Homozygous deletion of the DSG3 terminal exon associated with acantholytic blistering of the oral and laryngeal mucosa.

We report a novel homozygous 49.6 kb deletion of chromosome 18q12.1 involving the last exon of DSG3 in dizygotic twins with phenotype consistent with acantholytic blistering of the oral and laryngeal mucosa (ABOLM). The twin siblings presented predominantly with friability of the laryngeal and respiratory mucosa. This is only the second report in the literature of this unusual autosomal recessive blistering disorder. The diagnosis explains the mucosal phenotype of a pemphigus-like disorder without evidence of autoimmune dysfunction. The exclusion of an autoimmune basis has management implications. The deletion also involved the DSG2 gene, which is associated with arrhythmogenic right ventricular dysplasia (ARVD). The affected siblings and heterozygous parents do not show any cardiac phenotype at this time. Functional studies would further clarify how deletions resulting in loss of function of DSG3 may cause the reported phenotypes of DSG3-related ABOLM.

Effects of Inhaled Fluticasone Propionate on Wound Healing After Surgical Phonotrauma Model in Rabbit Larynx.

OBJECTIVES: The aim of this study was to evaluate the effects of inhaled fluticasone propionate on wound healing after phonosurgical trauma of larynx in rabbit model. STUDY DESIGN: A randomized controlled study on experimental animals (rabbits). METHODS: In this prospective experimental animal study, surgically induced type 2 scar was created under general anesthesia in 52 vocal folds of 26 rabbits. Inhaled fluticasone propionate was administered to 13 rabbits in the treatment group for 5 days after the trauma. Rabbits were sacrificed on the 10th, 30th, and 90th days. Histopathological examinations were performed to evaluate epithelization process, inflammation density, and collagen density at the wound side and the results compared between the groups. RESULTS: On the 10th day after surgical trauma, re-epithelialization was completed in both the treatment and the control groups. There was no difference between the groups in terms of mononuclear cell density on the 10th and 90th days (P > 0.05), but the inflammatory cell density was found to be lower in the treatment group on the 30th day (P = 0.005). Collagen density was significantly lower in all animals treated with inhaled fluticasone propionate, and sacrificed on the 10th, 30th, and 90th days, compared to the control group (P = 0.010, P = 0.038, and P < 0.001, respectively). CONCLUSIONS: Inhaled fluticasone propionate to be applied after phonotrauma reduces inflammation and collagen density in scar tissue in rabbits. Future clinical studies will be promising for the positive effects of inhaled steroids on voice quality after phonosurgery.

The role of Glut-1 and H+/K+-ATPase expression in hyperplasia of mice laryngeal epithelium induced by pepsin.

PURPOSE: To explore the role played by Glut-1 and H+/K+-ATPase in pepsin-induced, mouse laryngeal epithelial proliferation, growth, and development. METHODS: We established a mouse model of laryngopharyngeal reflux and measured Glut-1 and H+/K+-ATPase expression levels in mouse laryngeal epithelium treated with artificial gastric juice containing pepsin. RESULTS: Artificial pepsin-containing gastric juice induced significant hyperplastic changes in mouse laryngeal epithelium compared to control mice at 15, 30, and 45 days. Inhibition of Glut-1 expression by 2-DG significantly suppressed such hyperplasia compared to mice exposed to artificial gastric juice containing pepsin at 15, 30, and 45 days. After treatment with pepsin-containing artificial gastric juice, RT-PCR and Western blotting showed that the levels of Glut-1 and H+/K+-ATPase α, ß increased significantly. CONCLUSIONS: Pepsin-containing artificial gastric juice promoted mouse laryngeal epithelial hyperplasia associated with abnormal expression of Glut-1 and H+/K+-ATPase α, ß.

[Molecular laryngology : A new chapter in the understanding of laryngeal diseases]. / Molekulare Laryngologie : Ein neues Kapitel im Verständnis laryngealer Erkrankungen.

BACKGROUND: Despite considerable advances in laryngological research, there is still a plethora of (benign) vocal fold pathologies that cannot be treated causally. This is due to the limited accessibility and sensitive microarchitecture of the vocal folds, which cannot be investigated at a cellular level. Consequently, current pathophysiological knowledge is frequently based on macroscopic findings. The impact of interventions is mainly evaluated endoscopically or via indirect diagnostic methods. OBJECTIVE: The aim of this article is to discuss state-of-the-art biotechnological methods used in laryngological research, illustrated by practical examples. RESULTS: In recent years, animal and in vitro experiments have significantly contributed to a continuous expansion of knowledge in this field, particularly regarding vocal fold inflammation and scar formation. Vocal fold fibroblasts, the most important cellular component of the lamina propria, can be accredited a central role in these processes. CONCLUSION: Our knowledge regarding macroanatomy and macropathophysiology of several pathologies has increased considerably in recent years. In vitro trials have shown, e.g., that vocal fold fibroblasts in an inflammatory setting secrete less profibrotic and proinflammatory cytokines when exposed to vibration. Early vocal exercises after surgical interventions on the vocal folds may therefore promote better wound healing and consequently improved phonation. Research in molecular laryngology should create a solid basis of knowledge for subsequent clinical studies.

'Mini-Microsuture Technique' for Phonosurgery: A New Simplified Method.

INTRODUCTION: Phonomicrolaryngeal surgery involves the surgical treatment of benign disorders of the vocal folds. Postoperative scar tissue in vocal fold mucosa is undesired because mucosal hypodynamia may lead to prolonged impairment in voice quality. This study aims to present and share the outcomes of a new endolaryngeal suture technique. METHODS: This study consists of patients who underwent vocal fold surgery followed by endolaryngeal microscopic suturation with a technique that we call the "mini-microsuture technique" between January 2018-December 2019. Videolaryngoscopic images were examined to observe the tissue healing process (suture elimination time, mucosal scar status, and wave pattern) at the first and the fourth week postoperatively. RESULTS: A retrospective analysis was made in 144 (57 males (39.5%) and 87 females (60.5%)) patients who underwent phonomicrosurgery with "Mini-microsuture technique." Mean age was 40.61 ± 13.54 (10-78) years. There were multiple pathological lesions in 41.66% (n: 60) of our patients, and 58.33% (n: 84) of them had single-lesion. 63.88% (n: 92) of the patients had bilateral vocal fold lesions where 36.22% (n: 52) of the patients had pathology in one vocal fold. CONCLUSIONS: The "mini-microsuture technique" is an easy and functional procedure that can be performed by a single surgeon under microscopy, which minimizes tissue trauma, prevents mucosal hypodynamia, and provides a better anatomical structure postoperatively for a symmetrical vibration. The technique does not significantly prolong operation time when mastered and is a cost-effective method in which surgery which can be concluded using a single suture material.

Selective Bacterial Colonization of the Murine Larynx in a Gnotobiotic Model.

The larynx is a mucosal organ situated between the respiratory and gastrointestinal tracts. Little is known about microbial contributions to laryngeal epithelial health and pathogenesis. Developing a gnotobiotic laryngeal model will introduce new avenues for targeted explorations of microbes in laryngeal mucosal biology, allowing for enhanced understanding of host-microbe interaction in the upper airway. In this study, we first assessed the potential of using gut microbiota as a source to establish laryngeal microbiota in germ-free mice. Results demonstrated the selective nature of the upper airway and provided evidence that gut bacteria can assemble into communities that resemble the commensal resident bacteria occurring in the larynx of conventionally-raised animals phylogenetically and functionally. Then, we confirmed the reproducibility of laryngeal colonization through comparison of laryngeal microbiota in the larynx along with neighboring regions (base of tongue, esophagus, and trachea) between conventionally-raised and germ-free mice that conventionalized with cecal microbiota. Despite taxonomic differences, the established laryngeal microbiota from cecal content exhibited similarity to commensal resident microbiota in diversity within/between communities and predicted metagenomic functions. Our data also suggests little difference in bacterial distribution across the larynx and its surrounding regions and that cell motility and the ability to degrade xenobiotics is critical for bacteria colonizing upper airway. Successful colonization of laryngeal and oropharyngeal regions with gut microbiota in our study will greatly facilitate the investigation of potential localized inflammatory responses within host tissues that contribute to the disorders of essential laryngeal functions. Utilizing said gnotobiotic model to conduct future studies will allow for novel insights into direct microbial contributions to laryngeal epithelial health and pathogenesis.

Differences in the diagnostic value between fiberoptic and high definition laryngoscopy for the characterisation of pharyngeal and laryngeal lesions: A multi-observer paired analysis of videos.

OBJECTIVES: High definition laryngoscopy (HDL) could lead to better interpretation of the pharyngeal and laryngeal mucosa than regularly used fiberoptic laryngoscopy (FOL). The primary aim of this study is to quantify the diagnostic advantage of HDL over FOL in detecting mucosal anomalies in general, in differentiating malignant from benign lesions and in predicting specific histological entities. The secondary aim is to analyse image quality of both laryngoscopes. DESIGN: Retrospective paired analysis with multiple observers evaluating endoscopic videos simulating daily clinical practice. SETTING: A tertiary referral hospital. PARTICIPANTS: In 36 patients, both FOL and HDL videos were obtained. Six observers were provided with additional clinical information, and 36 FOL and HDL videos were evaluated in a randomised order. MAIN OUTCOME MEASURES: Sensitivity, specificity, positive and negative predictive value and diagnostic accuracy of observers using both flexible laryngoscopes were calculated for detection of mucosal lesions in general and uncovering malignant lesions. Sensitivities were calculated for prediction of specific histological entities. Image quality (scale 1-10) was assessed for both flexible laryngoscopes. RESULTS: HDL reached higher sensitivity compared to FOL for detection of mucosal abnormalities in general (96.0% vs 90.4%; P = .03), differentiating malignant from benign lesions (91.7% vs 79.8%; P = .03) and prediction of specific histological entities (59.7% vs 47.2%; P < .01). Image quality was judged better with HDL in comparison with FOL (mean: 8.4 vs 5.4, P < .01). CONCLUSIONS: HDL is superior to FOL in detecting mucosal anomalies in general, malignancies and specific histological entities. Image quality is considered as superior using HDL compared to FOL.

[Influence of TNF-α on the immunomodulatory property of laryngeal mucosa mesenchymal stromal cells'].

Objective: To investigate the effect of tumor necrosis factor-alpha(TNF-α)on the immunoregulatory capacity of laryngeal mucosal mesenchymal stromal cells (LM-MSCs) and its potential molecular mechanism, and provide a theoretical basis for the study of chronic laryngitis. Methods: LM-MSCs were separated from epiglottal mucosa. The LM-MSCs cells were directly co-cultured with T cells in vitro to detect the immunomodulatory property of LM-MSCs. After long-term stimulation with inflammatory factors TNF-α in vitro, the differences were compared in the immunomodulatory ability of LM-MSCs between normal LM-MSCs and TNF-α stimulated LM-MSCs. The expression of general control non-repressed protein5(GCN5), FAS, FASL in normal LM-MSCs and TNF-α stimulated LM-MSCs was detected by Western blot and quantitative real-time RT-PCR(RT-qPCR). Results: After chronic stimulation of TNF-α, the RNA relative expression of GCN5 was 0.31±0.03 (3 days) and 0.53±0.06 (7 days) compared with control group, showing significant difference (F=13.45, P<0.05). The percentage of LM-MSC-induced T cell apoptosis was 6.27%±0.81% (3 days) and 4.99%±0.52% (7 days) in chronic stimulation group compared with control group 10.02%±1.02%. There is a significant difference among these groups (F=11.13, P<0.05). Moreover, the ability of LM-MSCs to induce T cell apoptosis is regulated by GCN5. Conclusion: With the chronic stimulation of TNF-α, the expression of GCN5 in LM-MSCs is decreased, thus impairing its immunoregulatory capacity.

The Correlation between Benign Laryngeal Mucosal Disease and Metabolic Syndrome

BACKGROUND AND OBJECTIVES: The aim of this study is verify the correlation between benign laryngeal mucosal disease and metabolic syndrome. MATERIALS AND METHOD: Data for patients diagnosed with benign laryngeal mucosal disease and metabolic syndrome from 2006 to 2015 were selected for analysis from the National Health Insurance Service database. RESULTS: The prevalence of Metabolic syndrome was 2,179,785 out of 6,437,051 patients (33.86%). The prevalence of benign laryngeal mucosal disease was 516,594 out of 6,437,051 patients (8.03%). Metabolic syndrome was a risk factor for benign laryngeal mucosal disease [hazard ratio: 0.99, 95% confidence interval: 0.984–0.997] after adjusting for age and other variables including age, gender, smoking status, alcohol intake, exercise, body mass index, and diabetes. The number of metabolic syndrome components was also risk factor. CONCLUSION: Metabolic syndrome was related to the incidence of benign laryngeal mucosal disease. However this correlation did not seem to be high.

Influence of TNF-α on the immunomodulatory property of laryngeal mucosa mesenchymal stromal cells′ / 中华耳鼻咽喉头颈外科杂志

Objective@#To investigate the effect of tumor necrosis factor-alpha(TNF-α)on the immunoregulatory capacity of laryngeal mucosal mesenchymal stromal cells (LM-MSCs) and its potential molecular mechanism, and provide a theoretical basis for the study of chronic laryngitis.@*Methods@#LM-MSCs were separated from epiglottal mucosa. The LM-MSCs cells were directly co-cultured with T cells in vitro to detect the immunomodulatory property of LM-MSCs. After long-term stimulation with inflammatory factors TNF-α in vitro, the differences were compared in the immunomodulatory ability of LM-MSCs between normal LM-MSCs and TNF-α stimulated LM-MSCs. The expression of general control non-repressed protein5(GCN5), FAS, FASL in normal LM-MSCs and TNF-α stimulated LM-MSCs was detected by Western blot and quantitative real-time RT-PCR(RT-qPCR).@*Results@#After chronic stimulation of TNF-α, the RNA relative expression of GCN5 was 0.31±0.03 (3 days) and 0.53±0.06 (7 days) compared with control group, showing significant difference (F=13.45, P<0.05). The percentage of LM-MSC-induced T cell apoptosis was 6.27%±0.81% (3 days) and 4.99%±0.52% (7 days) in chronic stimulation group compared with control group 10.02%±1.02%. There is a significant difference among these groups (F=11.13, P<0.05). Moreover, the ability of LM-MSCs to induce T cell apoptosis is regulated by GCN5.@*Conclusion@#With the chronic stimulation of TNF-α, the expression of GCN5 in LM-MSCs is decreased, thus impairing its immunoregulatory capacity.

Activation of the Wnt/ß-Catenin Pathway by an Inflammatory Microenvironment Affects the Myogenic Differentiation Capacity of Human Laryngeal Mucosa Mesenchymal Stromal Cells.

Various microenvironments influence the multiple differentiation potential of mesenchymal stromal cells. For example, inflammatory microenvironment can suppress the myogenic differentiation capability of laryngeal mucosa mesenchymal stromal cells (LM-MSCs). The present study therefore sought to identify the underlying molecular mechanisms regulating these processes. We isolated a novel population of MSCs, LM-MSCs, from the laryngeal mucosa tissues. The cells were cultured in osteogenic, adipogenic, and myogenic differentiation media in the presence or absence of interleukin-1ß and tumor necrosis factor α (to simulate inflammatory microenvironment). The expression of active ß-catenin, p-GSK3ß, and GSK3ß were detected by western blot and real-time polymerase chain reaction. The myogenic differentiation of LM-MSCs in inflammatory microenvironment and the regulation by Dickkopf-1 (DKK1) were tested both in vivo and in vitro. Inflammatory microenvironment could suppress the osteogenesis, adipogenesis, and myogenesis of LM-MSCs. The Wnt/ß-catenin signaling pathway was activated during myogenesis in inflammatory microenvironment. The suppressed myogenic differentiation capability of LM-MSCs in inflammatory microenvironment was reversed by DKK1. By regulating the Wnt/ß-catenin signaling pathway, DKK1 can improve the myogenic differentiation of LM-MSCs in inflammatory microenvironment. Thus, the results of this study may help improve the efficacy of LM-MSCs injection therapy for vocal fold regeneration.

Lesão de mucosa laringotraqueal e fatores associados após extubação endotraqueal: estudo piloto / Laryngotracheal mucosa injury and associated factors after endotracheal extubation: a pilot study

Resumo Objetivo Descrever os sinais clínicos de lesão de mucosa laringotraqueal e seus fatores associados. Métodos Estudo observacional, longitudinal, em pacientes intubados por ocasião da anestesia geral. Foram realizadas avaliações no pré-operatório, transoperatório, e nas 24, 48 e 72 horas após extubação. Para análise, utilizaram-se estatísticas descritiva e exploratória, e também foi verificada a razão de chances. Resultados Dentre os pacientes, 53,3% apresentaram pelo menos um sinal clínico de lesão de mucosa laringotraqueal, sendo predominantes: rouquidão (43,3%), disfagia (40%) e odinofagia (33,3%). Estiveram associados aos seguintes fatores: pressão intra-cuff acima de 25cmH2O, intubação por mais de 120 minutos e uso de tubos maiores que 7,5mm. Conclusão Os sinais clínicos de lesão de mucosa laringotraqueal mais frequentes na população deste estudo foram rouquidão, disfagia e odinofagia, associados à pressão do cuff acima de 25 cmH2O, seguido do tempo de intubação e tamanho inadequado de tubos endotraqueais.

Abstract Objective To describe the clinical signs of laryngotracheal mucosal injuries and associated factors. Methods This was an observational longitudinal study conducted with patients intubated due to general anesthesia. Assessment was carried out in the preoperative period, intraoperative period and at 24, 48, and 72 hours after extubation. Descriptive and exploratory statistics were used for analysis, in addition to odds ratio. Results 53.3% of the sample presented at least one clinical sign of laryngotracheal mucosal injury, mainly: hoarseness (43.3%), dysphagia (40%), and odynophagia (33.3%). The following factors were associated: intracuff pressure above 25 cmH2O, intubation longer than 120 minutes, and the use of tubes larger than 7.5mm. Conclusion The most common clinical signs of laryngotracheal mucosal injury among the studied population were hoarseness, dysphagia, and odynophagia, associated with cuff pressure above 25 cmH2O, followed by duration of intubation and inadequate endotracheal tube size.

Surgical approach to the thyroarytenoid branch of the inferior laryngeal nerve through the thyroid cartilage

ABSTRACT PURPOSE: To describe the anatomical course of the intralaryngeal portion of the inferior laryngeal nerve (ILN) and to standardize the surgical access to its thyroarytenoid branch (TAb) through the thyroid cartilage. METHODS: Under surgical microscopy, 33 adult human excised larynges were dissected, to expose the intralaryngeal portion of ILN. The point of entry of TAb, ILN's terminal branch, in the thyroarytenoid (TA) muscle was determined and correlated with thyroid cartilage dimensions. RESULTS: After entering the larynx, the ILN consistently traveled between the thyroid cartilage and the lateral cricoarytenoid muscle in an anterior and slightly cranial course. The distance from the point of entry of the TAb in the TA muscle to the midline (TAb-H) and to the inferior border (TAb-V) of the thyroid cartilage differed according to gender. In females, mean distances of TAb-H and TAb-V were 20.5mm and 5.2mm and in males, 22.3mm and 5.9mm, respectively. CONCLUSION: The intralaryngeal course of the inferior laryngeal nerve presents low variability and measures from landmarks in the thyroid cartilage help to estimate the point of entry of thyroarytenoid branch in thyroarytenoid muscle.

Level of anxiety versus self-care in the preoperative and postoperative periods of total laryngectomy patients / Nível de ansiedade versus autocuidado no pré-operatório e pós-operatório do paciente laringectomizado total / Nivel de ansiedad versus autocuidados en el preoperatorio y postoperatorio del paciente con laringectomía total

Abstract Objective: estimate the prevalence of anxiety in laryngectomy patients in the pre and postoperative periods and its relation with the self-care level. Method: observational research of 40 patients with stage IV laryngeal cancer. Three observations took place: in the preoperative phase, at seven and at 14 days after the surgery; between June 2010 and December 2012. Two self-care levels were defined: self-sufficient and needing help for activities of daily living and treatment-related activities. To assess the anxiety levels, Zigmond's hospital anxiety scale (1983) was used. Results: in the preoperative and postoperative phases, the patients presented high levels of anxiety. Concerning self-care, on average, self-sufficient patients presented lower levels of anxiety than patients who needed help to accomplish activities of daily living and activities deriving from the surgery, without significant differences. Conclusion: anxiety is present at all times in laryngectomy patients and the reduction of the self-care deficit seems to decrease it, without putting a permanent end to it.

Resumo Objetivo: estimar a prevalência de ansiedade do paciente laringectomizado no pré-operatório e pós-operatório e sua relação com o nível de autocuidado. Método: pesquisa observacional de 40 pacientes com câncer da laringe estágio IV. Foram realizadas 3 observações: no pré-operatório, a 7 e 14 dias pós-operatório, no período de junho de 2010 a dezembro de 2012. Dois níveis de autocuidado foram definidos: autossuficientes e precisar ajuda para as atividades da vida diária e relacionadas ao tratamento. Para avaliar a ansiedade, foi utilizada a escala de ansiedade hospitalar de Zigmond (1983). Resultados: no pré-operatório e pós-operatório, os pacientes apresentaram níveis elevados de ansiedade. Com relação ao autocuidado, os pacientes autossuficientes apresentaram na média níveis inferiores de ansiedades que os pacientes que precisavam de ajuda para realizar as atividades da vida diária y as derivadas da cirurgia, sem chegar a ser significativas estas diferenças. Conclusão: a ansiedade está presente a todo momento no paciente laringectomizado e a diminuição do déficit de autocuidados parece diminuí-la sem acabar definitivamente com ela.

Resumen Objetivo: estimar la prevalencia de ansiedad del paciente laringectomizado, en el preoperatorio y postoperatorio y su relación con el nivel de autocuidados. Método: investigación observacional de 40 pacientes con cáncer de laringe estadio IV. Se realizaron 3 observaciones: en el preoperatorio, a los 7 y 14 días del postoperatorio; en el periodo junio 2010 a diciembre de 2012. Se definieron dos niveles de autocuidados: autosuficientes y necesitar ayuda para las actividades de la vida diaria y derivadas del tratamiento; para evaluar la ansiedad se utilizó la escala de ansiedad hospitalaria de Zigmond (1983). Resultados: en el preoperatorio y postoperatorio los pacientes presentaron niveles elevados de ansiedad. En relación a los autocuidados, los pacientes autosuficientes presentaron en media niveles más bajos de ansiedad que los pacientes que necesitaban ayuda para realizar las actividades de la vida diaria y las derivadas de la cirugía, sin llegar a ser significativas estas diferencias Conclusión: la ansiedad está presente en todo momento en el paciente con laringectomia y la disminución del déficit de autocuidados parece disminuirla sin terminar definitivamente con ella.

Significance of S-100 and CD83+DC Expression in Laryngeal Mucosa Lesions / 天津医药

Objective To investigate the infiltration of dendritic cell (DC) in Vocal cord polyp, laryngeal leukopla-kia and glottic squamous cell carcinoma,and to observe laryngeal mucosal lesions of the state of the immune microenviron-ment, and to research significance of DC on the development of glottic squamous cell carcinoma. Methods The infiltration of S-100+and CD83+DC in 20 cases of Vocal cord polyp, 47 cases of laryngeal leukoplakia, 45 cases of glottic squamous cell carcinoma tumor and 20 cases of laryngeal normal mucosa were examined using immunohistochemistry. Results The num-ber of S-100+and CD83+DC were significantly higher in glottic squamous cell carcinoma, laryngeal leukoplakia and vocal cord polyp than that in laryngeal normal mucosa (P<0.05). The number of S-100+and CD83+DC were higher in laryngeal leukoplakia than that in glottic squamous cell carcinoma (P<0.05). The number of S-100+and CD83+DC in mild dysplasia and moderate dysplasia were less than that in severe atypical hyperplasia (P<0.01). In glottic squamous cell carcinoma, S-100+ and CD83+DC with poor-differentiated was significantly less than that with well-differentiated (P < 0.01). Conclu-sion Changes in the number of dendritic cell was found in vocal cord polyp, laryngeal leukoplakia and glottic squamous cell carcinoma, which indicated that there were an abnormal immune status. Changing of dendritic cell in laryngeal mucosa plays an important role in laryngeal cancer development.

Effect of adenoid hypertrophy on the voice and laryngeal mucosa in children.

INTRODUCTION: The adenoids, or pharyngeal tonsils, are lymphatic tissue localized at the mucous layer of the roof and posterior wall of nasopharynx. Dysphonia defined as perceptual audible change of a patient's habitual voice as self judged or judged by his or her listeners. The diagnosis of dysphonia relies on clinical judgment based on phoniatric symptoms, auditory perceptual assessment of voice (APA) and full laryngeal examination. PATIENTS AND METHODS: Our study was conducted to evaluate the effect of adenoid hypertrophy on voice and laryngeal mucosa. The study sample composed of sixty children, forty of them had adenoid hypertrophy (patient's group) and twenty healthy children (control group). Patient's group composed of 17 boys (42.5%) and 23 girls (57.5%), while control group consists of 8 males (40%) and 12 females (60%). All patients and control group subjected to history taking, clinical examination, lateral soft tissue X-ray on the nasopharynx, APA based on the modified GRBAS scale and full laryngeal examination. The data are collected and analyzed statistically by using software SPSS. RESULTS: Our results showed that there is a significant association between adenoid hypertrophy and, degree of dysphonia, leaky voice, pitch of voice and laryngeal lesion. Adenoid hypertrophy did not associate with loudness of voice, as well as character (irregular, breathy and strained). Laryngeal lesions were detected in thirteen children from patient group (32.5%): nodules (n = 6), thickening (n = 5), congestion (n = 2), while one child only out of 20 children of the control group had congestion (5.0%). CONCLUSION: Our results showed the importance of the assessment of voice and laryngeal examination in patients with adenoid hypertrophy, also treating the minimal mucosal lesions that results from adenoid hypertrophy should be taken in consideration.

The use of laryngeal mucosa mesenchymal stem cells for the repair the vocal fold injury.

Stem cell transplantation is a kind of attractive and new approach that complements traditional restorative or surgical techniques for the regeneration of injured or pathologically damaged laryngeal tissues. However, the best cell delivery strategy remains to be identified. The objective of this study was to establish a new strategy to the healing of injured vocal fold, using laryngeal mucosa mesenchymal stem cells differentiating into myofibroblasts or fibroblasts and improving the reconstruction microenvironment in the vocal fold injury as a new alternative as seed cells for laryngeal tissue engineering. After isolation and expansion, cells were identified as adherent mesenchymal cells with substantial proliferation potential in vitro, and were also characterized by flow cytometry. The differentiation potential of mesenchymal cells was maintained during proliferation as confirmed by culturing for adipogenesis, osteogenesis and chondrocyte. When LM-MSC was transplanted into the injured vocal fold, it has the potent differentiated into myofibroblasts and fibroblasts, which could regulate extracellular matrix, block collagen and the fibronectin rapid increased, inhibit the rapidly decrease of elastic fiber and HA, decrease the microenvironment inflammatory reaction, and prevent the formation of vocal fold scar.

Histological effects of inhaled corticosteroids and ß2-agonists on laryngeal mucosa in an allergic rat model.

OBJECTIVE: To constitute an animal model of laryngeal allergy and evaluate the laryngeal effects of inhaled corticosteroids and ß2-agonists on the laryngeal mucosa in an allergic rat model. STUDY DESIGN: Prospective randomized. SETTING: The Experimental Medical Research Institute (DETAE) at Istanbul University. SUBJECTS AND METHODS: Wistar Albino rats (n = 32) were sensitized with ovalbumin. Unsensitized rats (n = 8) served as controls. The rats were exposed to aerosolized ovalbumin (1%). On days 28 through 42, every 2 days preceeding ovalbumin exposure, rats were further exposed to aerosolized phosphate buffered saline (n = 8), fluticasone propionate (n = 8), salbutamol (n = 8), and combined salbutamol+fluticasone propionate (n = 8). Inflammatory cell infiltration was graded semi-quantitatively. The quantitative data included mast cell count and degranulation. Ultrathin sections were investigated under transmission electron microscope. RESULTS: The simultaneous and pairwise comparison of groups (Kruskal-Wallis) revealed statistically significant difference among groups at supraglottic level (critical P < .05, <.01) and no difference at glottic level. In ovalbumin+phosphate buffered saline exposed rats, the light microscopy of supraglottic mucosa revealed regular epithelium with severe inflammatory cell infiltration and increased mast cell count. Electron microscopy revealed increased mast cell degranulation. Increased inflammatory cell infiltration was detected along with reduced mast cell count among fluticasone propionate treated rats. Mild inflammatory cell infiltration was encountered in combined salbutamol+fluticasone propionate treated rats. CONCLUSION: This study supported the presence of localized allergic reaction in the supraglottic laryngeal mucosa through the observation of increased mast cell number and degranulation. It was also shown that inhaled corticosteroids increase inflammation whereas combined inhaled corticosteroids and ß2-agonists minimize allergic and inflammatory reactions in supraglottic laryngeal mucosa providing a safer therapeutic option.

Refluxo laringofaríngeo e bulimia nervosa: alterações vocais e larínegas / Laryngopharyngeal reflux and bulimia nervosa: laryngeal and voice disorders

TEMA: Características da bulimia nervosa (BN) e do Refluxo Laringofaríngeo (RLF) e alterações vocais e laríngeas que podem decorrer da exposição da laringe ao ácido gástrico. OBJETIVO: Descrever, por meio de revisão de literatura, as características do RLF e da BN, relacionando-os com as alterações vocais e laríngeas que podem se originar da exposição da laringe ao ácido gástrico que ocorre em ambas as condições. CONCLUSÃO: A BN se caracteriza por um transtorno alimentar de causa principalmente psicológica em que ocorre ingestão compulsiva de grande quantidade de alimentos, seguida de episódios de vômitos auto-induzidos com a finalidade de evitar o ganho de peso. O RLF consiste em uma variação clínica da DRGE, na qual o fluxo retrógrado do alimento e do ácido gástrico entra em contato com a laringe e suas estruturas. Em comum, a BN e o RLF apresentam este mecanismo de regurgitação que pode atingir a laringe. Dentre os sinais e sintomas laríngeos e vocais decorrentes da regurgitação do ácido gástrico sobre a laringe estão: globus faríngeo, disfonia, rouquidão, tosse seca, disfagia, halitose, lesões inflamatórias nas pregas vocais, laringite, amigdalite, edema e eritema glótico posterior e ou de aritenóides, da região retrocricóidea e interaritenóidea, estenose subglótica, irregularidades na mucosa das pregas vocais, hipertrofia de mucosa laríngea, leucoplasia, carcinoma, laringoespasmos, granulomas, úlcera de contato, nódulos vocais, pólipos vocais, edema difuso, granuloma, fixação uni ou bilateral de aritenóides, edema de Reinke, laringomalácia, estridor, e odinofagia.

BACKGROUND: Characteristics of bulimia nervosa (BN) and laryngopharyngeal reflux (LPR) and laryngeal and voice disorders that can arise from exposure to gastric acid of the larynx. PURPOSE: To describe, through literature review, the characteristics of LPR and the BN, linking them with laryngeal and voice disorders that can stem from exposure to gastric acid of the larynx, occurring in both conditions. CONCLUSION: BN is characterized by an eating disorder, where there is a mainly psychological compulsive ingestion of large quantities of food, followed by episodes of self-induced vomiting in order to prevent weight gain. LPR consists of a clinical variation of gastro esophageal reflux disease (GERD), in which the retrograde flow of food and stomach acid comes into contact with the larynx and its structures. In common, BN and LPR have this mechanism of regurgitation that may reach the larynx. The signs and symptoms arising from the vocal and laryngeal regurgitation of gastric acid on the larynx are: globus pharynx, dysphonia, hoarseness, dry cough, dysphagia, halitosis, inflammatory lesions on the vocal cords, laryngitis, tonsillitis, swelling and redness and / or posterior glottis of the arytenoids, and the retrocricoid and interarytenoid region, subglottic stenosis, irregularities in the vocal folds mucosa, hypertrophy of the laryngeal mucosa, leukoplakia, carcinoma, laryngospasm, granulomas, contact ulcer, vocal nodules, vocal polyps, diffuse edema, unilateral or fixing bilateral arytenoids, edema, laryngomalacia, stridor and odynophagia.

Relationship between external appearance of laryngeal carcinoma and submucosal infiltrating extent / 中国耳鼻咽喉头颈外科

OBJECTIVE To observe the submucosal infiltrating extent of laryngeal carcinoma tissue by different location,different T staging and external appearance and to analyze the impact of laryngeal carcinoma submucosal infiltrating extent on surgical margin.METHODS Forty-three laryngeal en bloc specimens coming from 43 cases with laryngeal carcinoma were vertically cut-down along tumor long axis,and were slivered into sections by which laryngeal carcinoma submucosal infiltrating distance was measured under microscope.Laryngeal carcinoma latent submucosal infiltrating extent was compared among different location,different T staging and external appearance.RESULTS Basing on tumor external appearance and infiltrating extent,laryngeal carcinoma was classified into three types:exogenic type,ulcerating infiltrating type and mixed infiltrating type.Of 43 specimens,the three types were 10,8 and 25 cases respectively.There was a significant difference in submucosal infiltrating extent between T1～T2 and T3～T4 laryngeal carcinoma.There was also significant difference in submucosal infiltrating extent between exogenic type and ulcerating infiltrating type or mixed infiltrating type.CONCLUSION The submucosal infiltrating extent of laryngeal carcinoma tissue plays an important role in the surgical margin. As laryngeal carcinoma T stage developing,tumor submucosal infiltrating extent is becoming more extensive.Laryngeal carcinoma submucosal infiltrating extents in ulcerating infiltrating and mixed infiltrating type are more extensive than that in exogenic type.The partial laryngectomy should be prudent to be performed in cases with local advanced ulcerating infiltrating and mixed infiltrating laryngeal carcinoma.