Iron Pill-Induced Chemical Laryngitis.

OBJECTIVE: To discuss the presentation and management of pill-induced chemical laryngitis by illustrating a rare case. METHODS: We report a unique case of a patient with iron pill-induced laryngitis. RESULTS: A 71-year-old male presented for evaluation of dysphonia. Five weeks prior, the patient had reportedly aspirated an iron pill. The pill was lodged in his throat for several hours before being coughed up, soft but still intact. Since that event, the patient noted complete voice loss and in clinic was found to have a very breathy and asthenic voice. Stroboscopy revealed aperiodicity with severe false fold compression and significant ulceration of the infraglottic region associated with thick exudate. Vocal folds were mobile but atrophic, with overlying crusted secretions. A sensory deficit was suspected based on scope tolerance. The patient was treated with nebulized ciprodex and humidified air with some improvement in mucosal crusting but had persistent glottic insufficiency and dysphonia, prompting bilateral hyaluronic acid injection. CONCLUSIONS: Pill-induced laryngitis is an extremely rare phenomenon. While typically associated with bisphosphonates, this condition should be considered in any patient presenting with dysphonia and history of aspiration of a pill, including iron supplements. Regardless of the inciting medication, pill-induced laryngitis may be treated with humidified air, nebulized steroids, and antibiotics. Injection augmentation of the vocal folds may be made considered when glottic insufficiency and weak cough contribute to the presentation.

Complementary and Integrative Medicine and the Voice.

Dysphonia is a ubiquitous problem impacting a broad range of people. As communication is central to the human experience, any perturbation of the voice can be frustrating for the patient and the physician. Nutritional, psychological, and physical means of preventing and treating hoarseness have been used by humans since the beginning of written record. Today, we use a selection of these approaches, along with traditional medicine, to alleviate problems of the vocal tract.

A spray-as-you-go airway topical anesthesia attenuates cardiovascular responses for double-lumen tube tracheal intubation.

BACKGROUND: Spray-as-you-go (SAYGo) airway topical anesthesia and nerve block are common techniques used during awake tracheal intubation. However, their effects have not been described during double-lumen tube intubation. We report on a prospective randomized study that aimed to compare the intubation effects of SAYGo and nerve block patients undergoing thoracic surgery. METHODS: Sixty-six American Society of Anesthesiologists (ASA) physical status I and II patients were scheduled to undergo double-lumen tube (DLT) tracheal intubation for thoracic surgery. The patients were randomly assigned into control (Group C), ultrasound (Group U), and flexible intubation scope (Group F) groups with 22 cases in each group. Patients in Group C were induced with a standard anesthetic regimen. Patients in Groups U and F were treated with superior laryngeal nerve (SLN) block combined with transtracheal injection (TTI) and given a SAYGo airway topical anesthesia before intubation. Hemodynamic variables during intubation process were recorded as the primary outcome. Additional patient data were recorded including the occurrence of adverse events, the level of hoarseness, the occurrence of sore throats, memory function and the level of patient satisfaction with anesthesia. RESULTS: The blood pressure (BP) and heart rate (HR) of patients in group C was significantly increased 1 min after tracheal intubation (P < 0.05) compared to before anesthesia. The BP and HR of patients in Groups U and F remained stable. 10 cases of hypertension were observed in Group C, 6 cases in Group U and 1 case in Group F. In Group C, tachycardia was observed in 9 patients along with 9 cases in Group U and 4 cases in Group F. In Group U, 4 patients experienced puncture and bleeding were and 8 patients had a poor memory of TTI. No significant differences were found in the incidence of hoarseness, sore throats, and satisfaction with anesthesia in postoperative follow-up. CONCLUSIONS: SAYGo airway topical anesthesia and SLN block combined with the TTI technique can inhibit the cardiovascular response during DLT tracheal intubation. The SAYGo technique has fewer complications and more advantages compared to other approaches.

The effect of breathing exercises combined with manual therapy on muscle tension dysphonia in traditional singers: a blinded randomized controlled trial.

BACKGROUND: Muscle tension dysphonia (MTD) is common in traditional singers and can lead to serious complications, but there is inconclusive evidence about how MTD should be treated in singers as professional voice users. This study was conducted to investigate the effects of breathing exercises combined with manual therapy versus breathing exercises and manual therapy on voice quality in traditional singers suffering from MTD. METHODS: In this blinded randomized clinical trial, 60 patients with MTD were randomly allocated to four groups: (1) breathing exercises, (2) manual therapy, (3) combined intervention (CI) and (4) control. Patients received treatments for 13 sessions, once per week. Treatment effects were assessed in terms of primary outcome measures: (1) breathing performance, measured by maximum phonation time (MPT) and (2) laryngeal function, measured by Stroboscopy Evaluation Rating Form (SERF). Secondary outcome measure was patient's self-perceived voice handicap, measured by Persian version of Singing Voice Handicap Index (SVHIp). All outcome variables were measured before and after treatment. The between group comparisons on MPT and SVHIp score were investigated using analysis of covariance (ANCOVA). The Kruskal-Wallis non-parametric test was used for between group comparisons of SERF items. RESULTS: Three treatment groups had improved regarding breathing performance, laryngeal function and voice handicap over the time (P < 0.01). The improvements achieved in all outcomes were significantly greater in the CI group than those of the breathing exercises, manual therapy and control groups. CONCLUSIONS: This randomized controlled trial showed that the combination of breathing exercises and manual therapy significantly improved the laryngeal function, breathing performance and voice handicap in traditional singers suffering from MTD. TRIAL REGISTRATION: IRCT2015102524686N1.

Effect of Vocal Therapy Associated With TENS in Women With Behavioral Dysphonia.

PURPOSE: This study aimed to investigate the effect of transcutaneous electrical nerve stimulation (TENS) associated with vocal therapy in women with behavioral dysphonia. METHOD: Seventeen women with behavioral dysphonia were divided into an experimental group (n = 8) and a placebo group (n = 9). All were submitted to six sessions of vocal therapy, according to the Comprehensive Voice Rehabilitation Program. In the experimental group, therapy was associated with TENS (30 minutes) and in the placebo group, the electrodes were placed and the equipment remained off. The vocal handicap, the voice through the acoustic and auditory perception evaluation, the electrical activity, and the superficial temperature of the suprahyoid and infrahyoid muscles were evaluated. Pre and post data were compared by parametric and nonparametric tests. RESULTS: There was a decreased in vocal handicap of the placebo group (P = 0.002) and a decreased in the percentage of electrical activity of the right (P = 0.036) and left (P = 0.017) infrahyoid muscles of the experimental group in vowel emission and sequential speech (P = 0.036). There was an increase in temperature in the right infrahyoid region in vowel emission (P = 0.027) and the temperature difference decreased quantitatively between the supra and infrahyoid regions in the experimental group. CONCLUSION: TENS associated with vocal therapy reduced the electrical activity of the infrahyoid muscles and balance the temperature between the supra- and infrahyoid regions in women with behavioral dysphonia.

A case of vocal polyps improved with herbal medicine: A case report.

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.

A new training method for velopharyngeal dysfunction: Self-inhalation for hypernasality.

OBJECTIVE: There are various methods to treat velopharyngeal dysfunction including　surgery and rehabilitation therapy. Even if a rehabilitation program is effective, the evaluation of its efficacy remains subjective. In this paper, we propose a new method of rehabilitation training for velopharyngeal dysfunction focusing on the objective peak inspiratory flow (PIF) rate. METHODS: Four patients, who were diagnosed with velopharyngeal dysfunction without cleft palate at ENT clinic of the National Hospital Organization, Tokyo Medical Center, participated in this study. All patients underwent our original rehabilitation program for velopharyngeal dysfunction, a method using the In-Check Dial, Turbohaler model. As a self-training rehabilitation program, we asked them to inhale forcefully 10 times daily at home using the In-Check Dial to increase the value of PIF rate for 3 months. We measured the patients' PIF rates with the In-Check Dial at the ENT clinic at the initial visit and after the 3-month training. RESULTS: The PIF rates of the four patients without nasal clips were higher than the rates with nasal clips at the initial visit. After the training, PIF rate without a nasal clip of all patients increased than the rate at the initial visit, which represented significant difference (P < 0.05). Also, after 3 months, PIF rate without a nasal clip was higher or equal than the rates with a nasal clip at the initial visit except one case. Naso-pharyngo-laryngeal fiberscopy did not detect salivary pooling around larynx and mirror fogging test did not show nasal escape in the three of four patients after 3 months of training. All reported improvement in dysphagia and dysarthria. CONCLUSION: This new method can be used not only to evaluate velopharyngeal function but also as an effective self-training treatment.

Functional outcomes of endoscopic arytenoid abduction lateropexy for unilateral vocal cord paralysis with dyspnea.

In unilateral vocal cord paralysis (UVCP), hoarseness is usually the leading symptom; however, the diminished airway might lead to breathing problems as well, especially with exertion. The application of the classic resection glottis enlarging or medialization procedures might shift the breathing and/or the voice to a worse condition. The non-destructive endoscopic arytenoid abduction lateropexy (EAAL) might be a solution for this problem. The aim of our study was to analyze the phonatory and respiratory outcomes of this treatment concept. The first year phoniatric [Jitter, Shimmer, harmonics-to-noise ratio (HNR), maximum phonation time (MPT), fundamental frequency (F 0), Voice Handicap Index (VHI), Dysphonia Severity Index (DSI), Global-Roughness-Breathiness scale (GRB)], peak inspiratory flow (PIF), and quality of life (QoL) were evaluated in ten UVCP patients treated by EAAL for dyspnea generally presented on exertion. PIF, Jitter, QoL, GRB, and VHI significantly improved. DSI, HNR, and MPT got non-significantly better. F 0 slightly increased in all patients, a mild deterioration of shimmer was observed. These results prove that improving respiratory function is not necessarily associated with a deterioration in voice quality. The EAAL provides a significant improvement in breathing and the vibratory parameters of the postoperative, more tensed and straightened vocal cords proved to be more advantageous than the original (para) median 'loose' position. The over-adduction of the contralateral side more or less compensates for the disadvantageous, more lateral position of the operated side. EAAL might be an alternative treatment for unilateral vocal cord paralysis associated with breathing problems.

Huge Subglottic Polyp Treated with Tracheotomy and Laryngofissure

Vocal polyps are benign laryngeal lesions which arise from the Reinke's space abd hoarseness is the most common symptom. However, airway compromised is rarely presented in the vocal polyp. A rare case of large subglottic polyp causing dyspnea is reported. Tracheostomy was performed under local anesthesia and then the mass was resected under general anesthesia using a laryngofissure approach. The dyspnea and hoarseness disappeared after surgery immediately. The histopathological findings indicated a diagnosis of vocal cord polyp with chronic inflammatiuon. We consider that tracheostomy is the safest and most useful procedure to guarantee the upper airway in cases of large vocal polyp showing dyspnea. We hereby report a case of huge subglottic polyp in which a tracheostomy and laryngofissure was required for removing the subglottic mass successfully.

Anaesthesia for carotid endarterectomy. Ultrasound-guided superficial/intermediate cervical plexus block combined with carotid sheath infiltration.

BACKGROUND: Carotid endarterectomy carries a significant risk of intraoperative brain ischaemia. Various methods for intraoperative cerebral function monitoring can be utilized, but the assessment of the patient's consciousness remains the easiest and most available method, requiring that the patient remain awake and under local/regional anaesthesia. The aim of this study was to compare infiltration anaesthesia with an ultrasound-guided superficial/combined cervical plexus block for patient safety and comfort. METHODS: Ninety-eight patients scheduled for carotid endarterectomy were randomly assigned to receive either infiltration anaesthesia performed by the surgeon or an US-guided superficial/combined cervical plexus block. The pain intensity using the numerical rating scale (NRS), the volume of local anaesthetic used and the anaesthesia-related complications were recorded. The data were analysed using selected statistical tools. RESULTS: In the US-guided group, a significantly lower volume of local anaesthetic was used (25 mL vs. 30 mL), and lower mean (1 vs. 3) and maximal (2 vs. 6) NRS scores were observed. However, hoarseness, cough and difficulty swallowing were significantly more frequent among those patients (90% vs. 27%, 30% vs. 12%, and 36% vs. 6%, respectively). CONCLUSIONS: Compared with infiltration anaesthesia, an US-guided superficial/combined cervical plexus block is an effective method for improving the comfort of the patient and the surgeon. The technique is safe, relatively simple and easy to master and requires little time to perform.

Green Tea Gargling Effect on Cough & Hoarseness After Coronary Artery Bypass Graft.

INTRODUCTION: Endotracheal intubation is a method necessary for controlling and maintaining airway during general anesthesia. Cough and hoarseness are common complications after endotracheal intubation. Inflammation has an important role in postoperative cough and hoarseness outbreak. Also it has been stated that green tea has anti-inflammatory properties. Therefore, the current study has been conducted to investigate green tea gargling solution effect on cough and hoarseness after coronary artery bypass graft (CABG) surgery. METHODS: In this single-blind, randomized, & controlled clinical trial, we enrolled 121 patients undergoing CABG admitted to the ICU. The intervention group participants were asked to gargle 30 cc of green tea solution. The control group patients gargled 30 cc of distilled water. An hour after extubation, the intervention group patients were asked to gargle 30 cc of green tea and the control group patients were required to gargle 30 cc of distilled water every 6 hour up to 24 hour (each patient for 4 times). Moreover, the cough and hoarseness questionnaire was also filled in 6, 12, and 24 hours after endotracheal extubation. RESULTS: The results showed no significant differences among the patients in both groups regarding age, gender, body mass index, smoking history, and anesthesia duration. There was a significant difference between the two groups in terms of cough 12 hours after removing the endotracheal tube. At other times, there was no significant difference between the two groups considering cough and hoarseness. CONCLUSION: The present study results showed that green tea gargling does not decrease hoarseness. Though, cough occurrence was less in the intervention group than the other group.

Chondronecrosis of the larynx following use of the laryngeal mask airway.

This case describes the development of laryngeal chondronecrosis after use of the laryngeal mask airway (LMA). A 69-year-old male with prior laryngeal irradiation underwent total knee replacement with general anesthesia via LMA. Postoperatively, he developed laryngeal chondronecrosis, bilateral vocal fold immobility, and aspiration, necessitating tracheostomy and gastrostomy placement. He improved with hyperbaric oxygen therapy, intravenous antibiotics, and endoscopic repair of a residual fistula. Vocal fold motion returned and he was decannulated. Chondronecrosis of the larynx may occur with the use of the LMA, and caution should be used in patients with a history of prior laryngeal irradiation.

Relation between voice disorders and work in a group of Community Health Workers / Relacao entre disturbio de voz e trabalho em um grupo de Agentes Comunitarios de Saude

Purpose: To analyze the relationship between voice disorders and work in a group of Community Health Agents (CHA). Methods: The subjects of this study were 65 CHA working in the city of São Paulo. Thefiinstrument used for data collection was an adaptation of the questionnaire named Conditions of Vocal Production – Teachers (CPV-P). The results were keyed in twice and submitted to statistical analysis, in order to verify: the self-reported frequency of voice disorder frequency of present vocal symptoms, the association among the three most frequently reported present symptoms, and environmental and organizational aspects of work. Results: Of the 65 (100%) CHA in the study, 37 (56.9%) self-reported having present or past vocal disorders. The most frequently reported present symptoms were: dry throat, tiredness when speaking, and burning sensation in the throat. There was significant association between: taking work to home, having personal items stolen, police intervention, violence against employees and vocal symptom dry throat, not having enough time to complete all tasks, difficulty in leaving work, inadequate furniture, intense physical strain, objects stolen from the health unit, racism and vocal symptom tiredness when speaking, dust, job dissatisfaction, work stress, building destruction, drug issues, and vocal symptom burning in throat. Conclusion: Based on the obtained results, the initial hypothesis of association between the development of vocal disorders among the subjects and the adversities present in their work environment and organization was confirmed. .

OBJETIVO: Analisar a relação entre distúrbio de voz e trabalho em um grupo de Agentes Comunitários de Saúde (ACS). MÉTODOS: Participaram 65 ACS atuantes no município de São Paulo. Para a coleta de dados, elegeu-se a adaptação do questionário Condições de Produção Vocal - Professor (CPV-P). Foram verificados: frequência autorreferida de distúrbio de voz; frequência de sintomas vocais; associação entre os três sintomas vocais mais citados e aspectos do ambiente e da organização do trabalho. RESULTADOS: Dos 65 (100%) ACS pesquisados, 37 (56,9%) autorreferiram apresentar distúrbio de voz. Os sintomas vocais mais citados foram: garganta seca, cansaço ao falar e ardor na garganta. Houve associação significativa entre: levar trabalho para casa, roubo de objetos pessoais, intervenção da polícia, violência contra os funcionários e o sintoma vocal garganta seca, não ter tempo para desenvolver todas as atividades, dificuldade para sair do trabalho, móveis inadequados, esforço físico intenso, roubo de material da UBS, manifestação de racismo e o sintoma vocal cansaço ao falar, poeira, insatisfação no trabalho, estresse no trabalho, depredações, problemas com drogas e o sintoma vocal ardor na garganta. CONCLUSÃO: Com base nos resultados obtidos, a hipótese inicial de associação entre o desenvolvimento do distúrbio de voz entre os pesquisados e as adversidades presentes no ambiente e na organização do seu trabalho foi confirmada. .

Functional hoarseness in children: short-term play therapy with family dynamic counseling as therapy of choice.

Children with nonorganic voice disorders (NVDs) are treated mainly using direct voice therapy techniques such as the accent method or glottal attack changes and indirect methods such as vocal hygiene and voice education. However, both approaches tackle only the symptoms and not etiological factors in the family dynamics and therefore often enjoy little success. The aim of the "Bernese Brief Dynamic Intervention" (BBDI) for children with NVD was to extend the effectiveness of pediatric voice therapies with a psychosomatic concept combining short-term play therapy with the child and family dynamic counseling of the parents. This study compares the therapeutic changes in three groups where different procedures were used, before intervention and 1 year afterward: counseling of parents (one to two consultations; n = 24), Brief Dynamic Intervention on the lines of the BBDI (three to five play therapy sessions with the child plus two to four sessions with the parents; n = 20), and traditional voice therapy (n = 22). A Voice Questionnaire for Parents developed by us with 59 questions to be answered on a four-point Likert scale was used to measure the change. According to the parents' assessment, a significant improvement in voice quality was achieved in all three methods. Counseling of parents (A) appears to have led parents to give their child more latitude, for example, they stopped nagging the child or demanding that he/she should behave strictly by the rules. After BBDI (B), the mothers were more responsive to their children's wishes and the children were more relaxed and their speech became livelier. At home, they called out to them less often at a distance, which probably improved parent-child dialog. Traditional voice therapy (C) seems to have had a positive effect on the children's social competence. BBDI seems to have the deepest, widest, and therefore probably the most enduring therapeutic effect on children with NVD.

Cryptococcal infection of the larynx: case report.

OBJECTIVE: Laryngeal cryptococcosis is a rare condition. In this report, we describe the findings for and treatment of a 58-year-old man with Cryptococcus gattii infection of the right vocal fold. METHOD: Case report and review of the relevant English language literature. RESULTS: The patient presented with persistent hoarseness of voice. Laryngoscopy demonstrated an irregular, red lesion on the right vocal fold. Histopathological examination identified cryptococcus. The patient was treated with oral fluconazole 400 mg/day for eight weeks. CONCLUSION: Laryngeal involvement by Cryptococcus gattii can result from prolonged inhaled corticosteroid therapy and proximity to eucalyptus trees. The clinical presentation, laryngoscopic findings and imaging results of laryngeal involvement may mimic a neoplasm. Histopathological examination can demonstrate the causative organism. Management consists of advice from an infectious disease specialist together with adequate treatment by antifungal agents.

Larynx preservation for patients with locally advanced laryngeal cancer.

A 53-year-old man presented with a 6-month history of mild hoarseness, with no associated pain, dysphagia, or stridor. At nasoendoscopy, a lesion was detected involving the whole length of the left vocal cord, with abnormal mucosa also seen in the right ventricle (Fig 1). The left vocal cord movement was impaired. There were no palpable neck nodes. Biopsy under anesthesia revealed moderately differentiated squamous cell carcinoma. He was a current smoker of 30 cigarettes per day (45 pack-year smoking history), and he consumed four standard drinks of alcohol per day. His Eastern Cooperative Oncology Group performance status was 1, and he had no significant comorbidities. Radiologic review of his outside computed tomography scan noted that it was of poor quality, and a magnetic resonance imaging scan was recommended, which showed low-volume T4a disease based on focal thyroid cartilage penetration (Fig 2). A positron emission tomography (PET) scan revealed no evidence of nodal or distant metastasis.

Relation between voice disorders and work in a group of Community Health Workers.

PURPOSE: To analyze the relationship between voice disorders and work in a group of Community Health Agents (CHA). METHODS: The subjects of this study were 65 CHA working in the city of São Paulo. Thefiinstrument used for data collection was an adaptation of the questionnaire named Conditions of Vocal Production - Teachers (CPV-P). The results were keyed in twice and submitted to statistical analysis, in order to verify: the self-reported frequency of voice disorder frequency of present vocal symptoms, the association among the three most frequently reported present symptoms, and environmental and organizational aspects of work. RESULTS: Of the 65 (100%) CHA in the study, 37 (56.9%) self-reported having present or past vocal disorders. The most frequently reported present symptoms were: dry throat, tiredness when speaking, and burning sensation in the throat. There was significant association between: taking work to home, having personal items stolen, police intervention, violence against employees and vocal symptom dry throat, not having enough time to complete all tasks, difficulty in leaving work, inadequate furniture, intense physical strain, objects stolen from the health unit, racism and vocal symptom tiredness when speaking, dust, job dissatisfaction, work stress, building destruction, drug issues, and vocal symptom burning in throat. CONCLUSION: Based on the obtained results, the initial hypothesis of association between the development of vocal disorders among the subjects and the adversities present in their work environment and organization was confirmed.