Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 29
Filtrar
1.
Am J Otolaryngol ; 38(2): 230-232, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28139319

RESUMO

INTRODUCTION: Paradoxical vocal fold motion (PVFM) is a condition in which the vocal cords exhibit inappropriate inspiratory adduction, and it has been poorly studied in the pediatric population. METHODS: Pediatric patients diagnosed with PVCM by a pediatric otolaryngologist and doctor of speech pathology from 2008 to 2012 were reviewed. Patients in whom another cause for their respiratory disturbance was eventually identified were excluded. Patient demographics, characteristics, treatment, and outcomes were reviewed. The study was approved by the Institutional Review Board at our institution. RESULTS: Thirty patients met criteria for inclusion; one with chiari malformation was excluded. 17/29 (59%) were female. Body mass index (BMI) numbers ranged from 16 to 25 with a mean of 21. 9/29 (31%) competed at the highest level of a sport; only 3/29 (10%) did not participate in athletics. Average age of onset was 12.0years; average diagnosis delay was 1.3years. Mean follow up was 2.3years. 24/29 (83%) were previously treated for asthma. 23/29(79%) were previously treated for reflux. 25/29(86%) completed at least one session of respiratory and laryngeal control therapy with overall average of 2.2 sessions completed. All patients who attended a second therapy session were recorded as having improvement in symptoms. CONCLUSIONS: Pediatric patients with PVFM often participate in high levels of organized sports and the frequency of concurrent asthma and reflux symptoms in this population supports the theory that laryngeal hypersensitivity contributes to the pathophysiology of PVFM. These patients were not found to have any associated psychiatric diagnoses. Pediatric patients with PVFM have an excellent prognosis when treated with speech therapy and for comorbid conditions as indicated.


Assuntos
Disfunção da Prega Vocal/complicações , Disfunção da Prega Vocal/fisiopatologia , Idade de Início , Asma/complicações , Criança , Feminino , Refluxo Gastroesofágico/complicações , Humanos , Masculino , Estudos Retrospectivos , Disfunção da Prega Vocal/diagnóstico
2.
Am J Otolaryngol ; 38(5): 603-607, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28688630

RESUMO

OBJECTIVE: Laryngopharyngeal reflux (LPR) symptoms are often resistant to management and cause significant quality of life impairment to patients with this disease. This study assesses the utility of a sleep-positioning device (SPD) in treating LPR. DESIGN: Single center prospective cohort study. SETTING: Tertiary medical center PARTICIPANTS: 27 adult patients with diagnosed laryngopharyngeal reflux. INTERVENTION: An SPD consisting of a two-component wedge-shaped base pillow and a lateral positioning body pillow (Medcline, Amenity Health Inc.) was given to patients with a diagnosis of LPR. Subjects slept using the device for at least 6h per night for 28 consecutive nights. MAIN OUTCOMES: Primary outcomes were Nocturnal Gastroesophageal Reflux Symptom Severity and Impact Questionnaire (N-GSSIQ) and the Reflux Symptoms Index (RSI) survey instrument. Each was collected at baseline, after 14, and after 28days of SPD use. RESULTS: 27 patients (19 female and 8 male; age 57.1±12.8, BMI 29.0±8.1) were recruited. At baseline mean N-GSSIQ was 50.1±22.4 and mean RSI of 29.6±7.7. Repeated measure analysis showed that subjects' total N-GSSIQ scores decreased by an average of 19.1 (p=0.0004) points by two weeks and 26.5 points by 4weeks (p<0.0001). RSI decreased an average of 5.3 points by 2weeks (p=0.0425) and an average of 14.0 points by 4weeks (p<0.0001). CONCLUSIONS: In patients with LPR, SPD treatment significantly improves self-reported symptoms of nocturnal reflux as well as symptoms specific to LPR. These results support the therapeutic efficacy of a SPD for patients with LPR.


Assuntos
Refluxo Laringofaríngeo/prevenção & controle , Posicionamento do Paciente/instrumentação , Postura , Sono , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Qualidade de Vida , Inquéritos e Questionários , Resultado do Tratamento
3.
Ann Otol Rhinol Laryngol ; 124(7): 509-14, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25573394

RESUMO

STUDY DESIGN: Retrospective chart review. OBJECTIVE: To determine the efficacy of adjuvant cryotherapy in the treatment of early glottic cancer and laryngeal papillomatosis. SUMMARY OF BACKGROUND DATA: The use of cryotherapy in conjunction with traditional modalities has recently been proposed to improve voice outcomes in patients with early laryngeal cancer as compared to pretreatment conditions. This study investigates its utility in improving oncological outcomes and decreasing recurrences of laryngeal papillomatosis. METHODS: Patients with either early glottic cancer or laryngeal papillomatosis that received cryotherapy as part of their surgical regimen were investigated. All patients were seen at a large tertiary care center within a 10-year window. Demographic data were collected and all postoperative notes were reviewed. Recurrences of the laryngeal cancer were noted, as was the duration of time between successive papillomatosis operations. RESULTS: The charts of 54 glottic cancer and 29 papillomatosis patients that received cryotherapy were reviewed. One patient from the papillomatosis cohort was excluded from statistical analysis due to lack of follow-up. Overall, 16 (30%) of the laryngeal cancer patient experienced a malignant recurrence. The overall 5-year survival of these patients was 98% and the 5-year disease-free survival was 74%. The use of adjuvant cryotherapy in the treatment of laryngeal papillomatosis extended the duration of time between surgeries by an average of 79 days (P=.23). CONCLUSION: The use of adjuvant cryotherapy in the treatment of early glottic cancer does not improve the rate of carcinoma recurrences. Additionally, cryotherapy does not result in a statistically significant increase in the duration of disease-free period for laryngeal papillomatosis patients, although the observed increase may be clinically important.


Assuntos
Crioterapia/métodos , Neoplasias Laríngeas/terapia , Estadiamento de Neoplasias , Papiloma/terapia , Adulto , Idoso , Feminino , Seguimentos , Humanos , Neoplasias Laríngeas/patologia , Masculino , Pessoa de Meia-Idade , Papiloma/patologia , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Qualidade da Voz
4.
J Voice ; 2024 Jun 22.
Artigo em Inglês | MEDLINE | ID: mdl-38910062

RESUMO

OBJECTIVE: To assess the long-term outcomes and efficacy of respiratory retraining therapy in patients with exercise-induced laryngeal obstruction (EILO). METHODS: A retrospective chart review and prospective questionnaire-based survey were conducted on 88 patients who received respiratory retraining therapy for EILO at our institution over the past 5 years RESULTS: Thirty-four patients were included in the final analysis, with a mean age at symptom onset and age at initial evaluation of 13.67 ± 2.96 and 15.12 ± 3.48, respectively. We found a statistically significant difference in the pretreatment and post-treatment Dyspnea indices following respiratory retraining therapy, with a mean difference of 12.03 ± 7.18 (P < 0.001). When asked about the effectiveness of respiratory retraining therapy, the majority of patients (n = 28) reported improvement (13.3% "a little," 13.3% "somewhat better," 53.3% ("a lot better," and 13.3% complete resolution of symptoms. Only two patients (6.7%) responded that their breathing "did not get better." The most effective therapy techniques cited by patients were abdominal breathing (n = 10), ratio breathing (n = 5), and pursed lips or "straw" breathing (n = 5). CONCLUSIONS: Respiratory retraining therapy represents an effective technique in both the short-term and long-term management of EILO. This therapy remains the first line in the management of EILO due to its ease of administration, non-invasive nature, and durable effect on breathing function.

5.
Am J Speech Lang Pathol ; 32(1): 1-17, 2023 01 11.
Artigo em Inglês | MEDLINE | ID: mdl-36383426

RESUMO

Inducible laryngeal obstruction (ILO), formerly referred to as paradoxical vocal fold motion and vocal cord dysfunction, is a complex disorder of the upper airway that requires skillful differential diagnosis. There are several medical conditions that may mimic ILO (or which ILO may mimic) that should be considered in the differential diagnosis before evidence-supported behavioral intervention is initiated to mitigate or eliminate this upper airway condition. A key in treatment planning is determination of an isolated presentation of ILO or ILO concurrent with other conditions that affect the upper airway. Accurate, timely differential diagnosis in the clinical assessment of this condition mitigates delay of targeted symptom relief and/or insufficient intervention. Accurate assessment and nuanced clinical counseling are necessary to untangle concurrent, competing conditions in a single patient. This tutorial describes the common and rare mimics that may be encountered by medical professionals who evaluate and treat ILO, with particular attention to the role of the speech-language pathologist. Speech-language pathologists receive referrals for ILO from several different medical specialists (allergy, pulmonology, and sports medicine), sometimes without a comprehensive team assessment. It is paramount that speech-language pathologists who assess and treat this disorder have a solid understanding of the conditions that may mimic ILO. Summary tables that delineate differential diagnosis considerations for airway noise, origin of noise, symptoms, triggers, role of the speech-language pathologist, and ß-agonist response are included for clinician reference. A clinical checklist is also provided to aid clinicians in the critical assessment process.


Assuntos
Obstrução das Vias Respiratórias , Doenças da Laringe , Laringe , Disfunção da Prega Vocal , Adulto , Adolescente , Humanos , Diagnóstico Diferencial , Doenças da Laringe/diagnóstico , Doenças da Laringe/terapia , Obstrução das Vias Respiratórias/diagnóstico , Obstrução das Vias Respiratórias/terapia , Disfunção da Prega Vocal/diagnóstico , Disfunção da Prega Vocal/terapia
6.
J Voice ; 2023 Jan 27.
Artigo em Inglês | MEDLINE | ID: mdl-36710197

RESUMO

OBJECTIVE: To report the diagnostic utility of the novel, high-ventilatory task assessment tool called the Milstein Breathing Pattern Assessment Index (M-BPAI) for evaluation of Breathing Pattern Disorder (BPD) in athletes with and without breathing difficulty, and to evaluate the prevalence of BPD in athletes referred for Exercise Induced Laryngeal Obstruction (EILO). BPD is an abnormal respiratory biomechanical pattern caused from functional or structural factors. The presence of BPD in athletes with EILO is unknown. The current clinical evaluations of dysfunctional breathing patterns are limiting for evaluation of BPD in patients with EILO, as these only evaluate the patients in low ventilatory output tasks of rest breathing. STUDY DESIGN AND METHODS: In this prospective study, a total of 77 athletes referred to the clinic for suspected EILO and 58 athletes without any respiratory difficulty underwent M-BPAI assessment. Data collection from the experimental group also included the Dyspnea Index, and laryngeal video endoscopic provocation test. RESULTS: The M-BPAI score was significantly larger in the patient group compared to the control group. An overall M-BPAI score of ≥8 corresponds to the AUC of 0.87 (95% CI: 0.81-0.93) with a sensitivity of 0.862 and specificity of 0.792. A total of 60 (78%) patients had an overall M-BPAI score of ≥8. CONCLUSION: The M-BPAI has the potential to be a valuable clinical diagnostic marker for identifying BPD in patients with suspected EILO with further research and validation.

7.
Laryngoscope Investig Otolaryngol ; 8(5): 1294-1303, 2023 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-37899858

RESUMO

Objective: Use of computational fluid dynamic (CFD) simulations to measure the changes in upper airway geometry and aerodynamics during (a) an episode of Exercise-Induced Laryngeal Obstruction (EILO) and (b) speech therapy exercises commonly employed for patients with EILO. Methods: Magnetic resonance imaging stills of the upper airway including the nasal and oral cavities from an adult female were used to re-construct three-dimensional geometries of the upper airway. The CFD simulations were used to compute the maximum volume flow rate (l/s), pressure (Pa), airflow velocity (m/s) and area of cross-section opening in eight planes along the vocal tract, separately for inhalation and exhalation. Results: Numerical predictions from three-dimensional geometrical modeling of the upper airway suggest that the technique of nose breathing for inhalation and pursed lip breathing for exhalation show most promising pressure conditions and cross-sectional diameters for rescue breathing exercises. Also, if EILO is due to the constriction at the vocal fold level, then a quick sniff may also be a proper rescue inhalation exercise. EILO affects both the inspiratory and the expiratory phases of breathing. Conclusions: A prior knowledge of the supraglottal aerodynamics and the corresponding upper airway geometry from CFD analysis has the potential to assist the clinician in choosing the most effective rescue breathing technique for optimal functional outcome of speech therapy intervention in patients with EILO and in understanding the pathophysiology of EILO on a case-by-case basis with future studies. Level of Evidence: 4.

8.
Laryngoscope ; 131(6): E1957-E1964, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33369738

RESUMO

OBJECTIVES: Functional dysphonia (FD) is one of the possible presentations of chronic dysphonia. Defined as dysphonia without gross abnormality of the larynx, FD manifests as aberrant muscle contractions resulting in mild-to-severe dysphonia. Despite increasing clinical awareness, diagnosis, and treatment strategies for FD remain challenging. STUDY DESIGN: Institutional review board. METHODS: A retrospective review of videostroboscopic examinations and EMR data from 109 patients treated for FD was performed. Videostroboscopy was analyzed by two independent reviewers and classified by laryngeal posturing and observer-rated quality of voice. Medical records were reviewed and patient characteristics, history of disease, and survey responses were collected. Statistics were calculated using JMP and SAS packages. RESULTS: A total of 85.1% of subjects were female and the average voice handicap index (VHI30) score was 71.0/120. Average time to diagnosis of FD was 688 days and average time from diagnosis to treatment was 3.7 days. 44.0% of patients exhibited hyperadducted laryngeal posturing, 31.9% hypoadducted, and 24.2% showed a mixed posture. 98% of patient voices improved after treatment. 85% returned to normal voice and 10% maintained a mild residual dysphonia. CONCLUSION: We describe here a large cohort of patients affected by FD, including clinical presentation and videostroboscopic findings. Our data show that most individuals with FD improve after specialized voice therapy once correctly diagnosed but that correct diagnosis and proper treatment was often significantly delayed. LEVEL OF EVIDENCE: 4-Case-series Laryngoscope, 131:E1957-E1964, 2021.


Assuntos
Disfonia/fisiopatologia , Disfonia/terapia , Qualidade da Voz , Treinamento da Voz , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estroboscopia
9.
Laryngoscope ; 130(6): E400-E406, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-31498449

RESUMO

OBJECTIVE: To identify different presentations, referral patterns, comorbidities, and laryngoscopy findings in children and young adults with exercise-induced laryngeal obstruction (EILO). METHODS: We performed a retrospective chart review of 112 patients, age <26 years, with EILO between 2013 and 2016. RESULTS: Of the 112 patients who met criteria, 91 were female and 21 were male. Patients were most frequently referred by pulmonologists (60.7%). The majority of patients (93%) participated in organized sports, most of them at a competitive level. The mean age at symptom onset was 13.8 ± 3.3 years, and the mean age of diagnosis was 15.4 ± 3.0 years. Sixty-seven (59.8%) patients presented with a prior diagnosis of asthma, the majority of whom had failed asthma treatment. The most common symptoms reported were dyspnea (93.8%), wheezing/stridor (78.6%), and throat tightness (48.2%). Ninety-one (81.3%) patients had spirometry performed, with 46 (51.1%) showing inspiratory loop flattening. On flexible laryngoscopy, 87 (78.4%) of 111 patients had paradoxical vocal fold motion. Supraglottic involvement was observed to obstruct the airway in 26 (23.9%) patients, with patterns of obstruction similar to those observed in children with laryngomalacia. CONCLUSION: Most patients participated in competitive sports, were female, and presented with exertional dyspnea. Most patients were diagnosed with exercise-induced asthma but treated unsuccessfully. Almost one-quarter of our patients showed supraglottic collapse obstructing the airway. Exercise-induced laryngeal obstruction is a more descriptive term than paradoxical vocal fold motion or vocal cord dysfunction, which only describe vocal fold involvement. The time to diagnosis of EILO was shorter than previously reported, suggesting that awareness of this condition is increasing. LEVEL OF EVIDENCE: 4 Laryngoscope, 130:E400-E406, 2020.


Assuntos
Obstrução das Vias Respiratórias/diagnóstico , Asma Induzida por Exercício/diagnóstico , Dispneia/diagnóstico , Doenças da Laringe/diagnóstico , Laringoscopia/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Adolescente , Obstrução das Vias Respiratórias/etiologia , Asma Induzida por Exercício/etiologia , Traumatismos em Atletas/complicações , Traumatismos em Atletas/diagnóstico , Criança , Dispneia/etiologia , Feminino , Humanos , Doenças da Laringe/etiologia , Masculino , Estudos Retrospectivos , Espirometria/estatística & dados numéricos
10.
Otolaryngol Head Neck Surg ; 162(3): 322-325, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31959050

RESUMO

OBJECTIVE: The objective of this study was to determine the prevalence of benign vocal fold lesions (BVFLs) in patients with chronic cough over a 1-year period. STUDY DESIGN: Case series with chart review. SETTING: Tertiary academic medical center. SUBJECTS AND METHODS: A retrospective cohort study of patients with chronic cough seen in our tertiary multidisciplinary cough clinic from 2016 to 2017 was conducted. Patient characteristics, presence of BVFLs by laryngoscopy, and Leicester Cough Questionnaire (LCQ) were recorded. RESULTS: A total of 419 patients were included (average age: 61 years), and 67% of patients were female. Ten percent of patients had BVFLs: granuloma (5%), leukoplakia (3%), nodules (2%), and polyps (1%). Median cough duration was 2.9 years (interquartile range [IQR], 0.7-8.5); no significant difference in median cough duration was observed between patients with BVFLs and those with no lesions (2.6 vs 3.0 years, P = .86). In total, 178 patients (42%) had available LCQ data: median score of 10.2 (IQR, 7.9-13.9); no significant difference in median LCQ was observed between patients with BVFLs and those with no lesions (10.5 vs 10.1, P = .54). CONCLUSION: Prevalence of BVFLs in our cohort of patients with chronic cough was 10%, with posterior glottic lesions-granuloma-being the most common (5%). Prevalence of midmembranous lesions was as follows: vocal fold nodules (2%) and vocal fold polyps (1%). BVFLs were not associated with longer cough duration or more severe cough. We cannot determine a causative or noncausative relationship between BVFLs and chronic cough at this time due to lack of a control group.


Assuntos
Tosse , Doenças da Laringe/diagnóstico , Prega Vocal/patologia , Doença Crônica , Feminino , Humanos , Doenças da Laringe/epidemiologia , Laringoscopia , Masculino , Pessoa de Meia-Idade , Ohio/epidemiologia , Prevalência , Estudos Retrospectivos , Inquéritos e Questionários
11.
Laryngoscope ; 130(12): 2843-2846, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32073668

RESUMO

OBJECTIVES/HYPOTHESIS: Respiratory laryngeal dystonia (RLD) is poorly understood and rarely reported in the literature. Patients have atypical laryngeal movement resulting in airway obstruction. This motion is neurogenic in nature, is constant while awake, nonepisodic, and non-trigger dependent. Given its rarity, it is often misdiagnosed for inducible laryngeal obstruction; however, it is refractory to medical and behavioral management. Although this condition has been addressed in the literature, this report is the largest case series characterizing presenting symptomology, multimodal treatment outcomes, and longitudinal course of these patients, and proposes a set of diagnostic criteria to aid in clinical identification of RLD patients. Our objectives were to characterize RLD clinically and offer diagnostic guidelines to clinicians. STUDY DESIGN: A prospective case series with a retrospective analysis at a tertiary referral center. METHODS: A review of clinical records and videostroboscopic analysis of 16 patients treated for respiratory laryngeal dystonia from October 2005 to October 2018 was performed. RESULTS: Sixteen patients with respiratory laryngeal dystonia were included. The common features of this group were persistent, nonepisodic dyspnea and stridor with laryngoscopic evidence of paradoxical vocal fold motion. Our patients had no structural neurologic abnormalities. These patients typically failed respiratory retraining therapy and medical management of laryngeal irritants. In our series, 100% of patients underwent respiratory retraining therapy, 68.8% received laryngeal botulinum toxin injection, and 31.3% required tracheostomy. CONCLUSIONS: RLD is a rare and challenging condition. The disorder can be severely disabling, and treatment options appear limited. A multidisciplinary approach may be helpful. Some patients responded to laryngeal botulinum injection and medical management, whereas others required tracheostomy for symptom control. Laryngoscope, 2020.


Assuntos
Distonia/diagnóstico , Doenças da Laringe/diagnóstico , Adolescente , Adulto , Idoso , Toxinas Botulínicas Tipo A/uso terapêutico , Dispneia , Distonia/terapia , Feminino , Humanos , Doenças da Laringe/terapia , Masculino , Pessoa de Meia-Idade , Fármacos Neuromusculares/uso terapêutico , Sons Respiratórios , Terapia Respiratória , Estudos Retrospectivos , Estroboscopia , Traqueostomia
12.
Laryngoscope ; 129(6): 1433-1437, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30588631

RESUMO

OBJECTIVES/HYPOTHESIS: Vocal tremor is a neurologic disorder that can be treated with laryngeal botulinum toxin injections (LBTX). We sought to describe our experience with thyroarytenoid and concurrent strap muscle injection. STUDY DESIGN: Retrospective chart review. METHODS: A chart review was performed of all patients with a primary diagnosis of vocal tremor treated with LBTX from 2012 through 2017. RESULTS: Twenty-one patients were included (mean age 69 years, 100% female). Thirteen patients (62%) had a minor component of spasmodic dysphonia in addition to their tremor. Fourteen patients had vertical and horizontal components to their tremor, and two had horizontal tremor alone. The remaining five patients did not have clear characterization of their tremor. A total of 49 injections were reviewed (25 thyroarytenoid [TA], 24 thyroarytenoid and strap muscle [TA+S]), and patients reported subjective voice benefit with 48 (96%) of these (92% TA, 100% TA+S). When available, the postprocedural change from baseline Voice Handicap Index-10 and Consensus Auditory Perceptual Evaluation of Voice scores were calculated (mean overall: -1.9, -7.8; TA: -2.7, -3.5; TA+S: -1.4, -10.3, respectively). Subjective patient improvement ratings (scale 0%-100%) were obtained for 46 injections, with a mean of 70% improvement per injection. Of patients with both horizontal and vertical tremor, outcomes were improved with TA+S injection versus TA alone (mean improvement 74% vs. 35%, P < .005). CONCLUSIONS: There is utility in the characterization of vertical and horizontal components of vocal tremor. Patients with both appear to have increased benefit with injection of strap muscles in addition to thyroarytenoid muscles. LEVEL OF EVIDENCE: 4 Laryngoscope, 129:1433-1437, 2019.


Assuntos
Toxinas Botulínicas Tipo A/administração & dosagem , Fármacos Neuromusculares/administração & dosagem , Tremor/tratamento farmacológico , Distúrbios da Voz/tratamento farmacológico , Idoso , Feminino , Humanos , Injeções Intramusculares , Músculos Laríngeos , Laringe/efeitos dos fármacos , Masculino , Estudos Retrospectivos , Resultado do Tratamento , Qualidade da Voz/efeitos dos fármacos
13.
Ann Otol Rhinol Laryngol ; 117(1): 40-5, 2008 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-18254370

RESUMO

OBJECTIVES: One treatment option for unilateral vocal fold paralysis (UVFP) is ansa cervicalis-to-recurrent laryngeal nerve (ansa-RLN) anastomosis to provide reinnervation to the affected vocal fold. The advantages of this treatment approach are that it 1) provides vocal fold tone, bulk, and tension, 2) is technically simple, and 3) does not preclude other medialization procedures. We present all patients who have undergone ansa-RLN anastomosis for UVFP at our institution. METHODS: An Institutional Review Board-approved retrospective chart review was performed to include all patients who had undergone an ansa-RLN anastomosis procedure for UVFP at our institution. Data from clinical and endoscopic laryngoscopy with stroboscopy were recorded. Statistical analysis was performed on visual and perceptual vocal data. RESULTS: A total of 46 patients were included in the study. Stroboscopic analysis and perceptual vocal evaluation was performed in a blinded fashion on the 21 patients who had preoperative and postoperative stroboscopy. Severity, roughness, breathiness, and strain all improved significantly over time. Glottic closure, vocal fold edge, and supraglottic effort all significantly improved after operation. Of the 38 patients with at least 3 months of follow-up, all except 1 demonstrated evidence of reinnervation. CONCLUSIONS: This technique for treating UVFP results in significant improvements in patients' voice and on visual examination.


Assuntos
Plexo Cervical/cirurgia , Nervo Laríngeo Recorrente/cirurgia , Paralisia das Pregas Vocais/cirurgia , Prega Vocal/inervação , Adulto , Idoso , Anastomose Cirúrgica/métodos , Feminino , Seguimentos , Humanos , Laringoscopia/métodos , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Estudos Retrospectivos , Estroboscopia , Técnicas de Sutura , Resultado do Tratamento , Paralisia das Pregas Vocais/fisiopatologia , Prega Vocal/fisiopatologia , Qualidade da Voz
14.
Otolaryngol Head Neck Surg ; 159(4): 705-711, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30016197

RESUMO

Objective Unexplained chronic cough (UCC) is a perplexing condition treated with neuromodulators. Although previous literature describes the effectiveness of neuromodulators, there is little on the development of tachyphylaxis or dependence to neuromodulators over time. Our objective is to capture the experience of a large cohort of patients with UCC over an extended period, looking for these 2 phenomena. Study Design Case series with chart review. Setting Tertiary care hospital. Subjects and Methods We performed a retrospective review of patients diagnosed with UCC from 2010 to 2014. Patient outcomes were measured through percentage improvement scores. Treatment failures were attributed to no benefit, intolerable side effects, or tachyphylaxis. Tachyphylaxis was defined as the need for higher doses of medication following diminishing therapeutic benefit, while dependence was defined as a failure to stop therapy following attempted de-escalation or resurgence following drug cessation. Results Sixty-eight patients were included in the study. Tachyphylaxis was observed among 35% of patients while dependence was observed among 27% of successfully treated patients, together effecting >50% of the cohort. Sixty-eight percent of patients ultimately experienced successful treatment with neuromodulators, demonstrating strikingly distinct responses to different neuromodulator drug classes. Conclusion Tachyphylaxis and dependence occur frequently during UCC treatment and have a major impact on treatment outcomes. Patients sometimes demonstrate distinct responses to different neuromodulator classes. The majority of patients will experience successful treatment for their cough, although several trials may be required.


Assuntos
Antitussígenos/administração & dosagem , Antitussígenos/efeitos adversos , Tosse/tratamento farmacológico , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Taquifilaxia , Adulto , Fatores Etários , Idoso , Doença Crônica , Estudos de Coortes , Tosse/diagnóstico , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Falha de Tratamento , Adulto Jovem
15.
Otolaryngol Head Neck Surg ; 159(3): 508-515, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29634404

RESUMO

Objective To evaluate the short- and long-term effects of tricyclic antidepressants (TCAs) and gabapentin in the treatment of unexplained chronic cough (UCC). Study Design Prospective cohort. Setting Tertiary care hospital. Subjects and Methods Patients seen between July 2016 and March 2017 were included following a formal workup and clinical evaluation indicative of UCC. Patients were placed on either a TCA (amitriptyline or nortriptyline) or gabapentin. Leicester Cough Questionnaire (LCQ) and percentage improvement scores were obtained prior to treatment initiation and at 2 and 6 months of neuromodulator treatment. A linear mixed model assessed the change in LCQ score between the 2 treatment time points and baseline scores. Results Twenty-eight patients completed a total of 37 neuromodulator trials. Gabapentin demonstrated statistically significant improvement in LCQ scores at 2 months (2.48 points, P≤ .01) and 6 months (5.40 points, P = .01) of treatment as compared with baseline. Patients taking TCAs demonstrated statistically significant improvement of LCQ scores at 2 months of treatment (3.46 points, P≤ .01). However, the majority of patients discontinued treatment, most commonly secondary to the development of tachyphylaxis after 2 months, precluding analysis at 6 months. Conclusion While both neuromodulator classes demonstrated short-term benefit, the majority of patients discontinue treatment prior to 6 months, with patients taking TCAs discontinuing more frequently than patients on gabapentin. Future investigations are warranted evaluating tachyphylaxis and the utility of dual treatment therapies designed to address peripheral and central sensory pathways involved in UCC.


Assuntos
Amitriptilina/administração & dosagem , Tosse/diagnóstico , Tosse/tratamento farmacológico , Gabapentina/administração & dosagem , Neurotransmissores/uso terapêutico , Nortriptilina/administração & dosagem , Inquéritos e Questionários , Adulto , Idoso , Doença Crônica , Estudos de Coortes , Relação Dose-Resposta a Droga , Esquema de Medicação , Feminino , Seguimentos , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Medição de Risco , Centros de Atenção Terciária , Fatores de Tempo , Resultado do Tratamento
16.
Otolaryngol Head Neck Surg ; 136(3): 450-4, 2007 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-17321876

RESUMO

OBJECTIVE: We sought to describe the results of ansa cervicalis to recurrent laryngeal nerve (ansa-RLN) reinnervation for unilateral vocal fold paralysis. STUDY DESIGN: A chart review was performed on patients undergoing ansa-RLN reinnervation for unilateral vocal cord paralysis at a tertiary care center. Patient perceptions of preoperative and postoperative voice quality was surveyed. Acoustic and visual parameters were assessed from videostroboscopy. RESULTS: From a total of 25 study patients, 15 patients underwent both preoperative and postoperativ video stroboscopies. In stroboscopies within 6 months, the average improvement in overall severity, roughness, and breathiness was 69, 79, and 100 percent, respectively. In stroboscopies after 6 months, the average improvement in overall severity, roughness, and breathiness was 63, 66, and 100 percent, respectively. Postoperatively, all patients had reinnervation of the vocal fold. CONCLUSIONS: Voice outcomes were improved in patients with preoperative and postoperative stroboscopies. SIGNIFICANCE: Ansa-RLN reinnervation should be considered as a treatment for unilateral vocal fold paralysis.


Assuntos
Músculos do Pescoço/inervação , Transferência de Nervo/métodos , Nervo Laríngeo Recorrente/cirurgia , Adulto , Idoso , Anastomose Cirúrgica , Atitude Frente a Saúde , Feminino , Seguimentos , Rouquidão/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Acústica da Fala , Estroboscopia , Resultado do Tratamento , Gravação em Vídeo , Paralisia das Pregas Vocais/fisiopatologia , Paralisia das Pregas Vocais/cirurgia , Prega Vocal/inervação , Prega Vocal/fisiopatologia , Qualidade da Voz/fisiologia
17.
J Voice ; 31(5): 594-600, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28416083

RESUMO

OBJECTIVE: Voice disorders are common conditions that may have a significant impact on patient quality of life, yet their prevalence and epidemiology are poorly documented. In this study, we estimated the prevalence, demographics, and occupation of patients with dysphonia. METHODS: Using the Commercial and Medicare MarketScan databases of 146.7 million lives (2008-2012), the prevalence of dysphonia was estimated. Patient demographics and industry occupation were evaluated. Prevalence estimates overall and by industry were made using Medical Expenditure Panel Survey. Industry estimates were compared with US government employment statistics to assess differences between dysphonia and the general population. RESULTS: A gradual increase in the diagnosis of dysphonia was noted from 1.3% to 1.7% of the population from 2008 to 2012, with an associated increase in the diagnosis of acute laryngitis, the largest diagnostic category. A strong correlation was present between diagnosis and age, with acute laryngitis more common in the younger populations and malignancies in older ages. Benign neoplasms were more prevalent in the service industry, with 2.6 times increased likelihood compared with the general population, and malignancies were more prevalent in the manufacturing industry, with 1.4 times increased likelihood. Almost 3 million laryngoscopies and stroboscopies were performed with $900 million in costs. CONCLUSION: Prevalence rates of the diagnosis of dysphonia are increasing and are associated with large healthcare costs. Prevalence rates also differ somewhat between industries, and there appears to be a higher percentage of malignant neoplasms in the manufacturing industry and benign neoplasms in the service industry.


Assuntos
Disfonia/epidemiologia , Neoplasias Laríngeas/epidemiologia , Laringite/epidemiologia , Ocupações , Bases de Dados Factuais , Disfonia/diagnóstico , Disfonia/economia , Disfonia/fisiopatologia , Custos de Cuidados de Saúde , Humanos , Neoplasias Laríngeas/diagnóstico , Neoplasias Laríngeas/economia , Neoplasias Laríngeas/fisiopatologia , Laringite/diagnóstico , Laringite/economia , Laringite/fisiopatologia , Laringoscopia , Medicare , Dados Preliminares , Prevalência , Estudos Retrospectivos , Fatores de Risco , Estroboscopia , Fatores de Tempo , Estados Unidos/epidemiologia , Qualidade da Voz
18.
Arch Otolaryngol Head Neck Surg ; 132(11): 1226-30, 2006 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-17116819

RESUMO

OBJECTIVE: To evaluate the vocal outcomes of patients with early-stage glottic carcinoma undergoing laser resection with adjuvant cryoablative therapy. DESIGN: Retrospective review. SETTING: Tertiary care center. Patients Twenty patients with early-stage glottic carcinoma. Intervention Treatment of early-stage glottic carcinoma with endoscopic carbon dioxide laser resection in conjunction with cryoablation. MAIN OUTCOME MEASURES: Disease-free survival and subjective and objective measures of posttreatment voice quality, based on serial videolaryngostroboscopy. RESULTS: There was 1 local treatment failure, with an overall mean disease-free follow-up of 32.6 months (range, 3-93 months). Carbon dioxide laser resection and cryoablative therapy were associated with a significant improvement in subjective voice quality (P<.001). Long-term dysphonia was uniformly improved vis-à-vis the pretreatment condition, even among patients with the most advanced disease undergoing the widest resections. Posttreatment web formation was not noted among 4 patients with anterior commissure involvement. CONCLUSIONS: Endoscopic laser laryngeal surgery performed in conjunction with cryotherapy for early-stage glottic carcinoma yielded excellent primary site control, while improving subjective and objective measures of voice quality. Combined laser surgery and cryotherapy is a possible alternative to radiotherapy for selected patients with early-stage glottic carcinoma who desire curative therapy, while optimizing vocal outcomes.


Assuntos
Criocirurgia , Glote , Neoplasias Laríngeas/cirurgia , Terapia a Laser , Qualidade da Voz , Intervalo Livre de Doença , Humanos , Neoplasias Laríngeas/mortalidade , Neoplasias Laríngeas/fisiopatologia , Fonação/fisiologia , Estudos Retrospectivos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA