Granular Cell Tumors of the Larynx: Diagnosis and Management

In this case study, a retrospective review of chart and literature was done to discuss the presentation and treatment of granular cell tumors of the larynx. One patient was diagnosed and treated successfully with surgical resection of a laryngeal granular cell tumor. Excellent voice recovery was obtained and there is no evidence of recurrence 6 months after surgery. Granular cell tumors should be considered in the differential diagnosis of laryngeal masses, particularly in the posterior glottis.     

Practice parameter: laryngeal electromyography (an evidence-based review)

This paper reports on an evidence-based review of laryngeal electromyography (EMG) as a technique for use in the diagnosis, prognosis, and treatment of laryngeal movement disorders, including the laryngeal dystonias, vocal fold paralysis, and other neurolaryngological disorders. The authors performed a systematic review of the medical literature from 1944 through 2001 on the clinical application of EMG to laryngeal disorders. Thirty-three of the 584 articles met the predefined inclusion criteria. The evidence demonstrated that in a double-blind treatment trial of botulinum toxin versus saline, laryngeal EMG used to guide injections into the thyroarytenoid muscle in persons with adductor spasmodic dysphonia was beneficial. A cross-over comparison between laryngeal EMG-guided injection and endoscopic injection of botulinum toxin into the posterior cricoarytenoid muscle in abductor spasmodic dysphonia found no significant difference between the two techniques and no significant treatment benefit. Based on the evidence, laryngeal EMG is possibly useful for the injection of botulinum toxin into the thyroarytenoid muscle in the treatment of adductor spasmodic dysphonia. There were no evidence-based data sufficient to support or refute the value of laryngeal EMG for the other uses investigated, although there is extensive anecdotal literature suggesting that it is useful for each of them. There is an urgent need for evidence-based research addressing other applications in the use of laryngeal EMG for other applications.     

Treatment of spasmodic dysphonia (laryngeal dystonia) with local injections of Botulinum toxin

In 1984 the authors performed the first laryngeal injection of Botulinum toxin for laryngeal dystonia via percutaneous, electromyographically guided technique. Since that time we have treated 450 patients with adductor spasmodic dysphonia, abductor spasmodic dysphonia, and adductor breathing dystonia. In general, the adductor patients received bilateral injections of 1.25 U to 3.75 U, obtaining greater than 90% of normal voice. The abductor patients received unilateral or staged bilateral injections of the posterior cricoarytenoid muscles with 0.6 to 3.75 U, obtaining 70% of normal function. We have found laryngeal injections of Botulinum toxin to be safe and effective therapy for the symptoms of laryngeal dystonia (spasmodic dysphonia).     

人体肿瘤组织的拉曼光谱相关系数成像

运用逐点扫描(Scanning)采谱技术,测量了人体乳腺肿瘤组织的阵列拉曼光谱集(Mapping);利用自编的软件,分析和计算了该谱集与参考谱DNA、细胞质等拉曼谱的相关系数;并将其映射为灰度值,构建了点阵的相关系数成像。结果表明,相关系数成像较好地反映了参考谱所代表的生化成分的分布;DNA谱与组织中其他成分谱的相关性很小,因此DNA谱的相关系数成像能够直接地反映成像区域DNA的分布,可信度尤其高。该研究结果为进一步研究乳腺肿瘤的拉曼诊断方法奠定了一定基础。     

Voice range in superior laryngealnerve paresis and paralysis

Evaluation of Physiologic Frequency Range (PFR) and Musical FrequencyRange (MRP) of Phonation was performed on 56 adults (singers and nonsingers) presenting with superior laryngeal nerve (SLN) paresis or paralysis confirmed by laryngeal electromyography. The most common etiology was neuritis (69.7%), followed by iatrogenic and unlcnown causes,each accounting for 10.2 % of cases, and finally trauma (8.9%). Both female and male singers with SLN paresis or paralysis had significantly higher PFR and MPR than nonsingers. Female classical singers presented PFR and MPR of up to 10 semitones (ST) higher than nonclassical singers and nonsingers. The lowest PFR and musical ranges were found in patients with SLN paresis associated with recurrent laryngeal nerve paresis or paralysis. The authors suggest that voice range measurement is a useful parameter for analyzing the effects of SLN paresis or paralysis on voice and that it may also assist in measuring outcome following voice therapy.     

Arytenoid Cartilage Dislocation: A 20-year Experience

SUMMARY: Arytenoid cartilage dislocation is an infrequently diagnosed cause of vocal fold immobility. Seventy-four cases have been reported in the literature to date. Intubation is the most common origin, followed by external laryngeal trauma. Decreased volume and breathiness are the most common presenting symptoms. We report on 63 patients with arytenoid cartilage dislocation treated by the senior author (RTS) since 1983. Significantly more posterior than anterior dislocations were represented. Although reestablishing joint mobility is difficult, endoscopic reduction should be considered to align the heights of the vocal processes. This process may result in significant voice improvement even long after the dislocation. Strobovideolaryngoscopy, laryngeal electromyography, and laryngeal computed tomography (CT) imaging are helpful in the evaluation of patients with vocal fold immobility to help distinguish arytenoid cartilage dislocation from vocal fold paralysis. Familiarity with signs and symptoms of arytenoid cartilage dislocation and current treatment techniques improves the chances for optimal therapeutic results.     

Phase transition in tumor growth: I avascular development

We propose a mechanism for avascular tumor growth based on a simple chemical network. This model presents a logistic behavior and shows a “second order” phase transition. We prove the fractal origin of the empirical logistics and Gompertz constant and its relation to mitosis and apoptosis rate. Finally, the thermodynamics framework developed demonstrates the entropy production rate as a Lyapunov function during avascular tumor growth.     

微环境促进的侵袭性肿瘤生长的元胞自动机模拟

肿瘤的侵袭和转移行为, 常常是导致病人的死亡的原因. 而人们对这些由复杂的肿瘤宿主以及肿瘤细胞与细胞之间相互作用而产生的群体性行为知之甚少. 对这一过程了解的加深, 需要多学科间的合作. 在本篇文章中, 作者将简要回顾肿瘤物理领域的一种新手段, 即近年来由作者参与的通过元胞自动机(CA)模型来研究微环境促进的实体瘤侵袭性生长的研究, 该模型整合了一系列微观的肿瘤宿主相互作用, 包含了肿瘤细胞对细胞外基质的降解, 肿瘤细胞趋向养分的迁移, 肿瘤生长导致的局部组织压力累积以及该压力对局部的肿瘤宿主界面稳定性的影响, 并且, 肿瘤生长时细胞间的粘连也被明确地考虑进来. 该元胞自动机模型能成功地重现出一系列的标志性的肿瘤侵袭行为, 这有力地表明出该模型的有效性和预测能力. 这一模型, 如果能与临床数据结合, 理论上能够拓展从医学数据中得到的现有结论, 帮助设计新的实验, 检验假说, 并且在实验难以检测到的情形下, 预测肿瘤的行为, 协助癌症的早期诊断和预后, 并针对不同病人, 提出最优的个体化医疗方案.     

Prolonged Ulcerative Laryngitis

Acute and prolonged laryngitis commonly are diagnosed and treated by primary care physicians. These ailments come to the attention of the otolaryngologist when symptoms are prolonged despite treatment. Since the beginning of 1991, the senior authors (RTS, JRS) have recognized a clinical syndrome defined by prolonged hoarseness, prolonged laryngeal inflammation, and vocal fold ulceration. Patients are frequently young, nonsmokers, and nondrinkers who have had an upper respiratory infection prior to, or associated with, the onset of laryngeal symptomatology. Patients may be affected for up to 1 year despite aggressive medical therapy. This review of 14 patients highlights the features of this previously undescribed entity.     

Nonlinear behavior of vocal fold vibration: The role of coupling between the vocal folds

Coupling between the vocal folds is one of the nonlinear mechanisms allowing regulation and synchronization of mucosal vibration. The purpose of this study was to establish that modulations such as diplophonia and abnormalities observed in vocal signals that may be observed in some cases of laryngeal pathology can be considered as nonlinear behavior due to the persistence of some physical interaction (coupling). An experimental model using excised porcine larynx was designed to create tension asymmetry between the vocal folds and to obtain vocal signals with modulations. Signals were analyzed by spectral analysis and the phase portrait method. Results were compared with computer-generated synthetic signals corresponding to nonlinear combinations of sinusoid signals. Under these conditions, evidence of nonlinear behavior was detected in 85% of experimental signals. These findings were interpreted as a demonstration of vocal fold interaction. Based on these findings, the authors conclude that (1) coupling must be taken into account in physical models of laryngeal physiology, and that (2) methods of nonlinear dynamics may be used for objective voice analysis.     

肿瘤周边组织拉曼光谱的模糊模式识别研究

基于模糊模式识别的基本理论,阐述了肿瘤周边组织拉曼光谱的预处理、特征提取和选择,根据这些特征改进了梯形分布的偏大型隶属函数,在40例样本的基础上建立了肿瘤周边组织拉曼光谱对恶性肿瘤的隶属函数,并根据此函数进行了分类器的训练学习,经过另40例样本的测试,恶性肿瘤的识别率为82.4%,非恶性肿瘤的识别率为73.9%,识别效果较为理想.     

Granular cell tumors of the larynx

Granular cell tumor is a rare neoplasm that may involve the larynx. It is almost always benign. Laryngologists should be familiar with this unusual tumor, its implications and appropriate treatment.     

Laryngeal Chondroma

Cartilaginous tumors of the larynx represent less than 1% of laryngeal tumors. Chondroma and "low-grade" chondrosarcoma are the most common; 70%-75% of these tumors arise on the endolaryngeal surface of the posterior lamina of the cricoid cartilage. The clinical presentation is varied and directly dependent on the size and location of the tumor; stridor, hoarseness, dyspnea, or a neck mass are common presenting signs. CT scanning in the axial plane is the mainstay of radiographic imaging due to its ability to show size, extent of the tumor, and invasion into surrounding structures. Surgical extirpation is the standard therapy with no role for radiation therapy or chemotherapy. Although significant recurrence rates have been reported, there is not a significant difference between initial conservative therapy followed by salvage therapy versus initial radical therapy.     

Acoustic roles of the laryngeal cavity in vocal tract resonance

The acoustic effects of the laryngeal cavity on the vocal tract resonance were investigated by using vocal tract area functions for the five Japanese vowels obtained from an adult male speaker. Transfer functions were examined with the laryngeal cavity eliminated from the whole vocal tract, volume velocity distribution patterns were calculated, and susceptance matching analysis was performed between the laryngeal cavity and the vocal tract excluding the laryngeal cavity (vocal tract proper). It was revealed that the laryngeal cavity generates one of the formants of the vocal tract, which is the fourth in the present study. At this formant, the resonance of the laryngeal cavity (the 1/4 wavelength resonance) induces the open-tube resonance of the vocal tract proper (the 3/2 wavelength resonance). At the other formants, on the other hand, the vocal tract proper acts as a closed tube, because the laryngeal cavity has only a small contribution to generating these formants and the effective closed end of the whole vocal tract is the junction between the laryngeal cavity and the vocal tract proper.     

Objective Voice Measures in Nonsinging Patients With Unilateral Superior Laryngeal Nerve Paresis

The clinical value of objective voice measures in nonsinging patients with superior laryngeal nerve dysfunction is unknown. In this study, patients with symptomatic unilateral superior nerve paresis were evaluated for maximum phonation time, frequency range of phonation, and mean flow rate. Patients with coexisting pathology, bilateral superior nerve paresis, and those with recurrent laryngeal nerve paresis were excluded from this analysis. A total of 35 nonsinging patients, 14 men and 21 women, with unilateral superior laryngeal nerve paresis were examined between 1999 and 2002. The severity of superior laryngeal nerve paresis ranged from 25% to 85% of normal recruitment with a mean of 70% superior laryngeal nerve recruitment in men and 65% in women by electromyography. In both men and women with superior laryngeal nerve paresis, the maximum phonation time and frequency range of phonation were decreased and the mean air flow rate was increased when compared with normal population values. The jitter percent, shimmer percent, and noise-to-harmonic ratio were also increased in patients when compared with normative data. Selected objective voice measures are abnormal in voice patients with superior laryngeal nerve paresis, which suggests that the measures may be useful as outcomes measures after therapy. More research is encouraged.     

早期乳腺肿瘤的超宽带微波稳健波束形成成像检测系统

提出了一种基于自主设计小型超宽带天线的微波稳健波束形成(RCB)成像肿瘤检测系统.仿真结果表明,该检测系统对肿瘤反射信号有很高的敏感度.在简单平面模型和核磁共振成像图(MRI)导出模型中进行仿真检测实验,并将天线阵列接收信号用RCB算法进行成像处理.从乳房重构图像中能够得到正确的肿瘤位置及大小信息,实现了平面模型中最小直径3 mm和MRI导出模型中最小直径4 mm的肿瘤检测,证实了该检测系统用于早期乳腺肿瘤检测的可行性.     

Odor Provocation Test for Laryngeal Hypersensitivity

This study was to present an odor provocation/challenge test for laryngeal hypersensitivity in a suspected odor induced dysphonic patient. The second aim was to rule out secondary gain from organic laryngeal hypersensitivity. Two steps were taken for this purpose. First, because the evaluation of hypersensitivity may be affected by the perception of odor, the study investigated laryngeal hypersensitivity during nasal and oral breathing separately to disentangle possible cognitive reactions to odors. Second, a healthy control (HC) participant was used with the identical testing protocol for nasal breathing to minimize unbiased results. The HC's response to nasal breathing of the odors showed no response to all the stimuli. The participant with possible secondary gain issues responded differently to the odors when presented nasally versus orally. Oral breathing showed less severe and less frequent laryngeal hypersensitive reactions. This suggests that laryngeal hypersensitivity was either due to the odor, cognitive information, sensory changes in olfaction leading to psychological conditioning, or for any possible secondary gain. Hence, it is difficult to indicate the precise reason (cause and effect) for the participant's laryngeal hypersensitivity; however, this study describes the first structured, controlled, repeatable, and randomized design to investigate odor induced laryngeal hypersensitivity and decipher possible secondary gain from true laryngeal hypersensitivity.     

肿瘤组织自体荧光光谱测量与分析

首先介绍了对人工培养鼠肿瘤组织的激光诱导荧光光谱的实验测量结果，并与同一机体正常组织的自体荧光光谱进行了比较，然后对肿瘤组织自体荧光的来源，与正常组织光谱特征差异的本质进行了详细分析，从而得出结论，生物组织自体荧光光谱能够反映肿瘤组织的特异性，可以作为组织诊断的依据。     

乳腺肿瘤周边组织的拉曼光谱研究

使用REMSHAW显微共焦拉曼光谱仪测量了40例手术切除乳腺肿瘤周边(肿块边约5 mm)组织的拉曼光谱.通过对浸润性导管癌、乳腺增生、纤维腺瘤等乳腺肿瘤周边组织的拉曼光谱分析,发现不同乳腺肿瘤周边组织的拉曼光谱有显著差异.这些差异在肿瘤诊断中,可作为乳腺癌和其他乳腺肿瘤拉曼光谱的特征,为乳腺疾病诊断提供依据.乳腺肿瘤周边组织的拉曼光谱对乳腺肿瘤诊断具有重要的价值.     

The Value of Laryngeal Electromyography in the Evaluation of Laryngeal Motion Abnormalities

SUMMARY: Laryngeal electromyography (EMG) functions routinely as a prognostic tool in the evaluation of vocal fold paralysis, as a guide for therapeutic injections into the laryngeal muscles, and more recently as an assessment tool in the evaluation of vocal fold paresis. This study investigates the clinical utility of laryngeal EMG as a diagnostic aid in the evaluation of movement disorders of the larynx in patients complaining of dysphonia. A retrospective chart review of all laryngeal EMGs performed at a tertiary laryngology referral center over a 13-month period was performed. All laryngeal EMGs were performed to evaluate laryngeal motion abnormalities in dysphonic patients. Thirty-seven laryngeal EMGs were completed during this study period. Analysis of the data revealed that the medical treatment plan changed as a result of findings on laryngeal EMG in 10/37 patients (27.0%); laryngeal EMG guided and/or confirmed the course of treatment in 12/37 patients (32.4%) and did not change the treatment plan in 15/37 patients (40.5%). Laryngeal EMG is a useful diagnostic tool that, in this study, contributed significantly to and helped guide the evaluation and management of motion disorders in the larynx of dysphonic patients.