Clinical Applications of Office-Based Laryngeal Surgery With KTP Laser

The pulsed photoangiolytic 532-nm potassium-titanyl-phosphate (KTP) laser has emerged in recent years as an efficacious treatment modality for vocal fold lesions. It also has broadened the indications for other laryngeal laser surgery. Features of KTP laser that it is a fiber-based delivery system and its energy is selectively absorbed by oxyhemoglobin make it suitable for office-based laryngeal procedures. An office-based KTP laser surgery provides an alternative management option for benign laryngeal diseases and can be performed comfortably under flexible endoscopic guidance which is placed through the nose of a fully awake patient. Office-based laryngeal surgery with a KTP laser can alleviate the need for general anesthesia. However, there are some limitations to apply due to reduced visual precision and the fact that the vocal folds are moving during procedures. Clinicians should carefully weigh the advantages and disadvantages of office-based procedures before a treatment option is selected. Patient selection and standardized laser energy parameters may help in decreasing complications and improving the treatment results.

The risk of laryngitis with herpes zoster infection: A nested case-control study using data from the Korean National Sample Cohort

Background Whether herpes zoster infection (HZI) affects laryngitis incidence remains unknown. Objective The purpose of this population-based retrospective study was to analyze the relationship between laryngitis and HZI using data from the Korean Health Insurance Review and Assessment Service—National Sample Cohort. Methods This study analyzed 1,197,093 medical claim codes from 2018. Patients with HZI (ICD-10: B02) were retrospectively identified. Laryngeal diseases were defined by ICD-10 codes for five subgroups: 1) malignant disease, 2) benign disease, 3) vocal cord palsy, 4) inflammatory disease, and 5) reflux disease. Results Among the Korean population older than 20 years, 12,809 experienced HZI. Subjects with HZI were more likely to be older (mean age: 51.54 years vs. 48.06 years, p <0.0001). The proportion of subjects with laryngeal disease was higher in those with HZI than in those without HZI (55.55% vs. 41.37%, p <0.0001). Laryngeal disease was significantly associated with HZI in multiple regression analysis (odds ratio (OR) = 1.77, 95% confidence interval: 1.71–1.84) after adjusting for age, sex, hypertension, diabetes, dyslipidemia, ischemic heart disease, cerebral stroke, and depression. Among laryngeal disease subgroups, inflammatory disease (OR = 1.05; 95% CI: 1.01–1.09) and reflux (OR = 1.20; 95% CI: 1.15–1.25) were associated with HZI. Conclusions HZI is independently associated with laryngitis. Results of this study have implications for etiological investigations and prevention strategies for laryngitis.

Role of Laryngeal Ultrasonography in screening for laryngeal diseases in symptomatic patients

Background Laryngoscopy is widely considered the most appropriate tool for evaluating the larynx, however, it is invasive and not all patients can tolerate it. Although laryngeal ultrasound has been proposed as a promising noninvasive technique that can play an important role in laryngeal imaging, there is lack of consensus regarding its role. Objective The aim of this study is to assess laryngeal ultrasound sensitivity compared to indirect laryngoscopy in screening for laryngeal diseases in symptomatic patients. Patients and methods 30 undiagnosed symptomatic patients underwent laryngeal ultrasound and indirect laryngoscopy. Their results were compared. Results Technical success rate of laryngeal ultrasound was (83%). It showed overall sensitivity of (78.9%) in detecting organic laryngeal diseases with high sensitivity in detecting laryngeal masses, reinke’s edema, vocal cord cysts and polyps (100%), vocal cord palsy (83.3%), intermediate sensitivity for vocal cord nodules (66.7%), and poor sensitivity for laryngitis and non organic voice disorders (0%). Conclusion Laryngeal ultrasound is a useful non invasive imaging tool that can be used with acceptable sensitivity in detecting organic laryngeal diseases excluding laryngitis, hindered mainly by complete thyroid cartilage calcification in older males. Consequently we recommend its use as complementary to clinical examination and mirror laryngoscopy, or as an alternative to indirect laryngoscopy when required and in routine neck ultrasound exams when appropriate.

Update on Angiolytic Laser Laryngeal Surgery

There are several lasers available for office-based or suspension microlaryngoscopy laser procedures in the treatment of laryngeal diseases. Each has advantages and disadvantages given the depth of penetration per unit of power, absorption in water, spectral absorption characteristics, mode of delivery, safety, and cost. It is important to note that while the proper selection of indication of treatment based on a laser wavelength is critical, of equal importance is selecting the appropriate power setting, focal length (or spot size), and time of exposure. The photoangiolytic lasers precisely target hemoglobin within the microcirculation of the highly vascularized tissue and may have better hemostatic effects and preservation of surrounding normal tissue than the CO2 laser. Although the choice of laser is purely theoretical and cannot be accurately concluded which parameters of laser (wattage and pulse width) were best to use, photoangiolytic laser surgery is safe and effective for specific laryngeal lesions. In this review, indications for photoangiolytic laser procedures for various laryngeal diseases, laser settings and surgical techniques for specific laryngeal lesions including sulcus vocalis, laryngeal dysplasia, and recurrent respiratory papillomatosis will be introduced. Pros and cons of in-office laser surgery using photoangiolytic laser and flexible CO2 laser will also be addressed.

Multivariate Analysis of Vocal Fold Vibrations on Various Voice Disorders Using High-Speed Digital Imaging

Although many quantitative parameters have been devised to describe abnormalities in vocal fold vibration, little is known about the priority of these parameters. We conducted a prospective study using high-speed digital imaging to elucidate disease-specific key parameters (KPs) to characterize the vocal fold vibrations of individual voice disorders. From 304 patients with various voice disorders and 46 normal speakers, high-speed digital imaging of a sustained phonation at a comfortable pitch and loudness was recorded and parameters from visual-perceptual rating, laryngotopography, digital kymography, and glottal area waveform were calculated. Multivariate analysis was then applied to these parameters to elucidate the KPs to explain each voice disorder in comparison to normal subjects. Four key parameters were statistically significant for all laryngeal diseases. However, the coefficient of determination (R2) was very low (0.29). Vocal fold paralysis (8 KPs, R2 = 0.76), sulcus vocalis (4 KPs, R2 = 0.74), vocal fold scarring (1 KP, R2 = 0.68), vocal fold atrophy (6 KPs, R2 = 0.53), and laryngeal cancer (1 KP, R2 = 0.52) showed moderate-to-high R2 values. The results identified different KPs for each voice disorder; thus, disease-specific analysis is a reasonable approach.

Initial Experience Treating HPV-Related Laryngeal Diseases with Oral Brincidofovir: A Pilot Study

Objective: To determine if brincidofovir, an oral analog of cidofovir that achieves high tissue levels of the active metabolite with low systemic toxicity, has an observable effect on HPV-related disease of the larynx. Methods: Two patients with laryngeal recurrent respiratory papillomatosis (one each of genotypes 6 and 11) and 1 with recurring aryepiglottic fold carcinoma in situ (genotype 16) received oral brincidofovir according to protocol. Close-range videoendoscopic examinations were done during and after the study period to observe disease behavior in the absence of other interventions, and after subsequent surgical intervention. Disease character and magnitude of recurrence for each patient were compared to their patterns prior to brincidofovir. Results: Brincidofovir reduced papilloma burden in 1 patient and markedly attenuated the rate and magnitude of recurrence in both. After surgical intervention, Patient 1 remains disease-free at 10 years (7 years from last intervention) and Patient 2 has no symptoms at 8 years. Patient 3 with recurring carcinoma in situ has required less frequent resections and specimens show reduced degrees of dysplasia present only in islands amid normal mucosa at 8 years (currently no evidence of disease at 21 months from last intervention). Conclusion: Brincidofovir appears to attenuate HPV disease of the larynx in this small pilot study, though further investigation is required because of the highly variable nature of the disease and potential confounding factors.

A Review of Pharmacological and Toxicological Effects of Sophora tonkinensis with Bioinformatics Prediction

Sophora tonkinensis Gagnep. (ST) (Fabaceae) is distributed chiefly in south-central and southeast China and Vietnam. In traditional Chinese medicine theory, the root and rhizome of ST are toxic and mainly used in the treatment of pharyngeal and laryngeal diseases. Modern studies provide new insights into the pharmacological and toxicological aspects of ST. The pharmacological and toxicological properties of ST were reviewed in this paper based on the literature from Google Scholar and CNKI, and the bioinformatics platforms were applied to explore the pharmacological and toxicological potentials of ST. The results of the literature analysis showed that ST has hepatoprotective, immunomodulatory, and anticancer effects and produces obvious toxicity to the liver and nervous and cardiovascular system. The results of bioinformatics showed that the compounds from ST may be applied to the treatment of cancer and digestive and nervous system diseases and show the possibility to cause hematotoxicity, neurotoxicity, and immunotoxicity. The present review demonstrates that attention should be paid to the potential toxicity of ST in the treatment of diseases and provides the reference for the subsequent pharmacological toxicological studies on the mechanism and chemical basis of ST.

Quantitative evaluation of the human vocal fold extracellular matrix using multiphoton microscopy and optical coherence tomography

Identifying distinct normal extracellular matrix (ECM) features from pathology is of the upmost clinical importance for laryngeal diagnostics and therapy. Despite remarkable histological contributions, our understanding of the vocal fold (VF) physiology remains murky. The emerging field of non-invasive 3D optical imaging may be well-suited to unravel the complexity of the VF microanatomy. This study focused on characterizing the entire VF ECM in length and depth with optical imaging. A quantitative morphometric evaluation of the human vocal fold lamina propria using two-photon excitation fluorescence (TPEF), second harmonic generation (SHG), and optical coherence tomography (OCT) was investigated. Fibrillar morphological features, such as fiber diameter, orientation, anisotropy, waviness and second-order statistics features were evaluated and compared according to their spatial distribution. The evidence acquired in this study suggests that the VF ECM is not a strict discrete three-layer structure as traditionally described but instead a continuous assembly of different fibrillar arrangement anchored by predominant collagen transitions zones. We demonstrated that the ECM composition is distinct and markedly thinned in the anterior one-third of itself, which may play a role in the development of some laryngeal diseases. We further examined and extracted the relationship between OCT and multiphoton imaging, promoting correspondences that could lead to accurate 3D mapping of the VF architecture in real-time during phonosurgeries. As miniaturization of optical probes is consistently improving, a clinical translation of OCT imaging and multiphoton imaging, with valuable qualitative and quantitative features, may have significant implications for treating voice disorders.