A Case of Huge Vocal Polyp in a Patient With Difficult Laryngeal Exposure Treated by Fiberoptic Laryngeal Laser Surgery Under Local Anesthesia

Indications of fiberoptic laryngeal laser surgery (FLS) procedure have broadened by the development of flexible fiberoptic endoscopes and flexible laser systems. FLS procedure performed under local anesthesia and it is the unique value of FLS. The surgery can be performed on patients who are impossible to undergo general anesthesia and difficult to be exposed by laryngeal microsurgery. Main indication of FLS procedure was small to moderate sized hemorrhagic vocal polyp, but we experienced a case of huge vocal polyp with difficult laryngeal exposure treated by FLS procedure under local anesthesia. The vocal polyp was removed successfully without vocal fold scar through fiberoptic laryngeal laser surgery under local anesthesia.

Tip of the iceberg: Immunohistochemical markers reveal malignant transformation underneath a vocal polyp surface

Novel molecular techniques including markers of laryngeal carcinogenesis could improve the difficult diagnosis of a wide array of laryngeal polypoid changes. The case reported herein shows that not every clinically diagnosed vocal fold polyp is a benign lesion as mostly considered in the literature. Further assessment including carcinogenesis markers detected a nest of micro-invasive squamous cell carcinoma. Therefore, we recommend biopsy backed up with immunohistochemical analysis whenever there is a suspicious polypoid formation in order to exclude or confirm a malignant transformation because of the possibility of multi-focal growth in the active laryngeal epithelium.

Causes of Hoarseness of Voice Based on Fiber Optic Laryngoscopy (FOL): Our Experiences in ENT OPD of a Peripheral Military Hospital

Introduction: This study was aimed to determine the common causes of hoarseness of voice in ENT OPD of a military hospital. Materials and Methods: This was an observational study carried out on 93 patients presented with hoarseness of voice in ENT OPD CMH Momenshahi, a peripheral military hospital, for a period of 2 years, from 1st April 2017 to 30th April 2019. Only Fiber Optic Laryngoscopy (FOL) findings were evaluated to diagnose the causes of hoarseness. Data were obtained from FOL findings documentation register. All data were analyzed using IBM SPSS version 25.0. Patients consent was taken. Results: Total 93 cases were studied irrespective of age and sex. Among them 34 (36.60%) were males and 59 (63.40%) were females. Commonly affected age group was 21-30 years. With a mean age of 33.34 years. Majority of the cases were housewife 44 (44.10%). The most common cause of hoarseness was Chronic Laryngitis 25 (26.9%). The other causes were vocal polyp 17 (18.30%), VC nodule 13 (14%), Incomplete Glottal closure 14 (18.30%), leukoplakia of VC 5 (5.40%) and Vocal cord palsy 3 (3.20%). Normal findings were found in 11 (11.80%) cases. Conclusion: Hoarseness is a common symptom of laryngeal dysfunction. Military personnel are frequently affected like general population. Common causes are almost same with a very few variations. FOL should be the basic tool to diagnose the causes of hoarseness. Medicine Today 2021 Vol.33(1): 34-37

The Effect of Vocal Fold Steroid Injection via Cricothyroid Membrane in Patients with Vocal Polyp

Background and Objectives Vocal polyps are generally caused by phonotrauma such as vocal overuse, and the first line treatment is known as laryngeal microsurgery. The aim of the study is to evaluate the applicability and effectiveness of percutaneous steroid injection via cricothyroid membrane in patients with vocal polyp and to evaluate its advantages and limitations of the technique.Subjects and Method We included in this study 70 patients with vocal polyp managed by vocal fold steroid injection via the cricothyroid membrane from Jan 2008 to July 2018. We compared their medical records of laryngoscopy, stroboscopy, and multi-dimensional voice program analysis at pre and post treatment. Subjective voice improvement was evaluated using Voice Handicap Index-30 (VHI-30).Results Of the patients, 54.3 percent showed morphological improvement. In acoustic analysis, the pre-treatment mean values of jitter, shimmer, and NHR were 2.20±2.23, 5.09±3.24, 0.15±0.04, respectively. The post-treatment values were 1.54±1.28, 5.00±4.40, 0.13±0.04, respectively, and only jitter was statistically significant. For subjective symptom improvement, 32 (45.8%) patients showed better score on the post-treatment of VHI-30 compared to pretreatment. Ten patients experienced mild complications such as vocal fold atrophy and scar; however, no critical complications such as internal bleeding or dyspnea were reported.Conclusion According to our study, steroid injection is a safe and effective procedure for patients with vocal polyp. A vocal fold steroid injection via the cricothyroid membrane can be an alternative treatment option for those who are not able to undergo conventional laryngeal microscopic surgery.

A STUDY ON VOCAL CORD LESIONS

Introduction - Vocal cord lesions may be benign or malignant or pseudotumors. Patients usually come to us with symptoms of hoarseness of voice, cough, foreign body sensation, or throat pain. The patient should be evaluated properly to find out the causes. A malignant condition should be detected as early as possible to give prompt treatment and the best prognosis. Aim and objectives - To study the clinical and pathological behavior of vocal cord lesions. Materials and methods - 30 cases of vocal cord lesions were studied. Results - Commonest age group is 61 - 70 years (36.7%). The male to female ratio is 3.28:1. Hoarseness of voice is the commonest symptom followed by cough. Smoking and alcohol are the commonest predisposing factor followed by vocal abuse. The commonest vocal cord lesion is the malignancy (squamous cell carcinoma)(56.6%) and the commonest benign condition is the vocal polyp (30%).

A study of phonosurgeries in vocal dysfunction in Salem district

<p class="abstract"><strong>Background: </strong>Phonosurgery essentially is surgery defined to improve or restore the voice. The objective of the study was to analyze and categorize the various benign lesions of the vocal cord causing vocal dysfunction requiring phonosurgeries, to analyze the incidence and distribution of cases according to age, sex, and etiology among the patients who require intense medical and voice therapy with surgical intervention.<strong> </strong></p><p class="abstract"><strong>Methods: </strong>This prospective study was conducted in fifty patients with vocal dysfunction from the ear, neck and throat (ENT) outpatient department of Otorhinolaryngology, Mohan Kumaramangalam Government General Hospital, Salem in the year September 2018 to October 2019 who failed conservative medical and voice therapy requiring phonological procedure were included in this study. Phonomicrosurgery was done for the patients with benign vocal fold mucosal disorders and medialization laryngoplasty using Gore-Tex was done for the patients with unilateral vocal cord palsy causing vocal dysfunction.</p><p class="abstract"><strong>Results: </strong>The present study on phono surgery concludes vocal polyp is the commonest benign lesion of the vocal cord that constitutes 40% in our study population. Males are affected more than females. Proper investigation of voice and larynx provides the exact pathological nature of the lesion and determines the timing of surgical intervention.<strong></strong></p><p class="abstract"><strong>Conclusion: </strong>Most of the patients who underwent medialization laryngoplasty using Gore-Tex also had a good outcome at the end of the voice therapy.</p><p> </p>

DETERMINE THE INCIDENCE AND CLINIC-DEMOGRAPHIC PROFILE OF PATIENTS UNDERGOING MICROLARYNGEAL SURGERY FOR VARIOUS PATHOLOGIES OF THE LARYNX AT TERTIARY CARE HOSPITAL.

Aim: to determine the incidence and clinic-demographic profile of patients undergoing microlaryngeal surgery. Materials and Methods: this is a prospective study of 100 patients attending an outpatient department with laryngeal lesions evaluated irrespective of their age, sex, and occupation. Biopsy-confirmed malignant cases were excluded. Result: of the 100 patients, 84 of them exhibited benign lesions and rest 16 patients showed malignant pathology. Most commonly seen benign vocal lesion is vocal nodule (37.0%) followed by vocal polyp (28.0%). Along with hoarseness of voice, other symptoms reported were cough and throat pain, Dysphagia and fever. Improvement in symptoms was seen after the treatment. Conclusion: Microlaryngeal surgery is a good therapeutic tool in both benign and malignant lesions. The differentiation of benign from malignant lesions is vital. Microlaryngoscopic examination has proved to be the best modality for visualizing these lesions and arriving at a clinical diagnosis Keywords: Benign, Larynx, Voice change, Vocal nodule