Reinke's edema is a benign lesion of the vocal folds affecting the subepithelial space. As part of a study of the management of Reinke's edema, we aimed to determine the prevalence of dysplasia and malignancy in histologically proven Reinke's edema. A retrospective analysis of all laryngeal biopsies performed in north Glasgow, United Kingdom, between 2001 and 2010 was carried out. Clinical and pathological data from patients with histologically confirmed Reinke's edema were recorded with specific respect to the reporting of dysplasia and malignancy. From the 10-year cohort, a total of 3902 laryngeal biopsies were performed. In total, 189 patients (18 males and 171 females) had histologically proven Reinke's edema. Of this cohort, 170 (90%) had no dysplasia, 16 (8%) had mild dysplasia, 2 (1%) had moderate dysplasia, and 1 (<1%) had severe dysplasia. There was no malignancy reported. In our predominantly female smoking population, the epithelium appears to differentiate to benign Reinke's edema rather than malignancy. Patients can be reassured with regard to the low risk of malignancy in classic Reinke's edema.

Oral Presentations P85Objectives: 1) Determine the etiology of unilateral vocal fold paralysis (UVFP) at a tertiary care institution over 10 years. 2) Determine the length of time between onset of symptoms and presentation/diagnosis of UVFP by an otolaryngologist at a tertiary medical center.Methods: Retrospective review of medical records of patients with UVFP between 2002 and 2012 in a tertiary care institution. Patients were seen and evaluated over 10 years by the Department of Otolaryngology at the Washington University School of Medicine. Medical records were reviewed for information relating to diagnosis, initial presentation date, date of onset of symptoms, and etiology of UVFP.Results: 938 patients were included in the study. 621 (66.2%) patients had left sided UVFP. 581 (61.9%) patients had UVFP due to iatrogenic effects related to surgery. 158 (27.2%) of these were related to thyroid/parathyroid surgery. 357 patients had UVFP due to reasons not related to surgery. 124 (34.7%) patients had idiopathic UVFP. The median time to presentation from symptom onset until presentation to any otolaryngologist was 2 months. There was a significant delay of 3.33 months between mean time to presentation to a community otolaryngologist and subsequent referral and evaluation at a tertiary medical center, P < 0.01.Conclusions: Iatrogenic injury related to surgery is the most common cause of UVFP. Thyroidectomy remains the leading cause of surgically related UVFP. Patients are typically seen within 4 months; however, a significant delay exists between diagnosis and referral to a specialist.

It is hypothesised that organ preservation strategies, endoscopic resection in early stage laryngeal cancer and chemoradiotherapy in advanced head and neck cancer are responsible for the increase in laryngeal biopsies.

Objective: To investigate the presence of Helicobacter pylori (H pylori), a key pathogen in chronic gastritis and recognized as a major cause of gastric cancer, in cancer samples and adjacent normal tissues of the head and neck region.Method: Twenty-eight fresh-frozen HNSCC samples and 11 biopsies from normal tissue were obtained from fully informed and consented patients at GSHU. From 8 of these cancer samples adjacent normal tissue was available. FISH using a probe for H pylori was used to examine sections of these samples and enumerate the bacterium.Results: The average number of H pylori per biopsy section was significantly higher in the SCC group (P < .03) than controls for all sites examined. Most interestingly, in paired SCC and adjacent normal biopsies from the same patient the average number of H pylori per biopsy was significantly higher in the SCC tissue compared with the adjacent normal tissue (P < .006). These data indicate that H pylori shows a numerical and spatial association with squamous cell cancer lesions of the head and neck. Conclusion:The fact that H pylori is present in higher numbers in the tumor tissue compared with adjacent tissue and tissue obtained from healthy individuals suggests either a predisposition for the colonization of SCC with H pylori, or a causative role for the bacterium in cancer at these sites.Laryngology/Broncho-Esophagology injection laryngoplasty: impact on Swallowing and Aspiration Elena Willis, MD (presenter); Melin Tan, MD; Gina Palma; Miriam Herschman Objective: Vocal fold paralysis (VCP) and glottic insufficiency result in difficulties with dysphonia, dysphagia, and cough strength. This pilot study compares quality of life (QOL) and aspiration in patients with VCP before and after injection laryngoplasty (IL).Methods: A prospective case series at an academic tertiary care hospital on 7 pilot patients (age 64-85 years, mean 71 years) with VCP and symptoms of aspiration. All patients underwent modified barium swallow (MBS) or fiberoptic endoscopic evaluation of swallow (FEES). MBS and FEES studies were evaluated using Penetration-Aspiration scale (PENASP). Additionally, patients completed 2 QOL questionnaires, the EAT-10 and the Voice Handicap Index (VHI). All patients underwent IL with micronized dermis. Four underwent unilateral injection, 3 underwent bilateral injection. Repeat evaluation at 3 months with MBS or FEES was again scored with PENASP scale. Patients again completed the questionnaires.Results: All 7 reported improvement in QOL on VHI (P = .03). There was no difference in pre and post procedure EAT-10 scores. Two of 7 patients showed decreased aspiration on thin liquid PENASP scores and 5 of 7 patients showed no change (P = .19). There was no difference in pre and post PENASP scores with semi-solids. Conclusion:This study suggests that IL improves QOL for patients with VCP and that IL may improve aspiration with thin liquids. A prospective case series with a larger sample size is needed to further evaluate the effects of IL on aspiration and quality...