A prospective study was designed to characterize patients with typical and extraesophageal reflux (EER) symptoms and seek predictive patterns for each group. Fifteen subjects without symptoms, 16 patients with symptomatic gastroesophageal reflux disease (GERD), and 37 patients with symptomatic EER were evaluated with outcomes tools, videolaryngoscopy, and 24-hour triple-probe pH monitoring. Higher symptom scores, Voice Handicap Index scores, and Gastrointestinal Symptom Rating Scale scores, as well as similarly decreased quality of life as measured by the Short Form 36, were noted among the two symptomatic groups. Patients with clinically diagnosed EER were more likely to have multiple abnormalities on laryngoscopy. There was a trend toward more pharyngeal reflux episodes in EER patients (6.9 +/- 8.9) as compared to GERD patients (6.0 +/- 9) and asymptomatic subjects (1.1 +/- 1.9). On the basis of the pH monitoring of asymptomatic subjects, we define pathological pharyngeal reflux as more than 5 episodes in 24 hours. Pharyngeal acid exposure is more common in patients presumed to have EER, but some pharyngeal reflux does occur in asymptomatic subjects. Neither symptom scores nor videolaryngoscopic findings were predictive of pathological EER as indicated by pH monitoring.
There is no consensus on the ideal management of premalignant lesions of the larynx. Published reports describe the use of mucosal stripping, microsurgical techniques, CO2 laser excision and ablation, and even conservation laryngeal surgery and radiotherapy. We performed a retrospective evaluation of 43 men and 11 women who underwent serial excision of dysplastic lesions with the microflap technique between 1990 and 2001. The average age of the patients was 57.2 years; 64% had a history of cigarette smoking, and 46% a history of alcohol consumption. The lesions were located on the middle part of the left vocal fold in 65% and on the mid-portion of the right vocal fold in 66%. The patients were followed for an average of 4.4 years. Of the 20 patients with severe dysplasia or carcinoma in situ treated with the microflap technique, only 1 progressed to invasive disease. Overall, there was a reduction in the severity of dysplasia after each procedure (p = .0008). The microflap technique reliably reduced the severity of dysplastic lesions of the vocal fold and was effective in local disease control.
Cases of LLS are extremely rare. Because the histologic changes are frequently subtle, LLS can be easily mistaken for a benign tumor. As a result, the diagnosis requires a high index of suspicion and diligence in examining biopsy specimens. Computed tomography and magnetic resonance imaging can assist in the diagnosis and surgical approach. Genetic and immunostaining analysis techniques may also prove to have valuable prognostic, diagnostic, and therapeutic implications for this disease. Wide surgical excision is the mainstay of treatment. The use of radiotherapy and chemotherapy in treating this cancer remains experimental, but might be considered on a case-to-case basis for palliation or to treat aggressive variants of the disease.
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