Section four: laryngitis and dysphonia.

Acute laryngitis is most often caused by viral illnesses through direct inflammation of the vocal cords or from irritation due to postnasal drainage. Bacterial infections, such as acute epiglottitis, also can cause dysphonia but typically have other systemic symptoms as well as respiratory distress. Chronic laryngitis is characterized by symptoms lasting more than 3 weeks. Chronic vocal cord issues can be related to overuse or stress on the vocal cords resulting in nodules or polyps. Individuals in certain occupations, such as singers, school teachers, and chemical workers, are at greater risk of chronic laryngitis. The diagnostic approach to chronic laryngitis should include visualization of the vocal cords to rule out potential malignant lesions. For acute and chronic overuse symptoms, the best treatment is vocal rest. The use of antibiotics or decongestants should be discouraged.

Prolonged ulcerative laryngitis: a new disease entity.

Over the last decade, a new disease entity, prolonged ulcerative laryngitis (PUL), with unique clinical presentation and prolonged disease course, has been recognized. Until now, very few studies dealing with this disease have been reported in the literature. From 1999 to 2008, we analyzed clinical data from a series of 39 PUL patients who were treated with an observational approach without implementing specific treatments. This disease affects adults, predominantly females. The age of patients in our series ranged from 26 to 76 years with a median of 49.5 years. This disease is characterized by ulcers and signs of acute inflammation on the membranous portion of the vocal folds with a prolonged clinical course. The recovery times of patients ranged from 4 to 20 weeks with an average of 9.4 weeks. The data in this study may reflect a natural history of this disease. PUL seems to be a self-limited disease, but the etiology of this disease is unknown. Specific infections or systemic inflammatory processes involving the larynx must be ruled out before diagnosis, and conservative treatments are suggested.

Endoscopic classification for reflux pharyngolaryngitis.

The quality of life in patients who have undergone surgery for esophageal cancer is frequently disturbed by postoperative gastroesophageal reflux disease or pharyngolaryngeal reflux disease. Recently, there have been many reports on gastroesophageal reflux disease after esophagectomy, and only a few on pharyngolaryngeal reflux disease. There is not yet any convenient endoscopic classification of reflux pharyngolaryngitis. We designed a new classification for reflux pharyngolaryngitis based on endoscopic findings. Our new classification consists of the five grades from 0 to IV based on (i) the extent and severity of erythema and/or edema in the pharynx and the larynx, and (ii) the extent and severity of granulation or scarring stenosis in the vocal cords. Ninety-three patients after cervical esophagogastrostomy after esophagectomy (the CEG group) and 28 patients after intrathoracic esophagogastrostomy (the TEG group) were reviewed in this study. We investigated the relation between the severity of reflux pharyngolaryngitis and clinical symptoms in these patients, and the correlation between this new classification of reflux pharyngolaryngitis and the Los Angeles classification of reflux esophagitis. Reflux esophagitis was more severe in the TEG group than in the CEG group, while there was no difference in the grading of reflux pharyngolaryngitis between the two groups. The pharyngolaryngeal symptoms and F-scale scores were not correlated with the severity of reflux pharyngolaryngitis in each group. The grading of reflux pharyngolaryngitis and that of reflux esophagitis was correlated in each group (P<0.001 in the CEG group and P=0.002 in the TEG group). We proposed a new endoscopic classification of reflux pharyngolaryngitis. The new classification of reflux pharyngolaryngitis correlated fairly well with the Los Angeles classification of reflux esophagitis, although this classification did not correlate with the clinical symptoms in patients who underwent esophagectomy. Follow-up attention including upper endoscopy should be paid to reflux pharyngolaryngitis in patients after esophagogastrostomy as well as reflux esophagitis, because there is often a lack in symptoms regardless of high incidence of pharyngolaryngitis.

Laringites.

Apresenta texto sobre laringites, com definição, anamnese, exame físico e métodos diagnósticos, infecções agudas e crônicas, e laringites não infecciosas. Traz referências bibliográficas. Documento em formato PDF, requer Acrobat Reader.

Correlation of histomorphological criteria used in different classifications of epithelial hyperplastic lesions of the larynx.

Different classifications of epithelial hyperplastic lesions of the larynx were proposed, but none of them has been generally accepted. The basic distinction among these gradings is evaluation of carcinoma in situ as a precancerosis or a distinct and separate entity. In the present study, atypical hyperplasia and carcinoma in situ are evaluated according to the proposed histomorphological criteria of the Kambic-Lenart classification. In an attempt to separate more objectively the histomorphological differences between these 2 lesions, in addition to traditional light microscopical examination, we also performed semiquantitative analysis with statistical evaluation using the Wilcoxon signed rank test. These results revealed a significant morphological and statistical difference comparing atypical hyperplasia and carcinoma in situ on the basis of the following criteria: abnormal mitotic figures (p = 0.005), mitotic activity (p = 0.014), nuclear pleomorphism (p = 0.006), cellular atypia (p = 0.005), dyskeratosis (p = 0.008), and stromal infiltration (p = 0.015). These results confirm our view that atypical hyperplasia and carcinoma in situ are 2 consecutive but different entities in the process of carcinonogenesis.

Infraglottic and bronchial infections.

Concerns over infraglottic and bronchial infections have been a source of anxiety and lost sleep for many children, parents, and physicians. The annual incidence of lower respiratory tract infections in children younger than 6 years old exceeds 5 million in the United States. Despite the frequency of these infections, the often common and nonspecific clinical symptomatology, variable severity, and changing epidemiology over time all have contributed to our understanding and misunderstanding of these disorders.

[Epiglottitis in the adult. A proposition for a clinical classification and therapeutic strategy]. / Epiglottite de l'adulte. Proposition d'une classification clinique et d'une stratégie thérapeutique.

Because lack of criteria for staging and treatment of epiglottitis can lead to unnecessary morbidity and mortality, we have introduced a staging system for early classification and appropriate management of adult epiglottitis patients. We retrospectively staged 20 adults with epiglottitis to see in their final outcome would have been altered using our protocol. We found that staging and management according to our protocol were appropriate and possibly could have reduced mortality from 10% to nearly 0%.