Giovanna Cantarella

Vocal outcome after endoscopic cordectomies for Tis and T1 glottic carcinomas

A cohort of 101 patients with previously untreated glottic cancer (15 Tis, 66 T1a, and 20 T1b) who underwent endoscopic CO2 laser excision between January 1995 and December 1997 was prospectively analyzed. The depth and extension of the excision were graded according to the European Laryngological Society Classification including 5 types of cordectomy. All patients were subsequently examined every 2 months for a period ranging from 30 to 66 months (mean, 48 months). The rates of 5-year overall survival, disease-free survival, ultimate local control with laser alone, and laryngeal preservation were 85%, 87%, 93%, and 95%, respectively. Sixty-nine patients underwent, at least 1 year after surgery, videolaryngostroboscopy combined with perceptual and objective evaluation of the voice, and spirometry. Acoustic parameters were compared with those obtained in a matched control group by Kruskal-Wallis test. No statistically significant difference was found (p > .05) between patients submitted to subepithelial (type I) and subligamental (type II) cordectomies and controls.

ERS/ELS/ACCP 2013 international consensus conference nomenclature on inducible laryngeal obstructions

Individuals reporting episodes of breathing problems caused by re-occurring variable airflow obstructions in the larynx have been described in an increasing number of publications, with more than 40 different terms being used without consensus on definitions. This lack of an international consensus on nomenclature is a serious obstacle for the development of the area, as knowledge from different centres cannot be matched, pooled or readily utilised by others. Thus, an international Task Force has been created, led by the European Respiratory Society/European Laryngological Society/American College of Chest Physicians. This review describes the methods used to reach an international consensus on the subject and the resulting nomenclature, the 2013 international consensus conference nomenclature. The condition leading to episodes of feeling like you cannot breathe now has a name: inducible laryngeal obstructions http://ow.ly/OMaNl

Comparing postoperative quality of life in children after microdebrider intracapsular tonsillotomy and tonsillectomy

OBJECTIVE To evaluate postoperative quality of life in patients undergoing microdebrider intracapsular tonsillotomy and adenoidectomy (PITA) in comparison with traditional adenotonsillectomy (AT) and to assess PITAs efficacy in solving upper-airway obstructive symptoms. METHODS 29 children with adenotonsillar hyperplasia referred for AT were included. Patients were divided into two groups: Group 1 (underwent PITA) included 14 children (age 5.1±1.8 years) affected by night-time airway obstruction without a relevant history of recurrent tonsillitis; Group 2 (underwent AT) included 15 children (age 5.2±1.7 years) with a history of upper-airway obstruction during sleep and recurrent acute tonsillitis. Outcomes measures included the number of administered pain medications, time before returning to a full diet, Obstructive Sleep Apnea survey (OSA-18), parents postoperative pain measure questionnaire (PPPM) and Wong-Baker Faces Pain Rating Scale (WBFPRS). RESULTS Postoperative pain was significantly lower in the PITA group, as demonstrated by PPPM and WBFPRS scores and by a lower number of pain medications used. PITA group also resumed a regular diet earlier (P<0.001). OSA-18 scores proved that both PITA and AT were equally effective in curing upper-airway obstructive symptoms. CONCLUSION PITA reduces post-tonsil ablation morbidity and can be a valid alternative to AT for treating upper-airway obstruction due to adenotonsillar hyperplasia.

Treatment of Frey's syndrome with botulinum toxin type B

OBJECTIVE: Freys syndrome is a frequent sequela of parotidectomy, causing facial sweating and flushing because of gustatory stimuli. Although botulinum toxin type A has become first-line therapy for Freys syndrome, some patients become resistant. In this study, we investigated whether another serotype, botulinum toxin type B, might be an effective alternative. STUDY DESIGN: Case series with planned data collection. SETTING: Otolaryngology department in a university hospital. SUBJECTS AND METHODS: Seven patients aged 30 to 68 years, with severe Freys syndrome, underwent the Minor test and had 80 U of botulinum toxin type B per cm2 (mean total dose, 2354 U) injected intracutaneously in the mapped area of gustatory sweating. All patients were followed up for 12 months. RESULTS: One month after treatment, six of the seven patients reported that gustatory sweating and flushing had resolved, and, in the remaining patient, these symptoms had decreased. The Minor test confirmed a significant improvement. The subjective benefits remained stable for six months in four patients and for nine months in the remaining three patients; 12 months after treatment, all patients still reported some improvement. CONCLUSION: Botulinum toxin type B afforded symptomatic relief in a small sample of patients with Freys syndrome and might be considered a potential alternative to botulinum toxin type A.

Spindle Cell Lipoma of the Hypopharynx

Larynx and hypopharynx lipomas are reported to account for approximately 0.6% of benign laryngeal neoplasms. Spindle cell lipoma is a histologically distinct variant characterized by mature adipocytes mixed with collagen-forming spindle cells; only one case of spindle cell lipoma of the larynx has been previously reported. We here describe a new case of spindle cell lipoma of the pyriform sinus successfully treated by means of endoscopic surgical excision. A 77-year-old woman with a 40-year history of dysphagia reported that the condition had markedly worsened over the three years before she came to us. She had difficulty swallowing even semisolid food and she experienced occasional nasal regurgitation of liquid or solid food. Flexible videolaryngoscopy showed a very large mass, covered by normal mucosa that almost totally occupied the right pyriform sinus and was apparently attached to the right arytenoid. Functional endoscopic study and videofluoroscopy of swallowing showed that the bolus progressed exclusively in the left pyriform sinus, with postdeglutitory pooling in the right pyriform sinus and a reflux toward the valleculae during consecutive deglutitions. Computed tomography demonstrated that the hypopharyngeal mass had low attenuation values and negative densitometry. The entire mass was surgically removed during suspension microlaryngoscopy. The histological sections showed mature adipocytes mixed with small and slender spindle cells. Postoperative endoscopic and videofluorosocpic deglutition studies revealed the recovery of normal swallowing. This case indicates that hypopharyngeal lipomas should be included in the differential diagnosis of slowly occurring swallowing impairments.

Management of Tracheostomy Scar by Autologous Fat Transplantation: A Minimally Invasive New Approach

BackgroundTracheotomy is a life-saving operation but may have bothersome sequelae. Because the defect resulting from tracheostomy is often allowed to repair spontaneously by secondary intention, hypertrophic scar formation is a frequent consequence. Furthermore, skin-to-trachea adhesions may develop, creating a “tracheal tug,” that is, the skin movement in conjunction with the trachea, causing discomfort on swallowing. The aim of this study was to verify whether lipofilling could treat the aesthetic and functional disturbances by remodeling tracheostomy scars. MethodsTen patients, aged 20 to 51 years, with retracted and/or hypertrophic tracheostomy scar underwent fat injection under local anesthesia or sedation. Fat harvesting was by a 2-mm blunt cannula connected to a 10-mL syringe. Before inserting the refined fat with a 19-gauge cannula, the fibrotic bands of the retracted scar between skin and underlying tissue were released with a sharp needle. The procedure required 2 sessions with an interval of 6 to 12 months. In the first session, 3.0 to 10 mL of fat were inserted. A further 3 to 5 mL were delivered during the second course. In 3 cases, scar excision was performed under local anesthesia as a final procedure. ResultsAll 10 patients achieved an aesthetic and functional improvement and were satisfied with the result at long-term follow-up (mean, 21.3 months). ConclusionsFat grafting proved to be a safe, minimally invasive, and effective procedure for the treatment of the tracheostomy scar both for functional and aesthetic purposes. It can be considered as a valid alternative to major open surgery.

Cough peak flow as a predictor of pulmonary morbidity in patients with dysphagia.

ObjectiveThe aim of this study was to ascertain whether an objective cough measure relates to the risk of pulmonary complications in dysphagic patients with persistent tracheobronchial aspiration. DesignThis is a retrospective observational study involving 55 dysphagic patients who underwent a modified barium swallow study and pulmonary function tests including cough peak flow measurement. The results were compared between subjects with and without pulmonary complications because of aspiration. ResultsThe 18 patients (33%) with pulmonary complications had significantly lower mean cough peak flow values (202.2 ± 68.8 vs. 303.9 ± 80.7 liters/min; P < 0.001) than those without pulmonary complications. The finding of tracheobronchial coating in a modified barium swallow was not related to the occurrence of pulmonary morbidity. Receiver operating characteristic curve analysis showed that a CPF level lower than 242 liters/min predicted the development of pulmonary complications with a sensitivity of 77% and a specificity of 83%; the positive and negative predictive values were 65% and 90%, respectively. ConclusionsOur findings indicate that cough peak flow is a valuable predictor of respiratory prognosis in chronic aspiration. This finding suggests a new rehabilitation strategy aimed at improving cough flows for dysphagic patients.

Treatment of Velopharyngeal Insufficiency by Pharyngeal and Velar Fat Injections

The aim of this prospective study was to evaluate the effectiveness of fat injections in the treatment of velopharyngeal insufficiency (VPI). The study involved 10 patients (6 adults aged 19-48 years and 4 children aged 5-13 years) with mild/moderate VPI who were injected with 3.5 to 8 mL of fat in the posterior, lateral pharyngeal walls and soft palate under general anaesthesia. A second fat-grafting procedure was performed in 2 patients to achieve further improvement. Nasoendoscopy revealed a reduction in the closure gap in all patients, and the perceptual evaluation demonstrated improved speech intelligibility and resonance and reduced nasal air leakage in all cases (P < .005). The aerodynamic assessment showed a significant reduction in nasal airflow during phonation (P < .05). Follow-up was 6 to 23 months. In conclusion, fat injections improved voice resonance and reduced nasal air escape in all treated cases and can be a promising alternative to major procedures, such as velopharyngoplasties, for the treatment of mild/moderate VPI.

VOICe THeRApy FOR LARyNgeAL HeMIpLegIA: THe ROLe OF TIMINg OF INITIATION OF THeRApy

OBJECTIVE Laryngeal hemiplegia, also known as vocal fold paralysis, causes severe communicative disability. Although voice therapy is commonly considered to be beneficial for improving the voice quality in several voice disorders, there are only a few papers that present scientific evidence of the effectiveness of voice therapy in treating the disabilities of laryngeal hemiplegia. The aim of this study was to evaluate the outcomes of voice therapy in patients with laryngeal hemiplegia and to evaluate the role of the time gap between onset of laryngeal hemiplegia and initiation of therapy. DESIGN A prospective study comparing subjects treated either within or more than 3 months after the onset of laryngeal hemiplegia. SUBJECTS The study involved 30 laryngeal patients with hemiplegia (16 males, 14 females, age range 15-80 years). METHODS All patients underwent videolaryngostroboscopy, maximum phonation time measurement, GIRBAS perceptual evaluation, Voice Handicap Index self-assessment and Multi-Dimensional Voice Program voice analysis before and after therapy. RESULTS In all tests, there were significant improvements in voice quality, both in the group treated within 3 months after the onset of laryngeal hemiplegia and in the group treated after this time. CONCLUSION Voice therapy is effective in treating laryn-geal hemiplegia even if treatment is delayed by more than 3 months from onset of laryngeal hemiplegia.

Botulinum Toxin Injection and Airflow Stability in Spasmodic Dysphonia

OBJECTIVE: The aim of this study was to analyze the effects of botulinum toxin (BT) injection on airflow stability, by measuring mean phonatory oral airflow and its coefficient of variation (CV), in subjects with adductor spasmodic dysphonia (SD). STUDY DESIGN AND SETTING: Twenty-four subjects with SD (aged 31-78 years) and 23 controls (aged 29-63 years) were evaluated for mean airflow and its CV during sustained phonation. Fifteen of the subjects with SD were also evaluated within 3 weeks after BT injection. RESULTS: BT increased airflow in subjects (P = 0.0130) but neither the preinjection nor postinjection values differed significantly from those of controls. Conversely, airflow CV was invariably higher in subjects than in controls (P < 0.0001). In 13 subjects in whom phonation perceptually improved, including 3 in whom airflow did not increase, airflow CV decreased significantly after BT treatment (P = 0.0232). CONCLUSIONS: Subjects with SD have highly unstable phonatory airflow; its CV is a valid measure for assessing the outcome of a BT injection. A reduced airflow CV probably does not depend solely on increased airflow due to thyroarytenoid muscle paresis, and may indicate a change in laryngeal motoneuronal activity. EBM rating: B-3b