SEARCH · Search PubMed
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.
Two cases of leprosy are reported, one of which was admitted as a case of acute tonsillitis and was referred only later to the ENT surgeons with hoarseness after a diagnosis had been made by biopsy of the lymph node; the other was referred with a possible facial paralysis. This is a rare diagnosis but it should still be kept in mind, particularly in the immigrant population of the United Kingdom and Saudi Arabia and particularly of the Saudis from the southern provinces.
Reinke's oedema is a disease which is characterized by oedema of the vocal cords. Women in middle age are particularly prone to this disease, which is encountered mostly in habitual smokers and is often connected with vocal abuse. The condition gives rise to a deep hoarse voice. The traditional treatment is decortication of the vocal cords followed by speech therapy, but the results have so far been disappointing. It has been shown by Moesgaard Nielsen et al. (1985) and Matsuo et al. (1983) that, in the long term, the incidence of recurrence is approximately 60 per cent. Medical treatment of this disease is therefore desirable. It is widely known that topical steroids are often used, but the effects of such treatment have not, so far as we know, been documented. We have found it interesting to observe the effects of BDP inhalation aerosol and placebo in the course of a four-week double-blind randomized trial treatment of Reinke's oedema.
The incidence of upper respiratory tract Candidiasis secondary to steroid aerosol treatment is disputed, and varies from series to series. We found a very low incidence of thrush, but a significant number of abnormalities of the upper respiratory tract in a random selection of asthmatics on steroid inhaler. A minority had positive Candida cultures, but 37 per cent had symptoms which were minor and self-limiting, but a complaint of hoarseness in asthmatics on steroid inhalers should be referred to a laryngologist, even if there is no evidence of fungal infection in order to ascertain the nature of the laryngeal abnormality, such as adductor cord paralysis, or even carcinoma. This study also implies that the history from a patient with laryngeal or pharyngeal symptoms is incomplete unless the patient's aerosol medication is also taken into account, as signs and symptoms in this group of patients are usually reversible when alternative treatment for asthma is instituted.
A previously healthy young adult presented with inspiratory stridor and hoarseness but minimal dysphagia. Indirect laryngoscopy and lateral neck X-rays confirmed a diagnosis of membranous tracheitis. This responded to humidification, antibiotics and steroids. Secretions removed at direct laryngoscopy sent for culture grew Staphylococcus aureus. The literature is reviewed.
Granular cell myoblastoma is an unusual benign tumour, which, when occurring in the larynx usually affects the vocal cords and causes hoarseness. We present a case presenting with symptoms strongly suggestive of globus pharyngis. These tumours probably arise from neuroectodermal tissue, and the current nomenclature is a misnomer. Complete excision rather than biopsy is recommended, as biopsy material may be misinterpreted as squamous carcinoma. In this case, endoscopic removal of the tumour was successful in producing complete symptomatic relief.
Thyroglossal duct cysts most frequently present in childhood as a painless midline swelling of the neck. Uncommonly, these embryonal remnant cysts present clinically in adult life. The majority of adults with thyroglossal duct cysts present with a swelling at the level of the thyrohyoid membrane. On rare occasions, a thyroglossal duct cyst can present with more sinister symptoms, such as hoarseness, dysphagia and dyspnoea. On these occasions, the pre-operative clinical and investigative diagnosis remains in doubt until histology is available.
We treated a 28-year-old woman with initial symptoms of hoarseness. At biopsy, atypical lymphoid cells infiltrate was observed in the submucosa of the larynx and polymorphic reticulosis was diagnosed. Immunohistochemical examination of the laryngeal material obtained at autopsy revealed a strong reaction of lymphoid cells to the monoclonal antibody to human T lymphocytes. The possibility that polymorphic reticulosis is a transitional form of peripheral T cell lymphoma was confirmed.
We report a lateral saccular cyst of the larynx with both an internal and external component. The patient had a four year history of a cervical swelling and hoarseness. He presented acutely with stridor. The cyst was resected successfully without tracheostomy.
A patient with a massive thyroid oncocytoma is presented. The symptoms of hoarseness and dysphagia were due to compression and were relieved by surgical excision of the tumour.
Cigarette-smoking is a well-established aetiological factor in squamous cell carcinoma of the larynx. In Great Britain the majority of patients with laryngeal cancer are treated by radiotherapy with salvage surgery if necessary. A troublesome side effect of radiotherapy is mucositis which may exacerbate hoarseness, dysphagia, airway obstruction or pain. Although it is a common belief that continued smoking and alcohol consumption during radiotherapy may increase the frequency and severity of these side effects this has not been demonstrated objectively. This study confirms and illustrates the relationship between such radiotherapy reactions to continued smoke exposure by using an objective biochemical marker of smoking status.
Synovial sarcoma of the hypopharynx is a rare neoplasm. To date only 23 cases of synovial sarcoma of the hypopharynx have been reported in the literature. An additional case in an 18-year-old male is presented. This is the first case of synovial sarcoma in the hypopharynx to be reported in Singapore. The presentation was that of a mass in the hypopharynx; progressive dysphagia, intermittent hoarseness and gradual airway compromise. A CT scan was valuable in determining the site of origin and extent of the lesion. Histopathology was diagnostic. Treatment comprised of wide surgical excision of the tumour and post-operative radiotherapy.
Granular cell tumour is a rare benign neoplasm, that can affect many parts of the body, as single or multiple lesions. It is more common in black people and females. Typically it occurs between the fourth and fifth decades of life, with the median age for the laryngeal variety as 36 years. About 30 to 50 per cent occur in the tongue and 30 per cent in the skin. A case of granular cell tumour of the larynx is reported in an eight-year-old girl, presenting with hoarseness of voice. She was successfully treated with local excision of the tumour. This tumour is rare in the larynx where it is more common in males than females although granular cell tumours are found more frequently in females generally. For these reasons the authors suspect that their case, of a laryngeal granular cell tumour occurring in an eight-year-old girl might be the youngest to be reported.
Thirty patients with external laryngeal trauma were analysed retrospectively. Injuries were mostly caused by motor vehicle accidents (car = 36.7 per cent; motorcycle = 23.3 per cent). The main presenting symptoms and signs were hoarseness, neck tenderness, dysphagia, and neck emphysema. Sites of laryngeal injury included arytenoid swelling, vocal fold injury, soft tissue contusion or superficial mucosal laceration, cricoarytenoid dislocation, thyroid fracture, epiglottic fracture and mixed injuries. Treatment was varied depending on the severity of the injuries. Sixteen cases were managed conservatively by medical treatment; two cases received intubation; four cases were treated initially by tracheostomy; eight cases received surgical repair and/or reconstruction; cases made a full recovery of the voice and 18 cases fair voice recovery due to either sustained vocal fold swelling or limitation of vocal fold movement. One case was graded as poor. Twenty-eight cases had good airway patency and two cases fair airway patency. A delay in the early detection of laryngeal trauma may precipitate into life-threatening airway problems, therefore prompt and accurate diagnosis should be followed immediately by skillful airway management.
Primary tracheal tumours are extremely rare and present with widely variant clinical and histological features. Treatment methods vary considerably, and few studies have sought to provide adequate guidelines. A retrospective analysis was carried out of all patients treated in our unit between 1965 and 1990. Our experience deals almost exclusively with high tracheal tumours involving the adjacent subglottic region. Squamous carcinoma (SCC) and adenoid cystic carcinoma (ACC) were the commonest subtypes, and presented with dyspnoea and hoarseness as the most frequent symptoms. ACCs occurred commonly in young individuals, presented insidiously, and ran a long, and often, unpredictable course. Endoscopic evaluation revealed the majority of the lesions to be bulky and obstructive in nature. Primary surgery with adjuvant radical radiotherapy, when indicated, appeared to provide optimal results. Debulking surgery followed by radiotherapy provided effective and lasting control in two cases of ACC. Other malignant subtypes behaved aggressively and progressed uncontrolled.
An 82-year-old male presented with a two-month history of hoarseness. A 2 cm pedunculated lesion was removed from the base of his epiglottis. Microscopy showed a polypoid atypical spindle cell lesion. Multiple levels failed to reveal an invasive squamous cell carcinoma. On the basis of haematoxylin and eosin stained sections the main differential diagnosis was a pseudosarcoma with an overlying dysplastic squamous mucosa or infiltrating spindle cell carcinoma. Immunohistochemistry showed positive staining for vimentin but no convincing staining with antibodies to cytokeratin and EMA. Ultrastructural analysis also failed to reveal epithelial characteristics. Ploidy analysis by static cytophotometry of the spindle cell proliferation revealed an aneuploid stem line with a DNA index of 1.67. On the basis of this the process was felt unlikely to be reactive and a diagnosis of a spindle cell squamous carcinoma was made. This diagnosis was subsequently supported by a clinical recurrence of the nodule at a six-month follow-up.
Primary infection of the larynx with Aspergillus spp. is rare. It is more commonly seen as part of a wider infection involving the respiratory system in an immunocompromised host. In noncompromised patients laryngeal aspergillosis may represent colonization rather than invasion requiring no systemic anti-fungal treatment. The diagnosis is important as the presenting symptoms are suggestive of malignant laryngeal disease. We present a 62-year-old man with a short history of hoarseness. Direct laryngoscopy and biopsy confirmed the diagnosis of aspergillosis. Clinical presentation, diagnosis and the important pathological characteristics of this infection are discussed.
A patient suffering from persistent hoarseness was eventually shown to have laryngeal leishmaniasis. The incubation period for the disease must have been at least 16 years, following infection in Southern Europe. Mucosal leishmaniasis is rare in the Eastern hemisphere, and laryngeal leishmaniasis has not previously been reported in the UK. Previous Mediterranean cases have run a similar chronic course and have caused diagnostic difficulty, in particular being mistaken for malignancy. Treatment with aminosidine was ineffective, but the patient responded to liposomal amphotericin.
A case of laryngeal leishmaniasis, with symptoms of hoarseness and odinophagia which had developed over the past year, is presented. Clinical features and histological findings are discussed. Visceral leishmaniasis is increasingly associated with HIV infection and some authors have suggested the possibility of including it as a diagnostic criterium for AIDS in HIV-positive patients. When any case of leishmaniasis presents atypical clinical features, localization or treatment response in endemic areas, HIV infection should be ruled out.