RESUMO
A woman in her early 30s presented to her primary care physician's office with hoarseness, joint pain and facial swelling. The objective evaluation revealed elevated inflammatory markers and angiotensin-1-converting enzyme, a chest radiograph with bilateral hilar prominence and a maxillofacial CT scan with diffuse inflammation in the upper airway. Otolaryngology evaluation revealed exophytic lesions diffusely within the nasal cavity, base of tongue, supraglottis, glottis and trachea. A biopsy confirmed the diagnosis of sarcoidosis. She was treated with corticosteroids with improvement in upper and lower airway symptoms. She continued to experience other extrapulmonary manifestations of sarcoidosis requiring alternative immunosuppressant therapy. At 30 months from symptom onset, her disease was noted to be in remission.
Assuntos
Doenças da Laringe , Sarcoidose , Doenças da Traqueia , Humanos , Feminino , Sarcoidose/diagnóstico , Sarcoidose/tratamento farmacológico , Sarcoidose/patologia , Doenças da Laringe/tratamento farmacológico , Doenças da Laringe/diagnóstico , Doenças da Laringe/patologia , Doenças da Laringe/diagnóstico por imagem , Adulto , Doenças da Traqueia/diagnóstico , Doenças da Traqueia/diagnóstico por imagem , Doenças da Traqueia/patologia , Tomografia Computadorizada por Raios X , Traqueia/patologia , Traqueia/diagnóstico por imagemRESUMO
A 21-year-old retired polo Argentinian thoroughbred horse from a teaching herd was presented for a routine bronchoalveolar lavage demonstration, during which an incidental finding of a granulomatous mass on the dorsal aspect of the epiglottis was made. Rhinosporidium seeberi was suspected from a histological section obtained from an initial biopsy, and the mass was removed via laser surgery for cytology and PCR. Sequencing of the PCR amplicons confirmed the diagnosis of R. seeberi. A treatment protocol of nebulized voriconazole for 10 d postoperatively was used. Long-term follow-up required 2 more laser surgeries plus oral fluconazole to resolve the remaining fungal spores. However, 2.5 y later, there was no evidence of remaining fungal spores. Key clinical message: Horses from endemic regions can potentially be exposed to R. seeberi. Based on its travel history, this horse may have contracted the infection in South America, California, or Alberta. Treatments administered, including diode laser resection, voriconazole antifungal nebulization, and oral fluconazole administration, were successful but required repeated interventions.
Suivi à long terme du Rhinosporidium seeberi laryngé diagnostiqué par PCR et traité par ablation au laser et nébulisation au voriconazole chez un cheval de polo thoroughbred pur-sang à la retraiteUn cheval thoroughbred argentin de polo retraité de 21 ans, issu d'un troupeau d'enseignement, a été présenté pour une démonstration de lavage broncho-alvéolaire de routine, au cours de laquelle une découverte fortuite d'une masse granulomateuse sur la face dorsale de l'épiglotte a été faite. Rhinosporidium seeberi a été suspecté à partir d'une coupe histologique obtenue à partir d'une biopsie initiale, et la masse a été retirée par chirurgie au laser pour cytologie et PCR. Le séquençage des amplicons PCR a confirmé le diagnostic de R. seeberi. Un protocole de traitement au voriconazole nébulisé pendant 10 jours après l'opération a été utilisé. Le suivi à long terme a nécessité 2 autres interventions chirurgicales au laser et du fluconazole oral pour éliminer les spores fongiques restantes. Cependant, 2,5 ans plus tard, il n'y avait aucune trace de spores fongiques restantes.Message clinique clé:Les chevaux des régions endémiques peuvent potentiellement être exposés à R. seeberi. D'après ses antécédents de voyage, ce cheval pourrait avoir contracté l'infection en Amérique du Sud, en Californie ou en Alberta. Les traitements administrés, notamment la résection au laser à diode, la nébulisation antifongique au voriconazole et l'administration orale de fluconazole, ont été efficaces mais ont nécessité des interventions répétées.(Traduit par Dr Serge Messier).
Assuntos
Antifúngicos , Doenças dos Cavalos , Nebulizadores e Vaporizadores , Rinosporidiose , Voriconazol , Animais , Cavalos , Doenças dos Cavalos/tratamento farmacológico , Doenças dos Cavalos/cirurgia , Doenças dos Cavalos/diagnóstico , Voriconazol/uso terapêutico , Voriconazol/administração & dosagem , Antifúngicos/uso terapêutico , Antifúngicos/administração & dosagem , Masculino , Rinosporidiose/veterinária , Rinosporidiose/tratamento farmacológico , Rinosporidiose/cirurgia , Rinosporidiose/diagnóstico , Nebulizadores e Vaporizadores/veterinária , Terapia a Laser/veterinária , Reação em Cadeia da Polimerase/veterinária , Doenças da Laringe/veterinária , Doenças da Laringe/cirurgia , Doenças da Laringe/tratamento farmacológicoRESUMO
INTRODUCTION: Endotracheal intubation is a common procedure to maintain an open airway with risks for traumatic injury. Pathological changes resulting from intubation can cause upper airway complications, including vocal fold scarring, laryngotracheal stenosis, and granulomas and present with symptoms such as dysphonia, dysphagia, and dyspnea. Current intubation-related laryngotracheal injury treatment approaches lack standardized guidelines, relying on individual clinician experience, and surgical and medical interventions have limitations and carry risks. AREAS COVERED: The clinical and preclinical therapeutics for wound healing in the upper airway are described. This review discusses the current developments on local drug delivery systems in the upper airway utilizing particle-based delivery systems, including nanoparticles and microparticles, and bulk-based delivery systems, encompassing hydrogels and polymer-based approaches. EXPERT OPINION: Complex laryngotracheal diseases pose challenges for effective treatment, struggling due to the intricate anatomy, limited access, and recurrence. Symptomatic management often requires invasive surgical procedures or medications that are unable to achieve lasting effects. Recent advances in nanotechnology and biocompatible materials provide potential solutions, enabling precise drug delivery, personalization, and extended treatment efficacy. Combining these technologies could lead to groundbreaking treatments for upper airways diseases, significantly improving patients' quality of life. Research and innovation in this field are crucial for further advancements.
Assuntos
Sistemas de Liberação de Medicamentos , Cicatrização , Humanos , Cicatrização/efeitos dos fármacos , Animais , Intubação Intratraqueal/métodos , Qualidade de Vida , Nanopartículas , Hidrogéis/administração & dosagem , Materiais Biocompatíveis/administração & dosagem , Materiais Biocompatíveis/química , Polímeros/química , Nanotecnologia , Doenças da Laringe/tratamento farmacológico , Traqueia/lesõesRESUMO
PURPOSE: Laryngeal surgeries using a flexible nasopharyngoscope equipped with an operative channel has gained popularity, with gradual increase in the variety of interventional office-based procedures, under local anesthesia. The purpose of this study is to analyze the tolerance of such procedures. MATERIALS AND METHODS: Retrospective cohort study. 337 cases were performed during 2 years. We collected the following data: type of pathology, type of procedure and modalities of anesthesia, adverse events. RESULTS: 19 % of the visits were for the purpose of Biopsy, 65 % for an injection, and Trublue Laser was utilized in 12 % of the procedures. Regarding the pathologies, 27 % were vocal fold paralysis, 18 % leukoplakia or another suspicious lesion, 15 % recurrent respiratory papillomatosis, 13 % neuromuscular disorder, 9 % vocal fold scarring, 7 % vocal cord atrophy and 6 % had an inflammatory presentation. Side effects were documented in 26 visits (7.7 %) and were minor in almost all the encounters: they included strong reflexive cough, deep throat pain, discomfort, gag reflex, anxiety, vagal discomfort, malaise, hypersalivation, nose pain, labile hypertension. More severe side effects were very rare and included septal wound and epistaxis, erythematous rash, dyspnea, and transient dysarthria. 13 procedures were either aborted, or canceled at initial steps, due to inability of the patient to tolerate the procedure and were rescheduled for general anesthesia. 97 % of the cases were released home after 1 h of surveillance. CONCLUSION: Office-based flexible interventional laryngoscopy under local anesthesia is a safe and well-tolerated procedure, with abundance of various interventions feasible on ambulatory, office-based setup.
Assuntos
Doenças da Laringe , Laringe , Humanos , Estudos Retrospectivos , Resultado do Tratamento , Laringe/cirurgia , Doenças da Laringe/tratamento farmacológico , Prega Vocal , Laringoscopia/efeitos adversos , Procedimentos Cirúrgicos Ambulatórios/efeitos adversos , DorRESUMO
OBJECTIVE: Photodynamic therapy (PDT) is a minimally invasive method with strong tissue selectivity and nonthermal effects. We aim to investigate the efficacy of an in-office method utilizing PDT with local application of 5-aminolevulinic acid (ALA) and 635 nm diode laser for treating laryngeal leukoplakia. STUDY DESIGN: Retrospective cohort study. SETTING: Outpatient clinic-tertiary medical center. METHODS: This study reviewed 32 patients with laryngeal leukoplakia, including 11 recurrent cases after surgery. All the procedures were performed in an office setting under topical anesthesia. Fifteen percent ALA solution was locally applied to the lesion through a flexible laryngoscope. Light illumination was performed using a 635 nm diode laser through a 400 µm optic fiber. The power density was 165 mW/cm2 to reach 100 J/cm2 . Results of laryngostroboscopy and voice evaluation during follow-up were collected. RESULTS: The mean follow-up was 7.91 ± 4.83 (3-18) months. Thirty-nine procedures were performed, including 1 session for 27 patients, 2 sessions for 3 patients, and 3 sessions for 2 patients. The total response rate was 96.875% (31/32), including complete responses in 26 (81.25%) patients, partial responses in 5 patients (15.625%), and no response in 1 patient (3.125%). It appeared that PDT selectively eliminated the leukoplakia without affecting lamina propria and the surrounding normal mucosa remained unharmed. Scores of Voice Handicap Index-10, jitter, shimmer, and harmonic-to-noise ratio were significantly improved after PDT. CONCLUSION: Office-based PDT is an effective, repeatable, and practical method for treating laryngeal leukoplakia. Local application of ALA is sufficient to achieve photodynamic reactions. PDT could eliminate laryngeal leukoplakia selectively while protecting the normal laryngeal structure.
Assuntos
Doenças da Laringe , Terapia a Laser , Fotoquimioterapia , Humanos , Ácido Aminolevulínico/uso terapêutico , Fármacos Fotossensibilizantes/uso terapêutico , Fotoquimioterapia/métodos , Estudos Retrospectivos , Leucoplasia/tratamento farmacológico , Leucoplasia/cirurgia , Lasers , Doenças da Laringe/tratamento farmacológico , Doenças da Laringe/cirurgiaRESUMO
OBJECTIVES: Current treatments for benign vocal lesions consist mainly voice therapy and phonomicrosurgery. However, these options are not always suitable for professional voice users because of their tight performance schedule and limited time for voice rest. This study investigated vocal fold steroid injection (VFSI) as an alternative treatment. STUDY DESIGN: Matched case series. METHODS: We retrospectively enrolled 28 professional voice users (i.e., singers, actors and news anchors) who received VFSI for vocal nodules and polyps in an office setting of a tertiary teaching hospital. Outcomes were evaluated using videolaryngostroboscopy (VLS), the 10-item Voice Handicap Index (VHI-10), maximum phonation time, and acoustic and perceptual analyses before and 1 month after VFSI. Study results were compared with 56 patients of nonprofessional voice users (i.e., routine or high occupational vocal demands), matched in a 1:2 ratio by age, sex, and treatment date. RESULTS: After VFSI, VLS revealed substantial lesion resolution in 82% professional voice users. One professional voice user developed a self-limited vocal fold hematoma after VFSI. VHI-10 scores in the professional group decreased from 21 to 14 points, compared with 23 to 16 points in the non-professional group, demonstrating a significant within-group effect (P < 0.01, GEE) and a nonsignificant between-group effect (P = 0.86). Other outcomes also improved significantly after VFSI (P < 0.05), without significant differences between the two groups. CONCLUSION: VFSI can be an effective and safe alternative treatment for professional voice users with benign vocal lesions.
Assuntos
Doenças da Laringe , Distúrbios da Voz , Humanos , Prega Vocal/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Doenças da Laringe/diagnóstico , Doenças da Laringe/tratamento farmacológico , Doenças da Laringe/patologia , Esteroides/efeitos adversos , Distúrbios da Voz/diagnóstico , Distúrbios da Voz/tratamento farmacológico , Distúrbios da Voz/patologiaRESUMO
Laryngeal botulinum toxin injection is an important treatment modality for spasmodic dysphonia and other laryngeal disorders. We sought to compare usage patterns of laryngeal botulinum toxin injections for voice disorders and to identify and quantify inefficiencies and barriers in providing this treatment. A 26 item survey was written and approved for distribution by the American Academy of Otolaryngology-Head and Neck Surgery and the National Spasmodic Dysphonia Association. It was distributed to Otolaryngologists who perform laryngeal botulinum toxin injections via the e-mail lists of the National Spasmodic Dysphonia Association provider database, American Academy of Otolaryngology-Head and Neck Surgery Voice Committee and the American Laryngological Association Neurolaryngology Study Group. There were 81 survey participants who collectively reported performing >1700 laryngeal botulinum toxin injections for voice disorders monthly (Mean = 21.5 pts/month). Regarding botulinum toxin A (BtxA) vial use, 54% of participants reported using multiple doses per vial for different patients during a single clinic day, while 14% reported using pharmacy predrawn single use aliquots. A combination of usage practices was reported by 7% of participants. Using an individual vial per patient and discarding the unused remainder was reported by 26% of participants with an associated annual cost in wasted BtxA of $84,300 per physician. There is wide variation in injection practices regarding management of BtxA vials and adherence to an individual vial per patient policy is associated with significant waste of health care resources. Alternative approaches to BtxA vial use could positively impact health care resource utilization.
Assuntos
Toxinas Botulínicas Tipo A , Disfonia , Doenças da Laringe , Distúrbios da Voz , Disfonia/diagnóstico , Disfonia/tratamento farmacológico , Humanos , Doenças da Laringe/diagnóstico , Doenças da Laringe/tratamento farmacológico , Músculos Laríngeos , Resultado do Tratamento , Distúrbios da Voz/diagnóstico , Distúrbios da Voz/tratamento farmacológicoRESUMO
Los quistes subglóticos adquiridos son una causa rara de estridor en la infancia, cuyo reporte ha ido en aumento en las últimas décadas. Su aparición se relaciona con la prematurez y la intubación en el periodo neonatal. Histológicamente, se observa una obstrucción de las glándulas mucosas de la subglotis debido una metaplasia escamosa del epitelio respiratorio. Esta es una condición que usualmente requiere de un alto índice de sospecha para llegar al diagnóstico, ya que pueden confundirse con otras patologías como laringitis aguda (croup), laringomalacia o asma. La nasofibroscopía permite sospechar su presencia, pero el gold standard diagnóstico lo constituye la laringo-tra-queo-broncoscopía directa en pabellón. Existen diversas técnicas para su manejo, siendo las más frecuentemente utilizadas la marsupialización con instrumental frío y láser. La recurrencia es frecuente, por lo que algunos autores han utilizado mitomicina C y la terapia antirreflujo para intentar disminuirla. Sin embargo, hasta la fecha falta evidencia de calidad que permita llegar a un consenso respecto al manejo ideal de esta patología. En este trabajo, presentamos tres casos clínico de pacientes con antecedentes de prematurez que fueron diagnosticados con quistes subglóticos adquiridos y manejados en un hospital pediátrico de alta complejidad.
Acquired subglottic cysts are an infrequent cause of stridor in infants, which has been increasingly reported in the last decades. Its appearance is related to prematurity and intubation in the neonatal period. Histologically, findings are characterized by an obstruction of the mucosal glands, due to squamous metaplasia of the respiratory epithelium. This condition usually requires a high index of suspicion to be diagnosed, as it can be misdiagnosed as croup, laryngomalacia or asthma. Flexible nasendoscopy allows an initial exploration of the larynx, but direct laryngo-tracheo-bronchoscopy in the operating room is the diagnostic gold standard. There are several techniques for its management, but the most frequently used are cold-steel marsupialization and laser. Recurrence is common, and some authors have used mitomycin C and antireflux therapy to try to decrease it. However, up to date, there is a lack of high-quality evidence, regarding the ideal management of this pathology, which prevents reaching a consensus. In this article, we present three clinical cases of premature patients who were diagnosed with subglottic cysts, treated in a tertiary pediatric hospital.
Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Doenças da Laringe/terapia , Cistos/terapia , Doenças do Prematuro/terapia , Laringoscopia/métodos , Recém-Nascido Prematuro , Doenças da Laringe/diagnóstico , Doenças da Laringe/tratamento farmacológico , Mitomicina/uso terapêutico , Antibióticos Antineoplásicos/uso terapêuticoRESUMO
BACKGROUND: Benign vocal fold lesions (BVFLs) can cause voice changes, including reduced loudness and pitch range. In recent times, with progression in endoscopic technology, office-based vocal fold steroid injection (VFSI) has been used as an alternative therapy for BVFLs. AIMS/OBJECTIVES: In this study, we analyzed the efficacy and safety of VFSI to investigate the mechanism underlying its therapeutic effects and determine the conditions in which VFSI will be most effective. MATERIALS AND METHODS: In this retrospective cohort study, we included 40 condition-matched patients (8 patients per lesion) with chorditis, vocal nodules, vocal polyps, Reinke's edema (RE), or vocal scars who received similar regimens of steroid injection using a commercial preparation of triamcinolone acetonide. Their phonological outcomes were evaluated 2 or 3 months after the injection. RESULTS: Significant improvements were observed in Voice Handicap Index scores, results of laboratory voice evaluation, and voice quality measured using the Grade, Roughness, Breathiness, Asthenia, Strain scale in all participants. In subgroup analysis, VFSI was highly effective against chorditis and vocal nodules, but less effective against RE and vocal scars. CONCLUSIONS: Single-dose VFSI is valuable as an alternative to voice rehabilitation and laryngo-microsurgery, but higher concentrations or repeated injections are required for intractable lesions.
Assuntos
Disfonia/tratamento farmacológico , Glucocorticoides/administração & dosagem , Doenças da Laringe/tratamento farmacológico , Triancinolona Acetonida/administração & dosagem , Prega Vocal/patologia , Adulto , Idoso , Disfonia/reabilitação , Glucocorticoides/efeitos adversos , Humanos , Injeções Intralesionais , Doenças da Laringe/reabilitação , Pessoa de Meia-Idade , Estudos Retrospectivos , Triancinolona Acetonida/efeitos adversos , Qualidade da Voz/efeitos dos fármacosRESUMO
OBJECTIVE AND IMPORTANCE: Rosai-Dorfman disease (RDD) is a benign and rare non-Langerhans cell histiocytic proliferative disorder. Laryngeal involvement is an unusual site of extranodal involvement of RDD. Laryngeal RDD can cause life-threatening airway obstruction that requires effective control of the disease. In this study, we report three cases of laryngeal RDD with excellent and durable responses to thalidomide. CLINICAL PRESENTATION: Patient 1 was a 39-year-old male who presented with a two-year history of nasal obstruction. Patient 2 was a 26-year-old woman who presented complaining of a hoarse voice for one year. Patient 3 was a 24-year-old man who presented with complaints of a hoarse voice and progressing dyspnea for five months. Electronic laryngoscopy revealed submucous nodular lesions in the nasal cavity, nasopharynx, and larynx of the three patients. Biopsy of the lesions showed large histiocytes with abundant pale cytoplasm which were S-100 and CD68 positive consistent with RDD. INTERVENTION: Before thalidomide treatment, patient 1 received chemotherapy and six times surgical excision due to the recurrence of laryngeal lesions. Patient 2 failed steroid treatment. Patient 3 underwent an emergency tracheostomy due to airway obstruction. All three patients then received thalidomide 100â mg/d treatment and achieved satisfactory and durable responses with the longest follow-up of 45 months. CONCLUSION: Thalidomide may induce long-term remission in laryngeal RDD.
Assuntos
Histiocitose Sinusal/tratamento farmacológico , Doenças da Laringe/tratamento farmacológico , Talidomida/administração & dosagem , Adulto , Feminino , Histiocitose Sinusal/metabolismo , Histiocitose Sinusal/patologia , Humanos , Doenças da Laringe/metabolismo , Doenças da Laringe/patologia , Laringe/metabolismo , Laringe/patologia , Masculino , Indução de RemissãoRESUMO
A 33-year-old woman on chronic immunosuppressive treatment for rheumatoid arthritis with a history of inhaled methamphetamine use presented with respiratory failure requiring mechanical ventilation for a prolonged period. After being given plasma exchange, pulses of methylprednisolone and a dose of cyclosporine for suspected ANCA (anti-neutrophilic cytoplasmic autoantibodies) vasculitis, she developed an obstructive supraglottic laryngeal mass that required a tracheostomy to bypass. Biopsy findings revealed the mass to be an inflammatory pseudomass secondary to cytomegalovirus (CMV). The mass resolved after several weeks of intravenous ganciclovir therapy. This is an extremely unusual presentation of localised CMV disease, with only two or three similar cases having been reported worldwide.
Assuntos
Infecções por Citomegalovirus/etiologia , Epiglote , Imunossupressores/efeitos adversos , Doenças da Laringe/etiologia , Adulto , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/tratamento farmacológico , Antivirais/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Ciclosporina/efeitos adversos , Ciclosporina/uso terapêutico , Infecções por Citomegalovirus/diagnóstico , Infecções por Citomegalovirus/tratamento farmacológico , Infecções por Citomegalovirus/patologia , Epiglote/patologia , Epiglote/virologia , Feminino , Ganciclovir/uso terapêutico , Humanos , Imunossupressores/uso terapêutico , Doenças da Laringe/diagnóstico , Doenças da Laringe/tratamento farmacológico , Doenças da Laringe/virologia , Metilprednisolona/efeitos adversos , Metilprednisolona/uso terapêuticoRESUMO
OBJECTIVES: Sarcoidosis is a multisystemic inflammatory disease with extrathoracic manifestations, most commonly affecting the young and middle-aged, female and Black populations. Diagnosis usually requires evidence of non-caseating granulomata and, when treated, prognosis is usually favourable. We aim to establish the incidence, clinical features and optimal treatment of ENT manifestations of this disease. DESIGN: We performed a PubMed literature review to determine the evidence base supporting this. RESULTS: ENT manifestations are present in 5%-15% of patients with sarcoidosis, often as a presenting feature, and require vigilance for swift recognition and coordinated additional treatment specific to the organ. Laryngeal sarcoidosis presents with difficulty in breathing, dysphonia and cough, and may be treated by speech and language therapy (SLT) or intralesional injection, dilatation or tissue reduction. Nasal disease presents with crusting, rhinitis, nasal obstruction and anosmia, usually without sinus involvement. It is treated by topical nasal or intralesional treatments but may also require endoscopic sinus surgery, laser treatment or even nasal reconstruction. Otological disease is uncommon but includes audiovestibular symptoms, both sensorineural and conductive hearing loss, and skin lesions. CONCLUSIONS: The consequences of ENT manifestations of sarcoidosis can be uncomfortable, disabling and even life-threatening. Effective management strategies require good diagnostic skills and use of specific therapies combined with established treatments such as corticosteroids. Comparisons of treatment outcomes are needed to establish best practice in this area.
Assuntos
Otopatias/patologia , Doenças da Laringe/patologia , Doenças Nasais/patologia , Sarcoidose/patologia , Diagnóstico Diferencial , Otopatias/diagnóstico , Otopatias/tratamento farmacológico , Humanos , Doenças da Laringe/diagnóstico , Doenças da Laringe/tratamento farmacológico , Doenças Nasais/diagnóstico , Doenças Nasais/tratamento farmacológico , Sarcoidose/diagnóstico , Sarcoidose/tratamento farmacológicoRESUMO
Candidiasis is a rare entity reported as an isolated and primary laryngeal disease. In this condition, inhaled steroids were the single most common predisposing factor. Also mycotic infections of larynx are frequently seen in patients with immune insufficiency, although they have also been reported in individual with normal immune status. We report a case of isolated laryngeal Candidiasis in an immunocompetent individual, with an unusual presentation with exophytic lesion, edema, ulceration, white plaque, and pseudomembranous formation mimicking supraglottic carcinoma, to highlight the clinical of this condition and provide a review of the literature.
Assuntos
Corticosteroides/efeitos adversos , Antiasmáticos/efeitos adversos , Candidíase/diagnóstico , Doenças da Laringe/diagnóstico , Neoplasias Laríngeas/diagnóstico , Administração por Inalação , Idoso , Antifúngicos/uso terapêutico , Asma/tratamento farmacológico , Candidíase/tratamento farmacológico , Candidíase/patologia , Diagnóstico Diferencial , Fluticasona/efeitos adversos , Humanos , Doenças da Laringe/tratamento farmacológico , Doenças da Laringe/patologia , Laringoscopia , Masculino , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Fatores de Risco , Xinafoato de Salmeterol/efeitos adversosRESUMO
The larynx-related adverse effects that depend on cisplatin decrease patient comfort and many antioxidants have been used to eliminate these side effects. We aimed to identify the laryngeal mucosal changes imposed by cisplatin and investigated whether antioxidants, and their healing effects on these changes, may help reduce laryngeal complications in patients resulting from adverse effects in the larynx. A rat model was designed to evaluate the effects of cisplatin on the larynx and the protective role of antioxidants. Single-dose cisplatin was given both intraperitoneally alone and additionally administered with p-coumaric acid, melatonin, resveratrol, vitamin D, and oleic acid over 5 days. Whole larynges were dissected and evaluated histologically, histochemically, and immunohistochemically. Varying degrees of mucosal changes cisplatin group, but neither erosion nor an ulcer was observed. Numerous variable histological effects of antioxidants were observed on cisplatin exposed laryngeal mucosa. The most obvious effects of cisplatin were edema. The results of the study showed that resveratrol was the most preventive antioxidant agent against cisplatin-dependent mucosal changes. The highest increase in the Ki67 index was in the oleic acid group. Vitamin D increased stromal cyclooxygenase-2 expression that may have an effect on increasing mucosal damage.
Assuntos
Antioxidantes , Cisplatino , Doenças da Laringe , Animais , Antioxidantes/farmacologia , Antioxidantes/uso terapêutico , Doenças da Laringe/induzido quimicamente , Doenças da Laringe/tratamento farmacológico , Laringe/efeitos dos fármacos , Estresse Oxidativo/efeitos dos fármacos , Ratos , Ratos WistarRESUMO
Vocal polyps are benign vocal cord lesions, which mainly manifest as a hoarse voice. Laryngeal microsurgery is the most common treatment. However, because of anxiety regarding invasive treatment, it is necessary to have a non-invasive treatment option. A 43 year old female patient who is a teacher visited a Korean medical hospital for persistent hoarseness with a vocal polyp. After taking herbal medicine for hoarseness (Kyung-Hee-cheong-um-whan) and pharyngitis (cheong-in-li-gyok-tang and cheong-in-ryu-que-whan) for almost 10 weeks, the vocal polyp was reduced and symptoms improved. Herbal prescription for pharyngitis and hoarseness can be applied to vocal polyps as non-invasive treatment.
Assuntos
Doenças da Laringe , Pólipos , Adulto , Feminino , Medicina Herbária , Rouquidão/tratamento farmacológico , Rouquidão/etiologia , Rouquidão/patologia , Humanos , Doenças da Laringe/tratamento farmacológico , Doenças da Laringe/patologia , Pólipos/tratamento farmacológico , Pólipos/patologia , Pólipos/cirurgia , Prega Vocal/patologiaRESUMO
OBJECTIVE: This study aimed to compare the long-term efficacy, durability, and dose and interval stability between alternating unilateral and bilateral injections of botulinum neurotoxin type A for the treatment of adductor spasmodic dysphonia. STUDY DESIGN: Retrospective cohort study. SETTING: Academic tertiary medical center. METHODS: A total of 137 patients (105 alternating unilateral and 32 bilateral injections) who were administered ≥5 injections of botulinum neurotoxin type A were included in this study. The mean dosage change, dose adjustment ratio (number of dose increases/total number of injections), and stability of treatment responses were compared between the alternating unilateral and bilateral injection groups. RESULTS: Long-term changes in the mean dosages for alternating unilateral (mean ± SD, -0.010 ± 0.048 IU) and bilateral (-0.042 ± 0.142 IU) injections did not differ between groups (P = .225), suggesting that both methods follow a decreasing dosing trend over time. The dose adjustment ratio also did not differ between groups (P = .077), although a longer average treatment interval (P < .001) and duration of hoarse voice (P = .045) were found in the bilateral injection group. The proportion of stable patients who did not increase injection dose and had regular follow-up did not differ between the groups. CONCLUSION: Both alternating unilateral and bilateral injection methods showed a long-term decreasing dosing trend, with comparable levels of efficacy, durability, and stability for treating adductor spasmodic dysphonia. Our findings indicate that alternating unilateral injections can be routinely performed with fewer side effects, albeit at shorter treatment intervals, than bilateral injections.
Assuntos
Toxinas Botulínicas Tipo A/administração & dosagem , Disfonia/tratamento farmacológico , Doenças da Laringe/tratamento farmacológico , Fármacos Neuromusculares/administração & dosagem , Espasmo/tratamento farmacológico , Prega Vocal , Adulto , Estudos de Coortes , Disfonia/etiologia , Feminino , Humanos , Injeções Intramusculares/métodos , Músculos Laríngeos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Espasmo/complicações , Adulto JovemRESUMO
A 57-year-old male chronic smoker with underlying diabetes mellitus presented with dysphonia associated with cough, dysphagia and reduced effort tolerance of 3 months' duration. Videoendoscope finding revealed bilateral polypoidal and erythematous true and false vocal fold with small glottic airway. The patient was initially treated as having tuberculous laryngitis and started on antituberculous drug. However, no improvement was observed. CT of the neck showed erosion of thyroid cartilage, which points to laryngeal carcinoma as a differential diagnosis. However, the erosion was more diffuse and appeared systemic in origin. The diagnosis of laryngeal perichondritis was made when the histopathological examination revealed features of inflammation, and the tracheal aspirate isolated Pseudomonas aeruginosa The patient made a good recovery following treatment with oral ciprofloxacin.
Assuntos
Doenças da Laringe/diagnóstico , Infecções por Pseudomonas/diagnóstico , Pseudomonas aeruginosa/isolamento & purificação , Antibacterianos/uso terapêutico , Ciprofloxacina/uso terapêutico , Tosse/microbiologia , Transtornos de Deglutição/microbiologia , Diagnóstico Diferencial , Disfonia/microbiologia , Humanos , Doenças da Laringe/complicações , Doenças da Laringe/tratamento farmacológico , Doenças da Laringe/microbiologia , Neoplasias Laríngeas/diagnóstico , Laringoscopia , Masculino , Pessoa de Meia-Idade , Infecções por Pseudomonas/complicações , Infecções por Pseudomonas/tratamento farmacológico , Infecções por Pseudomonas/microbiologia , Cartilagem Tireóidea/diagnóstico por imagem , Cartilagem Tireóidea/microbiologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Tuberculose Laríngea/diagnóstico , Prega Vocal/diagnóstico por imagem , Prega Vocal/microbiologiaAssuntos
Doenças da Laringe/patologia , Laringocele/diagnóstico por imagem , Doenças Nasofaríngeas/patologia , Penfigoide Mucomembranoso Benigno/patologia , Corticosteroides/uso terapêutico , Dapsona/uso terapêutico , Disfonia/fisiopatologia , Humanos , Fatores Imunológicos/uso terapêutico , Doenças da Laringe/tratamento farmacológico , Laringocele/fisiopatologia , Laringoscopia , Masculino , Pessoa de Meia-Idade , Ácido Micofenólico/uso terapêutico , Doenças Nasofaríngeas/tratamento farmacológico , Penfigoide Mucomembranoso Benigno/tratamento farmacológico , Penfigoide Mucomembranoso Benigno/fisiopatologia , Faringite/fisiopatologia , Rituximab/uso terapêutico , Tomografia Computadorizada por Raios XRESUMO
PURPOSE OF REVIEW: This review explores the recent evidence and established scientific literature surrounding proton pump inhibitors in the context of laryngology. RECENT FINDINGS: Proton pump inhibitors are often associated with gastroenterology; however, they also have a place in laryngology. Several laryngopharyngeal disorders are treated with proton pump inhibitors, though limited evidence regarding effectiveness, dosing and length of treatment exists. With the recent influx of articles reporting possible adverse effects of proton pump inhibitors, the appropriate prescribing of them has come under scrutiny. These reported risks include cancer, stroke, myocardial infarction, kidney disease and cognitive decline. It should be noted though that many of these studies by nature, are fraught with potential confounding. Regardless, clinicians ought to be aware of any risks associated with treatment regimens and prescribe the optimal dosage and duration. SUMMARY: Proton pump inhibitor treatment should be dose-appropriate and for a limited duration. Concerning potential adverse effects, the limitations of retrospective cohort studies must be taken into consideration when reviewing the evidence.
Assuntos
Doenças da Laringe/tratamento farmacológico , Inibidores da Bomba de Prótons/uso terapêutico , Humanos , Inibidores da Bomba de Prótons/administração & dosagem , Inibidores da Bomba de Prótons/efeitos adversosRESUMO
A 15-year-old girl presented with gradual-onset dysphonia and dysphagia. Laryngoscopy revealed significant supraglottic airway obstruction with swelling of both the epiglottis and arytenoids. After emergency tracheostomy, biopsy of the epiglottis revealed lymphoid hyperplasia with focal non-necrotising granulomata, leading to a presumed diagnosis of laryngeal sarcoidosis. Treatment with prednisolone and methotrexate produced minimal clinical improvement. A switch to sirolimus was followed by significant reduction in the laryngeal swelling, allowing decannulation of the tracheostomy. Treatment with sirolimus should be considered as a steroid sparing agent in laryngeal sarcoidosis, particularly in the presence of lymphoid hyperplasia on biopsy.