RESUMO
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.
Assuntos
Queimaduras Químicas , Cáusticos , Doenças da Laringe , Laringe , Masculino , Humanos , Idoso , Laringe/lesões , Queimaduras Químicas/diagnóstico , Queimaduras Químicas/etiologia , Queimaduras Químicas/terapia , Laringoscopia/efeitos adversos , Doenças da Laringe/complicações , Ingestão de AlimentosRESUMO
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.
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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
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
OBJECTIVES/HYPOTHESIS: Awake, unsedated in-office upper airway procedures are performed frequently and have high completion rates, yet less is known about the patients' pain experience and potentially influencing factors. It is also unclear if patients' pain experiences become worse with repeated procedures. We identified procedure- and patient-related factors that might influence procedural completion and pain scores. STUDY DESIGN: Retrospective chart review. METHODS: Pre-, intra-, and post-procedure pain scores were collected prospectively for awake unsedated upper airway procedures performed at a single institution over a 5-year period. Patient factors reviewed were demographics, body mass index, psychiatric and/or pain diagnosis, and related medications. Procedure factors reviewed were procedure type, route, side, and performance of the same procedure multiple times. Patients reported their pain level before, during, and after the procedure using a standard 0 to 10 scale. Maximum pain score change (PΔmax), or the difference between highest and lowest reported pain levels, was calculated. Descriptive and multivariate analyses were performed. RESULTS: Procedure completion was 98.7% for 609 first time patients and 99.0% in 60 patients undergoing 292 repeat procedures. PΔmax did not covary with age, gender, or BMI. PΔmax covaried with pain and psychiatric conditions and associated medications. PΔmax was highest for injection medialization and lowest for tracheoscopy. PΔmax decreased over time for those undergoing multiple identical procedures. CONCLUSIONS: Procedures were performed with a very high completion rate and low pain scores. Age, sex, and BMI did not affect pain experience. A combination of pain and psychiatric conditions did. Injection medialization had the highest PΔmax and tracheoscopy the lowest. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:E1580-E1588, 2021.
Assuntos
Procedimentos Cirúrgicos Ambulatórios/efeitos adversos , Doenças da Laringe/terapia , Laringoscopia/efeitos adversos , Dor Processual/diagnóstico , Administração Tópica , Adulto , Idoso , Anestesia Local , Biópsia/efeitos adversos , Biópsia/métodos , Feminino , Glucocorticoides/administração & dosagem , Humanos , Injeções Intralesionais/efeitos adversos , Doenças da Laringe/diagnóstico , Laringe/diagnóstico por imagem , Laringe/cirurgia , Lidocaína/administração & dosagem , Masculino , Pessoa de Meia-Idade , Medição da Dor/estatística & dados numéricos , Dor Processual/etiologia , Dor Processual/prevenção & controle , Estudos Retrospectivos , Resultado do Tratamento , VigíliaRESUMO
Focal dystonias are the most common forms of isolated dystonia; however, the etiopathophysiological signatures of disorder penetrance and clinical manifestation remain unclear. Using an imaging genetics approach, we investigated functional and structural representations of neural endophenotypes underlying the penetrance and manifestation of laryngeal dystonia in families, including 21 probands and 21 unaffected relatives, compared to 32 unrelated healthy controls. We further used a supervised machine-learning algorithm to predict the risk for dystonia development in susceptible individuals based on neural features of identified endophenotypes. We found that abnormalities in prefrontal-parietal cortex, thalamus, and caudate nucleus were commonly shared between patients and their unaffected relatives, representing an intermediate endophenotype of laryngeal dystonia. Machine learning classified 95.2% of unaffected relatives as patients rather than healthy controls, substantiating that these neural alterations represent the endophenotypic marker of dystonia penetrance, independent of its symptomatology. Additional abnormalities in premotor-parietal-temporal cortical regions, caudate nucleus, and cerebellum were present only in patients but not their unaffected relatives, likely representing a secondary endophenotype of dystonia manifestation. Based on alterations in the parietal cortex and caudate nucleus, the machine learning categorized 28.6% of unaffected relative as patients, indicating their increased lifetime risk for developing clinical manifestation of dystonia. The identified endophenotypic neural markers may be implemented for screening of at-risk individuals for dystonia development, selection of families for genetic studies of novel variants based on their risk for disease penetrance, or stratification of patients who would respond differently to a particular treatment in clinical trials.
Assuntos
Encéfalo/diagnóstico por imagem , Distúrbios Distônicos/diagnóstico por imagem , Endofenótipos , Doenças da Laringe/diagnóstico por imagem , Penetrância , Adulto , Idoso , Encéfalo/fisiopatologia , Estudos de Casos e Controles , Núcleo Caudado/diagnóstico por imagem , Núcleo Caudado/fisiopatologia , Cerebelo/diagnóstico por imagem , Cerebelo/fisiopatologia , Distúrbios Distônicos/genética , Distúrbios Distônicos/fisiopatologia , Família , Feminino , Neuroimagem Funcional , Humanos , Doenças da Laringe/genética , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Córtex Motor/diagnóstico por imagem , Córtex Motor/fisiopatologia , Lobo Parietal/diagnóstico por imagem , Lobo Parietal/fisiopatologia , Córtex Pré-Frontal/diagnóstico por imagem , Córtex Pré-Frontal/fisiopatologia , Medição de Risco , Aprendizado de Máquina Supervisionado , Lobo Temporal/diagnóstico por imagem , Lobo Temporal/fisiopatologia , Tálamo/diagnóstico por imagem , Tálamo/fisiopatologiaAssuntos
Saúde Holística , Doenças da Laringe/diagnóstico , Doenças da Laringe/terapia , Sintomas Inexplicáveis , Distúrbios da Voz/diagnóstico , Distúrbios da Voz/terapia , Comorbidade , Síndrome de Fadiga Crônica/epidemiologia , Fibromialgia/epidemiologia , Humanos , Síndrome do Intestino Irritável/epidemiologia , Doenças da Laringe/epidemiologia , Doenças da Laringe/etiologia , Distúrbios da Voz/epidemiologia , Distúrbios da Voz/etiologiaRESUMO
OBJECTIVES: Multiple topical anesthesia techniques exist for office-based laryngeal surgery. Our objective was to assess patient and surgeon satisfaction for three different techniques. STUDY DESIGN: Cohort study. METHODS: All consecutive patients presenting to an outpatient laryngology office for awake surgical procedures were enrolled. Patients were anesthetized with local anesthesia (2 cubic centimeters of 4% lidocaine) in one of three ways: 1) nebulizer, 2) flexible cannula through a channeled laryngoscope, or 3) transtracheal instillation. Demographics, procedure times, and surgeon satisfaction were recorded. A validated 11-item patient satisfaction questionnaire (Iowa Satisfaction with Anesthesia Survey) was administered after the procedure to calculate an overall satisfaction score (-3[worst] to 3[best]). Descriptive and correlative statistics were performed. RESULTS: One hundred consecutive patients were included (37 females, 73 males), with relatively equal numbers between groups (32 nebulizer, 35 cannula, 33 transtracheal). Seven procedures were aborted (4 nebulizer, 2 cannula, 1 transtracheal) due to movement, anxiety, or technical issues. Three patients did not adequately complete the survey. Of the 90 remaining patients, patient satisfaction was highest with the transtracheal technique (2.04) versus cannula (1.46) or nebulizer (1.45), and this was statistically significant (P = 0.0167). This difference was driven by decreased pain and nausea scores in the transtracheal group. Surgeon satisfaction was lower with nebulizer and higher with transtracheal injection (P = 0.0081). There was a correlation between surgeon satisfaction and patient satisfaction (P < 0.0001). CONCLUSION: Transtracheal instillation was favored by both patients and the surgeon. Choice of local anesthetic techniques may impact patient preferences and surgical success. This may serve as a basis for optimizing anesthetic care in office-based laryngeal surgery. LEVEL OF EVIDENCE: 4 Laryngoscope, 130:166-170, 2020.
Assuntos
Procedimentos Cirúrgicos Ambulatórios , Anestesia Local/métodos , Anestésicos Locais/administração & dosagem , Doenças da Laringe/cirurgia , Lidocaína/administração & dosagem , Preferência do Paciente , Estudos de Coortes , Feminino , Humanos , Satisfação no Emprego , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Otorrinolaringológicos/métodosRESUMO
OBJECTIVE: Despite the fact that vocal nodules are the most common cause of chronic dysphonia in children, uncertainty and lack of consensus complicates practically every diagnostic and management decision. Selecting an optimal staging system is fundamental to understanding a disease process, mandatory for uniform reporting, and crucial to predicting natural history and treatment outcomes. The ideal prognostic model for vocal nodules is under intense debate. The purpose of this study was to analyze the predictive power of vocal nodule grade to severity of voice metrics in children. METHODS: Seventy-nine patients diagnosed with vocal cord nodules between 2006 and 2012 were drawn from UPMC Children's Hospital of Pittsburgh Voice, Resonance and Swallowing Center Research Registry. Subject age at time of diagnosis, nodule grade, relevant co-morbidities, scores on The Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V), parent-reported Pediatric Voice Handicap Index (pVHI), the phonotraumatic behaviors profile, habitual speaking pitch fundamental frequencies, pitch range, volume intensity, and s/z ratio were recorded and compiled into a de-identified database for analysis. RESULTS: Based on the Kruskal-Wallis H Test, there was no statistically significant correlation between nodule grade and total pitch range (pâ¯=â¯.21), s/z ratio (pâ¯=â¯.50), volume intensity (pâ¯=â¯.33), overall CAPE-V Scores (pâ¯=â¯.15), or pVHI Scores (pâ¯=â¯.29). Chi-squared tests also revealed no significant associations between nodule grade and abnormality in habitual speaking pitch (pâ¯=â¯.14 for fundamental frequency while sustaining a vowel sound, pâ¯=â¯.37 for fundamental frequency while speaking structured tasks i.e. counting, or pâ¯=â¯.76 while speaking in conversation). CONCLUSION: The current "gold-standard" for grading vocal nodule size suggests that the nodules themselves are not driving the standard dysphonic metrics that are most commonly collected and monitored in such children. This outcome is consistent with other studies reporting similar findings and was expected based on the inconsistencies in the reported literature to date. By extension, the conventional wisdom of avoiding surgical treatment of vocal nodules in children seems prudent as there is little evidence to suggest that the nodules themselves are "driving" the severity of the dysphonia. Ultimately identifying the true "drivers" of dysphonia in children will suggest alternative therapies that are more specific and directed to the pathophysiology. Most pediatric voice care professionals will welcome such discoveries as those in the front line of patient care are often rendered helpless and frustrated.
Assuntos
Disfonia/diagnóstico , Disfonia/etiologia , Doenças da Laringe/complicações , Doenças da Laringe/diagnóstico , Pólipos/complicações , Pólipos/diagnóstico , Adolescente , Criança , Pré-Escolar , Estudos de Coortes , Disfonia/terapia , Feminino , Humanos , Doenças da Laringe/cirurgia , Masculino , Pólipos/cirurgia , Valor Preditivo dos Testes , Índice de Gravidade de Doença , Qualidade da VozRESUMO
OBJECTIVE: The fiber-guided carbon dioxide (CO2) laser is a useful device for laryngopharyngeal surgery. The flexible CO2 wave-guide laser has been developed and commercially available for several years. However, the transnasal use of CO2 flexible wave-guided laser surgery through the instrument channel of a flexible endoscope (CO2 TNFLS) is not permitted in Japan. This feasibility study aimed to assess the value and the safety of an in-office CO2 TNFLS procedure. METHODS: Patients with small laryngopharyngeal diseases were enrolled from June 2015. Eligible patients had indications with lesions generally localized superficial lesions such as the benign tumor, leukoplakia, and premalignant lesion-like carcinoma in situ (CIS). Patients were locally well anesthetized using xylocaine. After removing as much of the lesion(s) as possible with flexible forceps, the remainder of the lesions were evaporated using CO2 TNFLS through the instrument channel of a flexible endoscope under local anesthesia. RESULTS: Eighteen surgeries involving 13 patients, including 9 papilloma (7 recurrent respiratory papilloma [RRP]), 2 carcinoma in situ, 1 leukoplakia, and 1 large epiglottic cyst), were performed. Four patients with RRP required multiple surgeries. Except for 3 patients with RRP, all patients achieved disease control without additional intervention. All procedures were completed with no severe adverse events. CONCLUSION: Office-based CO2 TNFLS is safe and feasible for patients with laryngopharyngeal pathologies. It is especially valuable for RRP patients with small lesions to avoid surgery under general anesthesia.
Assuntos
Carcinoma in Situ/cirurgia , Neoplasias Laríngeas/cirurgia , Terapia a Laser/métodos , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Infecções por Papillomavirus/cirurgia , Neoplasias Faríngeas/cirurgia , Infecções Respiratórias/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos Ambulatórios , Anestesia Local , Cistos/cirurgia , Epiglote/cirurgia , Estudos de Viabilidade , Feminino , Humanos , Doenças da Laringe/cirurgia , Lasers de Gás/uso terapêutico , Leucoplasia/cirurgia , Masculino , Pessoa de Meia-Idade , Cavidade Nasal , Cirurgia Endoscópica por Orifício Natural , Doenças Faríngeas/cirurgia , Resultado do TratamentoRESUMO
Opera and chant singers learn to effectively use aerodynamic components by breathing exercises during their education. Aerodynamic components, including subglottic air pressure and airflow, deteriorate in voice disorders. This study aimed to evaluate the changes in aerodynamic parameters and supraglottic structures of men and women with different vocal registers who are in an opera and chant education program. Vocal acoustic characteristics, aerodynamic components, and supraglottic structures were evaluated in 40 opera and chant art branch students. The majority of female students were sopranos, and the male students were baritone or tenor vocalists. The acoustic analyses revealed that the mean fundamental frequency was 152.33 Hz in the males and 218.77 Hz in the females. The estimated mean subglottal pressures were similar in females (14.99 cmH2O) and in males (14.48 cmH2O). Estimated mean airflow rates were also similar in both groups. The supraglottic structure compression analyses revealed partial anterior-posterior compressions in 2 tenors and 2 sopranos, and false vocal fold compression in 2 sopranos. Opera music is sung in high-pitched sounds. Attempts to sing high-pitched notes and frequently using register transitions overstrain the vocal structures. This intense muscular effort eventually traumatizes the vocal structures and causes supraglottic activity.
Assuntos
Acústica , Exercícios Respiratórios , Glote/fisiologia , Fonação , Canto , Qualidade da Voz , Treinamento da Voz , Adulto , Feminino , Glote/diagnóstico por imagem , Humanos , Doenças da Laringe/diagnóstico por imagem , Doenças da Laringe/fisiopatologia , Laringoscopia , Masculino , Valor Preditivo dos Testes , Pressão , Estroboscopia , Gravação em Vídeo , Distúrbios da Voz/diagnóstico por imagem , Distúrbios da Voz/fisiopatologia , Adulto JovemRESUMO
Epiglottic cysts often cause difficulty in airway management, with potential serious life-threatening complications. 1 This case report describes a patient with an epiglottic cyst in whom mask ventilation became difficult after induction of anesthesia. Immediately, an AirWay Scope™ (TMAWS-S100; Pentax, Japan) was inserted orally, and the location of the epiglottis was clarified to assess the reason for difficulty with ventilation. This case demonstrates usefulness of the AirWay Scope in patients with epiglottic cyst.
Assuntos
Obstrução das Vias Respiratórias/etiologia , Cistos/complicações , Epiglote , Intubação Intratraqueal/instrumentação , Doenças da Laringe/complicações , Laringoscópios , Laringoscopia/instrumentação , Respiração Artificial , Gravação em Vídeo/instrumentação , Obstrução das Vias Respiratórias/diagnóstico , Anestesia Geral , Anestesia Local , Cistos/diagnóstico , Humanos , Doenças da Laringe/diagnóstico , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Bucais , Resultado do TratamentoRESUMO
Inflammatory myofibroblastic tumor (IMT) is a benign neoplasm of intermediate biologic potential. It rarely occurs in the larynx, and it has not been previously reported in the epiglottis. We treated a 66-year-old woman who presented with progressive dysphonia and a mass on her suprahyoid epiglottis. The tumor was completely excised with a CO2 laser; no adjuvant therapy was administered. Histopathology revealed that the mass was an IMT. No evidence of recurrence was noted after 6 months of follow-up. We present what we believe is the first case of an epiglottic IMT to be reported in the literature, and we propose CO2 laser excision without adjuvant therapy as an acceptable treatment.
Assuntos
Epiglote , Granuloma de Células Plasmáticas , Lasers de Gás/uso terapêutico , Idoso , Disfonia/etiologia , Epiglote/patologia , Epiglote/cirurgia , Feminino , Granuloma de Células Plasmáticas/diagnóstico , Granuloma de Células Plasmáticas/fisiopatologia , Granuloma de Células Plasmáticas/cirurgia , Humanos , Doenças da Laringe/diagnóstico , Doenças da Laringe/cirurgia , Miofibroblastos/patologia , Resultado do TratamentoRESUMO
PURPOSE: This is a retrospective study to evaluate the results of surgical treatment of patients with pathological sulcus vocalis. METHODS: Thirty-six patients with pathological sulcus underwent surgery and in 33 cases were performed additional injection laryngoplasty. The pre- and postoperative evaluation of patients included the GRBAS scale, stroboscopic, and objective acoustic voice assessment. The Voice Handicap Index questionnaire (VHI-30) was also used and the scores were obtained from 33 patients. RESULTS: The stroboscopic evaluation showed significant improvement of amplitude, mucosal wave, and glottal closure after treatment (p < 0.001). The VHI-30 scores decreased considerably indicating improvement due to the treatment for all aspects measured by VHI (p < 0.05, or p < 0.01). In all domains of GRBAS scale, the differences between preoperative and postoperative assessment were statistically significant (p < 0.001). We observed a significant change in Shim and APQ parameters (p < 0.05). Improvement was also observed in the sAPQ parameter, but it was not statistically significant (p = 0.051). For the remaining acoustic parameters, no changes were observed. CONCLUSIONS: The surgical procedure with supplementary injection laryngoplasty of the vocal folds is a good treatment option for pathological sulcus vocalis. The post-treatment self-assessment indicates the significant improvement in VHI, just as perceptual-acoustic evaluation of voice does. Patients with pathological sulcus frequently present with amplitude disturbances, what explains their significant improvement after treatment.
Assuntos
Doenças da Laringe/terapia , Distúrbios da Voz/terapia , Qualidade da Voz , Adulto , Idoso , Materiais Biocompatíveis/administração & dosagem , Durapatita/administração & dosagem , Feminino , Humanos , Ácido Hialurônico/administração & dosagem , Injeções , Doenças da Laringe/complicações , Laringoplastia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estroboscopia , Viscossuplementos/administração & dosagem , Distúrbios da Voz/etiologiaAssuntos
Anestesia Local/métodos , Doenças da Laringe/cirurgia , Terapia a Laser/métodos , Lasers de Estado Sólido/uso terapêutico , Cirurgia Endoscópica por Orifício Natural/métodos , Pólipos/cirurgia , Prega Vocal/cirurgia , Feminino , Tecnologia de Fibra Óptica/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Nariz , Estudos Prospectivos , Resultado do TratamentoRESUMO
AIM: To describe our experience in the treatment of laryngeal dystonia (in abduction and adduction), with special emphasis given to the technical aspects (approach procedure, dosage and type of botulinum toxin type A used), as well as treatment response and possible side effects. PATIENTS AND METHODS: We conducted a cross-sectional descriptive study of a sample of patients with laryngeal dystonia treated by means of transoral administration of onabotulinumtoxinA or incobotulinumtoxinA over a period of 10 years (2007-2017). Data collected include demographic and clinical variables, treatment response (based on a self-rating scale), the duration of treatment and the appearance of side effects. SAMPLE SIZE: 15 patients (11 women; mean age: 44.06 years) with laryngeal dystonia (mean time since onset of 40 months; 12 patients with dystonia in adduction) and 174 administrations (92% incobotulinumtoxinA; average dosage of 5 U in each vocal cord). The procedure took an average of 11.7 minutes to perform. Response was good in 31% of the procedures and very good in 57.5%. Side effects were recorded in 14.4% of the procedures, although always mild and transitory, with a predominance of dysphagia and dysphonia. CONCLUSION: In our experience, transoral administration of botulinum toxin type A to treat laryngeal dystonia has proved to be a simple, quick, effective and safe technique.
TITLE: Distonia laringea: nuevas formas de administracion terapeutica de toxina botulinica por via directa.Objetivo. Describir nuestra experiencia en el tratamiento de la distonia laringea (en abduccion y aduccion), destacando los aspectos tecnicos (procedimiento de abordaje, dosis y tipo de toxina botulinica de tipo A utilizada), asi como la respuesta al tratamiento y los posibles efectos adversos. Pacientes y metodos. Estudio descriptivo transversal de una muestra de pacientes con distonia laringea tratados mediante administracion transoral de onabotulinumtoxina o incobotulinumtoxina A durante un periodo de 10 años (2007-2017). Se recogen las variables demograficas y clinicas, la respuesta al tratamiento (a partir de una escala de autoevaluacion), la duracion de este y la aparicion de efectos adversos. Resultados. Tamaño muestral: 15 pacientes (11 mujeres; edad media: 44,06 años) con distonia laringea (tiempo medio de evolucion de 40 meses; 12 pacientes con distonia en aduccion) y 174 administraciones (92% incobotulinumtoxina A; dosis media de 5 U en cada cuerda vocal). La duracion media del procedimiento fue de 11,7 minutos. La respuesta fue notable en el 31% de los procedimientos y alta en el 57,5%. Se registraron efectos adversos en el 14,4% de los procedimientos, siempre de caracter leve y transitorio, con predominio de la disfagia y la disfonia. Conclusion. En nuestra experiencia, la administracion transoral de toxina botulinica de tipo A como tratamiento de la distonia laringea ha demostrado ser una tecnica sencilla, rapida, eficaz y segura.
Assuntos
Toxinas Botulínicas Tipo A/administração & dosagem , Distúrbios Distônicos/tratamento farmacológico , Doenças da Laringe/tratamento farmacológico , Adulto , Anestesia Local , Toxinas Botulínicas Tipo A/efeitos adversos , Toxinas Botulínicas Tipo A/uso terapêutico , Estudos Transversais , Transtornos de Deglutição/induzido quimicamente , Avaliação de Medicamentos , Disfonia/induzido quimicamente , Feminino , Humanos , Injeções Intralesionais/instrumentação , Injeções Intralesionais/métodos , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Prega VocalRESUMO
BACKGROUND: Photoangiolytic lasers have broadened the surgical armamentarium for many phonosurgical interventions. However, the pulse dye laser and potassium titanyl phosphate (KTP) laser have technical drawbacks and a smaller spectrum of indications. METHODS AND RESULTS: The new 445 nm wavelength laser, the so-called 'blue laser', proves to show tissue effects comparable to the KTP laser and is also capable of treating subepithelial vessels due to its photoangiolytic properties, it can coagulate and carbonize at higher energy levels, and can be used via glass fibers in non-contact and contact mode for in-office procedures. DISCUSSION: In contrast to the KTP, the new 445 nm laser can also be used as a cutting laser, thus combining very much wanted properties of diode or CO2 lasers with photoangiolytic lasers. Further advantages of the new laser are the; (1) portability of the shoe box sized, shock-proof laser machine for in-office and operating room usage, (2) the selection of pulse rates from continuous wave (cw) to less than a millisecond, (3) stronger tissue effects compared to KTP with similar energy and pulse settings, (4) far better cutting properties than the KTP, and thus (5) more possibilities for usage in laryngology as well as in other fields or surgery. CONCLUSION: We demonstrate the feasibility of the 445 nm laser in several laboratory experiments and show clinical cases where photoangiolysis and cutting was possible. However, this is a preliminary report and further systematic studies in greater numbers are warranted.
Assuntos
Doenças da Laringe/cirurgia , Laringoscopia/instrumentação , Terapia a Laser/instrumentação , Fototerapia/instrumentação , Feminino , Humanos , Técnicas de Cultura de TecidosRESUMO
INTRODUCTION: Since the development of distal chip endoscopes with a working channel, diagnostic and therapeutic possibilities in the outpatient clinic in the management of laryngeal pathology have increased. Which of these office-based procedures are currently available, and their clinical indications and possible advantages, remains unclear. MATERIAL AND METHODS: Review of literature on office-based procedures in laryngology and head and neck oncology. RESULTS: Flexible endoscopic biopsy (FEB), vocal cord injection, and laser surgery are well-established office-based procedures that can be performed under topical anesthesia. These procedures demonstrate good patient tolerability and multiple advantages. CONCLUSION: Office-based procedures under topical anesthesia are currently an established method in the management of laryngeal pathology. These procedures offer medical and economic advantages compared with operating room-performed procedures. Furthermore, office-based procedures enhance the speed and timing of the diagnostic and therapeutic process.
Assuntos
Procedimentos Cirúrgicos Ambulatórios , Doenças da Laringe/diagnóstico , Doenças da Laringe/terapia , Laringoscopia , Laringe/efeitos dos fármacos , Laringe/cirurgia , Terapia a Laser , Distúrbios da Voz/diagnóstico , Distúrbios da Voz/terapia , Procedimentos Cirúrgicos Ambulatórios/instrumentação , Anestesia Local , Biópsia , Humanos , Injeções , Doenças da Laringe/patologia , Doenças da Laringe/fisiopatologia , Laringoscópios , Laringoscopia/instrumentação , Laringe/patologia , Laringe/fisiopatologia , Terapia a Laser/instrumentação , Visita a Consultório Médico , Valor Preditivo dos Testes , Resultado do Tratamento , Prega Vocal/efeitos dos fármacos , Prega Vocal/fisiopatologia , Prega Vocal/cirurgia , Distúrbios da Voz/patologia , Distúrbios da Voz/fisiopatologiaRESUMO
Amyloidosis is a term that involves a group of diseases characterised by deposition of extracellular monoclonal light-chain fibrillar immunoglobulin aggregates in the body, including many organs, with the larynx among them. A case is presented of a 78 year-old man who was referred to our institution for strangulated umbilical hernia treatment. He suffered from progressive hoarseness and dysphagia for 5months. He had a history of primary laryngeal amyloidosis. Awake intubation was performed successful with the King Vision® video-laryngoscopy. Sedation was achieved using a remifentanil infusion and midazolam. Haemorrhagic lesions are caused by deposition of amyloid in and around vessels, resulting in increased vascular fragility. Therefore, anaesthetists should take care in intubating the tracheas of these patients.
Assuntos
Amiloidose/cirurgia , Intubação Intratraqueal/métodos , Doenças da Laringe/cirurgia , Laringoscopia/métodos , Idoso , Manuseio das Vias Aéreas , Amiloidose/complicações , Amiloidose/diagnóstico por imagem , Anestesia Local , Sedação Consciente , Emergências , Desenho de Equipamento , Hemorragia/etiologia , Hemorragia/prevenção & controle , Hérnia Umbilical/cirurgia , Herniorrafia , Humanos , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/prevenção & controle , Doenças da Laringe/complicações , Doenças da Laringe/diagnóstico por imagem , MasculinoRESUMO
Wstep: Cel badania stanowi ocena efektów dlugoterminowych augmentacji krtani w znieczuleniu miejscowym przy pomocy hydroksyapatytu wapnia. Material i metody: W badaniu wzielo udzial 17 pacjentów, którzy z powodu niewydolnosci szpary glosni (z powodu jednostronnego porazenia krtani oraz niewydolnosci miesni wewnetrznych krtani) zostali zakwalifikowani do przeprowadzenia augmentacji krtani (10 kobiet i 17 mezczyzn), w wieku: 57,6±17,7 lat, mediana 61 lat, z zakresem: 32-83 lata. U wszystkich pacjentów wykonano augmentacje krtani w znieczuleniu miejscowym, przez jame ustna, podajac bocznie od faldu glosowego/ faldów glosowych hydroksyapatyt wapnia (preparat Radiesse). W celu oceny efektów dlugoterminowych augmentacji krtani - przeprowadzano ocene jakosci glosu pacjenta przed augmentacja, a nastepnie 3 i 12 miesiecy po augmentacji krtani, przy pomocy oceny videolaryngostroboskopowej krtani, oceny odsluchowej, analizy akustycznej, oceny aerodynamicznej oraz samooceny glosu dokonanej przez pacjenta przy pomocy kwestionariusza VRQoL. Wyniki: Uzyskano istotna statystycznie poprawe w ocenie odsluchowej glosu dla parametrów G i A, po 3 miesiacach, dobre wyniki utrzymywaly sie w czasie 12-miesiecznej obserwacji. W ocenie akustycznej MDVP_Jitt, MDVP_Shim i MDVP_NHR poprawily sie odpowiednio do wartosci: 2,5; 5 oraz 0,1 (3 miesiace po augmentacji) i 1,9; 3,6 oraz 0,1 (12 miesiace po augmentacji). MPTa wydluzyl sie do 12,2 i 11,9 s., odpowiednio po 3 i 12 miesiacach od augmentacji. Natezenie glosu poprawilo sie z 67 do 68 oraz 71 dB(A), odpowiednio po 3 i 12 miesiacach. Wyniki: VRQoL poprawily sie do wartosci 19,5 i 20, odpowiednio 3 i 12 miesiecy po augmentacji. Dyskusja Augmentacja krtani w znieczuleniu miejscowym przy pomocy hydroksyapatytu wapnia daje dlugotrwale, dobre efekty leczenia.