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Feijen J, Verguts M, Van Gool K, Maryn Y, Bernaerts A, De Foer B, van Dinther JJS. Two Cases of Atraumatic Laryngeal Fractures. J Voice 2023; 37:973.e11-973.e14. [PMID: 34294489 DOI: 10.1016/j.jvoice.2021.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/20/2021] [Accepted: 05/21/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND AIM Atraumatic laryngeal fractures are extremely rare and are most commonly provoked by sneezing or coughing. Only seven cases have been described in medical literature, and only one case described a fracture after swallowing. We present two cases of atraumatic laryngeal fracture after swallowing. CASE REPORT A 37-year-old male presented to the outpatient ENT clinic with severe dysphonia and odynophagia. He reported feeling a crack in the throat after swallowing with a flexed head. The patient's physical examination showed diffuse swelling and tenderness over the thyroid cartilage without subcutaneous emphysema. Flexible nasolaryngoscopy showed a large right true vocal fold hematoma with normal vocal fold movement. Computed tomography (CT) showed a fracture of the thyroid. Treatment consisted of corticosteroids and pantoprazole. Two years later he presented again at the emergency department with extreme odynophagia after suffering a knee punch on the larynx. CT showed a new fracture line, slightly off midline to the left in the thyroid cartilage. A 42-year-old male presented at the emergency department with odynophagia, dysphonia, and fever after feeling a crack in the throat during forceful swallowing in an extended neck position. Physical examination demonstrated a painful thyroid cartilage with subcutaneous emphysema. Flexible nasolaryngoscopy was normal but CT scan showed a slightly displaced fracture line of the median thyroid cartilage. Complaints gradually disappeared with conservative treatment with corticosteroids and antibiotics. CONCLUSION Congenital anomalies by abnormal mineralization and ossification could lead to focal weakness of the thyroid cartilage and thus predispose to non-traumatic fractures. The double triad of odynophagia, dysphagia, and dysphonia after sneezing, coughing or swallowing should raise the physician's attention to the possibility of thyroid cartilage fracture, especially after feeling or hearing a crack. Further investigation is obligatory with high-resolution CT of the neck and examination by an ENT specialist.
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Affiliation(s)
- Jef Feijen
- European Institute for ORL-HNS, Department of ENT-HNS, Sint-Augustine's, GZA Hospital, Antwerp, Belgium.
| | - Monique Verguts
- European Institute for ORL-HNS, Department of ENT-HNS, Sint-Augustine's, GZA Hospital, Antwerp, Belgium; Departement of ENT, AZ Diest, Diest, Belgium
| | | | - Youri Maryn
- European Institute for ORL-HNS, Department of ENT-HNS, Sint-Augustine's, GZA Hospital, Antwerp, Belgium
| | - Anja Bernaerts
- Department of radiology, Sint-Augustin's GZA, Antwerp, Belgium
| | - Bert De Foer
- Department of radiology, Sint-Augustin's GZA, Antwerp, Belgium
| | - Joost J S van Dinther
- European Institute for ORL-HNS, Department of ENT-HNS, Sint-Augustine's, GZA Hospital, Antwerp, Belgium
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2
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Laryngeal injury in a coronavirus disease 2019 caregiver following voluntary cough-holding within an inappropriately sized personal protective equipment suit. J Laryngol Otol 2023; 137:342-349. [PMID: 35478067 PMCID: PMC9203418 DOI: 10.1017/s0022215122001025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To document laryngeal framework rupture following voluntary cough-holding as an airway complication of donning a personal protective equipment suit that was too small in size. METHODS Clinical record and literature review, with proposition of plausible aerodynamics of the airway injury. RESULTS Whilst carrying out his duty in the coronavirus disease ward, a resident attempted to stifle a paroxysm of cough when wearing a personal protective equipment suit that was too small with his neck flexed and restricted. There was a sudden release of pressure, intense pain and swelling in the neck with crepitus. Imaging revealed a non-displaced fracture in the lower end of the partially ossified right thyroid lamina, a cricothyroid membrane tear and subcutaneous emphysema. The symptoms resolved gradually on conservative management. CONCLUSION This report underlines the importance of donning appropriately sized personal protective equipment and encouraging its proper use amongst coronavirus disease 2019 caregivers. Non-traumatic laryngeal injury, itself a rare event, has never been reported as a posture-related complication of wearing personal protective equipment.
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3
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Sbeih F, Tierney WS, Bryson PC, Kominsky AH. Considerations and Management of a Laryngeal Fracture after Sneezing. Am J Otolaryngol 2021; 42:103036. [PMID: 33873050 DOI: 10.1016/j.amjoto.2021.103036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 04/05/2021] [Indexed: 10/21/2022]
Abstract
Non-traumatic laryngeal fracture is uncommon but should be suspected whenever patients present with dysphonia, odynophagia, dysphagia, neck crepitus, or hemoptysis following a sneeze or coughing episode. Physical examination coupled with computed tomography is essential for making the diagnosis. Management can vary depending on the severity of the case, but the general approach is similar to any trauma. In this report, we describe a non-traumatic laryngeal fracture that occurred following a forceful sneeze. The case was notable for the presence of pneumomediastinum, independent mobility of the thyroid ala, and operative intervention was pursued to repair the fracture.
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Khalid N, Bilal M, Umer M. Non-Traumatic Laryngeal Fractures: A Systematic Review. Turk Arch Otorhinolaryngol 2021; 59:65-75. [PMID: 33912863 PMCID: PMC8054934 DOI: 10.4274/tao.2020.6093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 12/27/2020] [Indexed: 12/01/2022] Open
Abstract
Non-traumatic laryngeal fractures are an extremely uncommon presentation, and the diagnosis can be missed. Recognizing these fractures is important to appropriately direct management because most have a good prognosis and result in complete recovery. This article aimed to review the characteristics of all documented cases of non-traumatic fractures of the larynx. We sought to address questions related to the etiology, clinical presentation, and diagnostic assessment of this condition and provide recommendations about the management of these fractures. Electronic databases, mainly PubMed and Google Scholar, were searched for relevant literature with no language or time restrictions. Since 1950, 15 cases of non-traumatic laryngeal fractures have been documented in the medical literature. Out of these, thyroid cartilage fractures have been described in 14 patients, while only one instance demonstrated a fracture in the cricoid cartilage. Patients were managed conservatively using voice rest and observation with complete recovery in all cases. All patients who present with odynophagia, hoarseness, and tenderness over the thyroid cartilage after an episode of severe coughing or sneezing, should be evaluated for a thyroid cartilage fracture using laryngoscopy and computed tomography scan. Management of the airway should be the primary priority in any laryngeal injury, and further management performed after the airway is stable.
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Affiliation(s)
- Noor Khalid
- Department of Otorhinolaryngology, Rawalpindi Medical University, Rawalpindi, Pakistan
| | - Muhammad Bilal
- Department of Otorhinolaryngology, Foundation University Medical College, Islamabad, Pakistan
| | - Muhammad Umer
- Department of Otorhinolaryngology, Army Medical College, Rawalpindi, Pakistan
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Tsur N, Amitai N, Shoffel-Havakuk H, Abuhasira S, Hamzany Y. Forceful sneeze: An uncommon cause of laryngeal fracture. Radiol Case Rep 2021; 16:742-743. [PMID: 33520044 PMCID: PMC7820294 DOI: 10.1016/j.radcr.2021.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 12/31/2020] [Accepted: 01/02/2021] [Indexed: 01/29/2023] Open
Abstract
Laryngeal fractures are generally induced by direct blunt or penetrating trauma to the neck. Coughing vigorously or sneezing forcefully is extremely rare causes of laryngeal fractures, with only 4 cases found after thorough literature search. Herein we present a case of a 34-year-old male presenting to the ENT emergency room with throat pain, odynophagia, dysphagia, and hoarseness. Following primary evaluation, through physical examination and imaging he was diagnosed with thyroid cartilage fracture and treated conservatively. The triad of odynophagia, dysphagia, and dysphonia after a severe episode of coughing or sneezing in a young adult male patient should prompt suspicion of a laryngeal fracture.
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Affiliation(s)
- Nir Tsur
- Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Nimrod Amitai
- Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Hagit Shoffel-Havakuk
- Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Shlomi Abuhasira
- Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petach Tikva, Israel
| | - Yaniv Hamzany
- Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Balai E, Bhamra N, Gupta KK, Jolly K, Barraclough J. A Case of Laryngeal Fracture Precipitated by Swallowing. Cureus 2020; 12:e10303. [PMID: 33052266 PMCID: PMC7544551 DOI: 10.7759/cureus.10303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
We report the case of a non-traumatic laryngeal fracture precipitated by swallowing where the symptoms were initially misinterpreted as representing a possible laryngeal malignancy. By the time of diagnosis, the injury was associated with an anterior neck abscess that required urgent surgical intervention. A 61-year-old male presented with dysphonia, odynophagia and neck swelling that had begun shortly after feeling a sudden crack in his neck upon swallowing. This was initially suspected to represent a laryngeal malignancy until, while awaiting outpatient investigation, the patient re-presented with rapid progression of his symptoms. Urgent CT scan revealed a vertical fracture of the thyroid cartilage, and a large anterior neck abscess causing posterior displacement. This required urgent surgical drainage. No underlying neoplasm was found, and the patient made a full recovery with complete resolution of symptoms. Non-traumatic laryngeal fractures are extremely rare. This case demonstrates the diagnostic challenge they can pose and is the first to describe the presentation and surgical management of a case with fracture displacement due to localised infection.
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Affiliation(s)
- Edward Balai
- Department of Otolaryngology, The Royal Wolverhampton NHS Trust, Birmingham, GBR
| | - Navdeep Bhamra
- Department of Otolaryngology, The Royal Wolverhampton NHS Trust, Birmingham, GBR
| | - Keshav K Gupta
- Department of Otolaryngology, The Royal Wolverhampton NHS Trust, Birmingham, GBR
| | - Karan Jolly
- Department of Otolaryngology, The Royal Wolverhampton NHS Trust, Birmingham, GBR
| | - James Barraclough
- Department of Otolaryngology, The Royal Wolverhampton NHS Trust, Birmingham, GBR
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Ateş MS, Turhal G, Aysel A, Durusoy D, Öztürk K. A Case with Thyroid Cartilage Fracture after Sneezing. Turk Arch Otorhinolaryngol 2020; 58:197-199. [PMID: 33145506 DOI: 10.5152/tao.2020.5306] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 05/19/2020] [Indexed: 11/22/2022] Open
Abstract
Non-traumatic laryngeal injuries are unusual occasions. In the medical literature we found only six reports of cases that had laryngeal injury after sneezing. We report a case of a 34-year-old man diagnosed with thyroid cartilage fracture after a strong sneeze. In physical examination, edema and hematoma were seen in the right vocal cord and the right band. Computed tomography scan revealed an anterior thyroid cartilage fracture without separation. Antibiotics and steroids were administered. This is a very rare entity and the seventh case reported in the literature. Ear Nose Throat specialist should be aware of this situation.
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Affiliation(s)
- Murat Samet Ateş
- Department of Otorhinolaryngology, Ege University School of Medicine, İzmir, Turkey
| | - Göksel Turhal
- Department of Otorhinolaryngology, Ege University School of Medicine, İzmir, Turkey
| | - Abdulhalim Aysel
- Department of Otorhinolaryngology, University of Health Science, Bozyaka Training and Research Hospital, İzmir, Turkey
| | - Duygu Durusoy
- Department of Otorhinolaryngology, Ege University School of Medicine, İzmir, Turkey
| | - Kerem Öztürk
- Department of Otorhinolaryngology, Ege University School of Medicine, İzmir, Turkey
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Irwin RS, Dudiki N, French CL. Life-Threatening and Non-Life-Threatening Complications Associated With Coughing: A Scoping Review. Chest 2020; 158:2058-2073. [PMID: 32565267 DOI: 10.1016/j.chest.2020.06.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/08/2020] [Accepted: 06/10/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND This is an update of the section on complications that are associated with coughing in the 2006 CHEST cough guidelines that addresses two aims: (1) to systematically identify and thematically categorize the diverse complications of cough by providing a guide for future studies and (2) to identify gaps in the literature for future research. RESEARCH QUESTION What are the potential complications that are associated with the act of coughing that have been reported in infants, children, adolescents, and adults? STUDY DESIGN AND METHODS A scoping review was performed with the use of PubMed and SCOPUS databases that were searched from their beginning until September 6, 2019. RESULTS Two hundred forty-seven publications met our inclusion criteria. To these, we added 38 articles from the 2006 complications paper that were not identified in the literature search plus the paper itself for a final total of 286 publications that formed the basis of this review. Since 2006, three new categories of complications have been reported: ear, nose and throat; disease transmission; and laboratory testing. Multiple additional complications that fall outside of these three categories have also been identified and included in the following categories: cardiovascular, constitutional symptoms, dermatologic, GI, genitourinary, musculoskeletal, neurologic, ophthalmologic, psychosocial/quality of life, and respiratory. Not previously highlighted is that some of the complications led to serious morbidity that included death, especially in patients with comorbid conditions, and potentially resulted in harm to others when cough resulted in a motor vehicle accident. INTERPRETATION Our work identified a large number of cough complications that we thematically categorized primarily by organ system so that future studies of each system or each complication can be conducted. The gap in the literature that future studies should address is to identify the frequency of the complications and the strength of their association with cough. Only then will one be able to describe the findings in a manner that allows specific recommendations for avoiding these complications. In the meantime, patients with cough should be evaluated and treated according to evidence-based guidelines to mitigate or prevent the myriad of potential complications that are associated with coughing.
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Affiliation(s)
- Richard S Irwin
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Massachusetts Medical School, Worcester, MA.
| | - Natasha Dudiki
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Massachusetts Medical School, Worcester, MA
| | - Cynthia L French
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Massachusetts Medical School, Worcester, MA
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- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Massachusetts Medical School, Worcester, MA
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Matsuo Y, Yamada T, Hiraoka E. Unique presentation of cricoid cartilage fracture causing intermittent dyspnea without preceding trauma. NAGOYA JOURNAL OF MEDICAL SCIENCE 2020; 81:687-691. [PMID: 31849386 PMCID: PMC6892678 DOI: 10.18999/nagjms.81.4.687] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Cricoid cartilage fracture is generally caused by significant neck trauma and causes continuous dyspnea, neck pain, or hoarseness developing immediately after the traumatic episode. A 69-year-old woman without any history of trauma was admitted to our hospital with intermittent dyspnea. Six months before admission she had started to complain of dyspnea occurring several times a month without warning, improving spontaneously within a few hours without treatment. Her primary care doctor diagnosed asthma and she was treated with inhaled short-acting beta agonists and glucocorticoids, without improvement. On initial evaluation at our hospital, the cause of dyspnea was unclear. Laryngoscopy was performed, which excluded vocal cord dysfunction. A further attack of dyspnea occurred on the fourth admission day. Stridor was evident during the attack, and bronchoscopy revealed subglottic narrowing of the trachea on both inspiration and expiration with no mass or foreign objects. Computed tomography (CT) of the neck revealed cricoid cartilage fracture causing airway narrowing and dyspnea. She was orally intubated, and tracheostomy was performed 2 weeks later to maintain her airway, which resolved her dyspnea. This patient's presentation was unique in two aspects. First, there was no history of trauma that may cause her cricoid cartilage fracture. Second, her symptoms of dyspnea were intermittent rather than continuous. These aspects led to suspicions of other diseases such as asthma or vocal cord dysfunction, thus delaying the diagnosis. Cricoid cartilage fracture should be considered in patients with dyspnea of unknown cause, irrespective of continuous or intermittent symptoms and preceding traumatic episodes.
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Affiliation(s)
- Yuichiro Matsuo
- Department of Internal Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan
| | - Toru Yamada
- Department of Internal Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan.,Department of General Medicine/Family and Community Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Eiji Hiraoka
- Department of Internal Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan
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Byrne B, Tillman R, Johansson M. Laryngeal Fracture After a Stifled Sneeze: A Case Report. J Emerg Med 2020; 58:e97-e98. [DOI: 10.1016/j.jemermed.2019.11.047] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 10/30/2019] [Accepted: 11/15/2019] [Indexed: 11/26/2022]
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Nontraumatic Laryngeal Fractures: Report of Two Cases and Review of the Literature. Case Rep Otolaryngol 2017; 2017:2153521. [PMID: 28487801 PMCID: PMC5401724 DOI: 10.1155/2017/2153521] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 03/21/2017] [Indexed: 11/18/2022] Open
Abstract
Laryngeal fractures occur mainly in the context of cervical trauma, hanging, or strangulation. Nontraumatic laryngeal fractures are rare and there are few reports in the literature. We present two cases of nontraumatic laryngeal fractures evaluated in our service.
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