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PubMed2004

Hoarseness as an unusual initial presentation of aortic dissection.

Aortic dissection is a life-threatening medical emergency. While an abrupt, tearing pain in the chest or back is present in more than 90% of the patients, diagnosis of aortic dissection has been shown to be particularly difficult when such symptoms are not present. In this report we describe a 36-year-old man presenting with a 10-day history of new onset of hoarseness associated with several transient headache episodes. The possibility of aortic dissection was overlooked at the initial presentation, and unilateral vocal cord palsy due to a cerebrovascular accident was the initial diagnosis. The patient's abnormal chest radiograph led to a re-diagnosis, and a Standford type-B aortic dissection was confirmed using thoracic computed tomography. The unusual presentation of aortic dissection is emphasized, and its management is discussed.

Adult↗
PubMed2006

Dysphagia and hoarseness associated with painless aortic dissection: a rare case of cardiovocal syndrome.

Cardiovocal syndrome (Ortner's syndrome) is characterized by left recurrent laryngeal nerve palsy due to cardiovascular disease, but in rare cases it can also be caused by aortic dissection. An 81-year-old man with hypertension was admitted to the hospital with aspiration pneumonia. He had been developing progressive dysphagia and hoarseness for several months before admission. A videofluoroscopic swallowing study showed supraglottic penetration with barium paste and liquid. Laryngoscopy and electromyography revealed left vocal cord palsy caused by left recurrent laryngeal neuropathy, and a contrast-enhanced chest CT revealed dissection of the aortic arch.

Aged, 80 and over↗
PubMed2003

Proximal left subclavian artery aneurysm presenting hemoptysis, hoarseness, and diplopia: repair through partial cardiopulmonary bypass and perfusion of the left common carotid artery.

Isolated true aneurysm of the subclavian artery is rare and can rupture, thrombose, embolize, or cause symptoms by local compression. We describe a case of a 67-year-old man with proximal left subclavian artery aneurysm presenting with hemoptysis, hoarseness, and diplopia. These symptoms suggested that the aneurysm ruptured, that the left recurrent laryngeal nerve was compressed by it, and that its mural thrombus caused cerebral embolism. It was incidentally confirmed that the aneurysm grew at the rate of 1.31 cm/year, from 3.0 to 4.2 cm in diameter for 11 months, preciously measured in a computed tomography scan. The aneurysm was successfully repaired via partial cardiopulmonary bypass and separate perfusion of the left common carotid artery through cross-clamping the descending thoracic aorta and the aortic arch between the origins of the brachiocephalic artery and the left common carotid artery. Neither partial clamping of the aortic arch at the portion branching the left subclavian artery nor taping the aortic arch between the origins of the left common carotid artery and the left subclavian artery could be achieved.

Aged↗
PubMed1990

Hoarseness as the sole presenting symptom of foramen magnum meningioma.

Foramen magnum tumours are rare. They may present with bizarre symptoms and mimic many conditions. We report a presentation with the sole complaint of hoarseness, never previously described in the literature. Voice returned to normal after surgical removal of the foramen magnum meningioma.

Aged↗
PubMed1993

Histiocytosis: an unusual cause of dysphagia, hoarseness and stridor.

We present a patient with established histiocytosis who developed dysphagia, retching, regurgitation, hoarseness and stridor. These symptoms were managed with carbon dioxide laser vaporization, electively on three occasions, and once as an urgent procedure, while awaiting radiotherapy, to control her airway. Histiocytosis is a rare cause of a number of otolaryngological syndromes, but there has been no previous record of this disease causing laryngopharyngeal symptoms. This paper discusses the classification of histiocytosis, and describes our management of this rare and intriguing case.

Deglutition Disorders↗
PubMed2001

Vagal schwannoma of the cerebello-medullary cistern presenting with hoarseness and intractable tinnitus: a rare case of intra-operative bradycardia and cardiac asystole.

Schwannomas arising from the lower cranial nerves (IX-XI) are rare, constituting only 3% of all intracranial schwannomas unassociated with neurofibromatosis. A great majority of these tumours present as jugular foramen lesions and less commonly they occur along the extracranial course of these nerves. An intracisternal location is extremely rare. We report a case of vagal schwannoma purely in the cerebello-medullary cistern causing distortion of the medulla oblongata. Total microsurgical excision of this tumor, arising from one of the rootlets of the vagus nerve, was achieved with preservation of the 9th, 10th and 11th cranial nerves.The intraoperative course was complicated by two episodes of complete cardiac asystole, each lasting for 4(s), and six episodes of severe bradycardia. The patient was relieved of his intractable tinnitus but continued to have a hoarse voice due to an ipsilateral partial vocal cord palsy.

Bradycardia↗
PubMed1989

Recurrent neonatal herpes presenting initially with hoarseness.

This report describes a newborn with recurrent herpes simplex meningoencephalitis despite vigorous antiviral therapy. The course is unusual in that the presenting symptom was hoarseness. Despite probable adequate acyclovir levels in the spinal fluid, a second episode or progression of herpetic encephalitis occurred, suggesting impairment of host defenses, particularly cellular immunity. This episode was treated with both acyclovir and vidarabine. Pharmacokinetics of the antiviral therapy and immune responses are discussed.

Acyclovir↗
PubMed2005

Hoarseness and misdirected swallowing before and after antireflux surgery.

CONCLUSION: Patients with hiatus hernia can be relieved from H, MSL and MSN by hiatus hernia repair. OBJECTIVE: It has been hypothesized that respiratory symptoms in patients with gastro-oesophageal reflux disease (GORD) may, in some cases, be due to misdirected swallowing as a consequence of defective opening of the upper oesophageal sphincter. The aim of this study was to investigate whether patients with hiatus hernia are relieved from symptoms of misdirected swallowing to the larynx (MSL) and nose (MSN), as well as hoarseness (H), as a result of hiatus hernia repair. MATERIAL AND METHODS: A questionnaire concerning symptoms of H, MSL and MSN was administered to 90 patients under investigation for hiatus hernia repair before and after surgery. RESULTS: Before surgery, MSL occurred in 30% of patients, MSN in 30% and H in 25%. These symptoms were significantly interrelated (p <0.008). After antireflux surgery, all symptoms were significantly reduced (p <0.001). Symptom reduction was not related to the weight of the patients.

Adult↗
PubMed1980

Persistent hoarseness: an aggressive approach for early detection of laryngeal cancer.

Persistent hoarseness in a patient should always alert the physician to the possibility of laryngeal carcinoma. Prompt visualization of the larynx is essential, particularly in high-risk patients over 40 years of age without a history of upper respiratory infection. Mirror examination (indirect laryngoscopy) is the usual initial diagnostic procedure, although Hopkins' rod telescope and the fiberoptic laryngoscope may provide more adequate visualization. Direct laryngoscopy and biopsy allow definitive diagnosis.

Adult↗
PubMed2003

Hoarseness caused by unilateral vocal fold paralysis: how long should one delay phonosurgery?

We present a case of idiopathic right vocal fold paralysis which resolved completely 18 months after onset. Instead of using surgery to improve the hoarseness of our patient, our experience suggested that speech therapy might be effective. Although the voice can be improved by overadduction of the healthy vocal fold, as surgery is irreversible it is better to wait for 18 months after onset in case spontaneous recovery occurs. During this period, one should of course continue to investigate the origin of the paralysis.

Aged↗
PubMedDate not supplied

Ductus arteriosus aneurysm in an adult patient presenting with hoarseness.

Aneurysm of the ductus arteriosus is a rare diagnosis, with most cases found in the pediatric population. The unusual adult cases reported in the literature have been associated with high morbidity and a surgical repair has been recommended. We report a case of a 60-year-old man who presented with hoarseness secondary to a ductus arteriosus aneurysm and underwent a repair of this abnormality via a left posterolateral thoracotomy utilizing partial cardiopulmonary bypass.

Aneurysm↗
PubMed1988

A pitch-synchronous analysis of hoarseness in running speech.

A method of pitch-synchronous acoustic analysis of hoarseness requiring a voice sample of only four fundamental periods is presented. This method calculates a noise-to-signal (N/S) ratio, which indicates the depth of valleys between harmonic peaks in the power spectrum. The spectrum is calculated pitch synchronously from a Fourier transform of the signal, windowed through a continuously variable Hanning window spanning exactly four fundamental periods. A two-stage procedure is used to determine the exact duration of the four fundamental periods. An initial estimate is obtained using autocorrelation in the time domain. A more precise estimate is obtained in the frequency domain by minimizing the errors between the preliminary calculated power spectrum and the predicted spectrum spread of a windowed harmonic signal. Analysis of synthesized voices showed that the N/S ratio is sensitive to additive noise, jitter, and shimmer, and is insensitive to slow (8 Hz) modulation in fundamental frequency and amplitude. An analysis of pre- and postoperative voices of six patients with benign laryngeal disease showed that the N/S ratio for vowel /u/ in running speech consistently improved after surgery for all subjects, in agreement with their successful therapeutic results.

Hoarseness↗
PubMed2001

Collapse, hoarseness of the voice and swelling and bruising of the neck: an unusual presentation of thoracic aortic dissection.

A 66 year old woman presented to the accident and emergency department with history of collapse, hoarseness of the voice, and swelling and bruising of the neck. The diagnosis was not initially obvious because of the absence of chest pain. The findings on the radiograph of the soft tissue of the neck and chest radiograph suggested the need for computed tomography of the neck and chest. This confirmed the cervical haematoma and typical signs of aortic dissection. This unusual presentation of thoracic aortic dissection is discussed below.

Aged↗
PubMed1994

Metastatic calcification of the true vocal cords as a cause of hoarseness.

Visceral soft tissue calcification is common in patients with end-stage renal disease. However, metastatic calcification of the true vocal cords has not been described. We present a patient with chronic renal failure and hoarseness in whom an exophytic true vocal cord mass was diagnosed as a metastatic calcification.

Adult↗
PubMed2006

Clinical and radiological analysis of ossification of the anterior longitudinal ligament causing dysphagia and hoarseness.

OBJECTIVE: We retrospectively analyzed the clinical and radiological characteristics of ossification of the anterior longitudinal ligament (OALL). METHODS: Seventeen patients with OALL who underwent surgery between 1995 and 2003 were reviewed. Symptomatic OALL was found in four patients. In 13 asymptomatic OALL patients who experienced mild to severe myelopathy, no swallowing difficulty was noted. The OALL was classified into three types by sagittal computed tomographic (CT) scans as segmental, continuous, and mixed and three types on axial CT scans as flat, nodular, and globular type. The thickness, numbers of involved vertebral bodies, and type and shape for symptomatic OALL were analyzed and compared with those for asymptomatic OALL. RESULTS: The mean thickness of 13.5 mm for symptomatic OALL was significantly higher than that of 6.5 mm for asymptomatic OALL (P = 0.0009). A globular shape on axial CT was common for symptomatic OALL. There were no differences in the numbers of involved vertebral bodies and types of OALL on sagittal CT scans. Surgical excision of OALL was performed for all cases of symptomatic OALL. In 7 of 13 asymptomatic cases, OALL was simultaneously removed during anterior decompressive surgery for the associated pathology. CONCLUSION: The thickness on axial CT scans was an important contributing factor to dysphagia and hoarseness as was the shape of the OALL. The type of OALL on sagittal CT scans was similar to that of ossification of the posterior longitudinal ligament but did not influence the development of dysphagia. Good relief from symptoms was achieved for symptomatic OALL after removal of OALL.

Aged↗
PubMed2000

Hoarseness due to leech ingestion.

This paper presents a case of hoarseness caused by the pharyngolaryngeal localization of a leech. This pathological lesion is extremely rare in western European countries, but is more frequent in endemic areas. Possibly lethal dyspnoea, haemoptysis or haematemesis can be the revealing symptoms. When the diagnosis is suspected simple examination under anaesthesia and removal of the leech will effect a cure.

Animals↗