Objectives: To adapt the voice handicap index (VHI) for usage in Hindi and evaluate its internal consistency, reliability, and clinical validity in cases of dysphonia. Setting: Tertiary healthcare centers. Materials and Methods: The original VHI was translated into Hindi and was completed by 175 patients with voice disorders and 84 asymptomatic subjects. Internal consistency was analyzed through Cronbach's alpha coefficient. For test-retest reliability, the Hindi VHI was filled twice by 63 randomly selected patients and assessed through the Spearman rank correlation coefficient test. For the clinical validity assessment, the scores obtained in the pathological group were compared with those found in asymptomatic individuals through the Kruskal-Wallis test. Also, the correlation between VHI and the patients' self-perceived grade of voice disorder was assessed. Finally, the effect of age and gender on overall VHI and its three subscales was analyzed. Results: Internal consistency was found to be good (alpha = 0.95); the test-retest reliability was high (r = 0.95). Nonparametric Kruskal-Wallis analysis revealed that the control group scored significantly lower than the dysphonics. The overall VHI score positively correlated with the patients' self-perceived grade of voice disorder (r = 0.44). In the voice-disorder group, age and gender were not correlated to the overall VHI score and to their three domains. Conclusion: The Hindi VHI so developed is a valid and reliable measure for use in the Hindi-speaking population.

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Vallecular cyst in an infant is uncommon, and it finds infrequent mention in the literature as well. However when present, it accounts for severe inspiratory stridor, causing airway compromise, and sometimes even death. Laryngomalacia is the commonest congenital anomaly of the larynx, which is present after birth giving rise to inspiratory stridor. Laryngomalacia results as a collapse of supraglottic structures of the larynx. Clinical co-presentation of vallecular cyst and laryngomalacia is very rare. This is a report of two cases of 2-month-old infants who presented with the history of noisy breathing and refusal to feeds since 10-15 days. CT scan of the neck revealed a huge cyst in the vallecula compromising the airway. Microlaryngoscopic-guided aspiration and marsupilization of the cyst was done using CO ₂ laser and the release of aryepiglottic fold was done using microlaryngeal scissors. Respiratory and feeding problems dramatically improved in these patients by immediate surgical intervention.

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Rhinosporidiosis is chronic granulomatous disease of likely fungal etiology which usually affects the nasal mucosa. Extranasal manifestations of rhinosporidiosis are relatively uncommon. Laryngeal and tracheobronchial tree involvement is extremely rare and only six cases have been reported till date. Here we report a case of laryngeal rhinosporidiosis, which occurred in a patient with coexisting nasal rhinosporidiosis and was successfully managed surgically.

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Background: Laryngopharyngeal reflux disease (LPRD) cases are common in clinical practice and usually neglected for want of a definitive diagnosis. Diagnosis requires a documented evidence of fall in pH levels in the laryngopharynx with dual-probe 24-hour ambulatory pH-metry. Aim: To study pH-metry findings in laryngopharyngeal reflux cases. Settings and Design: Study was done in a tertiary teaching hospital. Material and Methods: A total of 30 normal volunteers (Group A) and 65 patients (Group B) with complaints of hoarseness of voice for more than six weeks in the age group of 20 to 40 years were studied. A thorough ENT examination including fiberoptic laryngoscopy (FOL) was done on all cases. Group B was further divided into two subgroups. Subgroup B1 (n = 32) consisted of FOL positive and subgroup B2 (n = 33) comprised of FOL negative patients by reflux finding score. 24-hour ambulatory pH-metry was done for both groups. Results: Group A had no abnormal reflux patterns. In Subgroup B1, all 32 patients showed at least single laryngopharyngeal reflux episode over the 24-hour period. The most common pattern was 2 to 5 episodes occurring in 16/32 cases. Of the 32, five (15.6%) also had abnormal De Meester's score (gastroesophageal reflux disease [GERD] positive). In subgroup B2, 2 of 33 patients showed a typical LPR on 24-hour ambulatory pH-metry, despite showing LPRD negativity on FOL. None had an abnormal De Meester's score. Conclusion: LPRD may not coexist with GERD. Two to five reflux episodes pattern were found to be more common in LPR patients. Dual-sensor pH-metry is confirmatory for establishing diagnosis of LPRD.

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Early glottic carcinoma can be treated using endoscopic surgery, radiotherapy, or partial open surgery. Lesions limited to the vocal fold are normally treated with endoscopic surgery or partial open surgery, with local control results between 80% and 90%. The choice of one treatment over another should contemplate the cure rate, larynx preservation rate, post-treatment voice quality, morbidity, and treatment cost. Although both external beam radiotherapy and endoscopic carbon dioxide laser excision of early glottic cancer will affect voice quality, it is difficult to compare them. A complete voice assessment including perceptual, objective, and subjective evaluation is mandatory whenever a meaningful analysis of the pathological voice is to be accomplished. Meta-analyses of the results of voice treatments are generally limited and may even be impossible owing to the major diversity in the ways functional outcomes are assessed. The postsurgical voice outcome depends upon having a straight postoperative vocal fold for glottic closure and intact vibration from the contralateral vocal fold. Subepithelial and subligamental cordectomies are oncologically safe resections and have a quality of voice comparable to that of controls. By contrast, with wider resections (types III-V cordectomies), a concave neocord may form resulting in an aerodynamic glottic incompetence. In order to select the most appropriate treatment modality according to the patient's age, gender, compliance, and professional activity, a detailed preoperative counseling concerning vocal outcome is recommended. After phonosurgical resection, patients who have lost paraglottic musculature may benefit from medialization and augmentation procedures to re-establish glottic competence.

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Virchow described a laryngocoele as a saccule extending above the thyrohyoid membrane. Total excision and marsupialisation are established surgical techniques for external and internal laryngocoeles. The external cervical approach is advocated for external and combined laryngocoeles. We describe here a case of combined laryngocoele that was treated endoscopically, using a CO ₂ laser. Both the internal and external components of the laryngocoele were excised completely; its internal supraglottic component was excised followed by the external component into the neck. The CO ₂ laser with its property of minimal trauma to adjacent tissues, quick tissue recovery, reduced hospital stay and avoidance of tracheostomy makes it useful for treatment of laryngocoele. Endoscopic CO ₂ laser excision also avoids the necessity of an external approach.

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Surgical debulking is the main treatment for recurrent respiratory papillomatosis (RRP); however, intralesional cidofovir has been widely used off-label as adjuvant therapy. Concern exists about the safety profile of this drug in humans. The objective of this systematic review was to explore current evidence for the efficacy and safety of intralesional cidofovir in RRP. A comprehensive search strategy was used in MEDLINE and the Cochrane Central Register of Controlled Trials. Human in vivo studies were eligible for inclusion. A total of 41 studies met the inclusion criteria, including 30 studies providing efficacy outcome data (one randomized controlled trial (RCT), two retrospective case-control studies, and 27 case series). The RCT showed no significant difference in outcome between placebo and intralesional cidofovir groups. One case-control study favored cidofovir, and the other favored the control group. Combining all series, the overall complete remission rate with intralesional cidofovir was 53%, with a rate of 63% in adult-only studies compared to 37% in pediatric-only studies. There was no evidence for an increased rate of dysplasia or malignancy associated with intralesional cidofovir. Vocal cord scarring was reported, and may be associated with higher doses, as may risk of nephrotoxicity through systemic absorption. High-quality evidence for efficacy of cidofovir is very limited. Intralesional cidofovir should only be used after informed consent, based on a discussion of available safety and efficacy evidence. This adjuvant therapy should only rarely be considered in children, as it may be less effective, and long-term risks are potentially increased.

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