Kaza S, Rao TJM, Mikkilineni A, Ratnam GV, Rao DR. Ki-67 Index in Salivary Gland Neoplasms. Int J Phonosurg Laryngol 2016;6(1):1-7.

Benign vocal cord lesions cause significant dysphonia by disrupting the normal vibratory function of the vocal fold mucosa. Multidimensional assessment of voice characteristics allows for an accurate analysis of voice impairment and can be used to assess the outcome of different treatment modalities.

To evaluate the outcome in patients treated for benign vocal fold lesions using multidimensional voice assessment

Thirty adult patients with benign vocal fold lesions were treated according to standard protocols and followed up for 6 months. Voice was evaluated by visual analog scale (VAS), GRBAS (grade, roughness, breathiness, asthenia, strain) scale, maximum phonation time (MPT), S/Z ratio, and acoustic parameters using PRAAT. Pre- and posttreatment voice was compared.

Benign lesions observed were vocal polyps (16), vocal nodules (7), vocal fold cysts (5), vocal cord papilloma (1), and sulcus vocalis (1). Mean VAS rating improved from 7.5 to 2 at 3 months and 1.6 at 6 months. Mean GRBAS score improved from 7.5 to 2.96 at 3 months and 2.3 at 6 months. Maximum phonation time increased from 9.43 seconds to 14.16 seconds at 3 months and 14.46 seconds at 6 months. S/Z ratio reduced from 1.37 to 1.16 at 3 months and 1.15 at 6 months. Jitter reduced from 1.81 to 1% at 3 months and 0.97% at 6 months; shimmer decreased from 6.07 to 2.19% at 3 months and to 2.03% at 6 months. Harmonic-to-noise ratio values improved from 8.01 to 10.78 dB at 3 months and 10.96 dB at 6 months; mean F₀ increased from 207.27 to 217.89 Hz at 3 months and 219.65 Hz at 6 months.

A single measurement of voice cannot be used as a reliable outcome measure. Perceptual, aerodynamic, acoustic, and self-analysis together allow a multidimensional assessment of voice characteristics.

Virmani N, Sharma A, Dabholkar J. Outcome Analysis in Patients with Benign Vocal Fold Lesions. Int J Phonosurg Laryngol 2016;6(1):8-13.

Subglottic malignancies are rare. Most of these are predominantly squmous cell carcinoma and common in male. It is usually advanced when initially presented. This study was to analyze the clinical presentation, treatments, and outcomes of subglottic carcinoma.

The study was conducted in the Department of Otorhinolaryngology and Head Neck Surgery, Assam Medical College, Dibrugarh, Assam, India, between March 2014 and September 2015.

Of the three patients, two had lymph node metastasis and intralaryngeal involvements. The patients have been followed up till date. All the patients were tracheostomized and received radiotherapy and chemotherapy.

Subglottic carcinoma is relatively rare in comparison with supraglottic and glottic carcinoma. It is presented at advance stage and tend to spread larynx and other organs too.

Moran N. Subglottic Carcinoma: Treatments and Outcomes. Int J Phonosurg Laryngol 2016;6(1):14-16.

The aim of this study is to highlight the changing clinical patterns of laryngeal tuberculosis (TB) and to increase the awareness of this uncommon manifestation of extrapulmonary TB which will help the clinician in early diagnosis and appropriate management of this condition.

A retrospective analysis was done of 34 suspected cases of tubercular laryngitis who presented to our institution from January 2009 to December 2011. All of these patients were subjected to hematological tests, sputum microscopy, and radiological investigations.

Out of these 34 patients, hematological profile, sputum testing, and radiological profile was positive for TB in 13 patients who were started on antitubercular treatment. Out of 13, 1 patient had resolution of cough but persistent hoarseness and was diagnosed as having severe epithelial dysplasia. Twentyone patients were tested negative for TB and were diagnosed as chronic laryngitis (11), histoplasmosis (1), amyloidosis (2), sarcoidosis (1), and invasive squamous cell carcinoma (4). Primary laryngeal TB was diagnosed in two cases.

Laryngeal TB, though rare, is increasingly presenting to the otolaryngologists nowadays due to increase in the number of immunocompromised hosts and development of resistant microorganisms. It presents with nonspecific symptoms and can often be missed leading to delay in diagnosis and treatment. Starting empirical steroids without diagnosis may flare up the TB. It often mimics and occasionally may coexist with laryngeal malignancy. Thus the clinician should be vigilant and should always consider laryngeal TB as an important differential for laryngeal lesions.

Nerurkar NK, Singh S, Nerurkar R. Tubercular Laryngitis: A Rebirth?. Int J Phonosurg Laryngol 2016;6(1):17-19.

To generate base line data of different otorhinolaryngological manifestations of laryngopharyngeal reflux (LPR) disease in Uttar Pradesh, India.

Fifty cases were selected from OPD setup and diagnosed to be having LPR disease based on predefined inclusion and exclusion criteria. They were then explained the necessary details and purpose of the study and were subjected to further standard protocol. The patients with ear complaints were advised pure tone and impedance audiometry. The findings were charted and data extrapolated.

Among various complaints, the most common complaint was lump in the throat; others were frequent throat clearing, cough, choking, hoarseness, and excessive throat mucus. The nasal complaints were nasal discharge and blockage, and ear complaints were otalgia and hard of hearing

Laryngoscopy showed hyperemia of larynx and vocal fold edema, ventricular obliteration, laryngeal edema, posterior commissure hypertrophy, thick endolaryngeal mucus, pseudosulcus vocalis and vocal cord granulations. Nasal findings were rhinitis, congestion, and turbinate hypertrophy. Ear complaints had tube dysfunction. On upper gastrointestinal (UGI) endoscopy most of the patients had normal study; some showed esophagitis or hiatus hernia. Mean body mass index of the study population was in normal range.

Globus, a common presenting complaint in ENT outdoors is usually related to reflux. Reflux was found associated with Eustachian tube dysfunction and rhinitis. Results demonstrated that obesity and esophagitis are not associated with LPR.

This study investigated a range of parameters responsible for LPR disease. The understanding of the entity of LPR and its manifestations is far from being completely understood. Present-day thrust is in the direction of increasing importance of LPR being recognized in ENT practice. The results and their analyses created an important base line document for the population of the state of Uttar Pradesh (population about 200 million) and adjoining states who commonly call on the Sir Sunderlal Hospital, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.

Roy S, Jain RK. Diverged Otorhinolaryngological Manifestations of Reflux Disease in Indian Condition: A Base Line Data Generation. Int J Phonosurg Laryngol 2016;6(1):20-26.

The complex sensory motor activity of swallow consists of transferring food from the mouth to the stomach. Several evidences on swallow biomechanics reveal different tastes leading to variations in swallow. However, there exists dearth of studies exploring this area using simple noninvasive effective procedure like 100 mL water swallow test.

The present study focused to observe swallow ability across 100 mL neutral, sweet, salt, sour, and bitter liquids in healthy young adults.

A total of 30 healthy adults within the age of 18 to 23 years participated. All were given lukewarm neutral, sweet, sour, salt, and bitter tastes to swallow individually in a handheld 120 mL cup. Simultaneously, the clinician monitored total time taken to swallow and number of hyolaryngeal movements to calculate volume per swallow, time per swallow, and swallow capacity. Subjects also ingested 10 mL of each taste to estimate the taste threshold which were rated on a minima of 0- point to a maxima of 10-point visual analog scale.

Statistical test and repeated measures of Analysis of Variance (ANOVA) revealed no significance at 95% confidence level. However, clinical difference was noted with neutral taste having highest volume per swallow, increased swallow capacity, and least time per swallow. Following this, sweet taste had higher volume per swallow and swallow capacity while sour taste had increased time per swallow.

The present study helps in understanding the wide dynamic nature of swallow which modulates the physiology as per the bolus ingested.

Thejaswi D, Kunwar S, Mathew B. Contribution of Different Tastes on 100 mL Water Swallow Test. Int J Phonosurg Laryngol 2016;6(1):27-31.

Baruah R, Khaund G, Kalita A. Localized Laryngeal Amyloidosis. Int J Phonosurg Laryngol 2016;6(1):32-34.

Swallowing problems have significant subjective component. Their evaluation necessitates the use of questionnaires to know both the extent of symptoms and the effect on quality of life. Questionnaires should be designed to get maximum information with minimum trouble to the patient. Parkinson's disease (PD) involves swallowing disorder as a symptom, often unreported. Hence, this needs to be assessed separately.

This study aims to develop a questionnaire, in the vernacular, to check for the presence of swallowing problems in PD patients, and to study its reliability and validity.

We developed an 11-item questionnaire in English, modeled on the Tel Aviv swallowing disturbance questionnaire (SDQ), chosen for its brevity. This was translated into the vernacular (Malayalam, native tongue of the state of Kerala in India), and administered to patients (n = 106) attending the weekly PD clinic of a tertiary care center, in consultation with the attending neurologist in charge of movement disorder patients. The same questionnaire was also administered to age-matched controls (patients without any swallowing disorders; n = 63), attending the ENT, neurology, and geriatric clinics. The scores were documented and statistical analysis done, to check for internal reliability and validity.

Comparison of mean total scores between cases (2.89) and controls (1.51) showed a statistically significant difference indicating statistical validity (p = 0.009). Guttman's split-half correlation showed fairly good reliability for both cases (0.812) and controls (0.851).

The present questionnaire to assess dysphagia in PD patients was found to be reliable and valid for use. We recommend it as a screening tool in the neurology OPD.

Menon U, Radhakrishnan SK, Sundaram KR. Reliability and Validity of a Questionnaire to assess Swallowing Disorders in Parkinson's Disease Cases. Int J Phonosurg Laryngol 2016;6(1):35-39.

Varma A, Agrahari AK. An Unusual Presentation of Syringomyelia. Int J Phonosurg Laryngol 2016;6(1):40-41.

Gupta R, Sharma D, Minhas RS. Extramedullary Plasmacytoma of Soft Tissue Neck. Int J Phonosurg Laryngol 2016;6(1):42-46.

Mahore D, Kadam S, Rane SV, Paikrao Y. Surgical Management of Severe Case of Laryngomalacia. Int J Phonosurg Laryngol 2016;6(1):47-48.

John BT, Chandrasekharan R, Paul RR. Laryngeal Amyloidosis: A Rare Entity causing Hoarseness of Voice. Int J Phonosurg Laryngol 2016;6(1):49-51.