Evaluation and management of voice disorders: Our experiences

Background: Change in voice is one of the most common complains among patients visiting to ENT outpatient. The causes are numerous and need to be evaluated before approaching to curative intent of treatment. Aims and Objectives: The current study was designed with an aim to analyze the spectrum of voice disorders and their management option. Materials and Methods: Prospective study conducted between June 25, 2020, and November 30, 2021. Clinical, demographic profiles were recorded. Fiber-optic laryngoscopy was performed in all the cases. Radiology examination computed tomography/magnetic resonance imaging was supplemented only in required cases. Treatment was executed based of etiological profile analysis. Minimum 3 months follow-up was collected post-therapy. Statistical analysis was performed using Statistical Package for the Social Sciences version 24. Pearson Chi-square test was used for see the association between parameters. P-value was considered significant while being <0.05. Results: Out of 218 patients, the most patients (approx. 70%) occupied in the age group of 30–50 years. There was male predominance (76.6%). Voice change secondary to laryngopharyngeal reflux was seen in 56.4% of cases. Benign vocal fold lesions (nodule/cyst/polyp) were noticed in 26.5% of cases. Malignant lesions were seen in 1.8% of cases. Benign vocal fold lesions (polyp and cyst) were treated by microlaryngeal surgery (MLS). Pre-malignant lesion (leukoplakia) was treated with MLS stripping. Out of four malignant lesions, one was in early stage and underwent supraglottic laryngectomy while others were in advanced stage (T4) and treated by total laryngectomy. Conclusions: Voice disorders comprise wide etiological profile from reflux to malignant lesion. Timely proper evaluation followed by definitive management achieves good treatment outcomes.

Different clinical symptom patterns in patients with reflux micro-micro-aspiration

BackgroundPulmonary manifestation of gastro-oesophageal reflux disease (GORD) is a well-recognised entity, however little primary reported data exists on presenting symptoms of patients in whom reflux micro-aspiration is confirmed. The aim of this study is to report symptoms and presenting patterns of a large group of patients with confirmed reflux micro-aspiration.Patients and methodsData was extracted from a prospectively populated database of patients referred to a tertiary specialist centre with severe, refractory, or atypical reflux. Patients with reflux micro-aspiration on scintigraphy were included in this study. Separate group included patients with evidence of proximal reflux to the level of pharynx when supine and/or upright.ResultsInclusion criteria were met by 243 patients with confirmed reflux micro-aspiration (33% males; mean age 59). Most common symptoms amongst patients with micro-aspiration were regurgitation (72%), cough (67%), heartburn (66%), throat clearing (65%), and dysphonia (53%). The most common two-symptom combinations were heartburn/regurgitation, cough/throat clearing, regurgitation/throat clearing, cough/regurgitation and dysphonia/throat clearing. The most common three-symptom combinations were cough/heartburn/regurgitation, cough/regurgitation/throat clearing and dysphonia/regurgitation/throat clearing. Cluster analysis demonstrated two main symptom groupings, one suggestive of proximal volume reflux symptoms and the other with motility/inflammatory bowel syndrome (IBS)-like symptoms (bloat, constipation).ConclusionCombination of typical symptoms of GORD such as heartburn or regurgitation and a respiratory or upper aero-digestive complaint such as cough, throat clearing, or voice change should prompt consideration of reflux micro-aspiration.

Topical Capsaicin for the Treatment of Sensory Neuropathic Cough

Objective To evaluate a novel treatment for sensory neuropathic cough (SNC): topical capsaicin. Study Design Retrospective review. Setting Tertiary care laryngology clinic. Methods A retrospective review was performed on 201 consecutive patients treated for SNC with capsaicin 0.02% to 0.04% applied topically to the upper aerodigestive tract, typically after failure of standard medications. Patients were asked to use the spray 4 times daily for 2 weeks prior to assessment of benefit. Items assessed included the percentage reduction of coughing, type of benefit noted, and side effects. Results Of the 201 patients who used the spray, 36.3% noted no benefit, whereas 63.7% (n = 128) had benefit in terms of cough reduction: 30.8% (n = 62) reported ≥75% reduction; 17.4% (n = 35), 50%-74% reduction; 7.0% (n = 14), 25%-49% reduction; and 8.5% (n = 17), 1%-24% reduction. Of all patients, 78.3% reported no side effects or complications. Of the remaining 21.7%, 1 patient noted a nosebleed after a single administration, and 1 patient noted transient wheezing after administration. The others reported unpleasant local effects, including throat/ear discomfort, voice change, sneezing, reflexive vomiting, and headache. Conclusion In our group of 201 patients with SNC, most of which had failed to respond to standard treatments, 63.7% had some response to capsaicin spray, with 30.8% reporting ≥75% reduction. Minimal side effects of treatment were reported. Thus, we suggest that this therapy can be another treatment option for patients with SNC.

Cranial autonomic symptoms: prevalence, phenotype and laterality in migraine and two potentially new symptoms

BackgroundWhilst cranial autonomic symptoms (CAS) are typically associated with the trigeminal autonomic cephalalgias (TAC’s), they have also been reported in migraine. Identification and understanding of these symptoms in migraine is important to ensure timely diagnosis and effective management. MethodsMigraineurs seen within our tertiary headache service between 2014-2018 ( n =340): cohort one, and a separate cohort of headache patients seen between 2014-May 2021 reporting voice change and/or throat swelling as CAS were selected ( n =64); cohort two. We examined, as a service evaluation, our records regarding age, sex, diagnosis, headache and CAS frequency and laterality as acquired from the first consultation, during which a detailed headache history is taken by a trained physician. ResultsCohort 1: Mean age 43 (range 14-94, SD 15). The most common diagnosis was chronic migraine (78%). Median monthly headache frequency was 26 days (IQR 15-75). At least one CAS was reported in 74%, with a median of two (IQR 0-3). The most common were nasal congestion (32%), lacrimation (31%) and aural fullness (25%). Most patients reported unilateral headache (80%) and strictly unilateral CAS (64%). There was a positive association between headache and CAS laterality (ꭓ 2 1 = 20.7, P < 0.001), with a positive correlation between baseline headache frequency and number of CAS reported ( r = 0.11, P = 0.047). Cohort two: mean age 49 (range 23-83, SD 14). Diagnoses were chronic migraine (50%), chronic cluster headache (11%), undifferentiated continuous lateralised headache (9%), SUNCT/SUNA (8%), hemicrania continua (8%), episodic migraine (8%), episodic cluster headache (3%) and trigeminal neuropathies (3%). Most (89%) described trigeminal distribution pain; 25% involving all three divisions. Throat swelling was reported by 54, voice change by 17, and both by 7. The most common CAS reported were lacrimation ( n = 47), facial swelling ( n = 45) and rhinorrhoea ( n = 37). There was significant agreement between the co-reporting of throat swelling (ꭓ 2 1 = 7.59, P = 0.013) and voice change (ꭓ 2 1 = 6.49, P = 0.02) with aural fullness. ConclusionsCAS are common in migraine, are associated with increasing headache frequency and tend to co-lateralise with headache. Voice change and throat swelling should be recognized as possible parasympathetically-mediated CAS. They may be co-associated and associated with aural fullness, suggesting a broadly somatotopic endophenotype.

A Case of Laryngeal Mucosa Associated Lymphoid Tissue Lymphoma Mimicking Laryngeal Amyloidosis

Laryngeal amyloidosis is a rare disorder characterized by localized amyloid deposition and carries an excellent prognosis. On the other hand, mucosa associated lymphoid tissue (MALT) lymphoma is the most common type of marginal zone lymphoma. MALT lymphoma has a poorer prognosis compared to laryngeal amyloidosis due to more frequent local recurrence, distant metastasis and malignant changes. Despite the differences, as both are found in the form of benign mass and have slow progression, accurate diagnosis is necessary. This report deals with the case of a patient with voice change accompanied by a mass, in which the initial biopsy did not include enough specimen for an accurate diagnosis. However, in the second attempt, an adequate sample was obtained, hence the final diagnosis of laryngeal MALT lymphoma. Based on our recent experience and a review of related literature, we report a case of laryngeal MALT lymphoma mimicking laryngeal amyloidosis.

Do I Look Gawky? The Association between Pubertal Asynchrony and Peer Victimization

Pubertal synchrony is defined as the degree of coherence to which puberty-related body changes (e.g., breast development, growth spurt, voice change, underarm hair growth) are coordinated. During the pubertal transition, youth’s body parts grow asynchronously, making each youth’s physical appearance unique. Physical appearance is a known correlate of youth’s psychosocial functioning during adolescence, but we know little about how pubertal asynchrony plays a role in their peer relationships. Using data from an adoption study (the Early Growth and Development Study; n = 413; 237 boys, 176 girls), this study examined the effect of pubertal asynchrony on peer victimization. Results revealed sex-specific effects of pubertal asynchrony; pubertal asynchrony was associated with a higher risk of peer victimization for girls but a lower risk for boys. Findings highlight the intersection of physical development and social context in understanding youth’s experiences of puberty.

Laryngotracheal stenosis: A more common problem in the COVID era

Laryngotracheal stenosis (LTS) is a rare cause of dyspnoea. It is associated with emergency or prolonged intubation and with tracheostomy. It is expected to increase in incidence following the coronavirus 2019 (COVID-19) pandemic, due to the increased numbers of prolonged intensive care admissions. Presentation may be weeks or even years after the acute episode. A variety of symptoms may be present, and include dyspnoea, cough, dysphagia, stridor or voice change. LTS can be confused with commoner respiratory diseases such as asthma. Awareness of the condition is important to facilitate a timely referral to Otolaryngology for diagnosis and management.

A Case of Glottic Cavernous Hemangioma Mimicking Malignancy in Elderly Patient

The etiology of laryngeal hemangioma is unclear, and it is classified into infant and adult types. The former is capillary hemangioma and relatively common, the latter is cavernous type and very rare. The adult laryngeal hemangioma mainly occurs in supraglottis and glottis. A 75-year-old man came to our clinic with a voice change that started four months ago. The laryngoscopic finding showed that the surface of oval-shaped mass is covered with turbid exudates. We performed the laryngeal microsurgery with CO2 laser. The mass was pathologically proven as cavernous hemangioma. We report a very rare and didactic case with review of relevant literature.