Bilateral Vocal Fold Granuloma and Anterior Glottic Web After Papilloma Excision

We present a case of delayed vocal process granulomas and anterior glottic web after treatment of vocal fold papillomas with a laryngeal microdebrider and CO2 laser ablation. This case highlights a risk of vocal fold granuloma in the setting of recurrent respiratory papillomatosis and microdebrider use, warranting close follow-up and consideration of prophylactic voice therapy, anti-reflux medications, and steroid injection in cases of violation of vocal cord epithelium.

Laser Reduction Glottoplasty for Voice Feminization: Experience on 28 Patients

Objectives: Laser reduction glottoplasty is a relatively new surgical procedure for voice feminization on transgender women. This study aims to determine long-term voice results of glottoplasty on transwomen. Methods: Nonrandomized, retrospective, cohort. Tertiary referral center. Endoscopic laser reduction glottoplasty was performed on 28 transwomen. Voice Handicap Index (VHI-30), Transsexual Voice Questionnaire (TVQ), acoustic analysis with /a/ for F0, jitter, shimmer, noise to harmonic ratio and acoustic analysis for speaking F0 were measured before and after surgery. Patients self-evaluated their postoperative voices and medical students and 2 voice experts scored patients’ pre- and postsurgery voice samples as masculine, feminine or neither. Results: Mean total VHI and TVQ scores improved significantly postoperatively ( P < .001). Pre- and postsurgery mean F0 were 132 and 198 Hz and mean speaking F0 were 123 and 194 Hz, respectively; these variations were found statistically significant ( P < .001). Postoperative mean jitter, shimmer and NHR increased significantly compared to preoperative values ( P < .05). Nine patients (32%) were not happy with their postsurgery voice result and were offered anterior glottic web formation as secondary procedure. MFT women’s self-ratings of their postsurgery voices showed 3 masculine, 19 feminine and 6 neither outcomes, leading to patient gratification score of 68%. Medical students evaluated 79% of postsurgery voice specimens as feminine. Voice experts evaluated 75% of postsurgery voice specimens as feminine. Conclusions: Laser reduction glottoplasty is an accomplished and satisfying operation for feminizing voice of transwomen. Its voice outcome appears to be durable for 5 years. However, secondary operation may be needed to further gratify transwomen.

Cryptococcal Anterior Glottic Web from Disseminated Infection Presenting as Confusion: A Case Report

Objectives: To educate healthcare providers on Cryptococcus neoformans as a novel cause of glottic webs especially in an immunocompromised patient and discuss recurrence of the glottic web. This case also emphasizes the importance of a comprehensive patient evaluation in cases such as this, as laryngeal involvement in this case was only a portion of the patient’s disease burden. Methods: An extensive review of the patient’s clinical course was assessed including patient presentation, diagnostic techniques, medical and surgical treatment, and complications. Results: Prolonged Fluconazole therapy and two excisions of the glottic web, the second with keel placement, was an effective treatment course for our patient. Conclusion: Cryptococcal glottic webs are rare, and this case report demonstrates successful treatment in one such case with operative intervention following medical management of disseminated disease.

Surgical management of acquired anterior glottic web: a systematic review

BackgroundAcquired anterior glottic web poses a significant challenge to laryngologists given its propensity to recur following treatment, and there are a wide variety of described techniques.MethodsA systematic review of the medical literature was undertaken in order to identify all articles pertaining to the management of acquired anterior glottic web.ResultsThirteen studies meeting the inclusion criteria were identified and analysed. All were retrospective series, with varying surgical techniques and outcome measures. Only two studies reported on the use of topical mitomycin C.ConclusionMucosal graft techniques and keel placement appear to improve success rates, but both carry risks and disadvantages. Based on the available evidence, the use of topical agents such as mitomycin C cannot be recommended in the management of acquired anterior glottic web.

Fundamental Frequency in Excised Human Larynges after Anterior Glottic Web Formation of Various Extents

Objective To determine the effect of vocal fold anterior web formation on fundamental frequency with a cadaveric excised larynx model. Study Design Experimental study with excised human larynges. Setting Academic tertiary care hospital. Subjects and Methods Sixteen freshly excised human larynges were evaluated with high-speed videoendoscopy and digital kymography during artificially produced vibration. Each larynx was assessed in 4 conditions: preoperative controls and after 25%, 33%, and 50% decreases in the vibratory portion of the vocal folds. The following parameters were evaluated: fundamental frequency, periodicity, vocal fold vibration amplitude, phase symmetry, and glottic closure. Results The mean fundamental frequencies were 208.87, 250.20, 292.37, and 342.67 Hz for preoperative controls and 25%, 33%, and 50% reductions in vibratory length of the vocal folds, respectively. Fundamental frequency increased with each increase in anterior glottic web extent, and the difference among the groups was statistically significant in absolute values in hertz and in semitone elevation. The mathematical models for estimating postoperative fundamental frequency had a statistically significant coefficient. The vibration of the vocal folds remained periodic in all larynges before and after the procedures. Conclusion There was a significant and progressive increase in the fundamental frequency with each enlargement of anterior glottic web. Based on the control frequency, mathematical models could estimate the value of the fundamental frequency after the procedure.

Airway Anomalies in Patients With 22q11.2 Deletion Syndrome: A 5-Year Review

Objectives: To characterize the frequency of airway anomalies in patients with 22q11.2 deletion syndrome (22q11DS). Methods: Retrospective review of patients with 22q11DS who had undergone microlaryngoscopy/bronchoscopy (MLB) for aerodigestive symptoms at a tertiary care children’s hospital from 2011 to 2016. Results: Thirty patients underwent an MLB due to the following indications: aspiration (11), stridor (10), chronic respiratory failure due to ventilator dependence (8), and difficult intubation (1). Median age at MLB was 6.5 months (range, 0.25-32 months). Forty airway anomalies were identified in 20 (66%) patients. Laryngomalacia (10), tracheomalacia (8), and bronchomalcia (8) were the most common intraoperative findings, followed by laryngeal cleft (5), anterior glottic web (5), subglottic stenosis (3), and subglottic cysts (1). Synchronous airway anomalies were common and identified in 11 (55%) of the patients who had identified anomalies on MLB. Nineteen of the 20 patients required operative intervention due to the anomalies identified. Conclusions: Structural airway abnormalities are common in children with 22q11DS undergoing MLB, and synchronous anomalies can frequently exist. Providers caring for children with 22q11DS should be vigilant about airway evaluation when aerodigestive symptoms are present.