T. Kurita, S. Chitose, Kiminori Sato, T. Sakazaki, M. Fukahori, S. Sueyoshi, H. Umeno, T. Nakashima
Human papilloma virus (HPV) types 6 and 11 are thought to infect the basal cells of the squamous epithelium. These infections cause laryngeal papillomatosis and condyloma acuminatum in the uterine cervix, which manifest the same pathological phenotype. The site of predilection is the junction of the stratified squamous epithelium and simple columnar epithelium (SCJ), however, the morphological characteristics of the epithelial junction in the larynx differ from that in the uterine cervix. Therefore, these observations suggest that the developmental mechanism of underlying the onset of laryngeal papilloma differs from that of condyloma acuminatum. The newborn larynx, which is infected by HPV in case of juvenile-onset laryngeal papillomatosis, has no SCJ in the supraglottic regions. This suggests that HPV infects the laryngeal epithelium with or without SCJ. Moreover, the immaturity of the epithelia in the newborn larynx allows HPV to easily infect the tissue. In investigations of adult larynges, the basal cells of the squamous epithelium and stratified ciliated epithelium in the larynx express p63, an epithelial stem cell marker. Integrin-α6 is, the receptor for HPV, is positive in the stratified ciliated epithelium and lower half of the squamous epithelium. These findings indicate that HPV is able to infect the squamous epithelium and stratified ciliated epithelium and that both infection with HPV in epithelial stem cells and stratification of epithelial cell layer are necessary for the development of laryngeal papilloma.
{"title":"Developmental Mechanisms of Laryngeal Papilloma : Distribution and Characteristics of the Epithelium in the Larynx","authors":"T. Kurita, S. Chitose, Kiminori Sato, T. Sakazaki, M. Fukahori, S. Sueyoshi, H. Umeno, T. Nakashima","doi":"10.5426/LARYNX.26.69","DOIUrl":"https://doi.org/10.5426/LARYNX.26.69","url":null,"abstract":"Human papilloma virus (HPV) types 6 and 11 are thought to infect the basal cells of the squamous epithelium. These infections cause laryngeal papillomatosis and condyloma acuminatum in the uterine cervix, which manifest the same pathological phenotype. The site of predilection is the junction of the stratified squamous epithelium and simple columnar epithelium (SCJ), however, the morphological characteristics of the epithelial junction in the larynx differ from that in the uterine cervix. Therefore, these observations suggest that the developmental mechanism of underlying the onset of laryngeal papilloma differs from that of condyloma acuminatum. The newborn larynx, which is infected by HPV in case of juvenile-onset laryngeal papillomatosis, has no SCJ in the supraglottic regions. This suggests that HPV infects the laryngeal epithelium with or without SCJ. Moreover, the immaturity of the epithelia in the newborn larynx allows HPV to easily infect the tissue. In investigations of adult larynges, the basal cells of the squamous epithelium and stratified ciliated epithelium in the larynx express p63, an epithelial stem cell marker. Integrin-α6 is, the receptor for HPV, is positive in the stratified ciliated epithelium and lower half of the squamous epithelium. These findings indicate that HPV is able to infect the squamous epithelium and stratified ciliated epithelium and that both infection with HPV in epithelial stem cells and stratification of epithelial cell layer are necessary for the development of laryngeal papilloma.","PeriodicalId":126820,"journal":{"name":"THE LARYNX JAPAN","volume":"43 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124649978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Differential diagnosis of patients who present with vocal cord paralysis can be difficult. We describe a patient who presented with vocal cord paralysis, which lead to a diagnosis of mediastinal lung cancer. The patient, a forty-seven-year-old female, complained of laryngeal pain and hoarseness. A detailed examination revealed paralysis of the right vocal cord, but did not uncover weight loss, pharyngeal and laryngeal tumors, and cervical lymphadenopathy. Plain computed tomography(CT)showed small thyroid nodules and small lymphadenitis in the subclavicular fossa and mediastinum, but was otherwise indefinite. Positron emission tomography (PET)CT undertaken a month after the initial presentation showed a rapid increase in the size of the esophageal and mediastinal nodules, multiple lymph nodes and distant metastases. Gastrointestinal fiberscopy did not reveal esophageal cancer. Based on PET-CT, GIF and neck nodule fine needle aspiration findings, she was diagnosed with mediastinal lung cancer. Chemotherapy was commenced, and the clinical course was good. Mediastinal symptoms including vocal cord paralysis and superior vena cava syndrome can be primary symptoms of mediastinal lung cancer. Otolaryngologists should consider mediastinal lung cancer in the differential diagnosis of patients presenting with mediastinal symptoms.
{"title":"Mediastinal Lung Cancer in a Patients Presenting with Vocal Cord Paralysis","authors":"Aiko Oka, Tsunehisa Ohno, Shinichi Sato","doi":"10.5426/LARYNX.26.140","DOIUrl":"https://doi.org/10.5426/LARYNX.26.140","url":null,"abstract":"Differential diagnosis of patients who present with vocal cord paralysis can be difficult. We describe a patient who presented with vocal cord paralysis, which lead to a diagnosis of mediastinal lung cancer. The patient, a forty-seven-year-old female, complained of laryngeal pain and hoarseness. A detailed examination revealed paralysis of the right vocal cord, but did not uncover weight loss, pharyngeal and laryngeal tumors, and cervical lymphadenopathy. Plain computed tomography(CT)showed small thyroid nodules and small lymphadenitis in the subclavicular fossa and mediastinum, but was otherwise indefinite. Positron emission tomography (PET)CT undertaken a month after the initial presentation showed a rapid increase in the size of the esophageal and mediastinal nodules, multiple lymph nodes and distant metastases. Gastrointestinal fiberscopy did not reveal esophageal cancer. Based on PET-CT, GIF and neck nodule fine needle aspiration findings, she was diagnosed with mediastinal lung cancer. Chemotherapy was commenced, and the clinical course was good. Mediastinal symptoms including vocal cord paralysis and superior vena cava syndrome can be primary symptoms of mediastinal lung cancer. Otolaryngologists should consider mediastinal lung cancer in the differential diagnosis of patients presenting with mediastinal symptoms.","PeriodicalId":126820,"journal":{"name":"THE LARYNX JAPAN","volume":"46 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117310291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Amyloidosis accounts for less than 1% of all benign tumors of the larynx. We herein report a case of supraglottic amyloidosis in the larynx. A37 -year-old male presented with a three-year history of hoarseness of voice. The initial examination revealed a tumor with a smooth surface on the left false vocal cord, with intact vocal cord mobility. We subsequently performed laryngomicrosurgery and resected the tumor. Histopathologically, the specimen showed submucosal deposition of amyloid with hematoxylin and Congo red staining. A diagnosis of systemic amyloidosis was excluded on follow-up examinations. The patient’s voice quality improved, and with no episodes of recurrence for five years after the surgery. Amyloidosis of the larynx is a rare and usually benign condition. However, long-term follow-up is required in such cases, as the disease may recur a long time after treatment.
{"title":"A Case of Laryngeal Amyloidosis","authors":"N. Nagai, Y. Ueki, T. Tono","doi":"10.5426/LARYNX.26.143","DOIUrl":"https://doi.org/10.5426/LARYNX.26.143","url":null,"abstract":"Amyloidosis accounts for less than 1% of all benign tumors of the larynx. We herein report a case of supraglottic amyloidosis in the larynx. A37 -year-old male presented with a three-year history of hoarseness of voice. The initial examination revealed a tumor with a smooth surface on the left false vocal cord, with intact vocal cord mobility. We subsequently performed laryngomicrosurgery and resected the tumor. Histopathologically, the specimen showed submucosal deposition of amyloid with hematoxylin and Congo red staining. A diagnosis of systemic amyloidosis was excluded on follow-up examinations. The patient’s voice quality improved, and with no episodes of recurrence for five years after the surgery. Amyloidosis of the larynx is a rare and usually benign condition. However, long-term follow-up is required in such cases, as the disease may recur a long time after treatment.","PeriodicalId":126820,"journal":{"name":"THE LARYNX JAPAN","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126372651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
R. Motohashi, R. Tokashiki, Hiroyuki Hiramatsu, Masaki Nomoto, U. Konomi, Eriko Sakurai, Fumimasa Toyomura, K. Tsukahara, Mamoru Suzuki
Thyroarytenoid muscle myectomy(TAM) is a useful procedure for treating adductor spasmodic dysphonia (ADSD), in addition to type II thyroplasty(TP II), and both are performed in our department in Japan. In the present study, we examined the surgical outcomes of TAM. The subjects were 31 patients who underwent TAM between 2008 and 2013 at Tokyo Medical University Hospital, who could be followed up for at least six months following surgery and whose voice quality evaluation data were available. A comparison of voice evaluations pre-surgery and six months post-surgery was made. After six months, a significant improvement was seen in all of the voice quality evaluation items, including “strangulation”, “interruption”, “tremors” and voice handicap index (VHI). There was a marked recurrence of the symptoms in two of the 31 subjects within six months. Hemorrhage and scarring were observed as postoperative complications. In addition, we gave a questionnaire to 30 of the subjects who were followed up for at least one year following surgery, which asked about the recurrence of hoarseness and the degree of satisfaction with the surgery. Fifteen subjects responded (50%). The period of continuous hoarseness had ranged from one to 24 months. No subject felt that the hoarseness was a serious impediment in daily life, and the median period required for its disappearance was four months. Symptoms recurred in three subjects, but they tended to be mild. All 15 subjected reported experiencing a benefit from the surgery. The degree of satisfaction with TAM is very high, and we consider it to be a useful procedure for adductor spasmodic dysphonia.
{"title":"Thyroarytenoid Muscle Myectomy for Adductor Spasmodic Dysphonia","authors":"R. Motohashi, R. Tokashiki, Hiroyuki Hiramatsu, Masaki Nomoto, U. Konomi, Eriko Sakurai, Fumimasa Toyomura, K. Tsukahara, Mamoru Suzuki","doi":"10.5426/LARYNX.26.93","DOIUrl":"https://doi.org/10.5426/LARYNX.26.93","url":null,"abstract":"Thyroarytenoid muscle myectomy(TAM) is a useful procedure for treating adductor spasmodic dysphonia (ADSD), in addition to type II thyroplasty(TP II), and both are performed in our department in Japan. In the present study, we examined the surgical outcomes of TAM. The subjects were 31 patients who underwent TAM between 2008 and 2013 at Tokyo Medical University Hospital, who could be followed up for at least six months following surgery and whose voice quality evaluation data were available. A comparison of voice evaluations pre-surgery and six months post-surgery was made. After six months, a significant improvement was seen in all of the voice quality evaluation items, including “strangulation”, “interruption”, “tremors” and voice handicap index (VHI). There was a marked recurrence of the symptoms in two of the 31 subjects within six months. Hemorrhage and scarring were observed as postoperative complications. In addition, we gave a questionnaire to 30 of the subjects who were followed up for at least one year following surgery, which asked about the recurrence of hoarseness and the degree of satisfaction with the surgery. Fifteen subjects responded (50%). The period of continuous hoarseness had ranged from one to 24 months. No subject felt that the hoarseness was a serious impediment in daily life, and the median period required for its disappearance was four months. Symptoms recurred in three subjects, but they tended to be mild. All 15 subjected reported experiencing a benefit from the surgery. The degree of satisfaction with TAM is very high, and we consider it to be a useful procedure for adductor spasmodic dysphonia.","PeriodicalId":126820,"journal":{"name":"THE LARYNX JAPAN","volume":"286 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"120850511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The purpose of this paper is to provide a concept, protocol and preliminary efficacy data for a behavioral voice therapy program for patients with adductor spasmodic dysphonia(ADSD). A voice therapy program was designed to target the underlying pathophysiology of focal laryngeal dystonia accompanying a disordered voice in patients with ADSD. The focus of the treatment was systematic voice training to improve the simple short nonspasmodic phonation to the conversational level. Twenty-one patients (twenty females, one male) were included in this therapy program. The outcome of the treatment was measured using the mora method. Recorded materials, including a passage from “The North Wind and the Sun”(24 morae total) read by the patients before and after the treatment were judged by three clinicians: two speech-language-hearing therapists and one otolaryngologist. The median score based on the mora method for all 21 patients was 24 pre-treatment and 12 post-treatment, indicating statistically significant improvement of the voice following treatment (Wilcoxon signedranks test, p<0.01). In detail, the score was improved in 10 patients, remained unchanged in 10 patients and was worsened in one patient after the treatment. Five (24%) of the twenty-one patients were satisfied with the effectiveness of the treatment, and required no further medical interventions. Our results indicated that behavioral voice therapy for ADSD was efficacious and could be a treatment option for ADSD.
{"title":"The Voice Therapy Program for Adductor Spasmodic Dysphonia (ADSD)","authors":"Miyoko Ishige","doi":"10.5426/LARYNX.26.99","DOIUrl":"https://doi.org/10.5426/LARYNX.26.99","url":null,"abstract":"The purpose of this paper is to provide a concept, protocol and preliminary efficacy data for a behavioral voice therapy program for patients with adductor spasmodic dysphonia(ADSD). A voice therapy program was designed to target the underlying pathophysiology of focal laryngeal dystonia accompanying a disordered voice in patients with ADSD. The focus of the treatment was systematic voice training to improve the simple short nonspasmodic phonation to the conversational level. Twenty-one patients (twenty females, one male) were included in this therapy program. The outcome of the treatment was measured using the mora method. Recorded materials, including a passage from “The North Wind and the Sun”(24 morae total) read by the patients before and after the treatment were judged by three clinicians: two speech-language-hearing therapists and one otolaryngologist. The median score based on the mora method for all 21 patients was 24 pre-treatment and 12 post-treatment, indicating statistically significant improvement of the voice following treatment (Wilcoxon signedranks test, p<0.01). In detail, the score was improved in 10 patients, remained unchanged in 10 patients and was worsened in one patient after the treatment. Five (24%) of the twenty-one patients were satisfied with the effectiveness of the treatment, and required no further medical interventions. Our results indicated that behavioral voice therapy for ADSD was efficacious and could be a treatment option for ADSD.","PeriodicalId":126820,"journal":{"name":"THE LARYNX JAPAN","volume":"22 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121380817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Shinya Okada, Etuyo Tamura, M. Shibuya, H. Fukuda, M. Iida, Takafumi Ogawa
Myxoma is a benign mesenchymal tumor and occurs rarely in the head and neck region. We report a case of a myxoma of the larynx in a 36-year-old woman. Her symptoms are gradually progressive hoarseness and diffi-culty of phonation. Endoscopic examination revealed a solid mass in the subglottic area of the anterior commissure. Phonosurgery performed with a microscope showed that the mass was encapsulated and located in the subglottic mucosa. This hard, elastic mass which measured 10 mm in diameter, was diagnosed as a myxoma. Although excision was microscopically incomplete, there is no evidence of recurrence macroscopically 13 months after the surgery and she remains asymptomatic.
{"title":"A Case of Laryngeal Myxoma in the Subglottic Area","authors":"Shinya Okada, Etuyo Tamura, M. Shibuya, H. Fukuda, M. Iida, Takafumi Ogawa","doi":"10.5426/LARYNX.26.132","DOIUrl":"https://doi.org/10.5426/LARYNX.26.132","url":null,"abstract":"Myxoma is a benign mesenchymal tumor and occurs rarely in the head and neck region. We report a case of a myxoma of the larynx in a 36-year-old woman. Her symptoms are gradually progressive hoarseness and diffi-culty of phonation. Endoscopic examination revealed a solid mass in the subglottic area of the anterior commissure. Phonosurgery performed with a microscope showed that the mass was encapsulated and located in the subglottic mucosa. This hard, elastic mass which measured 10 mm in diameter, was diagnosed as a myxoma. Although excision was microscopically incomplete, there is no evidence of recurrence macroscopically 13 months after the surgery and she remains asymptomatic.","PeriodicalId":126820,"journal":{"name":"THE LARYNX JAPAN","volume":"42 3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124968990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Among laryngeal cancers, which are often difficult to identify and diagnose, there is the possibility for cases of glottic cancer, similar to laryngeal polyps or cysts, and ventricular carcinoma of the larynx with swelling of the false fold. In the present case, we treated a patient with a lesion ventricular carcinoma, that was difficult to detect and diagnosed. The mass did not exhibit the characteristics of ventricular carcinoma to in the larynx and was instead located in the deep portion of the laryngeal ventricle; therefore, its discovery was delayed . In addi-tion, only swelling of the false fold was observed under an endoscope and the lesion may progress, requiring la-ryngectomy, during follow up. Ventricular carcinomas often progress in the top and bottom of the glottis region within the paraglottic space, making it difficult to detect such tumors early. In addition, ventricular carcinomas easily develop lymph node and distant metastaseis. We herein report the cases of the patient with false fold swelling who were found to have ventricular carcinoma of the larynx, and discuss the clinical and pathological characteristics of the tumor.
{"title":"Cases of Larynx Disease and Ventricular Carcinoma that were Difficult Diagnosis","authors":"T. Ono, H. Umeno, S. Chitose, T. Nakashima","doi":"10.5426/LARYNX.26.125","DOIUrl":"https://doi.org/10.5426/LARYNX.26.125","url":null,"abstract":"Among laryngeal cancers, which are often difficult to identify and diagnose, there is the possibility for cases of glottic cancer, similar to laryngeal polyps or cysts, and ventricular carcinoma of the larynx with swelling of the false fold. In the present case, we treated a patient with a lesion ventricular carcinoma, that was difficult to detect and diagnosed. The mass did not exhibit the characteristics of ventricular carcinoma to in the larynx and was instead located in the deep portion of the laryngeal ventricle; therefore, its discovery was delayed . In addi-tion, only swelling of the false fold was observed under an endoscope and the lesion may progress, requiring la-ryngectomy, during follow up. Ventricular carcinomas often progress in the top and bottom of the glottis region within the paraglottic space, making it difficult to detect such tumors early. In addition, ventricular carcinomas easily develop lymph node and distant metastaseis. We herein report the cases of the patient with false fold swelling who were found to have ventricular carcinoma of the larynx, and discuss the clinical and pathological characteristics of the tumor.","PeriodicalId":126820,"journal":{"name":"THE LARYNX JAPAN","volume":"122 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131032844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Laryngeal Disease and Human Papillomavirus -Laryngeal Tumor Related to Human Papillomavirus Infection-","authors":"H. Maeda","doi":"10.5426/LARYNX.26.75","DOIUrl":"https://doi.org/10.5426/LARYNX.26.75","url":null,"abstract":"","PeriodicalId":126820,"journal":{"name":"THE LARYNX JAPAN","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115742920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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