A. J. Parker

Management of laryngeal dysplasia: a review

Laryngeal dysplasia is a common clinical concern. Despite major advancements in otolaryngology, a significant number of patients with the condition progress to invasive carcinoma. In the recent years, new diagnostic techniques such as autofluorescence and contact endoscopy have been applied to increase the accuracy of the laryngeal biopsies. Moreover, significant efforts have been made to correlate the histopathological appearance of the dysplastic samples to their clinical course. So far, a wide range of therapeutic strategies for different grades of dysplasia has been suggested by authors; however, there is a lack of outcome reviews. In the current review, the outcome of different therapeutic strategies for severe dysplasia and carcinoma in situ has been compared with statistical analysis. The paper also summarises the current knowledge of the alternative management methods as well as current areas of research in the chemoprevention of the condition. (1) Significant efforts have been made to develop new techniques to improve the accuracy of microlaryngoscopic assessment of laryngeal premalignancy. Comparative studies are required using microlaryngoscopy against the new techniques to evaluate their clinical utility. (2) The meta-analysis suggests a better local control rate with radiotherapy compared to other standard methods of management of dysplasia; however, functional impairment and complications associated with each of the standard treatments should be further evaluated.

Assessment of safety and efficacy of arterial embolisation in the management of intractable epistaxis

To evaluate outcomes of intractable epistaxis managed with arterial embolisation. Fourteen sequential cases of intractable epistaxis that underwent embolisation in our centre were evaluated retrospectively and interviewed over the phone. All patients had several failed treatment modalities prior to embolisation. Patients’ follow up ranged from 1 to 57 months with median of 26 months. All 14 cases underwent a single embolisation procedure with successful arrest of epistaxis. Four cases (29%) developed recurrent epistaxis at a later date. One (7%) required re-embolisation 19 months after his first procedure. One bled 17 days after embolisation, but this settled with hospital admission and Bismuth Iodoform Paraffin Paste packing. The other two developed minor episodes of epistaxis, which did not require hospital admission. Two patients developed local ischaemic complications following arterial embolisation. Of those, one developed necrosis of the left alar skin and cartilage that healed reasonably well after 5 months. The other case developed mucosal necrosis of the right side of the hard palate; this patient was the one who bled 17 days post-embolisation. The palatal necrosis healed in a satisfactory manner without causing any functional impairment of the oral cavity. Embolisation is a successful intervention in management of persistent epistaxis, when other interventions fail. The risks of major complications such as stroke are well known, and discussed with patients prior to the procedure. It is also important to discuss the risks of ischaemic damage to the face and oral cavity. In our experience, these complications have been minor and the benefits still outweigh the complications.

Laryngeal dysplasia: aetiology and molecular biology.

Laryngeal premalignancy is a common clinical concern. While tobacco has long been established as the principal identifiable aetiological factor, the last two decades have seen publications investigating a potential role for gastroesophageal reflux, gastrectomy and human papilloma virus. Furthermore, there have been major advances in our understanding of the molecular biology of cancer and premalignancy. Accompanying this increased understanding, significant efforts have been made to correlate the expression of molecular markers with the clinical course of premalignant laryngeal lesions. This review summarizes current knowledge of the aetiological factors and molecular biology of laryngeal premalignancy. All aetiological factors, including molecular markers, are discussed separately and their possible role in the clinical course of these lesions is discussed.

Acoustical analysis of tracheoesophageal voice

Acoustical voice analysis of laryngectomees is a complicated matter because of the often weak periodicity of the voice and the high noise component. This study consists of a feasibility study and validation of an acoustical tracheoesophageal (TE) voice analysis on a sustained vowel based upon recordings of 66 laryngectomees from four clinics in three European countries. Based on reliability analysis of the acoustical data, TE voices can be objectively divided in three categories: (I) good voices with low-frequency harmonics and noise taking over at the higher frequencies; (II) moderate voices consisting of repetitive bursts of sound energy with low repetition rate and a weak periodicity due to high levels of noise, even at the low frequencies; (III) poor voices with no detectable or very weak fundamental frequency or envelope periodicity. The voice samples from category I and II correlate well with perceptually analyzed voice quality parameters, which supports the robustness and validation of this acoustical analysis method to analyze TE voices.

External carotid artery aneurysm in an infant presenting with oropharyngeal haemorrhage

We report an unusual case of a mycotic external carotid artery aneurysm presenting in a nine-month-old infant. She presented with coryzal-like symptoms and oropharyngeal haemorrhage. This was thought initially to be due to acute tonsillitis. There was significant haemorrhage and reversible hypovolaemic arrest. A contrast computerised tomography scan (CT) confirmed the diagnosis of a mycotic external carotid artery aneurysm. This was subsequently successfully treated by percutaneous embolization with microcoil insertion.

The Groningen valve voice prosthesis in Sheffield: a 4-year review

The Groningen valve was first used in Sheffield in 1986 in a patient who underwent laryngectomy for malignant disease. Since then a further 21 patients have made use of this device, 17 of whom underwent insertion at the time of surgery. All patients were male, two patients have since died and the median length of follow-up to date has been 22.0 (range 2-41) months. Prostheses were replaced mainly under general anaesthesia if they leaked or resulted in difficult phonation. A total of 73 valve insertions have been performed with a median time of 4.0 (range 0.25-27) months between each. Of the 15 men in whom the prosthesis is currently in use, speech was generally good-excellent. The Groningen valve provides a highly acceptable means of obtaining vocalization after laryngectomy in the patients in this series.

Quinolone ear drops for chronic otitis media: They are safer and more effective than aminoglycosides

An estimated 1.5% of the adult population in the United Kingdom has active chronic otitis media with perforated tympanic membranes; this is comparable to the prevalence in western Europe and the United States. Although surgery is often necessary, antibiotic ear drops are frequently prescribed to control the discharge that patients may have with this condition. Until recently aminoglycoside ear drops were widely used, but concerns about ototoxicity, which occurs rarely, have restricted their use. Quinolone ear drops are an effective alternative, and there is good evidence from randomised controlled trials that they are the best choice for treating chronic middle ear infections.1 They are already in use in the United States, Canada, New Zealand, Japan, and other countries, although they are still not available in the United Kingdom because they have not been licensed by the Medicines Control Agency. The principal organisms isolated from patients with chronic otitis media are …

In vitro comparison of the Groningen high resistance, Groningen low resistance and Provox speaking valves.

This paper compares the physical parameters of the newer Groningen low resistance and Provox indwelling laryngectomy prostheses with the established and original Groningen device. In vitro pressure/flow profiles were determined, using specially designed apparatus, in 44 standard Groningen high resistance (GHR), 37 Groningen low resistance (GLR) and 19 Provox tracheo-oesophageal prostheses prior to insertion. GHR valves had significantly higher forward opening pressures than both the newer valves and the GHR was significantly higher than the Provox (p < 0.01: Mann-Whitney U-test). The mean forward resistance of GHR was significantly higher than that of both; the Provox valve was significantly lower than that of GLR (p < 0.0001: Mann-Whitney U-test). This may be of relevance with respect to patient acceptability, voice quality and effective duration of valve action.

Acceptability and intelligibility of tracheoesophageal speech using the Groningen valve

This prospective study was set up to investigate the acceptability and intelligibility of speech produced by a population of male patients who had undergone total laryngectomy for malignant disease in Sheffield. Each had been fitted with at least 1 Groningen tracheoesophageal prosthesis and their phonatory qualities were assessed by a team of 8 naive listeners. Speech quality assessed in terms of acceptability and intelligibility was found to be generally very high and compares favourably with that produced by a population of patients using the Blom-Singer prosthesis.

Osteomyelitis of the cervical spine following laryngectomy

Only one case of osteomyelitis of the cervical spine following laryngectomy for carcinoma of the larynx has been reported in the literature to date. We report an unusual case of osteomyelitis of the cervical spine following treatment of laryngeal carcinoma by radiotherapy (RT) and subsequent laryngectomy and discuss the relevant literature.