Vallecular cyst in an infant is uncommon, and it finds infrequent mention in the literature as well. However when present, it accounts for severe inspiratory stridor, causing airway compromise, and sometimes even death. Laryngomalacia is the commonest congenital anomaly of the larynx, which is present after birth giving rise to inspiratory stridor. Laryngomalacia results as a collapse of supraglottic structures of the larynx. Clinical co-presentation of vallecular cyst and laryngomalacia is very rare. This is a report of two cases of 2-month-old infants who presented with the history of noisy breathing and refusal to feeds since 10-15 days. CT scan of the neck revealed a huge cyst in the vallecula compromising the airway. Microlaryngoscopic-guided aspiration and marsupilization of the cyst was done using CO ₂ laser and the release of aryepiglottic fold was done using microlaryngeal scissors. Respiratory and feeding problems dramatically improved in these patients by immediate surgical intervention.

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Background: Substances available for vocal cord augmentation procedure have their own advantages and limitations. Autologous fat is accepted to be one of the safest substance for augmentation. Objective: To evaluate the subjective and objective changes in vocal outcome following fat augmentation surgery for phonatory gaps. Materials and Methods: 30 patients with phonatory gap <2 mm were included in this prospective study. These consisted of sulcus vocalis (14), vocal cord atrophy (05) and vocal cord palsy (11). Per-operatively harvested umbilical fat was used for augmentation after mincing it and removing all the connective tissue. Follow-up of patients was done at 1, 3 and 6 months interval. Pre- and postoperative videostroboscopy was done. Objective analysis of voice was done using maximum phonatory time (MPT) and noise to harmonic ratio (NHR). Subjective assessment of voice was done using the voice handicap index (VHI) and subjective change in quality of voice as assessed by the patient. Results: Patients with early stage sulcus, vocal atrophy and vocal cord palsy, with small vocal gap, showed significantly good results after fat augmentation; however, results of patients with sulcus vocalis of grade II and III were not very satisfactory.

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Objectives: To adapt the voice handicap index (VHI) for usage in Hindi and evaluate its internal consistency, reliability, and clinical validity in cases of dysphonia. Setting: Tertiary healthcare centers. Materials and Methods: The original VHI was translated into Hindi and was completed by 175 patients with voice disorders and 84 asymptomatic subjects. Internal consistency was analyzed through Cronbach's alpha coefficient. For test-retest reliability, the Hindi VHI was filled twice by 63 randomly selected patients and assessed through the Spearman rank correlation coefficient test. For the clinical validity assessment, the scores obtained in the pathological group were compared with those found in asymptomatic individuals through the Kruskal-Wallis test. Also, the correlation between VHI and the patients' self-perceived grade of voice disorder was assessed. Finally, the effect of age and gender on overall VHI and its three subscales was analyzed. Results: Internal consistency was found to be good (alpha = 0.95); the test-retest reliability was high (r = 0.95). Nonparametric Kruskal-Wallis analysis revealed that the control group scored significantly lower than the dysphonics. The overall VHI score positively correlated with the patients' self-perceived grade of voice disorder (r = 0.44). In the voice-disorder group, age and gender were not correlated to the overall VHI score and to their three domains. Conclusion: The Hindi VHI so developed is a valid and reliable measure for use in the Hindi-speaking population.

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Background: Knowledge of the size and proportions of the human larynx is essential for the diagnosis and treatment of laryngeal disorders. Objective of the present cadaveric study was to study dimensions of larynx, various laryngeal folds and laryngeal cavity of adult human larynx in the western Indian population. Materials and Methods: Sagittal section of the head and neck region was taken from the cadaver. Larynx was separated from tongue from the level of hyoid bone to 3 ^rd tracheal ring. The measurements of intact and split larynx were taken with the help of digital vernier caliper, thread, and scale. Data was analyzed using software StatistiXL. For each of the parameters, the mean, standard deviation (S.D.), and range was calculated. Z test was used to test the significance of difference between the two mean. Results: Height of larynx from floor of thyroid notch to lower margin of cricoid cartilage was 32.42 ± 3.41 mm. Height of larynx from upper border of hyoid to lower border of cricoid. (L2) was 54.39 ± 6.04 mm. Height of larynx from tip of epiglottis to lower margin of cricoid cartilage was 57.13 ± 7.32 mm. Total height of laryngeal cavity was 61.51 ± 6.84 mm. Bilateral symmetry was noted in the size of vocal and vestibular folds length. Conclusion: There was wide individual variation in the dimensions of the most of the parameters in the selected population. Bilateral asymmetry, though present in majority of specimens, was insignificant. Morphometrical data of the larynx may be very useful in otorhinolaryngology, laryngeal microsurgery, and evaluation of results of diagnostic techniques. These parameters can be helpful in evaluation of the damage and proper repair of the larynx.

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The treatment of bilateral immobile vocal cords (BAP) is a balance between phonation, airway and swallowing. Various techniques of endoscopic approach for the treatment of bilateral vocal fold immobility have been proposed and have been modified by various surgeons. Trans oral CO ₂ laser endoscopic arytenoidectomy has become the most common method for its management. CO ₂ laser is arguably the most appropriate tool for cordectomy with the advantage of increased precision, better hemostasis and minimal tissue handling. We describe the procedure of posterior cordectomy with partial arytenoidectomy using trans oral CO ₂ laser for management of BAP. The present modality of preservation of part of shelf of arytenoid and use of laser in super pulse mode contribute to good results with minimum complication

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Early glottic carcinoma can be treated using endoscopic surgery, radiotherapy, or partial open surgery. Lesions limited to the vocal fold are normally treated with endoscopic surgery or partial open surgery, with local control results between 80% and 90%. The choice of one treatment over another should contemplate the cure rate, larynx preservation rate, post-treatment voice quality, morbidity, and treatment cost. Although both external beam radiotherapy and endoscopic carbon dioxide laser excision of early glottic cancer will affect voice quality, it is difficult to compare them. A complete voice assessment including perceptual, objective, and subjective evaluation is mandatory whenever a meaningful analysis of the pathological voice is to be accomplished. Meta-analyses of the results of voice treatments are generally limited and may even be impossible owing to the major diversity in the ways functional outcomes are assessed. The postsurgical voice outcome depends upon having a straight postoperative vocal fold for glottic closure and intact vibration from the contralateral vocal fold. Subepithelial and subligamental cordectomies are oncologically safe resections and have a quality of voice comparable to that of controls. By contrast, with wider resections (types III-V cordectomies), a concave neocord may form resulting in an aerodynamic glottic incompetence. In order to select the most appropriate treatment modality according to the patient's age, gender, compliance, and professional activity, a detailed preoperative counseling concerning vocal outcome is recommended. After phonosurgical resection, patients who have lost paraglottic musculature may benefit from medialization and augmentation procedures to re-establish glottic competence.

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Rhinosporidiosis is chronic granulomatous disease of likely fungal etiology which usually affects the nasal mucosa. Extranasal manifestations of rhinosporidiosis are relatively uncommon. Laryngeal and tracheobronchial tree involvement is extremely rare and only six cases have been reported till date. Here we report a case of laryngeal rhinosporidiosis, which occurred in a patient with coexisting nasal rhinosporidiosis and was successfully managed surgically.

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Background: Laryngopharyngeal reflux disease (LPRD) cases are common in clinical practice and usually neglected for want of a definitive diagnosis. Diagnosis requires a documented evidence of fall in pH levels in the laryngopharynx with dual-probe 24-hour ambulatory pH-metry. Aim: To study pH-metry findings in laryngopharyngeal reflux cases. Settings and Design: Study was done in a tertiary teaching hospital. Material and Methods: A total of 30 normal volunteers (Group A) and 65 patients (Group B) with complaints of hoarseness of voice for more than six weeks in the age group of 20 to 40 years were studied. A thorough ENT examination including fiberoptic laryngoscopy (FOL) was done on all cases. Group B was further divided into two subgroups. Subgroup B1 (n = 32) consisted of FOL positive and subgroup B2 (n = 33) comprised of FOL negative patients by reflux finding score. 24-hour ambulatory pH-metry was done for both groups. Results: Group A had no abnormal reflux patterns. In Subgroup B1, all 32 patients showed at least single laryngopharyngeal reflux episode over the 24-hour period. The most common pattern was 2 to 5 episodes occurring in 16/32 cases. Of the 32, five (15.6%) also had abnormal De Meester's score (gastroesophageal reflux disease [GERD] positive). In subgroup B2, 2 of 33 patients showed a typical LPR on 24-hour ambulatory pH-metry, despite showing LPRD negativity on FOL. None had an abnormal De Meester's score. Conclusion: LPRD may not coexist with GERD. Two to five reflux episodes pattern were found to be more common in LPR patients. Dual-sensor pH-metry is confirmatory for establishing diagnosis of LPRD.

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Surgical debulking is the main treatment for recurrent respiratory papillomatosis (RRP); however, intralesional cidofovir has been widely used off-label as adjuvant therapy. Concern exists about the safety profile of this drug in humans. The objective of this systematic review was to explore current evidence for the efficacy and safety of intralesional cidofovir in RRP. A comprehensive search strategy was used in MEDLINE and the Cochrane Central Register of Controlled Trials. Human in vivo studies were eligible for inclusion. A total of 41 studies met the inclusion criteria, including 30 studies providing efficacy outcome data (one randomized controlled trial (RCT), two retrospective case-control studies, and 27 case series). The RCT showed no significant difference in outcome between placebo and intralesional cidofovir groups. One case-control study favored cidofovir, and the other favored the control group. Combining all series, the overall complete remission rate with intralesional cidofovir was 53%, with a rate of 63% in adult-only studies compared to 37% in pediatric-only studies. There was no evidence for an increased rate of dysplasia or malignancy associated with intralesional cidofovir. Vocal cord scarring was reported, and may be associated with higher doses, as may risk of nephrotoxicity through systemic absorption. High-quality evidence for efficacy of cidofovir is very limited. Intralesional cidofovir should only be used after informed consent, based on a discussion of available safety and efficacy evidence. This adjuvant therapy should only rarely be considered in children, as it may be less effective, and long-term risks are potentially increased.

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Virchow described a laryngocoele as a saccule extending above the thyrohyoid membrane. Total excision and marsupialisation are established surgical techniques for external and internal laryngocoeles. The external cervical approach is advocated for external and combined laryngocoeles. We describe here a case of combined laryngocoele that was treated endoscopically, using a CO ₂ laser. Both the internal and external components of the laryngocoele were excised completely; its internal supraglottic component was excised followed by the external component into the neck. The CO ₂ laser with its property of minimal trauma to adjacent tissues, quick tissue recovery, reduced hospital stay and avoidance of tracheostomy makes it useful for treatment of laryngocoele. Endoscopic CO ₂ laser excision also avoids the necessity of an external approach.

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Various materials such as autogenous cartilage, silicone, hydroxylapatite, Gore-tex (expanded polytetrafluoroethylene), and titanium have been used for medialization laryngoplasty. We report an extrusion of Gore-tex implant after 11 months of medialization laryngoplasty. We believe tha t thought Gore-tex is a safe and easy-to-use implant for medialization laryngoplasty, the possibility of extrusion after the operation must not be ignored.

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A laryngeal granuloma (LG) is a benign tumor that usually develops on the cartilaginous vocal process of the vocal cords. Gastroesophageal reflux (GER), hyperfunctional use of the voice, and intubation injury are etiological factors. Patients usually complain of dysphagia, and dysphonia. A 53-year-old male consulted the Taksim Educational and Research Hospital ENT Department, complaining of a 6-month history of hoarseness, dysphagia, and globus sensation. On laryngoscopic examination, a granuloma was found on his left vocal process He was given an anti reflux treatments and advised on vocal hygiene. At the 1-month follow-up, the granuloma had disappeared. A thorough history was taken and disclosed that at time of his first visit, he saw a gastroenterologist for his heartburn and regurgitation and was administered pantoprazole 40 mg once daily. Consequently, the rapid resolution of the granuloma was thought have resulted from the high-dose double PPI treatment.

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Neuroendocrine tumors of the larynx are rare, comprising only about 0.5% of laryngeal tumors. These tumors are characterized by pathological and biological heterogeneity. Well differentiated carcinoid tumor is the rarest variety of laryngeal neuroendocrine neoplasms. This tumor most commonly appears as a submucosal lesion of the supraglottic larynx. As per our knowledge, this tumor has never been reported in the subglottis. In this article we describe a rare case of a well-differentiated carcinoid tumor of the larynx involving the subglottis.

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Microlaryngeal tracheal (MLT) tube, when inserted through nasal route, offers adequate space in front of the tube for proper vision, excision and hemostasis of vocal cord lesions in the anterior and middle third portions as compared to oral route. There is less risk of kinking of tube at the point of securing with skin and it provides easy instrumentation for exposure of oral cavity. MLT tube placed nasally lies in the posterior comissure of vocal cord between arytenoids, leaving anterior two-third or more unobscured.

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Unilateral vocal cord paralysis (UVCP) in children is a rare and challenging disorder for the pediatric otolaryngologist. The overall etiology differs from that in adults, iatrogenic causes are the commonest, followed by traumatic - birth or intubation trauma and neurologic causes. Prolonged spontaneous recovery occurs in up to 50% of cases. Management strategies used for adults have evolved and been utilized in children, with increasing reports of surgical intervention over the last decade. However, number of children treated remains small with no long-term follow-up. We used the terms "vocal cord palsy," "vocal cord paresis," "vocal fold immobility" each limited by "paediatric," "children," to search Medline, Embase, PubMed, Cochrane, and CINHAL. Reference lists were crosschecked to include relevant studies. Only English language literature was searched. Studies specifically relating to unilateral vocal cord or containing relevant data were identified and analyzed. We present our review of literature on pediatric UVCP with emphasis on various interventions for management, especially the growing experience with laryngeal re-innervation.

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Total laryngectomy (TL) results in the complete disconnection of the upper and lower respiratory tract, ceasing orthonasal airflow. Hence, olfaction and olfactory acuity are negatively impacted. Prior to the late 1990s, impaired olfaction was simply accepted as a negative consequence of TL surgery. However, a growing body of research conducted within this past decade has demonstrated that rehabilitation is possible with a simple and effective behavioral technique. The current review outlines the literature supporting the negative impact of altered olfaction on quality of life, details of known best practice methods for olfactory assessment both for research and clinical use, and outlines the evidence for interventions known to improve olfactory performance in the TL population. Intervention for olfactory impairment should be part of a holistic, evidence-based rehabilitation process for patients post-laryngectomy.

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