To explore the role of T-helper 17 cells and their cascade in the pathogenesis of laryngeal cancer.

Prospectively, 110 consecutive patients with a suspicious laryngeal lesion were evaluated for serum levels of T-helper 17 cell related interleukins, including interleukins 23, 17A and 22, determined by enzyme-linked immunosorbent assay. The patients were divided into 2 groups after pathological evaluation: 49 patients with malignancy and 61 with benign pathology. Associations between interleukin levels and malignancy were determined via correlation analyses.

Interleukin 17A and 22 levels were significantly higher in the malignancy group than the benign lesion group. Pearson correlation analysis showed that interleukins 17A and 22 acted in a cascade, but interleukin 23 did not. According to predictive values, interleukin 17A levels were 3.87 times and interleukin 22 levels were 1.09 times more likely to be associated with laryngeal cancer. The cut-off values for predicting laryngeal cancer were 3.55 pg/ml for interleukin 17A and 119.82 pg/ml for interleukin 22.

T-helper 17 cell related interleukins are potential biomarkers that may be helpful in diagnosing laryngeal cancer. Moreover, these data may support neutralisation of T-helper 17 cell related cytokine activity, which could be an attractive strategy for treating laryngeal cancer.

Takotsubo cardiomyopathy has been associated with the use of catecholamines; however, its development after the use of nebulised adrenaline for the management of acute airway obstruction has not previously been described.

A 66-year-old man with squamous cell carcinoma of the larynx, with tumour–node–metastasis staging of T3N2cM0, confirmed by biopsy and computed tomography, presented to the emergency department with acute airway obstruction. He was treated twice with nebulised adrenaline and intravenous dexamethasone. After a period of 24 hours, cardiac rhythm changes were noted on telemetry. A 12-lead electrocardiogram showed widespread T-wave inversion and QT prolongation suggestive of an acute coronary syndrome. Coronary angiography demonstrated no coronary artery disease, but left ventricular angiography showed marked apical ballooning and apical wall akinesia consistent with a diagnosis of takotsubo cardiomyopathy.

Takotsubo cardiomyopathy can mimic true ischaemic heart disease and the diagnosis requires a high index of suspicion in patients managed with nebulised adrenaline.

To assess the frequency of anterior pharyngeal pouch formation after total laryngectomy, and to discuss the causes and consequences of anterior pharyngeal pouch formation.

A prospective, observational study of 43 patients undergoing total laryngectomy.

Data collected included laryngeal defect closure type, tumour staging and demographic information. A barium swallow was performed on day 7–14 after surgery to assess for anterior pharyngeal pouch formation and fistula formation.

The incidence of anterior pharyngeal pouch formation was 47 per cent. Patients who did not have an anterior pharyngeal pouch on swallow imaging assessment were less likely to develop a pharyngo-cutaneous fistula. There was no statistically significant association between laryngeal defect closure type and anterior pharyngeal pouch formation.

The anterior pharyngeal pouch is a dynamic phenomenon best investigated with a fluoroscopic swallow imaging study. Its causes are multi-factorial. Absence of an anterior pharyngeal pouch appears to confer protection against pharyngo-cutaneous fistula formation, hastening commencement of adjuvant therapy and an oral diet.

We present the first report in the all English literature of a case of laryngeal squamous cell carcinoma metastasis to the orbit.

Case report of orbital metastasis from laryngeal carcinoma; clinical, radiological and pathological findings are discussed.

A 75-year-old man presented to the ENT department with a five-week history of left orbital pain, swelling and reduced vision. Past medical history included laryngectomy, bilateral neck dissection and post-operative radiotherapy for T4 N2c M0 squamous cell carcinoma of the supraglottis, 10 months earlier. Imaging showed an orbital mass extending along the roof and lateral aspect of the orbit into the optic canal and superior orbital fissure, and further posteriorly into the left cavernous sinus with meningeal enhancement in the left anterior cranial fossa. Histopathological analysis after biopsy showed the mass to be consistent with metastatic poorly differentiated squamous cell carcinoma.

After searching the all English literature, we report what is, to our best knowledge, the first case of laryngeal carcinoma metastasis to the orbit. Despite its rarity and poor prognosis, such a metastasis should be considered as part of the differential diagnosis of an orbital mass, as timely recognition can improve the patient's quality of life.

The electroglottogram approximate entropy value is a numerical variable which gives an overall measure of voice quality. It is derived by analysing the complexity of the electroglottogram waveform using regulatory statistics.

(1) To use electroglottogram approximate entropy to measure voice quality in patients with glottic pathology and in normal subjects, to ascertain whether this parameter can distinguish between pathological and normal voices. (2) To ascertain whether electroglottogram approximate entropy can measure voice change over time within individual subjects. (3) To determine any correlation between electroglottogram approximate entropy and the grade–roughness–breathiness–asthenia–strain scale.

One hundred and forty-one normal volunteers were recruited to characterise electroglottogram approximate entropy in the normal voice. One hundred and eighty-six patients with glottic squamous cell carcinoma underwent electroglottogram approximate entropy measurement prior to radiotherapy and then three to six months and one year after treatment. Subjects’ voices were categorised by a speech therapist using the grade–roughness–breathiness–asthenia–strain scale.

The mean electroglottogram approximate entropy of the normal volunteers was 0.302 (range 0.05–0.42). The mean electroglottogram approximate entropy of the glottic squamous cell carcinoma patients was significantly lower prior to treatment, at 0.227 (range 0.001–0.397; p < 0.0005), but improved after radiotherapy to 0.277 at three to six months and 0.282 at one year. Electroglottogram approximate entropy results correlated significantly with grade–roughness–breathiness–asthenia–strain scale results.

Electroglottogram approximate entropy can be used to assess change in voice quality resulting from glottic morphological abnormality. Electroglottogram approximate entropy values improve as voice quality improves after treatment. Electroglottogram approximate entropy values correlate significantly with grade–roughness–breathiness–asthenia–strain scale results.

We report the second known case of aggressive angiomyxoma of the larynx.

Case report and a review of the world literature concerning angiomyxoma of the larynx and recent advances in the immunohistochemical, cytogenic and clinical study of its female pelvic counterpart.

Aggressive angiomyxoma is a rare mesenchymal tumour originally thought only to occur in the female pelvis and peritoneum, or rarely in the male genital tract. A 47-year-old man presented with a one-month history of dysphonia. He was found to have a supraglottic mass on endoscopic examination, and underwent a laryngofissure approach excision biopsy and covering tracheostomy. Histological analysis showed a characteristic proliferation of spindle cells widely separated by loose, myxoid stroma with a prominent vascular component. Aggressive angiomyxoma was diagnosed.

To our knowledge, this is the second report in the world literature of aggressive angiomyxoma of the larynx. Comparison with the female pelvic counterpart facilitates diagnosis, aided by recent advances, and suggests that complete surgical excision with a wide margin is the treatment of choice.

We report the case of an osteoblastoma of the larynx arising from the vocal fold, which presented with acute airway obstruction and cardiopulmonary arrest.

The histopathological findings, differential diagnoses and a novel method of treating laryngeal osteoblastoma, using transoral laser therapy, are discussed.

Benign osteoblastoma is a rare primary bone tumour usually presenting in young patients in the spine and sacrum. Its occurrence in the larynx is very rare, with only three similar case reports in the literature, none involving tumour arising from the vocal fold. Differential diagnoses must be considered and excluded using both histopathological and clinical features. Once the diagnosis is confirmed, successful treatment is achieved with surgical excision.

Osteoblastoma of the larynx is rare, and the clinical features can vary with the anatomical site of the lesion. The recommended treatment is surgical excision which, if available, may be achieved by transoral laser microsurgery. Due to its potential rapid growth, careful follow up is essential in order to detect recurrence.