EVALUATION OF ETIOPATHOLOGY FOR HOARSENESS OF VOICE –A CLINICAL STUDY

ABSTRACT Hoarseness of voice is one of the commonest symptoms found in ENT clinics. The present study is to assess etiopathology of hoarseness of voice at our center. The diagnostic potential of laryngeal endoscopy for different laryngeal lesions and its correlation with histopathology is also done. In this retrospective study 126 patients were included. The commonest etiology for hoarseness of voice was found to be chronic laryngitis (51.6%) followed by malignancy (27.8%) and vocal cord paralysis (15.1%). Vocal abuse (33.3%) and smoking (29.4%) were found to be leading predisposing factors. Positive predictive value of laryngeal endoscopy for detecting malignant lesions was found to be 86.5%. Fibreoptic laryngoscopy is a good tool for preliminary evaluation of hoarseness of voice. However, direct laryngoscopy should not be delayed if a diagnosis cannot be made by fibreoptic laryngoscopy KEYWORDS Hoarseness, Laryngeal endoscopy, Voice, Etiolopathology

Diagnosis and Management of Giant Esophageal Fibrovascular Polyp With Hypopharyngeal Pedicle

Background: Fibrovascular polyps (FVPs) with hypopharyngeal pedicles (hFVPs) are the rare intraluminal benign tumours of the upper aerodigestive tract, and their accurate diagnosis and optimal management are challenging. Purpose: The present retrospective study attempted to explore the optimal diagnosis and treatment of hFVPs. Research Design: The clinical records of 2 patients with giant, irregularly shaped hFVPs, who underwent several failed surgical procedures after inaccurate diagnosis, were reviewed. Finally, the patients were correctly diagnosed and successfully treated at Capital Medical University Beijing Friendship Hospital in different years, 2018 and 2020. Results: Case 1 was of a 43-year-old woman with 2 months of progressive dysphagia. Gastroenterologists overlooked the origin of her FVP, and decided to sever its narrowest point in the oesophagus through endoscopy. However, upon unsuccessful removal of the mass, a gastrotomy procedure was performed to extract the mass 7 days later. Symptoms recurred 3 months after the treatment, and a fibreoptic laryngoscopy confirmed hFVP in the patient at our department. A transcervical approach was used to sever the hypopharyngeal pedicle, achieve haemostasis and remove the oesophageal tumour. No recurrence was detected during the 2-year follow-up period after the treatment. Case 2 was of a 32-year-old man with dysphagia who had previously undergone transthoracic and transcervical oesophagotomy procedures within a gap of 3 months for the removal of FVP causing dysphagia. The hypopharyngeal pedicle was not diagnosed in the patient. The symptoms of dysphagia recurred 4 years after the treatment, and a fibreoptic laryngoscope confirmed hFVP at our department. The tumour was removed successfully through the transcervical approach. No recurrence was detected during the 6-months follow-up after surgery. Conclusion: In conclusion, the transcervical approach is suitable for achieving haemostasis and removing giant, irregularly shaped hFVPs.

Additional respiratory measurements

This chapter describes how additional information can be obtained during an exercise test to detect the airflow obstruction of exercise-induced asthma. The forced expiratory volume in one second (FEV1) may fall a few minutes after cessation of exercise, but this test is not particularly sensitive for detecting exercise-induced bronchoconstriction. The flow–volume loop during exercise can be compared with the pre-test maximal trace to detect expiratory airflow limitation. Addition of inspiratory capacity measurements can be helpful. The flow–volume loop may also suggest exercise-induced laryngeal obstruction, which can be confirmed by continuous fibreoptic laryngoscopy during exercise.

Fiberoptic laryngoscopy-- experience in a private hospital

Background: Laryngoscopy is a medical procedure used to obtain a view from nose to voice box (larynx). A thin, lighted tube is usedto view the anatomical detailof the nose, nasopharynx, pharynx andvoice box including motion of the vocal cords in fibreoptic laryngoscopy. Biopsy can also be taken from the suspected lesions. The procedure is usually performed as an OPD procedure under local anesthesia.Methodology: This retrospective, cross sectional observational studywas conducted from June 2007 to October 2015 in a private hospital.Results: 12265 patients were examined and 625 patientsunderwent biopsy during the procedure. Among them male was55.39% and female was 44.61%. Findings were revealed normal in 69.80%,benign looking lesionsin 11.61%, suspected growth in 16.87% of the cases.54.24% were histologically positive for malignancy.Conclusion: Fiberopticlaryngoscopyis a very effective in-office or outdoor procedure for examination of the nose, nasopharynx, pharynx and larynxand also for taking biopsy from the suspected lesions under local anesthesia.J Shaheed Suhrawardy Med Coll, December 2015, Vol.7(2); 59-62

Hoarseness of voice – an institutional study

<p class="abstract"><strong>Background:</strong> Hoarseness is one of the earliest signal of local and systemic disease. It should be emphasized that hoarseness is not a disease in itself but a symptom of disease or disturbance of larynx or laryngeal innervation. The aim of the study was to analyse various causes and conditions associated with hoarseness of voice.</p><p class="abstract"><strong>Methods:</strong> We studied 150 patients in a prospective randomised study with inclusion criteria of hoarseness of voice, attending otolaryngology outpatient department of Dayanand medical college and hospital, Ludhiana, irrespective of their age, sex and duration of disease. No exclusion criteria were applied. All the routine investigations like Hb, BT, CT, TLC, DLC, urine-for albumin and sugar were carried out in all patients. X-ray chest- PA view and X-Ray soft tissue neck- AP and lateral view were done when required. Larynx was examined by flexible fibreoptic laryngoscopy followed by biopsy if suspicious looking area was seen. 4% lignocaine spray was used orally and nasally to provide local anaesthesia.</p><p class="abstract"><strong>Results:</strong> In the present study of 150 cases 87 were males and 63 were females with M:F ratio of 1.4:1 and age ranged from 10–90 years with majority of cases in 4th and 6th decade of their life. All patients had history of hoarseness of voice with most of patients having duration of disease between one month to one year. On flexible fibreoptic laryngoscopy 27% of cases showed normal study, vocal nodule was most common, seen in 20% of cases, 10% showed vocal cord palsy and 10% had laryngopharyngeal reflux disease. Bilateral lesion (72.6%) predominated overall, with left sided (15.2%) of larynx affected more as compared to right side (12%).</p><p><strong>Conclusions:</strong> Flexible fibreoptic laryngoscopy is an effective alternative for diagnosis of laryngeal lesions and various causes of hoarseness of voice. Vocal nodule has been found as the commonest cause of hoarseness of voice followed by vocal cord palsy and laryngopharyngeal reflux disease. </p>

The Availability of Advanced Airway Equipment and Experience with Videolaryngoscopy in the UK: Two UK Surveys

Fibreoptic intubation, high frequency jet ventilation, and videolaryngoscopy form part of the Royal College of Anaesthetists compulsory higher airway training module. Curriculum delivery requires equipment availability and competent trainers. We sought to establish (1) availability of advanced airway equipment in UK hospitals (Survey I) and (2) if those interested in airway management (Difficult Airway Society (DAS) members) had access to videolaryngoscopes, their basic skill levels and teaching competence with these devices and if they believed that videolaryngoscopy was replacing conventional or fibreoptic laryngoscopy (Survey II). Data was obtained from 212 hospitals (73.1%) and 554 DAS members (27.6%). Most hospitals (202, 99%) owned a fiberscope, 119 (57.5%) had a videolaryngoscope, yet only 62 (29.5%) had high frequency jet ventilators. DAS members had variable access to videolaryngoscopes with Airtraq 319 (59.6%) and Glidescope 176 (32.9%) being the most common. More DAS members were happy to teach or use videolaryngoscopes in a difficult airway than those who had used them more than ten times. The majority rated Macintosh laryngoscopy as the most important airway skill. Members rated fibreoptic intubation and videolaryngoscopy skills equally. Our surveys demonstrate widespread availability of fibreoptic scopes, limited availability of videolaryngoscopes, and limited numbers of experienced videolaryngoscope tutors.