Laryngeal amyloidosis: Observations of vocal folds kinematics with LVS, HSDP & NBI®

Chapter 17

  • Krzysztof Izdebski
  • Raul M. Cruz
  • Matthew Blanco
  • Herbert H. Dedo
  • Thomas Engel
  • Yuling Yan
Keywords: amyloidosis, larynx, surgery, HSDP, NBI®, LVS, symmetry, mucosal wave, voice quality, outcomes

Abstract

Amyloidosis refers to an unknown pathogenic process in which abnormally folded proteins are deposited in the extracellular space as macroscopic aggregates. Laryngeal deposits of these proteins are extremely rare. In a combined clinical practice of 45 years we have encountered 13 cases. Dysphonia, rather than ventilation, is a primary symptom, yet little is known about this process in these cases. As far as we can discern, no prior (February 2016) reports observations on vocal folds behavior in laryngeal amyloidosis by laryngovideostroboscopy (LVS), high-speed digital phonoscopy (HSDP), or narrowband imaging (NBI®) of this condition have been identified in the world literature, except papers published or presented by our group at the Pacific Voice Conferences. Our findings showed that LVS identifies the deposits clearly and that mucosal wave may not be disturbed in a well-executed surgery. NBI® exams showed amyloid as unvascularized, and thus benign, in appearance. HSDP studies provide information about the physiological impact of amyloidosis on the larynx, especially regarding voice effects. Conservative piecemeal surgical removal of amyloid deposits secures proper basic laryngeal functions: airway, aspiration prevention, and voice.

Published
2016-06-02