Ortner's syndrome: case series and literature review / Síndrome de Ortner: série de casos e revisão da literatura

More than a century ago, Ortner described a case of cardiovocal syndrome wherein he attributed a case of left vocal fold immobility to compression of the recurrent laryngeal nerve by a dilated left atrium in a patient with mitral valve stenosis. Since then, the term Ortner's syndrome has come to encompass any nonmalignant, cardiac, intrathoracic process that results in embarrassment of either recurrent laryngeal nerve-usually by stretching, pulling, or compression; and causes vocal fold paralysis. Not surprisingly, the left recurrent laryngeal nerve, with its longer course around the aortic arch, is more frequently involved than the right nerve, which passes around the subclavian artery. OBJECTIVES: To discuss the pathogenesis of hoarseness resulting from cardiovascular disorders involving the recurrent laryngeal nerve along with the findings of literature review. MATERIALS AND METHODS: This paper reports a series of four cases of Ortner's syndrome occurring due to different causes. DESIGN: Case study. RESULT: Ortner's syndrome could be a cause of hoarseness of voice in patients with cardiovascular diseases. CONCLUSION: Although hoarseness of voice is frequently encountered in the Otolaryngology outpatient department, cardiovascular- related hoarseness is an unusual presentation. Indirect laryngoscopy should be routinely performed in all cases of heart disease.

Há mais de um século, Ortner descreveu um caso de síndrome cardiovocal, no qual ele atribuiu um caso de imobilidade da prega vocal esquerda à compressão do nervo laríngeo recorrente causada por dilatação do átrio esquerdo em um paciente com estenose valvar mitral. Desde então, o termo Síndrome de Ortner tem sido usado para descrever qualquer condição cardíaca intratorácica não maligna que resulte no envolvimento do nervo laríngeo recorrente - geralmente por estiramento, contração ou compressão, causando paralisia vocal. Não é surpreendente que o nervo laríngeo recorrente esquerdo, com seu curso mais longo, contornando o arco aórtico, seja mais frequentemente afetado que o direito - que cursa ao redor da artéria subclávia. OBJETIVOS: Discutir a patogênese da rouquidão resultante de lesão cardiovascular que envolve o nervo laríngeo recorrente, juntamente com uma revisão da literatura. MATERIAIS E MÉTODOS: Este trabalho relata uma série de quatro casos de Síndrome de Ortner resultantes de diferentes causas. Tipo de estudo: Estudo de Casos. RESULTADO: A Síndrome de Ortner pode representar uma causa de rouquidão em pacientes com doenças cardiovasculares. CONCLUSÃO: Apesar de rouquidão ser frequentemente encontrada em ambulatórios de otorrinolaringologia, sua etiologia associada ao aparelho cardiovascular é pouco frequente. Laringoscopia indireta dever ser empregada rotineiramente em todos os casos de doenças cardíacas.

Clinical profile of patients with presenting hoarseness

To describe the causes of voice disorder [hoarseness] among general population attending E.N.T department in Abbasi Shaheed Hospital. It is the descriptive study of 100 patients, who enrolled from out patient department and admitted in E.N.T department of Abbasi Shaheed Hospital. The data was collected as per the specially designed Performa. This study was done in Abbasi Shaheed Hospital, Karachi. Most of the patient with hoarseness 38 [38%] were observed between 5-15 years followed by 16-24 years old 26 [26%] patients. The most common cause of hoarseness was vocal cord nodules 35 patients [35%] followed by acute laryngitis, 22 patients [22%] and chronic non specific laryngitis 14 patients [14%]. Hoarseness due to carcinoma of larynx, 13 patients [13%]

Avaliação por imagem da paralisia de pregas vocais / Imaging evaluation of vocal cord paralysis

Paralisia das pregas vocais é causa frequente de rouquidão, podendo ser secundária a várias lesões ao longo do trajeto do X par craniano e seus ramos, particularmente os nervos laríngeos recorrentes. Apesar de grande parte dos casos ser idiopática, os métodos de imagem são muito importantes na pesquisa de fatores etiológicos, tais como lesões neoplásicas da tireoide e esôfago com invasão secundária dos nervos laríngeos recorrentes. Além destas, outras anormalidades como aneurismas do arco aórtico e da artéria subclávia direita podem ser encontradas. É fundamental que o radiologista conheça a anatomia pertinente a esta região e as principais afecções que podem ocorrer, para que o estudo seja corretamente planejado, auxiliando o diagnóstico e o planejamento terapêutico. Além disso, como até 35 por cento dos casos de paralisia da prega vocal são assintomáticos, o conhecimento dos sinais radiológicos que indicam esta condição é indispensável, cabendo ao radiologista alertar o médico assistente sobre os achados do exame. Neste trabalho realizamos uma revisão da anatomia e das principais doenças responsáveis pela paralisia de cordas vocais, demonstrando-as por meio de estudos de tomografia computadorizada e ressonância magnética de casos típicos. Mostramos, também, as alterações radiológicas próprias da laringe que indicam a presença de paralisia das pregas vocais.

Vocal cord paralysis is a common cause of hoarseness. It may be secondary to many types of lesions along the cranial nerve X pathway and its branches, particularly the laryngeal recurrent nerves. Despite the idiopathic nature of a great number of cases, imaging methods play a very significant role in the investigation of etiologic factors, such as thyroid and esophagus neoplasias with secondary invasion of the laryngeal recurrent nerves. Other conditions such as aortic and right subclavian artery aneurysms also may be found. The knowledge of local anatomy and related diseases is of great importance for the radiologist, so that he can tailor the examination properly to allow an appropriate diagnosis and therapy planning. Additionally, considering that up to 35 percent of patients with vocal cord paralysis are asymptomatic, the recognition of radiological findings indicative of this condition is essential for the radiologist who must warn the referring physician on the imaging findings. In the present study, the authors review the anatomy and main diseases related to vocal cord paralysis, demonstrating them through typical cases evaluated by computed tomography and magnetic resonance imaging, besides describing radiological findings of laryngeal abnormalities indicative of this condition.

Extraesophageal Manifestations of Gastroesophageal Reflux Disease / 대한소화기학회지

Gastroesophageal reflux disease (GERD) often presents as typical symptoms such as heartburn or acid regurgitation. However, a subgroup of patients presents a collection of symptoms and signs that are not directly related to esophageal damage. These are known collectively as the extraesophageal manifestations of GERD, such as non-cardiac chest pain, laryngitis, chronic cough, hoarseness, asthma or dental erosion. They have a common pathophysiology, involving microaspiration of acid into the larynx and pharynx, and vagally mediated bronchospasm and laryngospasm. The role of extraesophageal reflux in such disorders is underestimated due to often silent symptoms and difficult confirmation of diagnosis. Endoscopy and pH monitoring are insensitive and therefore not useful in many patients as diagnostic modalities. Thus, anti-secretory therapy by proton pump inhibitor is used as both a diagnostic trial and as a therapy in the majority. Attention to optimizing therapy and judicious use of endoscopy and reflux monitoring are needed to maximize treatment success.

Hoarseness in Iraqi patients. Causes and management

this study was designed to determine the causes of hoarseness in a group of Iraqi patients and to document the influence of smoking and vocal abuse in the development of laryngeal pathologies. one hundred and sixteen patients presenting with hoarseness were evaluated at Al Zahrawi Teaching Hospital during the period from September 2000 to August 2001. there were 68 [58.6%] males and 48 [41.4%] females. The average age was 40 years. Cancer of the larynx was the most common cause of chronic hoarseness [38.8%], while acute laryngitis was the predominant diagnosis in acute hoarseness [64.5%]. Overall cancer of the larynx was the most frequent diagnosis being diagnosed in 33 [28.4%] of the patients. Smoking was found to be significantly related to the development of cancer of the larynx [p<0.001] and chronic laryngitis [p<0.05]. Vocal abuse had a significant relationship with the development of chronic laryngitis, vocal cord nodule, and Reink's edema. malignancy is an important cause of chronic hoarseness in Iraqi patients. Smoking is an important risk factor for malignancy. Smoking and vocal abuse are important risk factors in the development of hoarseness

Direct laryngoscopy: a prospective study

Prospective clinical analysis of direct laryngoscopic procedures performed in Mosul Teaching Hospital Iraq. Patients and 100 direct laryngoscopic procedures performed in the period from September 1996 to June 1997. There were 55 males and 45 females. The average age was 42.8 years. The most common surgical indications were hoarseness [77%] and tumor-like mass detected on indirect laryngoscopy [38%]. Laryngeal squamous cell carcinoma [SCC] was the most common final diagnosis in the malignant cases. Chronic nonspecific laryngitis was the most common benign diagnosis. The diagnostic accuracy of indirect mirror laryngoscopy compared to direct laryngoscopy was 61%. The diagnostic accuracy of direct laryngoscopic findings and histological diagnosis was 87%. Direct laryngoscopy was difficult in 3 patients, those with short and muscular neck structure. The incidence of major complications was at least 4%. Minor complications occurred in 7% of the patients. Laryngospasm was significantly higher in patients who underwent direct laryngoscopy along with other procedures than in those who underwent direct laryngoscopy alone. Conclusions: Direct laryngoscopy was performed most often indicated for chronic hoarseness and tumor-like masses detected on indirect laryngoscopy. Laryngeal SCC was the most common malignancy and chronic nonspecific laryngitis was the most common non-malignant finding. The incidence of major complications was 4%. Laryngospasm was significantly higher in patients who had undergone procedures in addition to direct laryngoscopy. It is felt that patients who undergo direct laryngoscopy are most safely managed as in patients for 24 hours

Rouquidao: avaliacao clinica e tratamento / Hoarseness: clinical avaliation and treatment

A historia de um paciente com doenca da laringe inclui os sintomas de rouquidao, dor, tosse, estridor e disfagia. A rouquidao geralmente e um sintoma inicial de lesoes da glote, mas um sintoma tardio de tumores originados em areas afastadas da glote.Qualquer pessoa que persista com rouquidao pormais de 10 dias deve submeter-se a um exame visual da laringe.