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Kumar Jindal A, Basu S, Tyagi R, Barman P, Sil A, Chawla S, Kaur A, Tyagi R, Jangra I, Machhua S, Sendhil Kumaran M, Dogra S, Vinay K, Bishnoi A, Sharma R, Garg R, Saka R, Suri D, Pandiarajan V, Pilania R, Dhaliwal M, Sharma S, Rawat A, Singh S. Delay in diagnosis is the most important proximate reason for mortality in hereditary angio-oedema: our experience at Chandigarh, India. Clin Exp Dermatol 2024; 49:368-374. [PMID: 38039144 DOI: 10.1093/ced/llad428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 11/20/2023] [Accepted: 11/21/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND Hereditary angio-oedema (HAE) is a rare autosomal dominant disorder characterized clinically by recurrent episodes of nonpruritic subcutaneous and/or submucosal oedema. Laryngeal oedema is the commonest cause of mortality in patients with HAE. Prior to the availability of first-line treatment options for the management of HAE, mortality was as high as 30%. Mortality has significantly declined in countries where first-line treatment options are available and patients can access these therapies. There is a paucity of literature on the outcomes of patients with HAE in developing countries where availability of and access to first-line treatment options are still a challenge. OBJECTIVES To report our experience on mortality in patients with HAE and to report factors associated with the death of these patients. METHODS We carried out a record review of all patients diagnosed with HAE between January 1996 and August 2022. Families with HAE who had reported the death of at least one family member/relative from laryngeal oedema were studied in detail. RESULTS Of the 65 families (170 patients) registered in the clinic, 16 families reported the death of at least one family member/relative from laryngeal oedema (total of 36 deaths). Of these 16 families, 14 reported that 1 or more family members had experienced at least 1 attack of laryngeal oedema. One patient died during follow-up when she was taking long-term prophylaxis with stanozolol and tranexamic acid, while the remaining 35 patients were not diagnosed with HAE at the time of their death. At the time of death of all 36 patients, at least 1 other family member had symptoms suggestive of HAE, but the diagnosis was not established for the family. CONCLUSIONS To our knowledge, this is the largest single-centre cohort of patients with HAE in India reporting mortality data and factors associated with death in these families. The delay in diagnosis is the most important reason for mortality.
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Affiliation(s)
- Ankur Kumar Jindal
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Suprit Basu
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Reva Tyagi
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Prabal Barman
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Archan Sil
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanchi Chawla
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anit Kaur
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rahul Tyagi
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Isheeta Jangra
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanghamitra Machhua
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Muthu Sendhil Kumaran
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sunil Dogra
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Keshavamurthy Vinay
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anuradha Bishnoi
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajni Sharma
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ravinder Garg
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ruchi Saka
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepti Suri
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vignesh Pandiarajan
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rakesh Pilania
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manpreet Dhaliwal
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Saniya Sharma
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Amit Rawat
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Surjit Singh
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Jahshan F, Marshak T, Qarawany J, Markel B, Sberro A, Lahav Y, Layous E, Eisenbach N, Shochat I, Sela E, Ronen O. Incidental Laryngeal Findings in Routine Laryngopharyngeal Reflux Diagnosis. Isr Med Assoc J 2024; 26:40-44. [PMID: 38420641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
BACKGROUND Laryngopharyngeal reflux (LPR) refers to the backflow of acidic stomach content into the larynx, pharynx, and upper aerodigestive tract. The diagnosis of LPR is based on the patient's history and findings of the laryngoscopy associated with LPR. Other possible manifestations consistent with LPR symptoms include laryngeal cancer, vocal fold granulomas, Reinke's space edema, and vocal polyps. In this study, we compared the characteristics of patients with LPR symptoms and incidental laryngeal findings (ILF) in the laryngoscopic evaluation to those without ILF (WILF). OBJECTIVES Determine the characteristics of LPR-symptomatic patients with ILF versus WILF. METHODS In this retrospective study, we examined 160 medical charts from patients referred to the otolaryngology clinic at Galilee Medical Center for LPR evaluation 2016-2018. The reflux symptoms index (RSI), reflux finding score (RFS), and demographics of the patient were collected. All patients with a positive RSI score for LPR (RSI > 9) were included, and the profiles of patients with versus without ILF on laryngoscopy examination were compared. RESULTS Of the 160 patients, 20 (12.5%) had ILF during laryngoscopy. Most had vocal cord findings such as leukoplakia (20%), polyps (15%), and nodules (20%). Hoarseness, throat clearing, swallowing difficulty, breathing difficulties, and total RSI score were significantly higher in patients with ILF. CONCLUSIONS Evaluation of LPR symptoms may provide otolaryngologists with a tool to identify patients with other findings on fiberoptic laryngoscopy. A laryngoscopic examination should be part of the examination of every patient with LPR to enable diagnosis of incidental findings.
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Affiliation(s)
- Forsan Jahshan
- Department of Otolaryngology-Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel, Department of Otolaryngology, Head and Neck Surgery, Hillel Yaffe Medical Center, Hadera, Israel, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Tal Marshak
- Department of Otolaryngology-Head and Neck Surgery, Galilee Medical Center, Nahariya, Israel, Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Jamal Qarawany
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Boaz Markel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Amiel Sberro
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Yonatan Lahav
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Eli Layous
- Department of Otolaryngology-Head and Neck Surgery, Galilee Medical Center, Nahariya, Israel, Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Netanel Eisenbach
- Department of Otolaryngology-Head and Neck Surgery, Galilee Medical Center, Nahariya, Israel, Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Isaac Shochat
- Department of Otolaryngology, Head and Neck Surgery, Hillel Yaffe Medical Center, Hadera, Israel, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Eyal Sela
- Department of Otolaryngology-Head and Neck Surgery, Galilee Medical Center, Nahariya, Israel, Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Ohad Ronen
- Department of Otolaryngology-Head and Neck Surgery, Galilee Medical Center, Nahariya, Israel, Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
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Móz LES, Martins RHG, Lapa RML, Villacis RAR, Dos Reis PP, Rogatto SR. DNA rare copy number alterations in Reinke’s Edema. Braz J Otorhinolaryngol 2022; 89:279-284. [PMID: 36243603 PMCID: PMC10071534 DOI: 10.1016/j.bjorl.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 07/21/2022] [Accepted: 09/08/2022] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Reinke's Edema (RE) is a laryngeal lesion related to excessive tobacco smoking, voice overuse, and laryngopharyngeal reflux. Although the risk of malignancy has been considered low in literature, RE is classified among precancerous lesions. OBJECTIVES We investigated DNA Copy Number Alterations (CNAs) in specimens of RE and its potential association with malignant progression. METHODS We used array-based comparative genomic hybridization (aCGH, Agilent 4 × 180 K platform) to study eight RE cases. All patients were heavy tobacco users for at least 30 years, and none of them progressed to cancer in the follow-up (>8 years). Two RE presented mild dysplasia, one moderate dysplasia, and no histological alterations were found in the remaining five cases. CNAs were compared with the Database of Genomic Variants (DGV) and genes mapped on altered regions had their functions annotated. RESULTS Six of eight patients showed different rare copy number alterations on chromosomes 2q37.3, 4q13.1, 4q13.3, 7q11.22, 10p14, and 13q34. A gain of the whole chromosome 8 were detected in one case. Of interest, four of eight RE cases showed copy number imbalances involving genes previously described in several tumor types (RASA3, COL6A3, LINC00707, LINP1, SMR3A, and SMR3B). CONCLUSION The genomic imbalances herein found in RE have the potential to contribute to the phenotype but with limited or no risk of cancer. A long-term follow-up in a large series of patients could clarify the mechanisms involved in the malignant progression of RE. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Luis Eduardo Silva Móz
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil; São Camilo Oncologia
| | - Regina Helena Garcia Martins
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina, Departamento de Especialidades Cirúrgicas e Anestesiologia, Botucatu, SP, Brazil.
| | - Rainer Marco Lopez Lapa
- National University Toribio Rodríguez de Mendoza of Amazonas, Institute of Livestock and Biotechnology, Laboratory of Molecular Physiology, Chachapoyas, Peru
| | - Rolando André Rios Villacis
- Universidade de Brasília (UnB), Instituto de Ciências Biológicas, Departamento de Genética e Morfologia, Brasília, DF, Brazil
| | - Patricia Pintor Dos Reis
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina, Departamento de Cirurgia e Ortopedia, Botucatu, SP, Brazil
| | - Silvia Regina Rogatto
- University Hospital of Southern Denmark, Department of Clinical Genetics, Vejle, Denmark; University of Southern Denmark, Institute of Regional Health Research, Odense, Denmark.
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Abstract
Two cases of anaesthetic complications after robotic-assisted laparoscopic radical prostatectomy using the da Vinci Remote-Controlled Surgical System are presented. Case 1 describes a patient with post-extubation respiratory distress requiring reintubation and subsequent ventilation in an intensive care unit. This was attributed to laryngeal oedema, which was most likely due to the reduction in venous outflow from the head caused by the pneumoperitoneum and prolonged, extreme Trendelenburg position. Case 2 describes a patient with mild brachial plexus neurapraxia, which was most likely due to compression by shoulder braces (to prevent cephalad sliding) during the exaggerated head-down tilt. For this procedure, the authors recommend limiting the duration and extent of head-down tilt as much as possible, avoiding excessive intravenous fluids and careful positioning of the patient with avoidance of shoulder braces whenever possible.
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Affiliation(s)
- S V N Phong
- Department of Anaesthesia and Surgical Intensive Care, Singapore General Hospital, Singapore
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Artemenko VY, Budnyuk OO. [PROGNOSTICATION OF "HARD" TRACHEAL INTUBATION IN PATIENTS, SUFFERING PURULENT-INFLAMMATORY DISEASES OF THE JAW-FACIAL REGION]. Klin Khir 2015:54-56. [PMID: 26939430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Clinical follow-up was conducted in 75 patients, to whom the operation and intensive therapy were performed in 2006-2015 yrs for phlegmon of the neck. Difficulties while providing passability of respiratory ways have occurred in 73.3% patients. It was established, that the predictors of "hard" tracheal intubation in patients, operated on for cervical phlegmon, are follows: the cervical tissues oedema, restriction of the mouth opening lesser than 3 cm, odontogenous phlegmon of oral cavity and the neck, rigid epiglottis, the larynx oedema. Presence of these factors demands application of endoscopic methods for tracheal intubation in such patients.
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Keeratichananont W, Limthong T, Keeratichananont S. Cuff leak volume as a clinical predictor for identifying post-extubation stridor. J Med Assoc Thai 2012; 95:752-755. [PMID: 22774617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Post-extubation stridor occurs after translaryngeal intubation results to re-intubation in a number of patients. OBJECTIVE To determine the cut-off value of the cuff leak volume test among Thai patients as a predictor for post-extubation stridor MATERIAL AND METHOD Demographic data and cuff leak volume were collected from patients who had been intubated with planned extubation. Clinical stridor was observed and identified after extubation. RESULTS Among 115 patients, the cuff leak volume of less than 114 ml was used to predict post-extubation stridor with the sensitivity of 89%, specificity of 90%, positive predictive value of 65%, and negative predictive value of 98%, respectively. Among the stridor group, 12 of 19 cases (63.2%) needed re-intubation. CONCLUSION The cuff leak volume of less than 114 ml can be used as a clinical predictor for identifying post-extubation stridor
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Affiliation(s)
- Warangkana Keeratichananont
- Division of Respiratory and Respiratory Critical Care Medicine, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
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Abdel-Aziz M, Azab NA, Bassyouni IH, Hamdy G. Laryngeal involvement in juvenile idiopathic arthritis patients. Clin Rheumatol 2011; 30:1251-6. [PMID: 21614473 DOI: 10.1007/s10067-011-1781-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Accepted: 05/11/2011] [Indexed: 11/26/2022]
Abstract
Juvenile idiopathic arthritis (JIA) is an autoimmune diseases characterized by chronic arthritis and systemic manifestations. Autoimmune diseases can affect the upper airways including the larynx. The aim of this study was to investigate laryngeal involvement in JIA patients and its possible association with JIA disease parameters. Fifty consecutive JIA patients were screened for laryngeal abnormalities using flexible fiberoptic laryngoscope and laryngeal computerized tomography. Laryngeal abnormalities were detected in nine (18%) of our cases, with cricoarytenoiditis in six cases (12%) and a rheumatoid nodule in the pyriform fossa in only one case (2%). Diffuse congestion and edema of the posterior part of the larynx with normal vocal cord mobility was detected in two cases (4%). In our study, laryngeal abnormalities were significantly higher in patients with polyarticular seropositive disease subtype and also were significantly higher in patients with longer disease duration, higher disease activity scores, and those with erosive disease. JIA may affect the larynx. Laryngeal involvement in JIA patients is more in polyarticular seropositive cases. JIA patients have to be subjected to thorough otolaryngologic examination for early diagnosis and prompt management.
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Affiliation(s)
- Mosaad Abdel-Aziz
- Department of Otolaryngology, Faculty of Medicine, Cairo University, Cairo, Egypt
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8
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Ino H, Sato H, Furuya A, Okuyama K, Iwashita H, Okawa I, Horimoto Y, Matsukawa T. [Spinal anesthesia for a inguinal hernia repair in a small child with laryngeal stenosis]. Masui 2009; 58:1017-1020. [PMID: 19702223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
We experienced spinal anesthesia for inguinal hernia repair in combination with general anesthesia in a 4-year-old child with functional laryngeal stenosis and tendency of laryngeal edema. His airway was managed without endotracheal tube or laryngeal mask airway because these devices could worsen the upper airway stenosis. Spinal anesthesia offered reliable and potent analgesia leading to safe anesthetic management under spontaneous breathing. Although spinal anesthesia in combination with general anesthesia is not common in pediatric patients, it is effective and safe to apply for a case requiring more reliable and potent analgesia with understanding anatomical and physiological characteristics in children.
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Affiliation(s)
- Hirofumi Ino
- Department of Anesthesiology, Faculty of Medicine, University of Yamanashi, Yamanashi 409-3898
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9
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Zernotti M, Jackson-Menaldi C, Rubin AD. Vocal fold mucosal bridge without sulcus vocalis in a smoker. Ear Nose Throat J 2009; 88:950. [PMID: 19517396] [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: 05/27/2023] Open
Affiliation(s)
- Mauro Zernotti
- Lakeshore Professional Voice Center, Lakeshore Ear, Nose and Throat Center, St. Clair Shores, Mich., USA
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10
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Abstract
BACKGROUND In the case of Reinke's edema, the usual aim of microlaryngoscopic vocal fold stripping is an improvement of voice quality. Long-term results concerning functional voice quality in the literature vary widely. Whether and to what degree surgical intervention leads to the desired postoperative results is therefore still an open question. Therefore we conducted a follow-up study to review our own treatment results. MATERIALS AND METHODS We questioned 88 patients treated for Reinke's edema, either orally or by means of a written questionnaire, 6 months to 7 years (mean: 3.5 years) after the operation (longitudinal incision, removal of the edema by suction, resection of surplus vocal cord mucosa), asking about postoperative voice quality and subjective impression of how successful the operation had been. In all 63 patients answered the questionnaire; 16 agreed to undergo follow-up laryngostroboscopy. RESULTS 51 patients (81%) reported a postoperative improvement in voice quality, 8 patients (13%) rated their voice quality as unchanged, and 4 patients (6%) complained of deterioration in their voice quality. Among the patients whose voices were subject to professional strain (n=27) a lower proportion experienced successful results (voice quality improved: 71%; unchanged: 21%; worse: 8%) than among patients without vocal strain (n=36; improved: 86%; unchanged: 11%; worse: 3%). Postoperative elimination or restriction of such etiological factors as smoking and vocal strain also improved the long-term results. Follow-up examination in 16 patients revealed a good correlation between the patients' subjective reports and the stroboscopic and auditory findings. CONCLUSION Patients should be selected very carefully for surgical treatment of Reinke's edema. The elimination of etiological factors is of highly significant in terms of the prognosis. Before surgery patients should be fully informed of how uncertain the prognosis is.
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Affiliation(s)
- C Sommer
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, plastische Operationen, Phoniatrie und Pädaudiologie, Städtische Kliniken Neuss
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11
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Abstract
The purpose of this study was to determine the most appropriate scaling procedure for evaluating voice activity limitation (AL) and voice participation restriction (PR). In a randomly counterbalanced design, 32 dysphonic individuals rated their self-perceived extents of voice AL and PR using two scaling procedures [equal-appearing interval (EAI) scaling and visual analogue (VA) scaling]. Results revealed that test-retest reliabilities were similar for the two scaling procedures. The overall extents of voice AL and PR obtained from the two scaling procedures were similar. Moreover, the significant linear relationships obtained between the EAI and VA data of voice AL and PR suggest both dimensions as metathetic in nature. Therefore, either EAI or VA scaling procedure would be considered as appropriate for rating voice AL and PR. However, the relative ease to use by consumers favours the choice of EAI over VA scaling procedure for evaluating voice AL and PR.
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Affiliation(s)
- Estella P-M Ma
- Voice Research Laboratory and Centre for Communication Disorders, Division of Speech and Hearing Sciences, The University of Hong Kong, Hong Kong, SAR, China.
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12
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Abstract
AIMS To determine the frequency of anaphylactic deaths amongst coronial autopsy cases performed in the greater Auckland region from 1985 to 2005, and review the circumstances of death and autopsy findings. METHODS A computerised search for anaphylactic deaths was performed using the Forensic Pathology Department database at Auckland City Hospital. Postmortem reports and police reports were reviewed to determine the circumstances of death. Details recorded included basic demographic data, medical history, agent responsible for the allergic reaction, and pathologic findings at autopsy. RESULTS A total of 18 cases of anaphylactic deaths were identified for the study period, including nine males and nine females, age range 33-76 years, mean 51.9 years. There were 10 reactions to drugs or contrast media (4 anaesthetic agents, 3 antibiotic, 2 IV contrast media, 1 streptokinase), four to bee/wasp venom, two to seafood, and two undetermined. Death occurred within 1 hour of onset of anaphylaxis in 12 cases. Findings at autopsy included non-specific pulmonary oedema and congestion (n = 13), laryngeal oedema (n = 5), cerebral hypoxia (n = 4) and cutaneous oedema (n = 1). Serum tryptase levels were measured in 15 cases, and were significantly elevated (>20 microg/L) in eight cases. CONCLUSION Anaphylactic reaction is an uncommon cause of sudden death. In many cases, no specific macroscopic or microscopic findings were detected at autopsy. In the presence of a typical clinical history, postmortem measurement of serum tryptase levels can be a useful diagnostic aid.
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Affiliation(s)
- Irene Low
- Department of Forensic Pathology, Auckland Hospital, New Zealand.
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Abstract
Cricothyroidotomy is a well established technique of airway management in emergency situations where translaryngeal intubation cannot be achieved. This case report describes a case where cricothyroidotomy was used for elective ventilation for short period of 48 hours in a patient who had a vocal cord palsy, supraglottic oedema and inflammation. Surgical tracheostomy was considered the preferred option, but this was deemed impossible due to the challenging neck anatomy in this case.
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Affiliation(s)
- H G W Paw
- Intensive Care Unit, York Hospital, United Kingdom
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14
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Basaranoglu G, Erden V, Kokten N, Verim A, Isikci Y, Saitoglu L. Laryngeal web as a result of Reinke's oedema: a cause of difficult endotracheal intubation. Br J Anaesth 2006; 96:406-7. [PMID: 16467441 DOI: 10.1093/bja/aei643] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
PURPOSE We report an unusual case of upper airway compromise in a patient with Graves' disease. We speculate that this complication may be due, in part, to poorly controlled hyperthyroidism. CLINICAL FEATURES A 26-yr-old female suffering from Graves' disease underwent a total thyroidectomy. Awake fibreoptic intubation was attempted because of a large goiter and orthopnea. Upper airway edema impeded the passage of an armored 7.5 mm endotracheal tube. She was subsequently intubated awake with a regular 7.5 mm endotracheal tube under direct laryngoscopy over an Eschmann bougie. The patient was extubated in the operating room over a tube exchanger. Two hours later she developed stridor and upper airway obstruction. Using direct laryngoscopy, she was reintubated with difficulty because of upper airway edema. At this time, she manifested signs of thyrotoxicosis which were managed medically. On postoperative day three she underwent a tracheostomy after failing a trial of extubation. The upper airway was edematous with minimal vocal cord movement. On postoperative day nine the tracheostomy was downsized and the patient was sent home. The vocal cords were still edematous with minimal movement. Three weeks later, she demonstrated normal right vocal cord movement and weak left vocal cord movement, and the tracheostomy was decannulated. CONCLUSIONS Uncontrolled hyperthyroid patients with large goiters secondary to Graves' disease may develop edema of the upper airway. A high degree of vigilance for airway obstruction is necessary, with a carefully planned approach at each stage of the patient's hospital course to treat this potentially life-threatening situation.
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Affiliation(s)
- William Li Pi Shan
- Department of Anesthesia, Royal Victoria Hospital, McGill University Health Center, Montreal, Quebec, Canada.
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Lim JY, Choi JN, Kim KM, Choi HS. Voice analysis of patients with diverse types of Reinke's edema and clinical use of electroglottographic measurements. Acta Otolaryngol 2006; 126:62-9. [PMID: 16308257 DOI: 10.1080/00016480510043927] [Citation(s) in RCA: 20] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
CONCLUSIONS Reinke's edema shows a variety of clinical patterns and differences in voice analysis depending on its type. Electroglottographic measurements help to objectively assess the severity of edema and voice quality before and after surgery. OBJECTIVES Reinke's edema manifests various clinical findings and different voice characteristics depending on the degree of swelling and the severity of voice impairment. The aim of this study was to compare the aerodynamic, acoustic and electroglottographic parameters for the different types of Reinke's edema according to its morphological, perceptual and histopathological classifications, and to assess voice quality in patients with Reinke's edema before and after laryngomicrosurgery. We also aimed to determine which parameter was most associated with the improvement in postoperative voice quality and to investigate the clinical usefulness of electroglottographic analysis in Reinke's edema. MATERIAL AND METHODS The clinical and voice records of 61 patients with Reinke's edema were reviewed. All the patients were classified according to stroboscopic findings (Yonekawa's classification), perceptual grade and histopathological findings. Voice analysis of the perceptual, acoustic, aerodynamic and electroglottographic measurements was carried out using various classifications, and the voices of 23 patients who underwent laryngomicrosurgery were evaluated 2 months after surgery. Furthermore, the voices of 30 normal speakers (controls) were recorded and analyzed. RESULTS The fundamental frequency (FxM) of Yonekawa Type III was significantly lower than those of the other types of Reinke's edema, and the SD of the FxM, the percentage irregularity of the FxM (CFx) and the percentage irregularity of the amplitude were larger than those of the other types of Reinke's edema. The closed quotient was significantly higher in Yonekawa Type III. In addition, the mean flow rate (MFR), maximum phonation time and harmonics:noise ratio (HNR) differed significantly among the different types of Reinke's edema. The postoperative results showed an increase in the FxM and an improvement in the MFR, subglottic pressure, shimmer and HNR. Correlation analysis showed that jitter, the HNR, the mean closed quotient and the irregularity of the frequency were the parameters that had the best correlation with improvement in postoperative voice quality.
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Affiliation(s)
- Jae-Yol Lim
- Department of Otorhinolaryngology, Institute of Logopedics and Phoniatrics, Yongdong Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
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18
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Butterworth J, D'Hulst D, Oaks T, Dale S. Polyps and Reinke???s Edema: Distinct Laryngeal Pathologies with Different Potential for Glottic Airway Obstruction. Anesth Analg 2005; 100:1863-1864. [PMID: 15920241 DOI: 10.1213/01.ane.0000156696.28573.ff] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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19
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Chandradeva K, Palin C, Ghosh SM, Pinches SC. Percutaneous transtracheal jet ventilation as a guide to tracheal intubation in severe upper airway obstruction from supraglottic oedema. Br J Anaesth 2005; 94:683-6. [PMID: 15708873 DOI: 10.1093/bja/aei088] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
We report two cases of severe upper airway obstruction caused by supraglottic oedema secondary to adult epiglottitis and Ludwig's angina. In the former case, attempts to intubate with a direct laryngoscope failed but were successful once percutaneous transtracheal jet ventilation (PTJV) had been instituted. In the case with Ludwig's angina, PTJV was employed as a pre-emptive measure and the subsequent tracheal intubation with a direct laryngoscope was performed with unexpected ease. In both cases recognition of the glottic aperture was made feasible with PTJV by virtue of the fact that the high intra-tracheal pressure from PTJV appeared to lift up and open the glottis. The escape of gas under high pressure caused the oedematous edges of the glottis to flutter, which facilitated the identification of the glottic aperture. We believe that the PTJV should be considered in the emergency management of severe upper airway obstruction when this involves supraglottic oedema.
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Affiliation(s)
- K Chandradeva
- Magill Department of Anaesthesia, Queen Mary's Hospital, Sidcup DA14 6LT, UK.
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20
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González González G, Marenco de la Fuente ML, Bertomeu Cornejo M. [Fastrach mask to resolve a difficult airway during emergency cesarean section]. Rev Esp Anestesiol Reanim 2005; 52:56-7. [PMID: 15747709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
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21
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Abstract
BACKGROUND A pattern of edema on the ventral surface of the vocal fold, called pseudosulcus vocalis, was described in 1995. It refers to infraglottic edema extending from the anterior commissure to the posterior larynx. It can be differentiated from sulcus vergeture, which is caused by adhesion of the vocal fold epithelium to the vocal ligament. Although it has been related to laryngopharyngeal reflux (LPR), this has not been thoroughly investigated. PURPOSE Our goal was to evaluate the association between pseudosulcus and LPR. METHODS Thirty patients with a clinical diagnosis of LPR confirmed by double-probe pH monitoring and 30 controls without LPR were enrolled. The prevalence of pseudosulcus was determined with fiberoptic laryngoscopy. RESULTS Seventy percent (21 of 30) of patients with lpr and 30% (9 of 30) of controls had pseudosulcus. Patients with pseudosulcus were 2.3 times more likely to have pH-documented LPR (95% confidence interval 1.3-4.2). The sensitivity and specificity of pseudosulcus in the diagnosis of LPR are 70% and 77%, respectively. CONCLUSIONS Pseudosulcus is highly correlated with pH-documented LPR (P < 0.001). The presence of pseudosulcus is suggestive of LPR.
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Affiliation(s)
- Peter C Belafsky
- Center for Voice Disorders of Wake Forest University, Winston-Salem, NC 27157-1034, USA
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22
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Abstract
The use of cannabis in our society is a common problem and the subject of much medical and political debate. We present a case in which a 17-year-old male regular cannabis user developed a large swollen uvula (uvulitis) and partial upper airway obstruction after smoking cannabis. Symptoms resolved with the administration of corticosteroids and antihistamines.
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Affiliation(s)
- Stephen H Boyce
- Accident and Emergency Department, Crosshouse Hospital, Kilmarnock Dumfries, Scotland.
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23
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Abstract
The perceptual analysis of voice for 40 dysphonic and normal subjects was studied according to the GRBAS method and with the consensus of three experts. In order to evaluate the effects of voice onset on the evaluation by the jury, we presented two sample materials for each subject: a sustained /alpha/ and the same sustained /alpha/ for which voice onset was suppressed. In a blind test, the two sample materials were presented in the same session in a random way. The jury did not notice the sustained /alpha/ for which voice onset was suppressed.The influence of voice onset on the jury was based on the percentage of identical answers for each material. Our results show that the influence of voice onset is correlated with the dysphonic level. Voice onset would be of major importance for intermediate dysphonia (G1, G2), whereas it seems not to exert any influence in the case of normal voices (G0) or severe dysphonia (G3).
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Affiliation(s)
- J Revis
- Laboratoire d'Audio-Phonologie Clinique, Marseille, France.
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24
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Kosztyła-Hojna B. [Video-laryngo-stroboscopy in diagnosis of senile voice disorders]. Pol Merkur Lekarski 2001; 11:221-3. [PMID: 11761815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Clinical applications of videolaryngostroboscopy (VLSS) in 110 senile persons in phoniatrics was investigated. Each patient was examined laryngologically and phoniatrically. The patients were divided into two groups, according to the changes observed in the larynx as edema and vocal folds atrophy. Measurements of vibration, amplitudae, frequency glottic closure and oscillation (mucosal wave) of vocal cords yielded objective information about vibration in edema and vocal fold atrophy. This method can find application in training and therapeutic procedures in patients with senile dysphonia.
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Watts CR, Clark R, Early S. Acoustic Measures of Phonatory Improvement Secondary to Treatment by Oral Corticosteroids in a Professional Singer: A Case Report. J Voice 2001; 15:115-21. [PMID: 12269626 DOI: 10.1016/s0892-1997(01)00011-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Short-term administration of corticosteriods is sometimes indicated for professional voice users experiencing laryngeal edema and/or inflammation. Unfortunately, no data are available to document the effectiveness of these medications to improve phonatory parameters. We present a case report of a 32-year-old male professional singer with vocal fold edema experiencing imminent vocal demands who was prescribed a 6-day course (dose-pack) of oral methyl prednisolone. Endoscopic and stroboscopic evaluations were completed premedication and postmedication, and acoustic measures of phonatory function were obtained premedication, 3 days during the dose cycle, 5 days during the dose cycle, and 1 day postmedication. Postmedication results revealed an increase in fundamental frequency (F0) and large decreases in jitter, shimmer, long-term frequency, and amplitude variability. These corresponded with patient and evaluator perceptual measures of improved voice, and with endoscopic observations of reduced edema. The benefits and risks of corticosteroid therapy are discussed, specific to their use in the professional voice population.
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Affiliation(s)
- C R Watts
- Department of Speech Pathology and Audiology, University of South Alabama, Mobile 36688, USA.
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26
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Aviv JE, Liu H, Parides M, Kaplan ST, Close LG. Laryngopharyngeal sensory deficits in patients with laryngopharyngeal reflux and dysphagia. Ann Otol Rhinol Laryngol 2000; 109:1000-6. [PMID: 11089989 DOI: 10.1177/000348940010901103] [Citation(s) in RCA: 92] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There are no reliable means of quantifying the edema that results from acid exposure to the posterior larynx in patients with laryngopharyngeal reflux (LPR). However, it is possible to quantify laryngopharyngeal sensitivity in these patients by endoscopic administration of air pulses to the laryngeal mucosa in order to elicit the laryngeal adductor reflex. The purpose of this study was to determine whether patients with LPR have sensory deficits in the laryngopharynx, and whether treatment of these patients with a proton pump inhibitor (PPI) results in resolution of sensory deficits. Flexible endoscopic evaluation of swallowing with sensory testing was prospectively performed in 54 patients with dysphagia without neurologic disease and in 25 healthy controls. The laryngopharyngeal sensory level, posterior laryngeal edema, and LPR were assessed. We defined LPR as passage of food material from the esophageal inlet retrograde into the hypopharynx. Patients with LPR were placed on 3 months of omeprazole or lansoprazole and then retested. Patients without LPR were placed on H2 blockers for 3 months and then retested. In the dysphagia group, 48 of 54 patients (89%) had edema of the posterior larynx, and 42 of 54 (78%) had laryngopharyngeal sensory deficits. We noted LPR in 38 of 54 (70%). In the control group, 1 of 25 subjects (4%) had edema, sensory deficits, and LPR. The differences in incidence of edema, sensory deficits, and LPR between the dysphagia group and the control group were significant (p < .001, chi2 test). Twenty-three patients with LPR placed on a PPI returned for follow-up, with improvement in laryngeal edema in 14 of the 21 (67%) who had pretreatment edema and resolution of sensory deficits in 15 of the 19 (79%) who had pretreatment deficits. In the non-LPR, non-PPI group, 11 of 16 patients returned for follow-up, with improvement in laryngeal edema in none of the 11 and improvement in sensory deficits in 1 of the 11 (9.1%). The differences in improvement in laryngeal edema and sensory deficits between the LPR, PPI group, and the non-LPR, non-PPI group were significant (p < .01, Fisher's exact test). We conclude that patients with dysphagia and edema of the posterior larynx as a result of LPR have sensory deficits in the laryngopharynx. Treatment of these patients with a PPI appears to result in resolution of laryngopharyngeal edema and improvement of sensory deficits, both subjectively and objectively.
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Affiliation(s)
- J E Aviv
- Department of Otolaryngology-Head and Neck Surgery, New York-Presbyterian Hospital and College of Physicians and Surgeons, Columbia University, New York, New York 10032, USA
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27
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Efferen LS, Elsakr A. Post-extubation stridor: risk factors and outcome. J Assoc Acad Minor Phys 2000; 9:65-8. [PMID: 10826000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Post-extubation stridor is a potential complication of endotracheal intubation. The incidence, risk factors, and outcome in adult patient populations are poorly defined. It was our clinical impression that the occurrence of post-extubation stridor in our medical intensive care unit was more frequent than generally reported. We therefore monitored all intubated patients to determine the incidence of post-extubation stridor and to identify any predisposing factors. All adult patients requiring endotracheal intubation and medical intensive care admission were prospectively observed over a 5-month period in a university-affiliated medical intensive care unit. Sixty-seven patients requiring intubation and medical intensive care admission were evaluated. Twenty-two patients were excluded from analysis because no extubation was attempted. The remaining 45 patients were divided into two groups: 8 with and 37 without post-extubation stridor. Of the parameters analyzed, cuff pressure, treatment with corticosteroids at the time of extubation, and the presence of a primary neurologic process necessitating intubation differed significantly between groups. Six of the 8 patients who developed post-extubation stridor required reintubation. Four of these patients were subsequently successfully extubated, one required tracheostomy, and one patient died after a 2-week deteriorating clinical course. The incidence of significant stridor in our population was 17.8%. Medical management was successful in the majority of patients with post-extubation stridor. Routine tracheostomy following a single episode of post-extubation stridor is not indicated. Further investigation regarding risk factors and a placebo-controlled trial evaluating the efficacy of systemic corticosteroids before extubation in individuals at risk for developing post-extubation stridor are needed.
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Affiliation(s)
- L S Efferen
- Department of Internal Medicine, SUNY Health Science Center at Brooklyn, Kings County Hospital Center 11203, USA
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28
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Abstract
In most cases the cause of intermittent dysphonia remains undiagnosed. This descriptive study explores the relationship between this problem and delayed food allergy. Double-blind intradermal provocation/neutralization skin tests to food antigens were used to do 12 tests in 10 subjects with food allergies. Strobovideolaryngoscopy was used to document changes in the vocal folds and in the quality of the voice. Double-blind measurements of signs and symptoms, digital audio recordings of the voice for perceptual and acoustic analysis, and aerodynamic laryngeal airflow and resistance measurements were done. The cause of dysphonia appeared to be associated with an increase in thick mucus production and irregular and asymmetric glottic edge edema of the vocal folds. Elimination of the positive specific foods resulted in cessation of dysphonia in all the test subjects. Statistical analysis was not done because of the lack of parametric data for paired analysis, lack of sufficient data points for resampling statistics, and the small sample size.
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Affiliation(s)
- H S Dixon
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University, Rome, Georgia, USA
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Abstract
Angioedema is an immunologically mediated, anatomically limited, nonpitting edema that can lead to life-threatening airway obstruction. To predict the risk of airway compromise in angioedema, we retrospectively reviewed 93 episodes in 80 patients from 1985 to 1995. Intubation or tracheotomy was necessary in 9 (9.7%) cases. Angiotensin-converting enzyme inhibitor use in 36 cases (39%) was associated with intensive care unit (ICU) admission (P = 0.05). ICU stay correlated significantly with presentation with voice change, hoarseness, dyspnea, and rash (P < 0.05). Voice change, hoarseness, dyspnea, and stridor were present in patients requiring airway intervention (P < 0.05). On the basis of our data, we propose a staging system by which airway risk may be predicted from the anatomic site of presentation. Patients with facial rash, facial edema, lip edema (stage I), and soft palate edema (stage II) were treated as outpatients and on the hospital ward. Patients with lingual edema (stage III) usually required ICU admission. All patients with laryngeal edema (stage IV) were admitted to the ICU. Airway intervention was necessary in 7% of stage III patients and in 24% of stage IV cases. No deaths were caused by angioedema. Airway risk in angioedema may be predicted by anatomic site of presentation, allowing appropriate triage with preparation for airway intervention in selected cases.
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Affiliation(s)
- E Ishoo
- Department of Otolarngology-Head and Neck Surgery, Boston University School of Medicine, USA
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30
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Abstract
Laryngomalacia is the most common cause of stridor in children. Previous studies using barium esophagrams or single-probe esophageal pH testing have indicated that 68% to 80% of infants with laryngomalacia have reflux. A recent study in a large series of pediatric patients has shown that these 2 testing modalities are relatively insensitive in detecting reflux when compared with 24-hour double-probe pH testing. This study was undertaken to determine the incidence and frequency of reflux in children with laryngomalacia by use of 24-hour double-probe pH monitoring. Twenty-four children with endoscopically diagnosed laryngomalacia underwent 24-hour double-probe pH testing. The distal probe was placed in the lower esophagus, and the proximal probe was placed just above the cricopharyngeus immediately posterior to the larynx. All 24 (100%) children had pharyngeal acid exposure as judged by the proximal pH probe. These children had a mean of 15.21 episodes of reflux to the level of the pharynx during the 24-hour study period. In contrast, only 16 (66%) children had abnormal acid exposure as measured by the distal esophageal probe. These results indicate that essentially all children with laryngomalacia have reflux of gastric acid to the pharyngeal level. Multiple authors have documented the detrimental effects of acid and the accompanying pepsin in the larynx and tracheobronchial tree. Persistent laryngeal edema is an almost universal finding in patients with reflux to the pharyngeal level and is a common finding in children with laryngomalacia. In some patients with laryngomalacia, reflux may be the primary cause of their airway compromise, whereas in others it may be a significant cofactor exacerbating a preexisting neurologic or anatomic abnormality.
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Affiliation(s)
- B L Matthews
- Department of Otolaryngology, Bowman Gray School of Medicine, Wake Forest University, North Carolina, USA
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31
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Medina Pérez A, De las Nieves MA. [Antifibrinolytics as a treatment for severe factor XI deficiency in laryngeal surgery]. Sangre (Barc) 1999; 44:246-7. [PMID: 10481596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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32
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Abstract
We report a case of total upper airway obstruction occurring immediately after extubation after elective bi-maxillary osteotomy. The obstruction was caused by severe, progressive supraglottic oedema, which totally obscured the laryngeal inlet. No swelling had been present at initial laryngoscopy and intubation. Immediate re-intubation of the patient's trachea was difficult but life saving. Subsequent investigations revealed extensive soft tissue swelling, maximal at the level of the hyoid and extending downwards into the trachea. The cause of such severe oedema in this case is not certain, but may be related to vigorous submental liposuction carried out at the end of operation. We have found no other reports of total airway obstruction occurring immediately after extubation as a result of this cause. We review the appropriate literature, describe the postoperative management and suggest precautions in similar patients.
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Affiliation(s)
- A Dark
- Department of Anaesthesia and Intensive Care, Aberdeen Royal Hospitals NHS Trust, Foresterhill, UK
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33
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Khorasani A, Appavu SK, Saatee S. Succinylcholine cannot relieve an airway obstruction caused by pharyngeal and laryngeal edema. Anesth Analg 1998; 87:229. [PMID: 9661581 DOI: 10.1097/00000539-199807000-00048] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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34
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Abstract
An 86-year-old man was referred by his family physician to our clinic because of sudden onset aphonia immediately after a Japanese-style bath. On examination, the only abnormality was aphonia, with an otherwise normal physical examination. However, we found vocal fold oedema on laryngeal fibrescopy. For treatment, he was immediately given 30 mg prednisolone intravenously. Twelve hours after injection the oedema had completely disappeared and his aphonia had resolved. The patient was healthy for three months after returning home. However, at the beginning of a cold winter night he again complained of sudden onset hoarseness, after taking a Japanese-style bath. Japanese-style baths are completely different from Western-style baths. There is a temperature difference of almost 30 degrees C between the inside and outside of a bath; the transition may represent a type of physical exercise in elderly and exhausted individuals. This difference could cause a cold or heat-induced allergic reaction. We strongly recommend a laryngeal study in case of sudden onset aphonia.
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Affiliation(s)
- K Tsunoda
- Department of Otolaryngology, Nissan Tamagawa Hospital, Tokyo, Japan
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Castelli R, Cicardi M, Gardinali M, Zingale LC, Savi C, Munari M, Agostoni A. Cardiopulmonary by-pass in a patient with acquired C1 inhibitor deficiency. Int J Artif Organs 1997; 20:175-7. [PMID: 9151154] [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: 02/04/2023]
Abstract
C1 inhibitor (C1-INH) regulates, complement, contact system, coagulation and fibrinolysis. Bleeding complications during cardiopulmonary bypass (CPB) have been described in a deficient patient. We report a 72 year old man affected with acquired C1-INH deficiency who successfully underwent CPB.
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Affiliation(s)
- R Castelli
- Institute of Internal Medicine, University of Milano, Italy
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Abstract
STUDY OBJECTIVE Laryngotracheal injury or edema in the setting of intubation may narrow the upper airway and predispose toward postextubation stridor. The presence or absence of an audible airleak when the sealing balloon cuff of the endotracheal tube is deflated has been demonstrated to be a marker of laryngotracheal edema in high-risk patients. We hypothesized that (1) the volume of the cuff leak can be quantified in a general medical ICU population, and (2) the cuff leak volume can be correlated with likelihood of postextubation stridor. METHODS Within 24 h of both the initiation and termination of mechanical ventilation, the cuff leak volume, defined as the difference between the inspiratory tidal volume and the averaged expiratory tidal volume while the cuff around the endotracheal tube was deflated, was recorded. RESULTS In 100 consecutive intubations, the preextubation cuff leak volume was 349 +/- 163 mL [mean +/- SD]). Overall, 6% of extubations were accompanied by postextubation stridor. The mean cuff leak volume measured within 24 h of planned extubation was significantly lower in those who subsequently developed stridor in comparison to those who did not (180 +/- 157 mL vs 360 +/- 157 mL; p = 0.012). The positive predictive value for postextubation stridor in the setting of a cuff leak less than 110 mL was 0.80, the predictive value for absence of postextubation stridor with a cuff leak volume greater than 110 mL was 0.98, and the specificity of the test was 0.99. No other demographic factors or indexes related to mechanical ventilation were significantly different between the two groups. CONCLUSIONS A reduced cuff leak volume prior to extubation identifies a population at increased risk for postextubation stridor.
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Affiliation(s)
- R L Miller
- Department of Medicine, Columbia-Presbyterian Medical Center, New York, NY 10032, USA
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37
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Sataloff RT, Hawkshaw M, Rosen DC, Spiegel JR. Acute vocal fold hemorrhage with minimal dysphonia. Ear Nose Throat J 1996; 75:583. [PMID: 8870362] [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: 02/02/2023] Open
Affiliation(s)
- R T Sataloff
- Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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King CJ, Davey AJ, Chandradeva K. Emergency use of the laryngeal mask airway in severe upper airway obstruction caused by supraglottic oedema. Br J Anaesth 1995; 75:785-6. [PMID: 8672333 DOI: 10.1093/bja/75.6.785] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
We report two cases of severe upper airway obstruction caused by supraglottic oedema which developed rapidly at the time of anaesthesia. Conventional methods to relieve the obstruction failed and it was only overcome when a laryngeal mask airway (LMA) was inserted and positive pressure applied manually during inspiration. In one case a fibrescope was passed via the LMA and this revealed two cushions of oedematous false vocal cords protruding into the bowel of the LMA which were pushed out of the way when positive pressure was applied during inspiration. We believe that the LMA should be considered in the emergency management of severe upper airway obstruction even when this involves supraglottic oedema.
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Affiliation(s)
- C J King
- Rex Binning Department of Anaesthesia, Royal Sussex County Hospital, Brighton
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39
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Abstract
A photographic version of the Mallampati test was developed and applied to 242 pregnant patients at 12 weeks' gestation and again at 38 weeks' gestation. At 38 weeks the number of grade 4 cases had increased by 34% (P < 0.001). This is in agreement with other evidence which suggests that difficult laryngoscopy is slightly more frequent in obstetrics (1.7%) than in general surgery (1.3%). The increase in Mallampati score correlated with gain in body weight (r = 0.3, P < 0.001), which gives some support to the concept that fluid retention is the underlying cause. We conclude that pharyngeal oedema causes some hindrance to tracheal intubation in obstetrics, but not enough to explain the high failure rate reported. A case is made for rationalizing the management of difficult intubation. Our data also show that more research is needed on factors which affect Mallampati's test, particularly neck extension.
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Affiliation(s)
- S Pilkington
- Division of Anaesthesia, Northwick Park Hospital and Clinical Research Centre, Harrow
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40
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Abstract
Laryngeal papillomata can undergo spontaneous malignant transformation without being detected histologically and, in some instances, the disease may become so advanced, before the diagnosis is confirmed, that it is beyond any form of curative treatment. Because of this limitation imposed by histopathological investigation, a study was undertaken in 17 adults with benign laryngeal papillomata, (three of whom underwent malignant transformation) to determine whether malignant transformation can be predicted from the clinical behaviour of the tumour. The following features were analysed: age, sex, patient's symptoms, frequency of excision of the papillomata, site of lesion, presence or absence of laryngeal oedema, the need for tracheostomy, vocal fold mobility and presence or absence of cervical lymph nodes. It was found that decreased vocal fold mobility, the presence of cervical lymph nodes, exuberant and rapid growth requiring very frequent excisions, oedema of the larynx with airway obstruction requiring a tracheostomy are clinical features suggestive of malignant transformation.
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Affiliation(s)
- B Singh
- Department of Otolaryngology, University of Natal, South Africa
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41
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Cervera-Paz FJ, Dikkers FG. [Ultrastructure and pathogenesis of vocal nodules on the vocal cords]. Acta Otorrinolaringol Esp 1994; 45:261-5. [PMID: 7917477] [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: 01/27/2023]
Abstract
Controlled electron microscopy of the epithelium in voice lesions revealed: thickening and destruction of basement membrane, reduplication of the lamina densa, near absence of normal hemidesmosomes and anchoring fibrils, abundant electro-dense vesicles at the basal cell pole (discharging through the cell membrane), abundant mitochondria, euchromatin and nucleolar prominence. These histologic phenomena suggest that the basal cell layer responds to trauma to its anchorages with metabolic hyperactivity. Therefore the traumatic mechanism should be considered as damaging to the basement membrane.
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Affiliation(s)
- F J Cervera-Paz
- Departamento de Cirugía, Area de ORL, Universidad de Cádiz, Hospital Universitario de Puerto Real
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42
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Abstract
Adult respiratory distress syndrome (ARDS) could be related to upper airway obstruction. Mechanical obstruction and complement activation could lead to ARDS development. We describe a patient with hereditary angioedema, laryngeal edema, and ARDS.
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Affiliation(s)
- J T da Costa
- Department of Allergy and Clinical Immunology, Hospital de S. João, Porto, Portugal
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43
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Affiliation(s)
- M J Cunningham
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston 02114
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44
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Bacić A, Gluncić I, Drnasin-Buklijas J. [Pulmonary edema following obstruction of the upper airway]. Lijec Vjesn 1992; 114:249-51. [PMID: 1343128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The development of pulmonary edema after the relief of upper airway obstruction in two patients is described. Pulmonary edema in those patients was the result of increased negative intrapleural and intra-alveolar pressure during forceful inspiration and in the course of upper airway obstruction. An increase in the venous return occurs and the established transpulmonary pressure gradient promotes transudation into the interstitium and alveoli. Consequent alveolar hyperventilation results in hypoxia and acidosis. All patients developing pulmonary edema should be treated with positive pressure ventilation within 24-36 hours. The aim of this study was to alert physicians that besides know factors for the development of cardiogenic and noncardiogenic pulmonary edema there are also other significant mechanisms that cause the accumulation of fluid in pulmonary tissue.
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Affiliation(s)
- A Bacić
- Medicinskog fakulteta u Zagrebu
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45
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Affiliation(s)
- R J Ebert
- Department of Anaesthetics, Faculty of Medicine, University of Natal, Durban, South Africa
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46
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Gasthuys F, Verschooten F, Parmentier D, De Moor A, Steenhaut M. Laryngotomy as a treatment for chronic laryngeal obstruction in cattle: a review of 130 cases. Vet Rec 1992; 130:220-3. [PMID: 1566534 DOI: 10.1136/vr.130.11.220] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
One hundred and thirty cattle with chronic laryngeal obstruction were treated by surgery; the diagnostic and operative techniques are discussed. A simplified technique using local anaesthesia of the laryngeal area was used in sedated calves weighing up to 200 kg. Inhalation anaesthesia through a distal tracheotomy was needed in heavier animals. Complications related to the surgical intervention are described. The animals were reviewed from five months to over one year after discharge from the clinic. The long term survival rate of the 130 animals was 58 per cent. The results after surgery were excellent in 40.9 per cent and good in 15.2 per cent of the animals.
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Affiliation(s)
- F Gasthuys
- Large Animal Surgical Clinic, Faculty of Veterinary Medicine, Ghent, Belgium
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47
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McConachie I. Laryngeal oedema following anaphylactic shock. Br J Hosp Med (Lond) 1992; 47:201. [PMID: 1543976] [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: 12/27/2022]
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48
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Gerard E, Anastasio D, Nanty J. [Dentistry and angioneurotic edema]. Inf Dent 1990; 72:4273-8. [PMID: 2149125] [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: 12/30/2022]
Affiliation(s)
- E Gerard
- Hôpital Notre-Dame de Bon-Secours à Metz
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49
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Drake AF, Sidman JD. The child with a tracheotomy. A review of the surgical options in airway reconstruction. N C Med J 1990; 51:507-10. [PMID: 2243557] [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: 12/30/2022]
Affiliation(s)
- A F Drake
- Division of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill 27599-7070
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50
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Abstract
In evaluating the long term results of surgical treatment of Reinke's oedema, there has been found to be a high incidence of recurrence. The recurrence rate is significantly lower amongst those patients who gave up smoking after treatment. A group of patients with chronic Reinke's oedema were followed for six months. Maximum efforts were made to help the patients to stop smoking. Twenty-nine patients entered the study, but only eight of them (28 per cent) refrained from smoking; all were women (39-70 years) and all experienced reduced discomfort, although none of the voices were restored to normal. Diffuse laryngitis disappeared completely, but the oedema did not disappear entirely in any patient. Before treatment of chronic Reinke's oedema patients must be well advised and informed, and if surgery is decided upon, they must be urged most strongly to stop smoking, if they wish to enhance the possibility of satisfactory long-term results.
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