Safety considerations and safety protocol for laser surgery.

The critical importance of laser safety depends on a precise knowledge of the physics of each type of laser and on the tissue effects each type produces in the constantly changing environment during surgery. The considerations involved in using the most common lasers--safety guidelines, general protocol, and specific measures--are outlined.

Diagnosis and management of ventricular dysphonia.

Ventricular phonation may develop on a functional level, or it may occur as an alternative voice for the patient who has an organic disease of the true vocal folds. Three cases that represent iatrogenic, traumatic, and neurologic forms of the disorder are reported. Diagnosis, treatment, and guidelines for follow-up speech therapy are discussed.

Airway foreign bodies: a diagnostic challenge.

Foreign bodies can become lodged anywhere in the air passages, depending on their size, shape, and makeup. Symptoms of laryngeal foreign body inhalation can vary greatly but usually include one or more of the following: hoarseness, croupy cough, stridor, wheezing, dyspnea, cyanosis, hemoptysis, aphonia, odynophagia, or a subjective feeling of the presence of a foreign substance. Foreign body inhalation occurs most often in children and the elderly. The symptoms of bronchial foreign body inhalation are very similar to those of laryngeal foreign body inhalation. Usually, after the initial expression of acute symptoms, a period of quiescence follows during which little or no evidence of a problem is manifest. It is during this period of subtle symptoms that treatment is often mistakenly directed toward an infectious cause. The authors describe two unusual cases, one of laryngeal and one of bronchial foreign body ingestion. They also discuss their diagnosis and management.