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At least 1,117 records · Page 62Linked to original sources
PubMed2006

Sequelae of recurrent laryngeal nerve injury after patent ductus arteriosus ligation.

OBJECTIVES: To prospectively study the clinical course of neonates with vocal cord paralysis (VCP) after patent ductus arteriosus (PDA) ligation. METHODS: A prospective cohort study of all premature infants undergoing PDA ligation from March 2001 to February 2004. Flexible laryngoscopy was performed after extubation to assess vocal cord function. Data regarding patient characteristics, operative findings, post-operative endoscopic findings, and the subsequent clinical course were collected. RESULTS: One hundred patients were enrolled. Flexible laryngoscopy was performed on 61 patients. Median birth weight was 740 g, gestational age 25 weeks, and age at operation 23 days. Flexible laryngoscopy was performed at an average of 8 days after extubation. Seven cases of vocal cord paralysis were identified. Two had stridor and feeding difficulty requiring nasogastric feeding. Five of the seven had an average follow-up of 9 months after surgery. At last follow-up, endoscopically satisfactory compensation by the normal vocal cord was observed in all five patients. No patient had feeding problems. CONCLUSIONS: The majority of infants who can be successfully extubated after PDA ligation tend to be asymptomatic despite vocal cord paralysis. Compensation appears to occur rapidly, and patients generally have no *long-term problems with the airway or feeding.

Ductus Arteriosus, Patent↗
PubMed2006

The presentation and management of vascular rings: an otolaryngology perspective.

OBJECTIVE: To review the presentation and natural history of children with vascular rings and present management guidelines. METHODS: Retrospective study of tertiary care pediatric medical center charts from 1991 to 2002. RESULTS: There were 37 males and 27 females with a diagnosis of vascular rings. At presentation, 91% of patients had airway symptoms and 47% had esophageal symptoms. Airway symptoms included stridor (63%), recurrent respiratory infections (47%), respiratory distress (19%), and cough (17%). The most common esophageal symptom was dysphagia (27%). Pre-operative studies included: echocardiography (96%), chest X-ray (93%), barium swallow (75%), magnetic resonance imaging (MRI) (60%), and computerized tomography (CT) scan of the chest (59%). Surgical management included open (n=25) and thoracoscopic (n=39) approach. Complications included recurrent laryngeal nerve injury in five patients (8%). CONCLUSION: Children with vascular rings present with respiratory and/or feeding difficulty. The evaluation should include chest X-ray, echocardiography, and barium swallow. Direct laryngoscopy and bronchoscopy are recommended to assess the degree of compression of the airway and/or esophagus, tracheomalacia, and vocal fold motion prior to intervention. Indication for surgical release is given when the diagnosis is made and can be assisted by advanced radiology studies. Surgical options include minimally invasive techniques involving either thoracoscopic or robotic-assisted repairs, as well as open procedures involving thoracotomy.

Aorta, Thoracic↗
PubMed2005

Why to start the concomitant boost in accelerated radiotherapy for advanced laryngeal cancer in week 3.

PURPOSE: We analyzed toxicity and the local control rates for advanced laryngeal cancer, treated with two accelerated fractionation schedules. The main difference between the schedules was the onset of the concomitant boost, in Week 3 or Week 4. Overall treatment time and total dose were equivalent. METHODS AND MATERIALS: In a prospective, nonrandomized study of T3, T4, and advanced T2 laryngeal cancer, concomitant boost schedules were used in 100 patients. Thirty patients received a schedule of twice daily 1.2 Gy in Weeks 1-3, followed by twice daily 1.7 Gy in Weeks 4 and 5; total dose was 70 Gy (the hyperfractionated accelerated schedule [HAS] regimen). Seventy patients were treated with 5 times 2 Gy in Weeks 1 and 2, followed by daily 1.8 Gy and 1.5 Gy (boost) in Weeks 3-5; total dose 69.5 Gy (the accelerated schedule only [ASO] regimen). Distribution of T stage was 47%, 40%, and 12% for T2, T3, and T4, respectively. In 24% of the patients, lymph nodes were positive. Pretreatment tracheotomy or stridor or both occurred in 8 patients. The distribution of prognostic factors was not significantly different between the two fractionation schedules. Acute and late toxicity was assessed. Results were estimated by the use of actuarial methods. For late toxicity and local control univariate and multivariate analyses were performed. Tumor control probability analysis was used to model cure rate differences. RESULTS: Overall acute mucositis score was equal for both schedules. Acute mucositis started and decreased significantly earlier in the HAS regimen. In all patients acute mucositis healed completely. The treatment was completed within 38 days in all patients. The regional control rate was 100% for clinical N0, and 75% for the clinical N+ patients. The 3-year local control rate was 59% and 78% for the HAS and ASO regimens, respectively (p = 0.05); the ultimate local control was 80% and 94%, respectively. In multivariate analysis, besides the fractionation schedule (relative risk [RR], 2.6 for HAS vs. ASO), pretreatment tracheotomy/stridor (RR 4.3, yes vs. no), and local tumor response 3-6 weeks after radiotherapy (RR 5.1, no vs. yes) were independent factors for local control. Tumor control probability analysis indicated that the onset of repopulation may be about 4-6 days earlier for the HAS regimen. The onset of repopulation in the HAS regimen is probably at the end of the second week or at the beginning of the third week. Severe late toxicity was observed in the HAS group and ASO group in, respectively, 11% and 16%. In multivariate analysis this toxicity related significantly to the field size and pretreatment tracheotomy/stridor. CONCLUSIONS: In our study the timing of the boost in accelerated radiotherapy for advanced laryngeal cancer was an independent factor for local control, favoring the use of a concomitant boost in Week 3. This finding may indicate that accelerated repopulation of tumor cells starts early in the treatment phase.

Adult↗
PubMed2004

Clinical features and severity grading of anaphylaxis.

BACKGROUND: Existing grading systems for acute systemic hypersensitivity reactions vary considerably, have a number of deficiencies, and lack a consistent definition of anaphylaxis. OBJECTIVE: The aims of this study were to develop a simple grading system and definition of anaphylaxis and to identify predictors of reaction severity. METHODS: Case records from 1149 systemic hypersensitivity reactions presenting to an emergency department were analyzed retrospectively. Logistic regression analyses of the associations between individual reaction features and hypotension and hypoxia were used to construct a grading system. Epinephrine use, etiology, age, sex, comorbidities, and concurrent medications were then assessed for their association with reaction grade. RESULTS: Confusion, collapse, unconsciousness, and incontinence were strongly associated with hypotension and hypoxia and were used to define severe reactions. Diaphoresis, vomiting, presyncope, dyspnea, stridor, wheeze, chest/throat tightness, nausea, vomiting, and abdominal pain had weaker, albeit significant, associations and were used to define moderate reactions. Reactions limited to the skin (urticaria, erythema, and angioedema) were defined as mild. These grades correlated well with epinephrine usage. Older age, insect venom, and iatrogenic causes were independent predictors of severity. Preexisting lung disease was associated with an increased risk of hypoxia. CONCLUSION: This simple grading system has potential value for defining reaction severity in clinical practice and research settings. The moderate and severe grades provide a workable definition of anaphylaxis. Age, reaction precipitant, and preexisting lung disease appear to be the major determinants of reaction severity.

Adolescent↗
PubMed2005

Anesthetic management for laser excision of recurrent respiratory papillomatosis in a third trimester parturient.

Recurrent respiratory papillomatosis (RRP) is characterized by the development of laryngeal papillomas, which can produce partial to complete upper airway obstruction. Patients with RRP often require intermittent surgical excision to treat symptoms such as hoarseness and stridor, and to control progression of the lesions. The anesthetic management of such patients is challenging, and it requires carefully coordinated care between an anesthesiologist and otolaryngologist. We present 2 cases of general anesthesia administration during surgical excision of laryngeal papillomas, both occurring during the third trimester of separate pregnancies in the same parturient. The complexity of management was amplified in these cases because of the physiological and anatomical changes associated with pregnancy, along with the need to monitor fetal well-being. Possible complications included complete airway obstruction, pulmonary aspiration of gastric contents, hypoxemia, fetal distress, and preterm labor. Because pregnancy may lead to activation of human papillomavirus, the causative organism of RRP, management guidelines are provided for anesthesiologists who may care for patients with RRP during pregnancy.

Adult↗
PubMed2003

Esophageal motor function in congenital esophageal stenosis.

BACKGROUND/PURPOSE: Congenital esophageal stenosis (CES) is a rare condition that is associated with various foregut symptoms. The aim of the current study was to investigate esophageal motor function in pediatric patients with isolated CES. METHODS: Four boys with CES (age, 3 weeks to 4 years old) were studied before treatment. The initial symptoms were dysphagia or stridor. The CES was caused by fibromuscular stenosis (FMS) in 2, tracheobronchial remnants (TBR) in 1, and membranous diaphragm (MD) in 1. An esophagram, endoscopy, 24-hour esophageal pH monitoring, and manometry were conducted. RESULTS: The esophagram showed the stasis of contrast medium proximally to the distal esophageal narrowing in FMS/TBR patients. Endoscopic esophagitis was not found in any patients. Three patients were documented with pathologic esophageal acid exposure by 24-hour esophageal pH monitoring. Manometry showed that esophageal contractions predominantly were synchronous in FMS/TBR patients but were peristaltic in an MD patient. Basal lower esophageal sphincter (LES) pressure was at least 20 mm Hg in all. Swallow-induced LES relaxations were incomplete in FMS/TBR patients. CONCLUSIONS: The presence of gastroesophageal reflux and impaired esophageal motility are common in patients with CES.

Child, Preschool↗
PubMed2004

Slide tracheoplasty for congenital tracheal stenosis.

BACKGROUND/PURPOSE: The aim of this study was to add to the experience of slide tracheoplasty in infants with congenital tracheal stenosis (CTS), to review the recent literature on this subject, and to evaluate the diagnostic workup in infants with CTS. METHODS: A retrospective review of 3 infants with CTS treated with slide tracheoplasty was conducted at our institution. They all underwent bronchoscopy, tracheobronchography, and echocardiography. Therapy consisted of slide tracheoplasty and simultaneous correction of associated vascular malformations. RESULTS: A pulmonary artery sling was missed initially on esophagography in 2 patients. Stridor became worse in 2 patients after tracheobronchography. After surgical therapy, 2 patients survived and were discharged 12 days after surgery. Both are without symptoms at follow-up of 12 and 20 months. One patient had inoperable restenosis and died 27 days after the operation. CONCLUSIONS: Esophagography is not a reliable tool to depict associated vascular anomalies for patients with CTS. According to the literature, computer tomography has become more reliable to depict the tracheobronchial tree and is useful to elucidate associated vascular anomalies as well. Compared with other surgical techniques for infants with CTS reported in the literature, slide tracheoplasty has fewer postoperative complications and comparable survival rates.

Esophagoscopy↗
PubMed2005

Surgical management for posterior laryngeal cleft developing subglottic airway obstruction.

A 3-year-old boy associated with Opitz syndrome including hypospadias and anorectal anomaly was transferred to Osaka University Hospital with orotracheal intubation because of respiratory distress after respiratory infection. He had laryngeal cleft diagnosed in the neonatal period because of symptoms including stridor and aspiration. After 2 attempts at extubation, tracheostomy was performed. Fiberscopic examination demonstrated obstruction of the airway from the vocal cord to subglottic space by inspired esophageal redundant mucosa. There was no improvement observed for 3 months. He underwent anterior repair of cleft, anterior laryngotracheoplasty with costal cartilage graft, closure of tracheostomy, and endoscopic Nissen fundoplication. The postoperative course during the subsequent year was uneventful without feeding or speaking disorders. Subglottic airway obstruction caused by inspired redundant mucosa is a rare complication in laryngeal cleft. Anterior laryngotracheoplasty and Nissen fundoplication should be considered for this complication, in addition to the usual procedure for cleft repair.

Abnormalities, Multiple↗
PubMed2006

Cytotoxic agents in the treatment of laryngeal sarcoidosis: a case report and review of the literature.

SUMMARY: Sarcoidosis is a multisystem disease with various clinical manifestations. It is characterized primarily on a histopathologic basis by the presence of noncaseating granulomata. Laryngeal involvement reportedly occurs in 3-5% of cases, and it is typically localized to the supraglottic region. Patients often present with hoarseness, dysphagia, stridor, or dyspnea. Laryngoscopy typically demonstrates a pale, edematous epiglottis studded with nodules. Tissue biopsy reveals the classic noncaseating granuloma; however, the finding is not diagnostic. Sarcoidosis remains a diagnosis of exclusion to be entertained once other verifiable etiologies for granulomatous disease of the larynx, such as TB, syphilis, fungal infection, berylliosis, or Wegener's granulomatosis, have been ruled out. Systemic corticosteroids remain the mainstay of treatment; however, new steroid-sparing therapies that target the inflammatory response of sarcoidosis are currently being investigated. The case history of a patient with laryngeal sarcoidosis who was managed with the immunosuppressant azathioprine (Imuran) is summarized along with a discussion of other treatment options.

Adult↗
PubMed2006

Tracheal incision for elective tracheotomy in oral cavity cancer.

The aim of this prospective study was to compare operative procedure and postoperative complications between horizontal tracheal incision and window-type tracheal excision for elective tracheotomy in patients with oral cavity cancer. Between February 2003 and April 2004, 40 patients with advanced-stage oral cavity cancer were consecutively seen at our tumor clinic. All patients underwent elective tracheotomy before wide excision of the tumor and free flap reconstruction. Either horizontal tracheal incision (H group) or window-type tracheal excision (W group) was randomly carried out in two groups comprising 20 patients each. The post-tracheotomy tracheal stenosis was evaluated by tracheal computed tomography (CT) coupled with advantage workstation 4.0 software for reconstruction. Both groups had the following similar characteristics: age, gender, tracheotomy days, or interval between decannulation and CT scan evaluation. However, the incision time was statistically less in the H group (16.4s) compared with the W group (43.4s). Tracheal stenosis was found in five patients (25%) in the H group and four patients (20%) in the W group, with no significant differences. Nevertheless, neither dyspnea or stridor after decannulation, difficulty in tube exchange, nor accidental extrusion was reported in either groups. The horizontal incision for elective tracheotomy is simpler and faster than the window-type tracheal excision. The complication rate is not significantly different in both groups. We therefore, recommend using horizontal incision for elective tracheotomy in patients with oral cavity cancer.

Adult↗
PubMed2006

Tracheobronchial foreign body aspiration: a continuing challenge.

OBJECTIVE: The aim was to present the features and outcomes for 140 cases of foreign body aspiration and to discuss specific problems and new management recommendations. STUDY DESIGN AND SETTING: Records were retrospectively reviewed and the following data were recorded for each patient: age, sex, symptoms, duration of symptoms, findings on physical examination and chest radiography, location and type of foreign body, complications related to aspiration itself or to extraction, and outcome. RESULTS: Seventy-eight (55.7%) patients presented within 24 hours of aspiration. The most common symptoms and findings were cough, dyspnea-stridor, decreased breath sounds, radiopaque foreign body, air trapping, and atelectasis. All 140 patients underwent rigid bronchoscopy, and 110 had the foreign material extracted via the scope. No foreign body was detected bronchoscopically in 25 cases. In the other 5 cases, the material was visualized but could not be removed via the scope, and 3 of these patients required thoracotomy for removal. Eleven patients developed morbidity after bronchoscopy. CONCLUSIONS: History suggestive of foreign body aspiration is a definite indication for bronchoscopy, and bronchoscopic extraction should only be performed by experts. Each case tends to present different challenges, and endotracheal intubation and tracheotomy may be required.

Bronchi↗
PubMed2006

Tracheal reconstruction with porcine small intestine submucosa in a rabbit model.

OBJECTIVE: To evaluate the ability of porcine small intestine submucosa (SIS) to 1) maintain airway patency, 2) integrate, 3) prevent granulation tissue formation, and 4) permit mucosalization when used for tracheal reconstruction. Further studies were performed to evaluate the ability of SIS to support neochondrogenesis and investigate the impact of neochondrogenesis on airway patency. STUDY DESIGN: Prospective, controlled animal trial with SIS used with and without a perichondrial flap to reconstruct a tracheal defect in a rabbit model. Functional, histologic and endoscopic analyses were performed. RESULTS: All animals except 1 control animal were without stridor. The SIS graft supported neochondrogenesis, was completely mucosalized and was well integrated into the neotrachea. There was minimal granulation tissue formation. Endoscopic analyses did not reveal a consistent, significant difference in airway patency when SIS, with or without a perichondrial flap, was used for reconstruction. CONCLUSION: SIS can be used to reconstruct a sublethal rabbit tracheal defect with no mortality and minimal morbidity.

Airway Obstruction↗
PubMed2006

The upper airway: congenital malformations.

The upper airway extends from the nasal aperture to the subglottis and can be the site of multiple types of congenital malformations leading to anatomical or functional obstruction. This can cause severe respiratory distress. Newborns are obligate nasal breathers; therefore nasal obstruction can lead to airway compromise and respiratory distress. The etiologies are varied and include, choanal atresia, pyriform aperture stenosis, and rarely tumors such as glioma, encephalocele, teratoma, or dermoid. More common upper airway congenital anomalies include laryngomalacia, vocal cord paralysis, and subglottic stenosis. Laryngolmalacia is the most common congenital laryngeal anomaly. Inspiratory stridor often does not present until two weeks after birth and resolves by 18 months of age. Most cases are managed with watchful waiting. Severe cases require a surgical intervention. Bilateral vocal cord paralysis is usually idiopathic. In certain cases, paralysis may occur secondary to central nervous system abnormality including Arnold-Chiari malformation, cerebral palsy, hydrocephalus, myelomeningocele, spina bifida, or hypoxia. Severe cases may necessitate endotracheal intubation and tracheostomy. Congenital subglottic stenosis is the third most common laryngeal anomaly. It is defined as a diameter of less than 4mm of the cricoid region in a full-term infant, and less than 3mm in a premature infant. This condition is the most common laryngeal anomaly that requires tracheotomy in newborns. Laryngotracheoplasty may be required to achieve decanulation. Knowledge of the upper airway embryological development and congenital anomalies is off prime importance in assessing the newborn with respiratory distress. In most cases flexible endoscopy establishes the diagnosis. Management is tailored to each condition and its degree of severity.

Choanal Atresia↗
PubMed2006

Severe vocal cord dysfunction resistant to all current therapeutic interventions.

Vocal cord dysfunction (VCD) is characterised by paradoxical vocal cord adduction during inspiration or throughout the respiratory cycle, it results in wheeze, stridor, cough and dyspnoea. Although asthma and VCD can coexist, patients with VCD are frequently misdiagnosed with refractory asthma. It can severely restrict an individual's level of activity and effective therapeutic control can be difficult to achieve. We report the case of a patient who was treated with all available therapeutic interventions, including intralaryngeal botulinum toxin injection, but failure resulted in a permanent trachesotomy.

Adult↗
PubMed2002

[Intra-laryngeal ectopic thyroid tissue. Report of one case and review of the literature].

A Ectopic thyroid is any thyroid tissue not located in his normal anatomic situation. There have been described four general groups within the upper aerodigestive tract: lingual, sublingual, thyroglossal and intralaryngotracheal. Intralaryngotracheal thyroid tissue is rare and constitute 7 per cent of all intratracheal tumours, and it represents a problem of diagnosis and management. The controversy about the genesis of this tumours remains. There are two established theories: "the malformation theory" and "the ingrowth theory". These tumours affect more frequently adult female. Intralaryngotracheal thyroid have been mainly reported on the posterior-left wall of the trachea. The most common clinical feature is stridor due to progressive upper airway obstruction. Up to 75% of the intralaryngotracheal goiters are associated with and external goiter. This paper reports a case of ectopic subglotic thyroid in a 42 year-old-female. The embryology, diagnosis and management of this tumours are discussed.

Adult↗
PubMed1999

Prognostic significance of clinically silent coronary artery fistulas.

Symptomatic coronary artery fistulas (CAF) are associated with significant morbidity and mortality. With the advent of high-resolution 2-dimensional and color Doppler echocardiography, the detection rate of clinically silent CAF has increased, but their clinical significance and outcome have not been defined. The clinical, echocardiographic, electrocardiographic, and angiographic findings and documented follow-up of 31 patients with an echocardiographic finding of a clinically silent coronary artery fistula from 1986 to 1997 were analyzed. Mean age at diagnosis was 7.2+/-8.4 years. Indications for echocardiography were murmur (n = 23), congenital heart disease (n = 2), cardiomegaly (n = 2), chest pain (n = 1), stridor (n = 1), syncope (n = 1), and chest trauma (n = 1). CAF were detected with color Doppler flow mapping in all patients. The origin of the fistula was from the left coronary artery system (n = 27), right coronary artery system (n = 3), and bilateral (n = 1). The exit sites were the pulmonary artery (n = 18), right ventricle (n = 8), right atrium (n = 2), and left ventricle (n = 3). Global and regional left ventricular function were normal in all patients at presentation and follow-up. Spontaneous closure of the fistula was documented in 7 patients (23%) at mean follow-up of 2.6+/-2.0 years. In 23 patients the fistula persisted without intervention. All patients remained asymptomatic, without adverse clinical events or evidence of ischemia at a mean age at follow-up of 9.3+/-9.1 years (range 4 months to 42.0). Based on this experience, there is no evidence that clinically silent CAF diagnosed incidentally by color Doppler echocardiography are associated with adverse clinical outcome in childhood and adolescence. Conservative management with continued follow-up of these patients appears to be appropriate.

Adolescent↗
PubMed2001

An overview of reflux-associated disorders in infants: apnea, laryngospasm, and aspiration.

Problematic airway responses in infants are common. Reflux-induced apnea affects nearly 1% of infants and involves airway closure or laryngospasm. Recurrent or chronic stridor, caused by dynamic or structural airway abnormalities, occurs in up to 1 in 100 babies. It can be difficult to distinguish microaspiration, which may represent inadequate airway protection mechanisms, from reflexive responses to esophageal refluxate, which may represent overeffective airway protection mechanisms. The diagnosis of gastroesophageal reflux (GER) in babies can be facilitated by a careful history in conjunction with esophageal pH probe monitoring, laryngoscopic evaluation, bronchoalveolar lavage, or nuclear medicine scintigraphy. Conservative lifestyle measures for treating supraesophageal manifestations of infantile GER include prone positioning and thickened feedings. Prokinetic and acid-suppressing therapies are widely used, but their efficacy is incompletely established, and none is currently approved by the US Food and Drug Administration for this purpose. Fundoplication is not indicated if nonsurgical management can prevent serious problems during the child's maturation phase when many of these manifestations spontaneously resolve. Much remains to be learned about the developmental aspects of these supraesophageal manifestations of GER. This information not only will provide a greater understanding of developmental pathophysiology, but also will improve the clinical care of large numbers of infants.

Apnea↗
PubMed2001

Update on gastroesophageal reflux disease in pediatric airway disorders.

In this article, the literature regarding the effects of gastroesophageal reflux disease (GERD) on otolaryngologic disorders in infants and children is reviewed. We specifically focus on studies that suggest how GERD may be associated with sinusitis, cough, laryngitis, airway obstruction, apnea, recurrent croup, laryngomalacia, stridor, and subglottic stenosis in children.

Airway Obstruction↗