Association of gastroesophageal reflux disease and laryngeal cancer

Objective:Studies examining the association of reflux disease with the risk of developing laryngeal cancer have both proven and disproven the null hypothesis.Methods:This retrospective caseecontrol study examines the association of reflux in two populations exposed to similar risk factors,including tobacco,to the extent that end-organ malignant transformation has occurred.After IRB approval was obtained,a search of our hospital’s cancer center’s database was performed from 2000 to 2013.A retrospective chart review was then performed and the prevalence of gastroesophageal reflux disease among patients with laryngeal cancer(n Z 290)was determined.It was then compared to the prevalence of gastroesophageal reflux disease among patients presenting with lung cancer(n Z 2440)during the same time period.A multivariate logistic regression was performed to determine the association of reflux with laryngeal cancer.Results:Taking into consideration tobacco use,there was a strong association between male gender and occurrence of laryngeal cancer as opposed to lung cancer(OR Z 3.30;95%CI 2.53e4.36,P<0.001).There was a modest association between reflux and laryngeal cancer(OR Z 1.65;95%CI 1.19e2.25,P Z 0.003).However,there was no association between reflux and the propensity for carcinoma in specific laryngeal subsites(P Z 0.47).Conclusions:In this study examining a heterogeneous population with end-organ malignancy there was a modest association between reflux and laryngeal cancer.Further research is necessary to determine the biologic relevance of this finding.

Injection medialization laryngoplasty improves dysphagia in patients with unilateral vocal fold immobility

Objective: To assess patient reported swallowing outcomes before and after injec-tion medialization laryngoplasty in patients with unilateral vocal fold immobility (UVFI). Methods: Case series with chart review of patients with UVFI who underwent injection media-lization laryngoplasty at a community laryngology practice by a single clinician between October 2015 and December 2017. Patient-reported validated surveys of swallowing impair-ment, Eating Assessment Tool (EAT-10), demographics, etiology and duration of symptoms were recorded before and after injection. A paired t test was done on EAT-10 surveys before and after IML to assess for statistical significance. Results: Twenty-one patients with UVFI and glottic insufficiency underwent IML between October 2015 and December 2017. Nineteen of 21 patients (90％) presented with dysphagia (EAT-10 ≥ 3). 76％ of patients with dysphagia reported improvement in swallowing function af-ter IML. The EAT-10 scores of UVFI patients with dysphagia before and after IML were 17.0 ± 14.0 and 4.2 ± 9.6, respectively (p = 0.004). Conclusions: Nearly all patients with UVFI and glottic insufficiency report associated dysphagia. Three fourths of these patients perceive improvement in their swallowing function after injection medialization laryngoplasty. Patients with idiopathic UVFI may have a more sus-tained improvement and those with severe preop dysphagia may not benefit. Further research is necessary to refine patient selection and to assess duration of improved swallowing function.