No abstract

Supracricoid laryngectomies (SCLs) are conservative organ-sparing surgical techniques for the treatment of selected T2-T4 laryngeal carcinomas. Although these procedures allow preserving the larynx and its functions, in several countries SCLs are not adopted in oncological protocols. One of the possible reasons to account for this choice is the complexity of post-surgical in-hospital management and the variability in functional results. The aim of this review is to analyse the literature on functional results after SCLs as knowledge on functional results will help in focusing on what is needed in the future to reach more standardized post-surgical procedures and homogeneous outcomes. The analysis of the length of hospital stay, feeding-tube removal time and time to eventual tracheotomy decannulation showed a marked variability across authors and centres. Several factors may come into play, including health-system organizations in different countries. In most studies in-depth description of the criteria applied for discharge, tracheotomy tube removal and commencement of oral feeding were not reported. Moreover, the review on swallowing functional outcomes showed marked variability, as well as a lack of consensus on how to assess swallowing after SCLs. The analysis of voice functional outcomes also revealed a marked variability; surprisingly, the tools applied in the assessments were very often not adequate for substitution voice. Literature review showed that voice- and swallowing-related quality of life are often satisfactory but the variability among centres is still too large. Therefore, there is a need for clearer clinical recommendations on early post-surgical management, tracheal-cannula and feeding-tube removal criteria, voice- and swallowing-assessment protocol, rehabilitation need and timing.

Multiple system atrophy (MSA) is a neurodegenerative disorder characterized by a combination of autonomic failure, cerebellar ataxia, and parkinsonism. Laryngeal stridor is an additional feature for MSA diagnosis, showing a high diagnostic positive predictive value, and its early occurrence might contribute to shorten survival. A consensus definition of stridor in MSA is lacking, and disagreement persists about its diagnosis, prognosis, and treatment. An International Consensus Conference among experts with methodological support was convened in Bologna in 2017 to define stridor in MSA and to reach consensus statements for the diagnosis, prognosis, and treatment. Stridor was defined as a strained, high-pitched, harsh respiratory sound, mainly inspiratory, occurring only during sleep or during both sleep and wakefulness, and caused by laryngeal dysfunction leading to narrowing of the rima glottidis. According to the consensus, stridor may be recognized clinically by the physician if present at the time of examination, with the help of a witness, or by listening to an audio recording. Laryngoscopy is suggested to exclude mechanical lesions or functional vocal cord abnormalities related to different neurologic conditions. If the suspicion of stridor needs confirmation, drug-induced sleep endoscopy or video polysomnography may be useful. The impact of stridor on survival and quality of life remains uncertain. Continuous positive airway pressure and tracheostomy are both suggested as symptomatic treatment of stridor, but whether they improve survival is uncertain. Several research gaps emerged involving diagnosis, prognosis, and treatment. Unmet needs for research were identified.