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At least 397 records · Page 22Linked to original sources
PubMed2005

Recurrent laryngeal nerve palsy during anterior cervical spine surgery: a prospective study.

OBJECT: Recurrent laryngeal nerve (RLN) palsy is a well-known complication of cervical spine surgery. Nearly all previous studies were performed without laryngoscopy in asymptomatic patients. This prospective study was undertaken to discern the true incidence of RLN palsy. Because not every RLN palsy is associated with hoarseness, the authors conducted a prospective study involving the use of pre- and postoperative laryngoscopy. METHODS: Prior to anterior cervical spine surgery preoperative indirect laryngoscopy was performed in 123 patients to evaluate the status of the vocal cords as a sign of function of the RLN. To assess postoperative status in 120 patients laryngoscopy was repeated, and in cases of vocal cord malfunction follow-up examination was conducted 3 months later. In the group of 120 patients who attended follow-up examination, two (1.6%) had experienced a preoperative RLN palsy without hoarseness. Postoperatively the rate of clinically symptomatic RLN palsy was 8.3%, and the incidence of RLN palsy not associated with hoarseness (that is, clinically unapparent without laryngoscopy) was 15.9% (overall incidence 24.2%). At 3-month follow-up evaluation the rate had decreased to 2.5% in cases with hoarseness and 10.8% without hoarseness. Thus, the overall rate of early persisting RLN palsy was 11.3%. CONCLUSIONS: Laryngoscopy revealed that the true incidence of initial and persisting RLN palsy after anterior cervical spine surgery was much higher than anticipated. Especially in cases without hoarseness this could be proven, but the initial incidence of hoarseness was higher than expected. Only one third of new RLN palsy cases could be detected without laryngoscopy. Resolution of hoarseness was approximately 70% in those with preoperative hoarseness. The true rate of RLN palsy underscores the necessity to reevaluate the surgery- and intubation-related techniques for anterior cervical spine surgery and to reassess the degree of presurgical patient counseling.

Cervical Vertebrae↗
PubMed2003

Laryngeal morbidity and quality of tracheal intubation: a randomized controlled trial.

BACKGROUND: Vocal cord sequelae and postoperative hoarseness during general anesthesia are a significant source of morbidity for patients and a source of liability for anesthesiologists. Several risk factors leading to laryngeal injury have been identified in the past. However, whether the quality of tracheal intubation affects their incidence or severity is still unclear. METHODS: Eighty patients were randomized in two groups (n = 40 for each) to receive a propofol-fentanyl induction regimen with or without atracurium. Intubation conditions were evaluated with the Copenhagen Score; postoperative hoarseness was assessed at 24, 48, and 72 h by a standardized interview; and vocal cords were examined by stroboscopy before and 24 and 72 h after surgery. If postoperative hoarseness or vocal cord sequelae persisted, follow-up examination was performed until complete restitution. RESULTS: Without atracurium, postoperative hoarseness occurred more often (16 vs. 6 patients; P = 0.02). The number of days with postoperative hoarseness was higher when atracurium was omitted (25 vs. 6 patients; P < 0.001). Similar findings were observed for vocal cord sequelae (incidence of vocal cord sequelae: 15 vs. 3 patients, respectively, P = 0.002; days with vocal cord sequelae: 50 vs. 5 patients, respectively, P < 0.001). Excellent intubating conditions were less frequently associated with postoperative hoarseness compared to good or poor conditions (11, 29, and 57% of patients, respectively; excellent vs. poor: P = 0.008). Similar findings were observed for vocal cord sequelae (11, 22, and 50% of patients, respectively; excellent vs. poor: P = 0.02). CONCLUSIONS: The quality of tracheal intubation contributes to laryngeal morbidity, and excellent conditions are less frequently associated with postoperative hoarseness and vocal cord sequelae. Adding atracurium to a propofol-fentanyl induction regimen significantly improved the quality of tracheal intubation and decreased postoperative hoarseness and vocal cord sequelae.

Adolescent↗
PubMed2005

Quality improvement in anesthetic practice--incidence of sore throat after using small tracheal tube.

BACKGROUND AND OBJECTIVE: Sore throat following surgery is common and is due to multitude of factors. The highest incidence of sore throat tends to occur in patients who have undergone tracheal intubation. Between 14.4% to 50% of intubated patients complain of sore throat and hoarseness in the immediate postoperative period, 3% of them are still hoarse after a week. This contributes to higher incidence of postoperative morbidity and patient dissatisfaction of the service. A prospective study was conducted to demonstrate the incidence of hoarseness and sore throat following the use of small tracheal tubes. METHODS: Adult patients, 16 years old and above, presented for tonsillectomy, nasal surgery and/or for functional endoscopic sinus surgery (FESS) were included in the study. Patients who had signs of, common cold were excluded from the study. Size 7-7.5 mm cuffed tracheal tube was used in males and size 6-6.5 mm in females. Patients were asked during 24 hours postoperatively about the presence of hoarseness of voice and of their satisfaction of the service. RESULTS: There were 1618 patients 883 males and 735 females, ages: 16-62 yrs included in the study between February 2000 and end of May 2003. 189 (11.7%) developed postoperative hoarseness of voice and 1429 (88.3%) did not have hoarseness or sore throat (P = 0.0001). Patient satisfaction was 95%. CONCLUSIONS: The use of small tube in intubating the trachea, together with other measures such as lubricating the tube with water soluble jelly, careful airway instrumentation, intubation only when patient was fully relaxed, careful suctioning technique, and extubation when the tracheal tube cuff was fully deflated, have dramatic effects on minimizing the incidence of postoperative hoarseness and sore throat. Accordingly, patient satisfaction has been reported to be high.

Adolescent↗
PubMed1997

A comparison of light wand and suspension laryngoscopic intubation techniques in outpatients.

UNLABELLED: Endotracheal intubation can produce postoperative sore throat and hoarseness, as well as changes in cardiovascular variables. A major goal of ambulatory surgery is the prompt return of patients to their daily activities. Postoperative sore throat may impede this and may decrease patient satisfaction with their anesthetic and surgical experience. We conducted a prospective, randomized study in 40 outpatients having lower extremity arthroscopies to compare the effects of direct laryngoscopy and light wand intubation on cardiovascular changes, sore throat, hoarseness, and dysphagia. Subjects were randomly assigned to either Group A (endotracheal intubation by rigid laryngoscopy) or Group B (endotracheal intubation with a light wand). A standardized anesthetic technique was used. Heart rate and blood pressure were recorded before induction, after induction but before endotracheal intubation, and at 1-min intervals for the first 5 min after intubation. Sixteen to twenty-four hours postoperatively, the incidence and severity of sore throat, hoarseness, and dysphagia was assessed by a follow-up phone call. This study demonstrated no clinically significant difference in cardiovascular variables between the two techniques. Patients had a significantly lower incidence and severity of sore throat, hoarseness, and dysphagia when a light wand was used for intubation. In conclusion, this study suggests that light wand intubation may decrease the incidence and severity of postoperative sore throat, hoarseness, and dysphagia, thereby potentially increasing satisfaction in ambulatory surgical patients. IMPLICATIONS: This prospective, randomized study found that the incidence and severity of postoperative sore throat, hoarseness, and difficulty in swallowing among ambulatory surgical patients is more frequent when they are endotracheally intubated with a rigid laryngoscope than with a light wand. The authors, therefore, recommend more frequent use of the light wand for endotracheal intubation.

Adult↗
PubMed1993

An analysis-by-synthesis approach to the estimation of vocal cord polyp features.

This paper deals with a new noninvasive method of estimating vocal cord polyp features through hoarse-voice analysis. A noteworthy feature of this method is that it enables us not only to discriminate hoarse voices caused by pathological vocal cords with a single golf-ball-like polyp from normal voices, but also to estimate polyp features such as the mass and dimension of polyp through the use of a novel model of pathological vocal cords which has been devised to simulate the subtle movement of the vocal cords. A synthetic hoarse voice produced with a hoarse-voice synthesizer is compared with a natural hoarse voice caused by the vocal cord polyp in terms of a distance measure and the polyp features are estimated by minimizing the distance measure. Some estimates of polyp dimension that have been obtained by applying this procedure to hoarse voices are found to compare favorably with actual polyp dimensions, demonstrating that the procedure is effective for estimating the features of golf-ball-like vocal cord polyps.

Acoustics↗
PubMed2001

[The relationship between acoustic analysis and auditory assessment].

OBJECTIVE: To investigate the relationship between acoustic analysis and auditory assessment of hoarseness. METHOD: 24 normal and 154 cases of pathological voice were included in this research. They were divided into 4 groups with different hoarseness and were accepted acoustic analysis. The parameters were analyzed by SPSS statistical software. RESULT: There were significant difference on acoustical parameters among each group excluding no difference of the jitter between normal and light hoarseness. NNE and SNR were the major parameters in descriptive of hoarseness. There were good correlation between 5 parameters and hoarseness assessment. CONCLUSION: Acoustic analysis is a useful method in clinical application to assess hoarseness with objective and simple advantage.

Adolescent↗
PubMed2000

[Variability in the digital voice analysis depending on the analyzed vocal, in normal patients and in patients with dysphonia].

UNLABELLED: The aim of this study is to decide which of Spanish's 5 vowels is the most suitable for the analysis of the voice by means of the program Dr. Speech 3.0. We assessed 98 patients: 51 normal subjects and 47 hoarse patients (34 polyps, 7 nodules, 2 hyperfunctional dysphonia, 4 other pathologies) before and after following a surgical and/or speech therapy. The methodology of the study included: protocolized questionnaire, ENT examination, perceptual evaluation of the hoarse voices and physical analysis of the 5 sustained vowels. Jitter, shimmer, NNE and HNR in the voice varied depending on the analyzed vowel and from normal subjects to hoarse patients. NNE and HNR for vowels [o] and [u] was higher than for [a], such differences were statistically significant (p < 0.001). Shimmer for vowels [o] and [u] was lower than shimmer for [a] in hoarse patients (p < 0.05). Jitter for [a] was higher than jitter for the other vowels in normal patients. All algorithms improveded with surgical and/or speech therapy. Especially levels of noise for vowels [a] [e] and [o] presented statiscally significant improvements (p < 0.001), shimmer for [a] and [e] (p < 0.001) and jitter for [e] (p < 0.01). The hoarse patients presented values more pathological than the normal subjects, especially jitter for vowels [a] [e] and [o] (p < 0.001), shimmer for [a] [e] [i] and [u] (p < 0.001) and level of noise for [a] [e] [o] and [u] (p < 0.001). CONCLUSION: The analysis of vowel [e] presented higher r than [a] when correlated with perceptual evaluation of voice or with voice quality that gave us Dr. Speech 3.0. Also, the [e] is the best vowel to express the improvements of jitter, shimmer and level of noise of hoarse patients after following surgical and/or speech therapy.

Adolescent↗
PubMed2006

Juvenile laryngeal papillomatosis.

Always ask about hoarseness and quality of voice in a history of any child presenting with cough or asthma-like symptoms. Children presenting with what appears to be an acute onset of hoarseness, without any physical signs of airways obstruction, should be reviewed after two weeks. If there is chronic hoarseness, referral to an ENT specialist should be considered with a view to laryngoscopy. If the child develops clinical signs of acute airway obstruction such as stridor or respiratory distress, prompt paediatric review is indicated. When referring, it is important to emphasise whether or not there is chronic hoarseness in order to differentiate the diagnosis from croup. Juvenile Laryngeal Papillomatosis may present with cough, pneumonia, dysphagia, or stridor, as well as hoarseness. These patients are often misdiagnosed as having asthma or allergies.

Airway Obstruction↗
PubMed2006

Airway injuries after one-lung ventilation: a comparison between double-lumen tube and endobronchial blocker: a randomized, prospective, controlled trial.

BACKGROUND: Vocal cord injuries, postoperative hoarseness, and sore throat are common complications after general anesthesia. One-lung ventilation can be achieved via two techniques: double-lumen endotracheal tube or endobronchial blocker such as the Arndt blocker. The current study was designed to assess the impact of these techniques for one-lung ventilation on the incidence and severity of postoperative hoarseness, vocal cord lesions, and sore throat. METHODS: In this prospective trial, 60 patients were randomly assigned to two groups. One-lung ventilation was achieved with either an endobronchial blocker (blocker group) or a double-lumen-tube (double-lumen group). Postoperative hoarseness and sore throat were assessed at 24, 48, and 72 h after surgery. Bronchial injuries and vocal cord lesions were examined by bronchoscopy immediately after surgery. RESULTS: In 56 included patients, postoperative hoarseness occurred significantly more frequently in the double-lumen group compared with the blocker group: 44% versus 17%, respectively (P = 0.046). Similar findings were observed for vocal cord lesions: 44% versus 17%, respectively (P = 0.046). The incidence of bronchial injuries was comparable between groups (P = 0.540). Cumulative number of days with hoarseness and sore throat were significantly increased in the double-lumen group compared with the blocker group (P < 0.01). No major complications such as bronchial ruptures were observed. CONCLUSIONS: Clinicians should be aware of an increased incidence of minor airway injuries that may impair patient satisfaction when using a double-lumen tube instead of an endobronchial blocker for one-lung ventilation.

Adult↗
PubMed1999

[Objective evaluation of vocal pathology in childhood].

Voice disorders in children are often described as existing on a continuum with anatomic or physiologic causes at one end and functional or psychogenic causes at the other. In this study we report the objective evaluation of the voice disorders on 48 school children. The evaluation was made by means of laryngostroboscopy, acoustic analysis of the voice and narrow-band spectrography. The stroboscopic examination was performed on more than a half of the patients, resulting in the change of diagnose in six cases. The severity of the hoarseness was classified in four groups according Yanagihara method. A multivariate analysis was carried out using jitter, shimmer and harmonic-to-noise ratio as variables. Only the harmonic-to-noise ratio predicts the severity of the spectrographic record. Classification of degrees of hoarseness is found to be clinically useful in two respects: the degree of hoarseness can be numerically expressed and the objective acoustic degree of hoarseness based on this method closely agrees with subjective perceived degree of hoarseness.

Adolescent↗
PubMed2002

[Typical and atypical symptoms of laryngopharyngeal reflux disease].

The aim of the study was to evaluate and compare intensity and incidence of both, typical (heartburn, acid regurgitation) and atypical (hoarseness, throat clearing, globus pharyngeus) symptoms of laryngopharyngeal reflux disease among 72 patients and 123 healthy persons. Diagnosis of laryngopharyngeal reflux disease in 58 cases (80.6%) was confirmed by endoscopic and histological findings of esophagitis and in 14 cases (19.4%) by Omeprasol test. The intensity of the symptom was calculated by multiplication of the intensity and frequency of the symptom. According to the data obtained laryngopharyngeal reflux disease manifested more frequently with atypical symptoms. In the patients' group mean intensity of hoarseness was 5.29 +/- 0.74 points, mean index of hoarseness 7.06 +/- 1.35 points. Typical symptoms were found only in 14-22% of patients. The mean intensity of heartburn was 2.6 +/- 0.66 points, mean index of heartburn was 4.73 +/- 1.02 points. The incidence of atypical symptoms was three times higher than the incidence of typical symptoms (p < 0.05). According to the multinomial logistic regression analysis the combination of three atypical symptoms (hoarseness, throat clearing and globus pharyngeus) separated groups of the patients and healthy persons. The combination of these symptoms increases the odds ratio for laryngopharyngeal reflux disease 59.7 times. Idiopathic hoarseness as a single symptom increases the odds ratio for laryngopharyngeal reflux disease 85 times.

Adult↗
PubMed2003

Causes of dysphonia in patients above 60 years of age.

OBJECTIVES: We evaluated the causes of hoarseness in patients above 60 years of age. PATIENTS AND METHODS: The study included 98 patients (40 females, 58 males; mean age 64 years; range 60 to 77 years) who presented with hoarseness. All the patients were examined by videolaryngoscopy. Temporary hoarseness secondary to respiratory tract infections was excluded. RESULTS: The most common cause of hoarseness was benign vocal fold lesions (28.6%) followed by malignant lesions (27.6%), vocal fold paralysis (25.5%), functional dysphonia (10.2%), and presbyphonia (8.2%). Laryngopharyngeal reflux was found in 13 patients (13.3%). Fourteen male and 11 female patients had paralysis of the recurrent laryngeal nerve. Malignancies that caused hoarseness without paralyzing the vocal folds were larynx carcinoma (n=18), hypopharynx carcinoma (n=8), and multiple malignancy (n=1). CONCLUSION: Our data show that dysphonia develops due to disease processes associated with aging rather than to physiologic aging alone. Considering adverse influences of dysphonia on the quality of life of elderly population, efforts should be directed to elucidation of the cause and to performing appropriate treatment.

Age Factors↗