Hiatal hernia repair and magnetic sphincter augmentation to treat laryngopharyngeal reflux aiding the prevention of recurrent laryngeal cancer.

Laryngopharyngeal reflux (LPR) is a difficult disease to treat and can result in mucosal injury in the pharynx and larynx. This typically results in symptoms such as cough, hoarseness, and globus sensation, but the manifestation of cancer is a possibility. We present a patient with a squamous cell cancer of the larynx who was diagnosed with gastroesophageal reflux disease (GERD) and found to have LPR. The cancer was treated locally and GERD was eradicated with magnetic sphincter augmentation. After 15 months of follow-up, there was no residual cancer. This case highlights the role that untreated LPR may play in patients' risk of developing laryngeal cancer.

The management of postintubation phonatory insufficiency.

INTRODUCTION: Prolonged intubation may lead to medial arytenoid cartilage erosion and cricoarytenoid joint scarring with subsequent glottic insufficiency. This has been referred to as postintubation phonatory insufficiency (PIPI). Reports on treatment outcomes for this condition are lacking. METHODS: A single institution retrospective chart review from January 2007 to present was preformed for PIPI diagnosis. Data were collected for intubation, symptoms, diagnosis, interventions, and outcomes. RESULTS: Five patients with PIPI underwent treatment to improve voice. Patient 1 underwent thyroplasty with adduction arytenopexy. Patient 2 had a revision thyroplasty and subsequently two injections of the posterior defect and true vocal fold. Patient 3 underwent injection of the medial arytenoid defect. Patient 4 had injection augmentation of the anatomic deficiency and the ipsilateral true vocal fold. Patient 5 underwent thyroplasty with adduction arytenopexy. Limited to no phonatory improvement was achieved in any case. CONCLUSIONS: The management of patients with PIPI is difficult. Currently, no reliable means are available to restore cartilaginous defects in the respiratory glottis. Patients with this condition should be counseled as to the difficult nature of treatment.

Challenges and opportunities in the management of the aging voice.

Presbyphonia, or age-related dysphonia, is a diagnosis of exclusion, and other comorbidities must be considered in a complete evaluation of elderly patients with dysphonia. The aging voice can have a significant effect on the quality of life of the patient. In addition to the molecular effects of aging on the laryngeal tissues, the etiology of presbyphonia is often multifactorial because of comorbidities in the other organ systems involved in phonation. After a comprehensive evaluation, presbyphonia may be treated conservatively with voice therapy or with a range of interventions. Research into tissue engineering and electrical reanimation offers future options for treatment of presbyphonia. Currently, a multidisciplinary approach offers the most complete improvement in the vocal quality of life in this patient population.

Long-term outcomes of injection laryngoplasty in patients with potentially recoverable vocal fold paralysis.

OBJECTIVES/HYPOTHESIS: Injection laryngoplasty (IL) is a temporary intervention for unilateral vocal fold paralysis (UVFP). IL is often performed in patients with a potentially recoverable recurrent laryngeal nerve insult while awaiting spontaneous recovery, compensation, or definitive intervention. This study investigates the long-term outcomes of subjects treated with an IL. STUDY DESIGN: Restrospective chart review. METHODS: A single-institution, retrospective review was performed from January 2004 to July 2008; subjects with potentially recoverable UVFP who underwent an IL were included. RESULTS: The following etiologies were noted for the 42 subjects included: idiopathic in 13 (31%), iatrogenic in 25 (60%), infectious in two (5%), traumatic in one (2%), and stroke in one (2%). Ten subjects (24%) had full recovery of their paralysis, four (10%) partially recovered movement with adequate recovery of voice, 16 (40%) had no recovery of motion but compensation with adequate recovery of voice, 12 (29%) required further definitive intervention in the form of laryngeal framework surgery. Voice-related quality of life scores improved for all patients surveyed after IL and improved more for those who ultimately recovered or compensated. CONCLUSIONS: The majority of subjects with potentially recoverable UVFP recover vocal fold motion and/or adequate voice after IL without permanent intervention.

The foreshortened malleus: Anatomic variant, not pathologic sign.

OBJECTIVE: To quantitatively study the appearance of the malleus as viewed through the external ear canal clinically to determine whether its shortened appearance in some ears is associated with otitis media. STUDY DESIGN: Postmortem material analysis. SETTING: University temporal bone laboratory. SUBJECTS AND METHODS: A total of 41 adult crania without clinical otitis. The mastoid size indicator of previous childhood otitis media was quantified radiographically. On digitized photographs of the tympanic membranes (64 ears useable), two sets of measurements were performed: 1) the distance from the malleus' lateral process to the umbo and to the annulus; and 2) angles formed anteriorly and posteriorly at the umbo. RESULTS: The two metrics of malleus foreshortening did not correlate with one another, that is, the ratio manubrium-length/tympanic diameter did not correlate with the ratio posterior/anterior umbo angles (for right ears, r = -0.34; for left, r = 0.30). Mastoid size did not correlate with either metric of malleus foreshortening. As to right-left symmetry, the size of mastoid pneumatization had good correlation (r = 0.68, 95% confidence interval 0.47-0.82); but, r = 0.21 for lengths, r = 0.34 for angles, each confidence interval included zero. CONCLUSION: Because the data showed no correlation of the physical appearance of the malleus with the mastoid size indicator of otitis media, and right-left symmetry was only hinted, we contend that a foreshortened malleus lacks clinical relevance. Foreshortened malleus is an anatomic variant, not a sign of pathology.