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Laryngopedia

To educate about voice, swallowing, airway, coughing, and other head and neck disorders

Laryngopedia By Bastian Medical Media

Multimedia Encyclopedia


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Hemilaryngectomy

A surgical procedure that removes part of the front of the larynx. Typically, a hemilaryngectomy is done in order to remove a cancerous growth. This procedure was once the primary treatment option for medium and large vocal cord cancers that could not be removed by endoscopic (through the mouth) laser. Today, when laser cannot be used because of patient preference or anatomical difficulty, chemotherapy and radiation therapy are usually attempted first. The biggest role for hemilaryngectomy now seems to be for carefully selected tumors (in the earlier stages, T1 through large T2) that have persisted or recurred after initial treatment of radiation therapy with or without chemotherapy.

In a hemilaryngectomy, the surgeon removes part of the thyroid cartilage, including the underlying vocal cord or cords. The extent of removal varies from procedure to procedure. In fact, the term “hemilaryngectomy” is somewhat misleading; “hemi” means “half,” but most hemilaryngectomies remove much less than half of the larynx. A very minimal procedure might only remove most of one side of the thyroid cartilage with the underlying soft tissue but not touch the arytenoid cartilage. On the other hand, a very extensive procedure might remove most of both sides of the thyroid cartilage, leaving the patient with only one arytenoid. Many other procedures would fall on a spectrum between these two extremes.


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Hemorrhagic Polyp

A vocal polyp that looks like a “blood blister” on the vocal cord. A hemorrhagic polyp may occur because of acute vocal trauma—sudden and extreme overuse of the voice—and may result in abrupt and fairly severe hoarseness that is persistent. In time, the blood may resorb and leave a translucent polyp; this kind of polyp may be prone to re-bruising intermittently.

Small hemorrhagic polyps may heal on their own, but usually require many months to do so. Larger ones should be surgically removed. Fortunately, the prognosis for full recovery after surgery is excellent.


Photos:

Hemorrhagic polyp

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Large hemorrhagic polyp right vocal fold

Hemorrhagic polyp (1 of 2)

Large hemorrhagic polyp right fold, with large polypoid nodule and vascularity, left fold, during breathing (Lab).
Hemorrhagic polyp

Hemorrhagic polyp (2 of 2)

Same patient during phonation, showing now faint bruise anterior part of left-sided lesion (Lab).













Videos:

Hemorrhagic Polyp: Before and After
Watch the story of a young man with a hemorrhagic vocal cord polyp. Listen to his voice and see his larynx both before and after surgical removal.


Hertz

Hertz is the term (symbol Hz) used by physicists and many voice clinicians as a unit of frequency. One hertz means “one cycle per second.” Thus, 440 Hz in a musical tone is called “concert A,” also known as A4 or “A above middle C.” This means that the vocal folds are vibrating at 440 cycles per second in order for the human ear to hear “A4.”



Histology

Histology is the study of the microscopic structure of tissue. In clinical medicine, this kind of study is typically done by a pathologist on a biopsy specimen.



Histoplasmosis

Infection by a fungal organism, Histoplasma capsulatum. This organism is found in soil, especially in areas contaminated by bird or bat droppings. Sometimes it is called “spelunker’s disease,” and it seems to be commoner in the Mississippi River valley than in other areas of the United States. Persons who contract this organism may not even know it, as they may have a self-limited, mild, flu-like syndrome. As with many infections, histoplasmosis can of course be more severe and even disseminated in persons who are immunocompromised. Transmission is primarily respiratory, and the primary target is the lungs, where it can cause non-progressive granulomas. It is quite rare in the larynx.


Photos:

Histoplasmosis of the larynx: Series of 4 photos

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inflamed vocal cords

Unexplained hoarseness (1 of 4)

Unexplained severe hoarseness of several months’ duration. The marked inflammatory change does not look neoplastic, yet a biopsy seemed mandatory. The pathologist’s answer? Histoplasmosis.
Histoplasmosis in the subglottis

Subglottis (2 of 4)

Note as well the involvement in the subglottis. The patient began a long course of the antifungal, itraconazole.
healed vocal cords

3 months later (3 of 4)

Still on itraconazole 3 months later, the vocal cords have healed to a great extent, and voice, while continuing to be hoarse, is at least functional. In this narrow band view, healing is indicated partly by neovascularization.
subglottic lesion

Signs of healing (4 of 4)

The subglottic lesion is also showing signs of healing as compared with photo 2.


History of the Present Illness

History of the present illness refers to the “story line of the problem” for which a patient is seeing a physician or other healthcare provider. Information sought includes such things as time of onset, symptoms, prior treatments and results, and so forth. The history may be provided by the patient or family members. During a voice-focused history, the information most relevant to the diagnostic process is carefully sought and organized.



Human Papillomavirus (HPV)

A DNA virus that may cause cutaneous warts, genital warts, or the clinical condition recurrent respiratory papillomatosis (RRP) in susceptible individuals. Human papillomavirus (HPV) may occur in as many as 150 or more subtypes. The most common subtypes seen in patients with RRP are HPV 6 and 11. Other less common subtypes that can induce papillomas or other growths within the larynx include HPV 16, 18, 31, 44, 45, 55, 69, 84 & 11, 33 & 45 and some of these subtypes are associated with a higher risk of cancer formation. See the photo series below, displaying all of the subtypes mentioned above.

Common Questions About HPV

Q:  What is the relationship between the terms RRP, HPV, and Papilloma?

A:  The underlying disorder is HPV (human papilloma virus) infection of the airway, especially the larynx.  The virus “sets up house” chronically inside airway and stimulates a kind of proliferation called papillomas, or papillomatosis.  Because these lesions tend to recur after surgical removal, the clinical syndrome has become referred to as recurrent respiratory papillomatosis (RRP).

Q:  HPV apparently has different subtypes.  What can you tell me about them?

A:  Human papilloma virus infection can consist of as many as 150 different subtypes.  Some are related to skin infection (causing warts).  Some are more common in genital or respiratory sites.  Genital lesions are typically called condylomata, or genital warts.  In the airway, the lesions are typically called papillomas.  Commonest subtypes in the airway are types 6 and 11.  These two subtypes comprise the vast majority of our patients at BVI.  We have patients who have also tested positive for types 16, 18, 45, 55, and a few others.

Q:  I have a low-risk subtype of HPV.  Can you explain what this means?

A: The human papilloma virus (HPV) comes in 150 or more subtypes.  Think of it like the many models of automobiles that all fall under the designation “Ford.”  Subtypes found most often in the respiratory and genital tracts are 6 and 11.  HPV infection is associated with some degree of risk of stimulating, or converting to, a carcinoma.  Hence the higher risk of cervical cancer in women with HPV infection.  Some subtypes are considered to have a low risk of viral carcinogenesis; others have a high risk.  At BVI, the majority of our many adult patients have 6 or 11, both of which are low-risk subtypes.  We also have one or two who have both 6 and 11.  Then we have a handful of patients with intermediate or high risk for cancer.  A few of these high-risk subtypes have in fact caused cancers in our population of ~150 adult patients  with RRP.  Thankfully, all have responded well to treatment and none to my memory have died from their cancer.


Photos:

Subtype 6

More common subtype seen in the airway. HPV 6 is associated with a lesser risk of cancer formation, as is HPV 11.








Subtype 11

One of the more common subtypes seen in the airway. HPV 11 is associated with a lesser risk of cancer formation, as well as HPV 6.





Subtype 16

Less common in the airway than the more common subtypes 6 and 11. HPV 16 is associated with a higher risk of cancer formation, along with HPV subtypes 18, 31, 45, 55, and others.




Subtype 18

This is less common in the airway than the more common subtypes 6 and 11. HPV 18 is associated with a higher risk of cancer formation, along with HPV subtypes 16, 31, 45, 55, and others.



Subtype 31

This is less common in the airway than the more common subtypes 6 and 11. HPV 31 is associated with a higher risk of cancer formation, along with HPV subtypes 16, 18, 45, 55, and others.





Subtype 44



Subtype 45

This subtype is less common in the airway than the more common subtypes 6 and 11. HPV 45 is associated with a higher risk of cancer formation, along with HPV subtypes 16, 18, 31, 55, and others.




Subtypes 33 & 45



Subtype 55

This subtype is less common in the airway than the more common subtypes 6 and 11. HPV 55 is associated with an intermediate degree of risk of cancer formation, as compared to other subtypes of HPV.



Subtype 69



HPV 84 & 11




Hypopharyngeal stenosis

Narrowing of the entrance to the upper esophagus, at the junction of the throat and esophagus. Hypopharyngeal stenosis is a possible but uncommon complication for individuals with larynx or pharynx cancer who undergo radiation therapy as part of their treatment regimen.


Photos:





Videos:

Post-Radiation Hypopharyngeal Stenosis


Hypopharynx

The inferior-most part of the pharynx, made up of the pyriform sinuses, the lowest part of the posterior pharyngeal wall, and the post-arytenoid/post-cricoid areas.



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