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PubMed2000

Permanent iatrogenic vocal cord paralysis after I-131 therapy: a case report and literature review.

A patient who underwent I-131 therapy for a solitary toxic thyroid nodule subsequently experienced vocal cord paralysis, a rare complication. The patient was examined because of hoarseness 1 week after treatment. Indirect laryngoscopy at the time confirmed right vocal cord paralysis. When the examination was repeated in 6 months, no improvement was noted; vocal cord paralysis was then declared permanent. Surprisingly, 11 months after the onset of symptoms, the patient observed improvement in her voice. At 14 months, she experienced complete vocal recovery. However, a computed tomography performed after this showed that her right vocal cord paralysis was unresolved. The apparent complete recovery of her voice is believed to be a result of adaptive compensatory mechanisms. Patients who recover from hoarseness after injury to the recurrent laryngeal nerve should have cord function documented by indirect laryngoscopy or other means before the physician performs a procedure that could harm the contralateral nerve, because damage to this nerve could result in devastating consequences.

Aged↗
PubMed1998

Adenoid cystic carcinoma of the trachea.

OBJECTIVE: Primary tracheal tumors are rare, occurring in 0.2 per 100,000 persons per year. Adenoid cystic carcinoma (ACC) is the second most common histologic type of tracheal malignancy. Its clinical behavior is different from the other tracheal neoplasms and thus should be studied separately. STUDY DESIGN/METHODS: Retrospective review of the medical records of six patients with tracheal ACC who were treated at University Hospitals of Cleveland between 1971 and 1996 and literature review. RESULTS/CONCLUSION: Tracheal ACC is an indolent tumor that affects people at any age but has a peak incidence in the fifth decade. There is a nearly equal male-to-female ratio. Almost half of tracheal ACCs occur in the proximal trachea, accounting for the most common presenting symptoms: dyspnea, cough, and hoarseness. Because of the hoarseness, patients are often referred to an otolaryngologist. Complete resection provides the best chance for increased survival. Neutron beam radiotherapy holds promise for adjuvant therapy.

Adult↗
PubMed2002

Medical malpractice and cancer of the larynx.

OBJECTIVE: To analyze the frequency, clinical characteristics, and legal outcomes of malpractice litigation initiated by patients with cancer of the larynx. STUDY DESIGN: Retrospective review of 23 jury verdict reports from 11 states. METHOD: Jury verdict reviews from 1976 to 1997 were obtained from a computerized legal database compiled from all state and federal civil court decisions. Reviews compile pertinent data on defendants, plaintiffs, verdict outcomes, indemnity payments, allegations of wrongdoing, and provide case summaries. RESULTS: Delays in diagnosis were alleged in 19 of 23 (83%) suits. Hoarseness was present in 10 of 19 (53%), a neck mass in 3 of 19 (16%), and no biopsy was taken in 11 of 19 (58%) of those delayed. Mean age was 47 years, with a peak incidence in the general population of 70 to 74 years. Laryngectomy was alleged to be a result or complication of delay in 12 of 19 (63%). Over half of the patients delayed received compensation, and over half of the defendants were in general practice. Outcome was poor with a 35% mortality and a total of 47% either dead of disease or alive with disease. Complications, incorrect diagnosis, and informed consent did not play a significant role in initiating litigation. CONCLUSIONS: The delayed diagnosis of cancer of the larynx associated with litigation is frequently seen in younger patients presenting with hoarseness or neck masses. These patients frequently have poor outcomes. Patients with symptoms of cancer of the larynx must be aggressively evaluated regardless of age. Risk management goals to prevent delays in diagnosis may help prevent subsequent litigation.

Age Factors↗
PubMed2002

Dedifferentiated chondrosarcomas of the larynx: a report of two cases and review of the literature.

OBJECTIVE: To analyze the long-term clinical outcome of dedifferentiated chondrosarcoma or chondrosarcoma with additional malignant mesenchymal component (CAMMC) of the larynx and compare the results with those of axial chondrosarcomas. STUDY DESIGN/METHODS: Two patients with CAMMC of the larynx (0.03%) were retrospectively identified within the archives of the Armed Forces Institute of Pathology between 1970 and 2001. We compared the clinical and histologic features of these two cases with those reported in the English literature (Medline 1966-2001) (Table I). RESULTS: Patient no. 1 was a 67-year-old man who presented with a 12-month history of hoarseness and was found to have a 4-cm mass involving the cricoid cartilage. Enucleation was performed and histologically demonstrated a dedifferentiated chondrosarcoma. Without additional intervention, the patient died after 136 months without evidence of disease. Patient no. 2 was a 41-year-old man who also presented with a 12-month history of hoarseness and dysphagia and was found to have a 5-cm mass involving the cricoid cartilage. A total laryngectomy was performed for the dedifferentiated chondrosarcoma. He is alive without evidence of disease at last contact (91 mo). CONCLUSION: CAMMC of the larynx are rare tumors but have a better prognosis than their axial counterparts (mean, 6 mo). Initial voice-sparing surgery can be followed with more aggressive surgery if recurrences develop.

Adult↗
PubMed1994

Multiple cranial neuropathies associated with leprosy.

We report on a Samoan man with dysphagia, voice hoarseness, facial erythema, and edema. Neurologic examination revealed hypesthesia at the site of the facial rash, enlarged auricular nerves, a right facial palsy, decreased gag reflexes, and voice hoarseness. Laryngoscopic examination showed paralysis of the left vocal cord, and a barium swallow revealed a possible compressive lesion. A skin biopsy specimen was diagnostic of tuberculoid leprosy. This patient has an unusual case of leprosy with multiple cranial neuropathies.

Adult↗
PubMed1999

Laryngeal tuberculosis in renal transplant recipients.

BACKGROUND: Tuberculosis is the most common non-pyogenic infection encountered among renal transplant recipients in India. Although the lung is the most common site of involvement, a number of extrapulmonary organs can be involved. There is often a delay in diagnosis and institution of effective chemotherapy when there is an unusual site of involvement. METHODS AND RESULTS: We report two renal transplant recipients with laryngeal tuberculosis who presented with prolonged hoarseness of voice and painful dysphagia. Acid-fast bacilli were demonstrated on laryngeal biopsy and smear. Fever and pulmonary involvement were seen in only one patient. This is the first report of laryngeal tuberculosis in renal transplant recipients. CONCLUSIONS: Laryngeal tuberculosis should be suspected in renal transplant recipients who develop hoarseness of voice and odynophagia. Demonstration of acid-fast bacilli on biopsy or smear obtained by direct laryngoscopy helps in determining the diagnosis.

Adult↗
PubMed2005

A novel mutation of the extracellular matrix protein 1 gene (ECM1) in a patient with lipoid proteinosis (Urbach-Wiethe disease) from Sicily.

BACKGROUND: Lipoid proteinosis (LP), also known as Urbach-Wiethe disease, is a rare autosomal recessive disorder characterized by a hoarse voice, warty skin infiltration and scarring. Mutations within the extracellular matrix protein 1 (ECM1) gene cause LP. OBJECTIVES: We report the molecular analysis of the ECM1 gene in a Sicilian patient with LP in order to extend the mutation spectrum of this genodermatosis. METHODS: We studied a 32-year-old female born from consanguineous parents who was diagnosed at the age of 11 years as having LP. She has a clinical phenotype corresponding to Urbach-Wiethe disease characterized by papules/nodules, indurated plaques and sometimes ulcerated lesions primarily involving the skin and mucous membranes, and extracutaneous features such as epilepsy, hoarseness of the voice and neuropsychiatric abnormalities. Samples of clinically affected skin obtained by biopsies were analysed after staining with haematoxylin and eosin, periodic acid-Schiff (PAS), and PAS-diastase. The whole ECM1 gene was analysed by direct sequencing. RESULTS: We identified a homozygous nonsense mutation in exon 6 of the ECM1 gene, C589T (Q197Ter). CONCLUSIONS: Over 60% of mutations occur in exons 6 and 7. Exon 7 is alternatively spliced and frameshift mutations in exon 7 lead to ablation of the ECM1a transcript, but not the shorter ECM1b transcript that normally lacks this exon. Homozygous nonsense or frameshift mutations in exon 6 are predicted to affect both full-length ECM1a and ECM1b transcripts, whereas ECM1b should be unaffected for similar types of mutation in exon 7. It has been suggested that individuals with mutations in exon 7 have a slightly milder phenotype than those with exon 6 mutations. This is the first report with respect to a novel mutation of the ECM1 gene responsible for recessive LP in Sicily.

Adult↗
PubMed1992

Prophylactic laryngo-tracheal aerosolized lidocaine against postoperative sore throat.

A randomized, double-blind study was carried out on 193 ASA I-II surgical patients to assess the effect of aerosolized lidocaine on sore throat, hoarseness and cough in connection with tracheal intubation. The study group received aerosolized lidocaine 100 mg 2 min before tracheal intubation, using a spray. The control group received no spray. The patients underwent a standardized general anaesthesia. The patients were interviewed when leaving the recovery room and the next day in the ward. Specific questions were asked regarding sore throat, cough and hoarseness. There were no significant differences between the two groups, which suggests that topical anaesthesia of the mucosa of the upper airway is ineffective as a means of ameliorating airway complaints in connection with tracheal intubation.

Administration, Inhalation↗
PubMed2003

Complications after outpatient upper GI endoscopy in children: 30-day follow-up.

OBJECTIVE: Upper GI endoscopy (UGE) is a common procedure performed for evaluation and treatment of various upper GI tract disorders in children. Limited comprehensive data are available on the complications of UGE in adults and particularly in children. The goals of this study were to identify complications and adverse events reported by patients and their parents after outpatient UGE under general anesthesia (GA). METHODS: Pediatric patients who underwent outpatient UGE under GA between April, 2000 and April, 2001 at the James Whitcomb Hospital for Children were identified. The interviewer obtained verbal consent and performed standardized telephone interviews 30 days after the outpatient UGE. RESULTS: A total of 393 patients participated in this survey. Of the patients, 165 (42%) had one or more complications or adverse events. The most common ones reported by patients or parents 30 days after the UGE under GA were sore throat or hoarseness (34.6%), fatigue (6.6%), cough (4.1%), headache (3.3%), excessive gas or burping (2.8%), nausea (2.5%), emesis (2.3%), abdominal pain (2%), fever (2%), behavior problems (1.8%), upper respiratory symptoms (1.3%), excessive drowsiness (0.5%), nosebleed (0.3%), perioral rash (0.3%), and chest pain (0.3%). Ten of 165 patients with complications or adverse events after UGE sought medical assistance. CONCLUSIONS: Approximately one third of pediatric patients complained of sore throat or hoarseness after UGE under GA. All other reported complications or adverse events were infrequent. We conclude that UGE under GA is safe and well tolerated in pediatric patients.

Adolescent↗
PubMed1999

Laryngeal aspergillosis following high dose inhaled fluticasone therapy for asthma.

The case history is presented of a 75 year old man with chronic asthma who was treated with inhaled fluticasone propionate in a daily dose of 2 mg using a Diskhaler. After three years of treatment he developed progressive hoarseness. Both vocal cords were colonised by Aspergillus fumigatus which formed a white slough on the surface. Biopsy specimens showed changes suggestive of laryngeal aspergillosis with an ulcerated epithelium, fibrinopurulent debris, and colonies of fungal hyphae. A slow recovery occurred after three months of treatment with topical amphotericin and with cessation of inhaled corticosteroids. Laryngoscopy is recommended if hoarseness occurs during treatment with fluticasone.

Administration, Topical↗
PubMedDate not supplied

Multidimensional voice evaluation in pretreatment glottic carcinoma.

It is generally accepted that, in glottic carcinoma, the voice will deteriorate, even in the early stages. This paper reports the degree of hoarseness and multidimensional vocal evaluation of glottic carcinoma patients. Forty-seven male glottic carcinoma patients and a control group of 13 normal subjects were included in this study involving psychoacoustic evaluation by doctors, acoustic analysis, phonogram, maximum phonation time and stroboscopy before treatment. A normal voice or mild hoarseness by psychoacoustic evaluation was found in 35% of cases with T1 and T2 glottic carcinoma. Patients with psychoacoustically inferior vocalization had high scores on acoustic analysis, small phonogram areas, and short maximum phonation time. Stroboscopy revealed attenuation or disappearance of the mucosal wave on the tumor side in all cases, whether the acoustic analysis data were within or beyond the normal limits. We identified two conditions offering superior vocalization in glottic carcinoma patients: (1) the lesion should be unilateral, and (2) the lesion should be flat with no protrusion. We should evaluate patients with glottic carcinoma not only with vocal examination but also using stroboscopy before biopsy.

Adult↗
PubMed1992

Laryngeal paraganglioma and pregnancy.

Paraganglioma is an uncommon tumor of the larynx. We present a 30-year-old woman with a paraganglioma which took a heretofore not described clinical course. The first clinical sign was persistent hoarseness, when she was 26 weeks pregnant. A histological examination of a piece of the reddish, racemose tumor removed during microlaryngoscopy revealed only some slight nonspecific inflammatory changes. The patient remained free of symptoms following this operative procedure until 3 years later when she presented with a recurrence of hoarseness and a laryngeal tumor and was 25 weeks pregnant. Histology showed a laryngeal paraganglioma in the same supraglottic localization as before. Histological studies failed to confirm the obvious suspicion that the episodic growth of the paraganglioma may have been induced by estrogen or gestagen. To date, 6 years after the removal of the tumor, there has been no recurrence.

Adult↗
PubMed1994

Spectrum of lateral medullary syndrome. Correlation between clinical findings and magnetic resonance imaging in 33 subjects.

BACKGROUND AND PURPOSE: Computed tomography is insufficient in evaluation of medullary lesions. Although lateral medullary infarction is a relatively common type of cerebrovascular disease, detailed correlation between clinical findings and magnetic resonance imaging (MRI) has not yet been reported. METHODS: We studied 33 consecutive patients with lateral medullary infarction who showed appropriate MRI lesions and correlated their clinical findings with the MRI results. RESULTS: Gait ataxia (88%), vertigo/dizziness (91%), nausea/vomiting (73%), dysphagia (61%), hoarseness (55%), Horner sign (73%), and facial (85%) and hemibody (94%) sensory changes were frequent clinical findings. MRI results showed that the lesions located in the rostral part of the medulla were usually diagonal band-shaped and were associated with more severe dysphagia, hoarseness, and the presence of facial paresis, whereas the caudal lesions, situated usually in the lateral surface of the medulla, appeared to correlate with more marked vertigo, nystagmus, and gait ataxia. Nausea/vomiting and Horner sign were common regardless of the lesion location, and lesions extending ventromedially correlated with facial sensory change on the contralateral side of the lesion. CONCLUSIONS: Analysis of MRI findings in rostrocaudal and dorsoventral aspects allows us, although not unequivocally, to make anatomicoclinical correlations in the evaluation of patients with lateral medullary stroke syndrome.

Adult↗
PubMedDate not supplied

Recurrent laryngeal nerve injury: a complication of central venous catheterization-a case report.

This case report highlights the emergence of new complications associated with old procedures as the frequency of their use increases. A 29-year-old man with aplastic anemia was admitted for a bone marrow transplant. Before this procedure, a Hickman line was inserted. This was followed by hoarseness of voice. An examination revealed an immobile left vocal cord. Further investigations did not show any cause for this complication. Therefore, the hoarseness and vocal cord paralysis was attributed to trauma associated with the insertion of the Hickman line.

Adult↗
PubMedDate not supplied

Clinical significance of asymmetrical vocal cord tension.

The effects of asymmetrical tension on the vibratory pattern of the vocal cords were studied in two kinds of experiments: 1) high speed motion picture photography of artificial voice production in excised canine and human larynges, and 2) computer synthesis of voice and vocal cord vibration via a theoretical model incorporating the physiological parameters required for phonation. In both approaches the asymmetrically tensed vocal cords consistently vibrated in three distinct modes which depend partly on the rest positions of the vocal cords; Type I. For rest positions at or near closure, the two cords vibrate at the same frequency with glottal closure every period, and with tense cord preceding the lax one in phase and with the line of contact moving toward the tenser cord during the closed phase. The voice produced is not hoarse; Type II. For wider rest positions glottal closure occurs irregularly, the vibrations become complex and less periodic, and the voice becomes hoarse; Type III. The glottis never closes and the vibrations become more periodic with reduced amplitude. Supplementary stroboscopic observations suggest a precedure for diagnosing tension asymmetry and the implications for surgical treatment for disorders of vocal pitch are discussed.

Animals↗
PubMedDate not supplied

Airway-obstructing epiglottic cyst.

Laryngeal cysts, particularly epiglottic cysts, are generally benign lesions which cause mild dysphagia or hoarseness. We report a case of an epiglottic cyst that caused almost complete airway obstruction. A 43-year-old man presented with progressive dysphagia, hoarseness, and airway obstruction secondary to a large cystic mass involving the entire epiglottis and filling the hypopharynx. He required emergency tracheotomy to secure the airway, and the cyst was incised and drained. Following a subsequent recurrence, laser excision of the cyst was performed and the problem resolved. The cystic mass was found to fill the valleculae, and involved the lingual and laryngeal surfaces of the epiglottis and the left false vocal cord. A review of laryngeal cysts is presented with emphasis on anatomic and embryologic considerations. The potential lethal nature of these lesions is emphasized.

Adult↗
PubMed1993

Vocal cord paralysis caused by esophageal cancer surgery.

Esophageal cancer surgery was the cause of paralysis in 111 (16.7%) of 664 patients with vocal cord paralysis seen from 1981 to 1990 at Kurume University Hospital. Eighty-six patients had unilateral paralysis, whereas 25 had bilateral lesions. Of the 111, 95 (86%) had hoarseness and 59 (53%) had aspiration. The crude survival rate was 63% for 1-year, 32% for 3-year, and 22% for 5-year follow-up. The average life expectancy was short. The general condition was poor in many patients. Thirty-four of the 136 paralytic vocal cords (25%) recovered mobility. An intracordal silicone injection was done in 30 patients, and a medialization procedure was performed in 1. The vocal function was improved in the majority of cases. In 4 patients, severe aspiration persisted following intracordal injection. Of the 4, 1 had cricopharyngeal myotomy and laryngeal suspension and 2 underwent total laryngectomy. The fourth patient died of aspiration pneumonia. The results of the review of the 111 patients have led us to the following treatment policy for patients with vocal cord paralysis caused by esophageal cancer surgery. When the patient has aspiration, vocal cord medialization should be performed as early as possible. If severe aspiration persists even after the medialization procedure, some additional intervention, including cricopharyngeal myotomy, laryngeal suspension, laryngotracheal separation, or total laryngectomy, should be considered. When hoarseness is the only major problem, the prognosis of vocal cord paralysis should be determined on the basis of the state of the recurrent laryngeal nerve and, if available, electromyography findings.(ABSTRACT TRUNCATED AT 250 WORDS)

Electromyography↗
PubMed1996

Home dampness, moulds and their influence on respiratory infections and symptoms in adults in Finland.

The aim of this study was to analyse the prevalence of mouldy homes and their association with respiratory symptoms and diseases in a subarctic climate. A questionnaire was mailed to a random sample of 2,000 males and females, aged 25-64 yrs, living in the county of Kuopio, Finland. A total of 1,521 (76%) responded and 1,460 were selected for the final analysis. The prevalence of homes with visible mould was 4%; with the odour of mould 5%; with damp spots, visible mould or the odour of mould 15%; and with moisture/ water damage, damp spots, visible mould or the odour of mould 23%. The number of reports of bronchitis, common cold, atopy, allergic rhinitis, rhinitis, fever and chills, hoarseness, fatigue, difficulties in concentration, lumbar backache and stomach ache were strongly associated with living in a damp home. Bronchitis, hoarseness and difficulties in concentration had the strongest associations, with adjusted odds ratios (95% confidence limits) of: 2.04 (1.49-2.78), 2.23 (1.37-3.63) and 2.17 (1.35-3.50), respectively. After controlling for a possible reporting bias by excluding those subjects reporting lumbar backache and recurrent stomach pain, eye irritation and tiredness remained significant. In conclusion, living in a home with mould problems may increase the risk of respiratory infections and symptoms in adults.

Adult↗