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1.
Nihon Shokakibyo Gakkai Zasshi ; 118(3): 264-271, 2021.
Artigo em Japonês | MEDLINE | ID: mdl-33692261

RESUMO

The patient was an 81-year-old man who presented with a complaint of hoarseness. When he was 80 years old, he had developed superficial esophageal cancer and had undergone endoscopic submucosal dissection (ESD) at our hospital. Two months after the ESD, he developed hoarseness. Computed tomography (CT) scan showed no abnormal findings at that time;therefore, he was diagnosed with idiopathic vocal cord paralysis, and followed up with symptom treatment in the Gastroenterology and Otolaryngology Departments. Ten months after the ESD, a CT scan revealed mediastinal lymph node swelling. He was admitted to our hospital for histopathological examination of the lymph node using endoscopic ultrasound-fine needle aspiration (EUS-FNA). The histopathological examination revealed squamous cell carcinoma of the lymph node, similar to the primary esophageal tumor. This result suggests that laryngeal nerve paralysis involving hoarseness is caused by lymph node metastasis of superficial esophageal cancer. We report that histopathological examination with EUS-FNA helps in determining the cause of hoarseness that develops after ESD.


Assuntos
Ressecção Endoscópica de Mucosa , Neoplasias Esofágicas , Idoso de 80 Anos ou mais , Biópsia por Agulha Fina , Ressecção Endoscópica de Mucosa/efeitos adversos , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/efeitos adversos , Neoplasias Esofágicas/diagnóstico por imagem , Neoplasias Esofágicas/cirurgia , Rouquidão/etiologia , Humanos , Linfonodos , Masculino , Recidiva Local de Neoplasia
3.
Medicine (Baltimore) ; 99(51): e23770, 2020 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-33371143

RESUMO

ABSTRACT: Laryngeal tuberculosis (LTB) is highly contagious and can cause permanent laryngeal damage. Therefore, correctly identifying laryngoscopic LTB lesion locations, sizes, and morphologic features are essential for LTB diagnoses. This study aimed to explore the appearance and morphologic features of LTB and correlated these features with clinical symptoms.We retrospectively analysed 39 LTB patients in our hospital between January 2013 and December 2019. Medical records, including clinical presentation, lesion appearance (locations, sizes, and morphology), complementary examination results, and histopathologic features were summarized and analysed.In this patient cohort, dysphonia and sore throat were the two most common clinical symptoms. In LTB patients with extensive lesions, ulcerative lesions were most common, and the proportion of cases with concurrent pulmonary tuberculosis (86.4%, P = .033) infection was higher, as were the positive rates of sputum smears (72.7%, P = .011) and cultures (86.4%, P = .002) than patients without concurrent pulmonary TB and with more localized and exophytic lesions. The histopathologic features of LTB-related ulcerative lesions included fewer granulomas and more areas with caseous necrosis. These lesions were more likely to have acid-fast bacilli detected with a Ziehl-Neelsen stain than exophytic lesions that rarely showed detectable bacilli.A complete knowledge regarding the visual and morphologic features of LTB on laryngoscopy is needed for the early detection and diagnosis of LTB. Our study revealed the lesion sites, sizes, and morphologic features of LTB. These parameters were also correlated with patient clinical symptoms. Future studies are needed to support and expand the results of this retrospective study.


Assuntos
Laringoscopia/métodos , Tuberculose Laríngea/complicações , Tuberculose Laríngea/fisiopatologia , Adulto , China , Estudos Transversais , Feminino , Rouquidão/etiologia , Humanos , Laringe/patologia , Laringe/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
5.
Anesth Analg ; 131(5): 1566-1572, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33079880

RESUMO

BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) patients typically receive either tubeless anesthesia or general endotracheal anesthesia (GETA). Patients receiving propofol-based total intravenous anesthesia (TIVA) are at higher risk of sedation-related adverse events (SRAEs) than patients receiving GETA, primarily due to the need for additional airway maneuvers. The increasing use of non-operating room (OR) anesthesia and the perception of a higher incidence of adverse outcomes in non-OR areas has led to the development of devices to improve safety while maintaining efficiency. The purpose of this study was to evaluate if the LMA Gastro™ could be used as a safe alternative to tubeless anesthesia for successfully completing ERCPs. METHODS: Eligible subjects were identified within the patient population at MD Anderson Cancer Center. Inclusion criteria consisted of adult patients (≥18 years old) scheduled for elective ERCP with TIVA. This was a prospective observational study in which the following data were collected: number of attempts and time to successful supraglottic airway (SGA) placement, vital signs, peripheral oxygen saturation (SpO2), median end-tidal CO2, practitioner satisfaction, and any complications. RESULTS: A total of 30 patients were included in this study. The overall rate of successful SGA placement within 3 attempts was 96.7% (95% confidence interval [CI], 82.8-99.9) or 29/30. The rate of successful ERCP with SGA placement within 3 attempts was 93.3% (95% CI, 77.9-99.2) or 28/30. Both the gastroenterologist and anesthesiologist reported satisfaction with the device in 90% of the cases (in 66.7% of the cases both anesthesiologist and gastroenterologist scored the device a 7/7 for satisfaction). Patients maintained an SpO2 of 95%-100% from induction to discharge, with the exception of 1 patient who had an SpO2 of 93%. The median end-tidal CO2 during the procedure for all patients was 35 mm Hg. Observed aspiration did not occur in any patient. Symptoms of hoarseness (13.3%), mouth soreness (6.7%), sore throat (6.6%), and minor bleeding/cuts/redness/change in taste to the tongue (3.3%) were determined through patient questioning before postanesthesia care unit (PACU) discharge. CONCLUSIONS: Our study suggests that the LMA Gastro might be a safe alternative for ERCP procedures. There was a high level of practitioner satisfaction. Only minor complications, such as hoarseness, mouth or throat soreness, or minor trauma to the tongue were experienced by patients. Similar incidences of complications may occur with GETA and tubeless anesthesia. The procedure was well tolerated by all patients; all patients maintained adequate oxygenation and required only minimal blood pressure support.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Máscaras Laríngeas/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Manuseio das Vias Aéreas , Anestesiologistas , Dióxido de Carbono/sangue , Colangiopancreatografia Retrógrada Endoscópica/métodos , Feminino , Gastroenterologistas , Rouquidão/epidemiologia , Rouquidão/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Oxigênio/sangue , Segurança do Paciente , Faringite/epidemiologia , Faringite/etiologia , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos , Língua/lesões
7.
Medicine (Baltimore) ; 99(21): e20221, 2020 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-32481292

RESUMO

RATIONALE: Behcets disease (BD) is a type of chronic systemic vasculitis that typically manifests as a mucocutaneous disease with orogenital ulcers, skin damage, and uveitis. The clinical diagnosis is often difficult because of the diversity of organs that may be involved and lack of specific pathological diagnosis. PATIENT CONCERNS: A 26-year-old woman presented as a nearly 2-week history of hoarseness with throat pain. DIAGNOSES: In the present case, Fiber laryngoscopy showed multiple ulcers involving the epiglottic tubercle, bilateral false vocal cord, middle area of the left vocal cord, and full length of the right vocal cord. Multidisciplinary physicians combined the patients clinical manifestations and pathological findings to make the Behcets disease diagnosis. INTERVENTIONS: As the diagnosis confirmed, immediately began appropriate medical therapy (prednisolone at 30 mg once per day and thalidomide at 50 mg once per night in a month). OUTCOMES: The ulcer on the right vocal cord disappeared but left a scar. Therefore, the patient experienced only partial recovery from the hoarseness. LESSONS: Behcets disease can cause damage to multiple organs. Although the combination of vocal cord ulcers and hoarseness is rare in patients with BD and has not been previously reported to date, such patients should be treated with caution in clinical practice.


Assuntos
Síndrome de Behçet/complicações , Rouquidão/etiologia , Faringite/etiologia , Prega Vocal/patologia , Adulto , Síndrome de Behçet/diagnóstico por imagem , Síndrome de Behçet/tratamento farmacológico , Quimioterapia Combinada/métodos , Feminino , Glucocorticoides/administração & dosagem , Glucocorticoides/uso terapêutico , Humanos , Imunossupressores/administração & dosagem , Imunossupressores/uso terapêutico , Laringoscopia/métodos , Faringite/diagnóstico , Prednisolona/administração & dosagem , Prednisolona/uso terapêutico , Talidomida/administração & dosagem , Talidomida/uso terapêutico , Resultado do Tratamento , Prega Vocal/diagnóstico por imagem
9.
Ann Otol Rhinol Laryngol ; 129(10): 983-987, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32456446

RESUMO

OBJECTIVE: Chronic rhinosinusitis (CRS) has long been associated with vocal dysfunction. However, studies quantifying the presence of voice dysfunction in CRS patients or the effects of functional endoscopic sinus surgery (FESS) are sparse. The goal of this study was to determine the voice-related quality of life in patients undergoing FESS for CRS using the validated Voice Related Quality of Life Survey (VRQL). We correlated the preoperative VRQL scores to the Sino-Nasal Outcome Test (SNOT-22) scores, and we determined the effect of FESS on postoperative VRQL scores. METHODS: Consecutive patients undergoing FESS were preoperatively administered both the VRQL and the SNOT-22 surveys. Spearman (ρ) and Pearson (r) correlation coefficients were calculated. The VRQL was mailed to patients postoperatively between 3 and 6 months. The paired t-test was used to compare pre- and post-FESS scores. RESULTS: A total of 102 patients were enrolled, and 81 patients completed the two surveys. A total of 51 (62.9%) patients had raw VRQL score ≥ 10, signifying presence of significant vocal symptoms. The mean ± standard deviation (SD) raw VRQL score of the entire study population was 12.4 ± 4.6, and the mean SNOT-22 score was 37.8 ± 19.2. The Spearman correlation coefficient between VRQL and the total SNOT-22 score was 0.34 (P =.002), and the Pearson correlation coefficient was 0.36 (P = .001). Both correlations were similar, demonstrating that increasing severity of CRS symptoms correlates with decreasing voice-related quality of life (QOL). Seventy patients completed the postoperative survey for an 86% retention rate. Thirty-six of these patients had abnormal preoperative VRQL scores, and these patients improved significantly after FESS. The mean preoperative versus postoperative raw scores were 15.2 ± 5.6 versus 12.5 ± 4.1, respectively (P = .003). CONCLUSION: This study demonstrates the increasing presence of vocal complaints with increasing severity of CRS. It also demonstrates that VRQL scores improve after FESS in those patients with preoperative vocal complaints. LEVEL OF EVIDENCE: IV.


Assuntos
Qualidade de Vida , Rinite/cirurgia , Sinusite/cirurgia , Distúrbios da Voz/fisiopatologia , Doença Crônica , Endoscopia , Rouquidão/etiologia , Rouquidão/fisiopatologia , Rouquidão/psicologia , Humanos , Procedimentos Cirúrgicos Otorrinolaringológicos , Rinite/complicações , Rinite/fisiopatologia , Índice de Gravidade de Doença , Teste de Desfecho Sinonasal , Sinusite/complicações , Sinusite/fisiopatologia , Voz , Distúrbios da Voz/etiologia , Distúrbios da Voz/psicologia
10.
Ann Otol Rhinol Laryngol ; 129(10): 1020-1029, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32468832

RESUMO

OBJECTIVES: To investigate the psychometric properties of the reflux symptom index (RSI) as short screening approach for the diagnostic of laryngopharyngeal reflux (LPR) in patients with confirmed diagnosed regarding the 24-hour multichannel intraluminal impedance-pH monitoring (MII-pH). METHODS: From January 2017 to December 2018, 56 patients with LPR symptoms and 71 healthy individuals (control group) were prospectively enrolled. The LPR diagnosis was confirmed through MII-pH results. All subjects (n = 127) fulfilled RSI and the Reflux Finding Score (RFS) was performed through flexible fiberoptic endoscopy. The sensitivity and the specificity of RSI was assessed by ROC (Receiver Operating Characteristic) analysis. RESULTS: A total of 15 LPR patients (26.8%) of the clinical group met MII-pH diagnostic criteria. Among subjects classified as positive for MII- pH diagnoses, RSI and RFS mean scores were respectively 20 (SD ± 10.5) and 7.1 (SD ± 2.5), values not significantly different compared to the negative MII-pH group. The metric analysis of the items led to the realization of a binary recoding of the score. Both versions had similar psychometric properties, α was 0.840 for RSI original version and 0.836 for RSI binary version. High and comparable area under curve (AUC) values indicate a good ability of both scales to discriminate between individuals with and without LPR pathology diagnosis. Based on balanced sensitivity and specificity, the optimal cut-off scores for LPR pathology were ≥ 5 for RSI binary version and ≥ 15 for RSI original version. Both version overestimated LPR prevalence. The original version had more sensitivity and the RSI Binary version had more specificity. CONCLUSIONS: It would be necessary to think about modifying the original RSI in order to improve its sensitivity and specificity (RSI binary version, adding or changing some items), or to introduce new scores in order to better frame the probably affected of LPR patient.


Assuntos
Monitoramento do pH Esofágico , Esôfago/fisiopatologia , Refluxo Laringofaríngeo/diagnóstico , Manometria , Adulto , Estudos de Casos e Controles , Tosse/etiologia , Tosse/fisiopatologia , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/fisiopatologia , Feminino , Sensação de Globus/etiologia , Sensação de Globus/fisiopatologia , Azia/etiologia , Azia/fisiopatologia , Rouquidão/etiologia , Rouquidão/fisiopatologia , Humanos , Refluxo Laringofaríngeo/complicações , Refluxo Laringofaríngeo/fisiopatologia , Masculino , Pessoa de Meia-Idade , Análise de Componente Principal , Psicometria , Reprodutibilidade dos Testes , Inquéritos e Questionários
11.
J Craniofac Surg ; 31(4): e409-e411, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32195841

RESUMO

Schwannoma is a benign slow growing nerve sheath tumor that is typically encapsulated and composed of well-differentiated schwann cells. Schwannomas may take origin from different nerves such as cranial, spinal nerves, and the sympathetic chain. Approximately 25% to 45% of all occur in the head and neck only 1% of them are located in the oral cavity. However, it is quite rare to for schwannomas to form on the tongue base. Ancient schwannoma is the rarest, and also extremely rare in oropharynx. A 32-year-old female patient was admitted to our clinic with complaints of hoarseness, difficulty in swallowing, throat pain, snoring, and dyspnea. In examination, a smooth surfaced circumscribed mass, which originated from the tongue base was observed. In the magnetic resonance imaging, a 4.5 × 3 cm sized tongue base mass which narrowed the upper airway was detected. An endoscopic transoral excisional biopsy was performed. The histopathological diagnosis was determined as ancient schwannoma. The use of the endoscopic transoral approach can be suitable to protect the important anatomical structures, functions, and reduce the complications and esthetic concerns for the resection of tongue base schwannomas.


Assuntos
Neurilemoma/cirurgia , Neoplasias da Língua/cirurgia , Adulto , Nervos Cranianos/cirurgia , Dispneia/etiologia , Endoscopia , Feminino , Rouquidão/etiologia , Humanos , Imagem por Ressonância Magnética , Neurilemoma/complicações , Faringite/etiologia , Procedimentos Cirúrgicos Reconstrutivos , Neoplasias da Língua/complicações , Neoplasias da Língua/patologia
12.
Pediatrics ; 145(3)2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32024750

RESUMO

An adolescent female patient presenting with subacute onset of dysphagia and hoarseness underwent a direct laryngoscopy, which revealed epiglottitis. After 2 hospitalizations and multiple consultations and biopsies, all infectious testing results for viral, bacterial, fungal, and acid-fast bacilli etiologies were negative. The patient's use of electronic cigarettes was the only exposure elicited with a likely role in her presentation. This case, combined with the growing body of evidence revealing the toxic effects of vaping and the increasing use of electronic cigarettes among adolescent patients, highlights the many unknowns and risks regarding the biological effects of this practice.


Assuntos
Sistemas Eletrônicos de Liberação de Nicotina , Epiglotite/induzido quimicamente , Vaping/efeitos adversos , Adolescente , Transtornos de Deglutição/etiologia , Epiglotite/diagnóstico , Feminino , Rouquidão/etiologia , Humanos , Laringoscopia
13.
Ann Otol Rhinol Laryngol ; 129(6): 628-632, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31965811

RESUMO

OBJECTIVE: Thyroglossal duct cysts are the most common congenital neck mass. They typically present as a painless midline neck mass in a child or young adult, but may also present later in adulthood when the cyst becomes symptomatic. Thyroglossal duct cysts are most commonly located inferior to the hyoid bone in close relation with the thyrohyoid membrane. Very rarely, they may extend intralaryngeal, occupy the posterior hyoid space, and present with dysphonia and/or dysphagia. To our knowledge, this is the 24th reported case in the literature. METHODS: Case report with a comprehensive review of the literature. RESULTS: The patient was a 43-year-old male experiencing dysphonia and dysphagia following a motor vehicle accident. He was subsequently found to have a large thyroglossal duct cyst with endolaryngeal extension that was previously asymptomatic and undiagnosed. He underwent successful surgical excision which resulted in resolution of symptoms. CONCLUSION: This is the first reported case of a thyroglossal duct cyst in the posterior hyoid space with endolaryngeal extension being diagnosed following a traumatic event. This case illustrates the need to consider thyroglossal duct cyst in the differential diagnosis when working up a post-traumatic intralaryngeal neck mass. A secondary educational objective in this case is to be diligent to consider and rule out laryngeal fracture in the case of a neck mass presenting after trauma as they can easily be missed and present with many overlapping symptoms.


Assuntos
Transtornos de Deglutição/etiologia , Rouquidão/etiologia , Laringe/cirurgia , Lesões do Pescoço/complicações , Cisto Tireoglosso/complicações , Acidentes de Trânsito , Adulto , Humanos , Laringoscopia , Masculino , Cisto Tireoglosso/diagnóstico por imagem , Cisto Tireoglosso/cirurgia , Tomografia Computadorizada por Raios X
14.
Vasc Endovascular Surg ; 54(3): 288-291, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31896319

RESUMO

We present a case of an 87-year-old female with new-onset hoarseness of unclear etiology. Imaging demonstrated a penetrating aortic ulcer (PAU) in the proximal descending thoracic aorta with an associated pseudoaneurysm that enlarged to a depth of 32 mm over 2 years. This patient was diagnosed with hoarseness being secondary to left recurrent laryngeal nerve (LRLN) palsy, a variant of Ortner syndrome. Patient was treated with endovascular stent-grafting successfully covering of the PAU and pseudoaneurysm with zone 3 proximal landing zone. The patient had moderate improvement in hoarseness after 1 year of follow-up. Endovascular repair is indicated for symptomatic patients with PAUs complicated by enlarging pseudoaneurysms or rupture. Endovascular treatment is effective with low procedural morbidity and mortality. In this case, the PAU and associated pseudoaneurysm at the level of the ligamentum arteriosum caused compression on the LRLN, resulting in a nerve palsy and hoarseness. This case highlights the importance of vascular imaging for patients presenting with unclear etiology of hoarseness or other signs of LRLN palsy. Therefore, aortic arch abnormalities, a variant of Ortner syndrome, even though rare, should be on the differential diagnosis of new onset hoarseness.


Assuntos
Falso Aneurisma/complicações , Aneurisma da Aorta Torácica/complicações , Rouquidão/etiologia , Úlcera/complicações , Paralisia das Pregas Vocais/etiologia , Idoso de 80 Anos ou mais , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/cirurgia , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular , Procedimentos Endovasculares , Feminino , Rouquidão/diagnóstico , Rouquidão/fisiopatologia , Humanos , Recuperação de Função Fisiológica , Resultado do Tratamento , Úlcera/diagnóstico por imagem , Úlcera/cirurgia , Paralisia das Pregas Vocais/diagnóstico por imagem , Paralisia das Pregas Vocais/fisiopatologia , Qualidade da Voz
15.
Spine (Phila Pa 1976) ; 45(9): 565-572, 2020 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-31770329

RESUMO

MINI: This randomized clinical trial showed different intubation mode in anesthesia did not affect the increase of endotracheal cuff pressure caused by the retractor splay in anterior cervical spine surgery. However, nasotracheal intubation improved postoperative dysphonia recovery after anterior cervical spine surgery. STUDY DESIGN: Prospective, randomized, double-blinded trial. OBJECTIVE: The aim of this study was to investigate whether the mode of tracheal intubation affects intraoperative endotracheal tube cuff pressure on retractor splay and post-anterior cervical spine surgery (ACSS) voice outcome. SUMMARY OF BACKGROUND DATA: The combination of endotracheal tube (ETT) and cervical retractors has been implicated in recurrent laryngeal nerve compression and neuropraxia after ACSS. The asymmetric position of the oroETT within the larynx, as being fixed distally by the cuff and proximally by taping on one side of the mouth, may contribute to unilateral vocal palsy. METHODS: Adult patients undergoing ACSS were randomized to receive either nasotracheal or orotracheal intubation under anesthesia. The primary endpoint was the maximal endotracheal tube cuff pressure (ETCP) when the retractors were set up. After the maximal ETCPs were recorded, then ETCPs were controlled to less than 25 mmHg. Secondary endpoints were self-assessed hoarseness, pitch, and loudness of voice on postoperative days (PODs) 1, 2, 7, and 30. RESULTS: We equally allocated 110 patients to nasotracheal and orotracheal intubation. The maximal ETCP during retractor splay did not differ for both the means and distributions of pressure range. After the surgery, more patients in the nasotracheal intubation group reported none or mild change of voice than did the orotracheal intubation group on PODs 1 and 2, in terms of hoarseness, pitch, and loudness (P = 0.001, 0.001, and 0.005, respectively, on POD 1; P = 0.002, 0.003, and 0.011, respectively, on POD 2). Mixed model analysis demonstrated that patients with nasotracheal intubation had significantly lower dysphonia scores after surgery (estimate treatment effect: -1.62, P < 0.0001). Statistics was adjusted to exclude interaction with ETT sizes. CONCLUSION: The tracheal intubation modes did not affect ETCP during retractor splay. However, nasotracheal intubation had a beneficial effect on dysphonia recovery after ACSS. LEVEL OF EVIDENCE: 2.


Assuntos
Vértebras Cervicais/cirurgia , Disfonia/etiologia , Intubação Intratraqueal/métodos , Complicações Pós-Operatórias/etiologia , Pressão , Recuperação de Função Fisiológica/fisiologia , Adulto , Idoso , Método Duplo-Cego , Disfonia/diagnóstico , Feminino , Rouquidão/diagnóstico , Rouquidão/etiologia , Humanos , Intubação Intratraqueal/efeitos adversos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Pressão/efeitos adversos , Estudos Prospectivos
16.
A A Pract ; 14(4): 99-101, 2020 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-31842194

RESUMO

Ventilation during microlaryngoscopy previously included jet ventilation, microlaryngeal endotracheal tubes, and extended apnea. Historically, apneic oxygenation provided a tubeless field but limited operative time. Increased utilization of high-flow nasal cannula in intensive care units and operating rooms has created new opportunities to expand tubeless microlaryngoscopy. Although few studies have described high-flow nasal cannula for microlaryngoscopy, there remains much to be explored. In this case report, we describe the unique setting of utilizing high-flow nasal cannula in a spontaneously breathing patient to create an optimal tubeless surgical field for both microlaryngoscopy and vocal cord electromyography.


Assuntos
Rouquidão/etiologia , Laringoscopia/métodos , Respiração Artificial/instrumentação , Prega Vocal/fisiologia , Administração Intranasal , Cânula , Eletromiografia/métodos , Feminino , Humanos , Pessoa de Meia-Idade
17.
Otolaryngol Clin North Am ; 53(1): 127-143, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31685239

RESUMO

Vagal nerve stimulation (VNS) therapy is a surgical treatment that involves the implantation of a device to electrically stimulate the vagus nerve. It is indicated as an adjunctive treatment of epilepsy that is refractory to antiepileptic medications and for treatment-resistant depression. The exact mechanism by which VNS achieves its effects is not known, but various mechanisms have been proposed, including afferent vagal projections to seizure-generating regions of the brain and desynchronization of hypersynchronized cortical activity. The most common complications of VNS therapy include hoarseness, throat pain/dysphagia, coughing, and shortness of breath.


Assuntos
Transtorno Depressivo Resistente a Tratamento/terapia , Epilepsia Resistente a Medicamentos/terapia , Neuroestimuladores Implantáveis , Estimulação do Nervo Vago/métodos , Animais , Dispneia/etiologia , Rouquidão/etiologia , Humanos , Resultado do Tratamento , Estimulação do Nervo Vago/efeitos adversos
18.
Endocr J ; 67(2): 161-165, 2020 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-31685721

RESUMO

Ectopic parathyroid adenomas (PAs) can occur in numerous locations and are thought to be the cause of a significant portion of failed primary surgery for hyperparathyroidism. PA is a rare cause of hoarseness, which may be harbingers of a malignant process. Here, we describe an unusual case of an ectopic PA in the carotid sheath presenting as unilateral vocal cord paralysis (VCP). A 49-year-old lady presented with a 1-week history of hoarseness, irritating cough and shortness of breath. Fibreoptic laryngoscopy revealed left VCP. Ultrasound and computed tomography of the neck demonstrated a mass in the carotid sheath. Laboratory investigations revealed hypercalcemia (3.10 mmol/L), hypophosphatemia (0.81 mmol/L) and elevated intact parathyroid hormone (iPTH) level (381.6 pg/mL), despite of a negative 99mTc-sestamibi scan. After more rigorous tests, the ectopic tumor adjacent to the left vagus nerve was successfully resected, with subsequent histopathological confirmation of PA. The patient eventually got a normal iPTH level and serum calcium postoperatively, and regular voice function was also regained 4 months after surgery. This case emphasizes the importance of broad differential diagnosis and thorough workup. Although most patients with PA present with hypercalcemia, this disease entity also need to be considered in the differentials of neck masses and VCP.


Assuntos
Adenoma/complicações , Coristoma/complicações , Síndromes de Compressão Nervosa/etiologia , Glândulas Paratireoides , Neoplasias das Paratireoides/complicações , Doenças do Nervo Vago/etiologia , Paralisia das Pregas Vocais/etiologia , Adenoma/diagnóstico por imagem , Adenoma/patologia , Adenoma/cirurgia , Tosse/etiologia , Dispneia/etiologia , Feminino , Rouquidão/etiologia , Humanos , Hipercalcemia/etiologia , Hipercalcemia/metabolismo , Hiperparatireoidismo Primário/complicações , Hiperparatireoidismo Primário/diagnóstico , Hiperparatireoidismo Primário/metabolismo , Hiperparatireoidismo Primário/cirurgia , Hipofosfatemia/etiologia , Hipofosfatemia/metabolismo , Laringoscopia , Pessoa de Meia-Idade , Neoplasias das Paratireoides/diagnóstico por imagem , Neoplasias das Paratireoides/patologia , Neoplasias das Paratireoides/cirurgia , Tomografia Computadorizada por Raios X , Ultrassonografia , Paralisia das Pregas Vocais/diagnóstico
19.
J Vasc Access ; 21(1): 116-119, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31232149

RESUMO

BACKGROUND: Central venous catheters are extensively used in critical care units and in dialysis centres to gain access to the blood stream for the purpose of invasive monitoring, drug administration, parenteral nutrition and to perform renal replacement therapy. One of the common areas of central venous catheter insertion is right internal jugular vein due to its anatomical continuity with the superior vena cava. The complication rates of central venous catheter insertion can be more than 15%, including early and late complications. CASE REPORT: We present an unusual complication of recurrent laryngeal nerve palsy, leading to right vocal fold paralysis, following insertion of a right internal jugular tunnelled dialysis catheter. The vocal fold paralysis improved over next 8 months with conservative management alone. CONCLUSION: This case illustrates an unusual complication of central venous catheter insertion and the importance of recognizing the possibility of such complications, to prevent them from happening and also to manage them appropriately.


Assuntos
Cateterismo Venoso Central/efeitos adversos , Cateterismo Venoso Central/instrumentação , Cateteres de Demora , Cateteres Venosos Centrais , Veias Jugulares , Paralisia das Pregas Vocais/etiologia , Idoso , Tratamento Conservador , Desenho de Equipamento , Feminino , Rouquidão/etiologia , Humanos , Resultado do Tratamento , Paralisia das Pregas Vocais/diagnóstico , Paralisia das Pregas Vocais/terapia
20.
J Voice ; 34(1): 162.e1-162.e3, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30243668

RESUMO

The etiology of laryngeal granuloma can typically be attributed to endotracheal intubation, vocal abuse, or gastroesophageal reflux disease. There is a strong male predominance, except in cases due to intubation, where incidence is higher in women. We report a case of spontaneous development of multiple granulomas in a female with no history of intubation who presented with hoarseness and massive bilateral supraglottic masses obscuring her glottis. The disparity between the massive lesions and asymptomatic reflux highlights the need for further research in the pathophysiology of laryngeal granulomas.


Assuntos
Granuloma Laríngeo/complicações , Rouquidão/etiologia , Idoso , Feminino , Granuloma Laríngeo/diagnóstico por imagem , Granuloma Laríngeo/cirurgia , Rouquidão/fisiopatologia , Humanos , Laringoscopia , Resultado do Tratamento , Qualidade da Voz
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