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PubMed2000

[Two out-of-the-ordinary (?) case reports an asthmatic disease].

This is a report on two cases of asthmatic disease presented to a general practitioner. After a prolonged course of many years during which the intensity of asthma varied, Ms K. suffered from constantly recurring exacerbations that required treatment with systemic corticosteroids. The reason was found to be an adrenocortical insufficiency suspected to be of iatrogenic origin. After various treatment attempts an optimal minimal therapy was found resulting in complete freedom from complaints, namely, a combination of fluticasone and 3 mg methylprednisolone. However, brief instruction and group training as well as freedom from complaints remained unsuccessful in keeping the patient compliant. Mr Pl had been suffering from allergic asthma since early childhood which escalated in 1982. Beclomethasone diproprionate (BDP) and Budesonid were not tolerated (hoarseness), so that polypharmacy became necessary. This could only be reduced after finding out that Flunisolid (Fls) was tolerated, so that stabilisation was achieved. Complaints were greatly reduced with sole inhalation of Fls and salbutamol. After having changed over to fluticasone it became possible to reduce salbutamol as stabilisation progressed, so that salbutamol was used only if required. Depending on the intensity of allergen exposure, complaints now occur in February/March only, requiring updating of the therapy in respect of dosage and number of drugs used. During the remaining part of the year a minimal therapy using one stroke of 250 micrograms fluticasone was found sufficient to ensure lasting freedom from complaints. Both patients reduced or terminated the treatment of their own accord despite freedom from complaints under minimal therapy and were reconverted to therapy compliance only after the peak flow values had dropped or the complaints had returned.

Albuterol↗
PubMed2000

The importance of magnetic resonance imaging in the evaluation of vertigo and imbalance.

Vertigo and imbalance are believed to be rare manifestations of skull base neoplasms. Patients with skull base neoplasms can present with vague otolaryngological complaints, including diplopia, facial numbness, facial weakness, hearing loss, tinnitus, hoarseness, headache, and otalgia. Physical examination of these patients can sometimes reveal paralysis or paresis of cranial nerves. Magnetic resonance imaging (MRI) is the gold standard for evaluation of cranial nerve involvement in skull base diseases. Vertigo and imbalance can be manifestations of a neuropathy or lesion within the vestibular system and may be subtle or overlooked findings in patients with skull base diseases. The purpose of this article is to review the clinical manifestations of patients presenting with vertigo and imbalance who were found to have skull base neoplasms. We will also highlight the importance of MRI in diagnosis and management of these patients.

Journal Article↗
PubMed2001

[Diagnosis and therapy of laryngeal diseases in the history of medicine. I: The pre-laryngoscopic era].

BACKGROUND: ANATOMY, PHYSIOLOGY AND PATHOLOGY: Hippocrates and Aristotle did not yet have a clear idea of the anatomy and physiology of the larynx. 500 years later Galenos carried out subtle studies on animals and elaborated a fairly precise description of the different cartilages, muscles and nerves of the larynx; he was the first to demonstrate the superior and the recurrent nerves of the larynx. He performed numerous experiments on animals with temporary or permanent interruption of the nervous function and thus developed a correct opinion of the vocal physiology. However, he did not draw clinical conclusions from his knowledge. In the 16th century the macroscopic anatomy of the larynx was elaborated further bei Andreas Vesalius, Fabricius ab Aquapendente et al.; Jacob Henle in 1838 described the different epithelia in the larynx, based on microscopic studies. The pathology was inaugurated by Giovanni-Battista Morgagni in 1761, including the pathology of the larynx. Francis Home in Edinburgh (1765) and Pierre-Fidèle Bretonneau in Tours (1826) made the first studies on croup and diphtheria and coined these names. Fr. Hermann Albers in Bonn in 1829 published the first monography on diseases of the larynx, incorporating more than 80 relevant case reports from the literature and numerous observations of his own. The first system of the pathology of the larynx was put up by von Rokitansky in Vienna. DIAGNOSIS AND THERAPY OF DISEASES OF THE LARYNX: Before the invention of laryngoscopy the physicians could deduce the underlying disease only from the clinical symptoms like hoarseness, dyspnoea, dysphagia. The conservative therapy followed the theory of humours and included bloodletting, leeches, purgatives and emetics; the surgical procedures were blind caustery with silver nitrate and ablation of polyps guided by palpation and scarification with a knife in cases of oedema; in desperate dyspnoea endonasal intubation was attempted (Desault 1789-1803) or a tracheotomy performed. Concluding the chapters a typical patient history of 1813 with a case of purulent laryngitis where most of these measures were applied but could not avert but rather provoked the death of the patient. This historical development is described with numerous anecdotic details.

Animals↗
PubMed2002

[Functional long-term results following hemipharyngo-hemilaryngectomy and microvascular reconstruction using the radial forearm flap].

BACKGROUND: The surgical treatment of advanced hypopharyngeal carcinomas with infiltration of the laryngeal skeleton often includes total laryngectomy for functional reasons, although tumor infiltration is limited to only one half of the larynx. When not only the infiltrated half of the thyroid cartilage but also the cricoid cartilage of the involved side has to be removed, in spite of adequate reconstruction using local or pedicled flaps (f. e. pectoralis major flap) persistent dysphagia and aspiration prevent oral food intake and closure of the tracheostoma. These functional disturbances are increased by the negative effects of postoperative radiotherapy, which has to be applied in most of the cases for oncological reasons. The routine use of free, microvascularly anastomosed flaps for reconstruction of defects following removal of extended carcinomas of the mouth, the tongue or the oropharynx as well as in total pharyngolaryngectomy led to considerable improvements in functional rehabilitation of swallowing and speech. An improved functional outcome is also reported following partial resections of the hypopharynx and reconstruction by means of these thin and pliable transplants (f. e. replacement of the entire posterior hypopharyngeal wall). METHOD: Since 1991 in 30 patients with a T3 or T4 squamous cell carcinoma of the piriform sinus a complete hemipharyngo-hemilaryngectomy including resection of the involved thyroid and cricoid cartilage was carried out. For reconstruction a radial forearm flap was dissected with two separate epithelial islands: The smaller island was used to create an epithelialized endolarynx, which allows complete closure of the glottis by the healthy vocal chord. With the bigger second island the hypopharynx was replaced, creating a highly mobile, adaptable neo-piriform-sinus, which was suspended to the ipsilateral half of the hyoid bone. Parts of the both islands were sutured together to create a new aryepiglottic fold. The laryngeal skeleton intentionally was not reconstructed. RESULTS: One year evaluation revealed 25 of the 30 patients swallowing normal diet and being decannulated. 4 patients could take up a soft diet, 1 patient with a severe stricture at the entrance to the esophagus however had to be laryngectomized for functional reasons. Most of the patients judged their postoperative voice as satisfactory, although there was a different impairment of the voice (quite normal up to a marked hoarseness). During follow-up (up to 10 years) 4 patients developed a local recurrence, in 3 cases a secondary metastasis after neck dissection occurred. In 3 patients a second primary was detected (oropharynx 2, esophagus 1), 3 patients died with lung metastases. CONCLUSION: Rehabilitation of normal swallowing and a satisfying voice restoration without a permanent tracheostoma following complete hemipharyngo-hemilaryngectomy can obviously be improved by the use of microvascular transplants (here radial forearm flap) in comparison to other surgical techniques. The necessary radical extirpation of these extended carcinomas also is guaranteed like in total laryngectomy, so that in spite of the advanced tumor stage an organ preserving surgery can be offered. A prolonged course of swallowing rehabilitation however has to be taken into consideration.

Adult↗
PubMed2002

Relapsing polychondritis.

Relapsing polychondritis (RP) is a rare disease causing inflammation and destruction of cartilage and other connective tissues. Specific laboratory aberrations are lacking. Predominant clinical manifestations include auricular chondritis, polyarthritis, nasal chondritis, ocular inflammation, audiovestibular damage, and respiratory tract chondritis. A relapsing course is characteristic. Airways are involved in 50% of patients and may cause dyspnea, stridor, wheezing, hoarseness, aphonia, and laryneal or tracheal tenderness. Airflow obstruction may result from RP involving the tracheobronchial tree; there is no interstitial or pulmonary vascular component. Collapse or failure of the trachea to dilate during inspiration is a key feature. Fast computed tomographic (CT) scanners can visualize dynamic airway collapse. Randomized, controlled trials of therapy have not been done. Corticosteroids and nonsteroidal anti-inflammatory drugs (NSAIDs) are used most commonly, but optimal regimens and duration of therapy have not been elucidated. Endobronchial stents or tracheostomy may be required for severe stenoses refractory to medical therapy.

Journal Article↗
PubMed2003

[Gastroesophageal reflux -- a common illness?].

For a long time heartburn was not considered a symptom for serious illness. By now, however, it is accepted that the incidence of secondary carcinoma of the esophagus caused by chronic GERD has increased dramatically since the nineteen-seventies. Mechanisms leading to GERD are complex and its incidence is not necessarily pathological. However pathological reflux in the lower esophagus (pH lower than 4 in 6 % of 24 hours), caused by decreased sphinctertonus, impaired peristalsis and clearance of the esophagus, may lead to complications. Helicobacter pylori may play a key role in GERD. There is strong evidence for a protective effect of Hp-infection in the development of GERD. In pangastritis, caused by Hp-infection, gastric acid production is inhibited resulting in a reduction of stomach-acid-concentration. This may be caused by either the chronic infection itself and the resulting atrophy of the stomach-mucosa, by the ammonia-producing HP-bacteria, or an increase in acid re-absorbtion of gastric epithelium. Laryngopharyngeal reflux (LPR) often results in atypical manifestations with oral, pharyngeal, laryngeal, and pulmonary disorders. Laryngopharyngeal reflux is known to contribute to posterior acid laryngitis and laryngeal contact ulceration or granuloma formation, laryngeal cancer, chronic hoarseness, pharyngitis, asthma, pneumonia, nocturnal choking, and dental diseases. Today, PPI are the medication of choice in both acute and long-term (prophylactic) therapy of GERD. The so called "step-up-strategy" of medication is no longer recommended. Here, patients were first treated with antacids, then prokinetics followed by H2-blockers and finally low-dose PPI. Only in the case of persisting symptoms medication was further increased to high-dose PPI therapy. In the past this increase in medication lead to a prolonged healing process and consequently to higher medication costs. Studies have shown that a "step-down"-therapy, beginning with high dose PPI, is highly preferable, since it is much more effective. Depending on the degree of the symptoms, however, medication may also be applied "on-demand". The BfArM has approved this kind of medication application only for Esomeprazol (Nexium mups 20 mg).

Anti-Ulcer Agents↗
PubMed2003

Surgery of Glomus Jugulare Tumors.

The treatment of choice for glomus jugulare tumors is still controversial. High rates of morbidity, incomplete resection, and the aggressive behavior of these tumors are the main arguments for advocates of primary radiotherapy. However, constant refinements in skull base techniques have made complete resection of these lesions a realistic goal. The high probability of achieving local control of these tumors by surgery has convinced us to support this option strongly. Between 1993 and 2000 we diagnosed 52 glomus tumors of the temporal bone. Of these patients, only 42 had a class C lesion (glomus jugulare) and were included in this study; 37 of these patients underwent surgery, 10 of whom had intracranial extension of the disease. The overall resection rate was 96 %. Facial nerve function at 1 year was House-Brackmann grade I to II in 52 % of patients and grade III or better in 84 % of patients. Hospitalization was shorter than 14 days in 33 patients (89 %). All patients with pharyngolaryngeal palsy had sufficient compensation at discharge. Twelve vocal chord Teflon injections were performed after surgery to reduce hoarseness and aspiration. No patient died. No relapse was observed (mean follow-up, 4.9 years).

Journal Article↗
PubMed2003

Skull Base Plasmacytoma in a Patient with Light Chain Myeloma.

Skull base involvement of plasmacytoma is reported in a patient with light chain myeloma. A 39-year-old man was admitted after experiencing paresthesia on the left side of the face and left arm, intermittent diplopia, and hoarseness for 2 years. Cranial magnetic resonance imaging revealed a large midline mass extending from the middle and posterior skull base into the upper two cervical vertebrae. An extramedullary plasmacytoma associated with light chain multiple myeloma was diagnosed after biopsy of the mass and laboratory investigations. The imaging findings and clinical features associated with this rare site of extramedullary plasmacytoma involvement are reported.

Case Reports↗
PubMed2005

Earliest clinical manifestations and natural history of neurofibromatosis type 2 (NF2) in childhood: a study of 24 patients.

BACKGROUND: Neurofibromatosis type 2 (NF2) is an autosomal dominant disease characterised by the development of multiple nervous system tumours, ocular abnormalities, and skin tumours. Although classically considered a disease of adults, initial signs and/or symptoms may be evident in childhood and are often unrecognised. OBJECTIVES: The aim of this study was to identify the earliest clinical presentations of NF2 and to characterise the clinical course and outcome in children with NF2. METHODS: We have performed a retrospective (years 1990-1998) and prospective (years 1998-2004) study of 24 patients (10 males, 14 females; currently aged 4 to 22 years) fulfilling the revised (Manchester) NF2 criteria seen at the Universities of Catania and Rome, Italy. RESULTS: Causes of referral prior to a definitive diagnosis of NF2 were: 1) Ophthalmologic problems: early onset lens opacities (n = 3); strabismus (n = 3) and amblyopia (n = 3) (due to underlying cranial nerves and/or brain tumours); 2) Otolaryngology problems: hearing loss and tinnitus (n = 2) in early teens disregarded or treated as ear infections; hoarse (n = 1) or bitonal (n = 1) voice; 3) Neurological dysfunction: seizures secondary to intracranial meningioma (n = 1) or vestibular schwannomas (VS) (n = 1), neurological dysfunction related to brainstem and/or spinal cord tumours (n = 7), isolated and multiple cranial nerve deficits (n = 10), and peripheral neuropathy secondary to schwannomas (n = 4); 4) Skin manifestations: schwannomas misdiagnosed as neurofibromas because of associated café-au-lait spots (n = 2); café-au-lait spots (n = 8) and skin tumours (n = 3). A family history was relevant in 20 % of the patients. Molecular genetic analysis of the NF2 gene revealed typical truncating mutations in all the 5 familial cases and in 2/10 sporadic cases analysed. CONCLUSIONS: Children with NF2 often first come to medical attention because of ocular, subtle skin, or neurological problems the significance of which is realised when they later present with more classical symptoms due to bilateral VS or other intracranial tumours. The clinical course at this young age is highly variable, depending on tumour burden, early surgical intervention, surgical outcome after tumour resection, and complications.

Adolescent↗
PubMed2005

The role of corticosteroids in chronic obstructive pulmonary disease.

Oral corticosteroids are powerful relatively nonspecific antiinflammatory agents with a range of well-characterized side effects. There is good evidence to show that they accelerate the rate of resolution of exacerbations of COPD and relapse is less likely if patients receive these drugs. Maintenance therapy with oral preparations is associated with worse mortality and skeletal muscle myopathy is a particular problem. Corticosteroids have little effect on biopsy proven inflammation or its surrogates in COPD and did not change the rate of decline of FEV (1) over a range of spirometric disease severity in a number of trials each lasting 3 years. However, meta-analysis of the data suggests that a small effect (up to 10 ml /year) might be present. There is more consistent evidence for an effect on postbronchodilator FEV (1) with both fluticasone propionate and budesonide. In patients with a postbronchodilator FEV (1) < 50% predicted where self-reported exacerbations become more common, inhaled corticosteroids can reduce the number of attacks. This effect is the major factor accounting for the reduction in deterioration in health status seen in patients who receive inhaled corticosteroids. Inhaled corticosteroids are much safer than oral therapy, although they do have a predictably higher incidence of candidiasis and hoarseness of the voice. Skin bruising is seen in patients with better lung function who use these drugs. Triamcinolone use is associated with reduction in bone density but this was not seen with budesonide. Combining an inhaled corticosteroid and a long-acting beta-agonist in the same inhaler increases the efficacy of the latte drug in COPD patients, with a significantly larger improvement in FEV (1), a larger reduction in reported breathlessness, and a reduction in exacerbation numbers in those with severe disease where beta-agonists appear to be less effective. Inhaled corticosteroids are not suitable for monotherapy in COPD but can be helpfully combined with an inhaled bronchodilator in patients with symptomatic disease.

Administration, Inhalation↗
PubMed2005

[The applicability of the ProSeal laryngeal mask airway for laparotomies].

OBJECTIVE: The ProSeal laryngeal mask airway (PLMA) has some design features, which in contrast to the classic LMA allow separation of the respiration from the gastrointestinal canal, a higher leak pressure and a better position assessment. It can be debated if these instrumental improvements justify the application of the PLMA for elective abdominal surgery in cases without aspiration risk. Insertion of airway instruments and gastric tube with regard to insertion time and difficulties and frequency of side effects were to be compared for the tracheal tube and the PLMA. The pharyngolaryngeal morbidity for both methods was also of interest. It was approached with direct and indirect postoperative interview techniques. METHODS: 65 patients were investigated both at the university hospital and at the hospital Neu-Bethlehem in Goettingen. The surgical intervention was a surgical or gynecological laparotomy. Anaesthesia was performed with a standardized application of propofol, alfentanil and rocuronium. Glycopyrroniumbromide was applied to minimize salivation. A total of 34 patients received the PLMA, 31 were intubated. All of them were provided with a gastric tube. RESULTS: The insertion of the PLMA took 70 seconds (21 - 234) on average, the intubation 57 seconds (35 - 145). Endotracheal intubation was accomplished in a shorter time period, but there was no significant difference in comparison with the PLMA-group (p = 0.1924). Insertion of the PLMA was significantly more difficult than oral intubation (p = 0.0006). The base of the tongue and the dorsal pharyngeal wall, but not the vocal cords or the epiglottis were visible in those cases, where the PLMA could not be positioned at all. Here the tip of the cuff was bended. The time period for positioning of the gastric tube was 38 seconds (15 - 75) in the PLMA- and 57 seconds (22 - 219) in the tracheal tube group. With these results the gastric tube positioning was accomplished in a significantly shorter time period in the PLMA-group (p = 0.0267), but not at a significantly higher level of difficulty for endotracheal intubation (p = 0,6247). In one case there was regurgitation through the drainage tube without aspiration before gastric tube placement. At the direct interview 16 patients in the PLMA-group and 23 of the tube group mentioned postoperative throat symptoms. The most frequent symptom was hoarseness (11 PLMA- and 18 intubated patients). There was no significant difference between PLMA- and tracheal tube application with regard to the total number of patients with pharyngolaryngeal morbidity and the frequency of single symptoms. The same is true for the degree of the symptoms. There was a tendency for a longer prevalence of throat symptoms after intubation, but no significant difference. CONCLUSION: In this investigation the PLMA could be successfully applied for elective laparotomies in cases without the risk of aspiration. Proper patient selection and a deep level of anaesthesia are important. The advantage for patients receiving the PLMA is a smooth recovery without cough, but not so much a reduced amount of pharyngolaryngeal morbidity. From this observation it might be concluded that the invasiveness of the surgical intervention might also influence the tolerance for the airway instrument. The disadvantage in this study was the more difficult insertion of the PLMA compared with the oral intubation. Further studies with a larger number of patients must show if these first results of the "Proseal"-LMA for lararotomies are to be confirmed.

Adolescent↗
PubMed1993

A comparison of transhiatal and transthoracic resection for oesophageal carcinoma.

We compared the results of 327 transthoracic (TT) resections and 82 transhiatal (TH) resections for carcinoma of the oesophagus operated on between July 1982 and June 1991. Significantly more patients with carcinoma of the lower third of the oesophagus (54% versus 28%) and with increased pulmonary risks for surgery (61% versus 22%) were selected for the TH approach as compared with the TT approach. Results showed comparable intraoperative complications between the two groups. 5% of patients in the TH group required a thoracotomy for control of haemorrhage (3 patients) and repair of bronchial tear (1 patient) which occurred during the transmediastinal dissection. Postoperatively, mechanical ventilation requirement and complications involving the cardio-pulmonary systems were similar between the two groups. Anastomotic leakage occurred in 3% and 4%, respectively for the TH and TT patients (p = NS), whereas hoarseness occurred in 16% and 5%, respectively (p = 0.001). The 30-day mortality rates and hospital mortality rates were comparable between the two groups as were the overall survival rates. Our results suggested that while TH resection did not diminish the operative morbidity and mortality rates overall, it is appropriate for patients with increased pulmonary risks to be preferentially selected for this approach, and for tumours located in the upper and lower portion of the thoracic oesophagus where dissection of the tumour can be carried out mostly under vision.

Aged↗
PubMed1998

[Secondary obstructive sleep apnea syndrome in a patient with tracheal stenosis and bilateral recurrent paresis. Successful treatment with nasal continuous positive airway pressure therapy].

HISTORY AND ADMISSION FINDINGS: A 67-year-old woman complained of marked daytime sleepiness, as well as loud snoring and apnoeas during sleep. She was known to have had 3 thyroidectomies for goitre 41, 23 and 12 years ago, with known tracheal stenosis and recurrent nerve palsy for 11 years. Physical examination revealed marked stridor, hoarse voice and slightly enlarged and palpable recurrent right thyroid. INVESTIGATIONS: Polysomnography demonstrated a clearly elevated obstructive sleep apnoea activity (apnoea index: 34/h, apnoea-hypopnea index: 40/h, desaturation index: 31/h, minimal saturation: 63%). Selective tracheal imaging showed subglottic tracheal stenosis with an inspiratory luminal diameter of 4 mm and an expiratory luminal diameter of 8 mm. Lung function analysis revealed marked flattening of the flow-volume curve as sign of a functionally effective tracheal stenosis. These findings indicated a secondary obstructive sleep apnoea (OSA) due to tracheal stenosis and bilateral recurrent nerve palsy. The patient declined further studies, such as bronchoscopy. TREATMENT AND COURSE: As the patient did not want any surgical treatment, nasal continuous positive airway pressure therapy (CPAP) was instituted as a trial. No apnoea occurred at a pressure of 12 mm H2O and this was well tolerated. She has now continued CPAP at home for 12 months and her vigilance was markedly improved. CONCLUSIONS: Tracheal stenosis or recurrent nerve palsy is a rare cause of OSA which can be effectively treated by nasal CPAP.

Aged↗
PubMed1997

[Diagnosis and therapy of tracheal rupture after blunt thoracic trauma].

Tracheobronchial ruptures are rare but potentially lifethreatening events. We report on the case of a 34-year-old suicidal unrestrained car driver, who developed subcutaneous and mediastinal emphysema and right-sided haematothorax following blunt thoracic trauma. Fibreoptical inspection of the tracheobronchial system revealed a rupture (approximately 2 cm in length) of the pars membranacea of the trachea ending shortly above the carina. CT-scan confirmed the diagnosis of mediastinal emphysema, tracheal rupture and, in addition, left-sided pulmonary contusion. A repair of the tracheal tear was performed by right-sided thoracotomy using a double-lumen tube. The left-sided double-lumen tube was used postoperatively to achieve respirator ventilation with low pressure on the tracheal lumen and on the suture of the tracheal tear. On the other hand, sufficient airway pressure with PEEP for the left lung showing contusion could be provided, using the endobronchial tube. The postperative course was without complications. The patient was on respiratory support for three days due to his-pulmonary contusion. Following final endoscopic control of the trachea he was discharged from the ICU one week after the trauma. The clinical and radiological signs of tracheobronchial ruptures are discussed (respiratory distress, haemoptysis, cyanosis, localised pain, hoarseness, coughing, dysphagia, stridor, subcutaneous emphysema and pneumothorax, tension pneumothorax, mediastinal emphysema). Fibreoptic bronchoscopy is the present gold standard for confirming the diagnosis. The surgical and anaesthesiological approach to the management of tracheobronchial ruptures is described reviewing the current literature.

Adult↗
PubMed1998

[External vocal cord medialization: functional outcome].

BACKGROUND: Comprehensive evaluation of voice function is the precondition for indication and quality control of every phonosurgical procedure. In 53 patients presenting with glottic insufficiencies of different etiologies an external vocal fold medialisation was performed. Functional voice results obtained with this operation are presented and discussed. METHODS: The following voice parameters were measured preoperatively and postoperatively, and statistical comparison was performed: mean fundamental frequency and sound pressure level, frequency and intensity range (voice range profile), perceptual evaluation of hoarseness, and maximum phonation time. The impairment of vocal communication skills was rated on a newly developed 7-point scale. A combined parameter called "Voice Dysfunction Index" was introduced for global assessment of vocal abilities in particular for long term observations. RESULTS: Statistically significant improvement of all voice parameters was demonstrated. Interestingly, in nearly all measurements male patients yielded significantly better results than females. Glottic insufficiencies due to scarring produced poorer functional results but without statistical significance. A statistically significant correlation between the preoperative and postoperative Voice Dysfunction Index could be observed. This score was also significantly correlated with the degree of glottal gap. No significant correlation between voice results and preoperative delay or follow-up period were observed. Voice therapy was performed in 81% of the patients. Correlation of duration of voice therapy and voice results was statistically significant and negative. Analysis of this surprising result showed that it was caused by some patients with vocal fold scarring in whom outcome was poor despite a long period of voice therapy. CONCLUSIONS: Significant improvement of vocal function can be obtained by external vocal fold medialization in patients with glottic insufficiencies. Glottal gaps caused by vocal fold scarring and/or atrophy can be treated with this method, too. However, results are not as good as in paralysis and require additional long term voice therapy. Satisfying results can be expected in patients with a long history of disturbances, and in older patients. Due to the reversibility of the operation, external vocal fold medialization can be performed even in cases of palsy prior to the spontaneous recovery period. The degree of glottic gap determines the functional disturbance. The degree of the preoperative impairment correlates with the outcome. Results are stable with respect to the follow-up period (mean 66 weeks).

Adult↗
PubMed1998

[Long-term functional outcome of Laccourreye hemipharyngectomy-hemilaryngectomy with reference to oncologic outcome].

BACKGROUND: Various techniques for the treatment of hypopharyngeal malignancies are used to achieve disease control while preserving laryngeal function. PATIENTS AND METHODS: This study details the long-term results of 22 patients (ages 39-80; average age 57 years) following hemipharyngo-hemilaryngectomy (described by Laccourreye) for unilateral hypopharyngeal squamous cell carcinomas (G2-G3; T1-T4; N0-N3). Follow-up was 16-83 months (average 43) and included extensive speech and swallowing assessment. From 1989-1994 the procedure was performed in 26 patients. Two died within one year postoperatively, two were lost for follow-up, and 22 were included in this study. RESULTS: One patient developed recurrent disease with liver metastasis; two patients were successfully treated for recurrent disease. Two patients developed second primary tumors, while all others had no signs of recurrent disease. Fourteen patients had no difficulties eating or drinking. Six patients could only eat soft foods, and two patients required a gastrostomy feeding tube. Nineteen patients had a useful but hoarse voice, and three patients had severe difficulties when communicating. Modulation of voice was decreased because the supraglottic structures (mainly false cord and scar tissue) were used for phonation. Eighteen patients were completely satisfied with their voice. The tracheotomy was closed in 18 patients within six months, while four patients required a tracheostoma for more than two years. CONCLUSIONS: These data show that function-preserving surgical techniques can be successfully used in hypopharyngeal carcinomas even for patients with advanced disease. Useful functional results for swallowing, voice, and airway were achieved in most patients undergoing this procedure.

Adult↗
PubMed1998

[Dislocation of the cricoarytenoid joint: diagnosis and therapy].

BACKGROUND: Laryngeal joint injury or cricoarytenoid dislocation is a relatively rare laryngologic finding, according to the international medical literature. It may occur as a result of external neck trauma or more frequently as a result of intubation. Chief symptoms are hoarseness, vocal fatigue, and loss of voice control. PATIENTS: Between 1993 and 1997 we diagnosed an arytenoid dislocation in 2 female and 5 male patients, in every case the etiology was an intubation trauma. Videolaryngoscopic recording was the most useful aid in diagnosis. RESULTS: Six patients were treated with closed reduction surgery between 8 and 49 days after dislocations. Normal voice was restored in four patients, and in one patient as late as 49 days after the dislocation. One patient had an additional recurrent nerve paralysis. CONCLUSIONS: Our results suggest that a closed reduction of the arytenoid luxation can be successful even several weeks after the injury.

Adolescent↗
PubMed1994

[Manifestation of Urbach-Wiethe syndrome in the ENT area].

Urbach-Wiethe's syndrome (hyalinosis cutis et mucosae) is a rare genetic defect of probably autosomal recessive origin. The exact nature concerning the pathogenesis of this disorder is still controversial. A characteristic symptom in early childhood might bei hoarseness, later on manifestations with hyalin deposits in the larynx, oral cavity and oropharynx might occur as well as yellowish-white papular deposits in the skin. The overall prognosis of this disease is good, therapeutic intervention might be necessary for functional purposes (narrowing of the laryngeal lumen) and consists of surgical removal of the lesions.

Adolescent↗