RESUMEN
The superior laryngeal nerve (SLN) has been attributed much less clinical significance than the recurrent laryngeal nerve. It has sometimes been described as the 'neglected' nerve in thyroid surgery, although injury to this nerve can cause significant disability. The external branch of the SLN is the only motor supply to the cricothyroid muscle, which increases the tension of the ipsilateral vocal fold during highfrequency phonation, particularly in women and voice professionals. Damage to this nerve can manifest as ipsilateral cricothyroid muscle paralysis, and clinical symptoms may include a hoarse, breathy voice, frequent throat clearing, vocal fatigue or diminished vocal frequency range, especially when rising pitch. SLN paralysis can be a significant issue for those whose careers depend largely on a full range of voice. The famous opera soprano, Amelita Galli-Curci, suffered SLN injury during thyroid surgery with distressing consequences.
Asunto(s)
Personajes , Traumatismos del Nervio Laríngeo/historia , Nervios Laríngeos , Canto , Historia del Siglo XIX , Historia del Siglo XX , ItaliaRESUMEN
OBJECTIVE: To evaluate serum antibody to heat shock protein (HSP) 70 as a marker for autoimmune sensorineural hearing loss (AISNHL). DESIGN: Sera from 20 patients with rapidly progressive sensorineural HL and 20 control volunteers without HL were tested for antibody reactivity against multiple HSP 70 substrates. Substrates included recombinant human HSP (rHuHSP) 72, purified bovine brain heat shock cognate (HSC) 73 and HSP 72, as well as heat-shocked and non-heat-shocked protein extracts from bovine kidney (MDBK) cells. All serum donors were previously tested for antibody to guinea pig inner ear supporting cells; 17 of 20 patients but none (0 of 20) of the controls were positive. METHODS: Sera were tested using Western blots. RESULTS: Reactivity with rHuHSP 70 was observed in 16 patients and 17 controls. Similarly, 15 of 20 patients and 17 of 20 controls stained for both HSP 72 and HSC 73 from the bovine brain. When tested against the heat-shock-induced and control MDBK extracts, six patients and nine controls had greater reactivity with the induced HSP 72. CONCLUSION: The frequency of antibodies to HSP substrates did not differ in patients and controls. Prior studies reported that HSP 72 is the 68 kD antigen commonly detected by AISNHL sera. However, we show that HSP 72 antibodies are no more prevalent in patients than in normal controls. Thus, it is unlikely that the 68 kD protein is HSP 72. Therefore, HSPs are not appropriate substrates for serodiagnosis of AISNHL.
Asunto(s)
Proteínas HSP70 de Choque Térmico/inmunología , Pérdida Auditiva Sensorineural/inmunología , Adulto , Anciano , Anciano de 80 o más Años , Western Blotting , Electroforesis en Gel de Poliacrilamida , Femenino , Proteínas del Choque Térmico HSC70 , Proteínas del Choque Térmico HSP72 , Proteínas de Choque Térmico/inmunología , Humanos , Immunoblotting , Masculino , Persona de Mediana EdadAsunto(s)
Pérdida Auditiva Provocada por Ruido/prevención & control , Ruido en el Ambiente de Trabajo/prevención & control , Enfermedades Profesionales/prevención & control , Exposición Profesional/normas , Humanos , Ruido en el Ambiente de Trabajo/efectos adversos , Estados Unidos , United States Occupational Safety and Health AdministrationAsunto(s)
Pérdida Auditiva Provocada por Ruido/diagnóstico , Ruido en el Ambiente de Trabajo/efectos adversos , Enfermedades Profesionales/diagnóstico , Audiometría , Diagnóstico Diferencial , Guías como Asunto , Humanos , Masculino , Persona de Mediana Edad , Estados Unidos , United States Occupational Safety and Health AdministrationRESUMEN
Substantial advances in understanding the anatomy and physiology of phonation, and the new technology that has improved voice measurement and voice surgery, have led to marked improvement in the standard-of-care for patients with voice disorders. Expert voice care is essential for all patients, but especially crucial for voice professionals. Professional voice users include not only singers and actors, but also clergy, teachers, receptionists, sales personnel, physicians, and anyone else whose ability to earn a living is impacted negatively by loss of vocal quality and endurance. Physicians should be familiar with the latest concepts in voice diagnosis and treatment, and with the management of common voice disorders.
Asunto(s)
Enfermedades Profesionales/diagnóstico , Enfermedades Profesionales/etiología , Trastornos de la Voz/diagnóstico , Trastornos de la Voz/etiología , Voz , Envejecimiento/fisiología , Trastornos de Traumas Acumulados/diagnóstico , Ronquera/etiología , Humanos , Hipersensibilidad/complicaciones , Hipotiroidismo/complicaciones , Laringitis/etiología , Laringitis/terapia , Enfermedades Pulmonares/complicaciones , Enfermedades Profesionales/terapia , Fonación/fisiología , Examen Físico , Sinusitis/complicaciones , Tonsilitis/etiología , Tonsilitis/terapia , Pliegues Vocales/lesiones , Pliegues Vocales/fisiopatología , Voz/fisiología , Trastornos de la Voz/terapia , Entrenamiento de la VozRESUMEN
Many studies have described and analyzed the singer's formant. A similar phenomenon produced by trained speakers led some authors to examine the speaker's ring. If we consider these phenomena as resonance effects associated with vocal tract adjustments and training, can we hypothesize that trained singers can carry over their singing formant ability into speech, also obtaining a speaker's ring? Can we find similar differences for energy distribution in continuous speech? Forty classically trained singers and forty untrained normal speakers performed an all-voiced reading task and produced a sample of a sustained spoken vowel /a/. The singers were also requested to perform a sustained sung vowel /a/ at a comfortable pitch. The reading was analyzed by the long-term average spectrum (LTAS) method. The sustained vowels were analyzed through power spectrum analysis. The data suggest that singers show more energy concentration in the singer's formant/speaker's ring region in both sung and spoken vowels. The singers' spoken vowel energy in the speaker's ring area was found to be significantly larger than that of the untrained speakers. The LTAS showed similar findings suggesting that those differences also occur in continuous speech. This finding supports the value of further research on the effect of singing training on the resonance of the speaking voice.
Asunto(s)
Habla/fisiología , Conducta Verbal , Calidad de la Voz , Adulto , Femenino , Humanos , Masculino , Competencia Profesional , Estudios Prospectivos , Espectrografía del SonidoRESUMEN
Vocal fold mucosal tears have been discussed in the literature rarely, although they are not uncommon clinically. Disruptions in the epithelium usually follow trauma that may result from voice abuse and/or misuse, coughing, and other causes. A high index of suspicion is necessary to avoid missing vocal fold mucosal tears, and strobovideolaryngoscopy is indispensable in making the diagnosis. A brief period of complete voice rest is the standard of care and appears to be helpful in avoiding adverse sequelae and advancing the healing process, but there are no scientific studies to confirm its efficacy. Mucosal tears may heal completely or may be followed by the development of vocal fold masses, scar, and permanent dysphonia.
Asunto(s)
Pliegues Vocales/lesiones , Trastornos de la Voz/diagnóstico , Adulto , Femenino , Humanos , Masculino , Enfermedades Profesionales/diagnóstico , Trastornos de la Voz/etiología , Calidad de la Voz , Heridas y Lesiones/complicacionesRESUMEN
We conducted a prospective, preliminary study to compare the cost-effectiveness of two different instrument-based techniques for diagnosing and managing dysphagia in 30 consecutive hospitalized patients with head and neck cancer. The two techniques are videofluoroscopy via modified barium swallow (MBS) and videoendoscopy via flexible endoscopic evaluation of swallowing with sensory testing (FEESST). Medicare was the primary insurer of all patients. Fifteen of these patients had their dysphagia diagnosed and managed by MBS and the other 15 by FEESST. Cost-effectiveness was assessed by determining the average Medicare reimbursement for each procedure. We found that the mean reimbursements were $451.01 (+/- $50.55) for MBS and $321.23 (+/- $3.01) for FEESST. The mean reimbursement for FEESST was significantly lower than that for MBS (p < 0.0001; Mann-Whitney U test). We conclude that FEESST appears to be more cost-effective than MBS for the inpatient management of dysphagia in patients with head and neck cancer.
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Trastornos de Deglución/economía , Trastornos de Deglución/etiología , Neoplasias de Cabeza y Cuello/complicaciones , Servicios de Salud/economía , Anciano , Análisis Costo-Beneficio , Femenino , Humanos , Masculino , Persona de Mediana EdadAsunto(s)
Amiloidosis/diagnóstico , Amiloidosis/cirugía , Enfermedades de la Laringe/diagnóstico , Enfermedades de la Laringe/cirugía , Biopsia con Aguja , Estudios de Seguimiento , Ronquera/diagnóstico , Ronquera/etiología , Humanos , Laringoscopía , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Otorrinolaringológicos/métodos , Resultado del TratamientoAsunto(s)
Aspergilosis/diagnóstico , Enfermedades de la Laringe/diagnóstico , Adolescente , Antifúngicos/uso terapéutico , Aspergilosis/complicaciones , Aspergilosis/terapia , Terapia Combinada , Femenino , Fluconazol/uso terapéutico , Humanos , Enfermedades de la Laringe/complicaciones , Enfermedades de la Laringe/terapia , Neoplasias Laríngeas/complicaciones , Neoplasias Laríngeas/cirugía , Procedimientos Quirúrgicos Otorrinolaringológicos , Papiloma/complicacionesRESUMEN
Postpoliomyelitis syndrome (PPS) is a disease that may occur in survivors of acute poliomyelitis several decades after their initial infection. It can present as dysphonia, with vocal weakness and fatigue. Swallowing, respiratory, and other laryngopharyngeal symptoms may be manifestations of the disease or they may represent worsening of previously stable and compensated deficits. Three cases of laryngeal changes in PPS with videostroboscopic and laryngeal electromyography findings highlight the features of this disorder. We review possible etiologies of laryngeal PPS, diagnostic criteria, and treatment, as well as the current literature.
Asunto(s)
Laringe/fisiopatología , Síndrome Pospoliomielitis/complicaciones , Trastornos de la Voz/etiología , Trastornos de la Voz/fisiopatología , Enfermedad Aguda , Anciano , Electromiografía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Índice de Severidad de la Enfermedad , Trastornos de la Voz/diagnósticoRESUMEN
Vocal fold scar disrupts the mucosal wave and interferes with glottic closure. Treatment involves a multidisciplinary approach that includes voice therapy, medical management, and sometimes surgery. We reviewed the records of the first eight patients who underwent autologous fat implantation for vocal fold scar. Information on the etiology of scar, physical findings, and prior interventions were collected. Videotapes of videostroboscopic findings and perceptual voice ratings [Grade, Roughness, Breathiness, Asthenia, Strain (GRBAS)] were randomized and analyzed independently by four blinded observers. Etiology of scar included mass excision (7), vocal fold stripping (3), congenital sulcus (2), and hemorrhage (1). Prior surgical procedures performed included thyroplasty (1), autologous fat injection (9), excision of scar (2), and lysis of adhesions (2). Strobovideolaryngoscopy: Statistically significant improvement was found in glottic closure, mucosal wave, and stiffness (P = 0.05). Perceptual ratings (GRBAS): Statistically significant improvement was found in all five parameters, including overall Grade, Roughness, Breathiness, Asthenia, and Strain (P = 0.05). Patients appear to have improved vocal fold function and quality of voice after autologous fat implantation in the vocal fold. Autologous fat implantation is an important adjunctive procedure in the management of vocal fold scar, and a useful addition to the armamentarium of the experienced phonomicrosurgeon.
Asunto(s)
Tejido Adiposo/trasplante , Cicatriz/complicaciones , Cicatriz/fisiopatología , Pliegues Vocales/fisiopatología , Trastornos de la Voz , Adulto , Femenino , Estudios de Seguimiento , Humanos , Inyecciones Intramusculares , Masculino , Estudios Retrospectivos , Trasplante Autólogo , Trastornos de la Voz/etiología , Trastornos de la Voz/fisiopatología , Trastornos de la Voz/terapiaRESUMEN
OBJECTIVES/HYPOTHESIS: To determine the incidence of second malignant neoplasms (SMN) in patients under 40 years of age with invasive squamous cell carcinoma (SCC) of the larynx. STUDY DESIGN: Retrospective. METHODS: Using a National Cancer Institute tumor registry database encompassing 1973-1996, the incidence of SMN in patients under 40 years of age with laryngeal cancer was determined and compared with that of the registry's older, more traditional laryngeal cancer population. Median follow-up was 136 months. RESULTS: Among the 364 patients under the age of 40 years with laryngeal cancer, 30 (8.2%) had developed a secondary malignancy to date. In comparison, 4876 (21.4%) of 22,786 patients 40 years or older with laryngeal cancer were affected by an SMN. Kaplan-Meier analysis of the younger cohort projected 3.0%, 6.8%, and 10.7% relative risk of developing a SMN at any site over 5-, 10-, and 15-year periods, respectively, after index tumor diagnosis. Similar results for the older cohort were 14.2%, 28.1%, and 39.4% at 5, 10, and 15 years, respectively. Further Kaplan-Meier analysis demonstrated at least a fourfold increased risk for the development of secondary upper aerodigestive tract malignancies among older compared with younger patients. CONCLUSION: Patients under 40 years of age with invasive SCC of the larynx are significantly less likely to develop a second malignancy than their older counterparts.
Asunto(s)
Carcinoma de Células Escamosas/epidemiología , Neoplasias Laríngeas/epidemiología , Neoplasias Primarias Secundarias/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Sistema de Registros/estadística & datos numéricos , Estudios Retrospectivos , Medición de Riesgo , Factores de TiempoAsunto(s)
Errores Diagnósticos , Granuloma Laríngeo/diagnóstico , Neoplasias Laríngeas/diagnóstico , Neoplasias Laríngeas/virología , Laringitis/diagnóstico , Recurrencia Local de Neoplasia/diagnóstico , Recurrencia Local de Neoplasia/virología , Papiloma/diagnóstico , Papiloma/virología , Papillomaviridae , Infecciones por Papillomavirus/complicaciones , Infecciones Tumorales por Virus/complicaciones , Pliegues Vocales , Adulto , Diagnóstico Diferencial , Femenino , Ronquera/virología , Humanos , Neoplasias Laríngeas/cirugía , Recurrencia Local de Neoplasia/cirugía , Papiloma/cirugíaRESUMEN
Otolaryngologists, nurses, and psychological professionals should be familiar with the potential psychiatric side effects of medications that are commonly prescribed by otolaryngologists. Because some of these side effects are atypical, their relationship to medications might not be obvious. An awareness of the potential for psychiatric side effects caused by adrenocorticoids, antihistamines and decongestants, and antisecretory medications will help the clinician avoid or detect and treat drug-induced disorders, as will an awareness of the potential for side effects caused by combinations of medications. Identification of individual risk factors such as age, pre-existing organic brain disease, a history of drug abuse or dependence, or coexisting or pre-existing psychiatric disorders is important in preventing and detecting drug-induced psychiatric disorders. The drugs discussed in this article can have serious, even fatal, interactions with certain psychiatric medications.
Asunto(s)
Prescripciones de Medicamentos , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos , Otolaringología , Psicosis Inducidas por Sustancias/etiología , Antiinflamatorios/efectos adversos , Antiulcerosos/efectos adversos , Quimioterapia/métodos , Utilización de Medicamentos , Antagonistas de los Receptores Histamínicos H1/efectos adversos , Humanos , Anamnesis , Descongestionantes Nasales/efectos adversos , Otolaringología/métodos , Pautas de la Práctica en Medicina , Psicosis Inducidas por Sustancias/prevención & control , Factores de Riesgo , EsteroidesAsunto(s)
Candidiasis/microbiología , Laringitis/microbiología , Adulto , Antifúngicos/uso terapéutico , Candidiasis/complicaciones , Candidiasis/tratamiento farmacológico , Femenino , Fluconazol/uso terapéutico , Reflujo Gastroesofágico/complicaciones , Glotis/fisiopatología , Humanos , Laringitis/complicaciones , Laringitis/diagnóstico , Laringitis/tratamiento farmacológico , Laringoscopía , Trastornos de la Voz/diagnóstico , Trastornos de la Voz/etiología , Trastornos de la Voz/fisiopatologíaRESUMEN
Because lymphoma frequently manifests as a neck mass, otolaryngologists are often the first to evaluate and diagnose it. Excisional biopsy of lymph nodes generally provides the definitive diagnosis. After diagnosis, however, the otolaryngologist's involvement generally wanes as subsequent treatment of the patient is provided by an oncology team. Nevertheless, it is important for the otolaryngologist to be familiar with current concepts in the comprehensive evaluation and treatment of lymphoma patients. This knowledge allows us to participate in and facilitate timely testing, which helps avoid undue delays between the documentation of physical findings and the initiation of treatment. Otolaryngologists also need to be up to date on recent developments in the treatment of lymphomas in order to be able to answer questions regarding staging and prognosis, to make the proper referrals, and to help our patients understand current controversies and treatment practices.