Pill Ingestion and Caustic Laryngeal Injury.

OBJECTIVE: To highlight an unusual mechanism of laryngeal injury. METHODS: Case report and literature review. RESULTS: A 66-year-old male ingested an over-the-counter preparation of bile acids as a dietary supplement. The capsule lodged in the patient's pharynx, and he sustained a caustic injury to the supraglottic and glottic larynx. His injury was managed conservatively, and his symptoms gradually resolved over a period of 8 weeks. A follow-up laryngoscopy at 8 weeks and 6 months showed no signs of injury. A barium swallow at 8 weeks was normal at that time and videostroboscopy results normalized with resolution of the injury as well. CONCLUSIONS: Caustic injury to the upper aerodigestive tract from pill ingestion is uncommon, and laryngeal injury even less so. Urgent evaluation should be undertaken, and appropriate therapies instituted promptly. Laryngeal injury can respond to conservative therapy, but there is a lack of clinical information to evaluate optimum treatment of this unusual injury.

[Antimicrobial anti-inflammatory photodynamic and light-emitting-diode phototherapy of the consequences of the gunshot and mine-blast injury to the face, head, and neck including damage to the ENT organs]. / Antimikrobnaia protivovospalitel'naia fotodinamicheskaia i svetodiodnaia fototerapiia posledstvii ognestrel'noi i minno-vzryvnoi travmy golovy i shei.

The objective of the present study was the enhancement of the effectiveness of the treatment of the consequences of the gunshot wounds and mine-blast injuries inflicted to the face, head, and neck encountered in the otolaryngological practice as well as the prevention of the formation of the large demarcation areas in the injured tissues and the preparation of these tissues for the further restorative treatment. Anti-microbial and anti-inflammatory photodynamic therapy (PDT) as well as light-emitting-diode (LED) phototherapy were carried out in 20 patients who suffered gunshot wounds and mine-blast injuries to the face, head, and neck. The photodynamic therapy was performed with the use of an aqueous solution of methylene blue at a concentration of 0.1%, the 'Alod-1' infrared laser ('Granat' modification, Russia), and the 'AFS-Solaris' light-emitting diode-based phototherapeutic apparatus (Russia). The analysis of the results of the study has demonstrated the high efficiency of the proposed approach that made it possible to prevent the development of severe septic complications, reduce the amount of drug therapy, significantly shorten duration of the treatment, and create the conditions for the earlier rehabilitation and further plastic and cosmetic restoration of the tissue structures.

Laryngeal injuries and intubating conditions with or without muscular relaxation: an equivalence study.

PURPOSE: The need for muscular relaxation to improve intubating conditions and to reduce the incidence of laryngeal morbidity is still controversial. The aim of this study was to determine the incidence of symptomatic laryngeal injuries (SLI) and of acceptable intubating conditions (including both good and excellent conditions), both with and without cisatracurium during induction of anesthesia, along with moderate doses of remifentanil and propofol. METHODS: In this prospective, randomized double-blind equivalence trial, the intubating conditions were compared in 130 ASA I or II female patients. All subjects received remifentanil 2 microg x kg(-1) i.v. and propofol 2.5 mg x kg(-1) i.v., with either cisatracurium 0.15 mg x kg(-1) i.v. (group Cisatracturium), or saline (group Placebo). Tracheal intubating conditions were assessed with the Copenhagen Score. A systematic screening for postoperative hoarseness and sore throat was performed 24 and 48 hr after anesthesia, followed by a nasofibroscopic examination when laryngeal symptoms persisted at 48 hr. RESULTS: Twenty-four hr after anesthesia, the incidence of postoperative hoarseness and sore throat in the Cisatracurium and Placebo groups was 26.5% and 21.5%, respectively, and 48 hr after anesthesia, the incidence was 7.8% and 6.1%, respectively (P = 0.32 and P = 0.50 between groups, respectively). In the clinically evaluable population, the incidence of SLI, assessed at 48 hr by nasofibroscopy, was equivalent in both groups, 1.6% vs 1.5% in group Placebo and group Cisatracurium, respectively (P < 0.001 for equivalence test), as was the occurrence of acceptable intubating conditions (95.4% vs 100%, P < 0.05 for equivalence test). However, the occurrence of excellent intubating conditions was more frequent in group Cisatracurium than in group Placebo (P = 0.0003). CONCLUSION: Following induction of anesthesia with propofol and moderate-dose remifentanil, cisatracurium did not confer a higher rate of good-to-excellent conditions for tracheal intubation, nor did muscle relaxation with cisatracurium decrease the rate of SLI after tracheal intubation.

Blunt laryngeal trauma resulting in arytenoid dislocation and dysphonia.

We present a case of left arytenoid dislocation due to blunt laryngeal trauma causing a subsequent large granuloma formation resulting in dysphonia and stridor. The patient underwent emergency excision of the obstructive granuloma and speech therapy was started post-operatively. A few weeks after surgery, the granuloma started to recur and laryngeal manipulation by a specialist osteopath was performed. A few weeks after the conservative management, the recurred granuloma resolved completely and patient's voice improved remarkably. Dislocation of the arytenoid cartilage due to blunt trauma is relatively rare and a consequent spontaneous granuloma formation has not been reported so far in the literature. This is also the first report about efficacy of speech therapy combined with laryngeal manipulation in the management of the arytenoid dislocation and the subsequent laryngeal granuloma.

Fatal hot coffee scald of the larynx. Case report.

We present a case of fatal upper aerodigestive tract scald sustained by a schizophrenic man who drank hot coffee. After describing the clinical and pathologic findings, we discuss the risks for incurring such injuries.

Laryngeal burns secondary to the ingestion of microwave-heated food.

Thermal injuries to the upper airway are a well-recognized complication of the inhalation of steam and hot gases, but have only rarely been reported to occur in relation to the ingestion of heated foodstuffs. We report the case of an acute laryngeal burn caused by the ingestion of a microwave-heated food product, a previously undescribed complication of ingesting microwave-processed foods.

Perceptual-physiologic approach to evaluation and treatment of dysphonia.

The value of a perceptual-physiologic approach to both the evaluation and treatment of voice disorders is described and illustrated with an example of a patient with ventricular fold phonation. Objective measures are obtained to facilitate the understanding of the underlying pathophysiology and to document change over time. Evaluation data are recorded and interpreted collectively by a speech-otolaryngology team and may be valuable for medicolegal cases. Finally, the evaluation methods, particularly videolaryngoscopy, may be used for biofeedback purposes to facilitate voice therapy.

The treatment of radiation necrosis with hyperbaric oxygen (OHP).

Sixty-nine patients with radiation necrosis were received by the authors from January 1, 1969 through August 1, 1975. The patients were categorized according to site of injury. Full treatment protocol is discussed including local wound care, antibiotic coverage, surgical procedures, and the administration of hyperbaric oxygen. Results indicate that the combination of hyperbaric oxygen, properly timed surgery, and antibiotic therapy has resulted in improvement in all cases of radiation necrosis and full healing in most.

Fibreoptic laryngoscopy in the assessment of laryngeal disorders.

The fibreoptic laryngoscope is described, and its method of use detailed. Seventy patients were submitted to this examination. Its advantages and disadvantages in the assessment of the various groups of laryngeal disorders in these patients are discussed and compared with indirect and direct laryngoscopy. Its teaching and research possibilities are also mentioned. The technique shows considerable promise and will, we believe, achieve an accepted place as an addition to our diagnostic armamentarium in the investigation of laryngeal disorders.