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PubMedDate not supplied

[Granular cell tumor: an infrequent cause of dysphonia in childhood].

Granular cell tumors (GCT) are rare and usually benign tumors whose histogenesis is debated. The skin, subcutaneous tissues, and mucosae of the head and neck are areas of predilection for GCT. Laryngeal involvement is uncommon, but may create diagnostic and therapeutic problems when it occurs. Laryngeal GCT are decidedly uncommon in children, only 17 cases having been reported in the literature. A case of GCT of the larynx in an 11-year-old girl is reported. The presenting symptom was hoarseness. The macroscopic tumor and hoarseness disappeared after chemotherapy (EVAIA) for Ewing sarcoma of the knee.

Biopsy↗
PubMed1999

[A case with frequent episodes of transient ischemic attack presenting the Wallenberg syndrome before and after the onset of brain infarction].

A 52-year-old man with diabetes mellitus, hyperlipidemia and smoking habit, experienced transient ischemic attacks (TIAs) with symptoms of left orbital pain, left blepharoptosis and hoarseness lasting for five minutes on March 10, 1997. Subsequently, the same symptoms repeated once or twice daily. On March 28, he had dysphagia, numbness and disturbance of pain and temperature sensation (segmental dissociated sensory disturbance) on the right side of the body above the level of the Th10, the right upper limb and face. The deficits persisted for more than 24 hours. Angiographic studies revealed an occlusion of the left vertebral artery immediately after branching of the posterior inferior cerebellar artery. MRI demonstrated a hyperintense lesion on MRI T2 weighted image in the left lateral medulla. About three months after the completed stroke, he had six episodes of TIAs of left Horner's sign and hoarseness. To our knowledge, this is the rare case that had frequent TIAs presenting the Wallenberg syndrome before and after the onset of lateral medullary infarction. We speculate that the TIAs resulted from microembolism from the proximal end of occluted left vertebral artery and failure of the microcirculation in and around the lateral portion of the medulla oblongata.

Cerebral Infarction↗
PubMedDate not supplied

[Hyperammonemia during hypothyroidism: an unusual biohumoral finding normalized by hormonal replacement treatment].

In this paper we describe 3 clinical cases of hypothyroidism causing myopathy and hyperammonemia. The patients, all females, aged 32 to 64 years, presented with hoarseness, fatigue, dyspepsia (case I), difficulty speaking secondary to the sensation of tongue swelling and hoarseness (case II), and progressive weight gain and difficulty speaking secondary to tongue swelling after delivery (case III). Laboratory tests showed a marked increase in creatine phosphokinase (up to 4090 U/L; normal values 24-176 U/L) of muscle origin, and an increase in transaminases and ammonia (124 to 150 micrograms/dL; normal values up to 75 micrograms/dL). Hypothyroidism was confirmed by TSH > 100 microIU/mL (normal values 0.3-5 microIU/mL). Treatment only with L-thyroxine determined the complete and persistent recovery of well-being and of biochemical abnormalities. The patients remained in good health after more than 2 years of follow-up. Our finding of hyperammonemia caused by the lack of thyroid hormones in 3 patients with hypothyroid myopathy appears to be of a certain interest as, to our knowledge, this phenomenon has not been previously described. In conclusion our hypothesis is that increased muscle production of ammonia secondary to the hypothyroid myopathy determined an increased ammonia load, resulting in hyperammonemia. Decreased liver ureagenesis induced by the lack of thyroid hormones also contributed to the hyperammonemia.

Adult↗
PubMed2000

99mTc-sulfur colloid gastroesophageal scintigraphy with late lung imaging to evaluate patients with posterior laryngitis.

UNLABELLED: The aim of this study was to use gastroesophageal and pulmonary scintigraphy to evaluate the prevalence of gastroesophageal reflux and airway involvement among patients with posterior laryngitis. METHODS: The study included a total of 201 patients (131 females, 70 males; age range, 15-77 y; mean age +/- SD, 49 +/- 16 y). All patients had posterior laryngitis documented by laryngoscopy and symptoms such as a dry cough, painful swallowing, and hoarseness. A control population of 20 healthy volunteers (13 females, 7 males; age range, 19-74 y; mean age, 53 +/- 13 y) was also evaluated. After a 12-h fast, all subjects underwent gastroesophageal scintigraphy through administration of 300 mL orange juice labeled with 185 MBq 99mTc-sulfur colloid. After 18 h, planar anteroposterior thoracic images were acquired with the subjects supine. RESULTS: Sixty-seven percent of patients (134/201) had scans positive for gastroesophageal reflux; of these, 30 (22%) had distal reflux and 104 (78%) had proximal reflux. In addition, the scans of 31 patients were positive for proximal reflux-associated pulmonary uptake. The frequency, duration, and degree of reflux episodes were significantly greater in patients with proximal reflux than in patients with distal reflux (P < 0.001). The 67 patients in whom reflux was not detected had diseases or reflux-associated cofactors that could account for laryngeal symptoms. No statistically significant difference in symptoms or esophageal motility parameters could be identified among the patient groups, but patients with proximal reflux had significantly prolonged gastric emptying times compared with healthy volunteers. CONCLUSION: Most patients with posterior laryngitis had detectable proximal gastroesophageal reflux. Exposure of the proximal part of the esophagus to acid, by setting the stage for microaspiration of gastric material into the larynx, remains a major cause of damage to the laryngeal mucosa. Slowed gastric emptying may be a predisposing factor. Moreover, symptoms such as a dry cough, painful swallowing, or hoarseness may not be reliable predictors of the presence of gastroesophageal reflux or of associated airway involvement.

Case-Control Studies↗
PubMed2001

[Early diagnosis and prevention of malignant tumors in the head and neck region].

In the Netherlands more than 2000 new patients with head and neck cancer are diagnosed annually. Most of these cancers are squamous cell carcinomas. The use of tobacco and alcohol are well established aetiologic factors. Head and neck cancers usually affect patients above the age of 40 years and are somewhat more common in men than in women. The type of the initial symptoms of head and neck cancer depends largely on the exact location. Often, these symptoms are rather aspecific. However, laryngeal cancer is an exception. In this site cancer usually presents at an early stage with sudden hoarseness. Hoarseness of more than three weeks' duration requires laryngoscopic examination. Particularly the cancers of the floor of the mouth and the borders on the tongue can be detected early because of the accessibility of these sites, which allows proper inspection and palpation. The most common clinical manifestation of oral cancer is an indurated ulcer. An oral ulcer present for more than three weeks is an indication for biopsy. The prognosis of head and neck cancer in general depends largely on the stage at diagnosis. Small cancers carry a much better prognosis after surgical removal or radiotherapy than larger ones.

Alcohol Drinking↗
PubMed2001

Cordotomy for bilateral cord abductal paralysis.

OBJECTIVE: To investigate the clinical effects of cordotomy on bilateral cord abductal paralysis. METHODS: With unilateral cordotomy, we treated 4 patients with bilateral cord paralysis whose glottis size was about 2.0 mm to 2.5 mm. They were followed up for over one year. RESULTS: One week after surgery, the tracheotomy tubes of all 4 patients were plugged and no dyspnea occurred during rest and mild action. Their voices were more hoarse than before surgery. After 3 months, the tracheotomy tubes were successfully decannulated, and in the following one year, their respiration was normal and then speech was clear, although their voices were still a little hoarse. CONCLUSION: We suggest that cordotomy be one option in the treatment of bilateral cord abductal paralysis.

Adult↗
PubMed2002

[A case of fibrosing mediastinitis manifesting recurrent nerve palsy].

A 68 year-old man was referred and admitted to our hospital because of hoarseness due to recurrent nerve palsy and an anterior mediastinal tumor detected on chest CT. Chest CT showed a low-density tumor surrounding the aorta and branching arteries. Chest MRI revealed a low-intensity tumor in both T1- and T2-weighted images. The tumor was adjacent to the heart and aorta in the upper anterior mediastinum. A biopsy was performed under minimally invasive video-assisted thoracic surgery (VATS) and a diagnosis of fibrosing mediastinitis was made histopathologically. Oral prednisolone treatment markedly reduced the tumor and improved not only abnormal laboratory data such as C-reactive protein, but also the hoarseness. We report herein that steroid monotherapy was successful in treating a case of fibrosing mediastinitis manifesting recurrent nerve palsy.

Aged↗
PubMed2002

[The outcome of hydration in functional dysphonia].

Functional dysphonia has high prevalence among professional voice users. Different aspects should be considered in vocal therapy. One of them is hydration. The aim of the present study is to assess the effect of hydration on a few aspect of vocal dysfunction. 75 subjects were distributed into three different groups. 23 participated as a control group, 27 received hydration treatment and 25 received hydration treatment plus voice training. Dryness, mucosity, phonatory effort, hoarseness, fundamental frequency (Fo), maximum phonatory time (MPT), time of speech and laryngeal status were the variables evaluated at time 0 and 14 days later, immediately after the completion of the treatment of each group. Statistical differences regarding dryness (p = 0.003) and hoarseness (p = 0.033) were found between the control group and the groups receiving treatment. There were no statistical differences in severity and frequency of variables measured at time 0 at 14 days later in the control group. However, all variables except laryngeal status, improved significantly in the groups receiving hydration alone. Only clinical variables improved in the combined group. These findings indicated a therapeutic benefit of hydration, with or without voice training, for functional dysphonia. Further studies using acoustic and stroboscopic analysis are required in order to define the effect of hydration on the compliance of glottic sphincter.

Adult↗
PubMed2002

The effects of exposure to organic dust on the respiratory system of potato processing workers.

A cross-sectional study was carried out to evaluate lung function and the prevalence of work-related symptoms in workers of a potato processing plant located in Lublin region (eastern Poland). The study group comprised 61 workers employed in 2 departments. The examination included: physician-administrated questionnaire on occurrence of work-related symptoms, occupational history and smoking habits. Spirometry was performed before (7:00-8:00) and after (16:00-17:00) the morning shift. Altogether 41/61 (67.2%) subjects reported at least one symptom associated with their job. Pulmonary symptoms were recorded in 28/61 (45.9%) subjects. The most commonly recorded complaints were: cough (44.3%), hoarseness (19.7%), shortness of breath (18%), followed by headache and skin lesion (13.1% each), and eye and nose irritation (11.5%). The prevalence of work-related symptoms (except for eye and nose irritation) was higher in the group of subjects working longer than 4 years (the difference was statistically significant only for skin lesion). Among non-smoking workers a significantly higher prevalence of headache was seen compared to smokers (Fisher's test, p < 0.05). Smokers complained more frequently of respiratory symptoms such as cough, shortness of breath, hoarseness and chest pain. The difference was significant only for cough (p < 0.05). A statistically significant over-shift decline in all measured spirometric values: FVC, FEV(1) (p < 0.001), FEV(1)/VC (p < 0.05), PEF (p < 0.01) was observed.

Adult↗
PubMed2002

[Reconstruction with pyriform sinus mucosa in partial laryngectomy].

OBJECTIVE: To assess the effectiveness of reconstruction with pyriform sinus mucosa in partial laryngectomy and resumed laryngeal function. METHOD: A total of 198 cases of laryngeal cancer who had undergone partial laryngectomy from 1980 to 1995 in our hospital were retrospectively reviewed. Defect of larynx were repaired with pyriform sinus mucosa in all cases. Surgery of local lesions: 87 cases underwent supraglottic horizontal partial laryngectomy, 65 vertical or extended vertical partial laryngectomy, 46 horizontal vertical partial laryngectomy. RESULT: In cases underwent supraglottic horizontal partial laryngectomy, postoperative decannulation rate is 100%, 5 year survival rate is 84.70% and functions of voice, respiration and deglutition were all preserved well. In cases underwent vertical or extended vertical partial laryngectomy, decannulation rate is 87.67% and 5 year survival rate is 86.15%. Functions of respiration and deglutition are good but existent hoarseness. In the earlier stage after operation, there was serious aspiration in the cases underwent horizontal vertical laryngectomy and it took patients more time to overcome aspiration by practice. In this group, decannulation rate is 82.60% and 5 year survival rate is 78.26%. all cases present hoarseness and part of them can't be extubated because of glottic stenosis. CONCLUSION: The authors believe that this method of surgery is safe and beneficial to some patients with partial laryngectomy. Laryngeal functions can be well preserved with this technique.

Adult↗
PubMed2003

Lipoid proteinosis in two siblings: a report from south India.

A 6-year-old girl and her 9-year-old brother, born of nonconsanguineous parents, had hoarseness and multiple, asymptomatic, raised skin lesions present since childhood. On examination, both siblings had hoarseness and numerous skin-colored, waxy papules distributed over the forehead, face, neck, axilla, groin, and extremities. Acneiform (pocklike) scars were present on the face, trunk, and extremities. Eyelid beading (moniliform blepharosis) was present over bilateral upper and lower eyelids. The tongue, lips, and frenulum were thickened and infiltrated, and the patients were unable to protrude the tongue out of the mouth. The scalp had patchy alopecia. Histological examination of representative skin specimens (from both siblings) showed deposition of pink, amorphous material in the papillary dermis, around blood vessels, and around appendages. These deposits stained positive with Periodic Acid-Schiff stain, were diastase resistant, and were negative for Congo red, confirming our clinical diagnosis of lipoid proteinosis. Over 250 cases of this rare disorder have been described in the literature, but occurrence of lipoid proteinosis in siblings is rare.

Basement Membrane↗
PubMed2003

Lipoid proteinosis in siblings.

Two sisters, aged 16 and 11, presented with skin lesions and hoarseness since early childhood. Skin lesions consisted of infiltrated warty nodules, and papules over elbows, axillae, and hands. The oral mucosa, tongue, lips, larynx, and vocal cords also showed infiltration. The characteristic beaded papules on eyelid margin and hoarseness pointed to the rare diagnosis of lipoid proteinosis.

Adolescent↗
PubMed2005

The role of bronchoscopic assessment in esophageal cancer - clinical and survival analysis in 153 patients.

BACKGROUND AND PURPOSE: The diagnostic value and indications for fiberoptic bronchoscopy in the preoperative assessment of patients with esophageal cancer have not been fully studied. We evaluated the role of fiberoptic bronchoscopic examination in the stage work-up of patients with esophageal cancer and correlated the results with survival time analysis. METHODS: The medical records of 153 patients with an initial diagnosis of esophageal cancer were reviewed. Clinical data, bronchoscopic findings, treatment courses, and survival time of these patients were analyzed. RESULTS: On initial bronchoscopic examinations, distortion/compression of the normal structure and protrusion at the posterior wall of the trachea or bronchus were the most common bronchoscopic findings (35.9%). We stratified patients into 3 subgroups according to bronchoscopic findings of direct invasion, external compression, and negative findings. The symptoms of dyspnea, hoarseness, aspiration and fever were more frequent in patients with direct airway invasion compared with patients with external compression and negative bronchoscopic findings (p < 0.02). Washing and brushing cytology examinations were all negative in patients with external compression of the airway. There was a significant difference of survival time among these 3 groups of patients (direct invasion: 5.6 +/- 0.6 months; external compression: 12.3 +/- 0.9 months; negative findings: 13.3 +/- 1.1 months, p < 0.01). Direct airway invasion and original cancer stage were the most important variables for survival in the multivariate analysis, and the hazard ratio for prognosis was 2.5 (95% confidence interval [CI], 1.1-4.6) and 4.2 (95% CI, 1.5-9.3), respectively. Twelve patients (80%) with tracheoesophageal (TE) fistulae died within 3 months after diagnosis due to aspiration pneumonia and septic shock. CONCLUSIONS: The role of bronchoscopic examination in patients with esophageal cancer for preoperative evaluation resides in its ability to predict airway invasion and its impact on survival. Advanced cancer stage (stage IV) and direct airway invasion (especially TE fistula) were significantly associated with poor prognosis. These results suggest that patients suffering from dyspnea, hoarseness, aspiration and fever, implicating a high probability of airway invasion, are more likely to benefit from bronchoscopic examination and proper management in order to prevent aspiration or complications.

Bronchoscopy↗
PubMed2005

A patient who underwent surgical treatment of an adult-type aneurysm in the nonpatent arterial duct.

Adult-type aneurysms in the arterial duct are rare, and their spontaneous prognosis is poor. We performed surgical treatment of an aneurysm in the arterial duct in a 62-year-old male. The patient had had hoarseness since November 2003, and was referred to our hospital in March 2004. Thoracic CT and aortography demonstrated a sacciform aneurysm in the aorta in the distal arch region on the lesser curvature side. The patient was diagnosed as having an adult-type aneurysm in the nonpatent arterial duct, and underwent surgical treatment in April 2004. Thoracotomy in the fourth left intercostal space was performed up to the thoracic aorta, and a sacciform aneurysm, measuring 35 mm x 32 mm, was detected in the arterial duct. The recurrent laryngeal nerve adhering to the front surface of the aneurysm was overextended. Under partial extracorporeal circulation, the aneurysm was excised, and replaced by an artificial blood vessel. The postoperative course was satisfactory, and the patient was discharged from the hospital 14 days after surgery. The surgical outcome was good, and the hoarseness was improved. Taking possible complications into consideration, surgical treatment can be recommended in the early stage.

Aortic Aneurysm, Thoracic↗
PubMed2006

[Influence of treatment of inhaled corticosteroids on the function of the larynx in asthmatic patients].

UNLABELLED: The objective of the study was to examine influence of inhaled glycocorticosteroids on phoniatric function of the larynx in patients suffering from asthma. MATERIAL AND METHODS: Thirty minutes after the administration and long-term therapy effect of the inhaled glycocorticosteroids on local condition of the phoniatric organ was assessed in 15 patients with recently diagnosed bronchial asthma. The diagnostics of asthma included: subjective and objective examination, prick tests, spirometry, total IgE and histamine test for bronchial hyperactivity. Evaluation of voice function was implemented subjectively and objectively with use of videolaryngostroboscopy (VLSS). Acoustic assessment of voice was also performed. RESULTS: Administration of glycocorticosteroids as inhaled discs resulted in incidents of cough, mouth and throat dryness, sensation of polydipsia and skin inflammation around the mouth. Occasionally, hoarseness and discomfort in the larynx area were noted. On long-term administration, dysphonia, hoarseness and voice fatigue due to dysfunction of innermost larynx muscles, particularly vocal fold adductors. After 30 minutes of the glycocorticosteroid administration in patients with recently diagnosed asthma, irritation of the pharynx and larynx mucosa was recorded. CONCLUSION: The long-term treatment with inhaled glycocorticosteroids resulted in myopathy of proper muscles of the larynx.

Administration, Inhalation↗
PubMed2006

Lipoid proteinosis: case report and review of the literature.

Lipoid proteinosis is a rare autosomal recessive disorder, characterized histologically by infiltration of periodic acid Schiff-positive hyaline material into the skin, upper aerodigestive tract, and internal organs. Classical clinical features include skin scarring, beaded eyelid papules, and laryngeal infiltration leading to hoarseness. Moreover, the infiltrates in the tongue and its frenulum limit lingual movements and cause speech difficulties. Usually, the hoarse voice is present at birth or in early infancy, as the first manifestation. In more severe cases, diffuse infiltration of the pharynx and larynx might cause respiratory distress, at times requiring tracheostomy. The disorder has recently been shown to result from loss-of-function mutations in the extracellular matrix protein 1 gene on chromosome 1q21. The function of the protein extracellular matrix protein 1 gene is still unclear, although an important role in skin physiology and homeostasis has been hypothesized. In this report, the case is described of a 6-year-old girl with lipoid proteinosis. Histopathological examination of a laryngeal biopsy specimen showed massive deposits of eosinophilic, periodic acid Schiff-positive, and diastase resistant material in the lamina propria corroborating the clinical diagnosis of lipoid proteinosis. Molecular analyses in this patient also confirmed the clinical diagnosis. The proposita was a compound heterozygote for a new small rearrangement (543de1TG/ins15) in exon 6, and a nonsense mutation (Arg243Stop) in exon 7. Together with previously documented mutations in the extracellular matrix protein 1 gene, this study supports the hypothesis that exons 6 and 7 are the most common sites for extracellular matrix protein 1 gene mutations in lipoid proteinosis.

Child↗
PubMed1991

Laryngeal cancer: diagnosis, treatment and speech rehabilitation.

Cancer of the larynx occurs most often in men between 50 and 70 years of age. Cigarette smoking and alcohol are responsible for more than 75 percent of cases. Hoarseness is the most common presenting complaint. If hoarseness persists for more than two weeks, laryngoscopy is indicated. Clinical staging utilizes direct laryngoscopy, esophagoscopy and bronchoscopy to exclude synchronous malignancies. The five-year cure rate, with preservation of voice and glottic function, is as high as 90 percent if the lesions of the vocal cords are found in an early stage. Total laryngectomy is required for more extensive disease. Speech rehabilitation has been revolutionized by tracheoesophageal speech techniques.

Bronchoscopy↗
PubMed1990

[Effects of cigarette smoking in women].

The relation between cigarette smoking and obstetrical history, characteristics of skin and voice, presence of hirsutism and newborn weight/height index was studied in 100 hospitalized women. 45 had never smoked, 36 were present and 19 former smokers. No differences were found in the average age of menarche, number of live births or stillborns. Abortions were twice as frequent in women smoking more than 10 cigarettes a day. Menopause occurred an average of 5 years earlier among smokers. A significant increase in hoarseness and face hirsutism was detected, the relative risk for heavy smokers (more than 10 cigarettes per day) being 14.2 for hoarseness, 5.6 for facial hirsutism and 2.8 for other locations of hirsutism. Obesity was twice as common among smokers. These findings, related to hormonal disturbance, should be used in education efforts in the anti-smoking campaign among Chilean women.

Chile↗