Hiroumi Matsuzaki

Gardasil Vaccination for Recurrent Laryngeal Papillomatosis in Adult Men: First Report: Changes in HPV Antibody Titer.

BACKGROUND Patients with human papillomavirus (HPV) DNA-positive recurrent laryngeal papillomatosis commonly have repeated recurrences following surgery. The reason is suspected to be a mechanism by which latent HPV infection in the surrounding healthy mucosa reinfects the surgical site. It may be that production of HPV antibodies in the laryngeal mucosa with Gardasil injection could inhibit postoperative recurrence. STUDY DESIGN This is a case series study. PURPOSE The purpose of this study was to examine whether Gardasil injection effectively inhibits recurrence. However, as a first report, we describe the antibody titers before and after vaccination. METHODS Gardasil was injected in 12 men (aged 32-74 years; mean age 47.9 years) with HPV-positive laryngeal papillomatosis. Serum antibody titers of HPV-6, -11, -16, and -18 were measured by a competitive Luminex-based immunoassay before the vaccination and 7 months after the start of the vaccination. RESULTS Each of the antibody titers was very low before vaccination, and they rose in all patients after the vaccination. CONCLUSIONS This finding demonstrates that antibody titers increase with Gardasil injection in post-adolescent males.

Assessment of human papilloma virus infection in adult laryngeal papilloma using a screening test.

OBJECTIVES Human papilloma virus (HPV) infection is involved in both juvenile and adult laryngeal papilloma. We wished to determine which types of adult laryngeal papilloma were clinically related to HPV infection. We hypothesized that multiple-site and recurrent papillomas would have a strong relationship to HPV and conducted the present study to test this hypothesis. METHODS Thirteen male patients with adult laryngeal papilloma who underwent resection of papilloma between August 2006 and September 2009 were studied. We examined the relationships between whether the tumor was solitary or multiple, presence or absence of recurrence after surgery, and HPV infection. High-risk HPV types (HPV-DNA types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, and 68) and low-risk HPV types (6, 11, 42, 43, and 44) were tested by a liquid-phase hybridization method. In addition, HPV typing was performed for patients positive for low-risk HPV types. Twenty patients with laryngeal carcinoma or laryngeal leukoplakia were enrolled as the control group. RESULTS In the laryngeal papilloma group, all patients tested were negative for high-risk HPV and 69.2% were positive for low-risk HPV. Typing performed for seven of the patients who tested positive for low-risk HPV showed that one patient was positive for HPV-11, whereas the remaining six patients were positive for HPV-6. All patients with recurrent laryngeal papillomatosis (RLP) were positive for low-risk HPV. All patients who were positive for low-risk HPV had RLP. Tumor samples from repeat operations were positive for low-risk HPV in all patients tested. HPV was not detected in the control group. CONCLUSIONS The relationship between RLP and low-risk HPV was strong, with all cases that were positive for low-risk HPV showing recurrence. Tumor tissue resected at the time of repeat surgery was positive for low-risk HPV in all cases tested.

Gardasil Vaccination for Recurrent Laryngeal Papillomatosis in Adult Men Second Report: Negative Conversion of HPV in Laryngeal Secretions

BACKGROUND In our first report on antibody levels in middle-aged and older men with recurrent laryngeal papillomatosis (RLP), we reported increases in human papillomavirus (HPV) antibody levels similar to those seen in adult women and young men. We posited that HPV antibodies produced in laryngeal mucus by Gardasil would prevent postoperative reinfection in patients with RLP. STUDY DESIGN This is a case series study. PURPOSE The purpose of this study was to examine whether Gardasil injection effectively inhibits recurrence of RLP. Specifically, in this second report, whether HPV antibodies produced in laryngeal secretions by Gardasil are capable of causing negative conversion of HPV-DNA (deoxyribonucleic acid) in laryngeal mucosa was investigated. METHODS A total of 11 patients for whom antibodies were measured in the first report were studied. Before vaccination and after 1 year Post-vaccination, HPV screening tests were performed on laryngeal secretions, and whether HPV-DNA negative conversion had occurred was evaluated. At the time of collection of laryngeal secretions, the presence or absence of laryngeal papillomas was examined. RESULTS Before vaccination, all patients were HPV low-risk positive on laryngeal secretion screening tests. After vaccination, three patients were positive. Laryngeal papillomas remained in five patients. CONCLUSIONS The HPV-DNA test showed negative conversion in eight of 11 (72.7%) patients after vaccination. Residual laryngeal papillomas were found in five of 11 (45.5%) patients. The serum HPV antibody titer did not differ significantly between the group in which laryngeal secretions showed HPV negative conversion and the group in which conversion did not occur. The serum antibody titer did not differ significantly as a function of whether there were residual tumors.

Prevention of neck infection by endoscopic suture closure of pyriform sinus fistulae: a report of two cases ☆

A fístula de seio piriforme (FSP) é uma doença congênita rara que pode levar à formação de abscesso cervical e/ou tireoidite supurativa.1 O tratamento mais comum consiste na excisão completa da fístula.2 Entretanto, na última década, a cauterização endoscópica da abertura da fístula foi descrita como cirurgia minimamente invasiva para FSP.3,4 Embora alguns estudos tenham sugerido que essa última opção seja confiável e minimamente invasiva, em alguns casos poderá haver necessidade de repetidos

Maxillary sinus hemangioma: usefulness of embolization according to classification.

Hemangioma in the nose and nasal sinuses is rare, particularly in the maxillary sinus. Differentiation of hemangioma from malignant tumors is important, because both may be accompanied by bone destruction. With regard to giant hemangioma, this type has a rich blood supply, and surgical treatment requires particular care due to the high risk of massive bleeding and obstructed field of view. Although maxillary sinus hemangioma has been sporadically reported, few reports have described cases of this type diagnosed according to the 1996 classification of the International Society for the Study of Vascular Anomalies (ISSVA) and treated with arterial embolization. Here, we report three cases of massive sinonasal heamangioma that were resected after arterial embolization.

Evaluation of Phonatory Function in the Elderly

This chapter summarizes how aging affects vocal function. First, the changes in voice pitch vary according to gender. Elderly men tend to speak at a higher pitch than younger men, whereas postmenopausal women speak at a lower pitch than younger women. Second, maximum phonation time is not a useful tool for assessing the healthy elderly, but it can be used for patients with age-related vocal fold atrophy. Third, aging has no impact on the mean airflow rate, but it affects airway resistance. The elderly tend to have lower airway resistance than younger people. However, no consensus exists on whether aging has an impact on expiratory pressure and sound pressure level. Finally, the elderly tend to have a weaker ability to regulate the larynx than the young.

Collagen Injection for the Elderly with Dysphonia

Many patients who complain of age-associated voice changes exhibit insufficient glottic closure during phonation owing to vocal cord atrophy. Some patients with pre-existing conditions, such as recurrent laryngeal nerve paralysis and sulcus vocalis, also experience insufficient glottic closure during speech, which progresses as the laryngeal adjustment function deteriorates in an age-dependent manner. Therapeutic methods for insufficient glottic closure during phonation include the intracordal injection of collagen. The procedure is selected or used in combination with other treatments based on detailed preoperative examinations. Thus, treatment with collagen is not necessarily always performed. It can be administered as office-based surgery under local anesthesia and is minimally invasive as long as allergy is not a concern.

Human Papillomavirus Infection Status of Various Laryngeal Diseases in Japan: A Comprehensive Study

OBJECTIVE The aim of our study was to clarify the human papillomavirus (HPV) infection status of various laryngeal diseases in Tokyo, Japan. STUDY DESIGN This is a retrospective study. METHODS A total of 144 patients who underwent surgical resection for various laryngeal lesions were enrolled in this study. These subjects were categorized into four groups based on lesion type: non-neoplastic, 44; precancerous, 29; cancer, 35; and papilloma, 36. To determine the rate of HPV infection, laryngeal secretions and resected tissue from our study participants were examined by liquid-phase hybridization (LPH) and consensus primer-directed polymerase chain reaction (PCR). RESULTS The LPH for low-risk HPV was applied to all 144 patients, and that for high-risk HPV was additionally applied to 121 of the 144 patients. The PCR was applied to 94 of the 144 patients. The LPH detected low-risk HPV-DNA in 23 patients (1 cancer and 22 papillomas) and high-risk HPV-DNA in 3 patients (1 cancer and 2 papillomas). The PCR detected HPV-6 and HPV-11 in the papilloma group, whereas it detected HPV-31 in one patient with laryngeal cancer and one patient with precancerous lesion. Both the LPH and the PCR revealed the HPV infection rate in the non-neoplastic group to be 0%. CONCLUSIONS Although we found no significant difference in the HPV-DNA positive rates of laryngeal cancer and precancerous lesions in the non-neoplastic group, the positive rates were significantly smaller in this group than in the papilloma group. In the Tokyo area, HPV had little or no association with laryngeal cancer, precancerous lesions, and non-neoplastic lesions in the larynx.

Clinical Application of Ho:YAG Laser to Laryngeal Microsurgery

Various lasers have been used for transoral laser microsurgery. We herein proposed the application of the Holmium: YAG(Ho:YAG)laser in transoral laser microsurgery for three cases of laryngeal benign lesions. According to the distance between the laser fiber tip and the target, we designed three irradiation methods: non-contact irradiation, contact irradiation, and shooting irradiation. Each of the three methods shows a different maximum depth of evaporation. Benign lesions in the larynx, such as leukoplakia, papilloma, and vascular malformation can be treated with non-contact irradiation and contact irradiation. The Ho:YAG laser can therefore be an alternative laser for performing transoral laser microsurgery.

High Prevalence of Laryngopharyngeal Reflux Disease in Patients With Lumbar Kyphosis.

OBJECTIVE To evaluate the relationship between laryngopharyngeal reflux disease and presence of lumbar kyphosis. STUDY DESIGN A cross-sectional study. METHODS We included 20 patients with lumbar kyphosis and 31 control subjects. A diagnosis of laryngopharyngeal reflux disease and gastroesophageal reflux disease was made if the Reflux Symptom Index score was ≥13 and if the Frequency Scale for the Symptoms of Gastroesophageal Reflux Disease was ≥8, respectively. We compared the prevalence of the two reflux diseases, frequent reflux symptoms, and demographic factors between the two groups. RESULTS There was no significant difference in demographic factors between the two groups. Five (25%) of 20 patients with lumbar kyphosis had a Reflux Symptom Index ≥13 compared with one (3.2%) of 31 controls. Seven (35.0%) of 20 patients had a Frequency Scale for the Symptoms of Gastroesophageal Reflux Disease ≥8 compared with three (9.7%) of 31 controls. A comparison of the prevalence of laryngopharyngeal reflux disease and gastroesophageal reflux disease showed a significant difference between patients with kyphosis and controls (P value = 0.029 and 0.036, respectively). In Reflux Symptom Index, heartburn, hoarseness, and a swallowing problem were significantly frequent symptoms in the kyphosis group compared with the control group. CONCLUSIONS The prevalence of laryngopharyngeal reflux disease and gastroesophageal reflux disease was significantly higher in patients with lumbar kyphosis than in controls. Therefore, otolaryngologists and orthopedic surgeons should be aware that patients with lumbar kyphosis are likely to have gastroesophageal reflux disease and also laryngopharyngeal reflux disease.