroblasts were not observed by electron microscopy, which confirmed abundant rough endoplasmic reticulum in the tumor cells and accumulated lipid droplets in some tumor cells. ALK gene rearrangement was detected by fluorescence in situ hybridization, and TIMP3-ALK fusion was confirmed by 5' rapid amplification of cDNA ends. We diagnosed the lesion as an IMT, and an ALK-rearranged stellate cell tumor may be postulated. This is the first report of a fusion partner gene of ALK in a case of laryngeal IMT.

[Clinical treatment of benign vocal cord lesions with occult vocal cord sulcus].

Objective:To discuss the correlation of benign vocal cord lesions with occult vocal cord sulcus and the treatment of benign vocal cord lesions with occult vocal cord sulcus, through the analysis of surgical data, preoperative voice evaluation data and postoperative follow-up data of patients.Method:The data from 377 patients of benign vocal cord lesions with concealed vocal cord sulcus admitted to Beijing Tongren Hospital from 2005 to 2016 were reviewed. The follow-up time was more than half a year after surgery.Result:About 2.9% of the benign lesions of the vocal cords were associated with occult vocal cords sulcus,of which 61.27% were bilateral vocal cords sulcus,22.55% was right vocal cords sulcus,and 16.18% was left vocal cord sulcus.Of the patients with bilateral vocal fold sulcus,64.5% had benign vocal cord lesions and 35.5% had unilateral vocal cord benign lesions.Of the patients with unilateral vocal fold,73.97% were associated with ipsilateral vocal cord benign lesions, and 26.03% were associated with contralateral vocal cord lesions.In the 531 sides of the vocal cords sulcus,183 sides of vocal fold sulcus typeⅠwere not treated. The 332 sides of vocal fold sulcus type Ⅱ were treated with removed lesions of the vocal cords and microdissection of vocal cord adhesion.The 16 sides of vocal fold sulcus type Ⅲ were treated with removed lesions of the vocal cords,local tamponaded of autogenous abdominal fascia and microsutured to close the wound. There were 9 cases with 11 sides of vocal fold sulcus combined with the mucous bridge.The satisfactory rate of sound improvement was 80.37% in half a year after the operation.Postoperative fundamental frequency,jitter,shimmer and maximum phonation time were significantly improved compared with preoperative.Conclusion:The occurrence of benign vocal cord lesions may be related to occult vocal fold sulcus.Simultaneous treatment of benign vocal cord lesions with occult vocal cord sulcus can achieve satisfactory voice improvement.Therefore, we should pay attention to the treatment of vocal fold sulcus in the diagnosis and treatment of benign vocal cord diseases.

Pólipo bilateral de cuerda vocal: presentación de un caso clínico / Bilateral vocal cord polyp: case report

Los pólipos de cuerda vocal son lesiones laríngeas benignas. Se asocian a micro-traumatismos por mal uso vocal que generan remodelación de la lámina propia y el epitelio. Es más frecuente en hombres entre los veinte y cuarenta años. En la gran mayoría de los casos se presenta de manera unilateral. Si bien estas lesiones están bien documentadas en la literatura, es raro encontrar presentaciones bilaterales, por lo que su enfrentamiento y manejo puede ser discutible. Se presenta el caso de una paciente de sexo femenino de 41 años, fumadora, que consulta por disfonía de larga data. Se diagnostican pólipos bilaterales de cuerda vocal, realizando una intervención quirúrgica en un tiempo, con un resultado favorable.

Vocal cord polyps are benign Iaryngeal lesions. They are associated to micro traumatisms because ofvocal misuse, generating a remodelation of the lamina propria and the epithelium. It is more common in men between twenty and forty years of age. In the vast majority of cases it unilaterally occurs. While these are well documented injuries in the literature, it is rare to find bilateral presentations, so their confrontation and management may be debatable. We present the case of a female patient, smoker, who consulted for chronic dysphonia. Bilateral vocal cord polyps were diagnosed, performing a bilateral resection with a positive outcome.

Correlation of positive expressions of HPV and EBV with laryngeal carcinoma / 实用医学杂志

Objective To investigate the relationships between expressions of HPV and EBV in larynge-al carcinoma. Methods DNA flow-through hybridization and gene chip genotyping technology(HybriMax)and real-time quantitative PCR were used for 37 subtypes of HPV detection and quantitative detection of EBV in 101 cases of laryngeal cancer paraffin embedded tissue specimens. 43 cases of vocal cord polyp of paraffin embedded tissue specimens were used as the controls. Results The positive rate of laryngeal carcinoma was 13.86% in group HPV and 9.3% in the control group ,with no statistically significant difference between the positive expres-sions of HPV in the laryngeal carcinoma group and control group(P>0.05). The positive rate of laryngeal carci-noma was 63.37% and 13.95%,respectively ,in group EBV ,and the control group ,with significant difference between them(P 0.05),but the difference was statistically significant in highly differentiated EBV as compared with those with low differentiation type,medium differentiation and poor differentiation(P 0.05). Conclusions The incidence of laryngeal carcinoma is closely related with EBV infection ,possibly relationed with HPV and high-risk subtypes of HPV have a certain role in the process of induced laryngeal carcino-ma. The gender ,age and duration of disease have no significant correlation with EBV infection. This study will provide a basis for further invesgitation of pathogenesis of laryngeal cancer and prevention and treatment of larynge-al cancer.

Voice outcomes following treatment of benign midmembranous vocal fold lesions using a nomenclature paradigm.

OBJECTIVES/HYPOTHESIS: Benign midmembranous vocal fold lesions (BMVFLs) are common voice disorders, but interpretation of outcomes following treatment is difficult due to the lack of a standardized nomenclature system for these lesions. Outcome results are increasingly important to third party payers. This study aimed to investigate the outcomes of patients with BMVFLs using a previously validated nomenclature, and to provide incidences and outcome results for each diagnosis. METHODS: A retrospective chart review of BMVFL patients was performed. Treatment was individualized but typically involved implementation of nonsurgical therapy followed by phonomicrosurgery as needed. A previously reported BMVFL stratification system was used. RESULTS: A total of 224 patients with BMVFLs were studied. Sixty-seven percent of all patients with a BMVFL underwent phonomicrosurgery. The most common BMVFL types were polyp and nonspecific vocal fold lesion. Pseudocyst represented 0.9% of the cohort. The Voice Handicap Index-10 (VHI-10) and acoustic data demonstrate a high degree of treatment success. The mean change in VHI-10 was greatest for cyst-subepithelial and polyp. Fibrous mass-ligamentous patients had the smallest mean change in VHI-10. Mean post-treatment VHI-10 scores of all the lesions except fibrous mass-ligamentous were within normal limits (<11). CONCLUSIONS: This study represents the first outcomes-based report of BMVFLs using a strictly defined nomenclature system for stratification of lesions. Ligamentous fibrous mass lesions have a decreased response to treatment compared to all other lesions. This study demonstrates the ability to return most BMVFL patients to normal speaking voice capabilities following treatment. LEVEL OF EVIDENCE: 4.

[Clinical and pathological analysis of 1116 cases of vocal cord polyp].

Objective:The aim of this study is to investigate the clinical and pathological features of vocal cord polyp. Method:Retrospective analyzed the clinical and pathological data of 1116 cases in vocal cord polyp patients treated with suspension microlaryngoscopic surgery. Result:The bradycardia was observed in 170 cases(15.2%) during the suspension of laryngoscope under general anesthesia. In this case，the suspension was stopped or the laryngoscope was taken out of mouth and atropine was administrated by intravenous injection. After that, heartbeat gradually accelerated and approached to normal,then the suspension was begun again to complete microlaryngoscopic surgery. Among the 1116 cases,1094(98%) were cured,22(2%) were improved，and no case was invalid. No pharyngeal injury was in 865 cases(77.5%). Mild,moderate and severe palatoglossal arch injury was observed in 139 (12.5%)cases，86(7.7%)cases,and 26 (2.3%) cases，respectively. The incidences of epithelial hyperplasia and dysplasia in vocal cord polyp were 35.3% and 5.0%, respectively. The prevalence rates of epithelial hyperplasia and dysplasia in male and female patients of vocal cord polyp were 76.2%,23.8% (P <0.01) and 78.6%,21.4% (P <0.01),respectively. And the prevalence rates of keratinization and parakeratosis in male and female patients were 93.1%,6.9% (P <0.01) and 93.1%,6.9% (P <0.01),respectively.The incidence of keratinization in patients of no epithelial hyperplasia, epithelial hyperplasia and epithelial dysplasia were 2.1%,18.2% and 30.3%,respectively，with significant difference in pairwise comparison.Conclusion:High incidence of vocal cord polyp is at the age from 31 to 60 years old.Although laryngomicrosurgery is an effective treatment for vocal cord polyp, pharyngeal injury and laryngopharyngeal vagal reflex should be noticed during the operation.In addition,vocal cord polyps in male patients are susceptible to epithelial dysplasia and keratinization.

Effect of CO2 laser under suspension laryngoscope on patients with vocal cord polyp / 中国内镜杂志

Objective To analyze the effect of CO2 laser under suspension laryngoscope on patients with vocal cord polyp. Method 118 patients with vocal cord polyp from November 2013 to August 2015 in our hospital were chose as research subjects, all patients were divided into observation group (n=54) and control group (n=64) accord﹣ing to different treatment. Control group: patients received conventional laryngoscope resection; observation group:patients received CO2 laser under suspension laryngoscope. Then compare the two group patients' voice indexes, a﹣cute phase proteins, rehabilitation and recovery speed after treatment. Results Observation group patients' F0, HNR values were higher than control group patients, PPQ, APQ, NNE values were lower than that in control group (P<0.05);early observation group patients' postoperative serum CRP, α1-AG, CER,β2-MG values were lower than con﹣trol group patients, ALB value was higher than control group patients (P< 0.05); observation group patients' cure rate was higher than control group patients, valid and invalid rates were lower than control group patients, the first sound time, sound full recovery time, discharge time were shorter than control group patients (P< 0.05). Conclusion Vocal cord polyp patients receive laser under suspension laryngoscope treatment, can effectively promote recovery rate, have advantages of minimally invasive and rapid recovery after surgery.

Polypoid laryngeal inflammatory myofibroblastic tumors: misleading lesions: description of six cases showing ALK overexpression.

OBJECTIVES: Laryngeal inflammatory myofibroblastic tumors (IMTs) are rarely reported in the literature but may be underrecognized. To better characterize their features, we report a series of six cases. METHODS: The clinicopathologic findings, including immunohistochemistry, fluorescence in situ hybridization (FISH) analysis, and follow-up, were evaluated and a review of the literature was performed. RESULTS: These cases presented as small polypoid vocal cord or ventricular band lesions, with a more advanced mean age at diagnosis (49 years) than typically reported in other localizations. Apart from one secondary revision surgery, no complementary treatment and no recurrences were observed. Histologically, various morphologic features were seen. All tumors were spindle cell proliferations on a myxoid background with more or less atypia and significant inflammatory infiltrate. All six cases showed anaplastic lymphoma kinase (ALK) immunohistochemical expression. FISH rearrangement was present in four of six cases. Only two cases were initially diagnosed as IMT. CONCLUSIONS: According to our series, laryngeal IMTs are easily misdiagnosed. They have a good prognosis, and ALK immunohistochemistry should be carried out to assess this diagnosis when spindle cell proliferations are observed in this localization.

VocaI PoIyps and Precancerous Lesions Treated with CO2 Laser and ConventionaI LaryngeaI Microsurgery / 听力学及言语疾病杂志

Objective To compare the efficacy of CO2 laser and conventional laryngeal microsurgery in the treatment of benign lesions of vocal cord (polyp of vocal cord) and precancerous lesions (leukoplakia of vocal cord) of patients. Methods A total of 60 patients with vocal cord polyps were selected, and randomly divided into two groups, each with 30 patients. Thirty patients with vocal cord leukoplakia were selected and randomly divided into two groups, each with 15 patients. One group was performed by cold instruments for lesion resection (conventional group), the other by CO2 laser for removal of diseased tissue or mucosal ablative surgery (laser group). Two groups of patients were examined by laryngostroboscope, electronic laryngoscopy, GRABS, VHI subjective ratings and objective voice analysis before operation and one week, one month and three months after operation. ResuIts The outcomes of those with vocal cord polyps in early recovery (1 week) laser group were slightly worse than the conventional group. In later recovery (1~3 months), with electronic laryngoscopy inspection, laryngostroboscope mucosal wave observation, the analysis of subjective and objective data from the two groups showed no significantly differences. For patients with vocal cord leukoplakia in early recovery (1 week), laser group slightly worse than the conventional group, in later recovery (1~3 months), there were no obvious difference between the two groups in electronic laryngoscopy inspection, laryngostroboscope mucosal wave observation, the analysis of subjective and ob_jective data. Follow -up operations, the recurrence rates in laser group was significantly lower than conventional group. ConcIusion The treatment by CO2 laser can significantly improve their pronunciation quality for vocal cord polyps and vocal cord leukoplakia patients, it has a good therapeutic effect, especially the long-term effective of vo_cal cord leukoplakia is better than conventional operation.

Changes of intraocular pressure in vocal cord polyp resections supported by pedestal laryngoscope / 中国医师进修杂志

Objective To observe the variations in intraocular pressure(IOP)in vocal cord polyp resections supported by pedestal Iaryngoscope with Tono-Pen tonometer.Methods The IOP of patients (grade Ⅰ-Ⅱby ASA)who underwent vocal cord polyp resections supported by pedestal laryngoscope were detected by Tono-Pen tonometer 5 minutes later on supine position before the operation(T1),5 minutes later on cervical hyperextension position before the operation(T2),5 minutes later on cervical hyperextension position after the operation(T3),5 minutes lateron supine position after the operation(T4),20 minutes later on supine position after the operation(T5)after general anesthesia respectively.At each point the changes of mean arterial pressure(MAP),heart mte(HR),end-tidal carbon dioxide partial pressure(PETCO2),and airway pressure(PAW)were observed as well.Results There were no differences in MAP,HR,RETCO2,PAW at each point statistically.The IOP increased significantly at T2,T3,T4 compared with IOP at T1[(19.0±1.8),(25.7±1.9),(17.8±1.9)mm Hg(1 mm Hg=0.133 kPa)vs(11.9±1.7)mm Hg](P＜0.05).The differences between IOP at T2 and T3 were manifest(P＜0.05).So it Was the situation when the IOP at T3 and T4,T4 and T5 were compared(P＜0.05).The IOP at T5 was(12.1±1.5)mm Hg,there was no difference compared with T1.Conclusion The IOP increases gradually from the point when the patient put on cervical hyperextension position before the operation after general anesthesia and achieves the summit when the patient put on cervical hyperextension position after the operation,finally,decreases back to the preoperative level when the patient put on supine position after the operation.

A Clinico-pathological study of Reinke'S oedema.

An analysis of 92 eases of Reinke's oedema was done in this study. It wen most often seen in middle-aged persons. A Male predilection (57%) was found. In 68 (74%) cases, the lesions were unilateral and in 24 (26%) teses, the lesions were bilateral. Smoking (83%), vocal alms or misuse (80%) and chromnic respiratory tract infection (43%) were the main aetiological factors. No significant relationship of reinke's oedema with hypotkyroidsm was found. There were no dysplastic changes in the epithelium The treatment of reinke's oedema is a combination of surgery and vocal rehabilitation. Conventional microlaryngeal surgery is ideal for the treatment of Reinke's oedema. Acquired laryngeal web involving the anterior part of the vocal cords may develop if stripping of the both vocal cords is performed carelessly. Operating measures do not prevent recurrences of Reinke's oedema. Voice therapy and cessation of smoking in the postoperative period play important roles in the long term treatment results of Reinke's oedema.

The Tissue Microarray Technology and Its Preliminary Application in Evaluation of the Expression and Clinical Significance of hBD in the Vocal Cord Polyp / 听力学及言语疾病杂志

0.05).?-defensin 2 was detected in the specimens of vocal cord polyp,but very little in the subjects of other two groups.Its expression level was significantly higher in the vocal cord polyp than that of the other two groups(P