RESUMEN
Many other diagnoses and treatments are of particular importance in caring for voice patients. Those discussed in this article are among the most common. The exacting demands of a professional singer or actor, his or her acute ability to analyze the body's condition, and his or her professional athlete's need for a nearly perfect result provide special challenges and gratification for physicians. However, a great many of our non-singer/actor patients are also extremely dependent on voice quality and endurance. Consequently, every patient with a voice complaint should be treated as Pavaroti or Sutherland would be treated, and every voice evaluation should be carried out systematically until a diagnosis has been made on the basis of positive evidence. The emergence of interdisciplinary teams, advanced instrumentation, and voice laboratories has made dramatic improvements in the standard of voice care, and the rapid development of voice as a subspecialty promises continuing advances in the care of voice disorders.
Asunto(s)
Trastornos de la Voz , Humanos , Trastornos de la Voz/etiología , Trastornos de la Voz/fisiopatología , Trastornos de la Voz/terapiaRESUMEN
Disruption of the cricoarytenoid joint is a relatively uncommon event, according to the world literature. Only 31 reported cases of arytenoid dislocation or subluxation exist other than the 26 cases described in this paper. Often cases are misdiagnosed as vocal fold paralysis. Knowledge of the signs and symptoms of arytenoid dislocation aids in correct diagnosis and early treatment. Even when diagnosis has been delayed, surgery may be highly effective. Familiarity with state-of-the-art diagnostic techniques and new concepts in management helps optimize the chances for good voice quality.
Asunto(s)
Cartílago Aritenoides/lesiones , Adolescente , Adulto , Anciano , Cartílago Aritenoides/cirugía , Niño , Diagnóstico Diferencial , Femenino , Estudios de Seguimiento , Ronquera/diagnóstico , Humanos , Intubación Intratraqueal/efectos adversos , Luxaciones Articulares , Laringoscopía , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento , Trastornos de la Voz/diagnóstico , Entrenamiento de la Voz , Heridas y Lesiones/diagnóstico , Heridas y Lesiones/terapiaRESUMEN
A soprano voice from cricothyroid fusion is a rare complication following thyroidectomy. Thyroid surgeons should be aware of this possibility and recognize it early if voice pitch rises following thyroid surgery. This patient's unfortunate complication may prove fortuitous for phonosurgeons and their patients. Cricothyroid fusion may provide a better long-term retention of frequency elevation than traditional cricothyroid approximation. It is also a reversible procedure. Cricothyroid fusion should be investigated as an alternative to cricothyroid approximation for pitch modification.
Asunto(s)
Cartílago Cricoides/patología , Cartílago Tiroides/patología , Tiroidectomía/efectos adversos , Voz , Cicatriz , Humanos , Enfermedades de la Laringe/etiología , Masculino , Persona de Mediana EdadRESUMEN
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 TiempoRESUMEN
OBJECTIVES: To determine the sensitivity of auditory brainstem response (ABR) testing for detecting acoustic neuromas and to determine whether the test is less sensitive for detecting small tumors. DESIGN: Retrospective review of the medical charts of 58 patients with acoustic neuroma who had all of the data necessary for inclusion in the study. SETTING: University-affiliated referral practice of one neurotologist. PATIENTS: Patients with acoustic neuromas who had both ABR tracings and magnetic resonance imaging films available for review. MAIN OUTCOME MEASURES: Positive ABR and negative ABR results correlated with tumor size. RESULTS: Tumor size ranged from 0.4 to 7 cm. The overall sensitivity of ABR in diagnosing acoustic neuromas was 90%. However, ABR was progressively less sensitive with decreasing tumor size. Only 7 (58%) of the 12 tumors 1 cm or smaller were detected by ABR. CONCLUSION: Auditory brainstem response testing cannot be relied on for detection of small acoustic neuromas and should not be used as a criterion to determine whether magnetic resonance imaging should be performed when an acoustic neuroma is suspected clinically.
Asunto(s)
Potenciales Evocados Auditivos del Tronco Encefálico , Neuroma Acústico/diagnóstico , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Sensibilidad y EspecificidadRESUMEN
Cornelia de Lange syndrome (CDLS) is characterized by multiple congenital malformations and mental retardation. New studies have documented otolaryngologic abnormalities. We examined 45 patients with CDLS. Virtually all had hearing loss, and most had impaired language development. Other otolaryngologic abnormalities, including external auditory canal stenosis and cleft palate, were also common. Because of the high incidence of otolaryngologic abnormalities, and the need for early intervention, it is important for otolaryngologists to recognize CDLS manifestations in the head and neck.
Asunto(s)
Síndrome de Cornelia de Lange/complicaciones , Sordera/etiología , Trastornos del Desarrollo del Lenguaje/etiología , Adolescente , Adulto , Niño , Preescolar , Sordera/diagnóstico , Diagnóstico Diferencial , Estudios de Evaluación como Asunto , Femenino , Humanos , Lactante , Discapacidad Intelectual/diagnóstico , MasculinoRESUMEN
Because of unsatisfactory results in treatment of malignant conditions of the temporal bone, a technique for total en bloc resection of the temporal bone and carotid artery was reported by Graham et al. in 1984. The procedure involves resection of the internal carotid artery, cranial nerves VI through XII, and structures adjacent to the temporal bone. Experience with two additional cases led to numerous modifications in the recommended procedure, as reported by Sataloff and Myers. Additional clinical experience with this technique and its complications has resulted in further modification. Additional pitfalls and specific changes in technique from previous reports are discussed in detail, including a new procedure to assure the adequacy of contralateral venous outflow.
Asunto(s)
Carcinoma de Células Escamosas/cirugía , Neoplasias del Oído/cirugía , Oído Externo/cirugía , Neoplasias Craneales/cirugía , Hueso Temporal/cirugía , Anciano , Carcinoma de Células Escamosas/patología , Neoplasias del Oído/patología , Oído Externo/patología , Femenino , Estudios de Seguimiento , Humanos , Disección del Cuello , Complicaciones Posoperatorias/patología , Neoplasias Craneales/patología , Hueso Temporal/patología , Tomografía Computarizada por Rayos XRESUMEN
Endoscopic repair of cerebrospinal fluid rhinorrhea is a promising alternative to traditional repair techniques. This article reports our experience with 21 cases (10 spontaneous, 8 iatrogenic, and 3 traumatic). Various diagnostic radiographic modalities were used, including computer-aided techniques. Most repairs were accomplished with a free fascial graft positioned in the epidural space. Postoperative lumbar drainage was used in 15 cases. Initial repair was successful in 18 cases (85.7%). In all 3 failures, the surgeon had difficulty with proper graft placement. Additionally, 2 of these cases were confounded by early inadvertent removal of the lumbar drain. All patients in whom the procedure failed underwent a second successful endoscopic repair. There were no major complications. In our experience endoscopic repair of cerebrospinal fluid rhinorrhea is a safe and effective approach that can be improved with computer-aided localization devices. Proper graft placement is critical, and lumbar drainage is an important adjunct in selected cases.
Asunto(s)
Rinorrea de Líquido Cefalorraquídeo/cirugía , Endoscopía , Adulto , Anciano , Rinorrea de Líquido Cefalorraquídeo/diagnóstico , Rinorrea de Líquido Cefalorraquídeo/etiología , Drenaje , Fascia/trasplante , Femenino , Humanos , Masculino , Persona de Mediana Edad , Cuidados Posoperatorios , Reoperación , Estudios Retrospectivos , Terapia Asistida por ComputadorRESUMEN
To determine the varied causes of oropharyngeal dysphagia and their respective pathophysiology, a working understanding of the normal anatomy and function of the highly integrated mechanism of swallowing is outlined. This information is presented as the basis for a reasoned and detailed approach to the history, physical examination, and endoscopic evaluation of normal and altered oropharyngeal swallowing. The management of swallowing disorders depends on the nature and magnitude of the responsible clinical condition. Conservative and surgical approaches are discussed. These modalities and their indications are described in detail.
Asunto(s)
Trastornos de Deglución , Deglución/fisiología , Sistema Estomatognático/fisiología , Trastornos de Deglución/diagnóstico , Trastornos de Deglución/etiología , Trastornos de Deglución/fisiopatología , Trastornos de Deglución/terapia , Humanos , Sistema Estomatognático/anatomía & histologíaRESUMEN
Scarring of the vocal folds can occur as the result of blunt laryngeal trauma or, more commonly, as the result of surgical, iatrogenic injury after excision or removal of vocal fold lesions. The scarring results in replacement of healthy tissue by fibrous tissue and can irrevocably alter vocal fold function and lead to a decreased or absent vocal fold mucosal wave. The assessment and treatment of persistent dysphonia in patients with vocal fold scarring presents both diagnostic and therapeutic challenges to the voice treatment team. The common causes of vocal fold scarring are described, and prevention of vocal fold injury during removal of vocal fold lesions is stressed. The anatomic and histologic basis for the subsequent alterations in voice production and contemporary modalities for clinical and objective assessment will be discussed. Treatment options will be reviewed, including nonsurgical treatment and voice therapy, collagen injection, fat augmentation, endoscopic laryngoplasty, and Silastic medialization.
Asunto(s)
Cicatriz/complicaciones , Cicatriz/fisiopatología , Pliegues Vocales/fisiopatología , Trastornos de la Voz/etiología , Colágeno/uso terapéutico , Humanos , Laringe/cirugía , Pliegues Vocales/ultraestructura , Trastornos de la Voz/terapia , Entrenamiento de la VozRESUMEN
Strobovideolaryngoscopy is a valuable addition to the diagnostic armamentarium because it allows the otolaryngologist to perform a detailed physical examination of the vibratory margin of the vocal fold. From 1985 through 1989, we performed 1,876 strobovideolaryngoscopy procedures, the majority on professional voice users. Previously, we reported findings on our first 486 strobovideolaryngoscopy procedures. Stroboscopic information influenced diagnosis or treatment in approximately one third. The present study was undertaken to determine whether additional experience had altered the clinical usefulness of the procedure. Diagnoses were noted before and after stroboscopy prospectively for 377 strobovideolaryngoscopy procedures performed during the calendar year 1989. In 53% of the procedures, strobovideolaryngoscopy resulted in no change in diagnosis. In 29%, preprocedure impressions were confirmed and additional diagnoses were made. In 18%, preprocedure diagnoses were found to be incorrect. The procedure has proven very helpful in caring for voice patients, modifying diagnoses in 47%, and confirming uncertain diagnoses in many of the other patients studied.
Asunto(s)
Laringoscopía , Grabación en Video , Humanos , Enfermedades de la Laringe/diagnóstico , Laringoscopía/métodosRESUMEN
Care of the professional voice user, particularly the professional singer, requires that the otolaryngologist acquire special training. This group of patients demands gentle and appropriate treatment, rarely surgery, for a wide range of conditions that may affect vocal performance.
Asunto(s)
Música , Enfermedades Profesionales , Trastornos de la Voz , Humanos , Enfermedades Profesionales/diagnóstico , Enfermedades Profesionales/terapia , Trastornos de la Voz/diagnóstico , Trastornos de la Voz/terapiaRESUMEN
It is essential for laryngologists, speech and language pathologists, and others caring for professional voice users to be familiar with the potential vocal effects of any substance ingested by a professional voice patient. This article reviews pharmacologic agents that may have laryngeal side effects. Essentially, any ingested substance is suspect as a cause for voice dysfunction. It is also necessary for laryngologists to educate voice professionals about the consequences of drugs on the voice and the potential problems associated with properly prescribed medication.
Asunto(s)
Enfermedad Iatrogénica , Trastornos de la Voz/etiología , HumanosRESUMEN
This article discusses the important aspects of pre- and postoperative care for phonomicrosurgical procedures. Making an accurate diagnosis is paramount to any surgical decision, which involves interdisciplinary evaluations by a laryngologist, voice pathologist, singing voice specialist, and other specialists. Patient selection and candidacy for phonomicrosurgery are discussed, including preoperative vocal rehabilitation, compliance, and pre- and postoperative timing issues. Postoperative voice rest issues are covered, and suggestions for postoperative voice rehabilitation are made. Risks of surgery and potential problems following phonomicrosurgery procedures are presented.
Asunto(s)
Laringe/cirugía , Microcirugia , Cuidados Posoperatorios , Cuidados Preoperatorios , Trastornos de la Voz/cirugía , HumanosRESUMEN
A patient with a surgically proven intracanalicular arachnoid cyst was studied using computed tomography, magnetic resonance imaging, and air CT cisternography. The lesion had a similar radiographic appearance to acoustic neuroma and therefore, although rare, must be considered in the differential diagnosis of intracanalicular mass lesions. We report a case in which examination was performed, in evaluating the lesion, utilizing high-resolution air CT cisternography and magnetic resonance imaging (MRI).
Asunto(s)
Quistes Aracnoideos/diagnóstico por imagen , Quistes Aracnoideos/diagnóstico , Imagen por Resonancia Magnética , Neuroma Acústico/diagnóstico por imagen , Neuroma Acústico/diagnóstico , Tomografía Computarizada por Rayos X , Adulto , Diagnóstico Diferencial , Humanos , Masculino , Hueso Petroso/diagnóstico por imagen , Hueso Petroso/patologíaRESUMEN
Young adulthood is notable for rapid physical changes and psychosocial instability. Care of the young adult professional voice requires knowledge of the specific anatomic and physiologic changes associated with the mutational voice, as well as the effects of general growth and maturation on the vocal mechanism. The effects of psychological stresses common to young adulthood, such as educational commitments and early career choices, must also be understood. Upper respiratory infection and allergies are common in this age group. Treatment of these conditions must be tailored in the professional voice user because of the potential side effects of some medications and the performance imperatives of the patient. Surgical indications for tonsillectomy in the young voice patient are discussed. There are no special considerations in the evaluation and treatment of laryngeal pathology in the young adult, with the exception of limiting the use of sedative anesthesia. However, conservatism in surgical decision-making is advised. The development of a stable, efficient vocal technique and a mature professional background requires time, patience, and hard work.
Asunto(s)
Calidad de la Voz , Voz/fisiología , Adolescente , Niño , Femenino , Reflujo Gastroesofágico/complicaciones , Humanos , Hipersensibilidad/complicaciones , Masculino , Infecciones del Sistema Respiratorio/complicaciones , Estrés Psicológico/psicología , Tabaquismo/complicaciones , Tonsilectomía/efectos adversos , Trastornos de la Voz/diagnóstico , Trastornos de la Voz/etiologíaRESUMEN
Advancing age produces physiologic changes that may alter voice. Some of these changes are inevitable; others may be avoidable or reversible. In addition, many treatable medical conditions may cause voice changes similar to those of aging. It is essential that all voice care providers be familiar with the expected changes of aging, and be alert to reversible conditions that may adversely affect phonation and be mistaken for presbyphonia.
Asunto(s)
Envejecimiento , Trastornos de la Voz/etiología , Factores de Edad , Anciano , Cognición , Femenino , Humanos , Masculino , Persona de Mediana Edad , Trastornos del Humor/psicología , Personalidad , Trastornos de la Voz/diagnósticoRESUMEN
Hard or abrupt glottal attack (HGA) is one of the vocal behaviors often associated with benign lesion of the vocal folds. This study was designed to determine whether the frequency of HGA was different in hyperfunctional voice patients with and without vocal fold masses. One hundred and forty-seven subjects were studied. All subjects received a complete otolaryngological evaluation including strobovideolaryngoscopy, objective voice measures, and evaluation by a speech-language pathologist. Thirty-two patients were diagnosed with muscle tension dysphonia (19 male, 13 female) without vocal fold masses. Fifty-seven patients were diagnosed with unilateral vocal fold masses (29 male, 28 female), most of which were cysts. Fifty-eight patients were diagnosed with bilateral vocal fold masses (13 male, 45 female). Of the 45 females with bilateral vocal fold masses. 26 had a vocal cyst and reactive nodule and 19 had bilateral vocal fold nodules. The control group was balanced and matched based on sex and on percentage of singers and nonsingers. It consisted of 49 subjects with no vocal fold pathology (20 male, 29 female). The group was composed of professional speakers, singers, and nonprofessional speakers. All voice disordered groups demonstrated higher frequencies of HGA than the control group. Differences were found between the male and female subjects in this study. No differences were found between the various disorders. Differences were also found between the subgroups of bilateral masses, where the bilateral nodules group presented a higher frequency of HGA than the cyst and contralateral reactive nodule.
Asunto(s)
Quistes/diagnóstico , Glotis/fisiopatología , Enfermedades de la Laringe/diagnóstico , Músculos Laríngeos/fisiopatología , Trastornos de la Voz/diagnóstico , Trastornos de la Voz/fisiopatología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Quistes/complicaciones , Femenino , Humanos , Enfermedades de la Laringe/complicaciones , Masculino , Persona de Mediana Edad , Índice de Severidad de la Enfermedad , Trastornos de la Voz/etiología , Calidad de la VozRESUMEN
New insights into the anatomy and physiology of phonation, along with technological advances in voice assessment and quantification, have led to dramatic improvements in medical voice care. Techniques to prevent vocal fold scar have been among the most important, especially scarring and hoarseness associated with voice surgery. Nevertheless, dysphonia due to vocal fold scar is still encountered all too frequently. Although it is not generally possible to restore such injured voices to normal, patients with scar-induced dysphonia can usually be helped. Voice improvement is optimized through a team approach. Treatment may include sophisticated voice therapy and vocal fold surgery. Although experience with collagen injection has been encouraging in selected cases (particularly in those involving limited areas of vocal fold scar), there is no consistently successful surgical technique. Attempts to treat massive vocal fold scar, such as may be seen following vocal fold stripping, have been particularly unsuccessful. This paper reports preliminary experience with the implantation of autologous fat into the vibratory margin of the vocal fold of patients with severe, extensive scarring. Using this technique, it appears possible to recreate a mucosal wave and improve voice quality. Additional research is needed.
Asunto(s)
Tejido Adiposo , Cicatriz , Ronquera/complicaciones , Trasplante Autólogo , Pliegues Vocales , Adolescente , Adulto , Cicatriz/complicaciones , Cicatriz/cirugía , Cicatriz/terapia , Terapia Combinada , Femenino , Humanos , Enfermedades de la Laringe , Masculino , Trastornos de la Voz/terapia , Calidad de la Voz , Entrenamiento de la VozRESUMEN
Sarcoidosis can affect the larynx as a manifestation of systemic disease or as isolated laryngeal involvement. Classically, laryngeal involvement affects the supraglottis, and less commonly the subglottis, and true vocal fold involvement is rare. The clinical course is often highlighted by frequent exacerbations and remissions that, when associated with vague complaints and constitutional symptoms, are probably the greatest contributor to delayed presentation and diagnosis. We describe an unusual case of sarcoidosis that presented after a long and protracted clinical course as an isolated submucosal vocal fold mass requiring deep biopsy for diagnosis. A review of the literature with emphasis on diagnosis, appropriate airway management, and treatment is presented.