The aim of this article is to describe the pathogenesis, etiology, clinical course, prevention, and management of recurrent respiratory papillomatosis (RRP). RRP is a challenging chronic disease of the respiratory tract that occurs in both children and adults. It is caused by human papillomavirus (HPV), with more than 90% caused by HPV 6 and HPV 11 types. While there is no definitive treatment for RRP, the goal of treatment focuses on improving voice quality and maintaining airway patency. The clinical presentation is nonspecific with the majority of patients presenting with hoarseness, stridor, or dyspnea. Surgical management is the mainstay of treatment of RRP, and about 20% of the patients benefit from adjuvant therapies including cidofovir, bevacizumab, interferon, and others. Prevention of the disease with the HPV vaccine and practicing safe sex may play a major role in decreasing the incidence of HPV infection and RRP.
Aim: This article aims to identify the unique requirements in evaluating and treating professional voice users with voice complaints.
Background: Professional or occupational voice users make up a large portion of a laryngological caseload. These individuals, including teachers, performers, salespeople, etc., rely on proper vocal function every day to carry out the demands of their job. As a result, these patients may require a more comprehensive clinical evaluation and intervention given the nature of their careers.
Patient care/Techniques: Otolaryngologists should consider the use of videolaryngostroboscopy to assess the subtleties of vocal fold function and vibration. Often, close collaboration with a speech pathologist is most beneficial to these patients to improve the overall health and functioning of the voice and promote longevity of proper voice use. A variety of vocal pathologies are seen in the professional voice population, including laryngitis, benign vocal fold lesions, and functional disorders such as muscle tension dysphonia. Management and treatment will depend not only on the findings from the evaluation, but also access to a collaborative voice team and the patient's wishes related to their profession. Voice rest is generally only implemented in specific cases where avoiding vocal fold collision is crucial to healing. Voice therapy is often warranted both for rehabilitation and learning appropriate compensatory strategies and healthier voicing behaviors. Depending on the evaluation findings and the comfort level of the provider, medication or surgical intervention may be most appropriate for certain patients.
Clinical significance/Conclusion: Professional voice users are frequently seen by otolaryngologists due to the essential role of their voices and the high demands often required. Providers should be knowledgeable in the assessment and treatment of voice disorders. If necessary, providers should establish a voice care team in the area that can appropriately assist these patients.
Aim: To provide an overview of neurological disorders affecting the larynx, either primarily or as part of a systemic disease process. In this review, we first present an overview of the approach to diagnosis and treatment of neurological diseases of the larynx, and then move on to discuss individual conditions in more detail.
Background: Neurolaryngology focuses on the neuromuscular function of the larynx. Laryngeal issues such as cough, aspiration, and hoarseness are among the most common problems in ambulatory medicine and aspiration is the leading cause of morbidity and mortality in the geriatric population and is especially prevalent in neurodegenerative disease.
Review results: Neurological voice disorders can be divided into three categories: those that originate from the central nervous system, those that originate from the peripheral nervous system, and those that are functional or behavioral in nature. Several central nervous system disorders have manifestations in the larynx—the disorders most commonly seen by otolaryngologists are: dystonia, essential tremor, Parkinson's disease, and stroke. Laryngeal disorders originating from the peripheral nervous system include vocal fold paresis/paralysis and myasthenia gravis. Functional voice disorders include muscle tension dysphonia and paradoxical vocal fold motion.
Conclusion: Neurological voice disorders can originate the from the central or peripheral nervous system, or be functional in nature. It is important for the otolaryngologist to be able to be familiar with history and physical examination findings that suggest neurological pathology, and also be able to recognize specific findings pertinent to each individual condition.
Clinical significance: Patients with central nervous system disorders can often have laryngeal complaints as their first presenting symptom. Therefore, the otolaryngologist can sometimes be the first physician to diagnose such conditions, and plays an important role in coordinating and providing therapies that significantly improve quality of life for these patients. Current research involving machine learning and functional neuroimaging may greatly improve the diagnosis of many of these disorders in the near future.
INVITED REVIEW ARTICLE
Kanav Pradeep Kumar,
Mohsin Ahmed Abdul Nabi Shaikh,
Ankur Kirankumar Walli,
Sultan Ahmed Pradhan
Early glottic cancers (Tis, T1a, T1b, T2) involve one or both cords. They may have some supraglottic or sub glottic extension, and the cords maybe either freely mobile or at the most have impaired mobility. For in situ cancer, microlaryngoscopic excision either with cold steel or CO2 laser is the treatment of choice. In T1 glottic cancers, the treatment trends have swung towards laser excision away from both radiation therapy and open partial laryngectomy. In T2 glottic cancers, radiation therapy is the mainstay of treatment in majority of the cases.
The objective of this review is to describe management options and their success in adults with acquired posterior glottic stenosis (PGS). Literature from PubMed search engine was reviewed, including recent and historical reports covering etiology, surgical techniques, and voice and swallowing outcomes in PGS. Damage to the posterior commissure after intubation is still the most common etiology for acquired PGS, with patients presenting with dyspnea weeks to months after injury. There is a multitude of surgical techniques described, regardless of the technique chosen, PGS is a challenging disease that often requires more than one procedure. Tracheostomy should be considered to secure the airway in the perioperative period, and decannulation is typically successful. Swallowing dysfunction is often temporary, and voice is often stable or improved after surgical intervention. As the laryngologist will continue to face this disease, especially with the recent pandemic, being familiar with various techniques options will be important in providing a safe and functional larynx.
Pharyngeal dysphagia may be due to different etiologies. But the commonest causes are neurological, and secondary to head and neck cancer treatments. Various stages of pharyngeal phase of swallowing can be affected. Understanding the pathophysiology and managing accordingly is the key to success. Proper history taking, clinical and instrumental evaluation are the important methods to diagnose the dysfunction. Flexible endoscopic evaluation of swallowing (FEES) and Video fluoroscopy (VFS) are the most commonly used instrumental evaluation techniques. Management includes alternative methods of swallowing, prevention of aspiration, swallowing therapy and interventional management.