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Baba A, Kurokawa R, Fukuda T, Kurokawa M, Tsuyumu M, Matsushima S, Ota Y, Yamauchi H, Ojiri H, Srinivasan A. Comprehensive radiological features of laryngeal sarcoidosis: cases series and systematic review. Neuroradiology 2022; 64:1239-1248. [PMID: 35246700 DOI: 10.1007/s00234-022-02922-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 02/20/2022] [Indexed: 12/18/2022]
Abstract
PURPOSE To comprehensively summarize the characteristic radiological findings of laryngeal sarcoidosis. METHODS We reviewed patients with laryngeal sarcoidosis who underwent computed tomography (CT) and/or magnetic resonance imaging (MRI) and included 8 cases from 8 publications that were found through a systematic review and 6 cases from our institutions. Two board-certified radiologists reviewed and evaluated the radiological images. RESULTS Almost all cases exhibited supraglottic lesions 13/14 (92.9%) and most of them involved aryepiglottic folds (12/13, 92.3%), epiglottis (11/14, 78.6%), and arytenoid region (10/14, 71.4%). Most lesions were bilateral (12/14, 85.7%). All cases showed well-defined margins and a diffuse swelling appearance (14/14, 100%). Non-contrast CT revealed a low density (4/5, 80%). The contrast-enhanced CT showed a slight patchy enhancement predominantly at the margin of the lesion in most cases (12/13, 92.3%). In one case, T2-weighted images showed high signal intensity peripherally and low signal intensity centrally (1/1, 100%). Gadolinium-enhanced MRI showed moderate heterogeneous enhancement predominantly at the margin of the lesion (2/2, 100%). In one case, diffusion-weighted imaging showed intermediate signal intensity; the apparent diffusion coefficient value was 2.4 × 10-3 mm2/s. The larynx was the only region affected by sarcoidosis in 57.1% (8/14) of the cases. Involvement of the neck lymph nodes and distant organs was observed in 4/14 (28.6%) patients, respectively. CONCLUSION We summarized the CT and MRI findings of patients with laryngeal sarcoidosis. Knowledge of these characteristics is expected to facilitate prompt diagnosis and appropriate management.
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Affiliation(s)
- Akira Baba
- Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E. Medical Center Dr, Ann Arbor, MI, 48109, USA. .,Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan.
| | - Ryo Kurokawa
- Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E. Medical Center Dr, Ann Arbor, MI, 48109, USA
| | - Takeshi Fukuda
- Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Mariko Kurokawa
- Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E. Medical Center Dr, Ann Arbor, MI, 48109, USA
| | - Matsusato Tsuyumu
- Department of Otorhinolaryngology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Satoshi Matsushima
- Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Yoshiaki Ota
- Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E. Medical Center Dr, Ann Arbor, MI, 48109, USA
| | - Hideomi Yamauchi
- Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Hiroya Ojiri
- Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Ashok Srinivasan
- Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E. Medical Center Dr, Ann Arbor, MI, 48109, USA
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Laryngeal Sarcoidosis and Swallowing: What Do We Know About Dysphagia Assessment and Management in this Population? Dysphagia 2021; 37:548-557. [PMID: 34037851 PMCID: PMC9072434 DOI: 10.1007/s00455-021-10305-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 04/20/2021] [Indexed: 11/17/2022]
Abstract
Introduction Sarcoidosis is a chronic granulomatous disease of unknown aetiology and laryngeal involvement is seen in a small percentage of cases. Dysphagia is a common but under-reported symptom. Little is known about how dysphagia typically presents or is managed in the context of this fluctuating disease. We present our case series using an SLT-led model of assessment and management. Methods A literature search was conducted for any articles that reported both laryngeal sarcoidosis and dysphagia. We then analysed a case series of laryngeal sarcoidosis patients treated at Charing Cross Hospital. We report on multidimensional swallowing evaluation and rehabilitative interventions. Results Seventeen papers report both laryngeal sarcoidosis and dysphagia, with only one paper giving details on the nature of the dysphagia and the treatment provided. In our case series (n = 7), patients presented with FOIS Scores ranging from 5 to 7 pre-operatively (median = 6). Aspiration (median PAS Score = 6 and Range = 3–8) and pharyngeal residue were common. Sensory issues were also prevalent with most unaware of the extent of their difficulties. Management interventions included safe swallowing advice, compensatory strategies, exercises and close surveillance given their potential for repeated surgical interventions. Conclusion Laryngeal sarcoidosis is a rare condition. Dysphagia is under-reported and our experience highlights the need for specialist dysphagia intervention. Further research is required to understand dysphagia management requirements in the context of this fluctuating disease process.
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Affiliation(s)
- Amy Rutt
- Department of Otolaryngology, Mayo Clinic, Jacksonville, FL, USA
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Leedman SR, Hendriks T, Leahy TW, Hall D. Supraglottic laryngeal sarcoidosis masquerading as supraglottitis. BMJ Case Rep 2020; 13:13/1/e232369. [PMID: 31937627 DOI: 10.1136/bcr-2019-232369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Sarcoidosis is a rare multisystem disorder of unknown aetiology characterised by non-caseating granulomas in involved organs; it is a diagnosis of exclusion. Laryngeal involvement affects only 0.5%-5% of those with sarcoidosis. It is an uncommon but important cause of supraglottic inflammation and oedema and should be considered in the differential diagnosis in patients with supraglottitis. This case describes a 30-year-old man who presented with stridor and shortness of breath. Flexible nasendoscopic examination revealed a grossly oedematous, pale pink, diffusely hypertrophied epiglottis. Surgical biopsy revealed non-caseating granulomatous inflammation. In the context of exclusion of hepatitis, anti-neutrophil cytoplasmic antibody (ANCA) positivity, malignancy and mycobacterial infection, the diagnosis of supraglottic laryngeal sarcoid was made. He is being treated with azathioprine immunosuppression with symptomatic improvement.
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Affiliation(s)
- Samuel Robert Leedman
- Otolaryngology Head and Neck Surgery, Fiona Stanley Hospital, Murdoch, Perth, Western Australia, Australia
| | - Thomas Hendriks
- Otolaryngology Head and Neck Surgery, Fiona Stanley Hospital, Murdoch, Perth, Western Australia, Australia
| | - Travis William Leahy
- Otolaryngology Head and Neck Surgery, Fiona Stanley Hospital, Murdoch, Perth, Western Australia, Australia
| | - David Hall
- Otolaryngology Head and Neck Surgery, Fiona Stanley Hospital, Murdoch, Perth, Western Australia, Australia
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Lang EE, Zaruk JE, Colreavy MP, Kennedy S, Rowley H, Timon C. An unusual Case of External Ear Inflammation Caused by Sarcoidosis. EAR, NOSE & THROAT JOURNAL 2019. [DOI: 10.1177/014556130308201213] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Emer E. Lang
- From the Department of Otolaryngology–Head and Neck Surgery, Royal Victoria Eye and Ear Hospital, Dublin, Ireland
| | - Jamilla El Zaruk
- From the Department of Otolaryngology–Head and Neck Surgery, Royal Victoria Eye and Ear Hospital, Dublin, Ireland
| | - Michael P. Colreavy
- From the Department of Otolaryngology–Head and Neck Surgery, Royal Victoria Eye and Ear Hospital, Dublin, Ireland
| | - Susan Kennedy
- Department of Pathology, Royal Victoria Eye and Ear Hospital, Dublin, Ireland
| | - Helena Rowley
- From the Department of Otolaryngology–Head and Neck Surgery, Royal Victoria Eye and Ear Hospital, Dublin, Ireland
| | - Conrad Timon
- From the Department of Otolaryngology–Head and Neck Surgery, Royal Victoria Eye and Ear Hospital, Dublin, Ireland
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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] [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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Edriss H, Kelley J, Demke J. Sinonasal and Laryngeal Sarcoidosis. Proc (Bayl Univ Med Cent) 2017; 30:452-454. [DOI: 10.1080/08998280.2017.11930226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Hawa Edriss
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - John Kelley
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Joshua Demke
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
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Yamasue M, Nureki SI, Ushijima R, Mukai Y, Goto A, Kadota JI. Sarcoidosis Presenting as Bilateral Vocal Cord Paralysis due to Bilateral Vagal Nerve Involvement. Intern Med 2016; 55:1229-33. [PMID: 27150886 DOI: 10.2169/internalmedicine.55.5441] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We herein report a rare case of sarcoidosis presenting as bilateral vocal cord paralysis due to bilateral vagal nerve involvement. A 72-year-old woman with uveitis of the left eye complained of hoarseness and aspiration due to bilateral vocal cord paralysis. An endobronchial needle aspiration biopsy specimen of the mediastinal lymph nodes showed non-caseating epithelioid cell granuloma. Total protein and cell concentrations in the cerebrospinal fluid were increased. We diagnosed her to have sarcoidosis with bilateral vagal nerve involvement. Corticosteroid therapy improved her symptoms of hoarseness and aspiration. Sarcoidosis should therefore be taken into consideration as a potential cause of bilateral vocal cord paralysis.
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Affiliation(s)
- Mari Yamasue
- Department of Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, Japan
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Morgenthau AS, Teirstein AS. Sarcoidosis of the upper and lower airways. Expert Rev Respir Med 2012; 5:823-33. [PMID: 22082167 DOI: 10.1586/ers.11.66] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Sarcoidosis is a systemic granulomatous disease of undetermined etiology characterized by a variable clinical presentation and disease course. Although clinical granulomatous inflammation may occur within any organ system, more than 90% of sarcoidosis patients have lung disease. Sarcoidosis is considered an interstitial lung disease that is frequently characterized by restrictive physiologic dysfunction on pulmonary function tests. However, sarcoidosis also involves the airways (large and small), causing obstructive airways disease. It is one of a few interstitial lung diseases that affects the entire length of the respiratory tract - from the nose to the terminal bronchioles - and causes a broad spectrum of airways dysfunction. This article examines airway dysfunction in sarcoidosis. The anatomical structure of the airways is the organizational framework for our discussion. We discuss sarcoidosis involving the nose, sinuses, nasal passages, larynx, trachea, bronchi and small airways. Common complications of airways disease, such as, atelectasis, fibrosis, bullous leions, bronchiectasis, cavitary lesions and mycetomas, are also reviewed.
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Affiliation(s)
- Adam S Morgenthau
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, 1 Gustave L. Levy Place, Box 12, New York, NY 10029, USA.
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Vieira JP, Lopes G, Neves M, Viana M, Pinto OT, Honavar M, e Rodrigues MR. [Nasal and laryngeal sarcoidosis - case presentation]. REVISTA PORTUGUESA DE PNEUMOLOGIA 2011; 16:829-35. [PMID: 20927498 DOI: 10.1016/s0873-2159(15)30075-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The authors present the case of a 41-year-old woman with nasal and laryngeal involvement by sarcoidosis, review the literature and discuss the otolaryngologic manifestations, the diagnostic evaluation, treatment and prognostic of this entity.
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Braun JJ, Riehm S, Imperiale A, Schultz-Carpentier AS, Gentine A, de Blay F. Sarcoïdose des voies aérodigestives supérieures. Rev Mal Respir 2011; 28:164-73. [DOI: 10.1016/j.rmr.2010.09.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2010] [Accepted: 09/27/2010] [Indexed: 10/18/2022]
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13
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Plit ML, Chhajed PN, Macdonald P, Cole IE, Harrison GA. Bilateral vocal cord palsy following interscalene brachial plexus nerve block. Anaesth Intensive Care 2002; 30:499-501. [PMID: 12180594 DOI: 10.1177/0310057x0203000409] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Acute respiratory complications of an interscalene brachial plexus block include ipsilateral phrenic nerve and recurrent laryngeal nerve palsies. A 71-year-old woman who had undergone a total thyroidectomy for papillary carcinoma 35 years ago was administered a right interscalene brachial plexus block for a shoulder hemi-arthroplasty. Subsequently she developed acute respiratory distress associated with marked stridor secondary to an acute right vocal cord palsy, which was superimposed on what was assumed to be a preexisting left-sided vocal cord palsy. On extubation the patient was noted to develop stridor again necessitating reintubation and tracheostomy was performed two weeks later. The vocal cord palsies failed to resolve over the subsequent 18-month follow-up. We describe this case to highlight the significant risk of this procedure in patients with preexisting or suspected contralateral vocal cord palsy.
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Affiliation(s)
- M L Plit
- Department of Thoracic Medicine, St Vincent's Hospital, Sydney, NSW, Australia
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Abstract
Sarcoidosis is a chronic granulomatous disease that tends to involve the lungs, hilar and mediastinal lymph nodes, liver, eyes, skin, bones, and nervous system. Sarcoidosis involves the larynx less commonly than it afflicts these other sites. Laryngeal sarcoidosis may occur in isolation or as a component of systemic sarcoidosis and it may produce hoarseness, dysphagia, and dyspnea. Life-threatening airway obstruction can occur. Treatments used for laryngeal sarcoidosis have included tracheotomy, low-dose radiation, surgical excision, systemic steroids, and intralesional steroids. An autoimmune etiology has been suggested. The patient reported in this manuscript showed marked, sustained improvement following the use of inhaled steroids prescribed for obstructive pulmonary disease. The possible efficacy of steroid inhalers for treatment of laryngeal sarcoidosis warrants further investigation.
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Affiliation(s)
- Carole M Dean
- Department of Otolaryngology--Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
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Vaz FM, Samuel D. Postcricoid sarcoid mimicking a malignancy: a lesson to remember. Otolaryngol Head Neck Surg 2000; 123:150. [PMID: 10889500 DOI: 10.1067/mhn.2000.107394] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- F M Vaz
- Department of ENT, Royal Sussex County Hospital, Brighton, UK
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Vasan NR, Allison RS. Sarcoidosis presenting as hoarseness and dysphagia. THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY 1999; 69:751-3. [PMID: 10527359 DOI: 10.1046/j.1440-1622.1999.01683.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- N R Vasan
- Department of Otolaryngology, Head and Neck Surgery, Christchurch Public Hospital, New Zealand.
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McLaughlin RB, Spiegel JR, Selber J, Gotsdiner DB, Sataloff RT. Laryngeal sarcoidosis presenting as an isolated submucosal vocal fold mass. J Voice 1999; 13:240-5. [PMID: 10442754 DOI: 10.1016/s0892-1997(99)80027-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Sarcoidosis can affect the larynx as a manifestation of systemic disease or as isolated laryngeal involvement. Classically, laryngeal involvement affects the supraglottis, and less commonly the subglottis, and true vocal fold involvement is rare. The clinical course is often highlighted by frequent exacerbations and remissions that, when associated with vague complaints and constitutional symptoms, are probably the greatest contributor to delayed presentation and diagnosis. We describe an unusual case of sarcoidosis that presented after a long and protracted clinical course as an isolated submucosal vocal fold mass requiring deep biopsy for diagnosis. A review of the literature with emphasis on diagnosis, appropriate airway management, and treatment is presented.
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Affiliation(s)
- R B McLaughlin
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospitals of the University of Pennsylvania, Philadelphia, USA
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Affiliation(s)
- G D Josephson
- Department of Otolaryngology-Head and Neck Surgery, New York Eye and Ear Infirmary, New York, USA
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Affiliation(s)
- S Fortune
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Abstract
Upper airway obstruction is a potentially life-threatening event that can be managed effectively when promptly recognized and treated. For this reason, all patients who are suspected of having disease affecting the larynx or trachea should be regarded as having a potentially compromised airway until proven otherwise. Although clinically significant upper airway diseases occur infrequently in rheumatic disorders, these manifestations should be considered in such patients who present with upper airway symptomatology.
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Affiliation(s)
- C A Langford
- Laboratory of Immunoregulation, national Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
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