Adam M. Klein

Prognostic Accuracy of Computed Tomography Findings for Patients With Laryngeal Cancer Undergoing Laryngectomy

PURPOSE The indications for upfront laryngectomy in the management of laryngeal cancer are a functionless larynx and extralaryngeal extension. Practically, clinicians rely on imaging to predict which patients will have T4 disease. Our goal was to review the accuracy of preoperative computed tomography (CT) scanning in determining the necessity for initial laryngectomy for advanced laryngeal cancer. PATIENTS AND METHODS In total, 107 consecutive untreated laryngectomy specimens with high-quality, preoperative CT imaging interpreted by our neuroradiologists were reviewed. Radiographic findings, including sclerosis, invasion, penetration, extralaryngeal spread, and subglottic extension were correlated with pathologic findings. CT images were not reinterpreted, since our purpose was to assess the original interpretations. RESULTS CT imaging reported 23 cases of thyroid cartilage penetration and 27 cases of extralaryngeal spread. Pathology reported 12 cases of thyroid cartilage invasion, 29 cases of penetration, and 45 cases of extralaryngeal disease. CT imaging identified 17 (59%) of 29 cases of pathologically documented thyroid cartilage penetration and 22 (49%) of 45 cases of pathologically documented extralaryngeal spread. Pathologically proven extralaryngeal spread without thyroid cartilage penetration occurred in 18 (40%) of 45 cases. The positive predictive values for thyroid cartilage penetration and extralaryngeal spread were 74% and 81%. Sclerosis was of limited value in predicting thyroid cartilage invasion or penetration. Cricoid or arytenoid destruction predicted for thyroid cartilage penetration at rates of 57% and 63%. CONCLUSION CT imaging has clear limitations when deciding whether there is thyroid cartilage penetration or extralaryngeal spread of advanced laryngeal cancer. Extralaryngeal spread without thyroid cartilage penetration was more common than expected. Alternate methods of pretreatment assessment are needed.

Current dysphonia trends in patients over the age of 65; Is vocal atrophy becoming more prevalent?

The current trends in geriatric voice referrals including the number of patients over the age of 65 years seen per year, the common diagnostic patterns, and specifically the number of patients with vocal atrophy were assessed.

Preliminary data on two voice therapy interventions in the treatment of presbyphonia

Presbyphonia is common among elderly individuals, yet few studies have evaluated behavioral treatment approaches for presbyphonia. The primary aim of this study was to assess the short‐term efficacy of two types of voice therapy—vocal function exercises (VFE) and phonation resistance training exercise (PhoRTE) therapy—in the treatment of presbyphonia. The secondary aim was to determine if differences in adherence and treatment satisfaction existed between the two therapy approaches.

Imaging the human vocal folds in vivo with optical coherence tomography: a preliminary experience.

Objectives: Optical coherence tomography (OCT) and polarization-sensitive OCT (PS-OCT) are promising noninvasive methods for in vivo, cross-sectional imaging of the microstructure of the vocal folds. Previous studies in other tissues have shown an axial resolution of less than 10 μm and a maximum imaging depth of about 2 mm. The objectives of this pilot study were to obtain images from the vocal folds of subjects who were being evaluated and/or treated for vocal fold disease and to evaluate how well normal and pathologic microstructure could be seen in these images. Methods: Twenty-six vocal folds in 13 subjects were imaged with a flexible OCT probe. The images were successfully collected from subjects who were either topically anesthetized or under general anesthesia for microlaryngoscopic procedures. Results: The thickness of the epithelium, the relative collagen content of the subepithelial connective tissue, and certain characteristic features of lesions (including cysts, scarring, and papilloma) were seen in the OCT and PS-OCT images. Conclusions: “Live microscopy” of the human vocal folds is very promising for improved diagnosis, mapping, and treatment planning. To our knowledge, this study is the first application of PS-OCT for in vivo imaging of the human vocal folds.

Long‐term outcomes of injection laryngoplasty in patients with potentially recoverable vocal fold paralysis1

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.

Comparison of an oropharyngeal pH probe and a standard dual pH probe for diagnosis of laryngopharyngeal reflux.

Objectives: We compared the ability of an oropharyngeal (OP) aerosol-detecting pH probe and a standard dual pH probe in measuring laryngopharyngeal reflux (LPR). Methods: Fifteen subjects with LPR symptoms had 24-hour simultaneous placement of the OP probe and a standard dual pH probe. Acid exposure was defined as a 10% pH decrease below baseline for the OP probe or a pH of less than 4 at the upper esophageal sphincter (UES) probe of the dual pH probe. Results: The mean duration of acid exposure was 650 seconds (SD, 619) or 0.75% of the total time for the OP probe and 438 seconds (SD, 511) or 0.51% of the total time for the UES probe. When we excluded meals and sleep, the mean duration of acid exposure was 271 seconds (SD, 356) or 0.31% of the total time for the OP probe and 271 seconds (SD, 359) or 0.31% of the total time for the UES probe. The correlation coefficient (R) between the two probes for measurement of the duration of acid exposure was 0.50 (p < 0.05). When we excluded meals and the supine position, the R was notably higher, at 0.95 (p < 0.0001). Conclusions: The OP probe reliably documented LPR events when meals and sleep were eliminated and was better tolerated than the standard dual probe.

Spontaneous resolution of hemorrhagic polyps of the true vocal fold.

Hemorrhagic polyps are the most common benign lesions surgically removed from the vocal folds. Although this modality does offer satisfactory results in most of the cases, there is a subset of polyps that seems to resolve with conservative therapy. This study was performed to examine this subset of polyps. Thirty-four consecutive subjects diagnosed with hemorrhagic polyps of the true vocal fold were retrospectively reviewed to determine the incidence of spontaneous resolution of the lesions with nonsurgical therapy. Sixteen subjects began conservative therapy, consisting of voice therapy and proper vocal hygiene, often while awaiting an optimal personal time for surgical intervention. Of these subjects, nine (56.3%) experienced a resolution of their lesion and symptoms without undergoing surgical therapy. Surgical removal of hemorrhagic polyps is often considered the standard of treatment for these benign lesions. However, these observations support a regimen of voice therapy and observation in select cases.

Validation of a laryngeal dissection module for phonomicrosurgical training.

To validate the use of a new phonomicrosurgical trainer called the laryngeal dissection module.

Polyglycolic acid/poly-L-lactic acid copolymer use in laryngotracheal reconstruction: a rabbit model.

Objective: To evaluate the tissue response and resorption of the polyglycolic acid/poly‐L‐lactic acid (PGA/PLLA) implant in laryngotracheal reconstruction and compare its dynamic stability with autologous cartilage grafts.

Coprevalence of tremor with spasmodic dysphonia: a case-control study.

The aim of this study was to define the coprevalence of tremor with spasmodic dysphonia (SD).