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PubMed1988

Primary upper aerodigestive tract manifestations of gastroesophageal reflux.

Chronic hoarseness, chronic sore throat, "lump in the throat," or cervical pain with swallowing were the primary complaints in 25 (6.6%) of 379 patients undergoing esophagoscopy for gastroesophageal reflux at the Denver Veterans Administration Medical Center between 1981 and 1985. In 18 (72%) of the 25 patients, these were the only reflux symptoms. Surgery was required to control symptoms in nine (36%) patients with upper aerodigestive tract complaints, versus 52 (15%) of 354 patients with more typical reflux symptoms (z = 2.77, p less than 0.01). Surgery was also necessary more often in patients with chronic hoarseness or sore throat (seven of 15) than in those with "lump in the throat" or cervical pain with swallowing (two of 10). These findings suggest reflux does cause otherwise unexplained upper aerodigestive tract symptoms, and that surgery may be required more often to control these symptoms than is the case in patients with more typical symptoms of reflux.

Adult↗
PubMedDate not supplied

Vocal function following carbon dioxide laser surgery for glottic carcinoma.

Vocal function following laser surgery for glottic T1a carcinoma was evaluated in 17 patients and compared to vocal function following radiotherapy in 14 patients. The results are summarized as follows. 1) A slight degree of hoarseness was found more frequently following laser surgery than following radiotherapy. The quality of hoarseness was rough and breathy in most cases. 2) In stroboscopic examination, incomplete glottal closure and diminution or lack of vibration of the operated vocal fold were frequently observed following laser surgery. 3) There was no marked difference in maximum phonation time, mean airflow rate, fundamental frequency range of phonation, intensity range of phonation, and intensity-flow ratio between the laser and the radiotherapy groups. On the basis of these results, we conclude that there is little difference in vocal function between postlaser and postradiotherapy patients as far as conversational voice is concerned.

Adult↗
PubMed1983

Nonrashes. 4. Audible signs of cutaneous disease.

There is more than one reason why dermatologists should listen to their patients. Audible signs of cutaneous disease range from the classic, early childhood hoarseness of lipoid proteinosis to a characteristic hoarseness due to syphilitic papules on the epiglottis and arytenoepiglottic folds.

Deglutition Disorders↗
PubMed2002

Laryngeal duplication cyst.

Benign congenital laryngeal cysts are rare. Infants and children with these lesions can present with chronic or intermittent airway obstructive symptoms, hoarseness, aspiration, chronic cough, or failure to thrive. The most common congenital laryngeal cysts include saccular cysts, laryngoceles, and ductal cysts. Other more unusual laryngeal lesions, such as hamartomas, choristomas, and teratomas, can also present with these symptoms. We describe a unique congenital cyst that arose in continuity with the larynx in a child with hoarseness and intermittent stridor. The features of this lesion are similar to those of bronchogenic duplication cysts of the trachea, but with histopathological features of the larynx.

Abnormalities, Multiple↗
PubMed1989

Laryngeal paralysis as the presenting sign of aortic trauma.

Disruption of the thoracic aorta is usually fatal without prompt surgical attention. Left recurrent laryngeal nerve paralysis has been reported in approximately 10% of patients who survive long enough to develop a pseudoaneurysm, but the time of onset has rarely been specified. In this study, 50 cases of thoracic aortic trauma were reviewed to determine the incidence and timing of laryngeal paralysis, compared with 50 cases of atherosclerotic aneurysms matched for location. Four patients in the traumatic group were hoarse, and the onset was immediate in 3. Six in the atherosclerotic group became hoarse. Results indicate that laryngeal paralysis following severe trauma can be a very early sign of aortic injury and requires prompt and thorough investigation.

Adolescent↗
PubMed1993

Gastroesophageal reflux and laryngeal disease.

OBJECTIVE: We wanted to determine if surgical correction of gastroesophageal reflux disease (GERD) would affect inflammatory laryngeal lesions in a select group of patients with known GERD and chronic inflammatory laryngeal lesions. DESIGN: Patients with persistent inflammatory lesions in the larynx were referred for workup of GERD when these lesions were not associated with smoking or drinking or when cessation of smoking failed to ameliorate these lesions during a minimum period of 6 months. Twenty-four-hour pH monitoring was used to confirm GERD in 10 patients, while two patients had GERD confirmed radiologically, and one patient had typical symptoms of esophagitis and incompetent lower esophageal sphincter. Thus, 13 patients with chronic laryngeal inflammation persistent after cessation of smoking had concomitant GERD. These patients were all treated with Nissen fundoplication for GERD. SETTING: Patients with chronic laryngitis were referred to an otolaryngologist at a tertiary medical center. PATIENTS: Patients were consecutively selected as they presented with chronic persistent laryngeal lesions and were found to have GERD. INTERVENTIONS: Surgical correction of GERD with Nissen fundoplication. MAIN OUTCOME MEASURES: Status of the larynx was assessed at 3-month intervals with fiberoptic laryngoscopy and symptoms (ie, hoarseness, sore throat) were evaluated. RESULTS: Laryngeal inflammatory lesions and voice changes (hoarseness and sore throat) promptly resolved in eight (73%) of 11 patients. To date, these improvements have continued after a mean follow-up of 11 months. CONCLUSIONS: Correction of GERD in a selected subset of patients with laryngeal inflammatory lesions ameliorates these lesions.

Chronic Disease↗
PubMedDate not supplied

Continuous ambulatory esophageal pH monitoring in the evaluation of patients with gastroesophageal reflux. Diagnostic and Therapeutic Technology Assessment.

OBJECTIVE: To provide clinicians with a technology assessment of the safety and effectiveness of continuous ambulatory esophageal pH monitoring (CAEpHM) in the diagnosis of pathologic gastroesophageal reflux in adults. PARTICIPANTS: A literature review and a Diagnostic and Therapeutic Technology Assessment (DATTA) survey questionnaire were mailed to 118 physicians with special interest in gastroesophageal reflux, esophageal disease, or the use of CAEpHM in the diagnosis of noncardiac chest pain. These panelists had been nominated to the DATTA panel by appropriate specialty societies and medical schools. A total of 93 panelists (79%) responded. EVIDENCE: Assessment was based on the expert opinion of the panelists, as well as on published scientific and medical literature (available as of June 1, 1994). Published studies were identified by a MEDLINE search using the terms esophagitis, reflux, and gastroesophageal reflux and by review of the references cited in these primary sources. CONSENSUS PROCESS: The respondents completed a DATTA survey questionnaire; the survey results were tabulated, analyzed, and interpreted by an American Medical Association medical scientist. CONCLUSIONS: The safety of CAEpHM was considered to be established in adults with chronic heartburn, chronic hoarseness, persistent acid reflux refractory to therapy, laryngeal lesions, or noncardiac substernal chest pain. The safety of CAEpHM was considered to be promising in adults with episodes of apnea. The effectiveness of CAEpHM was considered to be established in adult patients with clear primary symptoms that reflect esophageal damage, such as chronic heartburn, persistent acid reflux refractory to therapy, or noncardiac substernal pain; promising in adults with chronic hoarseness; and investigational in adults with episodes of apnea.

Adult↗
PubMed1999

Arytenoid adduction as an adjunct to type I thyroplasty for unilateral vocal cord paralysis.

BACKGROUND: Surgical management of unilateral vocal cord paralysis has evolved over the last three decades. The recent use of type I thyroplasty has resulted in improvements in voice, swallowing, and respiration. The study was performed to evaluate our experience in 28 patients undergoing arytenoid adduction as part of their surgical rehabilitation of unilateral vocal cord paralysis. METHODS: Patients undergoing arytenoid adduction with or without silastic medialization for unilateral vocal cord paralysis were entered into a prospective data base. Evaluation included symptomatic improvement in hoarseness, aspiration, dysphagia, dyspnea, and the radiographic documentation of pneumonia. Objective evaluation included mean phonatory air flow and acoustic analysis. Complications associated with surgery were recorded. RESULTS: A satisfactory result was obtained in 27 of 28 (96%) patients. By symptom, improvement in hoarseness was evident in 96%, dyspnea 80%, dysphagia 94%, and aspiration 84%. Improvements in phonatory flow rate (p < .001), estimated mean laryngeal airway resistance (p < .001), and maximally prolonged phonation (p < .01) were identified. Complications occurred in 18% and consisted of local wound sepsis (n = 1), hematoma (n = 1), seroma (n = 1), and transient airway edema (n = 2). There were no episodes of airway obstruction requiring tracheostomy or implant extrusion. CONCLUSIONS: Arytenoid adduction as part of type I thyroplasty is a safe and effective procedure. Subjective analysis confirms marked improvement in laryngeal function in the form of speech, swallowing, and respiration. Objective analysis confirms improvement in voice parameters. Future directions will focus on determination of those patients best served by arytenoid adduction.

Adult↗
PubMed2001

Surgical versus non-surgical interventions for vocal cord nodules.

BACKGROUND: Vocal cord nodules are bilateral swellings of the mid-portion of the membranous vocal folds. They are of variable size and are characterised histologically by thickening of the epithelium with a variable degree of inflammatory action in the underlying superficial lamina propria. They characteristically produce hoarseness. Treatment of vocal cord nodules aims to eliminate or reduce this hoarseness. OBJECTIVES: To assess the effectiveness of surgery versus non-surgical interventions for vocal cord nodules. SEARCH STRATEGY: We searched the Cochrane Controlled Trials Register (CCTR) and Medline (1966-2000), Embase (1974-2000), Biological Abstracts (1970-2000), Biological Abstracts RRM (Reports, Reviews and Meetings) on CD-ROM (1989-2000) and review articles. SELECTION CRITERIA: Randomised and quasi-randomised trials comparing any surgical intervention for vocal cord nodules with non-surgical treatment or no treatment. DATA COLLECTION AND ANALYSIS: No suitable trials were identified. MAIN RESULTS: No studies fulfilled the inclusion criteria. REVIEWER'S CONCLUSIONS: There is a need for high quality randomised controlled trials to evaluate the effectiveness of surgical and non-surgical treatment of vocal cord nodules.

Humans↗
PubMed2005

Inhaled fluticasone versus inhaled beclomethasone or inhaled budesonide for chronic asthma in adults and children.

BACKGROUND: Beclomethasone dipropionate (BDP) and budesonide (BUD) are commonly prescribed inhaled corticosteroids for the treatment of asthma. Fluticasone propionate (FP) is newer agent with greater potency in in-vitro assays. OBJECTIVES: To compare the efficacy and safety of Fluticasone to Beclomethasone or Budesonide in the treatment of chronic asthma. SEARCH STRATEGY: We searched the Cochrane Airways Group trial register (January 2004) and reference lists of articles. We contacted trialists and pharmaceutical companies for additional studies and searched abstracts of major respiratory society meetings (1997 to 2003). SELECTION CRITERIA: Randomised trials in children and adults comparing Fluticasone to either Beclomethasone or Budesonide in the treatment of chronic asthma. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed articles for inclusion and methodological quality. One reviewer extracted data. Quantitative analyses were undertaken using RevMan analyses 1.0.1. MAIN RESULTS: Fifty six studies (12, 119 participants) met the inclusion criteria. Methodological quality was variable. Dose ratio 1:2: FP produced a significantly greater FEV1 (0.14 litres, 95% Confidence Interval (CI) 0.06 to 0.22), morning PEF (11.10 L/min, 95%CI 3.12 to 19.09 L/min) and evening PEF (9.31 L/min, 95%CI 5.12 to 13.5 L/min). This applied to all drug doses, age groups, and delivery devices. No difference between FP and BDP/BUD were seen for trial withdrawals. Symptoms and rescue medication use were widely reported but few trials provided sufficient data for analysis. When given at half the dose of BDP/BUD, FP led to a greater likelihood of pharyngitis. There was no difference in the likelihood of oral candidiasis. Plasma cortisol and 24 hour urinary cortisol was measured frequently but data presentation was limited. Dose ratio 1:1: FP produced a statistically significant difference in am PEF (9.58 L/min (95% CI 5.20 to 13.97)), pm PEF (7.41 L/min (95% CI 2.61 to 12.22)), and FEV1 (0.09 L (0.02 to 0.17)). The effects on exacerbations were mixed. There was an increase in the incidence of hoarseness, but no significant difference in pharyngitis, candidiasis, or cough. AUTHORS' CONCLUSIONS: Fluticasone given at half the daily dose of beclomethasone or budesonide leads to small improvements in measures of airway calibre, but it appears to have a higher risk of causing hoarseness when given at the same daily dose. Future studies should attempt to establish the relative efficacy of inhaled steroids delivered with CFC-free propellants.

Adult↗
PubMed2003

Vocal cord abnormalities in Williams syndrome: a further manifestation of elastin deficiency.

Williams syndrome (WS) is due to a deletion in the WS critical region at 7q11.23 which includes the elastin gene (ELN). One of the most characteristic features of this disorder is a harsh, brassy, or hoarse voice but the etiology of the vocal characteristics are unknown. We report two patients with WS who had bilateral vocal cord abnormalities, bringing to four the number of children with WS in whom such defects have been documented. We suggest that vocal cord abnormalities may be a far more common feature of WS than has been previously suspected, and that mild vocal cord dysfunction caused by abnormal vocal cord elastin may be the cause of the hoarse voice in this condition.

Adult↗
PubMed2006

Daughter and her mildly affected father with Keipert syndrome.

A 10-year-old girl with characteristic features of Keipert syndrome (broad terminal phalanges, especially of the thumb and hallux, sensorineural deafness, unusual facial features, large head circumference, maxillary hypoplasia, hoarse voice) and her mildly affected father (broad terminal phalanges, especially of the thumb and hallux, large head circumference, maxillary hypoplasia, and hoarse voice) are presented. The girl is the first reported female with this rare syndrome to date, and the fact that she probably inherited the disease from her father suggests an autosomal dominant pattern of inheritance.

Abnormalities, Multiple↗
PubMedDate not supplied

Large thyroglossal duct cyst with laryngeal extension.

BACKGROUND: A thyroglossal duct cyst typically presents as a long-standing neck mass that becomes symptomatic when inflamed. Hoarseness is an uncommon complaint, and its association may suggest encroachment on and destruction of the larynx. Following removal of the cyst with the Sistrunk procedure, the larynx may need to be reconstructed. METHODS: A case is reported of a patient who was initially seen with hoarseness and a long-standing midline neck mass. Computed tomography (CT) demonstrated a large cystic neck mass that eroded the thyroid cartilage and encroached on the pre-epiglottic space and right paraglottic space. Although the clinical impression was that of laryngeal neoplasm, the CT diagnosis was that of a cyst. At surgery, a thyroglossal duct cyst was found and successfully removed with the Sistrunk procedure. Because the thyrohyoid membrane and thyroid perichondrium were preserved, the glottis did not require reconstruction. This case is presented and the literature of thyroglossal duct cysts that extend into the larynx is reviewed. CONCLUSIONS: The clinical and radiographic criteria that suggest encroachment of a thyroglossal duct cyst on the larynx are reviewed. The management and indications for laryngeal reconstruction are discussed.

Adult↗
PubMed1982

Pseudocarcinomatous hyperplasia of the larynx due to Candida albicans.

A female patient presented with hoarseness. Findings on physical examination showed whitish true vocal cords. Laryngeal biopsies were performed on two two occasions. On the first biopsy a histopathological diagnosis of Candida albicans and acanthosis was controversial because the acanthosis resembled squamous cell carcinoma. On the second biopsy, several months later, the diagnosis of acanthosis was again controversial, but a diagnosis of pseudocarcinomatous hyperplasia was not determined until several months later. Finally, we can point out that pseudocarcinomatous hyperplasia can be associated with primary candidiasis and state that hoarseness, whitish true vocal cords, and pseudocarcinomatous hyperplasia can masquerade as squamous cell carcinoma of the larynx.

Candidiasis↗
PubMed1984

Hyalinosis cutis et mucosae in siblings.

Hyalinosis cutis et mucosae is a rare autosomal recessive disorder of unknown aetiology. Clinical features are hoarseness from early infancy and yellowish papules and plaques in mucous membranes and skin. Light and electron microscopy demonstrates accumulation of PAS-positive material around blood vessels and in the dermis. This substance probably derives from glycoproteins of basement membranes. Carbon dioxide laser surgery of thickened vocal cords proved to be effective for the treatment of hoarseness.

Child↗
PubMed2001

Routine use of the intubating laryngeal mask airway results in increased upper airway morbidity.

PURPOSE: The classic laryngeal mask airway (LMA) has a soft, silicone tube and the intubating laryngeal mask airway (ILM) has a rigid, silicone-coated steel tube. We compare postoperative pharyngolaryngeal morbidity in patients randomised to receive either device. METHODS: Sixty-five female patients (ASA physical status class I or II, aged 18-80 yr) undergoing balanced regional anesthesia for gynecological laparotomy expected to last one to two hours were randomly assigned for airway management with the LMA or ILM. Intracuff pressure was maintained at 60 cm H20. Postoperative pharyngolaryngeal morbidity (sore throat, difficulty swallowing, sore mouth, sore neck/jaw, hoarseness) was assessed at two, 24 and 48 hr by blinded investigators. RESULTS: The number of insertion attempts and duration of anesthesia was similar between groups. Sore throat was more common for the ILM at two hours (44 vs 15%, P=0.01), 24 hr (59 vs 21%, P=0.008) and 48 hr (34 vs 3%, P=0.005). Sore mouth was more common for the ILM at two hours (16 vs 0%, P=0.02) and 24 hr (12 vs 0%, P=0.04), but not at 48 hr (6 vs 3%). Difficulty swallowing was more common for the ILM at two hours (25 vs 0%, P=0.04), but not at 24 hr (31 vs 3%) and 48 hr (12 vs 9%). There were no differences in the incidence of sore jaw/neck (ILM, 3-12%; LMA, 0-3%) and hoarseness (ILM, 12-31%; LMA, 16-18%). There was no correlation between postoperative pharyngolaryngeal morbidity and duration of anesthesia. CONCLUSION: Pharyngolaryngeal morbidity is more common with the ILM than the LMA following anesthesia lasting one to two hours.

Adolescent↗
PubMed2002

Laryngeal mask cuff inflation at removal does not affect early postoperative laryngopharyngeal morbidity.

PURPOSE: We assessed the effect of cuff inflation of the laryngeal mask airway at removal on sore throat, pharyngeal morbidity and airway complications. METHODS: In a prospective randomized trial, we used a standardized technique of anesthesia and of laryngeal mask insertion in 126 consecutive day-case patients. Postoperatively, on eye opening, the masks were removed either inflated (Group A) or deflated (Group B) and examined for blood by a blinded observer. Episodes of coughing, gagging, laryngospasm, hiccups and retching, and symptoms of sore throat and hoarseness were recorded by the same observer. RESULTS: Demographics were similar. Bloodstaining occurred in 21% of patients in Group A (n = 63) vs 13% in Group B (n = 63; P = 0.23); the incidence of sore throat was identical (19%). Group A experienced more hoarseness (22% vs 9%; P = 0.05). Overall airway complications did not differ between groups (19% vs 11%; P = 0.21). CONCLUSION: We conclude that removal of the laryngeal mask airway inflated does not reduce the incidence of sore throat, pharyngeal morbidity or airway complications.

Adolescent↗
PubMed2003

[First clinical experiences with the new LTS. A laryngeal tube with an oesophageal drain].

OBJECTIVE: The feasibility of prototypes of the LTS, a laryngeal tube with an additional oesophageal drain tube for pressure relief, was tested for ventilation during surgery. METHODS: After approval of the ethics committee, a LTS was placed in 30 orthopaedic patients, ASA I and II, induction of general anaesthesia with fentanyl and propofol. Position of the LTS was verified by auscultation and end tidal CO(2)-measurement. Oxygen saturation, number of placement attempts, cuff pressure, time until first tidal volume, tidal volume and airway pressures were registered intraoperatively. Patients were questioned about hoarseness and soar throat 1 h, 6 h and 24 hours after surgery, graded on a visual analogue scale (VAS). RESULTS: 16 women and 14 men were investigated. In 29 patients (96.7%), the LTS was placed successfully (second attempt in three patients). In one patient, sufficient ventilation was not possible. In this case and in another patient with sufficient ventilation but estimated duration of surgery >3 h, endotracheal intubation was performed. Average time until first tidal volume was 17.3 seconds, ventilation was performed for 74 minutes. Pulse oximetric oxygen saturation was > or =97% at all times. Auscultation over the stomach was negative in all patients with an average cuff pressure of 73.7 cm H(2)O. During controlled ventilation aiming at an end tidal CO(2) of 35 mmHg (average 36.3 mmHg), an average tidal volume of 579 ml was reached, resulting in an inspiratory peak pressure of 20.2 cm H(2)O. Minimal traces of blood on the LTS were found in 5 patients, hoarseness was present in one patient after 6 hours, soar throat was stated after 1 hour by one patient (VAS 3), after 6 hours by 6 (average VAS 2.7) and after 24 hours by 3 patients (VAS 1.3). CONCLUSIONS: The LTS can be used for ventilation during elective surgery and can be placed with a high success rate. Postoperative complaints are infrequent and mild.

Adult↗