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A case of laryngeal aspergillosis following radiation therapy.

Primary laryngeal aspergillosis is extremely rare. It is commonly seen as a part of a systemic infection involving the respiratory system in an immunocompromised host. Differential diagnosis is important, as the clinical symptoms are similar to those of malignant laryngeal disease. We describe a 73-year-old man with a history of hoarseness. He had a history of radiotherapy for laryngeal squamous cell carcinoma and had a history of diabetes. Direct laryngoscope and biopsy confirmed the diagnosis of aspergillus. We cauterized the lesion with a CO(2) laser. In the present case, irradiation seemed to have played a more important role in the onset of this disease rather than diabetes.

Aged↗

Laryngeal solitary multiple mucosal neuromas without multiple endocrine neoplasia (MEN) type 2B.

The first case of laryngeal solitary multiple mucosal neuromas (MMN) was reported. A 73-year-old man who had complained of hoarseness and abnormal prickly sensation in the throat for 3 months visited our hospital. Many small whitish-yellow nodules were observed in the laryngeal mucosa from the right arytenoid to the interarytenoid region. Using laryngomicroscopy biopsy was performed twice. The pathological study showed neurogenic nodular lesions consisting of regularly arranged nerve bundles with many axons and Schwann cell proliferation, and so MMN was finally diagnosed. As MMN is regarded as a constant component of multiple endocrine neoplasia (MEN) type 2B, screening of MEN type 2B was performed, however, they were all within normal limits. This case was, therefore, diagnosed as a laryngeal solitary MMN without MEN type 2B.

Aged↗

Thyroplasty type I with ceramic shim.

To improve hoarseness or misswallowing caused by unilateral recurrent laryngeal nerve paralysis, medialization of paralyzed vocal cord has frequently been performed. This method includes such techniques as injection method, insertion method, and arytenoid adduction, each presenting its merits and demerits. The insertion method which can be done while monitoring the patient's voice seems advantageous in that the technique is easy to perform and generally guarantees the voice improvement. Among insertion methods, Isshiki thyroplasty type I is the one most representative as well as popularized. However, since a silicone shim is inserted in this operation, it may be accompanied by the risks of carcinogenicity, foreign body reaction, and induction of collagen disease of silicone. Therefore we planned to use a ceramic as a safe substitute instead of silicone. There has been no article reporting the use of ceramic in this type of surgery. We used a fibrin glue to fix the ceramic shim and for hemostasis, which was found very useful. Hitherto, 2 cases of unilateral recurrent laryngeal nerve paralysis underwent Isshiki thyroplasty type I using ceramic shim with satisfactory results.

Aged↗

Carcinoid tumor of the larynx.

Carcinoid tumor of the larynx is a rare neoplasm. Two cases of laryngeal carcinoid tumor are reported and the relevant literature is reviewed. One patient was an 82-year-old male who complained of odynophagia. The tumor was located on the left arytenoid and neck metastasis were present when he died 3 years after surgery. The other patient was an 82-year-old male who complained of hoarseness. His tumor was located in the left ventricle. Bone metastasis was detected one month after surgery and he died of distant metastasis two months following surgery. A review of the literature showed that carcinoid tumors of the larynx are aggressive and malignant, with distant metastasis being the most common cause of death. This tumor is unresponsive to radiotherapy and chemotherapy, so adequate surgical excision remains the only effective treatment.

Aged↗

Laryngeal lymphangioma--case report.

Laryngeal lymphangioma is extremely rare. We have been able to find only seventeen cases reported in world literature. We recently, treated a patient suffering from laryngeal lymphangioma in our department. The female patient, aged 36, complained of hoarseness for several months. Indirect laryngoscopy revealed a growth on her right false vocal cord. Under general anesthesia, tracheostomy and laryngofissure were performed for removal of this neoplasm. The tumor was microscopically diagnosed as lymphangioma. The symptoms disappeared after surgery and there has been no recurrence. The pertinent literature on this rare disease is reviewed.

Adult↗

A clinical study of Reinke's edema.

A clinical study of 76 cases with Reinke's edema who underwent endolaryngeal microsurgery was carried out, and the postoperative results were evaluated. The patients were classified into three types: Type I, II, and III according to the severity of the disease as determined by laryngeal appearance. Postoperative changes in subjective symptoms were assessed and sound spectrographic and perceptual evaluations of voices were carried out before and after surgery in 38 cases. The majority of the patients were over 40 years of age for both sexes and most of the elderly patients were female. In Type III patients, the incidence was higher among females. All the patients complained of hoarseness and nine cases of Type III complained of dyspnea. Most of them had been chronically affected for over one year and showed a bilateral pathology. Smoking appeared to be the most dominant etiologic factor, while aging and a long history of vocal abuse also seemed to be causative factors. Improvement in subjective symptoms was found in almost all the patients treated with the squeezing technique proposed by the author's group. Improvement in voice quality was observed in acoustic evaluations. Among Type III females, it was often the case that the voice fundamental frequency was very low before surgery, while it increased markedly after surgery. In general, the voice after surgery showed less fluctuation in both pitch period and amplitude, as well as a smaller amount of noise components compared to that recorded before surgery. As measured by perceptual judgement, voice quality was found to be more improved in females than in males.

Adult↗

Sudden recurrent laryngeal nerve paralysis due to apoplexy of parathyroid adenoma.

Neoplastic lesions of the parathyroid are rare, and most of these are adenomas. Even rarer is a secondary involvement of the recurrent laryngeal nerve. A case is presented of sudden onset hoarseness in a 64-year-old man caused by acute vocal cord paralysis due to bleeding within an adenoma of the lower right parathyroid gland. Acute onset of vocal cord paralysis is rarely associated with benign processes; the current case is only the second report associated with parathyroid adenoma.

Adenoma↗

Chondrosarcoma of larynx: a case successfully reconstructed after total cricoidectomy.

A case of a 64-year-old male with low-grade chondrosarcoma of the left posterolateral lamina of the cricoid cartilage is reported, in which a total cricoidectomy and partial resection of the left thyroid cartilage were performed. The rest of the thyroid cartilage and the arytenoid mucosa were approximated with sutures to the first tracheal ring, and a silastic T-tube was placed through the tracheostoma as a stent. The postoperative course has been successful except for the existence of a tracheal stoma and slight hoarseness. There has been no evidence of laryngeal stenosis nor recurrence at about 9 years postoperatively.

Chondrosarcoma↗

Left recurrent laryngeal nerve palsy associated with primary pulmonary hypertension and patent ductus arteriosus.

Two patients with left recurrent laryngeal nerve paralysis in association with pulmonary artery hypertension are described. One had primary pulmonary hypertension and the other had patent ductus arteriosus. The greatly dilated pulmonary artery in these patients resulted in compression of the left recurrent laryngeal nerve and produced a cardiovocal (Ortner's) syndrome. The pathogenesis of the vocal cord palsy was documented by cross-sectional computed tomography. In conclusion, computed tomography is of great help in differentiating this syndrome from other diseases such as mediastinal mass or lymphadenopathy whenever hoarseness is complicated by pulmonary hypertension.

Adult↗

Subclavian mycotic aneurysm presenting as mediastinal abscess.

A 60-year-old man was admitted to a hospital for evaluation of intermittent fever, dysphagia, hoarseness, and general chest discomfort. Great vessel mycotic aneurysm was suspected when antibiotic trials failed and chest X-ray showed paraaortic mass with pleural effusion mimicking mediastinitis. Although the correct diagnosis of mycotic aneurysm of innominate artery was made thereafter and vigorous treatment was initiated immediately, this patient succumbed to overwhelming sepsis, probably due to a 2-week delay in another hospital. This case is reported to remind readers of the possibility of this unusual location of mycotic aneurysm. A high index of suspicion should be maintained to make an earlier diagnosis and obtain better prognosis. Computed tomography and 3D magnetic resonance angiography also significantly improve the diagnosis when mycotic aneurysm location is unusual and presentation is equivocal.

Abscess↗

Flumazenil reversal of lorazepam-induced acute delirium.

We report the case of a 63-year-old man who presented to the Emergency Department (ED) with a 1-week history of sore throat, hoarseness and dysphagia. During his ED workup, the patient experienced an acute delirium 25 min after being given 2 mg of Lorazepam. The patient's mentation returned to normal within 1-2 min of being given 1 mg of Flumazenil. We discuss the various behavioral side effects of benzodiazepines and the indications for the use of Flumazenil.

Anti-Anxiety Agents↗

Postoperative infection associated with polyester patch angioplasty after carotid endarterectomy.

OBJECTIVES: Postoperative infection is one of the most dreaded complications associated with use of synthetic patches for carotid endarterectomy. Although polyester patches were used extensively for carotid patch angioplasty throughout the last decade, few reports detail cases of deep patch infection. We describe our experience with polyester patch infections after carotid endarterectomy. Patients and methods From January 1996 through December 2001 we treated polyester patch infections after carotid endarterectomy in 10 patients. RESULTS: The interval from primary carotid endarterectomy to presentation with infection ranged from 11 days to 30 months. All patients underwent repeat operation that involved tissue debridement, excision of the polyester patch, and either interposition grafting or patch angioplasty with autologous vein. No perioperative stroke or death occurred; however, 1 patient had transient hoarseness, and in 1 patient a pseudoaneurysm developed that required additional surgical repair with a saphenous vein interposition graft. All patients remain well and free of infection with follow-up as long as 56 months. CONCLUSIONS: Infection is a serious and rare complication of carotid patch angioplasty with polyester material. Nonetheless, it can be treated successfully with good results and acceptable morbidity with soft tissue debridement, prosthetic patch excision, and either patch angioplasty or interposition grafting with autologous vein.

Aged↗

Multiple pseudoaneurysms of the aortic arch, right subclavian artery, and abdominal aorta in a patient with Behçet's disease.

A 38-year-old man presented with 2 months' history of a hoarseness and aphthous stomatitis. Image diagnosis showed that he had saccular-type aneurysms of the aortic arch, right subclavian artery, and infrarenal abdominal aorta. Simultaneous total arch replacement, including reconstruction of the right subclavian artery and replacement of the infrarenal abdominal aorta, was performed. Pathologic specimen of each aneurysmal wall revealed that intima and the majority of the medial layer were absent. Chronic inflammatory process was detected in the adventitia that was compatible with diagnosis of Behçet's disease.

Adult↗

[Laryngeal paralysis after tracheal intubation for anesthesia].

A 17 year old man was anaesthetized for osteosynthesis of a fractured left femoral diaphysis. Endotracheal intubation was easy, anaesthesia and surgery were both uneventful. On recovery, some hoarseness was noticed. Two months later, an ENT examination showed signs of laryngeal paralysis. The presumed explanation was compression of the recurrent nerve by the high-positioned balloon of the tracheal tube. Recovery was complete four months later.

Adolescent↗

[Recurrent nerve paralysis and Claude Bernard-Horner syndrome following an interscalene block of the brachial plexus].

The association of a recurrent laryngeal block with a Horner's syndrome occurred in one patient after right interscalene brachial plexus block. Hoarseness was the main clinical symptom of recurrent paralysis and lasted 4 h. The subsequent course was totally uneventful and required no specific treatment. But the interscalene route of brachial plexus block may be potentially hazardous in the patient with a full stomach.

Adult↗

Functional imaging of vocal fold vibration: digital multislice high-speed kymography.

For the diagnosis of voice disorders, and especially for the classification of hoarseness, direct observation of vocal fold vibration is essential. Furthermore, a quantitative description of the movement of the vocal fold becomes increasingly necessary to document and compare findings as well as the progression of speech therapy. On the base of digital high-speed sequences of vocal fold vibration, multiple "functional images"-also called digital kymograms-are obtained using image- and signal-processing algorithms. Digital kymograms can serve as a powerful aid for visualization, description, and classification of vocal fold vibration and as an intermediate step for image interpretation by biomechanical modeling. This visualization technique will be discussed and compared to other techniques currently available: videokymography and videostroboscopy. The technique is applied to several clinical examples: aperiodic processes (phonation onset), irregular vocal fold vibration (paralysis of the recurrent nerve), particular vibration modes (anterior-posterior modes), and running speech.

Humans↗

Shifts in relative prevalence of laryngeal pathology in a treatment-seeking population.

The prevalence of laryngeal pathology in a treatment-seeking population of southwestern Ohio underwent a 15-year reexamination. Relationships between pathology and demographic variables of age, gender, and occupation were investigated. Data were collected from 1,158 new patients seen by participating otolaryngologists between 1996 and 1998. The most frequent pathologies were reflux laryngitis, functional (including diagnoses of laryngeal myasthenia and hoarseness), vocal fold paralysis, nodules, and laryngitis. Pathologies were found to occur more often in females, with some pathologies more common to one gender. Pathologies occurred more often in the older age categories. The most common occupations found in the sample were retired persons, executives/managers, and homemakers. Comparisons were made to an earlier investigation of laryngeal pathology in the same otolaryngology practices. Differences from the previous study were noted in the prevalence of pathology and the distribution of demographic variables. Relationships between pathology and demographic variables reported by the two studies were examined for consistency.

Adult↗

Laryngeal chondroma.

Cartilaginous tumors of the larynx represent less than 1% of laryngeal tumors. Chondroma and "low-grade" chondrosarcoma are the most common; 70%-75% of these tumors arise on the endolaryngeal surface of the posterior lamina of the cricoid cartilage. The clinical presentation is varied and directly dependent on the size and location of the tumor; stridor, hoarseness, dyspnea, or a neck mass are common presenting signs. CT scanning in the axial plane is the mainstay of radiographic imaging due to its ability to show size, extent of the tumor, and invasion into surrounding structures. Surgical extirpation is the standard therapy with no role for radiation therapy or chemotherapy. Although significant recurrence rates have been reported, there is not a significant difference between initial conservative therapy followed by salvage therapy versus initial radical therapy.

Aged↗