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PubMed1981

Prolonged oro- or nasotracheal intubation.

From July 1975 to September 1979, 6 patients were treated with truly prolonged endotracheal intubation; the duration ranged from 55--155 days. Only patients who survived after extubation and were discharged from the hospital were included in this study. Of the 6 patients, 4 were still alive as of November 1980, 23 patients died from causes not related to the intubation. The most common complication was hoarseness, which occurred in 4 patients. During the time of the study, 3 patients who were intubated in excess of 50 days did not survive. In none of these cases was the patient's death related to the intubation. The authors believe that the risk of long-term intubation has been reduced significantly by the use of nasotracheal tubes and to the newer tube materials, which are completely biocompatible, and to improved techniques of cuff inflation. Complications to tracheostomy are less frequent, but often more serious, than complications of long-term nasotracheal intubation.

Adolescent↗
PubMed1998

New laryngeal muscle weakness in post-polio syndrome.

The authors describe the clinical presentations of post-polio laryngeal muscle weakness in three patients with prior polio infection who presented with new complaints including slowly progressive dyspnea, dysphagia, and/or hoarseness. Evaluations by laryngeal videostroboscopy and electromyography revealed vocal cord abductor and/or adductor weakness, recurrent posterior glottic web in one case, and, in the two patients who agreed to electromyography, evidence of prior denervation and reinnervation in laryngeal muscles. Treatment was directed at attempting to maintain an airway and optimize vocal quality. One patient benefitted from tracheostomy, one benefitted from vocal cord medialization, and one benefitted from resection of interarytenoid scarring. The authors conclude that diagnosis of laryngeal post-polio syndrome is facilitated by laryngeal electromyography. Interventions directed at maintaining an appropriate airway and optimizing vocal quality may be helpful.

Aged↗
PubMed1998

Management of substernal goiter.

OBJECTIVE: To analyze the presentation, evaluation and treatment of patients with large substernal goiters, with emphasis on the radiographic evaluation and the results of treatment. STUDY DESIGN: A retrospective chart review of 150 patients undergoing thyroidectomy at the Vanderbilt University Department of Otolaryngology-Head and Neck Surgery. METHODS: Charts of patients undergoing thyroidectomy were reviewed. Those with substernal goiter, defined as a major portion of the goiter within the mediastinum, were included in the study. When available, the radiographic studies were reviewed by a staff neuroradiologist. RESULTS: Twenty-three patients (15.3%) presented with substernal extension of the goiter. Characteristics of these patients included mean age of 59 years, 78% female, symptoms of compression such as dyspnea, choking, and dysphagia (65%), hoarseness (43%), and previous thyroid surgery (30%). Seventeen percent were asymptomatic. Preoperative radiographs demonstrated tracheal compression (73%), tracheal deviation (77%), esophageal compression (27%), and major vessel displacement (50%). Histology revealed multinodular goiter (16/23, 70%), thyroiditis (3/23, 13%), and malignancy (4/23, 17%). The average size of the resected specimen in greatest dimension was 8.0 cm (range, 3.0-14.0 cm) and weighed 148 g (range, 39-426 g). All were successfully approached through a transcervical incision without the need for sternotomy, and total thyroidectomy was performed in 83% of the cases. No major complications have been documented, and no evidence of tracheomalacia was encountered. CONCLUSION: Despite the large size of these goiters and the significant involvement of the major mediastinal structures, all were approached through the transcervical incision. Further, despite significant tracheal involvement, there were no cases of tracheomalacia or major complications. For intraoperative planning, the authors advocate the routine use of preoperative computed tomography scanning.

Adult↗
PubMed2000

Esophageal dysmotility as an important co-factor in extraesophageal manifestations of gastroesophageal reflux.

OBJECTIVE: Esophageal motility problems have been demonstrated in patients with noninflammatory typical gastroesophageal reflux (GER) and esophagitis, but the frequency of motility disorders in patients with extraesophageal manifestations of GER has not been studied. The primary aim of this study was to assess the frequency of esophageal motility disorders in patients with atypical GER. METHODS: A prospective study of 112 consecutive patients with laryngopharyngeal reflux (LPR) symptoms and demonstrated physical findings consistent with LPR were studied. Patients were divided into one of the following diagnostic categories: hoarseness; chronic cough; dysphagia or globus pharyngeus; and paroxysmal laryngospasm. Of the 112 patients, 81 (72%) underwent esophageal manometry and ambulatory 24-hour pH monitoring (pH-metry), 19 (17%) had motility studies only, and 12 (11%) had pH-metry studies only. Only patients who had motility studies were included in the analysis. Therefore the study population was 100 patients. Associations between diagnostic category, motility disorder, and abnormal reflux were evaluated with contingency-table analyses. RESULTS: Of the 100 patients, 29 (29%) presented normal motility function, 48 (48%) had ineffective esophageal motility, 10 (10%) had hypertensive lower esophageal sphincter (LES), and 9 (9%) and 4 (4%) had nutcracker esophagus and achalasia, respectively. There was a significant association between esophageal dysmotility and extraesophageal manifestations of GER However, there was no statistically significant association between esophageal motility disorders and abnormal acid reflux in our patients with atypical GER. CONCLUSIONS: In the present study, the frequency of esophageal motility problems in patients with extraesophageal or atypical manifestations of GER was 73% and suggested that these problems exist as an accompanying condition or pathogenic co-factor in some patients with atypical GER.

Adolescent↗
PubMed2001

Laryngeal angiosarcoma: a clinicopathologic study of five cases with a review of the literature.

OBJECTIVE: Primary laryngeal angiosarcoma (LA) is rare without a reported series evaluating these tumors. STUDY DESIGN/METHODS: Five patients with LA were retrospectively retrieved from the Otorhinolaryngic Registry of the Armed Forces Institute of Pathology. RESULTS: Three men and 2 women, aged 29 to 71 years, presented with hoarseness (n = 4) and hemoptysis (n = 1). Two patients had previous neck radiation. The tumors involved the supraglottis (n = 4) with a mean size of 3.1 cm. Histologically, all tumors had anastomosing vascular channels lined by remarkably atypical endothelial cells protruding into the lumen, frequent atypical mitotic figures, and hemorrhage. All cases tested (n = 4) demonstrated immunoreactivity with antibodies to Factor VIII-RA and CD34. All patients had surgery followed by postoperative radiation (n = 3 patients). Three patients died with disease (mean, 17 mo), whereas one patient is alive with no evidence of disease at 18 years. CONCLUSIONS: LA is a rare tumor, frequently associated with previous radiation, usually involving the supraglottis with characteristic histomorphologic and immunophenotypic features. LA has a poor prognosis, making appropriate separation from other conditions important.

Adult↗
PubMed2003

Amyloidosis of the upper aerodigestive tract.

OBJECTIVES/HYPOTHESIS: To delineate the clinical and pathologic characteristics of upper aerodigestive tract amyloidosis with particular attention to laryngeal amyloidosis. STUDY DESIGN: Retrospective chart review of patients with amyloidosis of Thomas Jefferson University and its affiliated hospitals. MATERIAL AND METHODS: The charts of 16 patients with upper aerodigestive tract amyloidosis identified from the databases of the Thomas Jefferson University pathology department were reviewed and included in the study. RESULTS: Sixteen patients (9 male and 7 female, with an average age of 49.8 years) with upper aerodigestive tract amyloidosis were identified. The most common site of amyloid involvement was the larynx. Consequently, patients most commonly presented with hoarseness (14 of 16). All patients underwent surgical removal of the amyloid deposits. Fourteen patients had primary localized amyloidosis. Two experienced systemic involvement. Seven of the 16 patients developed recurrences requiring further treatment. CONCLUSIONS: Amyloidosis of the upper aerodigestive tract generally behaves as a benign, localized condition treatable by surgical resection. Regular follow-up with laryngoscopy is indicated for early diagnosis of recurrence, and multiple surgical procedures may be required to control symptoms.

Adult↗
PubMed1998

Laryngeal manifestations of vasculitic disease.

Vasculitis can involve the larynx in 4% to 10% of cases and can cause arthritis, edema, or upper airway obstruction within the larynx. Since most of these laryngeal manifestations are nonspecific, the clinician needs to keep a high index of suspicion when a patient complains of hoarseness or laryngeal discomfort and chronic constitutional symptoms. We present a case of crescentic glomerulonephritis associated with antineutrophil crytoplasmic autoantibody (ANCA). In addition, we discuss the usefulness and indications of ANCA serology and review multiple laryngeal manifestations that have been associated with common vasculitides and reported in the medical literature.

Antibodies, Antineutrophil Cytoplasmic↗
PubMed2006

Intratumoral and brainstem hemorrhage in a patient with vestibular schwannoma and oral anticoagulant therapy.

OBJECTIVE: To report the first case of spontaneous intratumoral and brainstem hemorrhage in a patient with a vestibular schwannoma. STUDY DESIGN: Case report and review of the literature. SETTING: University-based, tertiary referral center. PATIENT: A 73-year-old woman with a vestibular schwannoma, anti-vitamin K overdose, and arterial hypertension experienced a rapid onset of headache, facial palsy, diplopia, and hoarseness. INTERVENTIONS: The patient was admitted to the intensive care unit and treated with vitamin K and corticoids. MAIN OUTCOME MEASURES: Clinical and radiologic findings. RESULTS: At admission, the magnetic resonance imaging and computed tomographic scans showed an intratumoral hemorrhage. The patient entered a coma 24 hours after the onset of the symptoms. At that time, the computed tomographic scan demonstrated a massive intratumoral and brainstem hemorrhage. The patient died 3 days later. CONCLUSION: Intratumoral, subarachnoid, and brainstem hemorrhages can occur in patients with vestibular schwannoma. Oral anticoagulant therapy is a risk factor for tumor-related hemorrhage.

Administration, Oral↗
PubMed2004

Review article: supra-oesophageal manifestations of gastro-oesophageal reflux disease and the role of night-time gastro-oesophageal reflux.

Gastro-oesophageal reflux disease (GERD) has been associated with a variety of supra-oesophageal symptoms, including asthma, laryngitis, hoarseness, chronic cough, frequent throat clearing and globus pharyngeus. GERD may be overlooked as the underlying mechanism for these symptoms because typical GERD symptoms may be absent, despite abnormal oesophageal acid exposure. Two basic mechanisms linking GERD with laryngeal symptoms have been proposed: direct contact of gastric acid with the upper airway, in some cases due to micro-aspiration, and a vagovagal reflex triggered by acidification of the distal portion of the oesophagus. Gastro-oesophageal reflux (GER) during sleep is believed to be an important mechanism for the development of supra-oesophageal complications of GERD, such as asthma and idiopathic pulmonary fibrosis (IPF). Several physiological changes during sleep, including prolonged oesophageal acid contact time, decreased upper oesophageal sphincter pressure, increased gastric acid secretion, decreased salivation, decreased swallowing and a decrease in conscious perception of acid, render an individual more susceptible to reflux-induced injury. Supra-oesophageal symptoms often improve in response to aggressive acid-suppressive therapy. However, many unanswered questions remain regarding the appropriate approach to diagnosis and treatment of patients with GERD-related supra-oesophageal symptoms. In this article we review the relationship between supra-oesophageal symptoms and GERD and, where possible, highlight the evidence supporting the role of night-time reflux as a contributing factor to these symptoms.

Asthma↗
PubMed1993

The Miller tracheal cuff pressure control valve. Clinical use in controlled and spontaneous ventilation.

A constant pressure differential valve for the control of tracheal tube cuff pressure was tested under clinical conditions. Fifty-one patients underwent controlled ventilation and 20 patients were allowed to breathe spontaneously. Nitrous oxide 66% with oxygen 33% and halothane were used via a circle system. With controlled respiration at a fresh gas flow of 3-10 l.min-1, the expiratory cuff pressures of 10.1-16 cmH2O and the inspiratory cuff pressures of 23.4-32.4 cmH2O were below venous and arterial mucosal capillary perfusion pressures respectively. Cuff pressures were unaltered with time. Methylene blue instilled into the larynx did not appear in the trachea. Fifty-two control patients had the same incidence of sore throat (40%) and hoarseness (30%) at 24 h. With spontaneous ventilation, fresh gas flows of 5-15 l.min-1 maintained the cuff pressure above 10 cmH2O. We conclude that this valve prevents excessive tracheal cuff pressure while maintaining the airway seal.

Adolescent↗
PubMed2005

Ortner syndrome and haemophilia.

Compression and paralysis of the left recurrent laryngeal nerve by a dilated pulmonary artery is a rare complication of pulmonary hypertension. We here report the case of a patient with severe haemophilia A and HIV infection who presented with a persistent hoarseness of voice and a left vocal cord palsy caused by HIV-associated pulmonary hypertension. This case suggests that HIV-associated pulmonary hypertension should be suspected in any HIV patient presenting with unexplained left vocal cord palsy.

Adult↗
PubMed1997

Laryngeal involvement during post kala-azar dermal leishmaniasis in India.

Post kala-azar dermal leishmaniasis (PKDL) involving the mucus membranes is relatively rare on the Indian sub-continent. We describe 3 cases of PKDL presenting with hoarseness of voice. In one case the skin, nasal, oral, oropharyngeal and laryngeal mucosa had nodular and nodulo-ulcerative lesions; in the 2 other cases, genitalia and anorectal mucosa were also affected. Laryngoscopic examination revealed nodular lesions on the vocal cords. Biopsy smear and culture confirmed their leishmanial origin.

Adolescent↗
PubMed1996

Lipoid proteinosis in three children.

We report on three children with lipoid proteinosis, an autosomal recessive disorder characterized by the deposition of hyaline-like material in the skin, mucous membranes and other tissues. All cases had characteristic hoarseness. Other symptoms observed were infiltrated whitish plaques and pock-like scars on the face, papules on the palpebral margins, and infiltrates in the mucous membranes of the lower lip and tongue. Two of the children were siblings whose parents were first cousins.

Child↗
PubMed1971

Otolaryngological aspects of Sjögren's syndrome.

Twenty-two patients with Sjögren's syndrome uncomplicated by a connective tissue disorder, 31 with Sjögren's syndrome complicated by rheumatoid arthritis, and 21 with rheumatoid arthritis alone were studied with particular reference to changes in the ears and in the upper respiratory and digestive tracts.Epistaxis, soreness and dryness of the throat, dysphagia, and hoarseness were common symptoms, and rhinitis sicca and postcricoid narrowing were not uncommon features of the Sjögren groups. Oesophagoscopy in one patient revealed a web identical to that found in Paterson/Brown Kelly syndrome; none of the patients, however, had an iron-deficiency anaemia or koilonychia. There was an increased frequency of deafness in all groups, and the deafness tended to be conductive in the Sjögren groups and sensorineural in the rheumatoid arthritis group.

Adult↗
PubMed1980

Left vocal cord paralysis and dysphagia in mitral valve disease.

Two cases of severe mitral stenosis with both hoarseness, caused by left vocal cord palsy, and dysphagia are described. This combination in the same patient has not, to our knowledge, been previously described. Previous studies have firmly established that vocal cord paralysis in mitral stenosis is a result of compression of the left recurrent laryngeal nerve as it passes around the aortic arch. It is suggested that dysphagia may also develop as a result of neurological damage, in this case to autonomic nerve plexuses supplying the oesophagus, leading to abnormal peristalsis and enabling external compression by a tense left atrium sufficient to cause symptoms

Adult↗
PubMedDate not supplied

From the archives of the AFIP. Paragangliomas of the head and neck: radiologic-pathologic correlation. Armed Forces Institute of Pathology.

Paragangliomas of the head and neck are ubiquitous in their distribution, originating from the paraganglia or glomus cells within the carotid body, vagal nerve, middle ear, jugular foramen, and numerous other locations. The typical patient is middle-aged and presents late in the course of the disease, with a painless slow-growing mass. Clinical manifestations include hoarseness of voice, lower cranial nerve palsies, pulsatile tinnitus, and other neuro-otologic symptoms. The overall prognosis of patients with a cervical paraganglioma is favorable, whereas its temporal bone counterpart often results in recurrence, residual tumor, and neurovascular compromise when in the advanced stage. Pathologic examination reveals a characteristic biphenotypic cell line, composed of chief cells and sustentacular cells with a peripheral fibrovascular stromal layer that are organized into a whorled pattern ("zellballen"). Imaging hallmarks of paragangliomas of the head and neck include an enhancing soft-tissue mass in the carotid space, jugular foramen, or tympanic cavity at computed tomography; a salt-and-pepper appearance at standard spin-echo magnetic resonance imaging; and an intense blush at angiography. Imaging studies depict the location and extent of tumor involvement, help determine the surgical approach, and help predict operative morbidity and mortality. Surgical treatment is definitive. Radiation treatment is included as a palliative adjunct for the exceptional paraganglioma not amenable to surgery.

Angiography↗
PubMedDate not supplied

Ancient schwannoma of the true vocal cord.

Ancient schwannomas are benign nerve origin neoplasms that may cause difficulties in the differential diagnosis with other benign or malignant tumors. They usually occur in the head and neck region (epiglottis, arytenoepiglottic fold, false vocal cord). Involvement of the true vocal cords is extremely rare (less than 10 cases have ever been reported in the English literature--mainly in women). The present case describes a 27-year-old man who presented with a 2-year history of hoarseness. Indirect laryngoscopy showed a small polypoid mass in the middle of the left vocal cord. During microlaryngoscopy under general anesthesia, the polypoidal mass was removed and sent for histology. Immunohistochemistry and detailed histological examination revealed an ancient schwannoma. The present case in a male patient aims to increase awareness of the possibility that these tumors may also exist in the true vocal cords mimicking other more frequent lesions.

Adult↗
PubMedDate not supplied

Correlates of varying vocal fold adduction deficiencies in perception and production: methodological and practical considerations.

In this study the voice characteristics of normal male and female speakers are compared to those of two groups of patients with unilateral vocal fold paralysis. In order to enhance phonation, the patients in the first group compensate for the adduction deficiency which results from paralysis. The patients in the second group do not use compensatory strategies. Sustained vowels [i:, a:, u:] were produced by the speakers and scored for roughness, breathiness and hoarseness (RBH) by 8 raters. Although interrater agreement for RBH scores is only moderate on average, these percepts make consistent distinctions between the three speaker groups. Consistent but different distinctions are made between the three speaker groups for male and female speakers. The results show that male and female speakers should not be pooled in experimental studies of the pathological voice. Our results also indicate that female patients with a compensated unilateral vocal fold paralysis cannot be clinically evaluated solely on the basis of perception, because their voices cannot be distinguished from normal, healthy female speakers, despite their physiological impairment. The group distinctions made on the basis of RBH scores are supported by differences in the acoustic parameters which are derived by automatic analysis of the sustained vowels. Despite identical group distinctions for RBH scores and acoustic parameters, the acoustic basis of the percepts is not straightforward. Different acoustic predictors of the percepts were found for male compared to female speakers. Additionally, interrater differences point towards the presence of perceptual trading relations.

Adult↗