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Ibrahim Y, Young K, Gane J, Judd O. A woman with recurrent spontaneous throat swelling. BMJ 2024; 385:e078481. [PMID: 38724082 DOI: 10.1136/bmj-2023-078481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/14/2024]
Affiliation(s)
- Yousef Ibrahim
- Ear, Nose, and Throat Department, Royal Derby Hospital, Derby, UK
| | - Kate Young
- Ear, Nose, and Throat Department, Royal Derby Hospital, Derby, UK
| | - Jennie Gane
- Respiratory Department, Royal Derby Hospital, Derby, UK
| | - Owen Judd
- Ear, Nose, and Throat Department, Royal Derby Hospital, Derby, UK
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2
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Waldron JL, Glennon CM, Kroshinsky DA, Khan DA, Wolfson AR. Drug Allergy Mimics. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:1122-1129.e1. [PMID: 38325764 DOI: 10.1016/j.jaip.2024.01.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 01/10/2024] [Accepted: 01/29/2024] [Indexed: 02/09/2024]
Abstract
When approaching a case of apparent drug allergy, the consulting clinician should consider a broad differential diagnosis. This article presents a series of cases that could be commonly referred to an allergist for assessment as "drug allergy," however, a real diagnosis exists that mandates a different diagnostic and treatment strategy, including a case of inducible laryngeal obstruction, multiple drug intolerance syndrome, viral rash, seizure due to metastatic malignancy, and hemophagocytic lymphohistiocytosis initially diagnosed as drug reaction and eosinophilia with systemic symptoms. The initial misdiagnoses of these patients delayed or interfered with their medical care, emphasizing the importance of accurate diagnoses for the benefit of our patients.
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Affiliation(s)
- Jamie L Waldron
- Harvard Medical School, Boston, Mass; Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass; Massachusetts General Physicians Organization, Massachusetts General Hospital, Boston, Mass
| | - Colleen M Glennon
- Department of Dermatology, Duke University Medical Center, Durham, NC
| | | | - David A Khan
- Department of Internal Medicine, Division of Allergy & Immunology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Anna R Wolfson
- Harvard Medical School, Boston, Mass; Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass; Massachusetts General Physicians Organization, Massachusetts General Hospital, Boston, Mass.
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3
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Hou L, Gong Y, Zhu L. Gerhardt's syndrome misdiagnosed as asthma. Lung India 2024; 41:218-220. [PMID: 38687234 DOI: 10.4103/lungindia.lungindia_521_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 02/23/2024] [Indexed: 05/02/2024] Open
Affiliation(s)
- Lili Hou
- Department of Critical and Pulmonary Medicine, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
- Department of Critical and Pulmonary Medicine, Shanghai General Hospital-Jiuquan Hospital, Shanghai Jiao Tong University, Gansu, China
| | - Ying Gong
- Department of Critical and Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lei Zhu
- Department of Critical and Pulmonary Medicine, Huadong Hospital, Fudan University, 221 West Yan'an Road, Shanghai, China
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4
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Sundar KM, Stark A, Morris MJ. Laryngeal Dysfunction Manifesting as Chronic Refractory Cough and Dyspnea: Laryngeal Physiology in Respiratory Health and Disease. Chest 2024:S0012-3692(24)00396-9. [PMID: 38508333 DOI: 10.1016/j.chest.2024.03.026] [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: 11/15/2023] [Revised: 03/10/2024] [Accepted: 03/12/2024] [Indexed: 03/22/2024] Open
Abstract
TOPIC IMPORTANCE Laryngeal dysfunction as a cause of chronic refractory cough (CRC) and episodic dyspnea is often missed, which results in unnecessary testing and delays in diagnosis. Understanding laryngeal roles in breathing and airway protection can help to appreciate the propensity to laryngeal dysfunction with aging, chronic lung disease, and sleep apnea. REVIEW FINDINGS The human larynx is a complex muscular structure that is responsible for multiple roles of breathing, vocalization, coughing, and swallowing. To undertake these activities, the larynx has a high density of sensory and motor innervation. In addition to common embryological origins with the pharynx and esophagus, with which many laryngeal activities are shared, somatomotor and autonomic pathways regulate emotional, cognitive, and complex motor sequence-planning activities within the larynx. Due to its unique location, the larynx is susceptible to infectious and gastroesophageal reflux-related insults. Couple this with key roles in regulation of airflow and mediation of airway protective reflexes, it is not surprising that neuropathic abnormalities and muscle dysfunction frequently develop. The expression of laryngeal dysfunction as hypersensitivity to mechanical, thermal, chemical, and other stimuli leads to exaggerated airway protective reflexes (laryngeal adductor reflex and cough reflex) manifesting as dyspnea and cough. SUMMARY Pulmonologists should incorporate assessment of laryngeal dysfunction during evaluation of CRC and dyspnea. Recognition of laryngeal hypersensitivity in patient with CRC can identify patients who may benefit from cough suppression therapies. Similarly, timely identification of inducible laryngeal obstruction may not only resolve episodic dyspnea but lessen the need for unnecessary testing and treatments.
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Affiliation(s)
- Krishna M Sundar
- Division of Pulmonary and Critical Care Medicine, University of Utah, Salt Lake City, UT.
| | - Amanda Stark
- Department of Otolaryngology & Voice Disorders Center, University of Utah, Salt Lake City, UT
| | - Michael J Morris
- Pulmonary & Critical Care Service, Brooke Army Medical Center, JBSA Fort Sam Houston, TX
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Ntoumenopoulos G, Andersen T, Hardingham NM. Upper airway assessment and its implications for interventions by respiratory physiotherapists. Physiother Theory Pract 2024; 40:184-189. [PMID: 35904123 DOI: 10.1080/09593985.2022.2106916] [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: 12/29/2021] [Accepted: 07/16/2022] [Indexed: 10/16/2022]
Abstract
BACKGROUND When noninvasive interventions such as chest physiotherapy fail, then more aggressive interventions for airway secretion clearance with nasotracheal airway suctioning may be required. Clinicians however have to insert the nasotracheal suction catheter "blindly" and the success of being able to trigger a cough and pass through the vocal folds with a suction catheter is low. CASE DESCRIPTION The patient, a 48-year-old male underwent a heart and lung transplant. Following extubation, the patient developed secretion retention with a weak ineffective cough and swallow and required physiotherapy interventions with frequent "blind" passes of nasotracheal suctioning. OUTCOMES The patient required nasotracheal suction with frequent multiple failed attempts before successful passage of the suction catheter to trigger a cough reflex and clear secretions. A combined physiotherapist and speech and language therapist intervention during fiberoptic endoscopic evaluation of swallow (FEES) was recorded to both evaluate swallow and passage of the suction catheter. The video illustrated the successful passage of a suctioning catheter through the vocal folds leading to an effective cough and airway clearance. DISCUSSION We present a case report demonstrating that it is feasible to visualize the upper airways during nasotracheal suctioning as an objective means to guide the more accurate successful insertion of the suction catheter past the vocal folds. Rather than "blind" placement of nasotracheal suction catheters visualization using transnasal laryngoscopy should be useful to increase chances of passing through the vocal folds.
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Affiliation(s)
| | - Tiina Andersen
- Norwegian Centre of Excellence for Home Mechanical Ventilation, Thoracic Department, Haukeland University Hospital, Bergen, Norway
| | - Nicola M Hardingham
- Speech Pathology Department, St Vincent's Hospital, Sydney, Australia
- School of Health and Rehabilitation Sciences, University of Queensland, St Lucia, Australia
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6
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Brodsky MB, Friedman LA, Colantuoni E, Pandian V, Vertigan AE, Needham DM, Chan KS. Instrument adaptation and preliminary validation study of the Laryngeal Hypersensitivity Questionnaire used for assessment of laryngeal symptoms in patients with artificial airways. Aust Crit Care 2024; 37:138-143. [PMID: 38135588 PMCID: PMC10842835 DOI: 10.1016/j.aucc.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 01/22/2023] [Accepted: 09/05/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND The Newcastle Laryngeal Hypersensitivity Questionnaire (LHQ) was developed to measure abnormal laryngeal sensation and was originally validated in a patient sample from otolaryngologic and respiratory outpatient clinics. Modification is needed for patients who are mechanically ventilated via an endotracheal tube or a tracheostomy tube. OBJECTIVES We sought to adapt and preliminarily validate a modified version of the LHQ appropriate for nurses and other clinicians to administer in acute hospital settings called the LHQ-Acute (LHQ-A). METHODS Internal consistency and construct validity analyses using secondary data from patients at a tertiary teaching hospital who presented with symptoms of laryngeal irritability/hypersensitivity between September 2012 and October 2013 were performed. RESULTS A total of 131 patients, most complaining of coughing and dysphonia, with a median age of 58 (interquartile range: 48, 66) years and 29 healthy participants with a median age of 62 (interquartile range: 50, 66) years were analysed. The original LHQ was reduced from 14 questions with responses on a 7-point scale to the LHQ-A containing 13 questions with responses on a 4-point scale. Correlations between items of the LHQ and LHQ-A were similar, and internal consistency was excellent and highly comparable, with Cronbach's alpha = 0.906 and 0.902, respectively. CONCLUSIONS The LHQ-A, which has been adapted for nurses and other clinicians to administer to a critically ill patient population, demonstrated comparable reliability and validity to the original LHQ. Validation of the LHQ-A in independent patient populations from acute settings is necessary to better understand norms and changes during recovery from acute illness.
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Affiliation(s)
- Martin B Brodsky
- Speech-Language Pathology, Head and Neck Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, USA; Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA; Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, MD, USA.
| | - Lisa Aronson Friedman
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA; Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, MD, USA.
| | - Elizabeth Colantuoni
- Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, MD, USA; Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
| | - Vinciya Pandian
- Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, MD, USA; Center for Immersive Learning and Digital Innovation, Johns Hopkins University School of Nursing, Baltimore, MD, USA.
| | - Anne E Vertigan
- Speech Pathology Department, Hunter Medical Research Institute, John Hunter Hospital, Newcastle, NSW, Australia; School of Medicine and Public Health, University of Newcastle, Newcastle, Australia.
| | - Dale M Needham
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, USA; Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA; Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, MD, USA; Center for Immersive Learning and Digital Innovation, Johns Hopkins University School of Nursing, Baltimore, MD, USA.
| | - Kitty S Chan
- MedStar-Georgetown Surgical Outcomes Research, Hyattsville, MD, USA.
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Fernandes P, Siembida F, Monla-Hassan J, Bitetto D. Recognizing Vocal Cord Dysfunction: Exercising Caution Before Intubation. Cureus 2023; 15:e46551. [PMID: 37933370 PMCID: PMC10625500 DOI: 10.7759/cureus.46551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2023] [Indexed: 11/08/2023] Open
Abstract
Vocal cord dysfunction (VCD) is the inappropriate adduction of the vocal cords during inhalation and sometimes, exhalation. Vocal cord dysfunction is often misdiagnosed in the emergency room as asthma exacerbation or laryngeal angioedema, leading to unnecessary and potentially harmful interventions including intubation and mechanical ventilation. Based on this, it is especially important to recognize this condition early to avoid intubation, which can further worsen VCD. This case presents a 74-year-old female with a history of hypertension and colon cancer who presented to the emergency department (ED) with respiratory distress associated with stridor and wheezing. Our literature review sheds light on identifying key clinical features, physical exam findings, diagnostic tests, existing treatment options for this condition, and preventive measures to minimize its occurrence.
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Affiliation(s)
- Pamela Fernandes
- Internal Medicine, Transitional Year Resident Program, Einstein Medical Center Montgomery, East Norriton, USA
| | - Filip Siembida
- Medicine, Transitional Year Resident Program, Einstein Medical Center Montgomery, East Norriton, USA
| | - Jaber Monla-Hassan
- Pulmonology and Critical Care, Einstein Medical Center Montgomery, East Norriton, USA
| | - Daniel Bitetto
- Hospital Medicine, Einstein Medical Center Montgomery, East Norriton, USA
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Ludlow S, Daly R, Elsey L, Hope H, Sheehan R, Fowler SJ. Multidisciplinary management of inducible laryngeal obstruction and breathing pattern disorder. Breathe (Sheff) 2023; 19:230088. [PMID: 37830100 PMCID: PMC10567073 DOI: 10.1183/20734735.0088-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 08/13/2023] [Indexed: 10/14/2023] Open
Abstract
We provide an overview of the assessment and management of inducible laryngeal obstruction and breathing pattern disorder. We highlight the multidisciplinary team members involved and their essential roles within a complex breathlessness service. We discuss treatments initiated by physiotherapy and speech and language therapy, the importance of joint working, and discuss the high incidence of comorbidities and the association with other respiratory disorders. Educational aims Inducible laryngeal obstruction and breathing pattern disorder are common causes of breathlessness.Inducible laryngeal obstruction is an inappropriate, transient, reversible narrowing of the laryngeal area that causes breathlessness and laryngeal symptoms.Breathing pattern disorder is an alteration in the normal biomechanical patterns of breathing that results in intermittent or chronic symptoms, which may be respiratory and/or non-respiratory.People with inducible laryngeal obstruction or breathing pattern disorder often have other comorbidities that will also need addressing.Multidisciplinary assessment and treatment is essential for comprehensive workup and holistic care.Timely assessment and diagnosis can prevent unnecessary medication use and hospital admissions and facilitate effective management of the condition using reassurance, advice, education, breathing retraining and vocal exercises.
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Affiliation(s)
- Siobhan Ludlow
- Manchester University Hospitals NHS Foundation Trust, Manchester, UK
- Division of Psychology and Mental Health, Medical Education, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Rachel Daly
- Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Lynn Elsey
- Manchester University Hospitals NHS Foundation Trust, Manchester, UK
- Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Helen Hope
- Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Reyenna Sheehan
- Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Stephen J. Fowler
- Manchester University Hospitals NHS Foundation Trust, Manchester, UK
- Division of Immunology, Immunity to Infection and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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Kumaresan T, Thomas M, Uppal PA, Setzen S, Brar S, Yalamanchili A, Panse D, Rodriguez RC, Suarez B, Kayajian D, Mortensen M. Predictors of voice therapy efficacy in vocal cord dysfunction at a tertiary care center. Am J Otolaryngol 2023; 44:103882. [PMID: 37031521 DOI: 10.1016/j.amjoto.2023.103882] [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: 01/17/2023] [Revised: 03/28/2023] [Accepted: 04/01/2023] [Indexed: 04/11/2023]
Abstract
OBJECTIVE Vocal cord dysfunction is inappropriate adduction of vocal cords during inspiration that causes dyspnea and is commonly mistaken for exercise-induced asthma. To improve diagnostic accuracy, this study aims to identify demographics associated with vocal cord dysfunction and to determine their impact on the efficacy of voice therapy in improving vocal cord function. STUDY DESIGN Retrospective chart review. SETTING Single tertiary care institution between January 2015 and December 2021. METHODS 184 patients who underwent voice therapy for vocal cord dysfunction were included. The primary outcome was patient self-reported percent improvement of symptoms. The secondary outcome was number of voice therapy treatments. RESULTS The mean duration of symptoms was 2 ± 3 years. The mean number of voice therapy treatments was 2.2 ± 1.5. Of the 107 (58.2 %) patients with documented perceived breathing improvement percentages recorded, the mean maximal percent improvement was 72.5 ± 21.5 %. Mean maximal percent improvement of symptoms increased with each voice therapy treatment (p = 0.01). This association remained significant when controlling for comorbid conditions such as allergic rhinitis with postnasal drip, anxiety, asthma, and gastroesophageal reflux disease in multivariate analysis (p = 0.005). Patients with asthma had significantly higher maximum percent breathing improvement compared to those without asthma (p = 0.026). Similarly, patients who played sports had significantly higher maximum percent breathing improvement compared to those who did not (p = 0.022). CONCLUSION Patient perceived breathing improvement with voice therapy is higher among those with concomitant asthma and those who play sports. Voice therapy is a safe and effective first line treatment of vocal cord dysfunction even when controlling for comorbid conditions.
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Affiliation(s)
| | - Melissa Thomas
- Albany Medical College, Albany, NY, United States of America
| | - Priya A Uppal
- Albany Medical College, Albany, NY, United States of America
| | - Sean Setzen
- Albany Medical College, Albany, NY, United States of America
| | - Simran Brar
- Albany Medical College, Albany, NY, United States of America
| | | | - Drishti Panse
- Albany Medical College, Albany, NY, United States of America
| | - Rafael Cardona Rodriguez
- Department of Otolaryngology and Head-Neck Surgery, Albany Medical Center, Albany, NY, United States of America
| | - Bethzaida Suarez
- Department of Otolaryngology and Head-Neck Surgery, Albany Medical Center, Albany, NY, United States of America
| | - Daniel Kayajian
- Department of Otolaryngology and Head-Neck Surgery, Albany Medical Center, Albany, NY, United States of America
| | - Melissa Mortensen
- Department of Otolaryngology and Head-Neck Surgery, Albany Medical Center, Albany, NY, United States of America.
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10
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Mendez EM. Angiomyomatous hamartoma of subglottic tracheal wall in a 12-year-old adolescent: a case report. J Med Case Rep 2022; 16:1. [PMID: 35034627 PMCID: PMC8762876 DOI: 10.1186/s13256-021-03218-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 12/03/2021] [Indexed: 11/30/2022] Open
Abstract
Background Allergic rhinitis is the most common allergic disease encountered in a primary care setting. Diagnosis is often made clinically based on response to empiric therapy. However, with long-term treatment failure and/or atypical disease presentation, a differential diagnosis should be considered. The following is a report of an unusual and rare presentation of a subglottic tracheal angiomyomatous hamartoma in an adolescent, treated for many years as allergic rhinoconjunctivitis and asthma. Case presentation A 12-year-old Caucasian was referred to the allergy clinic with a lifetime history of bronchospasms and rhinoconjunctivitis symptoms, treated for many years for asthma and environmental allergies. Cough, posterior nasal drainage, self-described “choking on phlegm,” and a sensation of “a flap in the throat,”, worsened 5 months prior to the initial evaluation. Puncture skin testing for common environmental allergens was negative. Spirometry, performed due to history of chronic cough, showed blunting of the forced expiratory phase. A chest X-ray, immediately ordered to rule out possible extrapulmonary obstruction, showed bilateral bibasilar infiltrates. A noncontrast computerized tomographic scan of the chest, ordered to further elucidate X-ray findings, revealed a subglottic tracheal mass. Following a subsequent transfer and admission to a tertiary hospital center, microlaryngoscopy, bronchoscopy, and microsuspension laryngoscopy were performed to remove the tracheal mass. Pathology confirmed squamous mucosa with polypoid angiomyomatous changes and chronic inflammatory features consistent with angiomyomatous hamartoma. Surgical intervention was successful, and follow-up 1 year postoperatively revealed a healthy, asymptomatic adolescent child with normal lung function. Conclusions Although posterior nasal drainage and cough are typical presenting symptoms in the general patient population, they may be clinically impactful as they could disguise more serious medical conditions. A detailed history and careful physical examination may provide a high index of suspicion of disease, and can help work the differential diagnosis. This case presentation is the first documentation of subglottic hamartoma reported in the pediatric literature with clinical manifestation of environmental allergy and asthma symptoms. Supplementary Information The online version contains supplementary material available at 10.1186/s13256-021-03218-1.
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Affiliation(s)
- Elvin M Mendez
- Medical Director of Academics, Clinical Research and Precision Medicine, Lee Physicians Group, Lee Health, 9800 S. HealthPark Drive, Suite 200, Fort Myers, FL, 33908, USA.
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Ronco L, Folino A, Goia M, Crida B, Esposito I, Bignamini E. Do not forget asthma comorbidities in pediatric severe asthma! Front Pediatr 2022; 10:932366. [PMID: 35967579 PMCID: PMC9372496 DOI: 10.3389/fped.2022.932366] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 06/28/2022] [Indexed: 11/18/2022] Open
Abstract
Asthma is the most common chronic respiratory disease in childhood. The long-term goals in managing asthma aim to control symptoms and prevent exacerbations, as well as to reduce side effects of therapy and mortality disease-related. Most of patients have mild to moderate asthma and respond well to standard therapies. However, a minor proportion of children with asthma has severe disease that remains uncontrolled despite optimal adherence to prescribed therapy and treatment of contributory factors, including trigger exposures and comorbidities, which can mimic or worsen asthma and contribute to exacerbations and poor quality of life. Evaluation of comorbidities is fundamental to optimize the management of the disease in a subgroup of patients with poor responder asthma. The overall aim of this article is to describe characteristics of main pediatric severe asthma comorbidities reported in literature, giving clinicians tools to recognize and manage properly these conditions.
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Affiliation(s)
- Lucia Ronco
- Department of Pediatric Science, School of Medicine, University of Turin, Turin, Italy
| | - Anna Folino
- Department of Surgical Science, University of Turin, Turin, Italy
| | - Manuela Goia
- Pediatric Pulmonology Unit, Regina Margherita Children Hospital, AOU Cittá Della Salute e Della Scienza, Turin, Italy
| | - Benedetta Crida
- Pediatric Pulmonology Unit, Regina Margherita Children Hospital, AOU Cittá Della Salute e Della Scienza, Turin, Italy
| | - Irene Esposito
- Pediatric Pulmonology Unit, Regina Margherita Children Hospital, AOU Cittá Della Salute e Della Scienza, Turin, Italy
| | - Elisabetta Bignamini
- Pediatric Pulmonology Unit, Regina Margherita Children Hospital, AOU Cittá Della Salute e Della Scienza, Turin, Italy
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Vertigan AE, Bone SL, Gibson PG. The Impact of Functional Laryngoscopy on the Diagnosis of Laryngeal Hypersensitivity Syndromes. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 10:597-601.e1. [PMID: 34666207 DOI: 10.1016/j.jaip.2021.10.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/09/2021] [Accepted: 10/11/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Chronic cough and vocal cord dysfunction are manifestations of laryngeal hypersensitivity syndrome. OBJECTIVE The aim of the study was to determine the clinical utility of functional transnasal laryngoscopy in patients with laryngeal hypersensitivity syndromes. METHODS This study was a prospective observational cross-sectional study design of 71 participants with laryngeal hypersensitivity syndrome referred for functional transnasal laryngoscopy. Participants had a clinical assessment with a speech pathologist after which a provisional diagnosis of chronic cough, suspected vocal cord dysfunction, suspected muscle tension dysphonia, or a combination was made. A laryngoscopy with provocation was performed and the diagnosis revised after which the provisional and revised diagnoses were compared. RESULTS The diagnosis changed in 67% of participants after laryngoscopy. Vocal cord dysfunction was diagnosed in an additional 17 cases when not expected clinically but discounted when suspected clinically in 12 participants. Muscle tension dysphonia was diagnosed in an additional 31 cases when not suspected clinically and not confirmed when suspected in 2. CONCLUSION This study demonstrated that conditions such as muscle tension dysphonia and vocal cord dysfunction cannot be diagnosed based on symptoms alone. In addition to diagnostic accuracy, functional laryngoscopy enhances treatment planning and provides immediate feedback regarding laryngeal movement during respiration and phonation.
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Affiliation(s)
- Anne E Vertigan
- Speech Pathology Department, John Hunter Hospital, Newcastle, NSW, Australia; Priority Centre for Healthy Lungs, Hunter Medical Research Institute, Newcastle, NSW, Australia; School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia.
| | - Sarah L Bone
- Speech Pathology Department, John Hunter Hospital, Newcastle, NSW, Australia
| | - Peter G Gibson
- Priority Centre for Healthy Lungs, Hunter Medical Research Institute, Newcastle, NSW, Australia; School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia; Department of Respiratory & Sleep Medicine, John Hunter Hospital, Newcastle, NSW, Australia
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