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At least 1,639 records · Page 91Linked to original sources
PubMed1990

Sulcus vocalis: functional aspects.

The vocal function of 126 patients with sulcus vocalis was evaluated with the use of a test battery of multidimensional evaluation items. Of the 126 patients, 31 had a unilateral sulcus and 95, bilateral lesions. The results were as follows. 1) The majority of the patients had a mild degree of hoarseness with a breathy quality. 2) An incomplete glottic closure, a small vibratory amplitude, and a small mucosal wave were frequently observed in the stroboscopic examination. 3) The maximum phonation time, fundamental frequency range, and sound pressure level range of phonation were decreased, whereas the airflow during phonation was increased. 4) The pitch perturbation quotient, amplitude perturbation quotient, and normalized noise energy were increased. 5) Abnormal test results were more frequent and more marked for bilateral lesions than for unilateral lesions.

Adult↗
PubMed1991

Laryngeal manifestations of gout.

Gout is a disorder of purine metabolism characterized by hyperuricemia with rare involvement of the head and neck. We present a 72-year-old woman with a known history of gout who presented with hoarseness and a lesion suspicious for carcinoma of the larynx. Endoscopic biopsy revealed a tophus of the true vocal cord with characteristic birefringent crystalline deposits and giant cell granuloma. There have been limited reports of gouty involvement of the larynx, more commonly involving cricoarytenoid arthritis. Tophi of the laryngeal soft tissues are exceedingly rare. In this paper we will discuss the pathophysiology and management of this interesting clinical entity.

Aged↗
PubMed1992

Communication status following laryngectomy: the Iowa experience 1984-1987.

Data regarding treatment and outcome for a consecutive series of 73 total laryngectomy patients were collected from clinical records with a follow-up period of 30 to 78 months postoperatively. Notable findings were that 27% were women; 75% reported hoarseness or a voice change as an early symptom; and 22% reported combined heavy use of both cigarettes and alcohol. Of the 73 patients, 38 (52%) died during the follow-up period; 18 of the 38 died within 1 year postoperatively. Thirty-nine (53%) of the 73 had received a surgical tracheoesophageal fistula (TEF) for voice restoration, as either a primary or a secondary procedure. Of the 39, 75% were using the TEF at last examination, with no failures attributed to sphincter spasm. Of the total group, the primary communication modality was reported to be use of a TEF by 44% and use of an electrolarynx by 50%. Limitations of the study and directions for future investigations are discussed.

Aged↗
PubMed1992

Organ-limited laryngeal amyloid deposits: clinical, morphological, and immunohistochemical results of five cases.

Five cases of organ-limited laryngeal amyloid deposits with no evidence of systemic disease are reported in detail and classified immunohistochemically. In four of the five cases the amyloid reacted with anti-A lambda antibodies and in one case with anti-A kappa antibodies. Four of our five female patients had already passed the fifth decade of life. One was 11 years old. Hoarseness was the predominant symptom in four cases, in which we found amyloid deposits in the glottic area. Only one patient, with amyloid deposits in the aryepiglottic fold, complained of pain. The therapy of choice of idiopathic, localized, or organ-limited amyloid deposits without underlying disease may be local excision. In one of the cases reported in this paper, a laryngofissure was performed, and in another a partial laser resection was performed. No therapy was performed in three of our five cases. In the larynx, as in many other locations and only if possible, removal at intervals is more feasible than radical resection, because these amyloid tumors grow slowly.

Amyloidosis↗
PubMed1992

Junctional epidermolysis bullosa of the larynx. Report of a case and literature review.

Epidermolysis bullosa (EB) is a group of rare inherited disorders in which minor trauma causes blister formation in the skin and mucosa, including the esophagus. Morbidity varies with the type of disease and ranges from occasional trivial skin blisters to death in infancy. Laryngeal involvement presenting as hoarseness and respiratory distress has been reported in nine patients, five of whom had junctional EB. We present the sixth case of junctional EB with laryngeal involvement, and offer guidelines for otolaryngologists and anesthesiologists caring for these fragile patients.

Child, Preschool↗
PubMed1993

Congenital ankyloglossia with deviation of the epiglottis and larynx: symptoms and respiratory function in adults.

We operated on 38 adult patients with congenital ankyloglossia with deviation of the epiglottis and larynx. The results were as follows. 1) Most patients had Angle's class III malocclusion, irregular alignment of the upper teeth, and high hard palate. 2) Fifty percent of the patients in our study population had obstructive respiratory failure. Their vital capacity increased significantly after the operation, but changes of forced expiratory volume in 1 second were not prominent. 3) Subjective symptoms of this disease were stiffness of the shoulders, a cold feeling in the extremities, an obstructed feeling in the throat, insomnia, fatigue, dry skin, irritability and/or anxiety, and nervousness. These improved postoperatively. 4) Objective symptoms included snoring, muscle cramps, difficulty in playing wind instruments, hoarseness, and incorrect articulation. The objective symptoms, except for incorrect articulation, improved postoperatively.

Adult↗
PubMed1994

Arytenoidectomy in children.

Vocal cord paralysis is the second most common cause of stridor in early infancy, and as many as 52% of patients will not recover spontaneously. Bilateral vocal cord paralysis often requires a tracheotomy for airway distress. If resolution of the bilateral vocal cord paralysis does not allow for decannulation, arytenoidectomy is an option. A retrospective review of 30 children with bilateral vocal cord paralysis who underwent an arytenoidectomy was undertaken. An external arytenoidectomy via laryngofissure was performed in 19 patients, a laser arytenoidectomy in 12 patients, and a Woodman procedure in 1 patient. Twenty-five of the 30 patients (83%) were decannulated. Decannulation was more likely after a laryngofissure (84%) than after a laser arytenoidectomy (56%). The probability of decannulation was related to the presence of concomitant conditions and the need for other airway procedures. While breathiness, hoarseness, and pitch change were common, all patients had an adequate voice postoperatively and demonstrated little change from the preoperative voice disturbance. Aspiration was a rare complication. After an adequate period of observation for spontaneous resolution, arytenoidectomy via external laryngofissure is recommended to aid in the decannulation of children with bilateral true vocal cord paralysis.

Adolescent↗
PubMed1994

Amyloidosis of the larynx in a child.

Localized laryngeal amyloidosis is a rare and benign process. Only three cases have been reported in children. We present the case of a 9-year-old girl with localized laryngeal amyloidosis that was excised via laryngofissure. The patient presented with a 3- to 4-week history of progressive hoarseness. Direct laryngoscopy revealed a smooth, firm, submucosal mass extending from the anterior aspect of the left false vocal cord to the vocal process. Biopsy of the mass revealed findings consistent with amyloidosis. The mass was approached via laryngofissure and excised with the thyroid cartilage and left true vocal cord left intact. An extensive workup for systemic amyloidosis was negative, including bone marrow biopsy. The postoperative recovery was uneventful, with good vocal quality and a sluggish but mobile left true vocal cord. This case is significant because of the young age of the child, the extent of disease, and the use of laryngofissure for excision.

Amyloidosis↗
PubMed1994

Herpes simplex chronic laryngitis and vocal cord lesions in a patient with acquired immunodeficiency syndrome.

Chronic laryngitis in patients with acquired immunodeficiency syndrome may be due to infections or tumors, such as Kaposi's sarcoma and non-Hodgkin's lymphoma. We present what we believe to be the first proven case of herpes simplex virus chronic laryngitis in a man positive for human immunodeficiency virus. Direct laryngoscopy showed leukoplakic lesions on both vocal cords. Biopsy of the lesions showed squamous epithelial cells with the characteristic features of herpes simplex virus, which was confirmed by immunohistochemical stains. We discuss the differential diagnosis of chronic laryngitis in a human immunodeficiency virus infection. Herpes simplex viral infection of the vocal cords should be considered in patients with acquired immunodeficiency syndrome presenting with chronic hoarseness and leukoplakic lesions on direct laryngoscopy, especially with no evidence of Kaposi's sarcoma, tumor, or cytomegaloviral or fungal infection elsewhere. Treatment should be acyclovir, except in the face of acyclovir resistance.

AIDS-Related Opportunistic Infections↗
PubMed1996

Postintubation arytenoid subluxation.

Arytenoid subluxation (AS), ie, malpositioning of the arytenoid cartilage with abnormal but existent contact between the joint surfaces, is an uncommon entity, and fewer than 70 cases have been reported, 26 of which were in a recently published series. Usually, AS is the result of upper airway instrumentation, and only a few cases were reported to occur with external trauma to the neck. Some predisposing factors and possible mechanisms have been suggested, but the reason for its occurrence remains obscure. Hoarseness and, to a lesser degree, dysphagia, odynophagia, cough, and sore throat may be indicative of AS. Diagnosis is established by the clinical course, laryngoscopy, and computed tomography. Electromyography and strobovideolaryngoscopy are additional diagnostic measures described. We report 7 cases of postintubation AS of long standing. Three of these patients had prior unilateral vocal cord paralysis, formerly undescribed as a possible contributing factor for AS. The pertinent literature is reviewed and treatment options are discussed.

Adult↗
PubMed1996

Omohyoid muscle transposition for the treatment of bowed vocal fold.

Imperfect glottal closure is usually the most important factor causing dysphonia in patients with bowing of the vocal folds. We have performed laryngeal framework surgery, which allows the medialization of the vocal folds from the outside without creating any scar tissue on them. Over the past 6 years, however, we encountered three cases with marked bowing of the vocal folds that could not be cured by laryngeal framework surgery alone. We used an open laryngeal procedure in these cases, even though such procedures had been considered contraindicated in the treatment of hoarseness. After performing a laryngofissure, we made a small pocket beneath the vocal fold mucosa at the anterior commissure. The superiorly based omohyoid muscle flap was then transposed into the mucosal pocket and sutured to the vocal process. This procedure should be considered an option in treating highly bowed vocal folds.

Adult↗
PubMed1997

Endoscopic management of a combined laryngocele.

A 70-year-old women presented with hoarseness, foul sputum, and a softneck mass. Clinical and radiographic examination disclosed findings consistent with a combined internal and external laryngopyocele. Antibiotics, throat irrigations, and warm packs applied to the neck resulted in full resolution of the neck mass and subtotal regression of the supraglottic swelling. Endoscopic vestibulectomy was performed with a carbon dioxide laser; neither residual neck mass nor a tract leading to the extralaryngeal neck swelling was detected. The immediate and long-term clinical course has been uneventful. This report is the first description of the definitive endoscopic management of a combined laryngocele. The pathogenesis of the laryngocele and the rationale and technique for endoscopic management are discussed.

Aged↗
PubMed1998

Osteosarcoma of the larynx.

About 11,600 cases of laryngeal cancer were reported in the United States in 1995, accounting for 1% of all reported cancers. Fewer than 1% of laryngeal cancers are sarcomas, osteosarcoma being the rarest type. Twelve cases of laryngeal osteosarcoma have been cited in the literature. A 47-year-old man presented with hoarseness following a benign vocal polypectomy. The entire larynx appeared swollen, although both vocal folds moved well. Biopsies did not reveal pathologic tissue. Computed tomographic imaging revealed a destructive, expansile lesion of the thyroid cartilage. A computed tomography-guided biopsy of this cartilage revealed a high-grade sarcoma. Laryngeal osteosarcoma was diagnosed following total laryngectomy. Laryngeal osteosarcoma is a highly malignant neoplasm with early hematogenous spread. Survival statistics for peripheral osteosarcoma are poor. Limited experience reveals that a combination of surgery and radiotherapy with adjuvant chemotherapy can offer some palliation. The literature and published cases of laryngeal osteosarcoma are reviewed.

Combined Modality Therapy↗
PubMed1998

Vocal evaluation of thyroplasty type I in the treatment of nonparalytic glottic incompetence.

This study investigated the prethyroplasty and postthyroplasty voices of patients with glottic incompetence of mobile vocal folds related to vocal fold bowing and scarring. Seventeen patients underwent vocal function evaluation preoperatively and 1 month postoperatively with videostrobolaryngoscopic examination, acoustic and aerodynamic analysis, and perceptual judgment of voice characteristics. The postoperative voice outcome in this group of patients was compared to that of a group of patients with unilateral vocal fold paralysis. Patients with vocal fold bowing showed significant improvement in glottic gap size and hoarseness after the surgery. There was minimal improvement on other test measures. Patients with vocal fold scarring exhibited worse preoperative and postoperative vocal functions, with little voice improvement after surgery. The outcome of thyroplasty type I in cases of vocal fold bowing or scarring is not as good as that in unilateral vocal fold paralysis.

Adult↗
PubMed1987

Symptomatic hypothyroxinemia with normal TSH levels in preterm infants.

The authors report eight preterm infants with hypothyroxinemia who developed clinical features similar to those described in congenital hypothyroidism: prolonged jaundice, hypoactivity, lethargy, constipation, edema, and hoarse cry. All had low serum thyroxine, normal thyroid stimulating hormone, and normal thyroid binding globulin levels. After exclusion of other causes for the symptoms, thyroid replacement therapy was started, resulting in rapid resolution of symptoms and return to euthyroid status. Follow-up of these infants after cessation of therapy revealed normal growth and development and normal thyroid function. The authors therefore recommend a prospective study to investigate the incidence of hypothyroxinemia, frequency of associated clinical features, and the benefits of thyroid replacement therapy based on a randomized controlled trial.

Humans↗
PubMed1995

Laryngeal cyst and sudden death.

Laryngeal cysts are relatively uncommon and account for about five per cent of benign laryngeal lesions. The commonest location is the epiglottis. Pathologically these lesions may be divided into epithelial, tonsillar or oncocytic types. The patients may be asymptomatic or present with hoarseness, dysphagia, cough or airway obstruction. Epithelial cysts of the larynx, although histologically benign, may produce sudden and unexpected death from asphyxia. A case is presented of a 32-year-old female who was sexually assaulted and later found dead. Death was most likely due to laryngeal obstruction caused by an epiglottic cyst. Alcohol intoxication (BAC = 0.25g%) is likely to have been a contributory factor. In this case the results of the autopsy helped to exonerate the accused from being charged with murder. Other medico-legal problems that may be encountered with laryngeal cysts are difficulty in intubation and accidental rupture of a cyst during intubation or otolaryngeal examination.

Adult↗
PubMedDate not supplied

The otolaryngologic presentation of amyotrophic lateral sclerosis.

Amyotrophic lateral sclerosis is a progressive dengenerative neuromuscular disease of insidious onset. It involves upper and lower motor neurons and causes both spastic and atrophic muscular symptoms. More than one fourth of patients have complaints relating to the head and neck (bulbar palsy); thus, the otolaryngologist may be the first physician to see them. Predominant symptoms are slurred speech, hoarseness, dysphagia, and dyspnea. Muscular weakness, atrophy, and fasciculation are noted on examination. The course is relentless, and only 20% of patients survive five years after diagnosis.

Adult↗
PubMedDate not supplied

Progressive neonatal airway obstruction secondary to cervical thymic cyst.

Cervical thymic cysts are extremely unusual neoplasms that only rarely produce signs and symptoms of upper airway tract compromise. Less than 7% of patients initially have dyspnea or hoarseness. We report the first known case of progressive neonatal airway obstruction secondary to a rapidly enlarging cervical thymic cyst. Because one half of these benign tumors may demonstrate mediastinal extension, computed axial tomography or B-mode ultrasonography or both is recommended prior to surgical excision. Review of the literature confirms that the majority are successfully removed via a transcervical approach without recurrence.

Airway Obstruction↗