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Comparison of voice and swallowing parameters after endoscopic total and partial arytenoidectomy for bilateral abductor vocal fold paralysis: a randomized trial.

IMPORTANCE Total arytenoidectomy is claimed to increase risk of aspiration and cause more voice loss than other operations performed for bilateral abductor vocal fold paralysis (BVFP). However, objective evidence for such a conclusion is lacking. There is no study comparing swallowing and voice after total and partial arytenoidectomy. OBJECTIVE To compare voice and swallowing parameters after endoscopic total and partial arytenoidectomy for BVFP. DESIGN, SETTING, AND PARTICIPANTS In this prospective, randomized, double-blind, case-control study conducted at a tertiary referral university, the study population comprised 20 patients with BVFP. INTERVENTIONS Endoscopic total and partial arytenoidectomy. MAIN OUTCOMES AND MEASURES Decannulation, duration of operation, Voice Handicap Index, acoustic and aerodynamic analysis, postoperative breathing ability, subjective comparison of preoperative and postoperative voice, speech intensity, and functional outcome swallowing scale. RESULTS Median duration of partial and total arytenoidectomies were 59 and 49 minutes, respectively. This difference was statistically significant (P = .04). Comparisons of preoperative and postoperative Voice Handicap Index, acoustic and aerodynamic measures, postoperative breathing ability, subjective comparison of preoperative and postoperative voice, speech intensity, and functional outcome swallowing scale were not statistically significantly different between both groups. CONCLUSIONS AND RELEVANCE Endoscopic total and partial arytenoidectomy are very successful static surgical options for BVFP. Partial takes longer than total arytenoidectomy. They both provide a comfortable airway, acceptable voice, and acceptable deglutition. It may be a sound practice to perform partial arytenoidectomy initially for primary BVFP cases and reserve total arytenoidectomy for revision cases. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01824849.

Recurrent Contact Granuloma Experience With Excision and Botulinum Toxin Injection

IMPORTANCE Contact granuloma is a difficult-to-treat laryngeal disorder associated with vocal abuse, habitual throat clearing, and laryngopharyngeal reflux. It has a high propensity for persistence and recurrence despite many treatment alternatives. OBJECTIVE To present our experience with recurrent contact granuloma treated with microlaryngoscopic excision and botulinum toxin injection. DESIGN Case series. The follow-up period had a mean (range) of 41 (11-88) months. SETTING Tertiary referral university clinic. PARTICIPANTS Twenty patients with recurrent, grade 3 and grade 4 contact granuloma whose lesion was excised at least once after failure of conservative treatments. INTERVENTIONS Microlaryngoscopic excision and botulinum toxin type A injection into the region of the bilateral thyroarytenoid and lateral cricoarytenoid muscles. MAIN OUTCOMES AND MEASURES Disappearance of contact granuloma. RESULTS Seventeen patients were cured of their contact granuloma. Three patients experienced recurrences: 2 received botulinum toxin injection only as outpatients and recovered. The other patient required reexcision and reinjection under general anesthesia. These 3 patients were free of granuloma at their last follow-up. CONCLUSIONS AND RELEVANCE After failed conservative treatment, microlaryngoscopic excision and botulinum toxin type A injection is successful in the treatment of recurrent contact granuloma. Removing recurrent granulomas can result in a low recurrence rate if botulinum toxin type A is added at the time of removal.

Identification of the peripheral blood levels of interleukin-12, interleukin-10, and transforming growth factor-β in patients with laryngeal squamous cell carcinoma.

The aim of this study was to investigate the biology of laryngeal squamous cell carcinoma (SCC) to develop effective novel treatment modalities.

Histopathological changes in nasal mucosa with nasal septum deviation

Histopathological changes in septal and nasal mucosa of patients with nasal septum deviation are not well known. Biopsies of septal and lateral nasal mucosae from both sides of nose were obtained from 20 patients undergoing septoplasty and control group of 10 patients undergoing head and neck surgery. Histopathological changes including lymphocytic infiltration and squamous metaplasia were compared. This study determined significantly higher rate of squamous metaplasia and lymphocytic infiltration in septal mucosa opposite the deviation compared to control group. Furthermore, there was a significantly higher rate of lymphocytic infiltration in the lateral nasal wall mucosa opposite the deviation when compared to control group. Increased lymphocytic infiltration and squamous metaplasia are observed on both sides of nasal mucosa; however, they are more severe on the side opposite the deviation. Septal deviation predisposes to chronic mucosal inflammation and squamous metaplasia, both of which may render patients susceptible to chronic rhinosinusitis.

Apoptosis in chronic tonsillitis and tonsillar hypertrophy

OBJECTIVE Chronic tonsillitis is the persistent inflammation of the tonsillar tissue that occurs due to recurrent, acute or subclinical infection. The recurrent and chronic inflammation of palatine tonsils sometimes results in hypertrophy. Apoptosis provides an important balance between lymphocytes in tonsillar lymphoid tissue. The aim of this study is to investigate the apoptosis in tonsillar diseases. METHODS 43 patients with chronic tonsilitis and tonsillar hypertrophy underwent tonsillectomy. The specimens were examined immunohistochemically for apoptosis. Tonsils were assembled into groups according to their size. Specimens were compared for their apoptotic cell count. RESULTS The apoptosis difference between the tonsil size groups is not statistically significant (p>0.05). However, when the study group was divided into two at age 6, the difference was not statistically significant for patients at and below 6 years of age; but, the difference was statistically significant for patients above 6 years of age (p<0.05). The comparison of apoptosis in microcompartments of tonsil tissue (intrafollicular, interfollicular, subepithelial and intraepithelial) between tonsil size stages and between chronic tonsillitis and tonsillar hypertrophy groups revealed no statistical significance (p>0.05). There was a statistically significant positive correlation between intrafollicular and interfollicular, interfollicular and intraepithelial & subepithelial and intraepithelial areas (p<0.05). CONCLUSIONS In the light of these findings, it was concluded that apoptosis played a role in the tonsillar hypertrophy and atrophy. Apoptosis functioned to balance lymphocyte proliferation in tonsil tissue. The association of apoptosis with tonsillar hypertrophy seemed to be age-dependent.

The effect of midline crossing of lateral supraglottic cancer on contralateral cervical lymph node metastasis

Abstract Conclusion: The degree of midline crossing of lateral supraglottic cancer does not significantly change its rate of contralateral cervical metastasis. The rate of occult metastasis is too high to take the risk of contralateral regional recurrence. We support routine bilateral neck dissection even in lateral supraglottic cancers with no or minimal midline crossing. Objectives: Data on the rate of contralateral cervical metastasis of laterally located supraglottic cancer, the effect of its degree of midline crossing on contralateral cervical metastasis, and its treatment are still controversial. Methods: This was a retrospective cohort, chart review involving 305 surgically treated patients with T1–3 squamous cell carcinoma of the supraglottic larynx. In all, 184 patients had bilateral neck dissection; 86 N0 contralateral necks were followed up. Thirty-five patients who needed postoperative radiation therapy because of the primary tumor or ipsilateral neck dissection specimen also received radiation therapy to the contralateral neck. The degree of midline crossing at the epiglottis was measured on a laryngectomy specimen with a ruler and expressed as ‘no,’ ‘<5 mm’ or ‘≥5 mm.’ Results: The rates of occult and overall contralateral metastasis in our series were 16% and 28%, respectively. There was no statistically significant difference between contralateral neck metastasis and recurrence rates in the neck dissection, follow-up, and irradiation groups according to the degree of midline crossing.

The effect of early routine grommet insertion on management of otitis media with effusion in children with cleft palate.

PURPOSE The aim of the study is to compare long term otoscopic and audiological findings of cleft palate patients with or without early grommet insertion. METHODS Cleft palate patients followed-up in Hacettepe University between 2008 and 2013 were included in the study. Age, gender, cleft types and palate surgery data, grommet tube insertion history and otological - audiological evaluations of the patients were recorded. Patients were evaluated in three groups according to grommet insertion history: A-early routine grommet insertion, B-grommet insertion during follow-up, C-no grommet insertion. Otological and audiological findings were compared. RESULTS There were 154 patients in the study, with a median age of 7.7 years. There were 67 patients in group A (43.5%), 22 patients in group B (14.3%) and 65 patients in group C (42.2%). OME was identified significantly higher in group A and normal otoscopic examination findings were higher in group C. Complications showed a higher rate than other otoscopic findings in group B patients. There was no significant difference for any frequencies in between the groups in terms of mean air-bone gap (ABG) values. There were 20 grade I, 25 grade II, 77 grade III and 32 grade IV patients in the study according to the Veau classification. CONCLUSION Prophylactic grommet insertion may not be applied as some cleft palate patients with no OME. Wait and see protocol can be recommended for these patients, and they should be followed-up up closely to avoid complications. If the effusion does not recover or tympanic membrane changes occur in follow-up, grommet insertion should be considered.

The relationship between the fistula tract and the facial nerve in type II first branchial cleft anomalies

OBJECTIVE To share our experience involving seven patients with type II first branchial cleft anomalies (hereafter, type II anomalies), to determine whether the location of the external fistula openings of the anomalies are associated with the location of the facial nerve tract, and elucidate the relationship between the location of the fistula opening and the facial nerve. METHODS The medical records of seven patients who underwent surgery from 2005 to 2013 for type II anomalies were retrospectively examined. The relationship between the fistula opening and the facial nerve was evaluated in each patient with respect to whether the fistula opening was superior or inferior to the mandibular angle. All patients underwent partial parotidectomy, facial nerve exposure, and total excision of the mass together with connection of a small cuff of the external auditory canal skin to the fistula tract. RESULTS The fistula tracts were located medially to the facial nerve in two patients, and both fistulae had openings inferior to the mandibular angle. The fistula tracts were located laterally to the facial nerve in the remaining five patients: one patient had no external opening, one had an opening inferior to the mandibular angle, and the remaining three had openings superior to the mandibular angle. CONCLUSION Because type II anomalies are rare, their diagnosis is difficult. Surgery of such lesions is challenging and associated with a high risk due to their proximity to the facial nerve. We believe that the location of the fistula opening may help to identify the relationship between the anomalous lesion and facial nerve. Studies involving larger series of cases are needed to confirm our hypothesis; however, because of the rarity of this specific anomaly, it will not be easy to compile a large number of cases. We believe that our study will encourage further investigation on this subject.

Sole effect of genioglossus advancement on apnea hypopnea index of patients with obstructive sleep apnea

Abstract Conclusion: Selected patients might have benefited from genioglossus advancement (GA), even it was applied solely. GA provided significant reduction on the apnea hypopnea index (AHI), with a 53% surgical success. Objectives: The aim of this study was to evaluate the impact of GA on AHI of patients with obstructive sleep apnea (OSA). Method: From January 2008 to April 2014 patients who underwent a genioglossus advancement procedure alone were included into the study and records of these cases were analyzed retrospectively. Pre-operative and post-operative values of body mass index (BMI), Epworth Sleepiness Scale (ESS), nocturnal polysomnographic data including AHI, mean, and minimum oxygen saturation were compared. Results: There were 16 males and one female patient with the mean age of 46 years. The AHI showed a significant reduction from 27.5 ± 8 pre-operatively to 17.3 ± 12.6 post-operatively. The pre-operative and post-operative mean O2 saturation value improved from 92.1 ± 2.4% to 93.4 ± 1.7%. Pre-operative ESS scores decreased significantly from 7.7 ± 1.6 to 4.8 ± 1.9. There were no significant difference between pre- and post-operative values of BMI and minimum O2 saturation. The success rate was found to be 53%, which was based on success criteria as an AHI of <20 with at least 50% reduction.

Endolaryngeal dilatation versus laryngotracheal reconstruction in the primary management of subglottic stenosis

OBJECTIVES The scope of the study is to compare endolaryngeal dilatations (ED) with laryngotracheal reconstruction with cartilage grafting (LTRCG) in terms of restenosis. METHODS Pediatric subglottic stenosis patients treated in Hacettepe University, between 2002 and 2012 were retrospectively evaluated. Patients who had ED or LTRCG as primary management were included in the study. EDs were grouped into bronchoscopic dilatation (BD), laser incision and balloon dilatation (LBD) and cold knife incision and balloon dilatation (CKBD). The groups were evaluated in terms of restenosis and decannulation rates. RESULTS There were 35 patients (9 females, 26 males; mean age 4.42). LTRCG was performed in 16 patients (9 anterior and 7 anterior and posterior grafts). EDs were performed in 19 patients with 6 CKBDs, 7 LBDs and 6 BDs. There were 3 grade II, 13 grade III cases in the LTRCG group while 4 grade I, 6 grade II, 8 grade 3 and 1 grade 4 in the ED group. Overall decannulation rate was 97% (34/35) in all patients. Restenosis was higher in the ED group (63.2%) than the LTRCG group (31.3%) with rates of CKBD 16.7% (1/6), LBD 71.4% (5/7) and BD 100% (6/6). Restenosis rates were found to be increasing with higher grades (grade I-25%, grade II-66%, grade III-85%). CONCLUSION ED may need more repetitive interventions than LTRCG due to restenosis. Less restenosis might be observed when balloon is used for dilatation and cold knife for mucosal incisions.