Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “HOARSENESS”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,009 records · Page 56Linked to original sources
PubMed2006

Sensitivity and specificity of intraoperative recurrent laryngeal nerve stimulation test for predicting vocal cord palsy after thyroid surgery.

INTRODUCTION: Recurrent laryngeal nerve (RLN) palsy after thyroidectomy, although infrequently encountered, can decrease quality of life. In addition to the hoarseness that occurs with unilateral RLN palsy, bilateral RLN palsy leads to dyspnea and often to life-threatening glottal obstruction. Therefore, intraoperative awareness of the nerve's status is of great importance. This study examined the sensitivity and specificity of a palpation technique to detect contraction of the posterior cricoarytenoid muscle (PCA) through the posterior hypopharyngeal wall while the RLN was being stimulated with a disposable nerve stimulator during thyroid surgery (the laryngeal palpation test) to predict postoperative RLN deficits. METHODS: A total of 2197 RLNs in 1376 patients were identified to be at risk of injury during thyroidectomy performed between July 2003 and August 2004. Postoperative RLN integrity was assessed using direct laryngoscopy or laryngofiberoscopy to visualize vocal fold mobility. RESULTS: Altogether, 76 RLNs failed to elicit a PCA contraction in response to nerve stimulation, and 80 cases of temporary vocal cord palsy and 21 cases of permanent vocal cord palsy were recognized on postoperative evaluation. For postoperative vocal cord palsy, the sensitivity and specificity of the laryngeal palpation test were 69.3% and 99.7%, respectively, with a positive predictive value of 92.1% and negative predictive value of 98.5%. For permanent vocal cord palsy, the sensitivity and specificity were 85.7% and 97.3%, respectively, with a positive predictive value of 23.7% and negative predictive value of 99.8%. CONCLUSIONS: The laryngeal palpation test is not a particularly useful method for predicting the level of RLN function after thyroidectomy. All patients must be examined postoperatively by direct laryngoscopy or laryngofiberoscopy to check vocal cord mobility. Even if there is no contraction of the PCA and we detect vocal cord palsy immediately after surgery, vocal cord palsy often recovers within 1 year when visual preservation of RLN is successful.

Adolescent↗
PubMed2000

Bedside percutaneous tracheostomy: prospective evaluation of a modification of the current technique in 100 patients.

Percutaneous dilatational tracheostomy (PDT) is being increasingly used. Concerns have been raised as to its safety, especially when it is done at the bedside. A prospective evaluation was conducted of 100 consecutive, unselected critically ill patients with PDT. The mean intensive care unit (ICU) stay before PDT was 12 days. One surgeon performed PDT alone (5 cases) or assisted residents (95 cases) in all operations; 84 were performed at the ICU bedside. Only the first six patients were taken to the operating room solely for tracheostomy. A modified technique was used: (1) the endotracheal tube was left in place during sequential dilations; (2) dilators were inserted in a 60-degree cephalad orientation to the skin and directed caudally after penetration of the anterior tracheal wall; (3) a digit was inserted through the tracheal opening to guide withdrawal of the endotracheal tube to the level of the vocal cords; and (4) size 8 tracheostomy cannulas were inserted over 28F dilators. The average time from skin incision to insertion of the tracheostomy tube was 12 minutes (< 10 minutes, 41 patients; 10 to 15 minutes, 37 patients; > 15 minutes, 22 patients). Sixty-five percent had unfavorable anatomic conditions due to spinal precautions or diffuse neck edema. Postoperative complications occurred in four patients; surgical emphysema after tracheal lacerations in three, cannula dislodgment in one. All complications were successfully managed without an operation by tube exchange (n = 3) or observation (n = 1); there was no procedure-related mortality. Forty patients were available for long-term follow-up (6-18 months after tracheostomy) by telephone; one had persistent hoarseness without respiratory difficulty. We concluded that bedside PDT is safe and easy to teach when performed with a technique that ensures correct instrumentation.

Adult↗
PubMed2000

[Classical brain stem syndrome. Definitions and history].

BACKGROUND: Inaccurate definitions of brain stem syndromes in the literature. METHOD: The original publications of the authors during the last century and the early years of this one were studied in relation to the neuro-ophthalmological diagnosis and neuroanatomy. It is the goal of this medico-historical investigation to compare the knowledge available at this time when the first descriptions were made with the clinical experience and understanding of today. RESULTS: The following classical brain stem syndromes are important for an ophthalmologist: diseases with III-paresis: Weber's syndrome (1863, ipsilateral oculomotor paralysis with alternating hemiplegia), Benedikt's syndrome (1889, oculomotor paralysis and crossed hemiparesis with tremor), Nothnagel Claude's syndrome (III-Paresis with alternating ataxia); diseases with VII-paresis: Millard Gubler's syndrome (1856, nuclear 7th nerve palsy with crossed hemiparesis), Foville's syndrome (1858, conjugate lateral gaze paralysis, ipsilateral nuclear palsy of the 7th nerve, crossed hemiparesis); diseases with VI-paresis: Raymond Cestan's syndrome (1895, abducent nerve paralysis with contralateral hemiparesis). Brain stem lesions are also found in Wallenberg's syndrome (1895, Horner's syndrome, absent corneal reflex, lateropulsion of saccadic eye movements, nystagmus, ataxia, dysphagia, hoarseness, sensory loss over the facial region, contralateral dissociated diminished sensibility (hemiparesis), etc.). The following two syndromes do not belong to the above-mentioned classical examples, because lesions of the long tracts of the brain stem are absent. However, since these two syndromes are accompanied by both ocular and neurological signs which indicate typical lesions of the brain stem, they are also mentioned here: Parinaud's syndrome (1883, paralysis of conjugate vertical gaze and paresis of convergence together with additional neuro-ophthalmological signs) and the Koerber Salus Elschnig's syndrome (1903, 1910, 1913, nystagmus retractorius, vertical gaze palsy, pupillary disturbances, and signs of midbrain disease). CONCLUSIONS: The first descriptions of these syndromes, together with the figures illustrating the neuroanatomical findings in these lesions, are helpful for assessing the clinical picture. Some named syndromes which are used today in clinical diagnosis (e.g. Parinaud's syndrome) do not exactly correspond to the first descriptions in the last century.

Brain Stem Infarctions↗
PubMed1998

[Ulcer of the thoracic aorta: diagnosis, therapy and prognosis].

Penetrating aortic ulcers (PAU) result from progressive erosion of atheromatose plaques perforating the internal elastic lamina. PAU is considered both a predisposing condition and differential diagnosis of classic aortic dissection; 93 cases of PAU are documented in the world literature, 60% of which are male over 60 years old. Systemic hypertension was prevalent in 85%, history of smoking in 72%, hyperlipoproteinemia in 35%, and diabetes mellitus in 31%. In 61%, PAU was associated with coronary artery disease, in 53% with abdominal or thoracic aortic aneurysm, in 31% with chronic renal insufficiency, in 17% with peripheral artery disease, and in 12% with a history of cerebrovascular accidents. In 73%, PAU was associated with formation of medial hematoma and in 16% with a thick, calcified intimal flap of less than 10 cm extent. Angiography, computed tomography, magnetic resonance imaging and transesophageal echocardiography were used in 66, 64, 23 and 14%, respectively, for diagnosing PAU; sensitivities for demonstrating PAU were 83, 65, 86 and 61%, respectively. Chest or back pain was found in 76% and an acute onset of symptoms in 68%. Signs of mediastinal widening were found in 59%, neurologic signs comprising hoarseness, syncope or coma in 8%, pulse differentials caused by embolism in 4%, aortic regurgitation in 7%, and mediastinal hematoma, pleural- or pericardial effusion in 42, 27 and 10%, respectively. PAU of the ascending aorta or aortic arch (type A) leads to dissection and rupture in 57%, compared to 12% and 5%, respectively, in the descending aorta (type B); 57% of medically managed type A PAU patients died within 30 d of hospital admission compared to only 14% of type B PAU with 20 cases of uncomplicated long-term outcome without surgery. Thus, similar to the Stanford classification for aortic dissection, type A PAU should primarily be considered for surgical management, whereas type B PAU without signs of instability may be managed medically.

Aortic Dissection↗
PubMed2004

Steroid injection to vocal nodules using fiberoptic laryngeal surgery under topical anesthesia.

Since 1990, we have performed steroid injection into the vocal fold by fiberoptic laryngeal surgery (FLS) under local anesthesia. In this study, the usefulness of this method was evaluated in 28 patients with vocal nodules. Under monitoring using a fiberoptic laryngoscope, a curved injection needle was inserted via the oral cavity and steroid was injected. Endoscopic findings showed that the vocal nodule had disappeared in 17 patients of the 27 patients and decreased in 10 after injection. The maximum phonation time was 10.9 s before operation and 13.9 s after operation, showing a significant increase (P<0.05), and the mean flow rate also showed a significant improvement (P<0.05). The patients self-rating concerning hoarseness demonstrated great improvement after injection. This technique can be performed under local anesthesia in combination with voice therapy on an outpatient basis, and it is considered to be useful for treating vocal nodules.

Anesthesia, Local↗
PubMed2004

Laryngeal solitary fibrous tumor treated with CO2 laser excision: case report.

The solitary fibrous tumor is an uncommon unilateral benign lesion that usually arises from the pleura. Recently, these tumors have been described in many other locations, such as the mediastinum, head and neck, orbit and urogenital system. To date, only two cases of solitary fibrous tumor arising from the larynx have been reported in the scientific literature. We describe a new case of laryngeal solitary fibrous tumor localized at the right false vocal fold. A 29-year-old man presented with a 6-month history of progressive hoarseness and foreign body sensation in the throat. A mass lesion was recognized in the right false vocal fold, and CT scan demonstrated a large, well-defined tumor without signs of infiltration. The tumor was removed by transoral CO(2) laser surgery. The definitive diagnosis was obtained by immunohistochemical analysis that showed vimentin and CD34-positive cells. The patient remains free of tumor after 15 months of follow-up.

Adult↗
PubMed2004

Hypoplasia of the epiglottis in a middle-aged man.

Hypoplasia of the epiglottis diagnosed at adulthood is extremely rare. Most patients with epiglottic hypoplasia have presented life-threatening symptoms of respiratory distress and severe aspiration in infancy or early childhood. This is a case of congenital epiglottic hypoplasia found in a 42-year-old man complaining of mild hoarseness and throat discomfort. Strobolaryngoscopy and CT scans revealed a unique anomaly with isolated epiglottic hypoplasia and normal appearance of other laryngeal structures. This case is discussed with a review of the literature on this rare occurrence.

Adult↗
PubMed2005

Growth hormone abuse and bodybuilding as aetiological factors in the development of bilateral internal laryngocoeles. A case report.

A 36-year-old man presented with hoarseness and stridor. He was an elite professional bodybuilder and admitted to having abusing anabolic steroids and growth hormone in the recent past. A CT scan showed bilateral laryngocoeles. The patient was initially managed with intravenous corticosteroids and broad-spectrum antibiotics, and the stridor resolved sufficiently to permit discharge from the hospital. He proceeded to undergo endoscopic marsupialisation of his laryngocoeles and to date has made a full recovery. This is the first reported case where anabolic steroid and growth hormone abuse combined with an elite bodybuilder's exercise regime has been implicated in the aetiology of bilateral laryngocoeles.

Adult↗
PubMed2006

Pediatric dyspnea caused by supraglottic stenosis: a rare complication of alkali corrosive injury.

Acquired supraglottic stenosis is a rare, but potential late sequela of corrosive injury, usually occurring 1 to 2 months after the initial trauma. The presentation may be delayed in children and is potentially lethal. We describe two pediatric patients, aged 31 and 16 months, who developed progressive inspiratory stridor and hoarseness about 2 months after accidental alkali ingestion. Fiberoptic laryngoscopy showed supraglottic stenosis. Intubation was achieved with a very small endotracheal tube under fiberoptic laryngobronchoscopic guidance prior to general anesthesia. Both patients successfully underwent CO(2) laser treatment under direct laryngoscopic guidance. There has been no case of recurrence reported after 1 year of follow-up other than a thin membranous scar in one case at the 3rd month of follow-up, which was easily dealt with by bronchoscopy dilatation. For such patients, monthly laryngoscopic examinations are advisable after alkaline corrosive injury for a minimum of 6 months. Prompt diagnosis and early airway intervention can reduce the need for tracheostomy and decrease the mortality rate.

Alkalies↗
PubMed2005

Treatment of recurrent respiratory papillomatosis with microsurgery in combination with intralesional cidofovir--a prospective study.

Recurrent respiratory papillomatosis (RRP) is an uncommon disease that may cause symptoms ranging from hoarseness to severe obstruction of the airway. Several treatment modalities have been tried, all with varying success. The goal of this study is to assess the benefit of the intralesional injection of cidofovir as an adjunct to microsurgical excision in treatment of laryngeal papillomatosis. All patients with RRP who presented between 1999 and 2004 at the University Medical Center Groningen were prospectively analyzed, regardless of the patients' age at presentation or duration of the disease. Not all patients were treated with cidofovir. To be included, all patients required a history of repeated microsurgery because of severe recurrence of RRP or because of severe technical difficulties in excising or vaporizing the lesion. Local microsurgery was performed, and then cidofovir, 2.5 mg/ml, was injected intralesionally. Treatment was repeated after 6, 12, 18, 24 and 30 weeks. Six male and three female patients were treated with cidofovir. Localization was the glottis in seven and the technically inaccessible dorsum epiglottidis and subglottis in one case each. The seven patients with glottic localization were cured. The two other patients showed recurrences, but at a lower rate than previously. Several times, however, more than six procedures were necessary. Cumulative doses of cidofovir ranged from 10.5 to 128 mg per patient. Cidofovir is a promising and powerful therapeutic approach for the treatment of RRP. Currently, the combination of microsurgery with intralesional cidofovir seems to be the treatment of choice for RRP.

Antineoplastic Agents↗
PubMed2006

Classic (Mediterranean) Kaposi's sarcoma of the true vocal cord: a case report and review of the literature.

Kaposi's sarcoma (KS) is a rare subcutaneous lesion linked mainly with patients suffering from acquired immunodeficiency syndrome. The aim of the present study is to present the first documented case of classic Kaposi's sarcoma (CKS) located in the right true vocal cord. A 62 year old male presented with cough and hoarseness for 2 months. Clinical examination revealed a nodule on the right vocal cord. The patient underwent surgery and the lesion was removed and biopsied. The histopathology report showed that the lesion was KS but with no complete removal of the lesion, since the surgical margins of the nodule were not healthy. The patient, although fully informed, refused any further treatment. Further laboratory tests were performed, revealing an HIV-negative immunodeficiency profile. Although (Mediterranean) CKS is not an aggressive malignancy, surgery with complete removal of the affected area is indicated when it is applicable. Moreover, conservative treatment and follow up of the patient is essential in order to prevent relapse or other primary lesions.

Greece↗
PubMed2006

Laryngeal pemphigus without skin manifestations and review of the literature.

Pemphigus is an uncommon chronic disease with dermatologic and mucosal manifestations. Primary laryngeal involvement without skin lesions is extremely rare. The present paper describes a 72-year old man who presented with a 2-month history of hoarseness, haemoptisis and dysphagia. Clinical examination revealed an erythematous oral mucosa without ulcerations. Indirect laryngoscopy revealed supraglottic ulcerations mainly in the laryngeal surface of the epiglottis and in the right arytenoid. The lesions had characteristic gray color membranes. The patient underwent microlaryngoscopy under general anesthesia and biopsies were taken for histology that revealed inflammatory and granular lesions with necrosis. The diagnosis of pemphigus was based on immunohistopathology and the clinical examination. The patient underwent intravenous treatment with high doses of corticosteroids (prezolon 75 mg/24 h) for 10 days and gradually the dose was reduced to 10 mg/24 h. The patient had a very good response to the treatment and after a week approximately 80% of the lesions disappeared. However, the dose of 10 mg prednisolone per day was sustained for 3 months because any attempt of prednisolone discontinuation was related with reappearance of the clinical symptoms. After 3 months, finally the treatment was discontinued without problems. Now, 15 months later, the patient is well and without symptoms. He is under long-term follow-up. ENT surgeons should be aware of pemphigus as primary laryngeal manifestation in order to investigate and manage patients accordingly.

Aged↗
PubMed1998

Malignant lymphoma of mucosa-associated lymphoid tissue in the larynx.

A 36-year-old woman was referred to the department of Otolaryngology/Head and Neck Surgery, University Hospital Vrije Universiteit, because of complaints of hoarseness. A submucosal swelling of the right ventricular fold was found that was subsequently biopsied. Histopathological examination showed a low-grade B-cell non-Hodgkin's lymphoma of mucosa-associated lymphoid tissue (MALT). Treatment consisted of local radiotherapy (to 2800 cGy). During the 2-year follow-up to date there has been no evidence of recurrent disease. To our knowledge, only four cases of MALT lymphomas in the larynx have been reported. The clinical behavior of MALT lymphoma is clearly quite distinct and requires proper recognition to prevent inadvertent misdiagnosis of overtreatment.

Adult↗
PubMed1999

Indications and results of fronto-lateral laryngectomy using a combined endolaryngeal and external approach.

Patients with laryngeal anterior commissure, cord-commissure, bilateral anterior cord-commissure carcinomas (T1 and T2 N0 M0) were subjected to a new method of frontolateral laryngectomy using a combined endolaryngeal and external approach. The proposed surgical procedure allowed the removal of the anterior commissure and part of one or both vocal cords in a single unit, together with the cartilaginous framework, respecting the integrity of the superior portion of the thyroid cartilage. The internal procedure permitted an accurate delimitation of the posterior part of the laryngeal neoplasm. In particular, this was performed during suspension microlaryngoscopy using the CO(2) laser or traditional cutting tools for section of the laryngeal visceral structures to the internal surface of the thyroid cartilage. Following this, the external approach included incision of the external perichondrium along the superior edge of the thyroid cartilage and along the median line, from the incisura to the inferior edge of the thyroid cartilage. The superior opening of the larynx is made side-to-side and the epiglottis separated at the level of the superior edge of the thyroid cartilage. The ends of the section are joined together with the superior parts of the section created during the laryngeal approach. Then progressive craniocaudal detachment of the internal perichondrium is performed backwards until the endolaryngeal sections are reached and downwards to the insertion of the cord ligaments. The inferior opening of the larynx is made by a horizontal section of the cricothyroid membrane at the level of the superior edge of the cricoid cartilage. Section of the thyroid cartilage is therefore performed in a trapezoidal shape. This section involves the inferior part of the protruding corner of the thyroid cartilage. After joining the ends of the cricothyroid section with the inferior extremities of the endolaryngeal sections, the surgical specimen is removed as a single unit. The method must be used only after accurate clinical evaluation. It is mostly recommended in subjects with cord-commissure carcinomas previously treated with radiotherapy. The results obtained were extremely satisfactory both as regards survival and functional results. In all, 27/28 patients (96.4%) were free from disease. The quality of voice was satisfactory but hoarse in 30% and breathy in 70% of the patients.

Adult↗
PubMed2000

Current advances in the basic research and clinical management of juvenile-onset recurrent respiratory papillomatosis.

Juvenile-onset recurrent respiratory papillomatosis is a relatively uncommon disease that presents clinically with symptoms ranging from hoarseness to severe dyspnea. Human papilloma viruses type 6 and 11 are important in the etiology of the papillomata and are most probably transmitted from mother to child during childbirth. Although spontaneous remission is frequent, a rare fatal course because of pulmonary spread or malignant transformation has occurred. CO2 laser evaporation of papillomas and adjuvant drug therapy using lymphoblastoid alpha-interferon are the most common treatment modalities at present. However, several other treatment modalities have been tried with varying success. Recent advances in basic research and different therapeutic approaches are reviewed.

Chemotherapy, Adjuvant↗
PubMed1999

Long-term results of organ preservation in chondrosarcoma of the cricoid.

Chondrosarcoma of the larynx is rare. The posterolateral lamina of the cricoid cartilage is the site most commonly involved. Although the symptomology, radiological and histopathological diagnostic features are well known, the condition continues to be diagnosed late and recurrences after excision are common. In general, radical surgical excision can result in long-term remission, although prognosis is related to the histopathological grade of the tumor. While a conservative surgical approach in low-grade tumors is justified, unexplained hoarseness, unilateral vocal cord paralysis and dyspnea requires CT scan examination.

Aged↗
PubMed1999

Effects on voice by endolaryngeal microsurgery.

Endolaryngeal microsurgery (EM) is functionally oriented. Therefore, assessment of vocal function is important to evaluate the effect of the surgery on voice. In all, 58 patients, including 26 patients with vocal cord nodules and 32 patients with vocal cord polyps, underwent EM. The patients' voices were recorded and analyzed before EM and 2 weeks after. Analysis of voice quality included perceptual assessment and each patient's own subjective evaluation of social acceptability of voice according to the 10.0 cm visual analogue scale (VAS) scale. Acoustic voice signal data were measured for fundamental frequency (Fo), jitter, shimmer and normalized noise energy (NNE) using Tiger Electronics Dr. Speech software. Statistically significant (P < 0.001) improvement was achieved in both perceptual and acoustic analysis and in both patient groups. According to the VAS scale, a high degree of satisfaction with the surgery was achieved. The grade of hoarseness (G) as well as roughness (R) and breathiness (B) decreased significantly after the operation. EM resulted in a statistically significant decrease in the mean jitter, shimmer and NNE postoperatively. There were no significant changes in the Fo after EM. These results confirm a high degree of effectiveness of EM on vocal rehabilitation and meet the expectations regarding the assessment and documentation of postsurgical voice changes.

Adult↗
PubMed2004

Evaluating swallowing dysfunction using a 100-ml water swallowing test.

This study used comparison with videofluoroscopic examination of swallowing (VFES) to examine the validity of a 100-ml water swallowing test (WST) in assessing swallowing dysfunction. Fifty-nine consecutive outpatients (15 females, 44 males) with clinically suspected dysphagia were enrolled in this study. Each subject underwent a 100-ml WST followed by VFES. Data was obtained on swallowing speed and signs of choking (coughing and a wet-hoarse voice). The analytical results revealed that 49 subjects had abnormal swallowing speeds (< 10 ml/s) in the 100-ml WST, and 47 of them were identified as having dysphagia by VFES. Among the ten participants with normal swallowing speed (> 10 ml/s), eight were diagnosed with dysphagia by VFES. Notably, 14 participants choked in the 100-ml WST, 11 of whom exhibited aspiration or penetration in VFES. Among the 45 participants without choking in WST, 12 displayed aspiration or penetration in VFES. The sensitivity of swallowing speed in detecting the swallowing dysfunction was 85.5%, and the specificity was 50%. Moreover, the sensitivity of using choking or wet-horse voice in the 100-ml WST as the sole factor for predicting the presence of aspiration was 47.8%, while the specificity was 91.7%. Therefore, this study concluded that swallowing speed is a sensitive indicator for identifying patients at risk for swallowing dysfunction. Moreover, choking in the 100-ml WST may be a potential specific indicator for followup aspiration.

Adult↗