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PubMed1977

Hiatus hernia and the respiratory tract.

Hoarseness, asthma, and bronchitis are common but sometimes obscure manifestations of gastroesophageal reflux, the etiology of when respiratory symptoms predominate. In 300 consecutive patients who underwent surgical correction for gastroesophageal reflux, 129 (43%) had major respiratory complaints. Group 1 patients (82, 64%) were those referred for respiratory problems alone. In Group 2 (patients referred because of peptic complaints), 47 had associated respiratory problems in various combinations, including an additional 10 patients who had bronchiectasis. Treatment with appropriate surgical resection, in addition to antireflux procedures, was carried out in these people. Noticeable relief of respiratory symptoms was obtained in 96 (74%) of the 129 patients; 30 were improved and 2 were unchanged. Recurrent hiatus hernia or esophagitis was documented in 21 (7%) of the 300 patients.

Asthma↗
PubMed1998

Multicenter VATS experience with mediastinal tumors.

BACKGROUND: The use of video-assisted thoracic surgery for diagnosis and treatment of mediastinal tumors in a multiinstitution patient population is not well understood. METHODS: We studied 48 cases from Cancer and Leukemia Group B thoracic surgeons. Of 21 men and 27 women, aged 41 +/- 16 years, 22 patients were asymptomatic. In the others, 92% of tumor-related symptoms improved or resolved after treatment. Five tumors involved the anterior compartment, 19 the middle, and 24 the posterior compartment. Diagnoses were typical for each compartment but also included uncommon problems such as superior vena cava hemangioma and a histoplasmosis cyst causing hoarseness. Of the lesions, a biopsy of 12 was done without excision and the rest were excised completely. Fifteen were cystic and 10 were malignant (8 biopsy only). Maximal dimensions were 5.2 +/- 3.3 cm. RESULTS: Operations were briefer for 24 posterior (93 +/- 41 min) than 5 anterior (195 +/- 46 min, p < 0.01) or 19 middle mediastinal tumors (170 +/- 78 min, p < 0.01). Although 96% had vital mediastinal relations, only six open conversions were performed because of bleeding (n = 3), large size, impaired exposure, or rib attachments, and no patient had morbidity beyond that expected for the thoracotomy. Postoperative stay was shorter for the nonconversion group (3.2 +/- 2.8 versus 5.5 +/- 2.1 days, p = 0.05), as was chest tube duration (1.7 +/- 1.4 days versus 3.2 +/- 1.9 days, p = 0.03). There were no postoperative deaths or major complications, but 7 patients had minor complications. During a mean of 20 months of surveillance (range, 1 to 52 months), one cyst recurred (asymptomatic) as did one sarcoma that was excised. CONCLUSIONS: Video-assisted thoracic surgery is a safe technique for benign mediastinal tumors, typically those in the middle and posterior mediastinum.

Adult↗
PubMed1986

Viral and bacterial organisms associated with acute pharyngitis in a school-aged population.

To investigate the causes and clinical characteristics of acute pharyngitis among school-aged children (4 to 18 years), we obtained throat cultures for respiratory viruses, Mycoplasma pneumoniae, group A streptococcus, and Chlamydia trachomatis from 320 patients with sore throat and 308 controls without respiratory complaints. The study was conducted from January to April 1985 in a private pediatric practice in central New York State. Sixty percent of the patients and 26% of the control subjects had positive cultures for at least one organism. Forty percent of patients had positive cultures for group A streptococcus, compared with 11.9% of the controls. Fifty (16%) patients had positive viral cultures, compared with eight (2.6%) controls; the predominant viral isolate was influenza A Philippines. Patients infected with influenza A were significantly more likely to complain of cough and hoarseness, and were less likely to have pharyngeal exudate or tender cervical adenopathy, than were patients who had positive cultures for group A streptococcus. Although 49 (15.8%) patients with acute pharyngitis had cultures positive for M. pneumoniae, 53 (17.6%) asymptomatic controls were also had M. pneumoniae-positive cultures. Thus detection of M. pneumoniae in the throat of school-aged children with pharyngitis may not be sufficient to establish a diagnosis of disease caused by this organism. C. trachomatis was not isolated from any patient or control.

Acute Disease↗
PubMed1998

Primarily extracranial jugular foramen neurinoma manifesting with marked hemiatrophy of the tongue: case report.

BACKGROUND: There have been no detailed descriptions of the clinical symptoms of a primarily extracranial jugular foramen neurinoma (JFN), because this type of tumor is extremely rare. CASE DESCRIPTION: Although the 51-year-old woman presented with only mild complaints of dysphagia and hoarseness, neurologic examination revealed marked left hemiatrophy of the tongue. Although magnetic resonance imaging suggested a JFN, the patient's mild symptoms and normal jugular foramen were potentially misleading in the diagnosis of this patient. Surgical exploration demonstrated that the tumor originated from the extracranial portion of the 10th cranial nerve, extending into the jugular foramen. Subtotal resection ameliorated the 12th cranial nerve palsy. CONCLUSION: The authors present a case of a primarily extracranial JFN manifesting as a 12th nerve palsy. The clinical symptoms and signs produced by a tumor in this extremely rare location are discussed.

Atrophy↗
PubMed1998

Comparison of external radiotherapy, laser microsurgery and partial laryngectomy for the treatment of T1N0M0 glottic carcinomas: a retrospective evaluation.

PURPOSE: The aim of this study was to retrospectively compare the efficacy and functional results of three treatment options for T1N0M0 glottic carcinomas applied in a single institution. MATERIALS AND METHODS: One hundred six charts of patients with biopsy-proven T1N0M0 glottic carcinomas treated between 1979 and 1995 were reviewed. There were 81 T1a and 25 T1b tumors. Forty-one patients were treated by radiotherapy (RT) (median dose of 64 Gy), 34 patients were treated by partial laryngectomy (PL) and 31 patients were treated by laser microsurgery (L) of which 10 received postoperative RT for positive margins. In 18 patients, a perceptual voice rating on a visual scale was performed by the patients themselves, three non-speech specialists and two speech therapists. RESULTS: With a median follow-up time of 63.5 months, the 5- and 10-year loco-regional control probabilities reached 91 and 87%, respectively, without any difference between the treatment groups. After salvage laryngectomy, the 5- and 10-year loco-regional control probabilities reached 97% without any difference between the treatment groups. For the whole population, overall survival reached 78 and 62.4% at 5 and 10 years, respectively. The actuarial incidence of second primary reached 19% at 10 years. Regarding the quality of voice, overall there was a trend towards a worse satisfaction index, more hoarseness and more breathiness after PL than after L or RT. CONCLUSIONS: Our data suggested that assuming proper selection of patients, RT and L yielded similar outcomes and functional results. Local recurrence can be adequately salvaged by surgery. On the other hand, PL appeared to yield similar loco-regional control probability but with a worse quality of voice.

Actuarial Analysis↗
PubMed1986

Lipoid proteinosis with pseudomembranous conjunctivitis.

Lipoid proteinosis is a rare autosomal recessive condition characterized by a diffuse mucocutaneous infiltration with histopathologic deposits that are positive for periodic acid-Schiff reagent and a sudanophil substance. We present a 9-year-old boy with lipoid proteinosis. His parents are siblings. He had classical manifestations, such as statural-ponderal delay, hoarseness, yellowish skin papules, atrophic scars, and moniliform blepharosis. A transmission deafness was also found. There were none of the intracranial calcifications that are usual at this age. A pseudomembranous conjunctivitis was surgically treated when he was 4 months old. This clinical manifestation has not hitherto been described in lipoid proteinosis.

Child↗
PubMed2003

Evaluation of laryngeal function after implantation of the vagus nerve stimulation device.

OBJECTIVES: The vagus nerve stimulation device (VNS) is used for the management of seizures. This study evaluated what effect the diameter of the vagus nerve helical electrode might have on true vocal cord (TVC) mobility. The study was prompted after 2 cases of TVC immobility. Electrode nerve compression was suspect. METHODS: Eighteen patients underwent intraoperative vagus nerve measurement and electrode placement with subsequent voice and TVC evaluation. Electrode selection was based on vagus nerve measurements. RESULTS: Seven patients had vagus nerves measuring less than 2 mm diameter and received the 2-mm inner diameter electrode. Eleven patients had vagus nerves measuring more than 2 mm in diameter and received the 3-mm inner diameter electrode. No patients experienced transient or permanent hoarseness or paresis/paralysis. CONCLUSION: Precise vagus nerve measurements and electrode selection appear to decrease the incidence of nerve compression injury and TVC immobility.

Adolescent↗
PubMed1995

Traumatic retropharyngeal hematoma: a case report.

We describe a case of retropharyngeal hematoma after a cervical hyperextension injury in an elderly man. Progressive hoarseness, dysphagia, and dyspnea were the early signs that necessitated oral endotracheal intubation and, ultimately, tracheostomy. The hematoma was explored and drained through a lateral cervical approach, and a bleeding vessel in a small tear in the anterior spinous ligament was noted and cauterized. The patient recovered uneventfully.

Aged↗
PubMed1984

Vocal cord hematomas complicating anticoagulant therapy.

Described are the cases of two patients who presented with vocal cord hematomas consequent to poor control of anticoagulation. Both patients presented with hoarseness and cough. One required intubation due to respiratory obstruction. Vocal cord hematomas should be considered in patients who present with upper airway symptoms while anticoagulated.

Aged↗
PubMed1997

[Paralysis of the left recurrent laryngeal nerve secondary to periprosthetic mitral insufficiency].

The paralysis of the left laryngeal nerve secondary to mitral valvular disease (Ortner's syndrome) is quite rare. Ortner believed that the paralysis was due to the compression of the nerve by the enlargement of the left atrium. Other authors have shown, by observation at operation, that this compression is produced between enlarged, tense pulmonary artery and the aorta at the ligamentum arteriosum. This complication has also been described in different cardiovascular pathologies which also have pulmonary hypertension. Cases have been described in the literature of vocal cord function recovery after a pulmonary hypertension decrease. We present a case of hoarseness secondary to the paralysis of the left recurrent laryngeal nerve within a context of a mitral periprosthetic insufficiency with severe pulmonary hypertension and its disappearance after the valvular change, coinciding with a significant artery pulmonary estimated pressure decrease, confirmed by cardiac Eco-Doppler.

Echocardiography↗
PubMed1981

Malakoplakia of the larynx.

The first case of malakoplakia of the larynx in the world literature is reported. The soft raised plaques were removed from a 61-year-old white male, who was a heavy smoker and complained of hoarseness, but was otherwise in good general condition. From the follow-up of our patient, it is concluded that malakoplakia is not of particularly bad prognosis when affecting the larynx, and that simple local excision seems to be enough to produce cure. On these grounds, the laryngologists should be aware of the entity and consider it when dealing with raised nodules or plaques in the larynx, while the pathologists should be alert to look for the Michaelis-Gutman bodies, when encountered with peculiar histiocytic reactions anywhere in the body, even in the larynx.

Hoarseness↗
PubMed1983

Vocal fold furrows. A 10-year review of 240 patients.

A retrospective review of 240 patients with vocal fold furrows seen at the Department of Otolaryngology, Kurume University Hospital over the 10-year period from 1971 to 1980 was completed. Of the 240 patients, 173 were male and 67 were female. In 195 patients, the furrows were the major pathology causing hoarseness; in 29, the furrows were associated with other major laryngeal diseases; and, in 16, there were no voice problems. We call the first group "sulcus vocalis" in this paper. The onset of voice problems in the cases of sulcus vocalis was at the age of 40 years or older in most case, at young childhood in some, and at adolescence in some cases. Typical findings of sulcus vocalis consisted of bilateral furrows on the vocal fold edges extending over the entire length of the membranous portion, bowed vocal fold edges, glottic incompetence during phonation and excessive ventricular fold adduction. No effective treatments have been established.

Adolescent↗
PubMed1983

Polypoid vocal folds. A 10-year review of 191 patients.

During the 10 years from 1971 to 1980, 191 patients with polypoid vocal folds were seen at the Department of Otolaryngology, Kurume University Hospital. A retrospective review of the clinical records of these 191 patients was completed. Results were the followings: 1) There was no marked difference in incidence between male and female; 2) The incidence was high in the age groups of 40 years or older; 3) Most patients were smokers; 4) Bilateral lesions were much more frequent than unilateral lesions; 5) Long-lasting hoarseness was the commonest symptom; 6) Vocal abuse, alcohol drinking and air pollution did not prove to be etiologic factors; and 7) No significant differences in subjective voice improvement were found between the stripping and the sucking technique.

Adolescent↗
PubMed1983

Tuberculosis of the larynx. A 10-year review of 14 patients.

A retrospective review of 14 patients with tuberculosis of the larynx seen at the Department of Otolaryngology, Kurume University Hospital during the 10 years from 1971 to 1980, was completed. Of these 14 patients, 11 were male and 3, female. All the patients were adults. Hoarseness was the commonest symptom. The laryngeal lesion was tumor-like in 5, granular in 7 and polyp-like in 2 patients and grayish in color in all the patients. Eight patients were admitted in our department. Chest X-rays revealed pulmonary tuberculosis and erythrocyte sedimentation rate was accelerated in all 8 patients. It should be emphasized that, even at present, there exist tuberculosis of the larynx.

Adult↗
PubMed1983

Wegener's granuloma localized in the larynx. Report of a case.

A case of Wegener's granuloma in which the lesion was localized in the larynx and the neighboring structures was reported. The patient was a 52-year-old male. The initial symptom was hoarseness. He died of severe laryngeal involvement and accompanying pneumonia after an entire course of 4 years and 8 months. Autopsy revealed no involvement of the nose, lung and kidney.

Granulomatosis with Polyangiitis↗
PubMed2003

[Topical methylprednisolone vs lidocaïne for the prevention of postoperative sore throat].

OBJECTIVE: We assessed the efficacy of topical methylprednisolone or lidocaine for prevention of postoperative sore throat. STUDY DESIGN: Randomised, prospective in single blind study. PATIENTS AND METHODS: Sixty patients ASA 1 or 2 undergoing tracheal intubation for dental surgery received before intubation either topical lidocaine 5% (15 puffs) or aerosolized methylprednisolone (80 mg). Postoperative pain was assessed by the patients using a VAS and a specific scoring system for sore throat, cough and hoarseness. Evaluations were performed immediately after emergence from anaesthesia, 1 h later, at time of the first postoperative drink, at time of the first postoperative meal and 24 h after surgery. RESULTS: Patients receiving methylprednisolone showed slightly better scores for sore throat and cough 1 h after surgery. CONCLUSION: Topical methylprednisolone may therefore be a useful adjuvant in the prevention of sore throat after intubation.

Adult↗
PubMed2006

[Ophthalmic manifestations of lipoid proteinosis].

INTRODUCTION: Lipoid proteinosis (LP), also known as hyalinosis (or lipoidosis) cutis et mucosae or Urbach-Wiethe disease, is a rare autosomal recessive disorder. It is associated with deposits of protein-lipid complexes in various tissues including the skin and mucous membranes. Ophthalmologic manifestations are frequent and can affect visual prognosis. CASE: This 28-year-old patient presented vesiculobullous lesions of the face that developed into varioloid scars associated with hoarseness. Ophthalmologic examination revealed unilateral lesions including hyaline deposits on the palpebral margins, iris, and trabecular zone, complicated by uveitis, cataract, and glaucoma, which caused the functional loss of the left eye. Histological examination of a cutaneous biopsy confirmed the diagnosis. DISCUSSION: Involvement of the eyelids is characteristic, and moniliform blepharosis is pathognomonic and frequent. This case featured a rare intraocular form (uveitis). Deposits may be found on the conjunctiva, cornea, trabecula and Bruch membrane. Conjunctival or cutaneous biopsy confirms the diagnosis. Available treatment is quite limited.

Adult↗
PubMedDate not supplied

Viral croup: a current perspective.

Viral croup is the most common cause of upper airway obstruction in children 6 months to 6 years of age. Parainfluenza virus accounts for the majority of cases. The disease is characterized by varying degrees of inspiratory stridor, barking cough, and hoarseness because of laryngeal and/or tracheal obstruction. The diagnosis is mainly a clinical one and diagnostic studies usually are not necessary. The management has altered dramatically in the past decade. Good evidence exists to support the routine use of corticosteroid in all children with croup. Intervention at an earlier phase of the illness will reduce the severity of the symptoms and the rates of return to a health care practitioner for additional medical attention, visits to the emergency department, and admission to the hospital. Most children respond to a single, oral dose of dexamethasone. For those who do not tolerate the oral preparation, nebulized budesonide or intramuscular dexamethasone are reasonable alternatives. Nebulized epinephrine should be reserved for patients with moderate to severe croup. Simultaneous administration of corticosteroid and epinephrine reduces the rate of intubation in patients with severe croup and impending respiratory failure.

Administration, Inhalation↗