Zoran Milutinovic

Contribution to the understanding of the etiology of vocal fold cysts: A functional and histologic study

The etiological theories of vocal fold cysts can be divided into two basic groups: those of congenital and acquired cysts. In ongoing practice, the authors had noted that the greater number of cysts appeared at the functionally most active segment of the vocal folds which, on the other hand, has the least number of glands. Also, it had been noted that patients with vocal fold cysts tended to have hyperkinetic patterns of voice production. These observations indicated the possibility of a functional aspect in the etiology of vocal fold cysts, and consideration of such a possibility was the aim of this work. In 37 cases, the exact location of the cyst was established. In addition, the muscular activity of the phonatory apparatus was estimated, patient self‐descriptions with respect to talkativeness were taken into account, and histological evaluations were made. The cysts were most frequently found in the area of the junction of the anterior and middle thirds of the free edge of the vocal fold. Muscular activity during speech and phonation was increased in study patients. Sixty‐five percent of patients had epidermoid cysts and 35% had retention cysts of the vocal fold. According to study results, the functional aspect of cyst genesis has a marked role in the etiology of vocal fold cysts, which points to the great importance of functional care for cyst patients.

Randomized prospective trial of hyperbaric oxygen therapy and intratympanic steroid injection as salvage treatment of sudden sensorineural hearing loss.

Objective To compare the effects of hyperbaric oxygen (HBO) and intratympanic (IT) steroid injection on hearing after the failure of primary treatment in patients with idiopathic sudden sensorineural hearing loss (ISSHL). Study Design A prospective randomized trial. Setting Tertiary referral center. Patients Fifty patients with failure of primary therapy for ISSHL. Intervention(s) After primary treatment with systemic steroids and failure of therapy, defined as less than 10-dB hearing gain, 50 patients were enrolled in the study and received either hyperbaric oxygen or intratympanic steroid treatment. The patients were not matched and not similar. Main Outcome Measure(s) Hearing gain at 0.25, 0.5, 1, 2, and 4 kHz after treatment. Results There were significant differences between hearing thresholds at all frequencies before and after the HBO treatment. Similarly, there were significant differences between hearing thresholds at most frequencies (except 2 kHz) before and after the treatment in the IT group. The subgroups of patients with pure tone average less than 81 dB and were younger than 60 years had better response to HBO treatment than those with profound deafness and in the elderly. Conclusion HBO and IT steroid therapy could be successfully used as salvage therapies in patients with sudden deafness. Further study is needed to demonstrate superiority of one of the treatments.

Trichinella spiralis and laryngeal carcinoma: a case report

An uncommon presentation of Trichinella spiralis with squamous cell carcinoma of the larynx is reported. The possible carcinogenic potential of trichinosis and its management are discussed.

Composite myo-mucosal reconstruction of the vocal fold.

It is well established that after cordectomy or radiation therapy for early glottic carcinomas varying disturbances of the voice occur. This has led some clinicians to consider the need for surgical reconstruction of the vocal fold. Since functional results desired have still not been achieved, vocal fold reconstruction was performed using a combination of the muscular flap described by Pogosov and the free mucosal transplant reported by Isshiki. This surgical approach has now been performed on 11 cases with excellent functional results. The technique has provided a suitable mass of the reconstructed vocal fold and also allows very close contact between the vocal folds during the closed phase of the vibratory cycles. Postoperative voice quality has been almost within physiological limits.

Giant Destructive Congenital Mastoid Cholesteatoma with Minimal Clinical Presentation

Congenital cholesteatoma (CC) is an epidermoid cyst arising from the squamous epithelial rest in the temporal bone. The reported sites of origin within the temporal bone include the middle ear, petrous apex, and external auditory canal, and the rarest is the mastoid process. CC is a benign, slowly progressive, non-self-limiting, very expansive and destructive mass. Usually, patients with CC of the mastoid region have dizziness and neck pain. We report the case of a patient with giant, extensive congenital cholesteatoma of mastoid origin with minimal clinical presentation.

An external approach without tracheotomy for submucosal cordectomy with laterofixation for bilateral abductor paralysis of the vocal folds

There are numerous surgical procedures now available to manage bilateral abductor paralyses of the vocal folds. These procedures have various success rates but mostly do not offer reliable and predictable postoperative results, and usually require ,tracheotomy. The technique described in this report is based on a trial study to obtain a safe airway for an affected patient and avoid tracheotomy, if possible. Submucosal cordectomy was used with lateral fixation of one vocal fold and preservation of the arytenoid. The procedure was performed by using continuous intravenous anesthesia, which does not require intubation of the patients airway. Seven patients were operated with this technique with excellent postoperative results. The glottal airway was largely improved in all patients, with only minor temporary complications.

Giant funicular intrapharyngeal schwannoma

Schwannoma is a rare solitary tumor of Schwann cell origin. The Schwann cell surrounds peripheral nerve tissue and is believed to originate from neural crest. Surgery presents main treatment for patients with schwannoma.

Activity of the subglottic voice (“chest resonator”): an echo-tomographic and acoustic study

In contrast to numerous studies of the activity of the supraglottic voice resonator and its acoustic effect, little is known about the subglottic resonator and its function. In the present investigation the phonatory behavior of the lower airway (the “chest resonator”) was studied and the quality of its acoustic output analyzed. Echo-tomographic analysis was used to study the tracheal diameter during various phonatory tasks. Acoustic analysis was also used, based on acoustic separation between the supra- and subglottic airways (including perceptual testing, sound pressure levels, and long-time spectral analysis). Evidence is presented of chest resonator activity having both perceptual and spectral effects.

Histological basis for indirect videostroboscopic phonosurgery--a scanning electron microscopic study.

Indications for indirect videostroboscopic surgery are well established for small, benign functional lesions of the vocal folds. Epithelial cells of the vocal folds are spindle-shaped and by their long axies run parallel to the free edge of the vocal fold. This occurrence is used clinically by surgeons to obtain an even operative defect when using a cup forceps during single-handed manipulations. Nevertheless, there are still some doubts about single-handed procedures, so that many surgeons prefer the convenience of bimanual manipulation offered by direct (suspension) microlaryngoscopic surgery. The aim of this study was to demonstrate that single-handed manipulation during indirect videostroboscopic surgery permitted obtaining regular edges of an operative defect during laryngeal surgery. A scanning electron microscopic study was conducted on five cadaver larynges following indirect videoscopic excisions at the vocal folds free edge and ten controls. Results demonstrated a clearly regular edge of the operative defects in cases when a posterior traction surgical procedure was followed. These findings reaffirm the value of indirect videostroboscopic surgery for small, benign functional lesions of the vocal folds.

Substitute laryngeal voice sources after partial laryngectomies.

The larynx is a highly adjustable organ, preserving at least some of its functions even when severely damaged. Partial surgical excision (trauma) of the larynx creates new anatomical and functional conditions for the production of voice. Depending on the type and extent of the excision, functional closure of the glottis is compromised, usually resulting in a hyperkinetic pattern of voice production. The glottal voice source is jeopardized, which can result in the creation of substitute laryngeal voice sources. Their capacity for voice production is limited, and therefore these mechanisms have considerable clinical significance. In this paper, the incidence of substitute laryngeal voice sources after partial laryngectomies and its clinical implications are analyzed.