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At least 37 records · Page 2Linked to original sources
PubMed1999

[Postoperative hoarseness and sore throat after tracheal intubation: effect of a low intracuff pressure of endotracheal tube and the usefulness of cuff pressure indicator].

Many clinical reports have described postoperative hoarseness and sore throat after general anesthesia. In most cases, these symptoms were attributed to high pressure of the endotracheal tube cuff. The recommended cuff pressure is less than 25 mmHg, as excessive pressure produces ischemia of the tracheal mucosa. However, within the safe pressure range, postoperative hoarseness and sore throat are still often observed. In this study, one hundred and ninety patients of ASA classes I or II were allocated randomly to two groups, low cuff pressure group (< 15 mmHg) or high cuff pressure group (15-25 mmHg), using continuous monitoring with a cuff pressure gauge. We investigated the incidence of postoperative hoarseness and sore throat at 24 hours after intubation and on the seventh postoperative day. The incidence of postoperative hoarseness and sore throat was significantly decreased in the low pressure group at 24 hours after intubation as compared with the high pressure group, but there was no significant difference between the two groups on the seventh postoperative day. These results suggest that keeping the cuff pressure under 15 mmHg can prevent postoperative hoarseness or sore throat at 24 hours after intubation, and that a cuff pressure gauge is thought to be one of the indispensable monitors during anesthesia.

Adult↗
PubMed2002

[Incidence and duration of hoarseness following endotracheal intubation].

The incidence and duration of hoarseness following tracheal intubation with general anesthesia were studied retrospectively from November 1998 to October 2000 in postanesthetic clinic of Nara Medical University. Total number of patients was 3977 and 37.1% of them complained of hoarseness. Most of there patients recovered within three days after surgery but in 4.2% the hoarshness persisted over ten days and in 0.7% persisted over one month after surgery. Most of these persistent hoarseness were considered to have originated from surgical procedures (such cervical, pulmonary, cardioaortic operation, etc.) and those following only tracheal intubation recovered within two months after surgery. The hoarseness decreased the satisfactory level for anesthesia in 1.0% of total patients and 12.8% of patients with persistent hoarseness. We consider that preoperative explanation and postoperative communication by anesthesiologists are important.

Adult↗
PubMed2003

[How to avoid hoarseness for operation of schwannoma of the cervical vagus nerve].

OBJECTIVE: To avoid hoarseness for operation of schwannoma of the cervical vagus nerve (SVN). METHODS: From Jan. 1997 to Sept. 2001, ten cases of SVN were operated. The procedures were as follows: Exposing the tumor and the vagus nerve, confirming its origin from the fascicle of recurrent laryngeal nerve (RLN) or the fascicle of non-RLN, making an small incision on the posterolateral surface of the tumor, usually posterior to the internal jugular vein, and then tearing and enlarging the small incision to enucleate the tumor. RESULTS: Two of the four cases of SVN originated from the fascicle of RLN happened temporary hoarseness and other two without hoarseness. All six cases of SVN originated from the fascicle of non-RLN, but one, happened no hoarseness. CONCLUSION: Above-mentioned technique is a good and reliable method to avoid hoarseness in the operation of SVN.

Adult↗
PubMedDate not supplied

[An overview of the symptoms and signs of voice disorders and the pathophysiology of hoarseness].

Voice disorders are due to organic and functional disturbances of the voice generator, activator and resonator. They appear as a consequence of different factors which lead to the development of hoarseness, and may as well be the result of disturbed phonatory patterns. Phonatory patterns refer primarily to the muscular activity of the vocal system, which is delicately balanced within the voice generator, activator and resonator. PATHOPHYSIOLOGY OF HOARSENESS: Basic causes of hoarseness are insufficient glottic closure during phonation (glottal gap), changes in the vocal fold stiffness and imbalance in mechanical properties between the two folds. Glottal gap leads to the excessive air leakage during phonalion and insufficient conversion of the expiratory air into pulses. Turbulence of the expiratory air particles is increased, leading to the development of noise. Excessively stiff or tax vocal folds, both disturb the vibration process and lead to the development of noise and hoarseness. Imbalance in tension between the two folds, and especially in their mass, may lead to the glottal gap, with the consecutive noise and hoarseness. PHONATORY PATTERNS: Phonatory patterns refer to habitual movements of the vocal organs during phonation and speech, which are acquired during the process of learning phonation and speech. This is primarily the muscular activity of generator, activator and resonator of the voice, which is so balanced to produce the optimal voice quality with the least effort and fatigue. The activity of the phonatory organs is not well balanced in cases of voice disorders. That is the primary cause of functional voice disorders, and a very frequent consequence of organic voice disturbances. Hyperkinetic dysphonia is the most common type of disturbed phonatory patterns, characterized by excessive vocal effort, while hypokinetic dysphonia is rarely seen. The third type of functional disorders of the phonatory patterns is an incorrect placement of the voice (imposlatio falsa), which is characterized by an imbalanced muscular activity of the vocal organs, but within the normal limits concerning the overall amount of activity.

Hoarseness↗
PubMedDate not supplied

[Characteristics of the voice in patients with glottic carcinoma evaluated with the RBH (Roughness, Breathiness, Hoarseness) and GIRBAS (Grade, Instability, Roughness, Breathiness, Asthenia, Strain) scales].

INTRODUCTION: Subjective voice analysis represents a diagnostic tool in phoniatry and is a part of everyday practice if a phoniatrist has a "trained ear". MATERIAL AND METHODS: This clinical prospective study included a sample of 20 male patients with malignant tumors involving one vocal cord-right or left. All patients underwent otorhinolaryngological and phoniatric examinations. Subjective acoustic analysis was done when patients pronounced numbers from 1 to 10. Afterwards, voice quality was evaluated separately by two professionals using a 4-levels scale: RBH scale (roughness-breathiness-hoarseness) and GIRBAS scale (grade-instability-roughness-breathiness-asthenia-strain). RESULTS: 60% of patients presented with vocal cord immobility. Subjective acoustic analysis revealed hoarseness in 100% of patients (the most frequent value was Mod = 3 intense hoarseness in 45% patients). Instability existed in 100% of patient (40% moderate, 40% intense). Strained voice existed in 100%, most frequently intense (45%). CONCLUSIONS: All patients with glottic carcinoma presented with hoarseness, strain and instability of phonation. Non vibration of vocal cord significantly affects the degree of dysphonia, roughness, strain and instability. Aerodycnamic changes affect voice hoarseness. RBH scale is simple, but GIRBAS scale described more psyhoacoustic phenomena most important in patients with glottic carcinoma.

Adult↗
PubMed1987

Harmonic emergence in formant zone of a sustained [a] as a parameter for evaluating hoarseness.

In order to test the value of the harmonic emergence in formant zone of a sustained (a) as a parameter for evaluating hoarseness, a multifactorial acoustical investigation was performed in 10 normal and 22 dysphonic subjects. The parameters were: a subjective evaluation (7-degree-scale) of the extent of the hoarseness by 3 trained specialists the phonation quotient the 0-6 kHz/6-10 kHz energy ratio, computed on a long--time--average--spectrum from a reading of a phonetically selected text the harmonic emergence in the bandwidth of the two first formants of a sustained (a). The harmonic emergence in the formant zone of a sustained (a) seems to be an interesting and complementary parameter, with respect to the previously investigated 0-6 kHz/6-10 kHz energy ratio, for evaluating hoarseness. Both of these parameters demonstrate highly significant differences between normal and pathological voices. Moreover, they show a high degree of correlation both with the subjective evaluation of the severeness of the hoarseness and with the mean transglottic air flow during phonation. The 0-6 kHz/6-10 kHz energy ratio seems to discriminate better in cases of severe dysphonia, while harmonic emergence seems more suitable in milder hoarseness. Both spectral parameters are suitable for automatic analysis.

Adolescent↗
PubMed1998

A case of mediastinal cystic hygroma whose only symptom was hoarseness.

Hoarseness caused by mediastinal cystic hygroma has not been reported before. The authors report a case of mediastinal cystic hygroma in which the patient's only symptom was hoarseness. A 6-year-old girl had hoarseness. Physical examination findings were normal except for indirect laryngoscopy, which showed unilateral vocal cord paralysis. The chest radiograph showed an opacification 3 cm wide in the left side of the superior mediastinum. Through a median sternotomy, a large multicystic mass was resected. During resection, left laryngeal recurrent nerve was seen to be intact, and its integrity was preserved. Six months later the left vocal cord was moving to a limited extent. A chest radiograph should be considered in a case of hoarseness caused by a peripheral nerve lesion to detect a mediastinal mass without any cervical component.

Child↗
PubMed2000

[Laryngeal amyloidosis: a rare cause of hoarseness].

INTRODUCTION: The larynx is a rare site of deposition for amyloidosis. Diagnosis may be delayed and evoked in patients with prolonged hoarseness. We have reported two cases of laryngeal amyloidosis. EXEGESIS: One man and one woman suffered from hoarseness during one and three years, respectively. Laryngoscopic examination showed diffuse infiltration of the larynx. Amyloidosis was confirmed by the characteristic Congo-red staining of laryngeal biopsies. The search for other localizations of amyloidosis was negative. No monoclonal plasma cell proliferation was detected. Both patients received endoscopic CO2 laser excision. In one case, chemotherapy was initially associated due to dystrophic plasma cells in bone marrow aspiration and then withdrawn because of clinical failure. With a 6-month follow-up, hoarseness remained stable. CONCLUSION: Laryngeal amyloidosis is an essentially localized disease revealed by hoarseness. Treatment is endoscopic by laser excision. In nearly half of the cases in the literature, it had to be repeated due to localized recurrent lesions. Long-term prognosis of localized laryngeal amyloidosis is better than systemic AL amyloidosis.

Amyloidosis↗
PubMed1999

Painless aortic dissection presenting as hoarseness of voice: cardiovocal syndrome: Ortner's syndrome.

Most of the neurological manifestations of the aortic dissection are due to neuronal ischemia secondary to either extension of the dissection process into a branch artery, or compression of an artery by the false lumen of the dissecting aortic hematoma. However, the enlarging false lumen may directly compress on an adjacent nerve, causing neuronal injury resulting in neurological symptoms. This may particularly take place when a distal intimal tear does not decompress the false lumen, resulting in formation of an expanding blind pouch. About 10% of aortic dissections are painless and may present with symptoms secondary to the complications of the dissection. Although cardiovocal syndrome, or Ortner's syndrome (hoarseness of voice due to involvement of recurrent laryngeal nerve in cardiovascular diseases) has been described with aortic dissection, it has not been reported as an initial presenting feature of this disorder. This report describes the first case of painless aortic dissection presenting with hoarseness of voice, the cardiovocal syndrome. The hoarseness remained the only symptom throughout the entire course of the disease. The aortic dissection was not suspected initially. During surgical exploration, the recurrent laryngeal nerve was found compressed by the false lumen at the level of aortic arch. Aortic root replacement was performed successfully, resulting in complete resolution of the hoarseness. The neurological manifestations of aortic dissection, and the cardiovocal syndrome, are discussed.

Aortic Dissection↗
PubMed1982

Harmonics-to-noise ratio as an index of the degree of hoarseness.

Degree of hoarseness can be evaluated by judging the extent to which noise replaces the harmonic structure in the spectrogram of a sustained vowel. However, this visual method is subjective. The present study was undertaken to develop the harmonics-to-noise (H/N) ratio as an objective and quantitative evaluation of the degree of hoarseness. The computation is conceptually straightforward; 50 consecutive pitch periods of a sustained vowel /a/ are averaged; H is the energy of the averaged waveform, while N is the mean energy of the differences between the individual periods and averaged waveform. Recordings of 42 normal voices and 41 samples with varying degrees of hoarseness were analyzed. Two experts rated the spectrogram of each voice sample, based on the amount of noise relative to that of the harmonic component. The results showed a highly significant agreement (the rank correlation coefficient = 0.849) between H/N calculations and the subjective evaluations of the spectrograms. The H/N ratio also proved useful in quantitatively assessing the results of treatment for hoarseness.

Adult↗
PubMed1984

Harmonic-intensity analysis of normal and hoarse voices.

Objective evaluation of normal and hoarse voices is performed considering the characteristic that hoarse voices show a prominent fundamental frequency intensity compared with harmonics in the voice spectrum. The relative harmonic intensity Hr, obtained from a stable portion of the sustained vowel/a/, is defined as the intensity of the second and higher harmonics expressed as a percentage of the total voice intensity. Ninety-five percent of the normal voices examined have Hr larger than the critical value of 67.2%, whereas 90% of the hoarse voices have Hr smaller than the critical value. The harmonic-intensity analysis thus provides good discrimination between normal and hoarse voices.

Adolescent↗
PubMed2003

Dysphagia, hoarseness, and unilateral true vocal fold motion impairment following anterior cervical diskectomy and fusion.

The charts of 100 patients who underwent anterior cervical diskectomy with fusion performed at our institution between January 1996 and February 1999 were reviewed. The incidences of hoarseness, dysphagia, and unilateral true vocal fold motion impairment were calculated. Univariate logistic regression was used to estimate the relationship of several patient and technical factors to the rates of occurrence of hoarseness and dysphagia. Patient age was found to be a significant predictor of postoperative dysphagia (p < .006), with an odds ratio of 1.113 (95% confidence limits, 1.04, 1.21) per year of age. Other factors studied were not found to be significant predictors. The overall incidence of these complications from the world literature was also calculated. The overall incidences of dysphagia, hoarseness, and unilateral true vocal fold motion impairment in the literature were calculated as 12.3%, 4.9%, and 1.4%, respectively. We conclude that dysphagia, hoarseness, and unilateral vocal fold motion impairment continue to remain significant complications of anterior cervical diskectomy with fusion. Older patients may be at higher risk for dysphagia.

Adult↗
PubMed2000

Postoperative sore throat and hoarseness following tracheal intubation using air or saline to inflate the cuff--a randomized controlled trial.

Sore throat and hoarseness following tracheal intubation is common. The aetiology may include high tracheal cuff pressures. We performed a double-blind, randomized controlled trial in 126 intubated patients to compare the incidence and severity of sore throat and hoarseness following inflation of the cuff using air or saline. Intra-cuff pressures were compared to assess any change due to inward diffusion of nitrous oxide. The incidence of significant sore throat and/or hoarseness overall was 15.0%. There was no statistically significant difference between the groups (air 15.9%, saline 14.5%). In the air group mean intra-cuff pressure increased significantly (start 14.0 mmHg, end 40.9 mmHg), while in the saline group there was no significant increase (start 12.7 mmHg, end 14.6 mmHg). The substitution of saline reliably results in sustained low intra-cuff pressures but high tracheal cuff pressure is not an important factor in the development of sore throat or hoarseness postoperatively within the pressure range and duration of operation studied.

Double-Blind Method↗
PubMed2000

[Hoarseness after endotracheal intubation caused by submucosal hemorrage of the vocal cord and recurrent nerve palsy].

Hoarseness often follows endotracheal intubation. A 58 year old man suffered from hoarseness due to recurrent nerve palsy and submucosal hemorrhage of the right vocal cord after general anesthesia. He was scheduled for resection of chronic pyoderma of the buttocks and atheroma of the right retroauricular region. Anesthesia was induced with thiopental 300 mg and endotracheal intubation was facilitated with vecuronium 6 mg. A spiral tube with 8 mm of inner diameter (Mallinckrodt Medical) was inserted with no problems. The tube was fixed at left side of the mouth. The cuff was inflated with air but the cuff pressure was not monitored. Anesthesia was maintained with sevoflurane (1-3%) and 67% N2O in 33% O2. Respiration was controlled mechanically. The patient was turned to the prone position and his head was turned to the right. The duration of surgery was one hour and forty minutes. Extubation of the tube involved no problems. He complained of hoarseness after surgery. Right recurrent nerve palsy and submucosal hematoma were observed. Without any treatment, hematoma disappeared in 70 days and hoarseness in 183 days. These hematoma and recurrent nerve palsy might be due to the compression of the vocal cord and recurrent nerve by tracheal tube and traction of the recurrent nerve by rotation of the neck.

Anesthesia, General↗
PubMedDate not supplied

Dual-probe pH monitoring for the assessment of gastroesophageal reflux in the course of chronic hoarseness in children.

The purpose of our study was to assess gastroesophageal reflux (GER) by dual-probe pH monitoring in children suffering from chronic hoarseness for more than six months. Seventeen children (aged between 2 and 12 years, 10 boys and 7 girls) were enrolled. All children underwent a laryngoscopy and a 24-hour dual-probe pH monitoring. At both sensor, distal and proximal esophageal, a pathological GER was defined as the presence of episodes of acid reflux with pH < 4 during a fraction of the total recording time greater than 5.2 percent. The computer considered the child was supine when asleep and upright when awake. Laryngoscopy revealed interarytenoid erythema and/or edema with vocal cord nodules or granulomas in 13 cases (76.4%), isolated vocal nodules or granulomas in three cases (17.6%) and a normal appearance in one case (5.8%). At both sensors, the majority of refluxes occurred when the child was upright, as analyzed by the percentage of time the intra-esophageal pH was below four (% time pH < 4), number of refluxes, reflux episodes/hour and longest reflux episode, p < 0.05 between upright and supine for each parameter. The median total % time pH < 4 on the proximal and distal probes was respectively 1.62 percent (95% CI 1.50-3.79) and 11.49 percent (95% CI 8.81-27.17), p < 0.0003. Among the 17 hoarse children, a pathological GER was observed in 12 (70.5%) at the distal sensor and in three (17.5%) at both sensors. Among the 16 hoarse children with abnormal findings on laryngoscopy, two (12.5%) had diagnosed pathological GER at the proximal and 11 (68.7%) at the distal sensor. The only child with normal findings on laryngoscopy exhibited a pathological GER at both sensors. Our results suggest that chronic hoarseness is associated with a pathological GER. The majority of these documented refluxes occurred when the child was awake.

Child↗
PubMed1988

[Hoarseness after removing a cervical schwannoma--a case report].

A 54-year-old man complained of asymptomatic lump in the right parotid gland region. The lump was well movable and had no fixation to the adjacent tissue. The lump was surgically extirpated and histological sections of the lump revealed benign schwannoma. In view of postoperative evidence of hoarseness, it was thought the tumor might be arose from the cervical vagal nerve. The hoarseness has been observed for one year after operation without any improvement. A statistic study on the hoarseness after removing the cervical tumor was done by sending out questionnaires to the members of the council of the Japan Surgical Society. Of 270, 180 replies were obtained and 67.2% of the members answered that they did not have any knowledge about the hoarseness after removing the cervical tumor.

Cranial Nerve Diseases↗
PubMed1983

[Hoarseness from the viewpoint of primary care].

Hoarseness is a symptom that is constantly encountered by doctors in primary care. It is the leading symptom in acute laryngitis and is often present as one of the symptoms in, for example, respiratory tract infections, influenza, and bronchitis. For the general practitioner, the infection factor as the cause of hoarseness is so dominant that other possible causes may fail to be taken into consideration. The general practitioner's possibilities for diagnosing the cause of this symptom are largely determined by habit, and by his ability to observe and assess the vocal chords. Examination of the vocal chords is often technically difficult, and patients in whom inspection presents difficulties should be remitted to an ear specialist. Hoarse smokers constitute a special group at risk, and these patients should be remitted for further examinations, if the general practitioner finds it hard to make a complete inspection of the chords. The article also describes an investigation on how hoarseness is handled at a health centre.

Hoarseness↗
PubMed1995

[Hoarseness].

Hoarseness is a cardinal symptom of laryngeal disease. It is a disturbance of the normal voice pitch that can be evaluated acoustically using the 'RBH scale' [R for roughness, B for breathiness, H for hoarseness]. Hoarseness lasting longer than three weeks or recurring must be evaluated by an ENT specialist or a phoniatrist. Causes of hoarseness include functional disorders of the voice, inflammation of the larynx, secondary changes of the vocal folds, polyps, cysts, edema, papillomas, tumors, trauma, or palsies of the vocal cords due to different reasons. Early diagnosis of malignant laryngeal tumors is a prerequisite for preserving voice quality. Functional disorders and unilateral palsies of the vocal folds are treated by logopedists. The therapy of choice for inflammations is relief of symptoms, and surgery is employed for organic lesions.

Diagnosis, Differential↗