A Cross Sectional Study on Loco-Regional Recurrences and Overall Survival Rate among Patients with Stage II (T2N0M0) Glottis Carcinoma Treated with Chemoradiation and Surgery

BACKGROUND Single modality treatment for stage I and stage II squamous cell carcinomas of glottis region gave excellent results. Since a long time these are treated either with definitive radiation therapy or surgical excision with endoscopes. There was not much difference with regard to voice preservation, local recurrence and disease-free survival period. Our aim was to study the clinical presentation and management protocol of glottis carcinoma in a tertiary hospital and observe the final outcome of stage II (T2N0M0) glottis carcinoma and specific factor for survival in patients treated with surgery, radiotherapy and concurrent chemoradiation. METHODS 43 patients of glottis carcinoma stage II (T2N0M0) attending a tertiary teaching hospital between May 2015 and April 2017 were included in the study. Demography and smoking status of subjects were recorded. Staging of the disease was according to American Joint Committee on Cancer (AJCC) Staging System 7th edition. Paraglottic space infiltration was taken as a criteria to upgrade the staging. The overall survival rate, recurrence free survival, disease specific survival rate and laryngeal function preservation rate were calculated. RESULTS Out of 43 patients, males were 90.69 % and 09.30 % were females. Male to female ratio was 10.57 : 1. Mean age was 58.62 ± 2.35 years. 67.44 % were current smokers, 27.90 % were former smokers and 02.32 % were non-smokers. The overall survival scores and disease specific survival was 100 % with 11.62 % locoregional recurrences. The voice preservation was 86.04 %. Radiotherapy was used in 72.09 %, chemoradiation in 18.60 % patients and 11.62 % patients underwent surgery. 11.62 % patients presented with locoregional recurrence during 24 months of follow up. 02.32 % patients had to undergo tracheostomy. CONCLUSIONS The overall survival scores and disease specific survival were 100 % with 11.62 % loco-regional recurrence. Voice preservation was 86.04 %. Proactive prevention rather than escalation of treatment protocol gives better prognosis. KEYWORDS Glottis, Larynx, Supra Glottis, Sub Glottis, Squamous Cell Carcinoma, Chemo Radiation and Trans Oral Laryngeal Surgeries

Laryngeal Leukoplakia: State of the Art Review

Objective This state-of-the-art article reviews the epidemiology, diagnosis, and management of vocal fold leukoplakia, with focus on recent advances. It focuses on the clinical challenges that otolaryngologists face balancing both oncological efficacy and functional outcomes in leukoplakia and presents the current philosophies and techniques to consider when managing such patients. Data Sources PubMed/MEDLINE. Review Methods We conducted a detailed review of publications related to vocal cord and laryngeal leukoplakia, dysplasia, hyperkeratosis, leukoplakia endoscopy, and leukoplakia management focusing specifically on oncologic outcomes, voice preservation, current and emerging diagnosis, and management techniques. Conclusions There has been a paradigm shift away from performing “vocal cord stripping” procedures that can cause irreversible hoarseness toward voice preservation surgery while achieving comparable oncologic control. Surgical technical and instrumental developments have been designed to maximally treat superficial disease while preserving underling vibratory mucosa. Recent improvements in histopathological grading systems and advances in biomarker classification may allow for improved oncologic risk stratification. Furthermore, improvements in endoscopic imaging capabilities and contact endoscopy are currently being studied for their potential diagnostic significance. Implications for Practice To optimally manage vocal fold leukoplakia, the otolaryngologist should become familiar with the oncologic implications of the disease and the importance of obtaining pathologic diagnosis to rule out malignancy. In addition, the surgeon should maintain surgical techniques and knowledge of available instruments and lasers that can assist in surgical management while prioritizing the preservation of vibratory tissue and voice quality. Finally, the surgeon and the patient should understand the clinical importance of routine endoscopic surveillance.

Surgical alternative to tracheoesophageal prosthesis for voice preservation in selected hypopharyngeal carcinoma

<p><strong>Background</strong><strong>: </strong>Pearson’s near-total laryngectomy (NTL) is a voice- preserving alternative to total laryngectomy in patients with advanced but localized laryngeal and hypopharyngeal cancers, wherein lung- powered speech is achieved by creation of a dynamic biological trachea-pharyngeal shunt. Report our experience with NTL in a series of 24 patients.</p><p><strong>Methods:</strong> A prospective case series analysis was done at VMMC and Safdarjung Hospital from January 2014- September 2019 after attaining ethical clearance. 24 patients with lateralized, locally a post- cricoid areas were included in the study. Patients who had involvement of the post cricoid region, interarytenoid region or involvement of bilateral cricoarytenoid units were excluded from the study. The subjects underwent Pearson’s NTL and were followed- up to examine for disease- control and functional results.</p><p><strong>Results:</strong> 22 patients (91.6%) attained a good quality voice following surgery with 2 patients (8.3%) developing minor aspiration problems. 1 patient (4.16%) developed local recurrence after 5 months. Surgical complications were surgical site infection (20.8%), pharyngocutaneous fistula (16.67%) and shunt stenosis (4.16%).</p><p><strong>Conclusion</strong>: NTL is an oncologically safe alternative to total laryngectomy in selected patients and is capable of achieving excellent functional results with minimal surgical complications and post-operative maintenance.</p>

The Role of Choral Singing in Speaking Voice Preservation of Aging Adults

Purpose This descriptive cohort pilot study, using a convenience sample, examined whether evidence from vocal function measures, auditory–perceptual ratings, and/or endoscopic signs of aging supported singing in senior chorales as a possible intervention to preserve the speaking voice in aging adults. Method Thirteen singers and five nonsinging controls, all over 65 years of age, participated. They were assessed at two visits, 15–20 months apart. Vocal function measures and auditory–perceptual ratings of estimated age and the presence of voice disorders were compared across singing status and visit. Changes in the presence and degree of laryngeal signs of aging between visits were compared across singing status. Results Using an alpha of .2, deemed acceptable for pilot studies, vocal function measures supported choral singing as an intervention to preserve the speaking voice as less noise energy between 2 and 3 kHz ( p = .01) and lower phonation threshold pressures (PTPs) were present ( p = .09) for singers compared to nonsinging controls. Greater flows at comfortable pitch ( p = .04) and high pitch ( p = .06) as well as lower cepstral peak prominence smoothed (CPPS) for the vowel /a/ ( p < .01) were found at Visit 2 for both groups, but singers demonstrated lower flows at Visit 2 than nonsinging controls at comfortable pitch ( p = .06). Auditory–perceptual ratings did not support preservation of speaking voice, although a larger percentage of listeners rated nonsinging controls as voice disordered at Visit 2. Endoscopic ratings supported preservation, as singers were more likely than nonsinging controls to be rated as having laryngeal signs of aging absent at both visits ( p = .02). Conclusion The findings from this pilot study provide evidence that regular singing in senior chorales may assist in preserving older adults' speaking voices.

Conclusion

The Conclusion to Phonopoetics explores conceptions of voice preservation and models of the voice archive. It takes early ideas of the audible archival artifact (the sound recording) and the event-oriented scenario of its use as useful points of departure for a historically motivated theorization of the voice recording and voice archive at the present time. Specifically, it considers the impact of digital media technologies on the status of the record and its archive. The Conclusion mediates on how the analogue artifact of the sound archive has shaped our ideas and expectations about what a digital repository should be, and reflects on the status of the artifact of study as we move increasingly from the study of material media artifacts to virtual instantiations of the signals those media may once have held, in the form of digital media files.

Phonosurgical voice rehabilitation in patients with primary larynx cancer after laser cordectomy CO2

The aim of the treatment of early laryngeal cancer is complete oncological cure and simultaneously voice and swallowing preservation. According to the European Laryngological Society (ELS) classification of CO2 laser cordectomy, full voice recovery is seen in subepithelial cordectomy (ELS Type I ) and near complete in subligamental cordectomy (ELS type II). Voice deterioration is usually seen after more extensive levels of cordectomy (ELS types III-V). Voice quality after microsurgical laser cordectomy depends on the presence or absence of synechiae in the anterior commissure and on the quantity of the removed thyro-arytenoid muscle. More extensive reduction of the vocal muscle quantity causes more intensive glottic incompetence. Contralateral healthy vocal fold, rudimentary, cicatrixial previously operated vocal fold and false ventricular folds may take part in postoperative supraglottic voice compensation. All patients should undergo speech and voice therapy after terminating the scaring process on the operated vocal fold. Patients routinely undergo a minimum of 6 months of voice rehabilitation which allows speech therapy to yield the best possible voice. Phonosurgical techniques i.e. medialization thyroplasty, augmentation techniques, Zeitels’s laryngoplasty or Lichtenberger’s technique in treatment of synechia in the anterior commissure are successfully performed to restore the vocal competence. Voice preservation after treatment of early laryngeal cancer of the vocal fold improves life quality of the patient.

Evaluation of acute/late toxicity and local recurrence in Τ1-Τ2 glottic carcinoma treated with accelerated hypofractionated 3D-conformal external beam radiotherapy (3D-CRT)

Background.The aim of the study was to evaluate the efficacy, as well as the acute and late toxicity of an accelerated hypofractionated 3DCRT schedule as radical treatment in patients with organ confined glottic cancer cT1-2N0. Patients and methods. Between June of 2004 and September 2010, 47 retrospectively selected patients (29 males, 18 females) diagnosed with organ confined T1 or T2 glottic cancer, were treated with external 3DCRT in an accelerated hypofractionation schedule. The median age was 70 years. A dose of 64.4 Gy in 28 daily fractions was prescribed. The primary study endpoints were to assess the acute and late effects of radiation toxicity, according to the EORTC/ RTOG scale, as well as the therapeutic impact of this schedule in terms of local recurrence. Results. The median follow up was 36 months. At the end of radiotherapy, grade I, II and III acute toxicity was observed in 34, 9 and4 patients, respectively. Late grade I and II toxicity was observed in 25 and in 8 patients respectively. Only two local recurrences were observed, 15 and 24 months post 3DCRT respectively. Conclusions. Our radiotherapy schedule achieves a high locoregional control rate with the advantage of voice preservation. The proposed hypofractionated schedule can be recommended as a standard radiotherapy treatment, since these results are comparable with those of conventional fractionation schedules.

Recurrent laryngeal nerve and voice preservation: routine identification and appropriate assessment – two important steps in thyroid surgery

INTRODUCTION The aims of this study were to assess and compare vocal cord functions before and after thyroid surgery after intra-operative identification of recurrent laryngeal nerve. PATIENTS AND METHODS Recurrent laryngeal nerve (RLN) is seen intra-operatively in all cases undergoing thyroid surgeries. Vocal cord functions including any voice change were evaluated by indirect laryngoscopy (I/L) and direct laryngoscopy (D/L) before and after surgery. RESULTS Prospective study on 100 patients over 18 months with a total of 146 nerves at risk (NAR). Majority were women (n = 86) with mean age of 37.48 years (range, 13–60 years). RLN was seen in all patients and 19 patients complained of some change in quality of their voice after surgery. Evaluation by I/L and D/L at 6 weeks showed recurrent laryngeal nerve palsy (RLNP) in nine (47.36%) and five (26%) of these 19 patients respectively. Analysed according to total NAR, the incidence of voice change and temporary RLN palsy (I/L and D/L) at 6 weeks was still less at 13.01%, 6.16% and 3.42%, respectively. Voice change improved in all cases at 3 months with no RLNP palsy by I/L or D/L. All these 19 patients had undergone difficult or extensive surgery for malignancy, large gland, extratyhroidal spread or fibrosis. CONCLUSIONS Despite identification and preservation of RLN, patients can develop postoperative voice change and RLNP although all voice change cannot be attributed to damaged RLN. Proper assessment of vocal cord functions by I/L and D/L laryngoscopy is required to rule out injuries to these nerves. Risk of damage is higher in patients undergoing more difficult surgery.