To introduce a simple diagnostic test performed with white light laryngoscopy for the diagnosis of sulcus vocalis.

This is a retrospective observational study. A total of 14 patients with voice-related complaints and a phonatory gap on examination were included. Obvious structural and neuromuscular glottic pathologies were excluded. Phonatory gap was measured using white light rigid laryngoscopy with the technique described here. Findings were then correlated with stroboscopy.

All 14 patients (10 U/L and 4 B/L), observed to have an asymmetric phonatory gap on white light rigid laryngoscopy, were diagnosed with sulcus vocalis.

An asymmetric phonatory gap, as seen on white light laryngoscopy and measured with the simple technique mentioned here, should make the laryngologist suspect a sulcus vocalis. However, the diagnosis needs to be confirmed by stroboscopy.

Nerurkar NK, Gupta HK, Shedge AE. Diagnostic Challenge of Sulcus Vocalis Made Easier. Int J Phonosurg Laryngol 2015;5(2):39-41.

The anatomical and physiological changes in the phonatory system due to aging have a major impact on voice. Widely researched parameters of voice like fundamental frequency and the perturbation measures have strong correlation with age. However, these measures depend on the location of the exact pitch pulses and it may yield unreliable results in case of a severely aperiodic voice. Also, harmonic measures of voice in healthy aging are scanty in the literature.

The present study focused on determining the changes in harmonic-related measures in healthy aging individuals using spectral amplitude measures.

The participants were classified into three groups as young, middle-aged, and elderly adults based on their age. All the participants were required to sustain three different types of vowels. Voice samples were analyzed using CSL software to obtain the spectral amplitude measures.

This showed that there was a decrease in spectral amplitude measures with aging.

Thus, suggesting that the harmonic structure of voice is not affected in healthy aged individuals. Vowel type and gender also influences the harmonic-related measures in the healthy aging population.

The results of the present study could be used by the voice clinicians while assessing adults with voice disorders. It will also help the clinicians in delineating the age and gender differences in the vocal parameters.

Monnappa D, Balasubramanium RK. Estimation of Spectral Amplitude Measures in Healthy Aged Individuals. Int J Phonosurg Laryngol 2015;5(2):42-47.

Recurrent laryngeal nerve (RLN) and superior laryngeal nerve (SLN) have been and continue to be the Achilles tendon of thyroidectomy. Many anatomical landmarks described and taught.

Prasad RG, Rao JVS, Hameed MAR. Pinch, Burn, Cut Parathyroid-sparing Thyroidectomy Saves Recurrent and Superior Laryngeal Nerves (Conventional, PBC and Harmonic Scalpel Techniques Compared). Int J Phonosurg Laryngol 2015;5(2):48-52.

Larynx is a complex organ with various subsites and a myriad of pathologies. Atypical presentations of laryngeal cancers are rare with literature only in the form of case reports or series with small number of patients.

It is important to recognize rare presentations of laryngeal carcinomas in order to pre-empt misdiagnosis and execute an appropriate treatment plan.

We present a case series of four such atypical presentations which were managed with precise and individualized approaches.

Three patients with rare manifestations of laryngeal squamous cancers were treated surgically in view of gross exolaryngeal spread. Single case of melanoma was treated with chemoradiation followed by surgical salvage.

All four patients were identified through adequate diagnostic precision on part of the clinician.

The form and function of the larynx are crucial to the quality of life of a patient. Laryngeal carcinomas require appropriate treatment approach to ensure the same. The clinician needs to be aware of these atypical presentations as well in order to diagnose and treat these patients effectively.

Dabholkar J, Kapre NM, Bihani A. Atypical Presentations of Laryngeal Cancers: Diagnostic and Treatment Dilemmas. Int J Phonosurg Laryngol 2015;5(2):53-56.

To establish posterior commissure hypertrophy as tool to diagnose laryngopharyngeal reflux (LPR) and to determine whether it can be used as a reliable marker for response to treatment.

A prospective study of 100 patients with voice disorder was conducted. Patients were evaluated using reflux symptom index (RSI) and reflux finding score (RFS) by 70° Hopkins’ rigid laryngoscope. Those patients in whom RFS score was 7 or more were diagnosed to have LPR. These patients were then started on antireflux therapy along with lifestyle modification and were evaluated regularly over a period of 6 months.

The prevalence of LPR in patients with voice disorders was found to be 25%. Mean age was 41.48 years and the male and female ratio was 0.85:1. Posterior commissure hypertrophy was present in 60 out of 100 patients (60%). Among laryngopharyngeal reflux disease (LPRD), 23 out of 25 patients (92%) had posterior commissure hypertrophy, out of which only 2 (8.6%) patients showed complete resolution of posterior commissure hypertrophy after 6 months of treatment. A total of 10 patients (43.47%) did not show any change in grading of posterior commissure hypertrophy. And 11 patients (47.82%) showed downgrading of posterior commissure hypertrophy. Sensitivity of posterior commissure hypertrophy for diagnosis of LPR was found to be 92%, whereas specificity was 50.66%.

Posterior commissure hypertrophy can be used as a screening tool for diagnosis of LPR but cannot be used reliably as a clinical marker for response to therapy.

Joshi AA, Chiplunkar BG, Bradoo RA, Shah KD. Posterior Commissure Hypertrophy as Diagnostic and Prognostic Indicator for Laryngopharyngeal Reflux. Int J Phonosurg Laryngol 2015;5(2):57-60.

Eustachian tube catarrh could be due to laryngopharyngeal reflux besides other causes.

To assess gastroesophageal reflux disease (GERD) in patients with Eustachian tube catarrh and the effect of proton pump inhibitors on symptoms of Eustachian tube disease.

A total of 50 patients were selected with symptoms of Eustachian tube catarrh and evaluated prospectively in the ENT Outpatient Department of the Pondicherry Institute of Medical Sciences, Puducherry.

The group consisted of 15 (30%) males and 35 (70%) females. The largest group was of the age of 45 years and above (44%). The most common symptom of Eustachian tube catarrh was itching (84%), followed by otalgia (76%) and popping sensation on swallowing (74%). On otoscopic examination, the commonest grade of tympanic membrane retraction was grade I (57%), on tympanometry 90% of cases had middle ear pressure in range −100 to +100. The middle compliance ranged from 0.5 to 1.75 (normal) in 86% of the cases. The tympanomeric curve was type A (normal) in 78% of the cases and type C in 8% of the cases. At the end of 4 and 8 weeks, the response of treatment to proton pump inhibitors was significantly higher (z = 3.53, p < 0.05) in the studied group.

Laryngopharyngeal reflux (LPR) could be an important etiological factor in Eustachian tube catarrh. The treatment, with proton pump inhibitors, of Eustachian tube catarrh with no local identifiable cause, could be very useful to this subsect of patients.

Bhargava A, Cherian M, Cherian TA, Gupta S. Gastroesophageal Reflux Disease in Patients with Eustachian Tube Catarrh. Int J Phonosurg Laryngol 2015;5(2): 61-66.

Lodha J, Sharma A, Dabholkar J, Virmani N. Unusual Presentation of Laryngeal Cavernous Hemangioma. Int J Phonosurg Laryngol 2015;5(2):67-69.

Rangappa VB, Hedne CN, Chauhan S, Naveen BS. Laryngotracheal Pleomorphic Adenoma: A Rare Entity. Int J Phonosurg Laryngol 2015;5(2):70-72.