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Thougaard J, Pedersen L, Walsted E. Feasibility of Constant Work Rate Testing to Detect Exercise-Induced Laryngeal Obstruction. Med Sci Sports Exerc 2024; 56:427-434. [PMID: 38356163 DOI: 10.1249/mss.0000000000003319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
INTRODUCTION Exercise-induced laryngeal obstruction (EILO) is a condition in which laryngeal structures inappropriately obstruct the upper airway during exercise. The standard diagnostic test for EILO is the continuous laryngoscopy during exercise (CLE) test, usually performed with an incremental work rate protocol regardless of the nature of the triggering event. Typically, laryngeal obstruction occurs only briefly at the end of an incremental test, near peak work capacity. We aimed to investigate constant work rate (CWR) protocols for CLE testing to expand diagnostic test modalities and improve the understanding of EILO. METHODS In this prospective, self-controlled feasibility study, 10 patients with EILO performed both an incremental and a CWR CLE test at 70%, 80%, and 90% of maximal exercise capacity. Laryngoscopic video data were recorded and compared, and we evaluated the ability of CWR to reproduce the symptoms and laryngeal obstruction seen in incremental testing. RESULTS In 70%-90% of cases, CWR testing induced at least the same severity of obstruction as incremental testing and CLE scores remained comparable across test modalities. CWR at 70% allowed observation of laryngeal obstruction for a significantly longer duration than in incremental testing (158 s; 95% confidence interval, 25-291 s; P = 0.027). Dyspnea intensity appeared higher during CWR testing compared with incremental testing. CONCLUSIONS Submaximal CWR CLE testing is feasible and able to induce EILO equivalent to the standard incremental CLE test. This is the first step toward tailored CLE exercise protocols, and further studies are now needed to establish the utility of CWR in clinical and research settings.
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Affiliation(s)
- Jens Thougaard
- Department of Respiratory Medicine, Bispebjerg Hospital, Copenhagen, DENMARK
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Davis RJ, Shilts MH, Strickland BA, Rajagopala SV, Das SR, Wootten CT, Gelbard A. Mucosal Microbiome Disruption in Acute Laryngeal Injury Following Intubation. Otolaryngol Head Neck Surg 2024; 170:977-980. [PMID: 37933740 DOI: 10.1002/ohn.580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 05/17/2023] [Accepted: 10/22/2023] [Indexed: 11/08/2023]
Abstract
The objective of this study was to characterize mucosal microbial shifts in patients with acute laryngeal injury (ALgI) after intubation. This cross-sectional study included 20 patients with ALgI who underwent early endoscopic intervention with tissue culture, 20 patients with idiopathic subglottic stenosis (iSGS) who underwent tissue culture during the routine endoscopic intervention, and 3 control patients who underwent mucosal swab culture. 70% of the ALgI patients had a positive culture compared to 5% of the iSGS patients and none of the controls. The most identified microbes isolated from ALgI patients included Staphylococcus species in 30% and Streptococcus species in 25%. The high rate of pathologic bacterial infiltration into postintubation laryngeal wounds supports efforts to reduce bacterial colonization of endotracheal tubes and highlights the role of culture-directed antibiotic therapy as a part of early intervention to improve outcomes for patients with ALgI.
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Affiliation(s)
- Ruth J Davis
- Department of Otolaryngology-HNS, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Meghan H Shilts
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Britton A Strickland
- Department of Infectious Disease, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Suman R Das
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Infectious Disease, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Christopher T Wootten
- Department of Otolaryngology-HNS, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Alexander Gelbard
- Department of Otolaryngology-HNS, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Jeppesen K, Philipsen BB, Mehlum CS. Prevalence and characterisation of exercise-induced laryngeal obstruction in patients with exercise-induced dyspnoea. J Laryngol Otol 2024; 138:208-215. [PMID: 37646338 PMCID: PMC10849894 DOI: 10.1017/s0022215123001494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 07/03/2023] [Accepted: 07/18/2023] [Indexed: 09/01/2023]
Abstract
OBJECTIVE The prevalence of exercise-induced laryngeal obstruction is largely unknown. This study aimed to evaluate the prevalence of this condition in a selected study population of patients with exercise-induced dyspnoea. METHOD A retrospective analysis was conducted of demographic data, co-morbidities, medication, symptoms, performance level of sporting activities, continuous laryngoscopy exercise test results and subsequent treatment. RESULTS Data from 184 patients were analysed. The overall prevalence of exercise-induced laryngeal obstruction in the study population was 40 per cent, and the highest prevalence was among females aged under 18 years (61 per cent). However, a high prevalence among males aged under 18 years (50 per cent) and among adults regardless of gender (34 per cent) was also found. CONCLUSION The prevalence of exercise-induced laryngeal obstruction is clinically relevant regardless of age and gender. Clinicians are encouraged to consider exercise-induced laryngeal obstruction as a possible diagnosis in patients suffering from exercise-induced respiratory symptoms. No single characteristic that can distinguish exercise-induced laryngeal obstruction from other similar conditions was identified.
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Affiliation(s)
- Karin Jeppesen
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Southern Denmark, Sønderborg, Denmark
| | - Bahareh Bakhshaie Philipsen
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Odense University Hospital, Odense, Denmark
| | - Camilla Slot Mehlum
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Odense University Hospital, Odense, Denmark
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Fujiki RB, Fujiki AE, Thibeault SL. Examining therapy duration in adults with induced laryngeal obstruction (ILO). Am J Otolaryngol 2024; 45:104094. [PMID: 37948819 PMCID: PMC10842780 DOI: 10.1016/j.amjoto.2023.104094] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 10/29/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE This study examined the number of therapy sessions required to sufficiently improve (exercise) induced laryngeal obstruction (EILO/ILO) symptoms for discharge. Factors predicting therapy duration were examined as was the likelihood of patients returning for additional therapy sessions following initial discharge. METHODS Retrospective observational cohort design. Data for 350 patients were gathered from the University of Wisconsin-Madison Voice and Swallow Clinics Outcome Database. Patients (>18 years of age) diagnosed with EILO/ILO received therapy from a Speech-Language Pathologist (SLP) and were successfully discharged. EILO/ILO treatment details, symptoms, triggers, medical comorbidities, and patient demographics were collected from initial evaluations and subsequent course of therapy. RESULTS Patients required an average of 3.59 (SD = 3.7) therapy sessions prior to discharge. A comorbid behavioral health diagnosis (p = .026), higher Vocal Handicap Index Score (p = .009) and reduced physical activity due to EILO/ILO symptoms (p = .032) were associated with increased therapy duration. Patients with ILO or EILO with secondary environmental triggers required significantly more sessions than those with exercise-induced symptoms (p < .01). Eight percent of patients returned for additional sessions following discharge. Patients returning for additional sessions all came from affluent neighborhoods as measured by the Area Deprivation Index (ADI). CONCLUSIONS Patients with EILO/ILO required an average of 3.59 therapy sessions prior to discharge. As such, 4 sessions is a reasonable estimate for clinicians to provide patients. Six sessions may be a more conservative estimate for patients who present with a behavioral health diagnosis, a voice complaint, or reduced physical activity from EILO/ILO symptoms.
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Affiliation(s)
- Robert Brinton Fujiki
- Department of Surgery, University of Wisconsin Madison, Madison, WI, United States of America
| | - Amanda Edith Fujiki
- Division of Psychiatry, Child and Adolescent Division, University of Utah School of Medicine, SLC, UT, United States of America
| | - Susan L Thibeault
- Department of Surgery, University of Wisconsin Madison, Madison, WI, United States of America.
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Wang X, Bi Y, Liu G, Wang W, Cui H. Smoking and alcohol consumption with the risk of 11 common otolaryngological diseases: a bidirectional Mendelian randomization. Eur Arch Otorhinolaryngol 2023; 280:5615-5623. [PMID: 37752250 DOI: 10.1007/s00405-023-08246-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 09/13/2023] [Indexed: 09/28/2023]
Abstract
PURPOSE In this study, a bidirectional mendelian randomization was applied to evaluate the association of smoking and alcohol consumption with 11 otolaryngological diseases. METHODS A total of 85,22,34 and 7 single nucleotide polymorphisms were used as instrumental variables for smoking initiation, cigarettes per day, alcoholic drinks per week and alcohol consumption, respectively. Genetic associations with 11 common otolaryngological diseases were obtained from the UK Biobank and FinnGen dataset. IVW, weighted median, MR-Egger, MR-PRESSO and leave-one-out method were used in this analysis. RESULTS Smoking initiation increased the risk of vocal cord and larynx diseases (OR 1.002; 95% CI 1.001-1.004; P = 4 × 10-4), head and neck cancer (OR 1.001; 95% CI 0.999-1.003; P = 0.027), thyroid cancer (OR 1.538; 95% CI 1.006-2.351; P = 0.047) and sleep apnoea (OR 1.286; 95% CI 1.099-1.506; P = 0.002). Cigarettes per day was associated with chronic sinusitis (OR 1.152; 95% CI 1.002-1.324; P = 0.046), chronic rhinitis and pharyngitis (OR 1.200; 95% CI 1.033-1.393; P = 0.017), vocal cord and larynx diseases (OR 1.001; 95% CI 0.999-1.002; P = 0.021) and head and neck cancer (OR 1.001; 95% CI 0.999-1.003; P = 0.017). Alcoholic drinks per week only was significantly associated with the risk of head and neck cancer (OR 1.003; 95% CI 1.001-1.006; P = 0.014). However, there was no evidence to support that genetically predicted alcohol consumption increased the risk of otolaryngological diseases. Reverse MR also did not find outcomes effect on exposures. CONCLUSION This study shows that smoking and heavy alcohol consumption promote the occurrence of some otolaryngological diseases indicating that lifestyle modification might be beneficial in preventing otolaryngological diseases.
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Affiliation(s)
- Xu Wang
- Department of Otorhinolaryngology, Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin, China
| | - Yuewei Bi
- Department of the Graduate School, Tianjin Medical University, Tianjin, China
- Department of Surgery, Tianjin Children's Hospital (Children's Hospital of Tianjin University), 225 Machang Road, Tianjin, 300000, China
- Institute of Pediatrics, Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin, China
| | - Guangping Liu
- Department of Otorhinolaryngology, Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin, China
| | - Wei Wang
- Institute of Pediatrics, Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin, China
| | - Hualei Cui
- Department of Surgery, Tianjin Children's Hospital (Children's Hospital of Tianjin University), 225 Machang Road, Tianjin, 300000, China.
- Institute of Pediatrics, Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin, China.
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Lee Y, Park HJ, Bae IH, Kwon S, Kim G. The Usefulness of Multi Voice Evaluation for Measuring Voice Recovery After Endolaryngeal Phonomicrosurgery in Patients with Vocal Fold Polyps. J Voice 2023; 37:951-956. [PMID: 34312023 DOI: 10.1016/j.jvoice.2021.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 06/24/2021] [Accepted: 06/24/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The purpose of this study was to the usefulness of a five-variable model predicting perceived voice severity and incorporating acoustic analysis based on cepstral analysis and self-reported questionnaires, for measuring voice recovery after endolaryngeal phonomicrosurgery in patients with vocal fold polyps. METHODS In this study, 72 patients with vocal fold polyps were included. Two voice evaluations, including acoustic analysis, self-reported questionnaires, and auditory perceptual assessments for each patient, were implemented before and after endolaryngeal phonomicrosurgery. Using these evaluations, we compared the mean values of the perceptual evaluation of voice, acoustic analysis parameters, self-reported questionnaires, and the five-variable model estimated severity pre- and post-endolaryngeal phonomicrosurgery. RESULTS Various parameters related to acoustic analysis, self-reported questionnaires, and auditory perceptual assessments were useful for measuring voice recovery after endolaryngeal phonomicrosurgery. In particular, a five-variable model incorporating spectral/cepstral analyses and self-reported questionnaires was able to effectively track voice changes after endolaryngeal phonomicrosurgery. CONCLUSION We verified that most of the variables and the five-variable model were useful for measuring voice recovery in patients with vocal polyps after endolaryngeal phonomicrosurgery.
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Affiliation(s)
- YeonWoo Lee
- Department of Otorhinolaryngology-Head and Neck Surgery and Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Hee J Park
- Deptartment of Speech and Hearing Therapy, Catholic University of Pusan, Busan, South Korea
| | - In Ho Bae
- Deptartment of Speech-Language Pathology, Kosin University, Busan, South Korea
| | - SoonBok Kwon
- Deptartment of Humanities, Language and Information, Pusan National University, Pusan, South Korea
| | - GeunHyo Kim
- Department of Otorhinolaryngology-Head and Neck Surgery and Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea.
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Guedj D, Seifert E, Jaquet Y. [Inducible laryngeal obstruction: detection and management]. Rev Med Suisse 2023; 19:1791-1795. [PMID: 37791693 DOI: 10.53738/revmed.2023.19.844.1791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Inducible laryngeal obstruction (ILO) is a phenomenon of paradoxical upper airway closure during breathing causing respiratory distress and a noisy breathing. It most often appears during maximal exertion but can also be induced by inhalation of irritants, pharyngolaryngeal reflux or stressful situations. It can sometimes be confused with an acute asthma attack. The gold standard investigation is a videolaryngoscopy during ergometry which can confirm the diagnosis, allowing appropriate treatment. The aim of this article is to describe the pathophysiology of ILO and to discuss paraclinical examinations and treatment options.
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Affiliation(s)
- Danaé Guedj
- Service d'ORL et chirurgie cervico-faciale, Département des neurosciences cliniques, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Eberhard Seifert
- Unité de Phoniatrie, Service d'ORL et chirurgie cervico-faciale, Hôpital de l'île, 3010 Berne
| | - Yves Jaquet
- Service d'ORL et chirurgie cervico-faciale, Département de chirurgie, Réseau hospitalier neuchâtelois, 2000 Neuchâtel
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Zhang R, Jiang X, Feng J. Difficult endotracheal intubation due to a large epiglottic cyst: A case report. Medicine (Baltimore) 2023; 102:e34026. [PMID: 37327259 PMCID: PMC10270465 DOI: 10.1097/md.0000000000034026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 05/26/2023] [Indexed: 06/18/2023] Open
Abstract
RATIONALE An epiglottic cyst is a type of benign tumor that is formed due to the obstruction of the mucinous duct and the retention of glandular secretion. In such cases, the glottis is not visible as it is covered by the enlarged epiglottic cyst. When conventional anesthesia is administered in such patients, they might have difficulty ventilation since the epiglottic cyst can easily form a flap and move with external pressure changes and can cause the blockage of the glottis due to the loss of consciousness and the relaxation of the throat muscles of the patient. If endotracheal intubation is not initiated and effective ventilation is not established, the patient may suffer from hypoxia and other accidents. PATIENT CONCERNS A 48-year-old male presented to the otolaryngology department with a foreign body sensation in the throat. DIAGNOSES A large epiglottic cyst was diagnosed. INTERVENTIONS The patient was planned to undergo epiglottis cystectomy under general anesthesia. After induction of anesthesia, the cyst severely covered the glottis and made endotracheal intubation difficult. The anesthesiologist rapidly adjusted the position of the laryngeal lens; thus, the endotracheal intubation was successful under the visual laryngoscope. OUTCOMES The endotracheal intubation was successful under the visual laryngoscope and the operation went well. LESSONS Patients with epiglottic cysts are more likely to have difficult airways after induction of anesthesia. Anesthesiologists should take preoperative airway assessment seriously, efficiently handle difficult airway and intubation failure, and make quick and correct choices to ensure patient safety.
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Affiliation(s)
- Ran Zhang
- Department of Anesthesiology, the Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
- Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou, Department of Anesthesiology, Southwest Medical University, Luzhou, Sichuan Province, China
| | - Xian Jiang
- Department of Anesthesiology, the Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
- Department of Anesthesiology, Luzhou People’s Hospital, Luzhou, Sichuan Province, China
| | - Jianguo Feng
- Department of Anesthesiology, the Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
- Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou, Department of Anesthesiology, Southwest Medical University, Luzhou, Sichuan Province, China
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Menon R, Vasani SS, Widdicombe NJ, Lipman J. Laryngeal injury following endotracheal intubation: Have you considered reflux? Anaesth Intensive Care 2023; 51:14-19. [PMID: 36168788 DOI: 10.1177/0310057x221102472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Laryngotracheal injury is an increasingly common complication of intubation and mechanical ventilation, with an estimated 87% of intubated and ventilated patients developing a laryngotracheal injury often preventing their rehabilitation from acute illness. Laryngotracheal injuries encompass a diverse set of pathologies including inflammation and oedema in addition to vocal cord ulceration and paralysis, granuloma, stenosis, and scarring. The existing literature has identified several factors including intubation duration, endotracheal tube size, type and cuff pressures, and technical factors including the skill and experience of the endoscopist. Despite these associations, a key aspect in the sequelae of laryngotracheal injuries is due to reflux and is not clearly related to iatrogenic and mechanical factors.Laryngopharyngeal reflux is a type of reflux that contaminates the upper aerodigestive tract. The combination of patient positioning and continuous nasogastric tube feeding act to affect the upper aerodigestive tract with acidic and non-acidic refluxate that causes direct and indirect mucosal injury impeding healing.Despite laryngopharyngeal reflux being an established and recognised causative factor of upper aerodigestive tract inflammatory pathology and laryngotracheal injury, it is very understudied in critical care. Further, there is yet to be an agreed pathway to assess, manage and prevent laryngotracheal injury in intubated and ventilated patients. The incidence of laryngopharyngeal reflux in the intubated and mechanically ventilated patient in the intensive care unit is currently unknown. Prospective studies may allow us to understand further potential mechanisms of upper aerodigestive tract injury due to laryngopharyngeal reflux and herald the development of preventative and management strategies of laryngopharyngeal reflux-mediated upper aerodigestive tract injury in critically ill patients.
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Affiliation(s)
- Rahul Menon
- Department of Otorhinolaryngology, Royal Brisbane and Women's Hospital, Herston, Australia
| | - Sarju S Vasani
- Department of Otorhinolaryngology, Royal Brisbane and Women's Hospital, Herston, Australia
| | - Neil J Widdicombe
- Department of Intensive Care, Royal Brisbane and Women's Hospital, Herston, Australia
| | - Jeffrey Lipman
- Department of Intensive Care, Royal Brisbane and Women's Hospital, Herston, Australia
- The University of Queensland Centre for Clinical Research, The University of Queensland, Herston, Australia
- Jamieson Trauma Institute, Royal Brisbane and Women's Hospital, Herston, Australia
- Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nimes University Hospital, Nimes, France
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Andrienko DI, Bulynko SA, Evgrafova KA, Soldatskiy YL, Amirbekov MA, Patrik YA. [A case of subglottic cysts in monochorionic monoamniotic twins]. Vestn Otorinolaringol 2023; 88:90-93. [PMID: 37450398 DOI: 10.17116/otorino20228803190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
The first observation in the world literature of the development of subglottic cysts in the larynx in monochorionic monoamniotic twins is presented. The girls were born prematurely at 34 weeks of gestation, from the first day of life for 7 and 8 days, respectively, were transferred to mechanical ventilation. At the fourth month of life, symptoms of laryngeal stenosis appeared and began to gradually progress, conservative therapy had no effect. The diagnosis of subglottic cysts was established on the basis of fibrolaryngoscopy; after endolaryngeal surgery, breathing returned to normal. This case demonstrates the importance of timely endoscopic examination of the respiratory tract in children with stridor.
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Affiliation(s)
- D I Andrienko
- Morozov Children's City Clinical Hospital, Moscow, Russia
| | - S A Bulynko
- Morozov Children's City Clinical Hospital, Moscow, Russia
| | - K A Evgrafova
- Morozov Children's City Clinical Hospital, Moscow, Russia
| | | | - M A Amirbekov
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - Ya A Patrik
- Pirogov Russian National Research Medical University, Moscow, Russia
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Lu YY, Zhang YH, Yu LX, Zeng XM, Yang CZ, Ma YL, Zhou LJ, Hu HY, Xie XH, Yu ZK. [Clinical report of hoding cricoarytenoid joint reduction with visual laryngoscope under intravenous anesthesia]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2022; 57:1095-1101. [PMID: 36177564 DOI: 10.3760/cma.j.cn115330-20220221-00076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Objective: To investigate the reduction effect of hoding cricoarytenoid joint reduction with visual laryngoscope under intravenous anesthesia. Methods: The therapeutic effects of 40 patients with arytenoid dislocation(AD)treated by closed reduction in the single center from January 2020 to September 2021 were retrospectively analyzed, including 21 males and 19 females, median age 48 years. The etiology, symptoms, preoperative evaluation methods, reduction mode, reduction times, and the recovery of arytenoid cartilage movement and sound after reduction were evaluated and analyzed. Results: All patients had obvious hoarseness and breath sound before treatment. Under stroboscopic laryngoscope or electronic nasopharyngoscope, different degrees of vocal cord movement disorder and poor glottic closure can be seen. There were 28 cases of left dislocation, 9 cases of right dislocation and 3 cases of bilateral dislocation. The etiology of dislocation of cricoarytenoid joint: 25 cases (62.5%) of tracheal intubation under general anesthesia were the most common causes, was as follows by laryngeal trauma, gastroscopy, cough, vomiting and so on. Among them, 28 cases of reduction were initially diagnosed in our department, and 12 cases were diagnosed later after failure of reduction treatment. Of the 40 patients, 6 underwent reduction 24 hours after dislocation; 18 cases from 3 days to 1 month; 7 cases from 1 to 3 months; 6 cases were reset in 3~6 months; Over 6 months in 3 cases. After one reduction, 10 cases (10/40, 25%) recovered normal pronunciation, 14 cases (14/40, 35%) recovered normal pronunciation after two reduction, 10 cases (10/40, 25%) recovered normal pronunciation after three times, 2 cases (2/40, 5%) recovered normal pronunciation after four times, and 1 case (2.5%) recovered normal pronunciation after five times. Thin slice CT scan of larynx and cricoarytenoid joint reconstruction showed the types of AD: subluxation in 37 cases (92.5%) and total dislocation in 3 cases; 28 cases of left dislocation, 9 cases of right dislocation and 3 cases of bilateral dislocation; 29 cases (72.5%) had posterior dislocation and 11 cases (27.5%) had anterior dislocation. All patients were treated by intravenous anesthesia with arytenoid cartilage clamped by cricoarytenoid joint reduction forceps under visual laryngoscope. The curative effect was evaluated by stroboscopic laryngoscope and/or voice analysis at 1-2 weeks after operation. The vocal cord movement returned to normal and the pronunciation was good in 37 cases (92.5%). Conclusions: Hoding cricoarytenoid joint reduction with the vision laryngoscope under intravenous anesthesia is easy to operate and the reduction effect is more stable. It is a effective method for AD.
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Affiliation(s)
- Y Y Lu
- Department of Otorhinolaryngology Head and Neck, BenQ Medical Center, the Affiliated BenQ Hospital of Nanjing Medical University, Nanjing 210019, China
| | - Y H Zhang
- Department of Otorhinolaryngology Head and Neck, BenQ Medical Center, the Affiliated BenQ Hospital of Nanjing Medical University, Nanjing 210019, China
| | - L X Yu
- Department of Anesthesiology, Medical Center, the Affiliated BenQ Hospital of Nanjing Medical University, Nanjing 210019, China
| | - X M Zeng
- Department of Imaging, Medical Center, the Affiliated BenQ Hospital of Nanjing Medical University, Nanjing 210019, China
| | - C Z Yang
- Department of Anesthesiology, Medical Center, the Affiliated BenQ Hospital of Nanjing Medical University, Nanjing 210019, China
| | - Y L Ma
- Department of Otorhinolaryngology Head and Neck, BenQ Medical Center, the Affiliated BenQ Hospital of Nanjing Medical University, Nanjing 210019, China
| | - L J Zhou
- Department of Otorhinolaryngology Head and Neck, BenQ Medical Center, the Affiliated BenQ Hospital of Nanjing Medical University, Nanjing 210019, China
| | - H Y Hu
- Department of Otorhinolaryngology Head and Neck, BenQ Medical Center, the Affiliated BenQ Hospital of Nanjing Medical University, Nanjing 210019, China
| | - X H Xie
- Department of Otorhinolaryngology Head and Neck, BenQ Medical Center, the Affiliated BenQ Hospital of Nanjing Medical University, Nanjing 210019, China
| | - Z K Yu
- Department of Otorhinolaryngology Head and Neck, BenQ Medical Center, the Affiliated BenQ Hospital of Nanjing Medical University, Nanjing 210019, China
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Li JY, Lin YH, Li N, Wang J, Li YJ. [Laryngo-onycho-cutaneous syndrome caused by variant of LAMA3: a case report]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2022; 57:207-209. [PMID: 35196767 DOI: 10.3760/cma.j.cn115330-20210316-00131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- J Y Li
- Department of Otorhinolaryngology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Y H Lin
- Department of Otorhinolaryngology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - N Li
- Department of Medical Genetics and Molecular Diagnostic Laboratory, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - J Wang
- Department of Medical Genetics and Molecular Diagnostic Laboratory, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Y J Li
- Department of Otorhinolaryngology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
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Lie AH, Grønnevik I, Frisk B, Røksund OD, Hammer I, Vollsæter M, Halvorsen T, Clemm HH. Breathing patterns in people with exercise-induced laryngeal obstruction. Physiol Rep 2021; 9:e15086. [PMID: 34822227 PMCID: PMC8613803 DOI: 10.14814/phy2.15086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 10/05/2021] [Accepted: 10/06/2021] [Indexed: 11/24/2022] Open
Abstract
Exercise-induced laryngeal obstruction (EILO) is common, but we lack readily available diagnostic tools. The larynx represents an important point of resistance in the airways, and we therefore hypothesized that EILO is associated with characteristic breathing patterns possible to record from a standard incremental ergospirometry test. We studied 24 individuals with moderate/severe EILO and 20 individuals with no-EILO, mean (SD) age 17 (6.1) and 24 (6.4) years, respectively. EILO versus no-EILO was verified from maximal continuous laryngoscopy treadmill exercise (CLE) tests, which also included ergospirometry. We described the relationships between minute ventilation ( V ˙ E ) versus tidal volume (VT ) and V ˙ E versus carbon dioxide output ( V ˙ CO 2 ), using respectively quadratic and linear equations, and applied adjusted regression models to compare ergospirometry data and curve parameters. Compared to the no-EILO group, the group with EILO had prolonged inspiratory time (Tin ), lower breathing frequency (Bf ), lower V ˙ E , and lower inspiratory flow rate ( V ˙ in ) at peak exercise. Mathematical modeling of the breathing pattern relationships was feasible in both groups, with similar coefficients of variation. For V ˙ E versus VT , the mathematical curve parameters were similar. For V ˙ E versus V ˙ CO 2 , the slope was similar but the intercept was lower in the EILO group. EILO was associated with prolonged Tin , lower Bf , V ˙ E , and V ˙ E . The relationship between V ˙ E versus VT was similar, whereas for V ˙ E versus V ˙ CO 2 , the slope was almost parallel but shifted downward for the EILO group. Most ergospirometry data overlapped, except V ˙ in which discriminated between EILO and no-EILO in a promising way.
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Affiliation(s)
| | | | - Bente Frisk
- Department of Health and FunctioningWestern Norway University of Applied SciencesBergenNorway
| | - Ola Drange Røksund
- Department of Health and FunctioningWestern Norway University of Applied SciencesBergenNorway
- Department of Pediatric and Adolescent MedicineHaukeland University HospitalBergenNorway
| | - Ida Hammer
- Department of Pediatric and Adolescent MedicineHaukeland University HospitalBergenNorway
| | - Maria Vollsæter
- Department of Clinical ScienceUniversity of BergenBergenNorway
- Department of Pediatric and Adolescent MedicineHaukeland University HospitalBergenNorway
| | - Thomas Halvorsen
- Department of Clinical ScienceUniversity of BergenBergenNorway
- Department of Pediatric and Adolescent MedicineHaukeland University HospitalBergenNorway
| | - Hege H. Clemm
- Department of Clinical ScienceUniversity of BergenBergenNorway
- Department of Pediatric and Adolescent MedicineHaukeland University HospitalBergenNorway
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Lowery AS, Malenke JA, Bolduan AJ, Shinn J, Wootten CT, Gelbard A. Early Intervention for the Treatment of Acute Laryngeal Injury After Intubation. JAMA Otolaryngol Head Neck Surg 2021; 147:232-237. [PMID: 33507221 PMCID: PMC7844690 DOI: 10.1001/jamaoto.2020.4517] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 09/28/2020] [Indexed: 01/08/2023]
Abstract
Importance Patients with laryngeal injury after endotracheal intubation often present long after initial injury with mature fibrosis compromising cricoarytenoid joint mobility and glottic function. Objective To compare functional outcomes between early and late intervention for intubation-related laryngeal injury. Design, Setting, and Participants This retrospective cohort study involved 29 patients with laryngeal injury resulting from endotracheal intubation who were evaluated at a tertiary care center between May 1, 2014, and June 1, 2018. Ten patients with intubation injury to the posterior glottis who received early treatment were compared with 19 patients presenting with posterior glottic stenosis who received late treatment. Statistical analysis was performed from May 1 to July 1, 2019. Exposures Early intervention, defined as a procedure performed 45 days or less after intubation, and late treatment, defined as an intervention performed greater than 45 days after intubation. Main Outcomes and Measures Patient-specific and intervention-specific covariates were compared between the 2 groups, absolute differences with 95% CIs were calculated, and time to tracheostomy decannulation was compared using log-rank testing. Results The 2 groups had similar demographic characteristics and a similar burden of comorbid disease. Ten patients who received early intervention (7 women [70%]; median age, 59.7 years [range, 31-72 years]; median, 34.7 days to presentation [IQR, 1.5-44.8 days]) were compared with 19 patients who received late intervention (11 women [58%]; median age, 53.8 years [range, 34-73 years]; median, 341.9 days to presentation [IQR, 132.7-376.3 days]). Nine of 10 patients (90%) who received early intervention and 11 of 19 patients (58%) who received late interventions were decannulated at last follow-up (absolute difference, 32%; 95% CI, -3% to 68%). Patients who received early treatment required fewer total interventions than patients with mature lesions (mean, 2.2 vs 11.5; absolute difference, 9.3; 95% CI, 6.4-12.1). In addition, none of the patients who received early treatment required an open procedure, whereas 17 patients (90%) with mature lesions required open procedures to pursue decannulation. Conclusions and Relevance This study suggests that early intervention for patients with postintubation laryngeal injury was associated with a decreased duration of tracheostomy dependence, a higher rate of decannulation, and fewer surgical procedures compared with late intervention. Patients who underwent early intervention also avoided open reconstruction. These findings may bear relevance to the management of patients requiring extended durations of endotracheal intubation during recovery for critical illness related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.
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Affiliation(s)
- Anne S. Lowery
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Jordan A. Malenke
- Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Alyssa J. Bolduan
- Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Justin Shinn
- Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Christopher T. Wootten
- Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Alexander Gelbard
- Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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15
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Van Stan JH, Mehta DD, Ortiz AJ, Burns JA, Marks KL, Toles LE, Stadelman-Cohen T, Krusemark C, Muise J, Hron T, Zeitels SM, Fox AB, Hillman RE. Changes in a Daily Phonotrauma Index After Laryngeal Surgery and Voice Therapy: Implications for the Role of Daily Voice Use in the Etiology and Pathophysiology of Phonotraumatic Vocal Hyperfunction. J Speech Lang Hear Res 2020; 63:3934-3944. [PMID: 33197360 PMCID: PMC8608140 DOI: 10.1044/2020_jslhr-20-00168] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Purpose This study attempts to gain insights into the role of daily voice use in the etiology and pathophysiology of phonotraumatic vocal hyperfunction (PVH) by applying a logistic regression-based daily phonotrauma index (DPI) to predict group-based improvements in patients with PVH after laryngeal surgery and/or postsurgical voice therapy. Method A custom-designed ambulatory voice monitor was used to collect 1 week of pre- and postsurgery data from 27 female patients with PVH; 13 of these patients were also monitored after postsurgical voice therapy. Normative weeklong data were obtained from 27 matched controls. Each week was represented by the DPI, standard deviation of the difference between the first and second harmonic amplitudes (H1-H2). Results Compared to pretreatment, the DPI significantly decreased in the patient group after surgery (Cohen's d effect size = -0.86) and voice therapy (d = -1.06). The patient group DPI only normalized after voice therapy. Conclusions The DPI produced the expected pattern of improved ambulatory voice use across laryngeal surgery and postsurgical voice therapy in a group of patients with PVH. The results were interpreted as providing new objective information about the role of daily voice use in the etiology and pathophysiology of PVH. The DPI is viewed as an estimate of potential vocal fold trauma that relies on combining the long-term distributional characteristics of two parameters representing the magnitude of phonatory forces (neck-surface acceleration magnitude) and vocal fold closure dynamics (H1-H2). Further validation of the DPI is needed to better understand its potential clinical use.
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Affiliation(s)
- Jarrad H. Van Stan
- Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, MA
- MGH Institute of Health Professions, Boston, MA
| | - Daryush D. Mehta
- Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, MA
- MGH Institute of Health Professions, Boston, MA
| | | | - James A. Burns
- Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, MA
| | - Katherine L. Marks
- Massachusetts General Hospital, Boston
- MGH Institute of Health Professions, Boston, MA
| | - Laura E. Toles
- Massachusetts General Hospital, Boston
- MGH Institute of Health Professions, Boston, MA
| | - Tara Stadelman-Cohen
- Massachusetts General Hospital, Boston
- MGH Institute of Health Professions, Boston, MA
| | - Carol Krusemark
- Massachusetts General Hospital, Boston
- MGH Institute of Health Professions, Boston, MA
| | - Jason Muise
- Massachusetts General Hospital, Boston
- MGH Institute of Health Professions, Boston, MA
| | - Tiffiny Hron
- Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, MA
| | - Steven M. Zeitels
- Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, MA
| | | | - Robert E. Hillman
- Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, MA
- MGH Institute of Health Professions, Boston, MA
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16
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Thong G, Lorenz H, Sandhu GS, AlYaghchi C. Emergency presentation of iatrogenic airway stenosis following intubation in a patient with COVID-19 and its management. BMJ Case Rep 2020; 13:e238508. [PMID: 33318277 PMCID: PMC10577753 DOI: 10.1136/bcr-2020-238508] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2020] [Indexed: 11/16/2022] Open
Abstract
A 59-year-old man presented to the emergency department with recent onset biphasic stridor, dyspnoea and increased work of breathing on the background of prolonged intubation for the novel COVID-19 2 months previously. Flexible laryngoscopy revealed bilateral vocal fold immobility with a soft tissue mass in the interarytenoid region. The patient's symptoms improved with oxygen therapy, nebulised epinephrine (5 mL; 1:10 000) and intravenous dexamethasone (3.3 mg). The following morning, the patient was taken to theatre, underwent suspension microlaryngoscopy and found to have bilateral fixation of the cricoarytenoid joints and a large granuloma in the interarytenoid area. He underwent cold steel resection of the granuloma and balloon dilatation between the arytenoids, with the hope of mobilising the joints. This failed and CO2 laser arytenoidectomy was performed on the left side. The stridor had resolved postoperatively, with normalisation of work of breathing and the patient was discharged home on the first postoperative day.
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Affiliation(s)
- Gerard Thong
- National Centre for Airway Reconstruction, Imperial College London, London, UK
| | - Harry Lorenz
- National Centre for Airway Reconstruction, Imperial College London, London, UK
| | - Guri S Sandhu
- National Centre for Airway Reconstruction, Imperial College London, London, UK
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17
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Lau D. Neuromuscular Disease Affecting the Larynx. Adv Otorhinolaryngol 2020; 85:144-157. [PMID: 33166980 DOI: 10.1159/000456694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Neuromuscular diseases (NMDs) are diseases involving the motor nuclei of the cranial nerves and anterior horn cells of the spinal cord, the peripheral nerves, the neuromuscular junction, and/or muscle itself. The following groups of disorders from the WHO International Classification of Diseases are usually included in the classification of NMDs: (1) Motor neuron diseases or related disorders; (2) Disorders of nerve root, plexus or peripheral nerves; (3) Diseases of neuromuscular junction or muscle. These diseases include myasthenia gravis or certain specified neuromuscular junction disorders, primary disorders of muscle, and secondary myopathies. The following discussion selects NMDs from each group, which may have unique laryngeal features and more commonly involve the laryngologist and highlights different diagnostic and treatment considerations related to the larynx.
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Affiliation(s)
- David Lau
- Gleneagles Medical Centre, Singapore, Singapore,
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18
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Raiber S, Sezin T, Sadik CD, Bergman R, Avitan-Hersh E. Neonatal Autoimmune Subepidermal IgG/IgA Blistering Disease With Severe Laryngeal and Esophageal Involvement: A Report of a Case and Review of the Literature. Am J Dermatopathol 2020; 42:783-786. [PMID: 32568839 DOI: 10.1097/dad.0000000000001700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Neonatal autoimmune subepidermal blistering disease is rare. Mucosal involvement is more common in neonatal linear immunoglobulin A (IgA) bullous dermatosis. We describe a neonate with subepidermal cutaneous blistering disease with severe laryngeal and esophageal involvement leading to acute respiratory distress. Histopathology demonstrated a subepidermal blister with neutrophils and eosinophils at the dermal base. Collagen IV was detected at the dermal floor, and direct immunofluorescence showed linear IgG, IgA, and C3 deposits at the basement membrane zone. The patient demonstrated markedly increased serum levels of anti-BP180 NC16A and anti-BP230 IgG antibodies (Abs) but failed to show anti-LAD-1 IgA Abs. His healthy mother showed serum anti-LAD-1 IgA Abs but did not show anti-BP180 and anti-BP230 Abs. The neonate responded promptly to systemic corticosteroid therapy. A review of the literature detected 11 cases of neonatal subepidermal blistering disease with linear IgA deposits. Nine of these cases demonstrated coexisting linear IgG deposits, often with C3. Respiratory compromise was present in most of the cases. Neutrophils and eosinophils were commonly present in the inflammatory cell infiltrates. Besides our case, 2 cases of neonatal IgG/IgA subepidermal blistering disease with esophageal involvement were previously described. IgA Abs were present in the sera of both cases. Anti-LAD-1 IgA Abs were detected in the mother's serum of our case alone, but IgA Abs do not cross the placenta. Our case was consistent with neonatal IgG/IgA pemphigoid. Neonatal IgG/IgA subepidermal blistering disease may be associated with severe laryngeal and esophageal involvement leading to respiratory compromise. Expedited diagnosis and prompt treatment are warranted.
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Affiliation(s)
- Sofia Raiber
- Department of Dermatology, Rambam Health Care Campus, Haifa, Israel
| | - Tanya Sezin
- Department of Dermatology, Allergy, and Venereology, University of Lübeck, Lübeck, Germany
| | - Christian D Sadik
- Department of Dermatology, Allergy, and Venereology, University of Lübeck, Lübeck, Germany
- Center for Research on Inflammation of the Skin (CRIS), University of Lübeck, Lübeck, Germany; and
| | - Reuven Bergman
- Department of Dermatology, Rambam Health Care Campus, Haifa, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Emily Avitan-Hersh
- Department of Dermatology, Rambam Health Care Campus, Haifa, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Abstract
INTRODUCTION Multiple symmetric lipomatosis (MSL) is an uncommon medical condition characterized by symmetric fat accumulation mainly in the neck and other upper body regions. The involvement of the larynx is rare according to the literature, and we present a case of MSL with larynx involvement treated with a surgical approach. PATIENT CONCERNS A 55-year-old male was admitted to our hospital due to progressively aggravated breathing difficulty, and tracheotomy was performed before transfer. When he tried to block the cannula, the breathing difficulty returned. The patient's neck had been thickening for the past 2 years. DIAGNOSIS Pathological examination confirmed the diagnosis of MSL. INTERVENTIONS The patient underwent lumpectomy and neck exploration. OUTCOMES The lipoma was removed, the patient was free of any dyspnea symptoms and recovered well, and the tracheal cannula was removed at a local hospital. CONCLUSION MSL can infiltrate the larynx and grow into the preepiglottic space and paraglottic spaces, resulting in breathing difficulties. Lipomas present in the spaces described above must be removed at the same time; otherwise, symptoms of dyspnea cannot be alleviated.
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Affiliation(s)
- Yu Cui
- Departments of Otolaryngology
| | | | | | - Zhanpeng Zhu
- Departments of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin, P.R. China
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Ho GY, Leonhard M, Denk-Linnert DM, Schneider-Stickler B. Pre- and intraoperative acoustic and functional assessment of the novel APrevent ® VOIS implant during routine medialization thyroplasty. Eur Arch Otorhinolaryngol 2019; 277:809-817. [PMID: 31845039 PMCID: PMC7031216 DOI: 10.1007/s00405-019-05756-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 12/03/2019] [Indexed: 11/27/2022]
Abstract
PURPOSE Persistent unilateral vocal fold paralysis (UFVP) with glottal insufficiency often requires type I medialization thyroplasty (MT). Previous implants cannot be adjusted postoperatively if necessary. The newly developed APrevent® VOIS implant (VOIS) can provide postoperative re-adjustment to avoid revision MT. The objective of this pilot study is to evaluate the VOIS intraoperatively concerning voice improvement, surgical feasibility and device handling. METHODS During routine MT, VOIS was applied short time in eight patients before the regular implantation of the Titanium Vocal Fold Medialization Implant (TVFMI™). In all patients, perceptual voice sound analysis using R(oughness)-B(reathiness)-H(oarseness)-scale, measurement of M(aximum)-P(honation)-T(ime) and glottal closure in videolaryngoscopy were performed before and after implanting VOIS/TVFMI™. Acoustic analyses of voice recordings were performed using freeware praat. Surgical feasibility, operative handling and device fitting of VOIS and TVFMI™ were assessed by the surgeon using V(isual)-A(nalog)-S(cale). Data were statistically analyzed with paired t test. RESULT All patients showed significant improvement of voice sound parameters after VOIS/TVFMI™ implantation. The mean RBH-scale improved from preoperative R = 2.1, B = 2.3, H = 2.5 to R = 0.6, B = 0.3, H = 0.8 after VOIS and R = 0.5, B = 0.3, H = 0.8 after TVFMI™ implantation. The mean MPT increased from preoperative 7.9 to 14.6 s after VOIS and 13.8 s after TVFMI™ implantation. VOIS/TVFMI™ achieved complete glottal closure in 7/8 patients. The satisfaction with intraoperative device fitting and device handling of VOIS was as good as that of TVFMI™. CONCLUSION The novel APrevent® VOIS implant showed similar intraoperative voice improvement compared to routinely used TVFMI™ without adverse device events and with safe device fitting.
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Affiliation(s)
- Guan-Yuh Ho
- Division of Phoniatrics-Logopedics, Department of Otorhinolaryngology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - Matthias Leonhard
- Division of Phoniatrics-Logopedics, Department of Otorhinolaryngology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Doris-Maria Denk-Linnert
- Division of Phoniatrics-Logopedics, Department of Otorhinolaryngology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Berit Schneider-Stickler
- Division of Phoniatrics-Logopedics, Department of Otorhinolaryngology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
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21
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Affiliation(s)
- Sheng-Yao Cheng
- 1 Department of Otolaryngology - Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, China
| | - Po-Jun Chen
- 1 Department of Otolaryngology - Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, China
| | - Yueng-Hsiang Chu
- 1 Department of Otolaryngology - Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, China
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Edriss H, Kelley JS, Demke J, Nugent K. Sinonasal and Laryngeal Sarcoidosis-An Uncommon Presentation and Management Challenge. Am J Med Sci 2018; 357:93-102. [PMID: 30665498 DOI: 10.1016/j.amjms.2018.11.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 11/03/2018] [Accepted: 11/14/2018] [Indexed: 12/23/2022]
Abstract
Sarcoidosis is a chronic inflammatory disease of uncertain etiology characterized by the formation of noncaseating granulomas. The thorax is involved in 95% of cases, but any organ can be involved. Sinonasal or laryngeal involvement is uncommon and can be difficult to diagnose. The reported incidence of sarcoidosis in the upper airway clearly depends on study characteristics, and this creates uncertainty about the actual incidence. In a large prospective study in the United States, upper respiratory tract involvement occurred in 3% of the patients. Some patients have upper airway involvement without thoracic disease, and this presentation may cause delays in diagnosis. These patients have nonspecific symptoms which range from minimal nasal stuffiness to life-threatening upper airway obstruction. Currently, there is no established standard therapy for the management of upper airway sarcoidosis. These patients often respond poorly to nasal and/or inhaled corticosteroids and require long courses of oral corticosteroids. Patients with poor responses to oral corticosteroids or severe side effects may respond to tumor necrosis factor alpha inhibitors. In this review, we will discuss the clinical presentation, pathogenesis, diagnostic tests, drug treatment, surgical management options and the challenges clinicians have managing these patients.
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Affiliation(s)
- Hawa Edriss
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas.
| | - John S Kelley
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Joshua Demke
- Department of Otolaryngology, Facial Plastic & Reconstructive Surgery, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Kenneth Nugent
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
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Shastri KS, Jaworek AJ, Sataloff RT. Paresis podule on a paralyzed vocal fold. Ear Nose Throat J 2018; 96:288. [PMID: 28846781 DOI: 10.1177/014556131709600813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Karthik S Shastri
- Department of Otolaryngology-Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, PA, USA
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24
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Ranneries TN, Balle J, Homøe P. [Laryngeal traumas in children caused by trampoline accidents]. Ugeskr Laeger 2018; 180:V02180092. [PMID: 30375955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Laryngeal trauma is rare in children due to the anatomical placement and the trauma mechanisms required for injury. Recently the trampoline has become frequent in Danish households leading to more high-energy laryngeal traumas. This case report is about two incidents occurring within a year. The first patient had a laryngeal fracture despite minimum objective findings. The second patient had a compromised airway and needed acute intubation, although she only presented with light hoarseness. We strive to underline the severity of laryngeal trauma in children and briefly discuss the correct handling of these cases.
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25
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Loos E, Lemkens P, Poorten VV, Humblet E, Laureyns G. Laryngeal Manifestations of Inflammatory Bowel Disease. J Voice 2018; 33:1-6. [PMID: 29605161 DOI: 10.1016/j.jvoice.2017.09.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 09/24/2017] [Accepted: 09/27/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Laryngeal involvement in inflammatory bowel disease is rare. Only 12 cases of laryngeal involvement in Crohn disease have been reported until now. Moreover, only one case of laryngeal manifestations in ulcerative colitis has been reported so far. MATERIALS AND METHODS In this article, we present a patient with ulcerative colitis, who consulted our ear, nose, and throat (ENT) clinic with laryngeal complaints. Furthermore, a review of current literature was performed. RESULTS A concise overview of this rare extraintestinal manifestation and other ENT manifestations of inflammatory bowel diseases is provided. CONCLUSIONS Laryngeal manifestations in inflammatory bowel disease are very rare, but these manifestations should be known by the otorhinolaryngologist.
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Affiliation(s)
- Elke Loos
- Department of Otorhinolaryngology-Head and Neck Surgery, Ziekenhuis Oost-Limburg, Genk, Belgium; Department of Otorhinolaryngology-Head and Neck Surgery, KULeuven, Leuven, Belgium
| | - Peter Lemkens
- Department of Otorhinolaryngology-Head and Neck Surgery, Ziekenhuis Oost-Limburg, Genk, Belgium
| | | | - Evelien Humblet
- Department of Gastroenterology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Griet Laureyns
- Department of Otorhinolaryngology-Head and Neck Surgery, Ziekenhuis Oost-Limburg, Genk, Belgium.
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Abstract
The epiglottis plays an important role in preventing food of different consistencies from entering the airway during swallowing. Calcification of epiglottis can, potentially, alter and limit its movement causing aspiration amongst other swallowing problems. Isolated calcification of the epiglottis and its clinical presentation remains a poorly understood entity for radiologists as well as clinicians. Therefore, it is important to recognize the imaging features of epiglottic calcification, and it's known clinical presentations to help clinicians with early diagnosis and management.
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Affiliation(s)
- Sunil Jeph
- Department of Radiology, Geisinger Medical Center, Danville, USA
| | - Michael Aidi
- Department of Radiology, Geisinger Medical Center, Danville, USA
| | | | - Thu-Thao Ly
- Department of Radiology, Geisinger Medical Center, Danville, USA
| | - Oleg Bronov
- Department of Radiology, Geisinger Medical Center, Danville, USA
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Che-Morales JL, Figueroa-Hurtado E, Cortes-Télles A. [Laryngeal disease. Endoscopic characterization of 1493 procedures based on age]. Rev Med Inst Mex Seguro Soc 2018; 56:38-44. [PMID: 29368893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Based on international epidemiology, some laryngeal diseases could be more frequent at certain ages. The objective was to describe endoscopic findings in patients through distinct decades of age in a laryngoscopy facility. METHODS retrospective and descriptive study; clinical and endoscopic records were collected from 1493 procedures performed between 2009 and 2015, and organized in five groups of age for analysis. Differences among them were analyzed by chi squared and ANOVA. RESULTS 70% of patients reported dysphonia as a main symptom; 24% of subjects were referred with cancer diagnosis and just 7% of them, showed findings related to malignancy; on the other hand, cancer suspicion increased in direct proportion with age (p < 0.0001); inespecific inflammation and other benign endoscopic manifestations (e.g. vocal fold paralysis, subglotic stenosis and nodules) represented 80% of the whole findings; 14% of the procedures were reported as normal. Glottic and supraglottic structures were the two regions affected by malignancy; this finding was directly related to advanced age, particularly in patients of 70 years of age or older. Finally, subglottic stenosis was observed in patients younger than 50 years of age (p < 0.0001). CONCLUSIONS Causes of laryngeal diseases are different in individuals according to their age. Carcinoma was more prevalent in adults of 70 years of age or older. Benign causes were secondary to inflammatory and functional conditions.
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Affiliation(s)
- José Luis Che-Morales
- Servicio de Broncoscopía, Departamento de Neumología e Inhaloterapia, Unidad Médica de Atención Ambulatoria 01, Instituto Mexicano del Seguro Social, Mérida, Yucatán, México
| | - Esperanza Figueroa-Hurtado
- Servicio de Broncoscopía, Departamento de Neumología, Hospital Regional de Alta Especialidad de la Península de Yucatán, Secretaría de Salud, Mérida, Yucatán, México
| | - Arturo Cortes-Télles
- Servicio de Broncoscopía, Departamento de Neumología, Hospital Regional de Alta Especialidad de la Península de Yucatán, Secretaría de Salud, Mérida, Yucatán, México
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Ziade G, Haddad G, Assaad S, Kasti M, Hamdan AL. Changes in abnormal muscle tension pattern after fiberoptic injection laryngoplasty. Ear Nose Throat J 2017; 96:472-476. [PMID: 29236271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023] Open
Abstract
We performed a retrospective chart review to compare the presence and types of abnormal muscle tension patterns (MTPs) in patients who had been diagnosed with glottal insufficiency before and after fiberoptic injection laryngoplasty. The main cause of glottal insufficiency had been unilateral vocal fold paralysis. Our review included an analysis of the medical records and laryngeal videostroboscopic recordings of 16 patients-9 men and 7 women, aged 25 to 87 years (mean: 59). Stroboscopic frames were analyzed for the presence of one or more types of abnormal MTP. Statistical analysis was performed to determine the significance of the change in scores for type II and type III MTP before injection and 1 month after injection. Before injection laryngoplasty, 15 of the 16 patients exhibited evidence of an abnormal MTP; 10 patients had MTP II only, 2 had MTP III only, and 3 patients had both. The mean percentage of frames showing MTP (i.e., MTP score) in patients with MTP II was 66.2% before the injection and 28.9% 1 month after; the decrease was statistically significant (p = 0.001). For MTP III, the corresponding figures were 71.6 and 37.7% (p = 0.043). We conclude that injection laryngoplasty has a positive effect on reducing muscle tension in patients with glottal insufficiency.
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Affiliation(s)
- Georges Ziade
- Division of Laryngology, Department of Otolaryngology-Head and Neck Surgery, American University of Beirut Medical Center, Cairo St., Hamra, Beirut, Lebanon
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Kendigelen P, Tutuncu AC, Ashyralyyeva G, Emreb S, Urkmez S, Utkua T, Kaya G. Laryngotracheal edema due to thermal injury: A complication after thyroidectomy in children. ARCH ARGENT PEDIATR 2017; 115:e31-e33. [PMID: 28097852 DOI: 10.5546/aap.2017.eng.e31] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 08/11/2016] [Indexed: 11/12/2022]
Abstract
Postoperative respiratory insufficiency is a serious complication of total thyroidectomies which can be multifactorial, especially in children. We report two siblings who had undergone thyroidectomy with subsequent respiratory distress. Electrothermal bipolar and harmonic scalpel were used during thyroid dissections. Both patients had early postoperative respiratory problems. The older one suffered from mild respiratory distress for 24 hours and then he spontaneously recovered. The younger one was extubated but then she had serious stridor accompanied with abdominal and intercostal retractions. She was re-intubated and admitted to ICU for mechanical ventilatory support, where she stayed for 14 days due to multiple failed extubation attempts. The symptoms were more severe in the younger child probably due to softer tracheal wall and weaker tracheal cartilages. We should keep in mind the probable postoperative respiratory complications due to thermal injury or inappropriate surgical technique after thyroid surgeries.
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Fraser-Kirk K. Laryngopharyngeal reflux: A confounding cause of aerodigestive dysfunction. Aust Fam Physician 2017; 46:34-39. [PMID: 28189129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Laryngopharyngeal reflux (LPR) is one of the most common and important disorders of upper airway inflammation. It causes significant impairment to quality of life, and can predict serious laryngeal and oesophageal pathology, yet it remains under-diagnosed and under-treated. OBJECTIVE This paper attempts to unravel the diagnostic dilemma of LPR and provide a practical, discriminating approach to managing this common condition. DISCUSSION Historical red flags mandating early referral for specialist review are identified, and pathophysiology, symptomatology and common signs are reviewed. In addition, a comprehensive treatment plan consisting of lifestyle modifications, counselling aids and empirical medical therapy is proposed. A strategy for tracking clinical improvement using Belfasky's validated symptom index is included to aid counselling, compliance and follow-up.
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González AM, Manso J, de la Rubia L, Canga AM. Laryngeal stridor secondary to a giant cervical haemangioma. Rev Esp Anestesiol Reanim 2016; 63:610-611. [PMID: 27424875 DOI: 10.1016/j.redar.2016.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 04/16/2016] [Accepted: 04/18/2016] [Indexed: 06/06/2023]
Affiliation(s)
- A M González
- Servicio de Anestesiología y Reanimación, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España.
| | - J Manso
- Servicio de Anestesiología y Reanimación, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España
| | - L de la Rubia
- Servicio de Pediatría, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España
| | - A M Canga
- Servicio de Radiología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España
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Abstract
OBJECTIVES There is a possibility of underestimation in the smoking rate surveyed by self-reported questionnaires. This study investigated the difference between the Korean female smoking rate as determined by self-reports and that determined by a biochemical test and elucidated the relationship between women's smoking and laryngeal disorders. DESIGN Nationwide cross-sectional survey. SETTING 2008 Korea National Health and Nutrition Examination Survey. PARTICIPANTS 1849 women who completed the health survey, urinary cotinine test and laryngoscope examinations. MAIN OUTCOME MEASURE This study defined smokers as those with urine cotinine contents of 50 ng/mL and over. Confounding factors included age, level of education, household income, occupation and problem drinking in the past year. For statistical tests, OR and 95% CI were presented by using complex samples logistic regression. RESULTS While there was no relationship between smoking as determined by a self-reported questionnaire and laryngeal disorders, smoking as determined by the urine cotinine test had a significant relationship with laryngeal disorders (p<0.05). After all the confounding factors were adjusted, those with urine cotinine concentrations of over 50 ng/mL had a 2.1 times higher risk of laryngeal disorders than those with urine cotinine concentrations of <50 ng/mL (OR=2.05, 95% CI 1.11 to 3.78) (p<0.05). CONCLUSIONS This national cross-sectional study verified that smoking is a significant risk factor for laryngeal disorders. Longitudinal studies are required to identify the causal relationship between smoking and laryngeal disorders.
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Affiliation(s)
- Haewon Byeon
- Department of Speech Language Pathology & Audiology, School of Public Health, Nambu University, Gwangju, Republic of Korea
| | - Dongwoo Lee
- Department of Physical Therapy, School of Public Health, Honam University, Gwangju, Republic of Korea
| | - Sunghyoun Cho
- Department of Physical Therapy, School of Public Health, Nambu University, Gwangju, Republic of Korea
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Ohki M, Kikuchi S, Ohata A, Baba Y, Ishikawa J, Sugimoto H. Features of oral, pharyngeal, and laryngeal lesions in bullous pemphigoid. Ear Nose Throat J 2016; 95:E1-E5. [PMID: 27792825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
Bullous pemphigoid is an autoimmune bullous disease characterized by skin lesions, with or without oral lesions. The occurrence of pharyngolaryngeal lesions is very rare in affected patients. We conducted a study to investigate the characteristics of oral and pharyngolaryngeal lesions in bullous pemphigoid. Our study population was made up of 6 consecutively presenting outpatients-2 men and 4 women, aged 40 to 83 years (mean: 68.2)-who had been referred to our department over an 11-year period. Presenting symptoms included sore throat in all 6 patients and oral pain in 3. The sites of mucosal lesions included the soft palate, epiglottis, gingiva, hypopharynx, tongue, nasal cavity, and buccal mucosa. These lesions appeared as erosions, erosions with white coating, erythematous patches, and/or blisters. Mucosal lesions preceded skin lesions in 2 patients, appeared after skin lesions in 1 patient, and appeared simultaneously with skin lesions in 3 patients. We conclude that bullous pemphigoid sometimes involves the mucosa, such as that of the laryngopharynx and the oral cavity, and it can manifest as skin lesions. In the differential diagnosis of refractory pharyngolaryngeal lesions, bullous pemphigoid should be considered.
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Affiliation(s)
- Masafumi Ohki
- Department of Otolaryngology, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe-shi, Saitama 350-8550, Japan.
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Lejeune L, Lefèbvre P, Finck C. [Laryngeal involvements in systemic diseases : a discussion based on a case report.]. Rev Med Liege 2016; 71:336-341. [PMID: 28383842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Systemic diseases can affect the larynx. The most common laryngeal involvements, although often unknown, consist in inflammatory laryngitis, laryngeal ulcers, cricoarytenoid arthritis, recurrent laryngeal nerve paresis and subglottic stenosis. The clinical case we report is more uncommon, but representative of autoimmune diseases : vocal folds bamboo nodes in a young female patient, age 34, suffering from active rheumatoid arthritis. In the present article, we detail the current knowledge of this pathology and later discuss different laryngeal involvements of systemic diseases by lesion type et their management.
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Affiliation(s)
- L Lejeune
- Service d'ORL, CHU de Liège, Site Sart Tilman, Liège, Belgique
| | - Ph Lefèbvre
- Service d'ORL, CHU de Liège, Site Sart Tilman, Liège, Belgique
| | - C Finck
- Service d'ORL, CHU de Liège, Site Sart Tilman, Liège, Belgique
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Abstract
Objectives: Advances in medicine have improved the survival of infants with increasingly lower birth weights. The histopathologic changes of intubation-related laryngeal injury in extremely low-birth weight infants (less than 1,000 g) have not been well known. We examined histopathologic changes in infant larynges, including extremely low-birth weight infants, after endotracheal intubation. Methods: Forty-four infants, including 21 extremely low-birth weight infants, who had been intubated for periods ranging from 10 minutes to 138 days, were examined in a whole organ serial section study. Results: As the duration of intubation increased, the ulceration was found to be larger and deeper. The injury at the subglottis and posterior glottis was greater than that at other portions. The perichondrium of the cartilage was exposed in many cases intubated longer than 8 days. Repaired epithelium that was composed of squamous epithelium was present in 6 of 7 larynges that had been intubated more than 20 days, indicating that not only injury but also the healing process occurred during long intubation. There were no obvious relationships between the degree of intubation injury and the birth weight of the infants. Conclusions: Prolonged intubation is better tolerated by infants than adults. The intubation-related laryngeal injuries of extremely low-birth weight infants were histopathologically the same as those of infants of other birth weights.
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Affiliation(s)
- Kiminori Sato
- Department of Otolaryngology-Head and Neck Surgery, Kurume University School of Medicine, Kurume, Japan
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Abstract
Bilateral adductor vocal cord paralysis (BAdP), presenting with features of laryngeal incompetence, is a rare form of congenital bilateral vocal cord paralysis, and only 2 small series of BAdP have previously been published. Three cases are reported here. The BAdP occurred as an isolated abnormality in 1 child, and was associated with a recognizable syndrome (Robinow's syndrome and 22q deletion) in the other 2 children. Gastrostomy tube feeding was required in 2 children, who both remain gastrostomy tube–dependent at 26 months and 10 years 9 months of age. The child with Robinow's syndrome received parenteral nutrition until 2 months, but was then able to feed orally after partial improvement in vocal cord function. The global impairment in vocal cord constrictor function observed in these 3 children is consistent with the site of lesion's being at the level of the laryngeal constrictor motoneurons in BAdP.
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Affiliation(s)
- Robert G Berkowitz
- Dept of Otolaryngology, Royal Children's Hospital, University of Melbourne, Parkville, Victoria, Australia
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Powitzky ES, Khaitan L, Garrett CG, Richards WO, Courey M. Symptoms, Quality of Life, Videolaryngoscopy, and Twenty-Four-Hour Triple-Probe Ph Monitoring in Patients with Typical and Extraesophageal Reflux. Ann Otol Rhinol Laryngol 2016; 112:859-65. [PMID: 14587976 DOI: 10.1177/000348940311201006] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A prospective study was designed to characterize patients with typical and extraesophageal reflux (EER) symptoms and seek predictive patterns for each group. Fifteen subjects without symptoms, 16 patients with symptomatic gastroesophageal reflux disease (GERD), and 37 patients with symptomatic EER were evaluated with outcomes tools, videolaryngoscopy, and 24-hour triple-probe pH monitoring. Higher symptom scores, Voice Handicap Index scores, and Gastrointestinal Symptom Rating Scale scores, as well as similarly decreased quality of life as measured by the Short Form 36, were noted among the two symptomatic groups. Patients with clinically diagnosed EER were more likely to have multiple abnormalities on laryngoscopy. There was a trend toward more pharyngeal reflux episodes in EER patients (6.9 ± 8.9) as compared to GERD patients (6.0 ± 9) and asymptomatic subjects (1.1 ± 1.9). On the basis of the pH monitoring of asymptomatic subjects, we define pathological pharyngeal reflux as more than 5 episodes in 24 hours. Pharyngeal acid exposure is more common in patients presumed to have EER, but some pharyngeal reflux does occur in asymptomatic subjects. Neither symptom scores nor videolaryngoscopic findings were predictive of pathological EER as indicated by pH monitoring.
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Affiliation(s)
- Eric S Powitzky
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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38
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Abstract
Objectives: Laryngeal dysfunction leading to incompetence and intractable aspiration can be a life-threatening problem. Laryngotracheal separation (LTS) can be used to prevent aspiration, but results in aphonia. The options for alaryngeal speech following LTS are limited. Methods: We performed tracheoesophageal puncture (TEP) and insertion of a Blom-Singer valve in 3 patients in an attempt to restore their voice after LTS for chronic aspiration. Results: Two patients had intractable aspiration (5 and 14 years) after full-course radiotherapy for laryngeal cancer, and 1 patient had aspiration after a stroke. In the first patient TEP was done as a secondary procedure, and in the other 2 patients it was done at the time of the LTS. The TEP was successful in providing these patients with phonation ability after their LTS procedure. There was no morbidity from these procedures. Conclusions: Creation of a TEP after an LTS procedure is relatively simple and relatively safe, and allows for the control of aspiration while maintaining vocal function.
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Affiliation(s)
- Rahul K Shah
- Department of Otolaryngology-Head and Neck Surgery, Tufts-New England Medical Center, Boston, Massachusetts, USA
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Sulica L, Simpson CB, Branski R, McLaurin C. Granuloma of the Membranous Vocal Fold: An Unusual Complication of Microlaryngoscopic Surgery. Ann Otol Rhinol Laryngol 2016; 116:358-62. [PMID: 17561764 DOI: 10.1177/000348940711600507] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: We describe the clinical features of granuloma of the membranous vocal fold (as opposed to granuloma of the vocal process, or “contact granuloma”), a poorly recognized sequela of microlaryngoscopic surgery. Membranous vocal fold granuloma may mimic the initial lesion in appearance, and thus be mistaken for recurrence. Methods: We performed a retrospective review of cases from 2 institutions. Results: Fifteen cases of membranous vocal fold granuloma from 2 institutions were identified. In all but 1 case, granuloma developed in the early postoperative period, within 8 weeks. Of the 15 cases, 10 followed laser resection of carcinoma. Five were noted following cold steel resection of benign lesions (2 papillomas, 2 cysts, 1 Reinke's edema). Technical aspects of these cases suggest that membranous vocal fold granulomas result from surgical violation of deep tissue planes and/or epithelial defects. All patients were treated with proton pump inhibitors. In 12 cases, the granulomas proved self-limited, resolving over weeks to months following surgery. Three patients underwent surgical removal of the lesion, which confirmed the diagnosis. One of these cases recurred and was treated nonsurgically. Conclusions: Granuloma should be suspected when a mass lesion appears at the surgical site early in the postoperative course. Surgical excision is generally not necessary and may provoke further growth of granulation tissue.
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Affiliation(s)
- Lucian Sulica
- Department of Otorhinolaryngology, Weill Medical College of Cornell University, New York, New YOrk, USA
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Affiliation(s)
- Sandeep R Mathur
- Department of Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110 029, India.
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Garrel R, Jouzdani E, Costes V, Makeieff M, Crampette L, Guerrier B. About the Existence of a Foraminal Laryngeal Cyst. Otolaryngol Head Neck Surg 2016; 133:641. [PMID: 16213950 DOI: 10.1016/j.otohns.2004.09.079] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2004] [Accepted: 09/21/2004] [Indexed: 10/25/2022]
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Affiliation(s)
- Annie Lapointe
- Department of Otolaryngology--Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA.
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Bobrov VM, Izhboldina NI. [The combination of laryngeal paresis in the patients presenting with systemic tick-borne borreliosis (Lyme disease)]. Vestn Otorinolaringol 2016; 81:59-60. [PMID: 26977572 DOI: 10.17116/otorino201681159-60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- V M Bobrov
- I.B. Odnopozov City Clinical Hospital No 8, Izhevsk, Russia, 426075
| | - N I Izhboldina
- I.B. Odnopozov City Clinical Hospital No 8, Izhevsk, Russia, 426075
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Sunohara M, Okada T. [An Adult Case of Difficult Intubation Caused by Late Complications of Radiotherapy for Pediatric Neck Malignancy, as well as a Later Laryngeal Elevation Surgery]. Masui 2015; 64:1269-1272. [PMID: 26790331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
We present a case of a 32-year-old female who underwent endoscopic sinus surgery under general anesthesia. She had been diagnosed as rhabdomyosarcoma of her neck at 5 years of age, and received tumor resection and chemoradiotherapy. Afterwards, she was suffering from dysphagia as a late complication of radiotherapy. She received laryngeal elevation surgery at 24 years of age, in order to improve swallowing disturbance. With rapid induction of anesthesia, she was easily ventilated with mask and bag. However, it was difficult to visualize her vocal cord with various intubating apparatus, because of her mandible hypoplasia, small oral cavity, and laryngeal elevation. After all, we were able to intubate her trachea using Pentax Airway-scope® (AWS) with a Pediatric-type INTLOCK Blade™ (ITL-P). Radiotherapy for head and neck malignancy at childhood causes various late complications, leading to difficult intubation. Meanwhile, laryngeal elevation surgery for dysphagia anatomically makes intubation more difficult An adult who has such past history should be expected as an extremely difficult intubation case, and we must be prepared with various intubating apparatus including AWS with ITL-P.
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45
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Fitzgerald CWR, Adeeb F, Timon CV, Shine NP, Fraser AD, Hughes JP. Significant laryngeal destruction in a northern European cohort of Behçet's disease patients. Clin Exp Rheumatol 2015; 33:S123-S128. [PMID: 26487319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 08/31/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES Behçet's disease (BD) is a multisystem autoimmune disease of unknown origin typically affecting the triad of oral and genital mucosa and the eye. Limited data are available in the literature regarding the otolaryngology-related manifestations of BD, particularly in northern Europeans. This is a novel study detailing surprising and significant laryngeal structural changes in a northern European cohort of BD. METHODS Patients meeting the International Study Group for Behçet's Disease (ISGBD) and the International Criteria for Behçet's Disease (ICBD) criteria for diagnosis were identified from an institutional database. Patients underwent examination with an otolaryngologist, including flexible laryngoscopy. Intra-oral, pharyngeal and laryngeal manifestations of BD were documented and characterised. Patients underwent hearing assessment with pure-tone audiometry. RESULTS Fifteen patients with BD were identified (4 male, 11 female; median age 36 years). 60% (n=9) showed evidence of disease on examination and flexible laryngoscopy. 33% (n=5) showed laryngeal changes related to BD. 13% (n=2) demonstrated bilateral sensorineural hearing loss. The 5 cases demonstrating laryngeal manifestations of disease are described in detail with photographic records. CONCLUSIONS Limited data has been published regarding the laryngeal manifestations of BD, particularly in a northern European population. Our cohort of BD patients demonstrate significant laryngeal structural changes. It would appear that these clinically relevant changes may be more common than was previously thought. Raised awareness of the risk of laryngeal pathology in BD patients, often in the absence of overt clinical symptomatology, may result in earlier diagnosis and treatment. Rheumatologists and otolaryngologists should consider closer multi-disciplinary co-operation in the management and follow up of patients with BD.
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Affiliation(s)
| | - Fahd Adeeb
- Department of Rheumatology, University Hospital Limerick, Dooradoyle, Limerick; and University of Limerick, Graduate Entry Medical School, Limerick, Ireland
| | - Conrad V Timon
- Department of Otolaryngology, Head & Neck Surgery, Royal Victoria Eye and Ear Hospital, Dublin, Ireland
| | - Neville P Shine
- Department of Otolaryngology, Head & Neck Surgey, University Hospital Limerick, Dooradoyle, Limerick, Ireland
| | - Alexander Duncan Fraser
- Department of Rheumatology, University Hospital Limerick, Dooradoyle, Limerick; and University of Limerick, Graduate Entry Medical School, Limerick, Ireland.
| | - Joseph P Hughes
- Department of Otolaryngology, Head & Neck Surgey, University Hospital Limerick, Dooradoyle, Limerick, Ireland
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Jakobi A, Stützer K, Bandurska-Luque A, Löck S, Haase R, Wack LJ, Mönnich D, Thorwarth D, Perez D, Lühr A, Zips D, Krause M, Baumann M, Perrin R, Richter C. NTCP reduction for advanced head and neck cancer patients using proton therapy for complete or sequential boost treatment versus photon therapy. Acta Oncol 2015; 54:1658-64. [PMID: 26340301 DOI: 10.3109/0284186x.2015.1071920] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND To determine by treatment plan comparison differences in toxicity risk reduction for patients with head and neck squamous cell carcinoma (HNSCC) from proton therapy either used for complete treatment or sequential boost treatment only. MATERIALS AND METHODS For 45 HNSCC patients, intensity-modulated photon (IMXT) and proton (IMPT) treatment plans were created including a dose escalation via simultaneous integrated boost with a one-step adaptation strategy after 25 fractions for sequential boost treatment. Dose accumulation was performed for pure IMXT treatment, pure IMPT treatment and for a mixed modality treatment with IMXT for the elective target followed by a sequential boost with IMPT. Treatment plan evaluation was based on modern normal tissue complication probability (NTCP) models for mucositis, xerostomia, aspiration, dysphagia, larynx edema and trismus. Individual NTCP differences between IMXT and IMPT (∆NTCPIMXT-IMPT) as well as between IMXT and the mixed modality treatment (∆NTCPIMXT-Mix) were calculated. RESULTS Target coverage was similar in all three scenarios. NTCP values could be reduced in all patients using IMPT treatment. However, ∆NTCPIMXT-Mix values were a factor 2-10 smaller than ∆NTCPIMXT-IMPT. Assuming a threshold of ≥ 10% NTCP reduction in xerostomia or dysphagia risk as criterion for patient assignment to IMPT, less than 15% of the patients would be selected for a proton boost, while about 50% would be assigned to pure IMPT treatment. For mucositis and trismus, ∆NTCP ≥ 10% occurred in six and four patients, respectively, with pure IMPT treatment, while no such difference was identified with the proton boost. CONCLUSIONS The use of IMPT generally reduces the expected toxicity risk while maintaining good tumor coverage in the examined HNSCC patients. A mixed modality treatment using IMPT solely for a sequential boost reduces the risk by 10% only in rare cases. In contrast, pure IMPT treatment may be reasonable for about half of the examined patient cohort considering the toxicities xerostomia and dysphagia, if a feasible strategy for patient anatomy changes is implemented.
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Affiliation(s)
- Annika Jakobi
- a OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf , Dresden , Germany
| | - Kristin Stützer
- a OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf , Dresden , Germany
| | - Anna Bandurska-Luque
- a OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf , Dresden , Germany
- b Department of Radiation Oncology , Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden , Dresden , Germany
| | - Steffen Löck
- a OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf , Dresden , Germany
| | - Robert Haase
- a OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf , Dresden , Germany
| | - Linda-Jacqueline Wack
- c Section for Biomedical Physics, University Hospital for Radiation Oncology, Eberhard Karls Universät Tübingen , Germany
| | - David Mönnich
- c Section for Biomedical Physics, University Hospital for Radiation Oncology, Eberhard Karls Universät Tübingen , Germany
- d German Cancer Research Center (DKFZ) , Heidelberg , Germany
- e German Cancer Consortium (DKTK) , Tübingen , Germany
| | - Daniel Thorwarth
- c Section for Biomedical Physics, University Hospital for Radiation Oncology, Eberhard Karls Universät Tübingen , Germany
| | - Damien Perez
- a OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf , Dresden , Germany
- d German Cancer Research Center (DKFZ) , Heidelberg , Germany
- f German Cancer Consortium (DKTK) , Dresden , Germany
| | - Armin Lühr
- a OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf , Dresden , Germany
- d German Cancer Research Center (DKFZ) , Heidelberg , Germany
- f German Cancer Consortium (DKTK) , Dresden , Germany
| | - Daniel Zips
- a OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf , Dresden , Germany
| | - Mechthild Krause
- a OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf , Dresden , Germany
- b Department of Radiation Oncology , Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden , Dresden , Germany
- d German Cancer Research Center (DKFZ) , Heidelberg , Germany
- f German Cancer Consortium (DKTK) , Dresden , Germany
- g Helmholtz-Zentrum Dresden - Rossendorf, Institute of Radiooncology , Dresden , Germany
| | - Michael Baumann
- a OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf , Dresden , Germany
- b Department of Radiation Oncology , Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden , Dresden , Germany
- d German Cancer Research Center (DKFZ) , Heidelberg , Germany
- f German Cancer Consortium (DKTK) , Dresden , Germany
- g Helmholtz-Zentrum Dresden - Rossendorf, Institute of Radiooncology , Dresden , Germany
| | - Rosalind Perrin
- a OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf , Dresden , Germany
| | - Christian Richter
- a OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf , Dresden , Germany
- b Department of Radiation Oncology , Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden , Dresden , Germany
- d German Cancer Research Center (DKFZ) , Heidelberg , Germany
- f German Cancer Consortium (DKTK) , Dresden , Germany
- g Helmholtz-Zentrum Dresden - Rossendorf, Institute of Radiooncology , Dresden , Germany
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Romanelli-Gobbi M, Ellerston J, DeFatta RA, Portnoy J, Sataloff RT. Posthemorrhagic polyp: Risk of misdiagnosis of the cause of glottic insufficiency. Ear Nose Throat J 2015; 94:E34-E35. [PMID: 26401680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Affiliation(s)
- Massi Romanelli-Gobbi
- Department of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, UT, USA
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48
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Yoda K. [Oral and laryngeal disease caused by sexual infection]. Nihon Jibiinkoka Gakkai Kaiho 2015; 118:841-853. [PMID: 26693555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Keiko Yoda
- Department of Otolaryngology, Tokyo Women's Medical University Medical Center East, 2-1-10 Nishiogu, Arakawaku, Tokyo, Japan
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49
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Lennon P, Lang E, O'Dwyer T. Acquired Anterior Laryngeal Web in a Shotgun Injury. Ir Med J 2015; 108:182-183. [PMID: 26182805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
We report the first case of an anterior laryngeal web post gunshot wound in the modern literature. A 27 year-old man suffered a close range shotgun injury to his neck. He presented with stridor and a large open neck wound. Emergency tracheostomy was required. A postoperative fibreoptic laryngoscopy revealed anterior glottic web formation. This case report highlights the difficulties in managing acquired anterior laryngeal webs and reviews the only other case in the in the literature from 1915.
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50
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Chernobel'sky SI. [The physiological changes in the larynx of the opera singers]. Vestn Otorinolaringol 2015; 80:38-40. [PMID: 26525470 DOI: 10.17116/otorino201580538-40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
A total of 30 opera soloists (15 men and 15 women) at the age from 27 to 35 years were examined to elucidate the influence of vocal loading on the vocal fold colour. Two types of the vocal load were used (20 and 60 minutes in duration). In the former case, the participants were examined prior to singing and 15 min after it. In the latter case, the examination was repeated in triplicate, viz. in the morning before singing, thereafter 15 min and 12 hours after singing. Mirror laryngosopy, laryngostroboscopy, and the acoustic test were employed for the examination. It was shown that 20 minute singing did not cause an appreciable vocal fold hyperemia. It developed after singing during 60 minutes and persisted for at least the next 12 minutes in 12 men and 13 women. However, simultaneous stroboscopy and the acoustic test failed to reveal any abnormalities in these singers. It is concluded that the majority of the singers develop physiological hyperemia of the vocal folds after singing during 60 minutes that exerts neither subjectively nor objectively noticeable influence on the voice quality even though it lasts at least 12 hours.
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Affiliation(s)
- S I Chernobel'sky
- Krasnoyarsk State Academy of Music and Theater, Krasnoyarsk, Russia, 660049
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