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At least 1,423 records · Page 79Linked to original sources
PubMed2000

Incidence of tracheal stenosis and other late complications after percutaneous tracheostomy.

OBJECTIVE: To determine the incidence of tracheal stenosis, voice and breathing changes, and stomal complications after percutaneous dilatational tracheostomy (PDT). METHODS: From December 1992 through June 1999, 420 critically ill patients underwent 422 PDTs. There were 340 (81%) long-term survivors, 100 (29%) of whom were interviewed and offered further evaluation by fiberoptic laryngotracheoscopy (FOL) and tracheal computed tomography (CT). Tracheal stenosis was defined as more than 10% tracheal narrowing on transaxial sections or coronal and sagittal reconstruction views. Forty-eight patients agreed to CT evaluation; 38 patients also underwent FOL. CT and FOL evaluations occurred at 30 +/- 25 (mean +/- standard deviation) months after PDT. RESULTS: Twenty-seven (27%) patients reported voice changes and 2 (2%) reported persistent severe hoarseness. Vocal cord abnormalities occurred in 4/38 (11%) patients, laryngeal granuloma in 1 (3%) patient, focal tracheal mucosal erythema in 2 (5%) patients, and severe tracheomalacia/stenosis in 1 (2.6%) patient. CT identified mild (11-25%) stenosis in 10 (21%) asymptomatic patients, moderate (26-50%) stenosis in 4 (8.3%) patients, 2 who were symptomatic, and severe (>50%) stenosis in 1 (2%) symptomatic patient. Ten patients (10%) reported persistent respiratory problems after tracheal decannulation, but only four agreed to be studied. Two patients had moderate stenosis, and one had severe stenosis. One patient's CT scan was normal. No long-term stomal complications were identified or reported. CONCLUSIONS: Subjective voice changes and tracheal abnormalities are common after endotracheal intubation followed by PDT. Long-term follow-up of critically ill patients identified a 31% rate of more than 10% tracheal stenosis after PDT. Symptomatic stenosis manifested by subjective respiratory symptoms after decannulation was found in 3 of 48 (6%) patients.

Adolescent↗
PubMed2002

Advances in airway management for outpatients.

PURPOSE OF REVIEW: As outpatient anaesthesia increases in volume so does research, especially in ways to reduce morbidity from relatively minor complications such as sore throat and hoarseness, as well as aiming to reduce costs and length of hospital stay. The past year has produced many studies in which newer airway devices have been compared with the laryngeal mask airway and this review evaluates them all. RECENT FINDINGS: The relatively recent introduction of the ProSeal laryngeal mask airway shows promise when insertion of a gastric tube is preferred in patients breathing spontaneously, whilst the intubating laryngeal mask airway has demonstrated its usefulness in those situations where the patient prefers to be anaesthetized but intubation may be difficult following classic laryngoscopy. The cuffed oropharyngeal airway and combitube probably only have a place in emergency airway management rather than elective anaesthesia. SUMMARY: Despite the introduction of new airway devices, some of which have specific indications for use, the classic laryngeal mask airway remains the 'gold standard' with which newer devices are compared. Whilst some of these new devices show promise in the outpatient setting, further research is required before their universal acceptance.

Journal Article↗
PubMed2000

Esophageal perforations after anterior cervical surgery.

An esophageal perforation after anterior cervical surgery is an uncommon but well recognized complication. During the past 25 years, 44 patients have presented to Craig Hospital (Rocky Mountain Regional Spinal Injury Center) with esophageal perforations; this is the largest series reported to date. There were 34 patients whose esophageal injury was related to the operations performed for cervical fractures, of which 28 patients had plate and screw fixation. The most frequently occurring clinical symptoms were that of neck and throat pain, odynophagia, dysphagia, hoarseness, and aspiration. The most common clinical findings were an elevated temperature, localized induration and neck tenderness, crepitus or subcutaneous air in the neck and anterior chest wall, an unexplained tachycardia, and blood in the nasogastric tube. Imaging studies indicated an esophageal injury in only 32 (72.7%) patients. Twenty-two patients experienced cervical osteomyelitis or an abscess of the neck. Nonoperative treatment is fraught with a high mortality, and 42 patients required surgical repair of their esophageal injury. The length of hospital stay averaged 253 days. Successful management of esophageal perforations depends on the physicians' awareness of the causes, prompt recognition of the symptoms and clinical findings, and immediate institution of treatment.

Adolescent↗
PubMed1982

Predictive value of stridor in detecting laryngeal injury in extubated neonates.

We evaluated 73 consecutively extubated neonates for evidence of acute laryngeal injury from intubation. Hoarseness and stridor were graded by a clinical scoring system. Direct laryngoscopy with a flexible fiberoptic bronchoscope yielded a 44% incidence of moderate or major laryngeal injury. All patients with stridor had moderate or major injury, as did 38% of patients without stridor. Stridor was quite specific for detecting moderate or major injury but did not identify the type of injury.

Humans↗
PubMedDate not supplied

Laryngeal and phonatory status after burn/inhalation injury: a long term follow-up study.

Although persistent hoarseness has been recognized in patients who have sustained burn and/or smoke inhalation injuries, there is little documentation to support this observation. Furthermore, there is no quantification of either the pervasiveness of the problem or the severity of the dysphonia resulting. It was the intent of this study to examine the laryngeal condition and voice production of a group of patients who were long-term survivors of burns and inhalation injuries. Only 10 patients (8 male and 2 female) of a larger cohort were willing to return for this examination. They were ambulatory and did not require respiratory assistance, and it had been 16 to 25 years since their initial traumas. Videostrobolaryngoscopic examinations were performed and analyzed, measures of various acoustic and aerodynamic parameters were made, and severity of dysphonia was judged. Seven of the 10 subjects were rated by experienced listeners as having some degree of dysphonia. All subjects had some abnormality of the laryngeal mucosa. Stroboscopic examination was found to be helpful in identifying laryngeal abnormalities in at least half of the subjects. Early attention to these problems, many of which are treatable surgically or behaviorally or both could lead to an improved voice for the patient and for this reason an improved quality of life.

Acoustics↗
PubMed2001

Vagus nerve stimulation, side effects, and long-term safety.

Vagus nerve stimulation (VNS) is an accepted therapy for the treatment of refractory epilepsy and now even depression. More than 10,000 people have had the device implanted over a period of 12 years. Initial side effects in the early years such as lower facial weakness and electrode lead breaks have now been resolved. Postoperative infections occur in approximately 3% of patients but can be treated with oral antibiotics. Side effects during the use of VNS are usually related to the "on" phase of stimulation. Common side effects are cough, hoarseness, voice alteration, and paresthesias. These side effects tend to diminish with time. Cognitive side effects often seen with antiepileptic drug use are not reported. The side effect profile of VNS is positive, and this treatment option offers patients with refractory epilepsy prospects of good efficacy with only minor and often resolvable side effects.

Adult↗
PubMedDate not supplied

Adult-onset disseminated tracheobronchial papillomatosis: CT features.

The high resolution CT (HRCT) findings in an adult with disseminated tracheobronchial papillomatosis are discussed. In addition to polypoid masses within the trachea and main bronchi, diffuse ill-defined parenchymal centrilobular opacities were present; these reflect lesions within the small airways. Some of the nodules showed central cavitation. In a patient with centrilobular opacities, some of which cavitate, on HRCT and concomitant endobronchial or endotracheal abnormality, disseminated papillomatosis should be considered in the differential diagnosis, particularly if there is a history of hoarseness or laryngeal disease.

Adult↗
PubMedDate not supplied

Tracheobronchopathia osteochondroplastica: report of three cases.

Tracheobronchopathia osteochondroplastica (TO) is a rare disease characterized by the presence of osseous and cartilaginous submucosal nodules in the tracheobronchial tree. The majority of patients remain asymptomatic; however, a small number develop severe airway stenosis. Symptoms may include dyspnea, hoarseness, cough, hemoptysis, and recurrent pneumonia. Plain chest X-ray films are often unremarkable but may demonstrate atelectasis, consolidation, tracheal nodularity, or narrowing. CT reveals tracheal nodularity with calcification and narrowing. This article reviews the cross-sectional imaging characteristics of TO.

Adult↗
PubMed2002

Esophageal pH monitoring, indications, and methods.

Symptomatic gastroesophageal reflux disease (GERD) is a common problem that affects a substantial proportion of the American population. It is estimated that the symptoms of GERD may afflict 40% to 45% of Americans each month. The diagnosis of GERD can be difficult, as its symptoms vary from typical symptoms like heartburn to atypical symptoms such as hoarseness, coughing, and chest pain. Most patients present with typical symptoms and are diagnosed with GERD if they respond to empiric trials of acid suppression. Many tests are available to help with diagnosing GERD in patients who either present with atypical symptoms or who do not respond to acid suppression; however, each test has its own shortcomings. The only test that directly measures whether acid is refluxing into the esophagus is the pH probe, but this test is uncomfortable for the patient, can be difficult to interpret, and may not be necessary in all cases. This article reviews the indications for pH monitoring, its technique, its advantages and limitations, and its role the diagnosis of GERD.

Esophagus↗
PubMed1985

Fractures of the styloid process and stylohyoid ligament: an uncommon injury.

Fracture of an elongated styloid process or ossified stylohyoid ligament is uncommon. Neck or throat pain, decreased mobility, hoarseness, and mass in the neck are signs and symptoms of fracture. The inciting trauma may be as mild as yawning but more often blunt trauma of a serious nature, such as motor vehicle accident, is the cause. The diagnosis may be missed because of difficulty imaging the stylohyoid apparatus. Two cases are presented that demonstrate the variability of symptoms and trauma. Previous reports of similar injuries and selection of radiographic examinations, including computed tomography, are discussed.

Adult↗
PubMed1987

Early bronchoscopy as a predictor of ventilatory support for burned patients.

Twenty-seven burned patients who had facial burns, hoarseness, or evidence of carbonaceous sputum or had been in a smoke-filled enclosed space underwent fiberoptic bronchoscopy at the time of admission. Airway severity was indexed (grades 1-5, grade 5 being the most severe). Fifteen nonsurvivors had a bronchoscopic index of 3.2 +/- 1.6 and 12 survivors an index of 3.4 +/- 1.2 (p greater than 0.05). No patient died of respiratory complications. Bronchoscopic index correlated poorly with the level of positive end expiratory pressure required to maintain oxygenation in any patient (r = 0.50). Likewise, bronchoscopic index did not correlate with duration of intubation in any survivor (r = 0.33). Immediate bronchoscopy after burn injury neither indicates the level of respiratory support that will be required nor predicts its duration.

Bronchoscopy↗
PubMed1996

Longitudinal evaluation of vocal function after thyroplasty type I in the treatment of unilateral vocal paralysis.

This study investigated longitudinal changes of vocal efficiency and stability after primary thyroplasty type 1. Fifty-three patients with unilateral vocal-fold paralysis underwent vocal-function evaluation preoperatively and at periodic intervals of 1, 3, and 6 months postoperatively. Vocal-function assessment included videostrobolaryngoscopic examination, acoustical and aerodynamic analysis, and perceptual judgment of voice characteristics. Parameters that included glottic-gap size, maximum phonation time, glottic-flow rate, jitter, harmonic/noise ratio, breathiness, hoarseness, loudness, and phrasing showed significant improvement after thyroplasty and remained stable as early as 1 month postoperatively, with only slight fluctuations over a 6-month period. Postoperative voice outcome was not affected by age, sex, duration of vocal symptoms, cause of paralysis, or preoperative pulmonary function.

Adolescent↗
PubMed1998

First results of clinical application of videokymography.

OBJECTIVES: Stroboscopy is based on the assumption that the vibration of the vocal folds is stable and regular. Irregular vibrations, which are common in voice pathology, cannot easily be studied and described in a reliable way. Videokymography overcomes most of these drawbacks. DESIGN: The use of the recently invented videokymography for studying vocal fold vibrations in patients is introduced. METHOD: Videokymography, using a modified CCD-video camera, works in two modes: standard and high speed. In standard mode the vocal folds are displayed on a video monitor in the usual way, providing 50 images per second (or 60 in the National Television Standards Committee (NTSC) system). This is used for routine laryngoscopic and stroboscopic examination of the larynx. In high-speed mode (nearly 8000 images per second) only one line from the whole image is selected and displayed on the x-axis of the monitor; the y-axis represents the time dimension. RESULTS: All kinds of vocal fold vibrations, including those leading to pathological rough, breathy, hoarse, or diplophonic voice productions can be observed. Videokymography visualizes small left-right asymmetries, open quotient differences along the glottis, lateral propagation of mucosal waves, and movements of the upper margin and, sometimes in the closing phase, the lower margin of the vocal folds. CONCLUSION: Videokymography is advantageous for a more accurate diagnosis of voice disorders. Videokymography provides a simple way to study irregular vibrations of the vocal folds. Information is directly available for further processing and allows a first-time quantification of vibrations registered.

Aged↗
PubMed1998

Quality of life and voice in patients with laryngeal carcinoma: a posttreatment comparison of laryngectomy (salvage surgery) versus radiotherapy.

OBJECTIVES: This study was designed to compare the voice and the quality of life (QOL) of laryngeal cancer patients receiving treatment with radical radiotherapy with or without laryngectomy as salvage surgery. We also compared the patients' own perceptual ratings of their voice to the perceptual ratings of a group of listeners. STUDY DESIGN: Two groups of laryngeal cancer patients were studied. METHODS: Fourteen irradiated laryngeal speakers with preserved larynx were matched with 14 salvage surgery laryngectomized patients speaking with tracheoesophageal prosthesis (TEP). To measure patients' QOL, we used the European Organisation for Research and Treatment of Cancer Quality of Life Core Questionnaire (EORTC QLQ-C30), the EORTC Head and Neck module (EORTC QLQ-H&N35), the Hospital Anxiety and Depression scale (HAD) and a study-specific questionnaire. For the perceptual speech evaluation we used visual analog scales. RESULTS: The perceptual ratings of speech intelligibility, voice quality, and speech acceptability showed a significant difference between the treatment groups. Both the patients who received treatment with radiotherapy and the listeners rated the irradiated laryngeal voices higher than the tracheoesophageal speech. The laryngectomized patients scored significantly better than the patients treated with radical radiotherapy on the question about hoarseness. No other significant difference was found for the QOL functions and symptoms. CONCLUSION: When patients treated with radiotherapy were compared with patients treated with laryngectomy as salvage surgery, QOL was similar, only small differences being found in the perceptual speech evaluation.

Aged↗
PubMed1999

A retrospective study of contact granuloma.

OBJECTIVES: This study evaluates the clinical features of contact granuloma and compares the results of voice therapy in operated versus unoperated cases. STUDY DESIGN: Retrospective review of 123 patients with contact granuloma. Thirty-six patients had undergone one or more surgeries before phoniatric consultation. After their final operation, 33 patients had recurrence. The three patients who were cured by operation were not studied further. The course of disease in the 33 patients with recurrence was compared with that of 87 patients who did not have surgery. METHODS: The hospital records were reviewed concerning age, sex, symptoms, side of granuloma, and outcome of treatment. RESULTS: The predominant symptoms were vocal fatigue, vocal discomfort, the need for excessive throat clearing, and hoarseness. The recurrence rate after operation was 92%. Twelve months after voice therapy, 35% of the operated group and 51% of the unoperated group were cured. The patients who had surgery had almost twice as many sessions of voice therapy as the unoperated group, and their mean recovery time was 17 months, compared with 8 months for the unoperated group. CONCLUSIONS: The recurrence rate after surgery was high. Surgery may prolong the recovery time. Subjective symptoms diminished during voice therapy, but we cannot confirm that it was beneficial for the healing process.

Adult↗
PubMed2000

Compliance with anti-reflux therapy in patients with otolaryngologic manifestations of gastroesophageal reflux disease.

OBJECTIVES: The otolaryngologic manifestations of gastroesophageal reflux include sore throat, throat clearing, sensation of postnasal drip, hoarseness, and globus. This constellation of laryngeal and pharyngeal symptoms can be referred to as laryngopharyngeal reflux (LPR). Many patients with LPR are treated empirically and the results are often rewarding. The objective of this study is to evaluate compliance with antireflux therapy in this patient population. STUDY DESIGN: A prospective analysis of 30 patients referred to an otolaryngology clinic for the above symptoms. METHODS: The patients were treated for LPR using a standardized behavior modification form in combination with medical management. Patient compliance was followed with a patient questionnaire and evaluation of medication renewal from pharmacy records. RESULTS: The patients were followed for an average of 4 months and 80% reported an improvement of their symptoms. Evaluation of patient questionnaires revealed that 50% of patients reported taking their medications as prescribed. Compliance varied widely with regard to behavioral modifications. The degree of symptomatic improvement was significantly correlated with overall compliance with both medications and behavioral changes (Pearson correlation coefficient, P < .05). The individual behavioral changes that were significantly correlated with the reduction of symptoms were avoidance of food and liquid before sleep and elevation of the head of bed, but not food habits. CONCLUSIONS: The treatment plan for gastroesophageal reflux disease requires behavioral modifications and prescription medications that many patients may find difficult to follow. However, those patients who comply with the treatment plan can be expected to have an improvement of their symptoms. Furthermore, simplifying the treatment regimen including those elements most correlated with symptomatic improvement may increase patient compliance.

Aged↗
PubMed2000

Stereotastic radiosurgery for glomus jugulare tumors.

OBJECTIVES/HYPOTHESIS: Surgery is considered to be the mainstay of treatment for glomus jugulare tumors. A subset of patients are poor surgical candidates based on age, medical problems, tumor size, or prior treatment failure. The purpose of this study was to review our results with stereotactic radiosurgery (gamma knife treatment) in this group of patients, with particular attention to adverse reactions and symptom relief. STUDY DESIGN: Retrospective review and phone survey. METHODS: Charts were reviewed for size and location of tumor, history of previous treatment, symptoms before and after treatment, amount of radiation received, acute and late complications, and functional level before and after treatment. Pre-treatment and posttreatment magnetic resonance imaging scans were also reviewed. Identified patients were then contacted for a phone interview. RESULTS: Eight patients were identified. Phone interviews were conducted with four patients. Four patients had failed previous treatment. Follow-up ranged from 7 to 104 months. One patient experienced an acute complication: intractable vertigo requiring hospitalization. No patient experienced delayed cranial neuropathies. No patient reported worsening of any of the following symptoms: pulsatile tinnitus, hearing loss, facial weakness, hoarseness, or difficulty swallowing. Three patients reported improvement in their pulsatile tinnitus. Two patients reported improvement in hearing loss, and one patient each reported improvement in vertigo and difficulty swallowing. CONCLUSIONS: Preliminary results suggest that stereotactic radiosurgery is useful to control symptoms and may be delivered safely in patients with primary or recurrent glomus jugulare tumors who are poor surgical candidates.

Aged↗
PubMed2000

Vocal fold paralysis after anterior cervical diskectomy and fusion.

OBJECTIVE: The anterior approach to the cervical spine now serves as the surgical access of choice for cervical spine disease. Vocal fold paralysis (VFP) may follow the procedure as a complication. The authors describe their experience with patients having VFP after anterior cervical diskectomy and fusion (ACDF), with an emphasis on outcome and prognosis. STUDY DESIGN: Retrospective. METHODS: Medical records of patients who underwent ACDF between January 1987 and February 1998 were reviewed. Further detailed review of the patients with documented VFP after surgery was then performed. RESULTS: Over the given time period 411 ACDFs were performed and 21 patients with this complication were identified (5%). All 21 patients had right-sided approaches. Eighteen patients had right VFP, 2 had left VFP, and 1 had bilateral VFP. Symptoms included hoarseness (18), persistent cough (7), aspiration (13), and dysphagia (7). The patient with bilateral VFP presented with stridor and respiratory distress requiring tracheotomy. The complete records of 17 patients with 18 VFPs were available for review. Fifteen of 18 VFPs (83.3%) had complete resolution within 12 months. One patient had recovery after 15 months. All patients were treated conservatively with speech and swallowing therapy. One patient required Gelfoam injection and another medialization thyroplasty, both for aspiration symptoms. CONCLUSIONS: The data suggest that at least 80% of VFP after ACDF will recover within 12 months of the procedure. The authors recommend regular follow-up and speech therapy for symptomatic patients. Medialization should be considered in patients with aspiration or persistent problems.

Adolescent↗