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   Table of Contents - Current issue
January-June 2018
Volume 8 | Issue 1
Page Nos. 1-28

Online since Wednesday, May 8, 2019

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Primary laryngeal tuberculosis: A frequently misdiagnosed disease p. 1
Santosh Kumar Swain, Mahesh Chandra Sahu, Sitanshu Sekhar Kar
Primary laryngeal tuberculosis (PLT) is a granulomatous infection of the larynx caused by Mycobacterium tuberculosis without affecting the lungs. It is a rare type of extrapulmonary tuberculosis seen in clinical practice. After the introduction of antitubercular therapy (ATT), the incidence of LT is reduced and remains stable. However, the incidence of PLT is increasing due to acquired immune deficiency syndrome epidemic. The important clinical presentations of PLT are dysphonia and odynophagia. The diagnosis is confirmed by histopathological examination as it often mimics laryngeal malignancy. The treatment is ATT, whereas surgery is only reserved in certain situations where is compromising the laryngeal airway by its granulomatous growth. Delayed or misdiagnosis or untreatable LT will lead to high morbidity and mortality of a patient. Although primary tubercular lesion has nonspecific clinical presentations, it is very important to have a high index of suspicions to rule out tubercular lesion in the larynx as this disease is a curable one.
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Oncologic outcomes of transoral laser microsurgery for early glottic carcinoma p. 6
Sachin Gandhi, Abren Santocildes, Shashank Gupta
Introduction: Laryngeal carcinoma comprises 2%–5% of all malignant diseases. Treatment options for early glottic cancers are open partial laryngectomy, radiotherapy (RT), and transoral laser microsurgery (TLM). The goals of management of early glottic carcinoma are complete oncological clearance, organ preservation, and functional preservation (voice, swallowing, and airway). This study aims to review oncologic results of TLM for management of early glottic carcinoma at our institute. Methodology: Patients with early glottic squamous cell carcinoma, i.e., Tis, T1, and T2 stage lesions managed with TLM from January 2011 to 2014 were included in the study. Medical records were analyzed to acquire data. Results: Sixty-six patients underwent TLM for management of early glottic cancer between 2011 and 2014. Tumor-free margins were obtained after TLM in all 10 cases with Tis. For T1a, T1b, and T2 lesions, surgery obtained tumor-free margins in 89.5%, 77.8%, and 77.8% cases, respectively. Nine patients were found to have a positive margin and they underwent revision surgery. The overall local cure rate obtained by TLM was 92.4%. The overall 3-year survival rate was 98.5%. One patient died of myocardial infarction 2 years after TLM, giving a disease-specific 3-year survival rate of 100%. Conclusion: TLM is a safe and effective treatment option for management of early glottic cancer. Its outcomes are comparable to those of RT, and it has lesser cost, treatment duration, and morbidity.
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Tumor size affects the quality of voice in oral and pharyngeal cancers: A preliminary study p. 10
Preema D'souza, Suresh Rao, Thomas Zacharia, Gwendelen D'souza, Pratima Rao, Manjeshwar Shrinath Baliga
Objective: Clinical observations indicate that the growth of cancers in the oral and pharyngeal region affects the voice of the individual. Literature study indicates that most of the studies have been on laryngeal cancers and that there are no reports, indicating the impact of tumor growth on the quality of voice in people afflicted by cancer in the oral and pharyngeal regions. For the first time, we have attempted at understanding the impact of tumor growth on voice (pitch, jitter, and shimmer) in people with cancer in the oral or pharyngeal regions. Methodology: This was a prospective study and was done in newly diagnosed oral and pharyngeal cancer patients with confirmed histopathological reports. The voice analysis software PRAAT and a dynamic unidirectional AUD-59 × LR microphone were used to record the voice in a soundproof recording laboratory. Voice was also recorded of healthy age-matched volunteers and used as positive control. The results of the voice parameters accrued were analyzed according to the gender (male or female), the region (oral and pharyngeal), and the tumor size using analysis of variance with Bonferroni's multiple comparison. Results: The results of the study indicate that when compared to the healthy controls, the pitch was decreased in people with cancers and was more prominent for females (P = 0.001). The jitter increased and was significant for both oral and pharyngeal cancers (males P = 0.001; females P = 0.002). With respect to shimmer, there was a decrease in men even as it increased in women with oral cancers, while it increased in both the genders in pharyngeal cancers (P = 0.035 and P = 001). Conclusions: The results indicate that there was a significant alteration in the pitch, jitter, and shimmer in people with cancers in the oral and pharyngeal regions and that these changes were dependent on the size of the tumor.
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Effect of vocal loading on throat temperature in young phono-normal adults p. 14
Lokheshwar Shanmugasundaram, Rathinaswamy Rajasudhakar
Background: Infrared thermography is used to detect heat on the surface and subsurface and online monitoring of process. Vocal loading has been defined as acoustic changes in the voice as a result of prolonged voice use. Vocal loading involves continuous oscillation of vocal folds where the colliding forces between the vocal folds for longer period would generate and dissipate heat. Aims: The primary objective of the study was to determine any difference in temperature (near the neck region) and fundamental frequency (F0) pre- and post-vocal loading task. The secondary objective was to find the influence of gender on these parameters during pre- and post-vocal loading task. Study Design: Pretest-posttest design. Subjects and Methods: The study included two groups: Group I and Group II which included ten phono-normal males and ten phono-normal females, respectively, between the age range of 18 and 24 years. Throat temperature and F0 (phonation sample) were measured before and after vocal loading task (reading a material in English at 70–75 dB for 40 min). The F0 was measured using PRAAT software and temperature using SmartView software. Results: Within-group and between-group comparisons were made using mixed ANOVA for both temperature and F0. There was a significant difference in temperature within groups; however, there was no significant difference between the groups. Comparison of temperature pre- and post-vocal loading revealed significant difference within groups; however, it was not significantly different between the two groups. Pre- and post-vocal loading comparison of F0 revealed significant difference within and between groups. Conclusions: Group II had more temperature and F0 when compared to Group I, that is, higher temperature and higher F0, whereas Group II individuals are vulnerable to get voice problems if they continue to use prolonged loud speech as their vocal behaviors.
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Effect of circadian cycle on voice: A cross-sectional study with young adults of different chronotypes p. 19
Thomas Zacharia, Preema D'souza, Minton Mathew, Gwendalene D'souza, Judith James, Manjeshwar Shrinath Baliga
Background: Circadian rhythm (CR) which is termed as the “physical, mental, and behavioral changes that follow a roughly 24 h cycle responding primarily to light and darkness in an organism's environment” has an important role in human health. A literature study indicates that there are no studies addressing the effect of CR on voice. The current study was conducted to understand the effect of CR on voice, pitch, jitter and shimmer in healthy young adults. Methodology: The study consisted of 216 participants (98 males and 118 females). The volunteers were asked to fill the Horne–Ostbery Morningness-Eveningness Scale questionnaire followed by an acoustic analysis using the voice analyzing software PRAAT using a dynamic unidirectional microphone at four time points of the day (morning [7.30–8.30 am], mid-day [12.30–1.30 pm], early evening [4.30–5.30 pm] and night [8.30–9.30 pm]). Results: The results of the current study indicate that the CR has got a very strong relationship with jitter, pitch and shimmer in the voice and how these parameters vary across evening type, intermediate type, and morning type through the day. Conclusions: The findings of the current study are very important for professional voice users as they can select their time slot for the performance based on their CR and be effective in their duties/job.
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Endoscopic phonomicrosurgery of an anterior commissure polyp using McCoy laryngoscope in a patient with difficult laryngeal exposure p. 24
Sandeep Singh Sindhu, Suresh Singh Naruka, Ayush Chawla
Phonomicrosurgery for benign vocal cord lesions is a common surgical procedure with an excellent phonetic outcome. Adequate laryngeal exposure is essential for complete and precise excision of vocal cord lesions. Anterior commissure is a site which can sometimes pose a challenge of exposure and difficulty in access. Various anatomical and physiological factors can lead to difficulty in the exposure of larynx. There are different scoring systems and parameters to preoperatively predict a case of difficult laryngeal exposure (DLE). However, management options for such cases remain limited. Here, we present such a case which was managed using McCoy intubating laryngoscope and modified microlaryngeal instruments.
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