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PubMed1983

Angioleiomyoma of the larynx. Report of a case and review of the literature.

A rare case of angioleiomyoma in a 76-year-old man is presented. The main symptoms were hoarseness and dyspnea. The tumor originated in the subglottic surface of the right vocal cord and there was only 3 mm of the laryngeal inlet free of the tumor. Histopathologically it was well circumscribed and composed of proliferating smooth muscle fibers and dilated blood vessels. The tumor was partially removed endoscopically, and subsequent cryotherapy was instituted. After two courses of cryotherapy the tumor had completely disappeared. Laryngeal function was restored to normal, and no signs of recurrence were observed after follow-up of 8 months.

Aged↗
PubMed1984

Injection injuries of the recurrent laryngeal nerve.

We describe a new etiology for vocal cord paralysis. Two patients, chronic drug abusers, had in time lost access to the usual peripheral veins, and proceeded then to have the drugs injected repeatedly into the jugular veins in the neck. Both presented with persistent hoarseness and were found to have a unilateral vocal cord paralysis. Neck exploration was undertaken to evaluate this pathology, to rule out other obscure disease, and to decompress the recurrent laryngeal nerve within the carotid sheaths. Severe fibrosis was encountered in the neck of one patient and mild fibrosis in the other. A biopsy specimen from the adjacent autonomic portion of the vagus nerve was submitted. Although the follow-up period was short, no definite return of function was observed. A discussion of injection injuries to nerves is presented.

Adult↗
PubMed1984

Carbon dioxide laser enucleation of polypoid vocal cords.

Polypoid vocal cords have routinely been treated by endoscopic vocal cord stripping, often-times resulting in prolonged hoarseness postoperatively. Submucosal CO2 laser enucleation of the polypoid tissue, with preservation of a mucosal flap on the medial edge of the cord, has proved to be a valuable improvement. The surgical procedure is described and results are presented which suggest that voice quality is better earlier than is the case after vocal cord stripping.

Adult↗
PubMed1986

Osteomyelitis of the base of the skull.

Infection in the marrow of the temporal, occipital, and sphenoid bones is an uncommon, but increasing occurrence. It is usually secondary to infections beginning in the external auditory canal and is caused almost uniformly by the gram negative Pseudomonas aeruginosa bacteria. Technetium and gallium scintigraphy help in the early detection of such infections while CT scans demonstrate dissolution of bone in well-developed cases. Headache is the predominant symptom. Dysphagia, hoarseness, and aspiration herald the inevitable march of cranial nerves. We have diagnosed and treated 17 cases of osteomyelitis of the skull base. Although the total mortality rate is 53%, it is now a curable disease. Six of our last 8 patients remain alive, although 1 is still under treatment. Treatment is medical and requires the long-term concomitant intravenous administration of an aminoglycoside and a broad spectrum semisynthetic penicillin effective against the causative organism.

Aminoglycosides↗
PubMed1990

Vocal cord paralysis resulting from neck injections in the intravenous drug use population.

Intravenous drug use patients present to the head and neck surgeon when injections are directed "in the pocket," or more appropriately, toward the internal jugular vein in the neck. The more common complications of this practice include the development of cellulitis, abscess, and venous thrombophlebitis and, potentially, pulmonary embolism and pseudoaneurysm of the carotid and subclavian arteries. Vocal cord paralysis as a result of neck injection in the intravenous drug-using population is rarely described, and a review of the literature has yielded only two reports addressing this uncommon phenomenon. During a 7 1/2-year period between October 1981 and June 1989, nine patients presented to Detroit Medical Center with hoarseness, upper-airway obstruction, or both following the injection of heroin or related substances into the neck. Otolaryngologic evaluation demonstrated unilateral or bilateral vocal cord paralysis coincident with recent neck injections. The clinical signs and symptoms, location of the injections, acute management, and subsequent complications are catalogued. Acute management of these patients consisted of airway assurance via tracheotomies when indicated and observation for the development of cellulitis, abscess, or more life-threatening neurovascular complications. Follow-up laryngeal examinations ranged from 4 months to 4 1/2 years and found no demonstrable return of vocal cord function in any of the nine patients.

Administration, Cutaneous↗
PubMed1990

The nasogastric tube syndrome.

The nasogastric tube can produce sudden, life-threatening bilateral vocal cord paralysis and is often an unrecognized cause of this clinical entity. The pathophysiologic mechanism is thought to be paresis of the posterior cricoarytenoid muscles secondary to ulceration and infection over the posterior lamina of the cricoid. Since our initial report of this entity in 1981, several cases have been photo-documented. Study of whole organ sections of an involved larynx have demonstrated the histopathology. Diabetic renal transplant patients appear to be particularly susceptible to the condition, due to prolonged gastroparesis and requirement for nasogastric tube drainage. Esophagoscopy should be performed promptly in these patients when pharyngodynia, hoarseness, or evolving stridor present in the postoperative period.

Adult↗
PubMed1990

Endoscopic laser surgery for early glottic carcinoma: a clinical and experimental study.

The purpose of this study is to define the indications for using the CO2 laser for the treatment of early glottic cancer. For this purpose, 52 consecutive laser resections of Tis to T2 vocal cord carcinomas were studied prospectively. In addition, laser resection was performed in eight human cadaver larynges, which were then examined histologically using whole organ sections. Both tumor size and tumor location had important influences on tumor resectability by laser. All of the Tis, 78% of T1, and one of four T2 carcinomas were successfully treated by laser surgery alone. Of the 10 carcinomas involving the anterior commissure, only four could completely be resected with the laser; of these four, two recurred in the anterior commissure. This finding is corroborated by the histologic study, which clearly shows that anterior commissure resection poses problems. The only laser resection complication of early glottic cancer was persistent hoarseness in one third of the patients. It is concluded that CO2 laser resection is a safe and effective alternative treatment for patients with Tis and T1 glottic carcinoma, provided the anterior commissure is free of tumor.

Adult↗
PubMed1991

Inhalation of foreign bodies in Chinese children: a review of 400 cases.

A retrospective review of 400 Chinese children who had inhaled foreign bodies was undertaken. There has been a yearly increase in the total number of cases of airway foreign bodies removed in our hospital. Fifty-eight percent of the children presenting were from the countryside; 42% were townspeople. Approximately 90% of the patients were under 3 years of age, with the peak incidence of foreign body inhalation occurring between 1 and 2 years of age (57.8%). The male-female ratio was about 1.2:1. About 95% of the removed foreign bodies were organic in origin. The majority of the foreign bodies were found most often in the right bronchial tree (46%). A positive history of foreign body inhalation was obtained in 98% of the cases. Twenty-eight percent of the children presented at the hospital within 24 hours, 71% within 1 week, and 29% more than 1 week after inhaling the foreign body. The most common presenting symptoms of laryngotracheal foreign bodies were cough, wheezing, dyspnea, and hoarseness; those of bronchial foreign bodies were cough, wheezing, decreased air entry, and rhonchi. More than two-thirds of the children with larygotracheal foreign bodies had normal x-ray findings. The most common fluoroscopic findings in those children with bronchial foreign bodies were mediastinal shift (36.8%), obstructive emphysema (35.7%), and normal findings (35%). A total of 348 (87%) bronchial foreign bodies were removed by rigid bronchoscopy (81%), rod-lens bronchoscopy (5%), and spontaneous expulsion (1%); 52 (13%) laryngeal and tracheal foreign bodies were removed by direct laryngoscopy (12%) and tracheotomy (1%). A single endoscopic procedure successfully removed 92.5% of 400 foreign bodies detected in the airways. One child died during bronchoscopy, for a mortality rate of 0.25%.

Adolescent↗
PubMed1992

Abductor laryngeal dystonia: a series treated with botulinum toxin.

Abductor laryngeal dystonia (LD) is characterized by a hoarse voice quality which is broken up by breathy or whispered portions. Botulinum toxin injection (Botox) has been a safe and effective treatment for adductor laryngeal dystonia and is currently accepted medical therapy. As an extension of the established treatment program, in 1989 treatment of abductor LD was initiated. Thirty-two patients have been treated by sequential percutaneous electromyogram-guided (EMG) injections of the posterior cricoarytenoid (PCA) muscles. Most patients required treatment of both PCA muscles and improved to an average of 70% of normal voice. Patients who had a preexisting tremor, evidence of dystonia in other muscle groups, vocal tremor, or respiratory dysrhythmia had less improvement. Ten patients also required injection of the cricothyroid muscles and/or type I laryngoplasty.

Adolescent↗
PubMed1992

Vocal evaluation of thyroplastic surgery in the treatment of unilateral vocal fold paralysis.

Vocal function was assessed in 15 patients who received thyroplasty type I for the rehabilitation of unilateral vocal fold paralysis. The function was assessed by perceptual evaluation, voice intensity and frequency range profiles, and questionnaire. Goals of the study were to evaluate the efficacy of thyroplasty in improving the voice, to compare postoperative thyroplasty voices to normal voices, and to correlate objective measurements to the results of the questionnaire regarding satisfaction with the voice. Perceptual evaluations were performed by randomizing normal and thyroplasty voices on a recording tape. The voices on the tape were then rated by independent, blinded, trained listeners. The perceptual qualities of pitch, intonation, and loudness were not statistically different than normals; however, voice qualities of strain, breathiness, hoarseness, harshness, and unsteadiness were different than normals. Mean frequency range and mean intensity range were moderately to severely reduced from normals with a wide variation being present in the results. The correlation between the higher threshold phonation pressures and decreased intensity ranges found in some patients is discussed. Questionnaire results indicated that a high degree of satisfaction with the surgery was present (92%). Extreme or general satisfaction with voice was present in 73%. The most difficult voicing was experienced at work, with 25% needing to adjust their employment to accommodate their voice abilities. These results indicate that thyroplasty type I is effective in partially rehabilitating unilateral voice fold paralysis. Voice function is still not normal, probably in part due to the underlying disease.

Adolescent↗
PubMed2001

Environmental sensitivities: prevalence of major symptoms in a referral center: the Nova Scotia Environmental Sensitivities Research Center Study.

Although the phenomenon of environmental sensitivities (ES) has no clear etiology nor well-accepted pathophysiology, affected individuals experience symptoms that cause varying levels of dysfunction. Through a dedicated, government-funded research and treatment center, a detailed questionnaire covering 217 symptoms in 13 systems was mailed in 1997-1998 to 812 individuals referred to the center by physicians. A total of 385 (47%) questionnaires were returned, and data were analyzed on 351 individuals. Participants tended to be women (80%), middle-aged individuals (37% age 40-49 years), and those in higher educational groups (28% completed university), but there was wide variation in demographic variables. General symptoms such as difficulty concentrating, fatigue, forgetfulness, and irritability dominated the overall prevalence of symptoms since the start of their illness. Those related to irritation such as sneezing, itchy or burning eyes, and hoarseness or loss of voice were more common after exposure to environmental irritants. Ranking of symptoms using severity scores was consistent between men and women. Overall scores were higher in women, in participants who were separated or divorced, and in low-income groups. The type and consistency of symptoms experienced after exposure to triggering substances may not fit a purely psychogenic theory.

Adolescent↗
PubMed1993

Bronchial carcinoid tumors in pediatric patients.

Bronchial carcinoid tumors (BCT) are the most frequent primary pulmonary neoplasms of childhood. Seventeen of 208 patients diagnosed as having BCT at the Massachusetts General Hospital were between 10 and 21 years of age. We reviewed our records of the 17 patients and 8 other pediatric cases and compared their findings with those of seven large series of adults. Distribution was equal between the sexes. The average age at diagnosis was 17 years; 4 patients were < or = 15 years old. The duration of symptoms prior to diagnosis varied from 2 weeks to 2.6 years, with a median duration of 8.5 months. In contrast to adults, no child was asymptomatic. The majority of children presented with wheezing and atelectasis in addition to the characteristic adult triad of cough, hemoptysis, and pneumonitis. Five patients presented with weight loss and one patient presented with hoarseness. One of the 17 pediatric patients presented with Cushing's syndrome and a functional BCT. Twelve of 14 patients were disease free for 9 months to 34 years after surgical resection. We conclude that BCT should be suspected in children with pneumonitis resistant to therapy, atelectasis, wheezing, and hemoptysis. Surgical resection will result in symptom-free recovery in the majority of cases in spite of low-grade malignancy.

Adolescent↗
PubMed1993

The role of staging bronchoscopy in the preoperative assessment of a solitary pulmonary nodule.

In order to assess the role of a staging fiberoptic bronchoscopy in the preoperative assessment of an indeterminate solitary pulmonary nodule (SPN), we reviewed our experience in 33 SPNs identified among 1,269 bronchoscopies performed at the Albert Einstein Medical Center between 1985 and 1989. All lesions were less than 4 cm in greatest diameter and were not associated with symptoms of weight loss, chest pain, hemoptysis, localized wheezing, or hoarseness. A tissue diagnosis was established in 25 patients, 23 of whom had a malignant SPN. This study failed to detect a single case in which a fiberoptic bronchoscopic examination of the airway discovered a lesion that would preclude surgery and potentially curative resection. We recommend the abandonment of a staging bronchoscopy in the evaluation of a patient with an indeterminant SPN in whom history, physical examination, laboratory, and imaging studies fail to document contraindications to surgery. No additional useful information is derived and a substantial cost savings to the patient can be realized if the procedure is eliminated.

Adenocarcinoma↗
PubMed1995

Aerosolized recombinant human DNase I for the treatment of cystic fibrosis.

Respiratory symptoms, recurrent infectious exacerbations, and progressive lung destruction in cystic fibrosis can be attributed to bacterial persistence and the accumulation of viscous purulent secretions in the airways. Purulent secretions contain high concentrations of extracellular DNA, a viscous material released by leukocytes. To evaluate the potential clinical utility of recombinant human DNase I (rhDNase or Pulmozyme), the human enzyme was cloned, sequenced, and expressed. In in vitro studies, rhDNase has been shown to reduce the viscoelasticity, reduce the adhesiveness, and improve the mucociliary transportability of cystic fibrosis sputum. In short-term phase 1 and phase 2 clinical trials, rhDNase has been shown to be safely tolerated and to improve the FEV1, FVC, and symptoms of dyspnea. A long-term placebo-controlled phase 3 study was performed in 968 adults and children (> or = 5 years) with cystic fibrosis to determine the effect of rhDNase on the risk of respiratory exacerbations requiring parenteral antibiotics and on the FEV1. Compared with placebo-treated patients, patients treated with rhDNase once daily or twice daily experienced a reduced risk of respiratory exacerbations by 28% (p = 0.04) and 37% (p = 0.01), respectively, and had a mean improvement in FEV1 of 5.8% (p < 0.01) and 5.6% (p < 0.01), respectively. Compared with placebo-treated patients, patients treated with rhDNase spent 2.7 fewer days receiving parenteral antibiotics (p = 0.04) and spent 1.3 fewer days in the hospital (p = 0.06) over the 6-month treatment period. Inhalation of rhDNase did not cause anaphylaxis but was associated with upper airway symptoms (ie, voice alteration, hoarseness, pharyngitis) that were generally mild and transient. In conclusion, aerosol administration of rhDNase was safely tolerated, reduced the risk of infectious exacerbations requiring parenteral antibiotics, and improved pulmonary function and patient well-being.

Administration, Inhalation↗
PubMed1999

The effect of high-dose inhaled beclomethasone dipropionate in patients with stable COPD.

BACKGROUND: The benefits of inhaled corticosteroids in the management of COPD are less apparent than they are in asthma therapy, and the potential for adverse systemic effects of high-dose inhaled corticosteroids has been recognized recently. It is therefore essential to know the maximal obtainable benefits in order to assess the risk/benefit ratio of this treatment. PURPOSE: The aim of this study was to investigate the maximal obtainable benefits of high-dose inhaled corticosteroids, 3 mg/d of beclomethasone dipropionate (BDP), when used in combination with adequate doses of regular bronchodilators in patients with stable COPD. STUDY DESIGN: Thirty patients with stable COPD completed a randomized, double-blind, placebo-controlled cross-over trial with either 3 mg/d of BDP or with a matching placebo using a metered-dose inhaler with a spacer device for 4 weeks during each treatment period. All of the patients continued to inhale both 400 microg of salbutamol qid and 80 microg of ipratropium bromide qid. RESULTS: The mean prebronchodilator FEV1 was 0.97+/-0.35 L during the placebo period and 1.08+/-0.38 L during the BDP period (p < 0.001). While on BDP, five patients demonstrated a response in their FEV1 of more than 8.5% of the predicted value, which was above the range that covered 95% of the distribution of the placebo response. The mean absolute improvement in the FEV1 in these 5 objective responders was 0.34+/-0.10 L, compared to 0.06+/-0.09 L in the 25 objective nonresponders. Symptom scores for wheezing and dyspnea were significantly better with BDP than with placebo. Hoarseness and sore throat were associated more with BDP treatment. CONCLUSION: Although a considerable minority of patients benefited substantially from this treatment, the overall outcome does not seem to justify the widespread use of this treatment in the light of increasing recognition of the potential adverse systemic effects of high-dose inhaled corticosteroids.

Administration, Inhalation↗
PubMed2000

Long-term follow-up of Griggs percutaneous tracheostomy with spiral CT and questionnaire.

OBJECTIVE: To assess late complications following percutaneous tracheostomy using the Griggs technique. DESIGN: Observational cohort study SETTING: General ICU of a 700-bed district general hospital in the United Kingdom. PATIENTS: Twenty-five patients who underwent Griggs tracheostomy in the ICU and survived for at least 6 months after decannulation. INTERVENTION: Patients were invited to attend for assessment by questionnaire and for spiral CT of the trachea. RESULTS: Eight patients had moderate tracheal dilatation, two patients were permanently hoarse, nine patients had minor voice changes, no patient had tracheal stenosis, and no patient had a disfiguring scar. CONCLUSION: Following Griggs percutaneous tracheostomy, 8 of 25 patients developed moderate tracheal dilatation, and none developed a tracheal stenosis. The cosmetic result after Griggs tracheostomy is good, but the number of patients with minor voice changes is high. A further investigation of long-term outcome following Griggs tracheostomy is necessary.

Aged↗
PubMed2001

Inhaled beclomethasone dipropionate improves acoustic measures of voice in patients with asthma.

BACKGROUND: Inhaled corticosteroids have the potential to produce upper-airway side effects such as hoarseness. As new compounds and delivery devices are developed and compared, it is difficult to quantify their adverse upper-airway effects. OBJECTIVE: We undertook the following study to test the ability of an acoustic analysis technique to quantify changes in vocal function in steroid-naive patients with asthma who receive inhaled beclomethasone dipropionate (BDP), 1,000 microg/d for 4 months. METHODS: Patients self-administered one of four regimens of inhaled BDP. Group 1 patients received one 250-microg puff qid via metered-dose inhaler (MDI); group 2 patients received one 250-microg puff qid via MDI with a holding chamber; group 3 patients received two 250-microg puffs bid via MDI; and group 4 patients received two 250-microg puffs bid via MDI with a holding chamber. A smaller cohort of nonsmoking asthmatic patients was managed without steroid intervention for 4 months. At baseline and again at 8 weeks and 16 weeks after the initiation of BDP treatment, patients underwent spirometry and methacholine challenge. At baseline and again at 2, 4, 8, 12, and 16 weeks, patients underwent voice recording for analysis of voice parameters. The recorded vowels were low-pass filtered (10 KHz), digitized (22 KHz), and analyzed by software to obtain two acoustic measures: (1) jitter, the cycle-to-cycle variation in the time period of the voice signal; and (2) shimmer, the cycle-to-cycle variation in voice signal amplitude. RESULTS: We recruited 77 patients for randomization to inhaled steroid therapy and 10 patients who continued to receive only occasional inhaled bronchodilator therapy. In all active treatment groups, FEV(1), FVC, and provocative concentration of methacholine causing a 20% fall in FEV(1) improved significantly after BDP treatment. Mean jitter scores, a measurement of variation in voice pitch, were not significantly influenced by BDP treatment. However, mean shimmer scores, a reflection of perturbation in vocal amplitude, fell significantly (p < 0.05) in the active treatment groups. These reductions in shimmer scores were not significantly different in the active treatment groups. Shimmer scores in the bronchodilator-treated group were unchanged during the 16 weeks of follow-up. CONCLUSIONS: Our data show that a simple and noninvasive acoustic analysis of voice is sensitive to subclinical changes associated with inhaled corticosteroid therapy. We have shown that 1,000 microg/d of inhaled BDP actually improves specific acoustic measures of voice in patients with inadequately controlled asthma. These improvements were uninfluenced by dosing schedule and whether a spacing chamber was used.

Administration, Inhalation↗
PubMed2002

Vocal cord paralysis after surgery for thoracic aortic aneurysm.

OBJECTIVE: To determine the incidence, etiology, prognosis, and treatment of vocal cord paralysis (VCP) after surgery for thoracic aortic aneurysm (TAA). STUDY DESIGN: Retrospective study performed between 1989 and 1995. SETTING: Academic, tertiary care, referral medical center. PATIENTS: Seventy-one TAA patients underwent surgery at the Kameda Medical Center between 1989 and 1995. RESULTS: Sixty-two of 71 patients were examined postoperatively for voice quality. Twenty patients (32%) had hoarseness develop caused by VCP, as confirmed by laryngoscopy. The left recurrent laryngeal nerve had been sacrificed in 1 patient during surgery, but it was preserved in the remaining 19 patients. Unilateral left VCP was noted in 19 patients, and bilateral VCP occurred in 1 patient. The incidence of VCP was higher in those patients who underwent surgery for type I aneurysms (9 of 14 patients, 64%). In 16 of the 19 patients (84%) who received follow-up for > 6 months, vocal cord movement did not return to normal. Surgery to improve voice quality, arytenoid adduction in five patients and intracordal injection in two patients, was performed with success. CONCLUSIONS: Our results indicate that surgery for TAA is associated with a relatively high incidence of VCP. VCP occurred despite preservation of the recurrent laryngeal nerve, and the paralysis did not show a spontaneous recovery even 6 months after surgery.

Adult↗