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Kaur T, Baijal N, Jana M, Manchanda S, Naranje P, Bhalla AS. Ultrasound in Causes of Stridor in Children. J Ultrasound Med 2024; 43:801-806. [PMID: 38205904 DOI: 10.1002/jum.16390] [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] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 08/27/2023] [Accepted: 12/03/2023] [Indexed: 01/12/2024]
Abstract
Airway ultrasound (US) is an easily available, portable, radiation-free imaging modality for quick, non-invasive, dynamic evaluation of the airway without sedation. This is useful in children with stridor, which is an emergency due to upper airway obstruction requiring immediate management. Several causes of stridor including laryngomalacia, laryngeal cyst, subglottic hemangioma, vocal cord palsy, and lymphatic malformations can be evaluated accurately. Thin musculature and unossified cartilages in children provide a good acoustic window. Thus, airway US is valuable, but underutilized for the evaluation of children with stridor. In this case-based review, we describe the technique, indications, anatomy, and pathologies on airway US.
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Affiliation(s)
- Tejinder Kaur
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Neha Baijal
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Manisha Jana
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Smita Manchanda
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Priyanka Naranje
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Ashu Seith Bhalla
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
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So RJ, Hillel AT, Motz KM, Akst LM, Best SR. Factors Associated with Iatrogenic Laryngeal Injury in Recurrent Respiratory Papillomatosis. Otolaryngol Head Neck Surg 2024; 170:1091-1098. [PMID: 38123898 DOI: 10.1002/ohn.629] [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: 08/18/2023] [Revised: 11/13/2023] [Accepted: 12/01/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE To describe iatrogenic laryngeal injury and identify its risk factors in recurrent respiratory papillomatosis (RRP) patients receiving surgical care. STUDY DESIGN Case-control. SETTING Tertiary care academic hospital in a metropolitan area. METHODS Charts of patients with RRP seen at our institution from January 2002 to December 2022 were reviewed. Patients were separated into 2 cohorts based upon whether they experienced any form of iatrogenic laryngeal injury-including anterior commissure synechiae, vocal cord scar, reduced vocal fold pliability, vocal fold motion impairment, and glottic and/or subglottic stenosis. Adjusted logistic regressions were performed to identify factors associated with iatrogenic laryngeal injury. RESULTS Of 199 RRP patients, 133 (66.8%) had identifiable iatrogenic laryngeal injury. The most common injuries were anterior commissure synechiae (n = 67; 50.4%) and reduced vocal fold pliability (n = 54; 40.6%). On a multivariate logistic regression, patients with diabetes mellitus (adjusted odds ratio [aOR] [95% confidence interval [CI]]: 2.99 [1.02, 8.79]; P = .04) and who received at least 10 surgeries lifetime (aOR [95% CI]: 14.47 [1.70, 123.19]; P = .01) were at increased risk for iatrogenic laryngeal injury, whereas receiving less than 5 surgeries (aOR [95% CI]: 0.21 [0.09, 0.51]; P < .001) was found to be protective. When treating the lifetime number of surgeries as a continuous variable, a greater number of surgeries was a significant risk factor for iatrogenic laryngeal injury (aOR [95% CI]: 1.32 [1.14, 1.53]; P < .001). CONCLUSION These results suggest the importance of strict glucose control for diabetic patients receiving RRP surgical care, and emphasize the clinical need to identify medical therapies to decrease RRP surgical frequency for patients.
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Affiliation(s)
- Raymond J So
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Alexander T Hillel
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kevin M Motz
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Lee M Akst
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Simon R Best
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Lee SJ, Heo M, Jeong JH, Park JH, Lee CM, Won SJ, Lee JD. Epiglottic retroversion as a cause of upper airway obstruction: A case report. Medicine (Baltimore) 2024; 103:e37142. [PMID: 38335418 PMCID: PMC10860951 DOI: 10.1097/md.0000000000037142] [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: 10/11/2023] [Revised: 12/23/2023] [Accepted: 01/11/2024] [Indexed: 02/12/2024] Open
Abstract
RATIONALE Epiglottic retroversion is the abnormal movement of the epiglottis to the rima glottis, resulting in blockage of inspiratory airflow. Acute upper airway obstruction caused by epiglottic retroversion can lead to sudden respiratory failure. Epiglottic retroversion has occasionally been reported in horses and dogs; however it is extremely rare in humans. Herein, we report a case of epiglottic retroversion causing recurrent upper airway obstruction in human. PATIENT CONCERNS We present the case of a 74-year-old man who was diagnosed with epiglottic retroversion without evidence of epiglottis. The patient presented with recurrent episodes of abnormal breathing sounds and dyspnea. Inspiratory stridor was evident whenever the patient experienced dyspnea. DIAGNOSIS Epiglottic retroversion was diagnosed as the cause of upper airway obstruction using fiber-optic bronchoscopy. INTERVENTIONS The patient underwent tracheostomy to prevent acute respiratory failure because the recurrent episodes of stridor and dyspnea did not improve. OUTCOMES The episodic dyspnea and oxygen desaturation did not relapse after tracheostomy and he could be discharged home. LESSONS This case highlights the importance of considering epiglottic retroversion as a cause of acute upper airway obstruction.
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Affiliation(s)
- Seung Jun Lee
- Division of Pulmonology and Allergy, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, South Korea
| | - Manbong Heo
- Division of Pulmonology and Allergy, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, South Korea
| | - Jong Hwan Jeong
- Division of Pulmonology and Allergy, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, South Korea
| | - Ji-Ho Park
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, South Korea
| | - Chang Min Lee
- Division of Gastroenterology, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, South Korea
| | - Seong Jun Won
- Department of Otolaryngology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, South Korea
| | - Jong Deog Lee
- Division of Pulmonology and Allergy, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, South Korea
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Niermeyer W, Diao G, Bielamowicz SA, Stager SV. Predicting Airflow from Measures Sensitive to Mid-cord Glottal Gap During the COVID-19 Pandemic. Ann Otol Rhinol Laryngol 2023; 132:1543-1549. [PMID: 37096374 DOI: 10.1177/00034894231170937] [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: 04/26/2023]
Abstract
OBJECTIVES To determine if trans-laryngeal airflow, important in assessing vocal function in paresis/paralysis and presbylarynges patients with mid-cord glottal gaps, could be predicted by other measures sensitive to mid-cord glottal gap size but with smaller risks of spreading COVID-19, and if any patient factors need consideration. METHODS Four populations were: unilateral vocal fold paresis/paralysis (UVFP, 148), aging and UVFP (UVFP plus aging, 22), bilateral vocal fold paresis/paralysis without airway obstruction (BVFP, 49), and presbylarynges (66). Five measures were selected from the initial clinic visit: mean airflow from repeated /pi/ syllables, longer of 2 /s/ and 2 /z/ productions, higher of 2 cepstral peak prominence smoothed for vowel /a/ (CPPSa), and Glottal Function Index (GFI). S/Z ratios were computed. Stepwise regression models used 3 measures and 5 patient factors (age, sex, etiology, diagnosis, and potentially impaired power source for voicing) to predict airflow. RESULTS Log-transformations were required to normalize distributions of airflow and S/Z ratio. The final model revealed age, sex, impaired power source, log-transformed S/Z ratio, and GFI predicted log-transformed airflow (R2 = .275, F[5,278] = 21.1; P < .001). CONCLUSIONS The amount of variance explained by the model was not high, suggesting adding other predictive variables to the model might increase the variance explained.
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Affiliation(s)
- Weston Niermeyer
- Division of Otolaryngology, The George Washington University, Washington, DC, USA
| | - Guoqing Diao
- Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Steven A Bielamowicz
- Division of Otolaryngology, The George Washington University, Washington, DC, USA
| | - Sheila V Stager
- Division of Otolaryngology, The George Washington University, Washington, DC, USA
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Fujii-Abe K, Ikeda M, Yajima M, Kawahara H. A Case of Anterior Arytenoid Cartilage Dislocation During Nasal Tracheal Intubation Using an Indirect Video Laryngoscope. Anesth Prog 2023; 70:191-193. [PMID: 38221697 DOI: 10.2344/837325] [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: 12/10/2021] [Accepted: 01/28/2022] [Indexed: 01/16/2024] Open
Abstract
Arytenoid cartilage dislocation can occur as a complication of tracheal intubation and laryngeal trauma, but its occurrence with indirect video laryngoscopy has not been reported. This paper reports anterior arytenoid dislocation occurring after nasotracheal intubation performed under indirect laryngoscopy using a video laryngoscope (McGRATH MAC; Medtronic). The dislocation is presumed to have resulted from the laryngoscope blade being initially inserted too deeply and applying pressure to the posterior aspect of the left cricoarytenoid joint. This patient's anterior arytenoid dislocation was treated conservatively using speech therapy with resolution occurring approximately 40 days postoperatively. On the 74th day after surgery, fibroscopic examination confirmed recovery and healing of the dislocation. However, other types of arytenoid dislocations and laryngeal injuries may require alternative treatment. Early consultation with an otolaryngologist is recommended if arytenoid dislocation is suspected.
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Affiliation(s)
- Keiko Fujii-Abe
- Department of Dental Anesthesiology, School of Dental Medicine, Tsurumi University, Yokohama, Japan
| | - Maho Ikeda
- Department of Dental Anesthesiology, School of Dental Medicine, Tsurumi University, Yokohama, Japan
| | - Manami Yajima
- Department of Dental Anesthesiology, School of Dental Medicine, Tsurumi University, Yokohama, Japan
| | - Hiroshi Kawahara
- Department of Dental Anesthesiology, School of Dental Medicine, Tsurumi University, Yokohama, Japan
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Xu Z. [The consensus among experts on the diagnosis and treatment of pediatric vocal cord paralysis]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2023; 37:765-770. [PMID: 37828877 PMCID: PMC10803239 DOI: 10.13201/j.issn.2096-7993.2023.10.001] [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] [Received: 06/12/2023] [Indexed: 10/14/2023]
Abstract
Pediatric vocal ford paralysis is a vocal cord movement disorder caused by damage to the pediatric laryngeal motor nerves.It is mainly characterized by voice, breathing,and swallowing difficulties,and in severe cases,it can lead to choking in affected children. Currently, the diagnosis and treatment of this condition pose a significant challenge for pediatric otolaryngologists, as the goal is to minimize damage to the vocal folds and laryngeal framework.In order to standardize the diagnosis and treatment of pediatric vocal cord paralysis, the Pediatric Otolaryngology Committee of the Chinese Medical Association,in collaboration with multiple children's medical centers nationwide, have formulated this consensus document.
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Affiliation(s)
- Zhengmin Xu
- Otolaryngology Professional Committee,Pediatrician Branch,Chinese Medical Doctor Association
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Leong P, Gibson PG, Vertigan AE, Hew M, McDonald VM, Bardin PG. Vocal cord dysfunction/inducible laryngeal obstruction-2022 Melbourne Roundtable Report. Respirology 2023; 28:615-626. [PMID: 37221142 PMCID: PMC10947219 DOI: 10.1111/resp.14518] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 01/06/2023] [Accepted: 05/08/2023] [Indexed: 05/25/2023]
Abstract
Vocal cord dysfunction/inducible laryngeal obstruction (VCD/ILO), is a common condition characterized by breathlessness associated with inappropriate laryngeal narrowing. Important questions remain unresolved, and to improve collaboration and harmonization in the field, we convened an international Roundtable conference on VCD/ILO in Melbourne, Australia. The aims were to delineate a consistent approach to VCD/ILO diagnosis, appraise disease pathogenesis, outline current management and model(s) of care and identify key research questions. This report summarizes discussions, frames key questions and details recommendations. Participants discussed clinical, research and conceptual advances in the context of recent evidence. The condition presents in a heterogenous manner, and diagnosis is often delayed. Definitive diagnosis of VCD/ILO conventionally utilizes laryngoscopy demonstrating inspiratory vocal fold narrowing >50%. Computed tomography of the larynx is a new technology with potential for swift diagnosis that requires validation in clinical pathways. Disease pathogenesis and multimorbidity interactions are complex reflecting a multi-factorial, complex condition, with no single overarching disease mechanism. Currently there is no evidence-based standard of care since randomized trials for treatment are non-existent. Recent multidisciplinary models of care need to be clearly articulated and prospectively investigated. Patient impact and healthcare utilization can be formidable but have largely escaped inquiry and patient perspectives have not been explored. Roundtable participants expressed optimism as collective understanding of this complex condition evolves. The Melbourne VCD/ILO Roundtable 2022 identified clear priorities and future directions for this impactful condition.
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Affiliation(s)
- Paul Leong
- Monash HealthMelbourneVictoriaAustralia
- Monash UniversityMelbourneVictoriaAustralia
| | - Peter G. Gibson
- John Hunter HospitalNewcastleNew South WalesAustralia
- Centre of Excellence in Treatable TraitsUniversity of NewcastleNewcastleNew South WalesAustralia
| | - Anne E. Vertigan
- John Hunter HospitalNewcastleNew South WalesAustralia
- Centre of Excellence in Treatable TraitsUniversity of NewcastleNewcastleNew South WalesAustralia
| | - Mark Hew
- Alfred HospitalMelbourneVictoriaAustralia
| | - Vanessa M. McDonald
- John Hunter HospitalNewcastleNew South WalesAustralia
- Centre of Excellence in Treatable TraitsUniversity of NewcastleNewcastleNew South WalesAustralia
| | - Philip G. Bardin
- Monash HealthMelbourneVictoriaAustralia
- Monash UniversityMelbourneVictoriaAustralia
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Rogde ÅJ, Lehmann S, Halvorsen T, Clemm HH, Røksund OD, Hufthammer KO, Kvidaland HK, Vollsæter M, Andersen TM. Prevalence and impact of exercise-induced laryngeal obstruction in asthma: a study protocol for a cross-sectional and longitudinal study. BMJ Open 2023; 13:e071159. [PMID: 37328176 PMCID: PMC10277068 DOI: 10.1136/bmjopen-2022-071159] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 05/30/2023] [Indexed: 06/18/2023] Open
Abstract
INTRODUCTION Exercise-induced laryngeal obstruction (EILO) and exercise-induced asthma can cause troublesome respiratory symptoms that can be difficult to distinguish between. Further, there is now a growing appreciation that the two conditions may coexist, complicating the interpretation of symptoms. The primary aim of this study is to investigate the prevalence of EILO in patients with asthma. Secondary aims include evaluation of EILO treatment effects and investigation of comorbid conditions other than EILO in patients with asthma. METHODS AND ANALYSIS The study will be conducted at Haukeland University Hospital and Voss Hospital in Western Norway, and enrol 80-120 patients with asthma and a control group of 40 patients without asthma. Recruitment started in November 2020, and data sampling will continue until March 2024. Laryngeal function will be assessed at baseline and at a 1-year follow-up, using continuous laryngoscopy during high-intensity exercise (CLE). Immediately after the EILO diagnosis is verified, patients will be treated with standardised breathing advice guided by visual biofeedback from the laryngoscope video screen. The primary outcome will be the prevalence of EILO in patients with asthma and control participants. Secondary outcomes include changes in CLE scores, asthma-related quality of life, asthma control and number of the asthma exacerbations, as assessed between baseline and the 1-year follow-up. ETHICS AND DISSEMINATION Ethical approval has been obtained from the Regional Committee for Medical and Health Research Ethics, Western Norway, (ID number 97615). All participants will provide signed informed consent before enrolment. The results will be presented in international journals and conferences. TRIAL REGISTRATION NUMBER NCT04593394.
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Affiliation(s)
- Åse Johnsen Rogde
- Thoracic Department, Haukeland University Hospital, Bergen, Norway
- Faculty of Medicine, Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Sverre Lehmann
- Thoracic Department, Haukeland University Hospital, Bergen, Norway
- Faculty of Medicine, Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Thomas Halvorsen
- Faculty of Medicine, Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
| | - Hege Havstad Clemm
- Faculty of Medicine, Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
| | - Ola Drange Røksund
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
- Department of Health and Function, Western Norway University of Applied Sciences, Bergen, Norway
| | | | - Haakon Kristian Kvidaland
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
- Department of Health and Function, Western Norway University of Applied Sciences, Bergen, Norway
| | - Maria Vollsæter
- Faculty of Medicine, Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
| | - Tiina Maarit Andersen
- Thoracic Department, Haukeland University Hospital, Bergen, Norway
- Department of Health and Function, Western Norway University of Applied Sciences, Bergen, Norway
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Zhang Y, Xia Z, Huang T. Clinical features and influencing factors of curative effect in children with acute laryngitis and laryngeal obstruction. Auris Nasus Larynx 2023; 50:254-259. [PMID: 35792017 DOI: 10.1016/j.anl.2022.06.005] [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: 02/06/2022] [Revised: 05/30/2022] [Accepted: 06/17/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVE We aim to explore the clinical features and influencing factors of curative effect in children harboring acute laryngitis with laryngeal obstruction. METHODS There involved 237 children with acute laryngitis and 80 healthy children who required physical examination in our hospital between January and September in 2021. The healthy children who required physical examination were allocated into the healthy/control group. The clinical data and laboratory indexes of each group were compared. We also analyzed the risk factors for curative effect of acute laryngitis with laryngeal obstruction among children using univariate/multivariate logistic regression. RESULTS The incidence of barking cough, sore throat, dryness, pruritus, dyspnea, diffuse congestion and swelling of laryngeal mucosa and vocal cord congestion or covered with vascular striation in degree III laryngeal obstruction group were significantly higher than other study groups, with degree II laryngeal obstruction group higher than degree I group, and degree I group higher than no laryngeal obstruction group (P<0.05). Moreover, the levels of CRP, TNF-α, IL-6, IL-8 and WBC in degree III laryngeal obstruction group were higher than other three study groups, with degree II higher than degree I laryngeal obstruction group and no obstruction group, and degree I higher than no laryngeal obstruction group (P<0.05). Multivariate logistic regression analysis showed that CRP, TNF-α, IL-6 and IL-8 were the risk factors affecting the curative effect of acute laryngitis with laryngeal obstruction in children, and the differences were statistically significant (P<0.05). CONCLUSION The study revealed the incidence of barking cough, sore throat, dryness, pruritus, dyspnea, diffuse congestion and swelling of laryngeal mucosa vocal cord congestion or covered with vascular striation is highly associated with the severity of acute laryngitis with laryngeal obstruction in children. Additionally, higher levels of CRP, TNF-α, IL-6, IL-8 and WBC indicated serious condition of the disease among children. Hence the risk factors responsible for the efficacy of acute laryngitis in children are CRP, TNF-α, IL-6 and IL-8.
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Affiliation(s)
- Yufeng Zhang
- Department of Otolaryngology, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Zhongfang Xia
- Department of Otolaryngology, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Tao Huang
- Department of Otolaryngology, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China.
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Liu J, Shao Y, Li J, Zhu L, Gong X, Xue L, Shen J, Li Y. New approach to establish a surgical planning in infantile vallecular cyst synchronous with laryngomalacia based on aerodynamic analysis. Comput Methods Programs Biomed 2023; 230:107335. [PMID: 36638553 DOI: 10.1016/j.cmpb.2023.107335] [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] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 12/15/2022] [Accepted: 01/02/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND AND OBJECTIVES A large proportion of infants with vallecular cyst (VC) have coexisting laryngomalacia (LM). Feeding difficulties, regurgitation, occasional cough, and sleep-disordered breathing are the common symptoms in moderate to severe cases. The surgical management of these cases is more challenging and remains controversial. The purpose of this study is to help surgeons select the effective surgical strategies by computer-aided design (CAD) and computational fluid dynamics (CFD) simulations of the upper airway flow characteristics. METHODS The three dimensional (3D) geometric model of the upper airway was reconstructed based on two dimensional (2D) medical images of the patient with VC accompanied with LM. Virtual surgeries were carried out preoperatively to simulate three possible post-operative states in silico. The different outcomes of virtual surgical strategies were predicted based on computational evaluations of airway fluid dynamics including pressure, resistance, velocity, and wall shear stress (WSS). RESULTS The CFD results of this study suggested the importance of the angle between the rim of epiglottis and arytenoid epiglottic (AE) fold. There was a small impact on the upper airway flow field while the VC was removed and the angle of epiglottis was unchanged. The partial lifting of epiglottis can further improve the flow field. With performing supraglottoplasty (SGP) and the marsupialization of VC, epiglottis was completely recovered, and the flow field was significantly improved. The clinical symptoms of this patient improved greatly after surgeries and no recurrence or growth retardation were noted during 1-year follow-up. The clinical prognosis was consistent with the prediction of the CFD results. CONCLUSIONS The state of epiglottis needs to be carefully checked to evaluate the necessity of performing further SGP in the patients with VC accompanied with LM. CFD and CAD could be developed as a new approach to help surgeons predict the post-operative outcomes through quantification of the airflow dynamics, and make the optimal and individualized surgical approaches for patients with airway obstruction.
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Affiliation(s)
- Jinlong Liu
- Institute of Pediatric Translational Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Yuancheng Shao
- Rensselaer Polytechnic Institute, Troy, NY 12180, United States
| | - Junyang Li
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Limin Zhu
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Xiaolei Gong
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Lianyan Xue
- Diagnostic Imaging Center, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Juanya Shen
- China-UK Low Carbon College, Shanghai Jiao Tong University, Shanghai 200240, China; Key Laboratory for Power Machinery and Engineering, Ministry of Education, Shanghai Jiao Tong University, Shanghai 200240, China.
| | - Youjin Li
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China.
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Wertheim BM, Kapur S, Lakdawala NK, Carroll TL. Hypertrophic Cardiomyopathy as an Unexpected Mimic of Inducible Laryngeal Obstruction: The Case for Cardiopulmonary Exercise Testing in Otolaryngology. J Voice 2023; 37:97-100. [PMID: 33388230 PMCID: PMC8243399 DOI: 10.1016/j.jvoice.2020.12.002] [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: 08/07/2020] [Revised: 12/03/2020] [Accepted: 12/04/2020] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Inducible laryngeal obstruction is a common and challenging cause of exertional dyspnea. We report a case of an unanticipated cardiac condition that presented with symptoms suggestive of inducible laryngeal obstruction. DISCUSSION A 55-year-old man was evaluated for progressive exertional dyspnea and throat tightness, unexplained after multiple medical evaluations. Resting laryngeal examination was suspicious for laryngopharyngeal reflux and mild vocal fold adduction during quiet expiration. Given progressive and refractory symptoms, maximal cardiopulmonary exercise testing with intermittent laryngeal examination was performed. This study excluded laryngeal causes of exercise limitation and led to an unexpected diagnosis of persistent atrial flutter and hypertrophic cardiomyopathy. CONCLUSION Cardiopulmonary exercise testing with laryngeal examination can identify unexpected and life-threatening mimics of inducible laryngeal obstruction that may be missed by unmonitored exercise challenges. Suspicion for inducible laryngeal obstruction at rest may not predict the true nature of exercise limitation on cardiopulmonary exercise testing.
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Affiliation(s)
- Bradley M Wertheim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
| | - Sunil Kapur
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Neal K Lakdawala
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Thomas L Carroll
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
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Melhorn J, Thomas J, Pavord ID. Take a Deep Breath - Time to Plunge into Inducible Laryngeal Obstruction. NEJM Evid 2023; 2:EVIDe2200299. [PMID: 38320096 DOI: 10.1056/evide2200299] [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] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Inducible laryngeal obstruction (ILO)/vocal cord dysfunction is frequently encountered in the specialist asthma clinic, where it is often misdiagnosed as asthma or is coexistent with asthma. It causes recurrent distressing episodes of acute dyspnea that can lead to hospital admissions, endotracheal intubation, and fruitless asthma treatment escalation, often including oral glucocorticoids.1-4 Early diagnosis and treatment of ILO offers the prospect of connecting patients with an effective speech- and language-based intervention earlier and avoiding these unnecessary and potentially harmful interventions.
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Affiliation(s)
- James Melhorn
- Respiratory Medicine Unit and Oxford Respiratory National Institute for Health and Care Research Biomedical Research Centre, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Jordan Thomas
- Respiratory Medicine Unit and Oxford Respiratory National Institute for Health and Care Research Biomedical Research Centre, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Ian D Pavord
- Respiratory Medicine Unit and Oxford Respiratory National Institute for Health and Care Research Biomedical Research Centre, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
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13
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Hseu AF, Spencer GP, Jo S, Clark R, Nuss RC. Laryngeal pathologies in dysphonic children with Down Syndrome. Int J Pediatr Otorhinolaryngol 2022; 157:111118. [PMID: 35405441 DOI: 10.1016/j.ijporl.2022.111118] [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: 02/10/2022] [Revised: 03/07/2022] [Accepted: 03/25/2022] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Down syndrome is the most common chromosomal abnormality and is associated with a higher incidence of congenital heart defects, which often require surgery within the first year of life. Previous studies have found that children with Down syndrome are at higher risk for subglottic stenosis, vocal fold paralysis, and laryngomalacia. The goal of this study is to review children with Down syndrome presenting with dysphonia and to characterize their laryngeal pathologies. METHODS A retrospective review was performed of patients with Down syndrome seen at a tertiary pediatric hospital's department of otolaryngology from Jan. 2007-Jul. 2021 for voice-related concerns. Inclusion criteria included age less than 18 years, diagnosis of Trisomy 21, and complaint of dysphonia. The data extracted included history of dysphonia, co-morbidities, demographic information, age at presentation, perceptual voice assessments, voice quality of life scores, acoustic data, laryngoscopic and/or videostroboscopic exams, and surgical procedures. RESULTS Twenty-three total patients met the study criteria. Of these children, 13 (57%) were male and 10 (43%) were female. The mean age at first presentation was 4.08 years (range 12 days-16.3 years). Eleven of the 23 patients presented within the first 12 months of life. Sixteen patients were diagnosed with vocal fold immobility, 13 of which were left-sided unilateral immobility and the remaining 3 were bilateral immobility. 5 patients were diagnosed with vocal fold nodules. 12 children in the immobility group had a history of cardiothoracic surgery at our institution. Only 3 patients had Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) assessments, though all three showed overall dysphonia ratings of severely deviant, with roughness and strain scores being the most severe. DISCUSSION The most common etiology of dysphonia in our Down syndrome patient population was vocal fold immobility and hypomobility, as opposed to vocal fold nodules (which is the most common in the general pediatric population). The higher likelihood of cardiac surgery in patients with Trisomy 21 may result in the increased incidence of vocal fold immobility. There should be a low threshold to refer dysphonic patients with Down syndrome for laryngoscopic evaluation, as treatment options may be available.
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Affiliation(s)
- Anne F Hseu
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA, USA; Department of Otolaryngology, Harvard Medical School, Boston, MA, USA.
| | - Grant P Spencer
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA, USA
| | - Stacy Jo
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA, USA
| | - Roseanne Clark
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA, USA
| | - Roger C Nuss
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA, USA; Department of Otolaryngology, Harvard Medical School, Boston, MA, USA
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14
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Lee JM, Roy N, Park A, Muntz H, Redmond SM, Smith M. Self-regulation in children with vocal fold nodules: A multilevel analysis. J Commun Disord 2022; 97:106203. [PMID: 35272152 DOI: 10.1016/j.jcomdis.2022.106203] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 02/09/2022] [Accepted: 02/23/2022] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Vocal fold nodules (VNs) represent the most common cause of voice disorders in children. Phonotrauma related to chronic, repetitive, intense vocal activity is often cited as the proximate cause of VNs. However, diminished self-regulation (SR) may predispose some children toward extreme phonotraumatic voice use, thereby contributing secondarily to their development. This case-control study examined the association between features of SR and VNs in children. METHOD Parents of children with VNs (N = 40, Age Mean = 7.5, SD = 2.03 years) and vocally normal, medical controls (VNCs; N = 40, Age Mean = 7.6, SD = 1.54 years) completed the Behavior Rating Inventory of Executive Function, Second Edition (BRIEF2; Gioia, Isquith, Guy & Kenworthy, 2015), an inventory that evaluates components of SR in children. RESULTS Children with VNs, as compared with the vocally normal control group, were described as (i) impulsive (i.e., scoring significantly worse on the Behavior Regulation Index, BRI; P < 0.001, Cohen's d = 0.86), and (ii) emotionally dysregulated (i.e., scoring significantly worse on the Emotional Regulation Index, ERI; P < 0.001, Cohen's d = 0.81). CONCLUSIONS Diminished SR in some children with VNs may contribute to phonotraumatic vocal behaviors and potentially attenuate the effectiveness of voice therapy.
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Affiliation(s)
- Jeong Min Lee
- Department of Communication Sciences and Disorders, The University of Utah, Salt Lake City, UT, United States.
| | - Nelson Roy
- Department of Communication Sciences and Disorders, The University of Utah, Salt Lake City, UT, United States
| | - Albert Park
- Pediatric Otolaryngology Clinic, Primary Children's Medical Center, Salt Lake City, UT, United States; Division of Otolaryngology, Head and Neck Surgery, The University of Utah, School of Medicine, Salt Lake City, UT, United States
| | - Harlan Muntz
- Pediatric Otolaryngology Clinic, Primary Children's Medical Center, Salt Lake City, UT, United States; Division of Otolaryngology, Head and Neck Surgery, The University of Utah, School of Medicine, Salt Lake City, UT, United States
| | - Sean M Redmond
- Department of Communication Sciences and Disorders, The University of Utah, Salt Lake City, UT, United States
| | - Marshall Smith
- Pediatric Otolaryngology Clinic, Primary Children's Medical Center, Salt Lake City, UT, United States; Division of Otolaryngology, Head and Neck Surgery, The University of Utah, School of Medicine, Salt Lake City, UT, United States
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15
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Affiliation(s)
- S Ghauth
- Department of Otorhinolaryngology, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
| | - L Y Toong
- Department of Otorhinolaryngology, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
| | - G Sakina
- Department of Otorhinolaryngology, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
| | - Y T Liew
- Department of Otorhinolaryngology, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
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16
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Li XP, Dai YF, Tan JJ, Deng CQ, Liu X, Lv ZH. Preliminary study on the relationship between pepsin and vocal fold polyp. Am J Otolaryngol 2021; 42:102835. [PMID: 33272715 DOI: 10.1016/j.amjoto.2020.102835] [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] [Received: 11/02/2020] [Accepted: 11/05/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Xiang-Ping Li
- Department of Otolaryngology - Head and Neck Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
| | - Yuan-Feng Dai
- Department of Otolaryngology - Head and Neck Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Jia-Jie Tan
- Department of Otolaryngology - Head and Neck Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Chao-Qun Deng
- Department of Otolaryngology - Head and Neck Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Xiong Liu
- Department of Otolaryngology - Head and Neck Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Ze-Hong Lv
- Department of Otolaryngology - Head and Neck Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
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Pasadyn SR, Cain R. 60-year-old man • chronic cough • history of GERD & dyslipidemia • throat tickle • Dx? J Fam Pract 2021; 70:41-42. [PMID: 33600515 DOI: 10.12788/jfp.0133] [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] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
► Chronic cough ► History of GERD & dyslipidemia ► Throat tickle.
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Affiliation(s)
| | - Robert Cain
- Lerner College of Medicine, Cleveland Clinic, OH; Department of Family Medicine and the Medicine Institute of Cleveland Clinic, USA
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18
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Heller Murray ES, Segina RK, Woodnorth GH, Stepp CE. Relative Fundamental Frequency in Children With and Without Vocal Fold Nodules. J Speech Lang Hear Res 2020; 63:361-371. [PMID: 32073342 PMCID: PMC7210445 DOI: 10.1044/2019_jslhr-19-00058] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Purpose Relative fundamental frequency (RFF) is an acoustic measure that is sensitive to functional voice differences in adults. The aim of the current study was to evaluate RFF in children, as there are known structural and functional differences between the pediatric and adult vocal mechanisms. Method RFF was analyzed in 28 children with vocal fold nodules (CwVN, M = 9.0 years) and 28 children with typical voices (CwTV, M = 8.9 years). RFF is the instantaneous fundamental frequency (f 0) of the 10 vocalic cycles during devoicing (vocal offset) and 10 vocalic cycles during the revoicing (vocal onset) of the vowels that surround a voiceless consonant. Each cycle's f 0 was normalized to a steady-state portion of the vowel. RFF values for the cycles closest to the voiceless consonant, that is, Offset Cycle 10 and Onset Cycle 1, were examined. Results Average RFF values for Offset Cycle 10 and Onset Cycle 1 did not differ between CwVN and CwTV; however, within-subject variability of Offset Cycle 10 was decreased in CwVN. Across both groups, male children had lower Offset Cycle 10 RFF values as compared to female children. Additionally, Onset Cycle 1 values were decreased in younger children as compared to those of older children. Conclusions Unlike previous work with adults, CwVN did not have significantly different RFF values than CwTV. Younger children had lower RFF values for Onset Cycle 1 than older children, suggesting that vocal onset f 0 may provide information on the maturity of the laryngeal motor system.
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Affiliation(s)
- Elizabeth S. Heller Murray
- Department of Speech, Language & Hearing Sciences, Boston University, MA
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, MA
| | - Roxanne K. Segina
- Department of Speech, Language & Hearing Sciences, Boston University, MA
| | | | - Cara E. Stepp
- Department of Speech, Language & Hearing Sciences, Boston University, MA
- Department of Otolaryngology—Head & Neck Surgery, Boston University School of Medicine, MA
- Department of Biomedical Engineering, Boston University, MA
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19
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Verdam FJ, Mahieu H. Thyroid Cartilage Cysts, A Rare Entity Causing Dysphonia. Laryngoscope 2020; 130:E628-E631. [PMID: 31917469 DOI: 10.1002/lary.28495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 05/02/2019] [Revised: 11/25/2019] [Accepted: 12/12/2019] [Indexed: 11/06/2022]
Abstract
Five cases are presented with a strained voice quality due to a unique underlying cause: thyroid cartilage cysts. Laryngoscopy and radiological images show antero-medial displacement of both vestibular and vocal fold(s). Swelling in the ala of the thyroid cartilage results in a pear-shaped lumen. These cysts were marsupialized with CO2 laser, fluid emerged, and histological biopsies confirmed cartilaginous cysts. Postoperatively, all cases report largely reduced or completely resolved vocal complaints, with a consistent follow-up of 2 years. Together with previous publications, an overview of 17 cases is presented, to enhance awareness that thyroid cartilage cysts can cause a strained voice quality. Laryngoscope, 130:E628-E631, 2020.
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20
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Affiliation(s)
- Antoine Eskander
- From the Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology (A.E., J.R.A., J.C.I.) and the Institute for Health Policy Management and Evaluation (A.E., J.R.A.), University of Toronto, Sunnybrook Health Sciences Centre and Michael Garron Hospital (A.E.), the Institute for Clinical Evaluative Sciences (A.E.), and Princess Margaret Cancer Centre (J.R.A., J.C.I.) - all in Toronto
| | - John R de Almeida
- From the Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology (A.E., J.R.A., J.C.I.) and the Institute for Health Policy Management and Evaluation (A.E., J.R.A.), University of Toronto, Sunnybrook Health Sciences Centre and Michael Garron Hospital (A.E.), the Institute for Clinical Evaluative Sciences (A.E.), and Princess Margaret Cancer Centre (J.R.A., J.C.I.) - all in Toronto
| | - Jonathan C Irish
- From the Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology (A.E., J.R.A., J.C.I.) and the Institute for Health Policy Management and Evaluation (A.E., J.R.A.), University of Toronto, Sunnybrook Health Sciences Centre and Michael Garron Hospital (A.E.), the Institute for Clinical Evaluative Sciences (A.E.), and Princess Margaret Cancer Centre (J.R.A., J.C.I.) - all in Toronto
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21
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Shirley F, Oshri W, Ari D, Gad F. The role of laryngeal ultrasound in the assessment of pediatric dysphonia and stridor. Int J Pediatr Otorhinolaryngol 2019; 122:175-179. [PMID: 31035176 DOI: 10.1016/j.ijporl.2019.04.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 02/24/2019] [Revised: 04/13/2019] [Accepted: 04/13/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Dysphonia and stridor are not infrequent in the pediatric population. Awake nasolaryngoscopy (ANL) is the primary diagnostic procedure used to evaluate a child with stridor and/or dysphonia. The major limitation of this technique is poor cooperation in children, resulting in inadequate visualization of the larynx. Ultrasound is a widely used noninvasive imaging modality that has yet to be applied to the laryngeal examination. Our goal was to investigate the feasibility and diagnostic potential of laryngeal ultrasound (LUS) in cases of pediatric stridor and/or dysphonia. METHODS Prospective blinded cohort study of infants and children 0-16 years of age referred for ANL due to voice disorders and/or stridor. Prior knowledge of the etiology was considered an exclusion criterion. RESULTS LUS concurred with the ANL in the diagnosis of abnormal vs normal larynx in 28/32 children that were recruited. LUS had a sensitivity and specificity of 87% (95% CI: 69%-96%) and 100% (95% CI: 16%-100%) respectively, for diagnosing overall laryngeal disorders in comparison to ANL. LUS also had an area under the receiver operating characteristic (ROC) curve (AUC) of 0.93, (P = 0.04, 95% CI: 0.84-1). CONCLUSION LUS may be applied as an adjuvant diagnostic tool for ruling in laryngeal pathologies in children including dysphonia and stridor. As further experience is acquired the value of LUS in diagnosis will be better understood.
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Affiliation(s)
- Friedman Shirley
- Pediatric Critical Care Unit, "Dana-Dwekˮ Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv University Sackler Faculty of Medicine, 6 Weizmann St, Tel Aviv, 6423906, Israel.
| | - Wasserzug Oshri
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv University Sackler Faculty of Medicine, 6 Weizmann St, Tel Aviv, 6423906, Israel
| | - Derowe Ari
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv University Sackler Faculty of Medicine, 6 Weizmann St, Tel Aviv, 6423906, Israel
| | - Fishman Gad
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv University Sackler Faculty of Medicine, 6 Weizmann St, Tel Aviv, 6423906, Israel
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22
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Yang X, Niu L, Yang C, Wang L, Liu J, He G. Clinical features of laryngeal myasthenia gravis: A case series. Am J Otolaryngol 2019; 40:292-296. [PMID: 30497698 DOI: 10.1016/j.amjoto.2018.11.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 10/09/2018] [Accepted: 11/01/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Myasthenia gravis (MG) is an autoimmune disease. Dysarthria, dysphagia, and difficulty swallowing as exclusive initial and primary complaints in MG (laryngeal MG) are rare and seldom reported. METHODS Here we review and analyze the largest series of laryngeal MG patients. RESULTS A total of 30 patients with laryngeal MG as primary manifestation were found in 20 case reports/series. Dysarthria was the most frequent primary symptom (14/30), followed by dysphagia (11/30), slurred speech (4/30) and dysphonia (1/30). Sixty-three percent visited the otolaryngology department first. Only 23.33% of patients were diagnosed with MG at the first clinic visit. Forty-five percent laryngeal MG patients were acetylcholine receptor (AChR) antibody positive, 52.9% showed decremental response in the repetitive nerve stimulation (RNS) test, and 92.6% were positive in the neostigmine/edrophonium test. Fluctuating weakness was examined in 16 of 30 patients and observed in 14/16 patients. CONCLUSION Laryngeal MG is a rare and possibly under-diagnosed condition. The patients can present with dysarthria, dysphagia, or difficulty swallowing. Fluctuation in severity of disease by neostigmine/edrophonium test is a typical feature for MG patients. AChR antibody and RNS tests should be included to evaluate the pathologic changes in the neuromuscular junction.
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Affiliation(s)
- XiangLi Yang
- Department of Otolaryngology Head and Neck Surgery, Tianjin Union Medical Center, Tianjin 300121, China
| | - Lin Niu
- Department of Otolaryngology Head and Neck Surgery, Tianjin Union Medical Center, Tianjin 300121, China
| | - ChunWei Yang
- Department of Otolaryngology Head and Neck Surgery, Tianjin Union Medical Center, Tianjin 300121, China.
| | - Lin Wang
- Department of Otolaryngology Head and Neck Surgery, Tianjin Union Medical Center, Tianjin 300121, China
| | - JiXiang Liu
- Department of Otolaryngology Head and Neck Surgery, Tianjin Union Medical Center, Tianjin 300121, China
| | - GuoYing He
- Department of Neurology, Tianjin Union Medical Center, Tianjin 300121, China
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Määttä OLM, Laurila HP, Holopainen S, Lilja‐Maula L, Melamies M, Viitanen SJ, Johnson LR, Koho N, Neuvonen M, Niemi M, Rajamäki MM. Reflux aspiration in lungs of dogs with respiratory disease and in healthy West Highland White Terriers. J Vet Intern Med 2018; 32:2074-2081. [PMID: 30311983 PMCID: PMC6271311 DOI: 10.1111/jvim.15321] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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: 03/01/2018] [Revised: 08/12/2018] [Accepted: 08/13/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Gastroesophageal reflux and microaspiration (MA) of gastric juice are associated with various human respiratory diseases but not in dogs. OBJECTIVE To detect the presence of bile acids in bronchoalveolar lavage fluid (BALF) of dogs with various respiratory diseases. ANIMALS Twenty-seven West Highland White Terriers (WHWTs) with canine idiopathic pulmonary fibrosis (CIPF), 11 dogs with bacterial pneumonia (BP), 13 with chronic bronchitis (CB), 9 with eosinophilic bronchopneumopathy (EBP), 19 with laryngeal dysfunction (LD), 8 Irish Wolfhounds (IWHs) with previous BPs, 13 healthy WHWTs, all privately owned dogs, and 6 healthy research colony Beagles METHODS: Prospective cross-sectional observational study with convenience sampling of dogs. Bile acids were measured by mass spectrometry in BALF samples. Total bile acid (TBA) concentration was calculated as a sum of 17 different bile acids. RESULTS Concentrations of TBA were above the limit of quantification in 78% of CIPF, 45% of BP, 62% of CB, 44% of EBP, 68% of LD, and 13% of IWH dogs. In healthy dogs, bile acids were detected less commonly in Beagles (0/6) than in healthy WHWTs (10/13). Concentrations of TBA were significantly higher in CIPF (median 0.013 μM, range not quantifiable [n.q.]-0.14 μM, P < .001), healthy WHWTs (0.0052 μM, n.q.-1.2 μM, P = .003), LD (0.010 μM, n.q.-2.3 μM, P = .015), and CB (0.0078 μM, n.q.-0.073 μM, P = .018) groups compared to Beagles (0 μM, n.q.). CONCLUSION AND CLINICAL IMPORTANCE These results suggest that MA occurs in various respiratory diseases of dogs and also in healthy WHWTs.
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Affiliation(s)
- O. L. Merita Määttä
- Department of Equine and Small Animal Medicine, Faculty of Veterinary MedicineUniversity of HelsinkiFinland
| | - Henna P. Laurila
- Department of Equine and Small Animal Medicine, Faculty of Veterinary MedicineUniversity of HelsinkiFinland
| | - Saila Holopainen
- Department of Equine and Small Animal Medicine, Faculty of Veterinary MedicineUniversity of HelsinkiFinland
| | - Liisa Lilja‐Maula
- Department of Equine and Small Animal Medicine, Faculty of Veterinary MedicineUniversity of HelsinkiFinland
| | - Marika Melamies
- Department of Equine and Small Animal Medicine, Faculty of Veterinary MedicineUniversity of HelsinkiFinland
| | - Sanna J. Viitanen
- Department of Equine and Small Animal Medicine, Faculty of Veterinary MedicineUniversity of HelsinkiFinland
| | - L. R. Johnson
- Department of Medicine and Epidemiology, Faculty of Veterinary MedicineUniversity of CaliforniaDavisCalifornia
| | - Ninna Koho
- Department of Equine and Small Animal Medicine, Faculty of Veterinary MedicineUniversity of HelsinkiFinland
| | - Mikko Neuvonen
- Department of Clinical Pharmacology, Faculty of MedicineUniversity of HelsinkiFinland
| | - Mikko Niemi
- Department of Clinical Pharmacology, Faculty of MedicineUniversity of HelsinkiFinland
- HUSLAB, Helsinki University Central HospitalFinland
| | - Minna M. Rajamäki
- Department of Equine and Small Animal Medicine, Faculty of Veterinary MedicineUniversity of HelsinkiFinland
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Khoramshahi H, Khatoonabadi AR, Khoddami SM, Dabirmoghaddam P, Ansari NN. Responsiveness of Persian Version of Consensus Auditory Perceptual Evaluation of Voice (CAPE-V), Persian Version of Voice Handicap Index (VHI), and Praat in Vocal Mass Lesions with Muscle Tension Dysphonia. J Voice 2018; 32:770.e21-770.e30. [PMID: 29029830 DOI: 10.1016/j.jvoice.2017.08.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 05/16/2017] [Revised: 08/07/2017] [Accepted: 08/09/2017] [Indexed: 02/08/2023]
Abstract
OBJECTIVES This study was aimed at determining the internal and external responsiveness of the Persian version of the Consensus Auditory-Perceptual Evaluation of Voice (called ATSHA), Persian version of the Voice Handicap Index (VHI), and Praat scales among patients with vocal mass lesions and secondary muscle tension dysphonia. STUDY DESIGN Prospective, within-participant repeated measures. METHOD Thirty patients with vocal fold nodules, polyps, and cysts related to secondary muscle tension dysphonia participated in the study. The measures of interest and videostroboscopy examination were used before and after treatment. The Global Perceived Effect questionnaire was used to separate those improved (moderately or greatly improved) and stable (slightly improved) patients. RESULTS The mean standardized response, standardized effect size, and Guyatt analyses indicated high internal responsiveness for the all target parameters of the ATSHA, total score of the VHI, and two parameters of the Praat (0.8<). There was poor correlation between the videostroboscopy and the other target scales (r Pearson = -0.1-0.1). The receiver operating characteristic analysis indicated that all the target scales did not significantly separate those improved and stable subjects (area under the curve = 0), except for the overall severity and roughness parameters of the ATSHA scale (area under the curve = 1). CONCLUSION This study recommends both the Consensus Auditory-Perceptual Evaluation of Voice and the VHI scales to show voice therapy changes. The target voice scale changes were not able to predict the videostroboscopy changes as external standard. Furthermore, we recommend that the overall severity and roughness may properly classify those improved and stable patients.
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Affiliation(s)
- Hassan Khoramshahi
- Tehran University of Medical Sciences, School of Rehabilitation, Speech Therapy Department, Tehran, Iran
| | - Ahmad Reza Khatoonabadi
- Tehran University of Medical Sciences, School of Rehabilitation, Speech Therapy Department, Tehran, Iran.
| | - Seyyedeh Maryam Khoddami
- Tehran University of Medical Sciences, School of Rehabilitation, Speech Therapy Department, Tehran, Iran
| | - Peyman Dabirmoghaddam
- Tehran University of Medical Sciences, School of Rehabilitation, Speech Therapy Department, Tehran, Iran
| | - Noureddin Nakhostin Ansari
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran; Sports Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran; Neuromusculoskeletal Research Center, Iran University of Medical Sciences, Tehran, Iran
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25
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Maweni RM, Shirazi S, Chatzoudis D, Das S. Laryngopyocoele with contralateral laryngocoele: a rare cause of respiratory distress. BMJ Case Rep 2018; 2018:bcr-2018-225444. [PMID: 30181400 PMCID: PMC6129081 DOI: 10.1136/bcr-2018-225444] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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] [Accepted: 08/16/2018] [Indexed: 11/03/2022] Open
Abstract
We present the case of a 76-year-old patient who attended our emergency department with signs of sepsis and severe respiratory distress. She had stridor, type 1 respiratory failure and a left-sided neck swelling. On CT, it was initially misdiagnosed as parapharyngeal abscess. When the imaging was reviewed, it was found to be a left-sided mixed laryngopyocoele obstructing the larynx with an asymptomatic contralateral laryngocoele. The internal component of the left laryngopyocoele was excised through a microlaryngoscopy approach while the external component was approached through a transcervical incision. The patient recovered well despite a postoperative myocardial infarction. Both laryngocoeles and laryngopyocoeles are rare, with the latter being the rarer of the two, however, extensive literature review could not identify any previous cases where both have coexisted in the same patient.
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Affiliation(s)
| | | | | | - Sudip Das
- Department of Otorhinolaryngology, Leicester Royal Infirmary, Leicester, UK
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Abstract
RATIONALE One-lung ventilation (OLV) is required during most thoracic surgeries to facilitate surgical visualization by collapsing the lung. Double-lumen tubes and bronchial blockers are two commonly used devices for OLV; however, it may be difficult to place two devices in patients with narrow inlets, such as those that have tumor-induced airway stenosis. PATIENT CONCERNS We report the case of an adult patient with a lung tumor that was growing rapidly and hemorrhaging; thus, a thoracotomy for lung resection should have been performed as early as possible. However, a large mass on the glottis obstructed the entry of the double-lumen tube or bronchial blocker. Therefore, the operation could not be performed because of the inability to provide one-lung ventilation via the conventional intubation method. DIAGNOSES Computed tomography (CT) revealed a lung tumor that was growing rapidly and preoperative bronchoscopy showed a large mass on the vocal cords. INTERVENTIONS After anesthesia induction, a Uniblocker and a small single lumen tube were intubated and the Uniblocker was inserted extraluminally of the single lumen tube. One-lung ventilation was achieved successfully in this patient. OUTCOMES The surgery proceeded uneventfully for 4 hours without any complications. LESSONS Extraluminal use of the Uniblocker and a small single lumen tube may be recommended for patients receiving OLV and who have narrow inlets, especially under emergency situations.
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Morse JC, Gelbard A. Laryngeal Cryptococcoma Resulting in Airway Compromise in an Immunocompetent Patient: A Case Report. Laryngoscope 2018; 129:926-929. [PMID: 30152047 DOI: 10.1002/lary.27456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 06/19/2018] [Accepted: 06/26/2018] [Indexed: 12/18/2022]
Abstract
Cryptococcus neoformans is a yeast than can result in isolated or disseminated infections. This case report describes an immunocompetent patient presenting with airway obstruction secondary to laryngeal crypotococcoma, mimicking a laryngeal malignancy, and describes associated management. A 68-year-old immunocompetent female with a new positron emission tomography-avid laryngeal lesion was intubated after acute respiratory decompensation. Airway evaluation revealed diffuse mucosal changes throughout the endolarynx with significant loss of normal native tissue architecture. Operative biopsy confirmed infection of C neoformans. The patient was treated with extended-course fluconazole. This case reinforces characteristic physical and histologic findings described for laryngeal cryptococcal infection. Laryngoscope, 129:926-929, 2019.
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Affiliation(s)
- Justin C Morse
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee, U.S.A
| | - Alexander Gelbard
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee, U.S.A
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Affiliation(s)
- Michael S Benninger
- Chairman, Head and Neck Institute, The Cleveland Clinic, Cleveland, United States.
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Oorts E, Widdershoven J, Huvskense J, Saleado R, Van de Hevnine P, Boudewyns A. Stridor caused by a blue laryngeal mass in an infant: case report. B-ENT 2017; 13:61-65. [PMID: 29557565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
Stridor caused by.a blue laryngeal mass in an infant: case report. We describe an infant who had inspiratory stridor that began a few weeks after birth. Flexible upper airway endoscopy while the infant was awake showed a large blue mass at the posterior glottis, above the esophageal inlet. The lesion was only visible upon crying or coughing; it was undetectable when we examined the infant in the supine position during spontaneous breathing and did not respond to systemic treatment with propranolol. Based upon these typical features, we established a diagnosis of pressure- dependent postcricoid mass.
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Warrington S, Jeyakumar A. Unusual case of dyspnea in a child. Ear Nose Throat J 2016; 95:442-443. [PMID: 27792820] [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: 06/06/2023] Open
Affiliation(s)
- Stephanie Warrington
- Department of Otolaryngology, Louisiana State University-Health Science Center, New Orleans, LA, USA
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Li-Qiao Y, Jian-Wei Z, Jing-Jie L, Cheng-Mi Z. The risk factors of intraoperative anesthesia adverse events in children with laryngeal diseases. J Clin Anesth 2016; 34:535-9. [PMID: 27687447 DOI: 10.1016/j.jclinane.2016.06.013] [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: 01/16/2016] [Revised: 05/25/2016] [Accepted: 06/15/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND This study aimed to investigate the risk factors of intraoperative anesthesia adverse events (IAAEs) in children with laryngeal diseases. METHODS We retrospectively recruited 118 children with laryngeal diseases who underwent surgical therapy. Based on medical history and preoperative imaging diagnosis, the baseline data, including sex, age, weight, onset age, the number of operation, the degree of airway obstruction, the nature of disease, the location of disease, complications, tracheotomy, and trachea intubation, were defined and recorded. IAAEs, such as pulse oxygen saturation (SpO2) decline, heart rate (HR) decline, emergency orotracheal intubation, emergency tracheotomy, and remaining intubated postoperatively, were also recorded. The risk factors for IAAEs were identified using multivariate logistic regression model. RESULTS Increasing severity of airway obstruction and the presence of pneumonia were risk factors for SpO2 and HR decline in children with laryngeal diseases. Older age, supraglottic rather than subglottic disease, and trachea intubation rather than unprotected airway during surgery were protective factors for SpO2 decline. Furthermore, severe airway obstruction increased risks of emergency orotracheal intubation and remaining intubated postoperatively, whereas supraglottic rather than subglottic disease were protective factors for emergency orotracheal intubation and remaining intubated postoperatively. Only HR decline was found to be associated with the presence of congenital heart disease. CONCLUSIONS The severe airway obstruction increases the risk of SpO2 decline and HR decline as well as the possibility of perioperative emergency orotracheal intubation and remaining intubated postoperatively, whereas supraglottic surgery and surgery performed under endotracheal intubation reduce the incidence rates of these IAAEs in children with laryngeal diseases.
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Affiliation(s)
- Yang Li-Qiao
- Department of Anesthesiology and Critical Care Medicine, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 20092, China.
| | - Zhang Jian-Wei
- Department of Anesthesiology, Shanghai Children's Medical Center Affiliated to Jiao Tong University School of Medicine, Shanghai 200127, China.
| | - Li Jing-Jie
- Department of Anesthesiology and Critical Care Medicine, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 20092, China.
| | - Zhang Cheng-Mi
- Department of Anesthesiology and Critical Care Medicine, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 20092, China.
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Shastri KS, Rutt AL, Sataloff RT. Laryngeal amyloidosis. Ear Nose Throat J 2016; 95:259. [PMID: 27434470] [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: 06/06/2023] Open
Affiliation(s)
- Karthik S Shastri
- From the Department of Otolaryngology-Head and Neck Surgery, Drexel University College of Medicine, Philadelphia (Dr. Shastri and Dr. Sataloff); and the Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Jacksonville, Fla. (Dr. Rutt)
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Abstract
Objectives: We undertook to explore the relationship between non-neoplastic voice disorders and patients' quality of life. Methods: A PubMed search (1966 to 2003) for the terms Voice Handicap Index (VHI), Short Form-36 (SF-36), voice disorders, voice quality, treatment outcome, voice outcome, quality of life, and questionnaires was performed. Raw data were obtained whenever possible. Studies were analyzed by meta-analysis techniques. Results: Of 54 VHI studies identified, 11 were excluded, and of 21 SF-36 studies, 7 were excluded for incomplete data, non-English language, measuring malignant disease, or duplicate publication. Patients with neurologic and inflammatory or traumatic laryngeal disease had worse VHI scores than controls, and those with neurologic laryngeal disease had the most severe impairment (p <.001, Kruskal-Wallis analysis of variance; p <.05, Dunn's method of multiple comparisons). Those with neurologic laryngeal disease had worse SF-36 subdomain scores than did controls in 6 of 8 subdomains (p <.03, Kruskal-Wallis analysis of variance; p <.05, Dunn's method of multiple comparisons). Both patients with neurologic disease and patients with inflammatory or traumatic laryngeal disorders had changes in SF-36 subdomains similar to those of patients with other chronic disease states. Conclusions: Non-neoplastic voice disorders adversely impact patients' voice-related and general quality of life, and neurologic voice disorders have the greatest impact.
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Affiliation(s)
- Seth M Cohen
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Abstract
Objectives: The aim of this prospective study was to verify whether vocal fold fat augmentation (VFFA) modifies upper airway patency. To the best of our knowledge, this is the first study analyzing the impact of VFFA on laryngeal resistance to airflow. Methods: Twenty-one consecutive patients 16 to 74 years of age underwent 24 VFFA operations because of glottic incompetence due to laryngeal hemiplegia (13 patients) or vocal fold tissue defects (8 patients). Flow-volume loop spirometry and body plethysmography were performed before and 1 to 6 months after surgery. Results: There were no significant differences between preoperative and postoperative pulmonary volumes (FVC and FEV1), expiratory flows (PEF, FEF50), or inspiratory flows (PIF, FIF50), although a slight increase in inspiratory flows meant that FEF50/FIF50 slightly decreased. Specific airway resistance (sRaw) increased after VFFA, but not in a statistically significant manner (p = .078). None of the patients experienced postoperative stridor. One obese woman with laryngeal hemiplegia had postoperative effort dyspnea; her respiratory studies showed a reduction in inspiratory flows and an increase in sRaw, and demonstrated progressive improvement. Conclusions: Flow-volume loop spirometry showed that VFFA does not significantly modify respiratory airflows, although a slight increase of inspiratory airflows suggested an improvement in variable extrathoracic obstruction. Body plethysmography proved to be a sensitive procedure that highlighted the subtle increase in upper airway resistance. Hence, VFFA can be considered a relatively safe procedure for achieving vocal fold medialization, and spirometry and plethysmography can be useful for preoperative assessment and postoperative follow-up.
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Affiliation(s)
- Giovanna Cantarella
- Department of Otolaryngology, Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Fondazione IRCCS (Istituto di Ricovero e Cura a Carattere Scientifica), Milan, Italy
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Abstract
Superficial fungal infection of the mucous membranes (thrush) isolated to the larynx is neither widely reported nor well recognized clinically. Therefore, it is often associated with ineffective treatment and delay in diagnosis, and sometimes associated with unneeded surgical intervention. Eight cases of thrush isolated to the larynx, with no oral or oropharyngeal manifestations, are presented. Four of these were isolated to the vocal folds alone. All patients were adults, and 4 were smokers. Hoarseness was always present. Pain was present inconsistently, and there was no dysphagia or odynophagia, in contrast to other forms of upper aerodigestive tract candidiasis. On average, diagnosis was not made until 6 months after the onset of symptoms. Possible causative factors included use of systemic steroids (3 cases), broad-spectrum antibiotics (1 case), or inhaled steroids (5 cases); diabetes (2 cases); and neutropenia (1 case). In 3 cases, all with thrush isolated to the vocal folds, inhaled steroids were the only causative factor identifiable — a feature reported only twice previously. Three patients underwent surgical procedures that might have been avoided had an accurate diagnosis been made. All patients responded readily to oral fluconazole and removal of predisposing factors where possible. The signs, symptoms, predisposing factors, and treatment are compared to those of 14 cases reported in the literature over 35 years.
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Affiliation(s)
- Lucian Sulica
- Department of Otolaryngology, Beth Israel Medical Center, New York, New York 10003, USA
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Abstract
Objectives: Although difficult laryngeal exposure (DLE) is a common problem encountered during microlaryngosurgery, reliable predictors of DLE and grading systems of laryngeal exposure have been scarcely suggested in the field of laryngology. We propose a new classification of laryngeal exposure focusing on the extent of glottic visualization. Methods: We investigated physical parameters that could predict DLE; 73 patients underwent a physical examination including 15 parameters. During endotracheal intubation and suspension laryngoscopy, Cormack-Lehane and laryngeal exposure scores were obtained for each patient and compared with the parameters. Results: The patients' ages ranged from 23 to 77 years. The laryngeal exposure score was correlated with the Cormack-Lehane score (p < .001, r = 0.469). Of all parameters, body mass index, neck circumference, thyroid-mental distance, and horizontal thyroid-mental distance showed significant correlation with the laryngeal exposure score (p < .05). From analysis of the candidate parameters in 13 patients with DLE and the non-DLE group, we found that the cutoff values for predicting DLE were a body mass index of >25.0 kg/m2, a neck circumference of >39.5 cm, a thyroid-mental distance of <5.5 cm, and a horizontal thyroid-mental distance of <4.0 cm. Conclusions: According to the proposed classification of laryngeal exposure, patients with obesity, a muscular neck, or retrognathia are likely to present DLE, and preoperative measurement of the predictors may be useful in preparing for microlaryngosurgery.
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Affiliation(s)
- Jong-Lyel Roh
- Department of Otolaryngology-Head and Neck Surgery, Cancer Research Institute, Chungnam National University College of Medicine, Daejeon, South Korea
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Kantarcioglu OE, Rutt AL, Sataloff RT. Asymptomatic medial vocal fold hemorrhagic polyp. Ear Nose Throat J 2016; 95:210. [PMID: 27304436] [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: 06/06/2023] Open
Affiliation(s)
- Ozlem E Kantarcioglu
- Department of Otolaryngology-Head and Neck Surgery, Ankara University Medical School, Ankara, Turkey
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38
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Affiliation(s)
- Hitoshi Bamba
- Department of Otorhinolaryngology, Kyoto Prefectural University of Medicine, Japan.
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Chen MF, Fang TJ, Lee LA, Li HY, Wang CJ, Chen IH. Huge supraglottic cyst causing obstructive sleep apnea in an adult. Otolaryngol Head Neck Surg 2016; 135:986-8. [PMID: 17141104 DOI: 10.1016/j.otohns.2005.11.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2004] [Indexed: 11/28/2022]
Affiliation(s)
- Meng-Feng Chen
- Department of Otolaryngology, Sleep Center, Chang Gung Memorial Hospital, Taipei, Taiwan, Republic of China
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40
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Batniji RK, Butehorn HF, Cevera JJ, Gavin JP, Seymour PE, Parnes SM. Supraglottic Myxedema Presenting as Acute Upper Airway Obstruction. Otolaryngol Head Neck Surg 2016; 134:348-50. [PMID: 16455394 DOI: 10.1016/j.otohns.2005.03.069] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2003] [Revised: 03/09/2005] [Accepted: 03/24/2005] [Indexed: 11/26/2022]
Affiliation(s)
- Rami K Batniji
- Division of Otolaryngology-Head and Neck Surgery, Albany Medical Center, Albany, NY, USA.
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41
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Henry LR, Packer MD, Brennan J. Airway-obstructing Laryngeal Candidiasis in an Immunocompetent Host. Otolaryngol Head Neck Surg 2016; 133:808-10. [PMID: 16274817 DOI: 10.1016/j.otohns.2004.10.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2004] [Accepted: 10/22/2004] [Indexed: 10/25/2022]
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Affiliation(s)
- C G Larsen
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, KS, USA
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Maeso-Plaza A, Dablanca-Blanco M, Ortega-Fernandez C, Ortega-Del Álamo P. Cicatricial posterior glottic stenosis. Our experience. Acta Otorrinolaringol Esp 2016; 67:330-338. [PMID: 27063587 DOI: 10.1016/j.otorri.2016.01.008] [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: 08/11/2015] [Revised: 01/17/2016] [Accepted: 01/21/2016] [Indexed: 11/19/2022]
Abstract
INTRODUCTION AND OBJECTIVES Presentation of the results obtained in the treatment of cicatricial posterior glottic stenosis. METHODS A retrospective study of 34 patients diagnosed and treated for cicatricial posterior glottic stenosis in our ENT Department. RESULTS In our series, 85.36% of our patients were decannulated. Of these, 80% of the patients with glottic stenosis were decannulated, while 92.9% of the patients with other associated laryngotracheal stenosis were paradoxically decannulated. Of all the patients, 70% required more than 1 surgical procedure, although most of these interventions were to resolve minor issues following our protocol. The number of subsequent interventions was determined by the location of the stenosis, with there being more interventions when the posterior glottic stenosis was associated with another type of laryngotracheal stenosis (p=.001). CONCLUSIONS The surgical results for treating cicatricial posterior glottic stenosis are quite positive. However, unlike other types of posterior glottic stenosis (such as neurogenic abductor paralysis), it requires a greater number of interventions to achieve definitive decannulation. Endoscopic procedures play an important role and represent our main tool.
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Affiliation(s)
- Ana Maeso-Plaza
- Servicio de Otorrinolaringología, Hospital Universitario de Móstoles, Móstoles, Madrid, España.
| | - María Dablanca-Blanco
- Servicio de Otorrinolaringología, Hospital Universitario de Móstoles, Móstoles, Madrid, España
| | - Consuelo Ortega-Fernandez
- Servicio de Otorrinolaringología, Hospital Infanta Sofía, San Sebastián de los Reyes, Madrid, España
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Imaizumi M, Tada Y, Okano W, Tani A, Omori K. Effectiveness of steroid injections for bamboo nodules: A case report. Ear Nose Throat J 2016; 95:E21-E23. [PMID: 27140024] [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: 06/05/2023] Open
Abstract
Vocal nodules are generally caused by vocal abuse, and conservative treatments such as voice therapy have been advocated as a first-choice treatment for vocal nodules. Reports of vocal fold lesions related to autoimmune diseases, such as bamboo nodules, are rare in the literature. Here we report a very rare case of bamboo nodules in a 30-year-old woman treated by steroid injection into the vocal folds by videoendoscopic laryngeal surgery in an outpatient setting. She was successfully treated without further recurrence. This report indicates that a steroid injection into bamboo nodules might be a useful treatment option, especially in patients who have not shown any improvement after conservative treatments.
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Affiliation(s)
- Mitsuyoshi Imaizumi
- Department of Otolaryngology, Fukushima Medical University, School of Medicine, 1 Hikarigaoka, Fukushima 960-1295, Japan.
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do Amaral Catani GS, Hamerschmidt R, Moreira ATR, Timi JRR, Wiemes GRM, Ido J, Macedo E. Subjective and Objective Analyses of Voice Improvement After Phonosurgery in Professional Voice Users. Med Probl Perform Art 2016; 31:18-24. [PMID: 26966960 DOI: 10.21091/mppa.2016.1004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVES To evaluate voice improvement after phonosurgery by subjective and objective voice analysis. DESIGN Prospective observational analytic group study. METHODS This study was conducted from January 2012 to December 2013. Two hundred forty professional voice users (patients), classified as Koufman level I or II with benign vocal fold lesions, were divided in two groups. Patients in group 1 had a diagnosis of superficial vocal fold lesions, and patients in group 2 had deep lesions on the vocal folds. All patients completed the Vocal Performance Questionnaire (VPQ) and underwent acoustic voice tests using the Praat program. Subjective and objective voice analyses were performed before phonosurgery and at 1, 2, and 3 months after phonosurgery. A control group of 100 volunteers was created and underwent the same voice metrics that were applied to the patients. RESULTS Jitter, shimmer, harmonic-to-noise ratio, and VPQ scores significantly differentiated patients with vocal fold lesions from individuals in the control group. All of the analyzed parameters improved significantly after phonosurgery. Additionally, patients with superficial vocal fold lesions achieved normal voice parameters 1 month after surgery, and patients with deep lesions achieved normal voice parameters 3 months after surgery. CONCLUSIONS Analysis of vocal parameters using the VPQ and acoustic tests revealed voice improvement after phonosurgery for both patient groups.
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Affiliation(s)
- Guilherme Simas do Amaral Catani
- Department of Otorhinolaryngology, Federal University of Paraná, Rua General Carneiro, 181-Alto da Glória, Curitiba PR 80060-900, Brasil. Tel +554132626711.
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Thompson JD, Moore JE, Sataloff RT. Laryngitis obscuring an anterior glottic mass. Ear Nose Throat J 2016; 95:16-20. [PMID: 26829678] [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)
- James D Thompson
- Department of Otolaryngology-Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, PA, USA
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Abstract
CONCLUSION It is suggested that transoral complete excision is the ideal treatment for adult vallecular cyst to avoid life-threatening acute airway obstruction and disease recurrence. OBJECTIVE The objective of this study was to review the clinical characteristics and surgical treatment outcomes of vallecular cysts in adults. METHODS A retrospective chart review was performed at Chonnam National University Hwasun Hospital from January 2009 to December 2014. RESULTS Nine patients (≥ 19-years-of-age) with a vallecular cyst were identified. Most of the patients had minimal or no symptoms at diagnosis. The presence of a vallecular cyst was confirmed in all of the patients by fiberoptic laryngoscopy. All of the cases with a vallecular cyst were treated by the transoral surgical procedure. Recurrence of the vallecular cyst was identified in two (22.2%) patients. One patient had been disease-free after the third operation through the transoral approach. Another patient who underwent marsupialization has been observed without surgery. There were no major complications resulting from surgical intervention.
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Affiliation(s)
- Dong Hoon Lee
- a Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School, and Chonnam National University Hwasun Hospital , Hwasun, South Korea
| | - Tae Mi Yoon
- a Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School, and Chonnam National University Hwasun Hospital , Hwasun, South Korea
| | - Joon Kyoo Lee
- a Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School, and Chonnam National University Hwasun Hospital , Hwasun, South Korea
| | - Sang Chul Lim
- a Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School, and Chonnam National University Hwasun Hospital , Hwasun, South Korea
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Abstract
Laryngeal cysts are relatively rare benign lesions of the larynx. Congenital cysts can cause neonatal respiratory distress and death, but airway obstruction due to acquired cysts in adults is rare. We present a case report of 51-year-old male with dysphagia who was found to have a mobile pedunculated epiglottic cyst that intermittently caused partial obstruction of the laryngeal inlet. Patient was taken to operating room and following transoral fiberoptic intubation, endoscopic excision of this cyst was accomplished. Patient's postoperative course was uneventful.
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Affiliation(s)
- Alissa M Collins
- Division of Otolaryngology, Head and Neck Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Nikita Chapurin
- Division of Otolaryngology, Head and Neck Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Walter T Lee
- Division of Otolaryngology, Head and Neck Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA.
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49
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Taillens JP. Modern indications for tracheotomy in cases of acute and chronic asphyxia. Fortschr Hals Nasen Ohrenheilkd 2015:1-31. [PMID: 4894142 DOI: 10.1159/000385356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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50
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Chen Z, Zhuo M, Yang F. [Primary laryngeal aspergillosis with laryngeal obstruction:a case report]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2015; 50:328. [PMID: 26081089] [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: 06/04/2023]
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