Joseph R. Spiegel

Treatment of chronic posterior laryngitis with esomeprazole

Objective: To evaluate the efficacy of acid‐suppressive therapy with the proton pump inhibitor esomeprazole on the signs and symptoms of chronic posterior laryngitis (CPL) in patients with suspected reflux laryngitis.

Vocal fold scarring: current concepts and management.

Scarring of the vocal folds can occur as the result of blunt laryngeal trauma or, more commonly, as the result of surgical, iatrogenic injury after excision or removal of vocal fold lesions. The scarring results in replacement of healthy tissue by fibrous tissue and can irrevocably alter vocal fold function and lead to a decreased or absent vocal fold mucosal wave. The assessment and treatment of persistent dysphonia in patients with vocal fold scarring presents both diagnostic and therapeutic challenges to the voice treatment team. The common causes of vocal fold scarring are described, and prevention of vocal fold injury during removal of vocal fold lesions is stressed. The anatomic and histologic basis for the subsequent alterations in voice production and contemporary modalities for clinical and objective assessment will be discussed. Treatment options will be reviewed, including nonsurgical treatment and voice therapy, collagen injection, fat augmentation, endoscopic laryngoplasty, and Silastic medialization.

Strobovideolaryngoscopy: Results and Clinical Value

Strobovideolaryngoscopy is a valuable addition to the diagnostic armamentarium because it allows the otolaryngologist to perform a detailed physical examination of the vibratory margin of the vocal fold. From 1985 through 1989, we performed 1,876 strobovideolaryngoscopy procedures, the majority on professional voice users. Previously, we reported findings on our first 486 strobovideolaryngoscopy procedures. Stroboscopic information influenced diagnosis or treatment in approximately one third. The present study was undertaken to determine whether additional experience had altered the clinical usefulness of the procedure. Diagnoses were noted before and after stroboscopy prospectively for 377 strobovideolaryngoscopy procedures performed during the calendar year 1989. In 53% of the procedures, strobovideolaryngoscopy resulted in no change in diagnosis. In 29%, preprocedure impressions were confirmed and additional diagnoses were made. In 18%, preprocedure diagnoses were found to be incorrect. The procedure has proven very helpful in caring for voice patients, modifying diagnoses in 47%, and confirming uncertain diagnoses in many of the other patients studied.

Arytenoid dislocation: Diagnosis and treatment

Disruption of the cricoarytenoid joint is a relatively uncommon event, according to the world literature. Only 31 reported cases of arytenoid dislocation or subluxation exist other than the 26 cases described in this paper. Often cases are misdiagnosed as vocal fold paralysis. Knowledge of the signs and symptoms of arytenoid dislocation aids in correct diagnosis and early treatment. Even when diagnosis has been delayed, surgery may be highly effective. Familiarity with state‐of‐the‐art diagnostic techniques and new concepts in management helps optimize the chances for good voice quality.

The aging adult voice

Advancing age produces physiologic changes that may alter voice. Some of these changes are inevitable; others may be avoidable or reversible. In addition, many treatable medical conditions may cause voice changes similar to those of aging. It is essential that all voice care providers be familiar with the expected changes of aging, and be alert to reversible conditions that may adversely affect phonation and be mistaken for presbyphonia.

Autologous fat implantation for vocal fold scar: a preliminary report.

New insights into the anatomy and physiology of phonation, along with technological advances in voice assessment and quantification, have led to dramatic improvements in medical voice care. Techniques to prevent vocal fold scar have been among the most important, especially scarring and hoarseness associated with voice surgery. Nevertheless, dysphonia due to vocal fold scar is still encountered all too frequently. Although it is not generally possible to restore such injured voices to normal, patients with scar-induced dysphonia can usually be helped. Voice improvement is optimized through a team approach. Treatment may include sophisticated voice therapy and vocal fold surgery. Although experience with collagen injection has been encouraging in selected cases (particularly in those involving limited areas of vocal fold scar), there is no consistently successful surgical technique. Attempts to treat massive vocal fold scar, such as may be seen following vocal fold stripping, have been particularly unsuccessful. This paper reports preliminary experience with the implantation of autologous fat into the vibratory margin of the vocal fold of patients with severe, extensive scarring. Using this technique, it appears possible to recreate a mucosal wave and improve voice quality. Additional research is needed.

Chondrosarcoma of the Skull Base

Objectives Sarcomas of the skull base are challenging, potentially lethal tumors. Prognosis is considered poor. The present report reviews treatment options and presents a case of treatment with en bloc resection of the temporal bone and adjacent skull base.

Delayed pharyngoesophageal perforation : a complication of anterior spine surgery

Stabilization of the cervical spine is often accomplished via an anterior cervical approach. Bone grafts and/or plates and screws are used to achieve stabilization. Injuries to the pharynx and esophagus are known complications in anterior exposure of the cervical spine. These injuries are manifest in the early postoperative period. Reports of late perforations are very rare. We present four cases of delayed injury to the pharynx and esophagus that resulted in abscess or fistula. We postulate that graft displacement with resulting erosion was responsible for these serious complications. Postoperative odynophagia in patients who undergo anterior cervical fusion warrants evaluation of the bone graft location. Early surgical intervention and repair may decrease prolonged morbidity in these patients.

Strobovideolaryngoscopy in professional voice users: Results and clinical value*

Summary Evaluation of the vibratory margin of the vocal fold is essential for accurate diagnosis and treatment of voice patients. Traditionally, physicians have performed this evaluation using their subjective impressions of the sound of the voice in conjunction with laryngoscopy under continuous light. Strobovideolaryngoscopy is a valuable addition to the diagnostic armementarium. It allows the physician to perform a proper physical examination of the vibratory margin. A review of 486 strobovideolaryngoscopy procedures in 343 voice patients during a 2-year period reveals that stroboscopic information influenced diagnosis or treatment in approximately one-third of the entities diagnosed.

Unilateral recurrent laryngeal nerve paralysis:The importance of “preoperative” voice therapy

This preliminary retrospective study of 19 female patients and 22 male patients with unilateral recurrent nerve lesions demonstrated the promise of objective measurements in predicting the need for surgery, the efficacy of voice therapy in ameliorating vocal symptoms, and the effects of therapy in conjunction with surgery. Sixty-eight percent (68%) of the female patients and 64% of the male patients did not elect to have surgery. Outcome satisfaction of nonsurgical and surgical patients appeared to be similar. The data from this study support the importance of preoperative therapy for patients with unilateral vocal fold paralysis.