Benign Laryngeal Lesions

Benign laryngeal lesions represent a diverse set of pathologies whose clinical presentation may range from no symptoms to dyspnea and/or dysphonia. Flexible fiberoptic laryngoscopy and videolaryngostroboscopy are important in distinguishingdifferent types of lesions, and management and treatment are dependent on the identification of these lesions, as they have different etiologies. Some lesions such as vocal fold nodules and polyps are primarily phonotraumatic and may benefit fromspeech therapy and vocal hygiene as initial approaches. Vocal fold cysts and benign tumors may benefit from microlaryngeal approaches, while capillary ectasias, polypoid corditis, laryngoceles, saccular cysts, and papilloma may benefit from laser therapy. Vocal fold granulomas may arise from various etiologies such as intubation, traumatic behaviors, or reflux. Polypoid corditis arises from smoking. This review is intended to provide an overview of the variety of lesions that encompass non-malignant laryngeal lesions that is both suitable for junior and senior residents. This review contains 12 figures, 5 tables, and 64 references Keywords: Benign laryngeal lesions, Laryngocele, Polyp, Cyst, Polypoid Corditis, Papilloma

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.

Laryngeal Helicobacter pylori Infection and Laryngeal Cancer-Case Series and a Systematic Review

Helicobacter pylori (H. pylori) infection involves the development of gastric cancer and may be associated with laryngeal cancer. However, laryngeal H. pylori infection in Taiwanese patients with newly diagnosed laryngeal cancer has not been reported. This study was aimed to investigate the possible association between laryngeal H. pylori infection and laryngeal cancer in Taiwan and perform a systematic review of previous reports in other countries. An analysis of 105 patients with laryngeal lesions found the positive rates of H. pylori DNA (determined by polymerase chain reaction) and antigen (determined by immunohistochemistry) of the laryngeal lesions were relatively low (vocal polyps: 3% and 3%; vocal fold leukoplakia: 0% and 0%; laryngeal cancers: 0% and 2%). Furthermore, H. pylori-associated laryngopharyngeal reflux and the expression of E-cadherin and CD1d (determined by immunohistochemistry) were comparable among the three subgroups. Fifteen studies were involved in the systematic review of the digital literature database, distributed to February 2021. The data of patients with laryngeal cancer and controls showed that the laryngeal H. pylori infection rates were 29.4% and 16.7%, respectively. Although current evidence supported that laryngeal H. pylori infection was associated with laryngeal cancer globally, it might not play a role in the development of laryngeal cancer in Taiwan.

Quantitative laryngoscopy with computer-aided diagnostic system for laryngeal lesions

Laryngoscopes are widely used in the clinical diagnosis of laryngeal lesions, but such diagnosis relies heavily on the physician's subjective experience. The purpose of this study was to develop a computer-aided diagnostic system for the detection of laryngeal lesions based on objective criteria. This study used the distinct features of the image contour to find the clearest image in the laryngoscopic video. First to reduce the illumination problem caused by the laryngoscope lens, which could not fix the position of the light source, this study proposed image compensation to provide the image with a consistent brightness range for better performance. Second, we also proposed a method to automatically screen clear images from laryngoscopic film. Third, we used ACM to segment automatically them based on structural features of the pharynx and larynx, using hue and geometric analysis in the vocal cords and other zones. Finally, the support vector machine was used to classify laryngeal lesions based on a decision tree. This study evaluated the performance of the proposed system by assessing the laryngeal images of 284 patients. The accuracy of the detection for vocal cord polyps, cysts, leukoplakia, tumors, and healthy vocal cords were 93.15%, 95.16%, 100%, 96.42%, and 100%, respectively. The cross-validation accuracy for the five classes were 93.1%, 94.95%, 99.4%, 96.01% and 100%, respectively, and the average test accuracy for the laryngeal lesions was 93.33%. Our results showed that it was feasible to take the hue and geometric features of the larynx as signs to identify laryngeal lesions and that they could effectively assist physicians in diagnosing laryngeal lesions.

Prevalence and factors associated to dysphonia and laryngeal lesions: a study among teachers in a region of the Brazilian Legal Amazon

<p><strong>Objective</strong>: to investigate the prevalence and factors associated with dysphonia and laryngeal lesions in teachers of basic education in a region of the Amazonian region. <strong>Methods: c</strong>ross-sectional study with collection of sociodemographic variables, occupational, environmental and clinics. Laryngeal lesions were evaluated by laryngoscopy. Was used a logistic regression to determine factors associated. <strong>Results</strong>: the prevalence of dysphonia and laryngeal lesions was 68.9% and 53.3%, respectively. There was association between self-reported dysphonia and respiratory problems (OR=3.00; CI95%=1.25-7.22), use of drugs (OR= 2.31, CI95%= 1.19-4.49) and noise in the internal environment (OR= 2.43; CI95%=1.24-4.73). Easy access to water was a protection factor against self-reported dysphonia (OR=0.09; CI95%: 0.01-0.79). We found a significant association between dysphonia diagnosed and digestive problems (OR= 6.09; CI95%=2.79-13.30), external noise (OR=5.20, CI95%=1.99-13.57) and inadequate ventilation (OR=3.24; CI95%=1.36-7.74). The variables associated with higher chance of laryngeal lesions in dysphonic teachers were lighting (OR=3.74; CI95%=1.15-12.14%), acoustics (OR= 4.14; CI95%=1.32-12.95) and inadequate room size (OR= 3.76; CI95%=1.29-10.91). The use of drugs (OR=0.34; CI95%=0.12-0.92), respiratory problems (OR=0.21; CI95%=0.06-0.76) and easy access to water (OR= 0.12; CI95%=0.04-0.38) were protection factors for laryngeal lesions. <strong>Conclusion:</strong> occupational environmental factors aggravated the vocal health of this professional category. Access to water in the work impacted positively.</p>

Validation of the European Laryngological Society classification of glottic vascular changes as seen by narrow band imaging in the optical biopsy setting

Purpose In 2016, the European Laryngological Society (ELS) proposed a classification for vascular changes occurring in glottic lesions as visible by narrow band imaging (NBI), based on the dichotomic distinction between longitudinal vessels (not suspicious) and perpendicular ones (suspicious). The aim of our study was to validate this classification assessing the interobserver agreement and diagnostic test performance in detecting the final histopathology. Methods A retrospective study was carried out by reviewing clinical charts, preoperative videos, and final pathologic diagnosis of patients submitted to transoral microsurgery for laryngeal lesions in two Italian referral centers. In each institution, two physicians, independently re-assessed each case applying the ELS classification. Results The cohort was composed of 707 patients. The pathologic report showed benign lesions in 208 (29.5%) cases, papillomatosis in 34 (4.8%), squamous intraepithelial neoplasia (SIN) up to carcinoma in situ in 200 (28.2%), and squamous cell carcinoma (SCC) in 265 (37.5%). The interobserver agreement was extremely high in both institutions (k = 0.954, p < 0.001 and k = 0.880, p < 0.001). Considering the diagnostic performance for identification of at least SIN or SCC, the sensitivity was 0.804 and 0.902, the specificity 0.793 and 0.581, the positive predictive value 0.882 and 0.564, and the negative predictive value 0.678 and 0.908, respectively. Conclusion The ELS classification for NBI vascular changes of glottic lesions is a highly reliable tool whose systematic use allows a better diagnostic evaluation of suspicious laryngeal lesions, reliably distinguishing benign ones from those with a diagnosis of papillomatosis, SIN or SCC, thus paving the way towards confirmation of the optical biopsy concept.