Primary Laryngeal Lymphoma and Voice Hoarseness: A Rare Etiology for A Common Clinical Feature

 

Abstract

Primary Laryngeal Lymphoma is rare both as a hematological and as a laryngeal malignancy. Unlike squamous cell carcinomas, lymphomas require chemo-radiotherapy as 1st-line treatment. A 67-year-old lady presented with voice hoarseness, dyspnea and dysphagia for solids. An otherwise unremarkable physical showed “hot-potato like” voice. Labs were normal, while laryngoscopy and CT revealed an epiglottic mass, which was resected. Biopsy results showed DLBCL. The patient then underwent chemotherapy with complete success. Voice hoarseness has a vast differential diagnosis depending on its character and complementary symptoms. Less than a 100 cases of Primary Laryngeal Lymphoma have been reported in the literature, proving the rarity of this clinical entity.

Keywords:Primary laryngeal lymphoma; voice hoarseness; diffuse large B-cell lymphoma; larynx; lymphoma; epiglottis; dysphagia; dyspnea; “hot-potato like” voice

Abbreviations:CT: Computed Tomography; PET-CT: Positron Emission Tomography- Computed Tomography; NHL: Non-Hodgkin Lymphoma; ECOG: Eastern Cooperative Oncology Group; WBC: White Blood Cells; NEU: Neutrophils; LYM: Lymphocytes; MONO: Monocytes; EOS: Eosinophils; BASO: Basophils; RBC: Red Blood Cells; Hgb: Hemoglobin; Hct: Hematocrit; MCV: Mean Corpuscular Volume; MCH: Mean Corpuscular Hemoglobin; PLT: Platelets; ESR: Erythrocyte Sedimentation Rate; LFTs: Liver Function Tests; AST: Aspartate Transaminase; ALT: Alanine Transaminase; γ-GT: Gamma-glutamyl transferase; Bil: Bilirubin; dBil: Direct bilirubin; iBIl: Indirect bilirubin; Cr: Creatinine; BUN: Blood Urea Nitrogen; Glu: Glucose; Alb: Albumin; TC: Total Cholesterol; TGL: Triglycerides; LDH: Lactate Dehydrogenase; CRP: C reactive protein; DLBCL: Diffuse large B-cell lymphoma; LPR: Laryngopharyngeal Reflux; NK: Natural Killer Cells; R-CHOP: Rituximab, Cyclophosphamide, Andriamycin, Oncovin, Prednisone; HD-MTX: High Dose Methotrexate; CNS: Central nervous system; SCC: Squamous Cell Carcinoma; MALT: Mucosa-Associated Lymphoid Tissue; EBV: Eibstein Barr Virus; BMI: Body Mass Index

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Gustatory Dysfunction in Covid 19 Patients: A Cross Sectional Study

 

Abstract

Background: Loss of smell and taste are considered potential discriminatory symptoms indicating triaging for coronavirus disease 2019 (COVID-19) and early case identification. However, the estimated prevalence essential to guide public health policy varies in published literature.

Methods: The prospective study evaluated 100 individuals with a COVID-19 infection, as confirmed by Reverse transcriptase PCR laboratory testing. Olfactory and gustatory testing were carried out by an examiner utilizing stringent safety standards and wearing full personal protective equipment.

Results: Among the 100 patients included in this study, 54% were male and 46% were female with a mean age of 38.82±12.21 years (18-72). Among the 100 patients included in this study, 13 patients had isolated taste dysfunction, 16 patients had isolated olfactory dysfunction, 51 patients had combined dysfunction, and 20 patients had neither taste nor olfactory dysfunction. Among the 51 patients who had combined olfactory and gustatory dysfunction, 31.3 % of them had predominant gustatory dysfunction, 47.1 % predominant olfactory dysfunction and 21.6% of the patients had both olfactory and gustatory dysfunction equally.

Conclusions: Olfactory and gustatory dysfunctions are strongly associated with SARS-CoV-2 infection. Olfactory with or without gustatory dysfunctions is potentially a reliable indicator of latent COVID-19.

Keywords:COVID-19; gustatory dysfunction; taste; SARS-CoV-2

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Oropharyngeal Manifestations in Covid-19 Patients

 

Abstract

Introduction: Coronavirus disease 2019 (COVID-19) an infectious disease was first identified in December 2019 in Wuhan, China, caused by severe acute respiratory syndrome corona virus 2 (SARS-CoV-2). It was considered by the World Health Organization (WHO) as a pandemic. Oropharyngeal manifestations like mucositis, glossitis, pharyngitis, tonsillar enlargement associated with COVID19 show inconsistency in their presentations. Hence the study aims at the early identification and better management of the oropharyngeal manifestations.

Aims and Objectives This study is to detect, analyze and to determine the prevalence of the different oropharyngeal manifestations reported in COVID19 positive patients

Materials: Patients who are diagnosed with COVID 19 using RT-PCR method, were assessed for symptoms and signs of oropharyngeal manifestations using standard questionnaires.

Method: Cross sectional study.

Results: Out of 486 COVID positive patients’ males outnumbered female patients. The highest number of oropharyngeal manifestations was seen in patients in the age group of 51-65 years (42%). Least age and highest age of the patient encountered in this study was 19 years and 78 years, respectively. Dry cough (37.8%) was the most common symptom followed by pharyngodynia (24.2%) with the least common being painful ulcers in mouth (4.9%). Among 486 COVID positive patients’ pharyngeal erythema(46.9%) was the most common manifestation followed by glossitis,(29.2%) and buccal mucositis(19.1%). Aphthous ulcer (4.9%) was the least common manifestation. In our study nearly 45.8% (223 in number) of patients had history of diabetes followed by hypertension in 38.7% (188 numbers) as the co morbidity found in COVID positive patients. Neoplasia was the least common co morbidity observed.

Conclusion: Oropharyngeal manifestations for COVID-19 are not common as fever and cough. But a universal questionnaire using well-defined COVID-19 manifestations is needed to make the COVID-19 data precisely defined, complete and homogenous and to differentiate from the etiology other than COVID 19.

Keywords:Oropharyngeal; COVID-19; manifestations

 

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Vocal Cord Paralysis –An Etiological Analysis

 

Abstract

Introduction: Vocal cord paralysis is the total interruption of nerve impulse resulting in absence of laryngeal muscle movement. The most common type of vocal cord paralysis found is due to recurrent laryngeal nerve injury. The pathology can be either along the course of the tenth cranial nerve from cerebral cortex to neuromuscular junction or could be from mechanical fixation of cricoarytenoid joint.

Objective: To study the various etiological factors contributing to vocal cord paralysis.

Materials and methods: Patients with vocal cord paralysis [unilateral and bilateral] who were treated at a tertiary institute for a period of 3 years were included. The immobility of cords was assessed with the use of indirect laryngoscopy via mirror or rigid angled telescopy or flexible laryngoscopy. The patients were categorized based on laterality of paralysis as well as based on various etiological factors into groups. Appropriate statistical analysis was done.

Results: Among 50 patients, 84 % cases had unilateral vocal cord paralysis. Surgical cause was found to be the most common etiology of unilateral vocal cord paralysis (34%) closely followed by idiopathic (18%) and neoplasm (16%). In bilateral vocal cord paralysis, surgical and neurological causes were found to be the main causative factor.

Conclusion: Vocal cord paralysis has a wide range of factors contributing to its occurrence with surgical cause being a common one. A comprehensive assessment of patient should be performed to determine the cause which facilitates a direct treatment plan.

Keywords:Vocal cord paralysis; etiologyb

Abbreviations:VCP: Vocal Cord Paralysis; RLN: Recurrent Laryngeal Nerve; UVCP: Unilateral Vocal Cord Paralysis

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Mastoid Exploration in the Management of Chronic Otitis Media with Complications

 

Abstract

Chronic suppurative otitis media is a common problem in developing countries. Complications due to chronic suppurative otitis media still pose a major problem in the developing countries. In cases of chronic suppurative otitis media associated with complications, after managing the complications, mastoid exploration should be done to remove the primary source of infection. Planning of mastoid exploration play an important role in the management. Here the management of primary otogenic septic foci, after the management of extracranial and intracranial complications is discussed.

Keywords:Mastoid exploration; otitis media; complications

 

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