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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.
Parathyroid tumours and cysts are rare and, when presenting as neck masses, can be clinically misdiagnosed as thyroid lesions. Symptoms may be caused by compression of the surrounding structures or hormonal overactivity. This paper describes a patient with recurrent hoarseness owing to the pressure effects of a parathyroid cyst on the recurrent laryngeal nerve.
A 62-year-old woman presented with a history of hoarseness. Although stable for ten years, she recently showed signs of deterioration. Investigations revealed left vocal cord paralysis and a large left atrial tumor displacing the left pulmonary artery under the arch of the aorta. The lesion was removed and the normal aortopulmonary window on computed tomography (CT) scan was restored. On review of the literature, this case appears to be the first to suggest that myxomas cause recurrent laryngeal nerve palsy through direct effects.
Palmar erythema is a very unusual manifestation of sarcoidosis. We report on a patient whose presenting features of sarcoidosis were palmar erythema and a hoarse voice. The diagnosis was confirmed by palmar skin biopsy and the patient responded well to treatment with prednisolone.
A patient who smoked heavily was under regular review by the oral medicine department because of oral keratosis. He subsequently complained of hoarseness of the voice, and was referred to the department of otorhinolaryngology. An early squamous cell carcinoma of the larynx was diagnosed, and the patient was treated with radical radiotherapy. This case highlights the importance of early diagnosis and the potential role of the dentist in the total healthcare of patients.
A 85-year-old woman was admitted to our hospital because of progressive hoarseness and dysphagia of two days' duration. Neurological examination on admission revealed right pharyngeal and vocal cord palsies. After admission, gradual swelling of her right ear was noted, and on day 6, vesicular eruptions in her right geniculate zone, the right VII and the VIIIth cranial nerve palsies were added. On the basis of these findings, she was diagnosed as Ramsay Hunt syndrome. Varicella zoster virus (VZV) infection was confirmed by the elevation of serum anti-VZV-antibody titer, and detection of VZV DNA from cerebrospinal fluid. Ramsay Hunt syndrome associated with multiple cranial neuropathy is not frequently reported. Reviewing Japanese literatures, we found that the IX and the Xth cranial nerves were most frequently affected, and the half of these cases were initiated with cranial neuropathy other than the VIIth. Additionally, spreading mechanisms of cranial neuropathy, and the early diagnostic problems of these conditions were discussed.
We report a 12-year-old girl who had multiple congenital cardiac lesions, specifically an arterial duct, left pulmonary arterial stenosis, an atrial septal defect in the oval fossa, and mild Ebstein's malformation of the tricuspid valve. Therapeutic transcatheter intervention was performed to stent the left pulmonary artery, occlude the arterial duct with a coil, and place a device to close the atrial septal defect. Subsequent to the catheterization, she complained of hoarseness, which was shown to be due to entrapment of the left recurrent laryngeal nerve between the coil used to close the arterial duct and the stent placed in the left pulmonary artery. Laryngoscopy confirmed paralysis of the recurrent laryngeal nerve.
Multiple myeloma, which primarily affects the elderly, is rare in the head and neck. We report the case of a 71-year-old man who came to us with hoarseness, dysphagia, intermittent aspiration, and cervical lymphadenopathy. Our work-up included laboratory tests, radiographic examinations, analysis of bone marrow aspiration, and histopathologic evaluations. Cervical lymph node biopsy confirmed a diagnosis of multiple myeloma. Despite treatment with chemotherapy and radiation, the patient died of his disease 6 months later.
A 45 year-old driver presented with a two months history of hoarseness, fever, productive cough, anorexia and weight loss. He chewed tobacco. He was previously seen and treated without benefit by a family Physician and two ear, nose and throat consultants. Crackles were heard in the left scapular region. An X-Ray of the chest showed a right apical cavity, perihilar infiltrates and blunting of left costophrenic angle. His sputum smear showed acid fast bacilli. A high index of suspicion for tuberculosis is recommended while dealing with such cases. Complete recovery of patient's voice with anti-tubercular therapy confirmed it was a case of laryngeal tuberculosis.
Treatment of paretic hoarseness by trans-thyroid cartilage puncture and injection of autogenous blood combined with breath exercise is presented. The results were evaluated according to voice records before and after treatment, indirect laryngoscopy and phonolaryngography. Clinically, 88.89% of the patients recovered completely.
Twenty-four adult dogs were used for the experiments. Cricothyroid approximation was performed in 17 of them. The bilateral external branches of the superior laryngeal nerves were severed in advance and their phonation under light anaesthesia investigated preoperatively, immediately and 6-20 weeks after operation by sound spectrum in all animals. Following the operation, the animals with cricothyroid approximation got higher pitch and lesser hoarseness than the controls, but would never reach the preoperative mean value. It is considered that the effect of cricothyroid approximation in raising vocal pitch and improving phonation is affirmative but limited.
We experienced a case of the ruptured pseudoaneurysm of the aortic arch. Patient complained left anterior chest pain, back pain and hoarseness. Considering the past history of pulmonary tuberculosis, emergency operation was performed median sternotomy approach and using aortic occlusion balloon catheter method and selective cerebral perfusion. Woven dacron graft was anastomosis intraluminal aneurysm. Postoperative course was good. Median sternotomy approach and AOBC method were better than intercostal approach method, because of a little bleeding, short operative time and method.
Cycle-to-cycle variations in voice fundamental frequency (jitter) and amplitude (shimmer) were derived by electroglottography for 10 children with velopharyngeal insufficiency (VPI). Jitter was found to be positively correlated with ratings of perceived nasality, whereas shimmer was found to be positively correlated with ratings of perceived hoarseness. Theoretic implications for a regulatory model of speech aerodynamics are discussed. Additionally, clinical applications, in terms of using electroglottography as a supplemental assessment procedure, are suggested.
A case is described in which the patient developed hoarseness following a left brachial plexus block, using the supraclavicular approach. Possible paralysis of the left recurrent laryngeal nerve is discussed.
There is a great deal of clinical overlap in patients with throat complaints. Foreign body sensation, difficulty in swallowing, and hoarseness may all stem from one entity or may be totally unrelated. First and foremost, always protect the airway. Thereafter, a thorough history, combined with a directed physical examination and radiologic studies, will provide a concise differential diagnosis. Once the diagnosis is formulated, treatment may take place in the Emergency Department or the patient may be referred to the appropriate specialist for definitive diagnosis or treatment.
A 64-year-old man was admitted with hoarseness. CT scan and selective angiography revealed a right subclavian artery aneurysm involved just distal to the origin of the subclavian artery. Through median strenotomy with the addition of supraclavicular incision, proximal and distal ligation and prosthetic graft bypass were successfully performed under simple clamping of brachiocephalic artery. Exclusion of the aneurysm is technically easier when the aneurysm adheres to the surrounding tissues.
There has been described a case of the right arytenoid cartilage subluxation in a 11-year-old girl who underwent several intubations and bronchoscopies as a newborn and an infant. The voice has gone hoarse owing to those interventions. Videolaryngoscopy revealed anterior and medial dislocation of the right arytenoid cartilage accompanied by the immobility in the cricoarytenoid joint, right vocal movement being preserved. Voice therapy was not successful as the parents lost their interest, considering the present child's voice to be normal.