"Raman Spectroscopy for Optical Biopsy in the Larynx"
David Lau, MD*
Murray Morrison, MD
Zhiwei Huang, MD*
Ken Berean, MD*
Harvey Lui, MD*
Haishan Zeng, MD*
Vancouver, Canada

Raman spectroscopy (RS) provided information about molecular structure and may enable optical biopsy without tissue removal. A non-contact tissue diagnosis could provide an adjunct to in-clinic videolaryngostroboscopy. New laser and charge couple device (CCD) technology makes this possible.
Objectives: Develop an RS system capable of analyzing the laryngeal tissue in-vitro, with in-vivo potential. Compare spectra from normal, benign and cancerous tissue.
Methods: We RS studied laryngeal biopsy specimens from 15 patients. A 785 nm diode laser at 300 mW was used for tissue excitation. A holographic spectrograph was coupled to a liquid nitrogen cooled CCD detector. A holographic notch filter attenuated elastic scattering. Integration times of 1, 5 and ten seconds were studied. RD results were competed to standard histology.
Results: Integration times of 5 seconds give spectra of sufficient signal to noise ratio for analysis. Analyses of spectral peaks show biochemical changes between normal laryngeal tissue, benign lesions and carcinoma.

"Tremor Laryngeal Dystonia: Treatment of the Lateral Cricoarytenoid Muscle"
Nicole C. Maronian, MD*
Allen D. Hillel, MD
Patricia Waugh, MA*
Lawrence Robinson, MD*
Seattle, WA

Tremor laryngeal dystonia is a distinct clinical entity from adductor laryngeal dystonia based on perceptual, stroboscopic, and fine wire EMG findings. Treatment for tremor laryngeal dystonia with botulinum toxin has proven more difficult than for adductor laryngeal dystonia, yet no distinctions have been made to consider treatment variations that might improve clinical results. We present 85 patients who have the clinical presentation of tremor laryngeal dystonia who have been treated with a variety of approaches with botulinum toxin. Based on fine wire EMG, clinical responses and follow-up data, we have treated 55 patients. Twenty-four (44%) patients have received treatments to the thyroarytenoid muscle, while 31 (56%) patients have received injections to the lateral cricoarytenoid muscle. The EMG findings in this group of patients will be presented along with their clinical outcome. Patients with tremor laryngeal dystonia can be successfully treated with botulinum toxin if the practitioner considers injections to the lateral cricoarytenoid muscle as a treatment option.

"Temporary Vocal Cord Medialization with Long-Term Benefits"
Lisa T. Galati, MD*
Albany, NY

Patients with newly diagnosed vocal cord paralysis who suffer from severe breathiness or persistent aspiration, despite speech therapy, require a temporizing procedure prior to being a candidate for permanent medialization. Gelfoam, traditionally used in these patients, last only about one month. Relief of hoarseness and dysphagia during the year of waiting for possible return of vocal cord function is difficult to attain. Twenty patients with new-onset vocal cord paralysis, hoarseness and/or dysphagia were offered injection of micronized acellular dermis. All patients underwent microlaryngoscopy and injection of 0.3-1.0 cc of acellular dermis. All but one patient had improvement in voice clarity and volume. The average length of time that the improvement lasted was 10 months. Micronized acellular dermis provides long-term temporary medialization and is useful in the management of the patient with newly diagnosed vocal cord paralysis.

"Roles of Vocal Ligament and Thyroarytenoid Muscle in Pitch Rising"
Shigerv Hirano, MD*
Jack Jiang, MD*
Diane M. Bless, PhD
Charles N. Ford, MD
Madison, WI

The roles of vocal ligament and thyroarytenoid (TA) muscle is pitch control have not been fully elucidated. Theoretical studies have suggested that TA might be a pitch raiser if vibration extends deep into TA. To confirm this aspect, we examined how deep mucosal wave extended under different airflow and subglottal pressure (Ps) using human adult excised larynges. The amplitudes of mucosal wave were measured on high-speed digital images taken during excised larynx experiments, and the thickness of each layer of vocal folds was determined histologically. Cricothyroid approximation was performed in one larynx. The results showed that mucosal wave was confined in the cover during low Ps, but extended to vocal ligament with increased Ps resulting in high pitch phonation. In elongated vocal fold, mucosal wave advanced into TA with increased Ps accompanied with higher pitch. The implications of the current study are that vocal ligament and even TA participate in pitch rising under specific conditions such as increased Ps and elongation.

"Post-Laryngectomy Voice Restoration Using Voice Prossthesis - A Single Institution's Ten Year Experience"
Antti A. Mäkitie, MD, PhD*
Riina Niemensivu, MD*
Hannu Lehtonen, MD, PhD*
Leena-Maija Aaltonen, MD, PhD*
Helsinki, Finland

Objectives: We describe speech rehabilitation outcome of patients treated by total Laryngectomy and insertion of Provox voice prostheses (Atos Medical AB, Hörby, Sweden) at the Helsinki University Central Hospital.
Materials and Methods: A retrospective chart review of 95 patients (88 men; mean age, 65 yrs) who underwent post-laryngectomy insertion of Provox voice prostheses in the period 1992-2002.
Results: 81% (77/95) of the patients underwent a primary prosthesis insertion at the time of laryngectomy. Long-term tracheoesophageal speech was rated as good or average in 74% (70/95). Main causes for replacement of the device were obstruction or leakage of the prosthesis and granulation or leakage of the fistula.
Conclusion: Based on our ten year experience, the Provox prosthesis is an effective method for post-laryngectomy voice rehabilitation

"Hamartoma of the Larynx - An Unusual Cause of Dyspnea"
Antti A. Mäkitie, MD, PhD*
Hannu Lehtonen, MD, PhD*
Leif Bäck, MD*
Leena-Maija Aaltonen, MD, PhD*
Ilmo Leno, MD, PhD*
Helsinki, Finland

We present a rare case of cartilaginous type hamartoma of the larynx as the etiologic factor causing dyspnea.
A 92-year old female patient presented with a six-month history of slowing progressing dyspnea and stridor. The initial diagnosis was asthma. At referral the fiberoptic examination revealed a subglottic rounded mass obstructing the subglottic airway. Tracheotomy including the 3rd-5th tracheal rings was performed under local anesthesia. A well-encapsulated tumor broadly attached to the left Subglottic wall was resected with CO2-laser. The histopathological diagnosis was osteochondritic hamartoma. The patient was decannulated and did not have any laryngeal or dyspneic symptoms. She died due to an acute myocardial infraction after seven months of follow-up.
Hamartoma of the larynx is a rare cause of slowly progressive airway obstruction and may be misdiagnosed with asthma.