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1.
Rev. bras. cir. cardiovasc ; 35(6): 970-976, Nov.-Dec. 2020. tab, graf
Article in English | SES-SP, LILACS, SES-SP | ID: biblio-1143989

ABSTRACT

Abstract Objective: To give an overview of the Ortner's syndrome caused by an aortic arch aneurysm. Methods: By comprehensive retrieval of the pertinent literature published in the past two decades, 75 reports including 86 patients were collected and recruited into this study along with a recent case of our own. Results: The aortic arch aneurysms causing hoarseness were most commonly mycotic aneurysms. In this patient setting, in addition to the left recurrent laryngeal nerve, trachea was the most commonly affected structure by the aortic arch aneurysm. Surgical/interventional/hybrid treatments led to a hoarseness-relieving rate of 64.3%, much higher than that of patients receiving conservative treatment. However, hoarseness recovery took longer time in the surgically treated patients than in the interventionally treated patients. Conclusion: The surgical and interventional treatments offered similar hoarseness-relieving effects. Surgical or interventional treatment is warranted in such patients for both treatment of arch aneurysms and relief of hoarseness.


Subject(s)
Humans , Aorta, Thoracic , Aortic Aneurysm/complications , Vocal Cord Paralysis/etiology , Hoarseness/etiology , Syndrome
2.
Rev. bras. anestesiol ; 70(5): 556-560, Sept.-Oct. 2020. graf
Article in English, Portuguese | LILACS | ID: biblio-1143960

ABSTRACT

Abstract Background: The role of type I thyroplasty (TIP) is well established as the treatment for glottal insufficiency due to vocal fold paralysis, but the ideal anesthetic management for this procedure is still largely debated. We present the case of a novel anesthetic approach for TIP using combined intermediate and superficial Cervical Plexus Block (CPB) and intermittent mild sedation analgesia. Case report: A 51-year-old presenting with left vocal fold paralysis and obstructive sleep apnea was scheduled for TIP. An ultrasound-guided intermediate CPB was performed using the posterior approach, and 15 mL of ropivacaine 0.5% were injected in the posterior cervical space between the sternocleidomastoid muscle and the prevertebral fascia. Then, for the superficial CPB, a total of 10 mL 0.5% ropivacaine was injected subcutaneously, adjacently to the posterior border of the sternocleidomastoid muscle, without penetrating the investing fascia An intermittent sedation analgesia with a target-controlled infusion of remifentanyl (target 0.5 ng.mL-1) was used to facilitate prosthesis insertion and the fiberoptic laryngoscopy. This technique offered a safe anesthetic airway and good operating conditions for the surgeon, as well as feasible voice monitoring and optimal patient comfort. Conclusion: The use of a regional technique is a promising method for the anesthetic management in TIP, especially in patients with compromised airway.


Resumo Introdução: O papel da tireoplastia tipo I (TPI) está bem estabelecido no tratamento de insuficiência glótica após a paralisia das pregas vocais, mas o manejo anestésico ideal para a TPI ainda é controverso. Descrevemos uma nova técnica anestésica para a TPI usando o Bloqueio do Plexo Cervical (BPC) superficial e o BPC intermediário associados, em presença de analgo-sedação leve e intermitente. Relato de caso: Paciente de 51 anos de idade com paralisia da prega vocal esquerda e apneia obstrutiva do sono foi agendada para TPI. BPC intermediário guiado por ultrassom foi realizado usando acesso posterior, e 15 mL de ropivacaína a 0,5% foram injetados no espaço cervical posterior entre o músculo esternocleidomastoideo e a fáscia prevertebral. A seguir, para o BPC superficial, 10 mL de ropivacaína a 0,5% foram injetados na região subcutânea adjacente à borda posterior do músculo esternocleidomastoideo, sem transfixar a fáscia de revestimento. Analgo-sedação intermitente com infusão alvo-controlada de remifentanil (alvo de 0,5 ng.mL-1) foi usada para facilitar a inserção da prótese e a laringoscopia com fibra ótica. A técnica ofereceu via aérea segura durante a anestesia, boa condição para o cirurgião, possibilidade de monitorar a voz, além de ótimo conforto à paciente. Conclusões: O uso de anestesia regional é uma técnica promissora para o cuidado anestésico durante a TPI, especialmente em pacientes com via aérea comprometida.


Subject(s)
Humans , Female , Vocal Cord Paralysis/surgery , Laryngoplasty/methods , Cervical Plexus Block/methods , Ultrasonography, Interventional , Ropivacaine/administration & dosage , Anesthetics, Local/administration & dosage , Middle Aged
4.
Article in Spanish | LILACS, COLNAL | ID: biblio-1102966

ABSTRACT

Introducción: la parálisis bilateral de cuerdas vocales (PBCV) y el síndrome de apnea hipoapnea obstructiva del sueño (SAHOS) son patologías que generan limitación respiratoria. Por tratarse de patologías obstructivas, es razonable considerar una posible relación. Materiales y métodos: se realizó un estudio antes y después en dos centros universitarios de Bogotá. Se describieron frecuencias y medidas de tendencia central. Se utilizaron las pruebas de McNemar BoWker y T pareada o Wilcoxon, considerándose significativo un p <0,05. Resultados: se incluyeron 14 pacientes con PBCV manejados con cordectomía posterior transversa. 100 % fueron del género femenino y la media de edad de 51,2±10,73 años. El promedio de índice de masa corporal (IMC) fue 25,42±5,4, 50 % tuvieron IMC normal. La severidad del SAHOS fue leve (42,9 %), moderada (28,6 %) y severa (28,6 %). La intervención fue exitosa en un 64,28 %, lo que evidencia una reducción del 54 % del índice apnea/hipopnea (IAH) prequirúrgico comparado con el posquirúrgico (p = 0,029), 85,6 % reducción en el índice de apneas obstructivas (p = 0,017), en el índice de hipopneas en 52 % (p = 0,028) y la latencia del sueño en 33,3 % (p = 0,025). Otras variables no mostraron diferencias significativas (p >0,05). Conclusiones e importancia clínica: los resultados descritos evidencian una relación estadísticamente significativa del SAHOS y la PBCV. Los pacientes con PBCV se beneficiaron del uso de la cordectomía posterior como intervención terapéutica ya que disminuye los índices de severidad del SAHOS y, por ende, mejora la calidad de vida de los pacientes.


Background: bilateral vocal cord paralysis (BVFP) and obstructive sleep apnea-hypopnea syndrome (OSAHS) are pathologies that generate respiratory limitation. As they are obstructive airway diseases, it is reasonable to consider a possible relationship. Materials and methods: a before and after study was performed, in two university centers in Bogotá, frequencies and measures of central tendency were described. The McNemar BoWker and paired T or Wilcoxon tests were used, considering p <0.05 significant. Results: 14 patients were managed with transverse posterior cordectomy. 100 % were female and the mean age of 51.2±10.73 years. The average BMI was 25.42±5.4, 50 % had normal BMI. OSAHS severity was mild 42.9 %, moderate 28.6 % and severe 28.6 % disease classification. The intervention was successful in 64.28 %, there was a 54 % reduction in presurgical Apnea Hypopnea Index compared to the post-surgical one (p = 0.029), 85.6 % reduction in the index of obstructive apneas (p = 0.017), in the index of hypopneas in 52 % (p = 0.028) and sleep latency in 33.3 % (p = 0.025). Other variables showed no significant differences (p >0.05). Conclusions: the results described show a statistically significant relationship between OSAHS and BVFP. Patients with BVFP benefited from the use of posterior cordectomy as a therapeutic intervention reducing the severity rates of OSAHS and thus improving the quality of life of patients.


Subject(s)
Humans , Sleep Apnea, Obstructive , Vocal Cord Paralysis
5.
Rev. otorrinolaringol. cir. cabeza cuello ; 79(2): 213-220, jun. 2019. graf
Article in Spanish | LILACS | ID: biblio-1014440

ABSTRACT

RESUMEN A pesar de los avances en cirugía de vía aérea, tanto abierta como endoscópica, la inmovilidad bilateral de cuerdas vocales continúa representando un desafio significativo para los cirujanos de vía aérea. Entre las alternativas quirúrgicas existen tanto abordajes endoscópicos como transcervicales, no obstante, la mayoría de estas técnicas modifican estructuralmente regiones de la cuerda vocal y/o aritenoides de manera permanente. La traqueostomía ha sido el tratamiento de elección en niños con inmovilidad bilateral de cuerdas vocales severamente sintomática, sin embargo, el procedimiento ideal debiese establecer una vía aérea adecuada evitando la necesidad de realizar una traqueostomía, y a la vez no generar un deterioro de la función fonatoria. La capacidad de expandir el aspecto glótico posterior sin modificación estructural de aritenoides y/o ligamento vocal ha convertido a la sección cricoidea posterior endoscópica con injerto de cartílago costal en una alternativa quirúrgica atractiva para estos casos. En este trabajo se realiza una revisión de la literatura y presenta un caso tratado mediante esta técnica en el Hospital Guillermo Grant Benavente de Concepción, Chile.


ABSTRACT Despite advances in both open and endoscopic airway surgery, bilateral vocal cord immobility still poses a significant challenge for airway surgeons. Among the surgical alternatives there are both endoscopic and transcervical approaches. However, most of these techniques structurally modify certain regions of the vocal cord and/or arytenoids permanently. Tracheostomy has been the treatment of choice in severely symptomatic children with bilateral immobility of vocal cords. Nevertheless, the ideal procedure should establish an adequate airway, avoiding the need to perform a tracheostomy, and at the same time not causing a deterioration of the phonatory function. The ability to expand the posterior glottis without structural modification of the arytenoids and/or vocal ligament has converted the posterior endoscopic cricoid split with costal cartilage graft into an attractive surgical alternative for these cases. In this article we review the literature and present a case treated by this technique in the Guillermo Grant Benavente Hospital in Concepción, Chile.


Subject(s)
Humans , Female , Child , Cartilage/transplantation , Vocal Cord Paralysis/surgery , Laryngostenosis/surgery , Cricoid Cartilage/surgery , Laryngoscopy/methods , Ribs/transplantation , Tracheostomy , Treatment Outcome , Minimally Invasive Surgical Procedures/methods , Airway Obstruction/etiology , Lasers, Gas
6.
Braz. j. otorhinolaryngol. (Impr.) ; 85(1): 3-10, Jan.-Feb. 2019. tab, graf
Article in English | LILACS | ID: biblio-984058

ABSTRACT

Abstract Introduction: Dysphonia is a common symptom after thyroidectomy. Objective: To analyze the vocal symptoms, auditory-perceptual and acoustic vocal, videolaryngoscopy, the surgical procedures and histopathological findings in patients undergoing thyroidectomy. Methods: Prospective study. Patients submitted to thyroidectomy were evaluated as follows: anamnesis, laryngoscopy, and acoustic vocal assessments. Moments: pre-operative, 1st post (15 days), 2nd post (1 month), 3rd post (3 months), and 4th post (6 months). Results: Among the 151 patients (130 women; 21 men). Type of surgery: lobectomy + isthmectomy n = 40, total thyroidectomy n = 88, thyroidectomy + lymph node dissection n = 23. Vocal symptoms were reported by 42 patients in the 1st post (27.8%) decreasing to 7.2% after 6 months. In the acoustic analysis, f0 and APQ were decreased in women. Videolaryngoscopies showed that 144 patients (95.3%) had normal exams in the preoperative moment. Vocal fold palsies were diagnosed in 34 paralyzes at the 1st post, 32 recurrent laryngeal nerve (lobectomy + isthmectomy n = 6; total thyroidectomy n = 17; thyroidectomy + lymph node dissection n = 9) and 2 superior laryngeal nerve (lobectomy + isthmectomy n = 1; Total thyroidectomy + lymph node dissection n = 1). After 6 months, 10 patients persisted with paralysis of the recurrent laryngeal nerve (6.6%). Histopathology and correlation with vocal fold palsy: colloid nodular goiter (n = 76; palsy n = 13), thyroiditis (n = 8; palsy n = 0), and carcinoma (n = 67; palsy n = 21). Conclusion: Vocal symptoms, reported by 27.8% of the patients on the 1st post decreased to 7% in 6 months. In the acoustic analysis, f0 and APQ were decreased. Transient paralysis of the vocal folds secondary to recurrent and superior laryngeal nerve injury occurred in, respectively, 21% and 1.3% of the patients, decreasing to 6.6% and 0% after 6 months.


Resumo Introdução: A disfonia é um sintoma comum após a tireoidectomia. Objetivo: Analisar os sintomas vocais, auditivo-perceptivos e acústica vocal, videolaringoscopia, procedimento cirúrgico e achados histopatológicos em pacientes submetidos à tireoidectomia. Método: Estudo prospectivo. Pacientes submetidos à tireoidectomia foram avaliados da seguinte forma: anamnese, laringoscopia e avaliações vocais acústicas. Momentos: pré-operatório, 1ª avaliação pós (15 dias), 2ª avaliação pós (1 mês), 3ª avaliação pós (3 meses) e 4ª avaliação pós-operatória (6 meses). Resultados: Dos 151 pacientes, 130 eram mulheres e 21, homens. Tipos de cirurgia: lobectomia + istmectomia n = 40, tireoidectomia total n = 88, tireoidectomia + dissecção de linfonodo n = 23. Sintomas vocais foram relatados por 42 pacientes na 1ª avaliação pós-operatória (27,8%), reduzidos para 7,2% após 6 meses. Na análise acústica, f0 e APQ estavam diminuídos nas mulheres. As videolaringoscopias mostraram que 144 pacientes (95,3%) tiveram exames normais no momento pré-operatório. Paralisia das cordas vocais foi diagnosticada em 34 pacientes na 1ª avaliação pós-operatória, 32 do nervo laríngeo recorrente (lobectomia + istmectomia - n = 6; tireoidectomia total - n = 17; tireoidectomia total + dissecção de linfonodos - n = 9) e 2 do nervo laríngeo superior (lobectomia + istmectomia - n = 1; tireoidectomia total + dissecção de linfonodos - n = 1). Após 6 meses, 10 pacientes persistiram com paralisia do nervo laríngeo recorrente (6,6%). Histopatologia e correlação com paralisia das cordas vocais: bócio coloide nodular (n = 76; paralisia n = 13), tireoidite (n = 8; paralisia n = 0) e carcinoma (n = 67; paralisia n = 21). Conclusão: Os sintomas vocais, relatados por 27,8% dos pacientes na 1ª avaliação pós-operatória, diminuíram para 7% em 6 meses. Na análise acústica, f0 e APQ diminuíram. A paralisia transitória de cordas vocais secundária à lesão do nervo laríngeo recorrente e nervo laríngeo superior ocorreu, respectivamente, em 21% e 1,3% dos pacientes, reduziu-se para 6,6% e 0% após 6 meses.


Subject(s)
Humans , Male , Child , Adolescent , Adult , Middle Aged , Aged , Young Adult , Postoperative Complications/physiopathology , Postoperative Complications/epidemiology , Thyroidectomy/adverse effects , Voice Disorders/etiology , Laryngeal Diseases/etiology , Time Factors , Voice Quality/physiology , Brazil/epidemiology , Sex Factors , Vocal Cord Paralysis/etiology , Vocal Cord Paralysis/physiopathology , Vocal Cord Paralysis/epidemiology , Voice Disorders/physiopathology , Voice Disorders/epidemiology , Laryngeal Diseases/physiopathology , Laryngeal Diseases/epidemiology , Prospective Studies , Laryngeal Nerve Injuries/etiology , Laryngeal Nerve Injuries/physiopathology , Laryngeal Nerve Injuries/epidemiology , Laryngoscopy/methods , Larynx/injuries , Larynx/pathology
7.
Article in Chinese | WPRIM | ID: wpr-774029

ABSTRACT

A female infant was admitted to the hospital due to perioral cyanosis two hours after birth. The infant was born at the gestational age of 35 weeks by cesarean section with a birth weight of 2 400 g. Physical examination revealed wry mouth to the left side while crying, small auricles, and high palatal arch; fibrolaryngoscopy suggested bilateral vocal cord paralysis; echocardiography suggested ventricular septal defect; single nucleotide polymorphism testing showed 22q11.21 microdeletion. Therefore, the infant was given a definite diagnosis of asymmetric crying facies syndrome accompanied by 22q11.21 microdeletion. After 8-month follow-up, the infant still had asymmetric crying facies with presence of growth retardation.


Subject(s)
Cesarean Section , Crying , Facial Paralysis , Female , Heart Defects, Congenital , Humans , Infant , Pregnancy , Vocal Cord Paralysis
8.
Article in English | WPRIM | ID: wpr-785356

ABSTRACT

BACKGROUND: Endotracheal intubation can cause focal ischemia, damage or edema to the laryngeal mucosa, and may be followed by serious complications such as vocal cord paralysis, ulcers, and granulation tissue formation. Laryngeal granuloma is rare but also a significant late complication of endotracheal intubation, and anesthesiologists should be concerned about it.CASE: We experienced four cases of laryngeal granuloma that developed after two-jaw surgery January 2017–December 2018 in our hospital and would like to report these cases with brief review of literature.CONCLUSIONS: There are frequent movements on the head and neck in maxillofacial surgery and the nasotracheal intubation should be prolonged after bimaxillary osteotomy surgery because of post-operative airway problems. This may be why two-jaw surgery may have higher occurrence of laryngeal granuloma than others.


Subject(s)
Edema , Granulation Tissue , Granuloma, Laryngeal , Head , Humans , Intubation , Intubation, Intratracheal , Ischemia , Laryngeal Mucosa , Neck , Osteotomy , Surgery, Oral , Ulcer , Vocal Cord Paralysis
9.
Article in Korean | WPRIM | ID: wpr-758523

ABSTRACT

BACKGROUND AND OBJECTIVES: Laryngeal electromyography (LEMG) is valuable to evaluate the innervation status of the laryngeal muscles and the prognosis of vocal fold paralysis (VFP). However, there is a lack of agreement on quantitative interpretation of LEMG. The aim of this study is to measure the motor unit action potentials (MUAP) quantitatively in order to find cut-off values of amplitude, duration, phase for unilateral vocal fold paralysis patients. MATERIALS AND METHOD: Retrospective chart review was performed for the unilateral VFP patients who underwent LEMG from March 2016 to May 2018. Patient's demography, cause of VFP, vocal cord mobility, and LEMG finding were analyzed. The difference between normal and paralyzed vocal folds and cut-off values of duration, amplitude, and phase in MUAP were evaluated. RESULTS: Thirty-six patients were enrolled in this study. Paralyzed vocal fold had significantly longer duration (p=0.021), lower amplitude (p=0.000), and smaller phase (p=0.012) than the normal. The cut-off values of duration, amplitude, and phase in MUAP for unilateral VFP were 5.15 ms, 68.35 µV, and 1.85 respectively. CONCLUSION: An analysis of MUAP successfully provided quantitative differences between normal and paralyzed vocal folds. But, additional research is needed to get more available cut-off value which is helpful to evaluate the status of laryngeal innervations.


Subject(s)
Action Potentials , Demography , Electromyography , Humans , Laryngeal Muscles , Methods , Paralysis , Prognosis , Retrospective Studies , Vocal Cord Paralysis , Vocal Cords
10.
Article in Korean | WPRIM | ID: wpr-758516

ABSTRACT

Herpes zoster oticus is one of complication of varicella zoster virus (VZV) reactivation in the geniculate ganglion of the facial nerve, which is the most common presentation of herpes zoster in the head and neck region. However, VZV infection of the larynx has rarely been described in the literature compared with Herpes zoster oticus. Moreover, zoster laryngopharyngitis simultaneously occurred with recurred Herpes zoster oticus which has no newly developing motor dysfunction has not been reported yet. Therefore, these diseases are difficult to diagnose due to its rareness. However, distinctive appearances such as unilateral herpetic mucosal eruptions and vesicles are useful and essential in making a quick and accurate diagnosis. Thus, we report a characteristic case of zoster laryngopharyngitis simultaneously occurred with recurred Herpes zoster oticus not accompanied by any newly developing motor palsy.


Subject(s)
Diagnosis , Facial Nerve , Geniculate Ganglion , Head , Herpes Zoster Oticus , Herpes Zoster , Herpesvirus 3, Human , Larynx , Neck , Paralysis , Vocal Cord Paralysis , Vocal Cords
12.
Article in English | WPRIM | ID: wpr-760131

ABSTRACT

We recently experienced a case of transoral endoscopic thyroidectomy combined with a modified radical neck dissection (MRND) using a facelift approach in a patient with keloid-prone skin. A 35-year-old female was diagnosed with a papillary thyroid carcinoma, which was 1.2 cm in diameter and showed level II-III lateral cervical metastases. The patient required total thyroidectomy and MRND; however, she was concerned about the neck incision because she had keloid-prone skin. We first performed a transoral, endoscopic total thyroidectomy combined with bilateral central node dissection via a tri-vestibular approach, and then followed it by MRND (II-V) using a facelift approach with the Da Vinci robotic system. We noted no significant complications, such as vocal cord palsy, hypoparathyroidism, or permanent loss of the lower lip or auricle. This new method of combining transoral and facelift approaches will be useful for patients with small thyroid cancers and lateral neck metastases.


Subject(s)
Adult , Female , Humans , Hypoparathyroidism , Lip , Methods , Neck , Neck Dissection , Neoplasm Metastasis , Rhytidoplasty , Skin , Thyroid Neoplasms , Thyroidectomy , Vocal Cord Paralysis
13.
Article in Korean | WPRIM | ID: wpr-760085

ABSTRACT

BACKGROUND AND OBJECTIVES: Radiesse® is a widely used calcium hydroxyapatite (CaHA) injection material used for vocal fold injection. Recently, a new CaHA injection material (Facetem ®) which complements the structural disadvantages of Radiesse has been developed and released in the market. The aim of this study is to compare the efficacy and short-term voice outcome of these two CaHA materials. SUBJECTS AND METHOD: A retrospective analysis was performed for 70 patients with unilateral vocal fold paralysis who underwent vocal fold injection using CaHA materials. Acoustic voice analysis, maximal phonation time (MPT), voice handicap index (VHI), and Grade, Roughness, Breathiness, Asthenia, Strain (GRBAS) scale were evaluated between Radiesse and Facetem injection group. RESULTS: Both groups showed a signifcant improvement of MPT, VHI, and G, B, A scale after injection. The Facetem group showed similar voice improvement as the Radiesse group, where pre- and postoperatively objective and subjective voice evaluation results were compared. CONCLUSION: Our study reveals that there is no significant difference in efficacy and nor any short-term vocal improvement between Radiesse and Facetem. Therefore, the use of Facetem as CaHA injection material could be considered as an alternative material for patients with unilateral vocal cord paralysis.


Subject(s)
Acoustics , Asthenia , Calcium , Complement System Proteins , Durapatite , Humans , Laryngoplasty , Methods , Paralysis , Phonation , Retrospective Studies , Vocal Cord Paralysis , Vocal Cords , Voice
14.
Rev. bras. anestesiol ; 68(6): 637-640, Nov.-Dec. 2018.
Article in English | LILACS | ID: biblio-977395

ABSTRACT

Abstract Background: General anesthesia is a safe, frequent procedure in clinical practice. Although it is very unusual in procedures not related to head and or neck surgery, vocal cord paralysis is a serious and important complication. Incidence has been associated with patient age and comorbidities, as well as the position of the endotracheal tube and cuff. It can become a dangerous scenario because it predisposes aspiration. Objectives: To present a case and analyze the risk factors associated with increased risk of vocal cord paralysis described in the literature. Case report: 53 year-old diabetic man, who developed hoarseness in the postoperative period after receiving general anesthesia for an elective abdominal laparoscopic surgery. Otolaryngological evaluation showed left vocal cord paralysis. Conclusions: Vocal cord paralysis can be a serious complication of general anesthesia because of important voice dysfunction and risk of aspiration. The management is not yet fully established, so prevention and early diagnosis is essential.


Resumo Justificativa: A anestesia geral é um procedimento seguro e frequente na prática clínica. Embora seja muito rara em procedimentos não relacionados à cirurgia de cabeça ou pescoço, a paralisia das cordas vocais é uma complicação séria e importante. Sua incidência tem sido associada à idade e comorbidades do paciente, bem como à posição do tubo endotraqueal e seu balonete. A paralisia das cordas vocais pode ser uma condição perigosa porque predispõe à aspiração. Objetivos: Apresentar um caso e analisar os fatores de risco associados ao aumento do risco de paralisia das cordas vocais descritos na literatura. Relato de caso: Paciente do sexo masculino, 53 anos, diabético, que desenvolveu rouquidão no pós-operatório após anestesia geral para cirurgia laparoscópica abdominal eletiva. A avaliação otorrinolaringológica mostrou paralisia da corda vocal esquerda. Conclusão: A paralisia de cordas vocais pode ser uma complicação séria da anestesia geral devido ao risco grave de disfunção da voz e aspiração. O manejo dessa condição ainda não está totalmente estabelecido, de modo que a prevenção e o diagnóstico precoce são essenciais.


Subject(s)
Humans , Male , Vocal Cord Paralysis/etiology , Intubation, Intratracheal , Anesthesia, General/adverse effects , Risk Factors , Middle Aged
15.
Braz. j. otorhinolaryngol. (Impr.) ; 84(5): 620-629, Sept.-Oct. 2018. tab
Article in English | LILACS | ID: biblio-974362

ABSTRACT

Abstract Introduction: Patients with unilateral vocal fold paralysis may demonstrate different degrees of voice perturbation depending on the position of the paralyzed vocal fold. Understanding the effectiveness of voice therapy in this population may be an important coefficient to define the therapeutic approach. Objective: To evaluate the voice therapy effectiveness in the short, medium and long-term in patients with unilateral vocal fold paralysis and determine the risk factors for voice rehabilitation failure. Methods: Prospective study with 61 patients affected by unilateral vocal fold paralysis enrolled. Each subject had voice therapy with an experienced speech pathologist twice a week. A multidimensional assessment protocol was used pre-treatment and in three different times after voice treatment initiation: short-term (1-3 months), medium-term (4-6 months) and long-term (12 months); it included videoendoscopy, maximum phonation time, GRBASI scale, acoustic voice analysis and the portuguese version of the voice handicap index. Results: Multiple comparisons for GRBASI scale and VHI revealed statistically significant differences, except between medium and long term (p < 0.005). The data suggest that there is vocal improvement over time with stabilization results after 6 months (medium term). From the 28 patients with permanent unilateral vocal fold paralysis, 18 (69.2%) reached complete glottal closure following vocal therapy (p = 0.001). The logistic regression method indicated that the Jitter entered the final model as a risk factor for partial improvement. For every unit of increased Jitter, there was an increase of 0.1% (1.001) of the chance for partial improvement, which means an increase on no full improvement chance during rehabilitation. Conclusion: Vocal rehabilitation improves perceptual and acoustic voice parameters and voice handicap index, besides favor glottal closure in patients with unilateral vocal fold paralysis. The results were also permanent during the period of 1 year. The Jitter value, when elevated, is a risk factor for the voice therapy success.


Resumo Introdução: Pacientes com paralisia unilateral de prega vocal podem apresentar diferentes graus de distúrbios da voz, dependendo da posição da prega vocal paralisada. A compreensão da eficácia da terapia vocal nesta população pode ser um coeficiente importante para definir a abordagem terapêutica. Objetivo: Avaliar a eficácia da terapia vocal em curto, médio e longo prazos em pacientes com paralisia unilateral de prega vocal e determinar os fatores de risco para falha na reabilitação da voz. Método: Estudo prospectivo, no qual 61 pacientes com paralisia unilateral de prega vocal foram recrutados. Cada participante foi submetido a terapia vocal com um fonoaudiólogo experiente duas vezes por semana. Um protocolo de avaliação multidimensional foi utilizado no pré-tratamento e em três momentos após o início da terapia da voz: curto prazo (1-3 meses), médio prazo (4-6 meses) e longo prazo (12 meses); incluiu videoendoscopia, tempo máximo de fonação, escala GRBASI, análise de voz acústica e a versão em português do Voice Handicap Index. Resultados: Os dados comparativos temporais das avaliações revelaram diferenças estatisticamente significativas, exceto entre médio e longo prazo (p < 0,005). Os dados sugerem que há melhora vocal ao longo do tempo com resultados de estabilização após seis meses (médio prazo). Dos 28 pacientes com paralisia unilateral permanente da prega vocal, 18 (69,2%) atingiram o fechamento glótico completo após a terapia vocal (p = 0,001). O método de regressão logística indicou que o Jitter entrou no modelo final como um fator de risco para melhora parcial. Para cada unidade de aumento de Jitter, houve um aumento de 0,1% (1,001) da chance de melhora parcial, o que significa um aumento na chance de não ocorrer melhora completa durante a reabilitação. Conclusão: A reabilitação vocal melhora os parâmetros de voz perceptiva e acústica e o índice de incapacidade vocal, além de favorecer o fechamento glótico em pacientes com paralisia unilateral da prega vocal. Além disso, os resultados também foram permanentes durante o período de um ano. O valor de Jitter, quando elevado, é um fator de risco para sucesso parcial da terapia vocal.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Voice Training , Vocal Cord Paralysis/etiology , Vocal Cord Paralysis/therapy , Neoplasms/complications , Quality of Life , Speech Acoustics , Time Factors , Voice Quality , Voice Disorders/etiology , Voice Disorders/therapy , Prospective Studies , Treatment Outcome , Neoplasms/classification
16.
Rev. bras. anestesiol ; 68(5): 521-523, Sept.-Oct. 2018.
Article in English | LILACS | ID: biblio-958333

ABSTRACT

Abstract Background and objective Some surgical procedures such as laryngoplasty require patients to remain conscious during the intraoperative phase in order to enable speech monitoring. Dexmedetomidine and remifentanil were used in this study, since they promote appropriate patient collaboration with facilitated awakening, and are rapidly eliminated. Case report The patient complained of dysphonia, which had resulted from unilateral vocal fold paralysis after previous thyroidectomy. The surgical treatment was performed under local anesthesia in association with sedation using dexmedetomidine and remifentanil. The patient was stable and cooperative during the entire intraoperative period, without desaturation and with rapid postoperative awakening. Conclusion Dexmedetomidine and remifentanil can be used for safe sedation; however, the presence of an anesthesiologist is required during the entire intraoperative period.


Resumo Justificativa e objetivos Alguns procedimentos cirúrgicos requerem que o paciente se mantenha consciente no intraoperatório, como as laringoplastias, para que a monitoração da voz seja feita. Optamos pelo uso de dexmedetomidina e remifentanil por serem fármacos que proporcionam adequada colaboração do paciente com fácil despertar, são rapidamente eliminados do organismo. Relato de caso Paciente com queixa de disfonia por paralisia de corda vocal unilateral após realização de tireoidectomia. O procedimento foi realizado com anestesia local associada à sedação com dexmedetomidina e remifentanil. A paciente ficou estável e colaborativa durante toda a operação, sem períodos de dessaturação e com rápido despertar pós-operatório. Conclusão Dexmedetomidina e remifentanil podem ser utilizados para sedação com grande segurança, mas isso não dispensa a necessidade do cuidado por um anestesiologista em tempo integral durante o procedimento.


Subject(s)
Humans , Dexmedetomidine/administration & dosage , Laryngoplasty/rehabilitation , Remifentanil/administration & dosage , Thyroidectomy/instrumentation , Vocal Cord Paralysis/physiopathology , Dysphonia/etiology
17.
Neumol. pediátr. (En línea) ; 13(1): 24-28, ene. 2018. ilus, tab
Article in Spanish | LILACS | ID: biblio-999235

ABSTRACT

Stridor is a musical, often high-pitched sound produced by a rapid, turbulent flow of air through a narrowed segment of the large airways. The cause of stridor can be located anywhere in the extrathoracic airway (nose, pharynx, larynx, and trachea) or the intrathoracic airway (tracheobronchial tree). Stridor may be acute (caused by inflammation/infection or foreign body inhalation) or chronic. It may be congenital or acquired. Various congenital and acquired disorders prevail in neonates, infants, children, and adolescents, and need to be distinguished. Medical history and age of the child, together with physical examination, often allow a presumptive diagnosis. Further tests may be necessary to establish a definite diagnosis, and flexible airway endoscopy is the diagnostic procedure of choice in most circumstances


Estridor es un sonido musical, de alta frecuencia, generado por el paso de un flujo de aire turbulento en zonas con calibre disminuido de la vía aérea de mayor tamaño.La causa del estridor puede estar localizado en cualquier lugar de la vía aérea extratorácica (nariz, faringe, laringe y tráquea) o la vía aérea intratorácica (árbol traqueobronquial). El estridor puede ser agudo (causado por inflamación/infección o aspiración de cuerpos extraños) o crónica. Puede ser congénita o adquirida. Varios trastornos congénitos y adquiridos prevalecen en neonatos, lactantes, niños y adolescentes, y tienen que ser distinguidos. La historia clínica, edad del niño y examen físico a menudo permiten un diagnóstico presuntivo. Puede requerirse mayor estudio para establecer un diagnóstico definitivo, y la endoscopia flexible de la vía aérea es el procedimiento diagnóstico de elección en la mayoría de las circunstancias


Subject(s)
Humans , Infant , Respiratory Sounds/diagnosis , Respiratory Sounds/etiology , Airway Obstruction/complications , Respiratory Function Tests , Bronchoscopy , Gastroesophageal Reflux/complications , Vocal Cord Paralysis/complications , Airway Obstruction/diagnosis , Endoscopy , Laryngomalacia/complications
18.
Rev. colomb. cir ; 33(1): 27-36, 2018. fig, tab
Article in Spanish | LILACS, COLNAL | ID: biblio-905298

ABSTRACT

Introducción. La temida complicación de la tiroidectomía es la parálisis de las cuerdas vocales secundaria a lesiones del nervio laríngeo recurrente. En este estudio se analiza una técnica de reconstrucción para estas lesiones neurales. Objetivo. Describir los resultados funcionales de la reconstrucción inmediata de las lesiones del nervio laríngeo recurrente con la técnica de Horsley. Material y métodos. Se llevó a cabo un estudio prospectivo entre enero del 2000 y diciembre del 2015, en pacientes con sección del nervio laríngeo recurrente y reconstrucción de Horsley, en el cual se evalúan: a) los índices del análisis acústico de voz [tiempo máximo de fonación, perturbación involuntaria de la frecuencia (jitter), perturbación de la amplitud (shimmer) y frecuencia fundamental], b) los hallazgos estroboscópicos, y c) el índice de discapacidad vocal. El análisis estadístico se hizo con la prueba exacta de Fisher y con el programa SPSS™. Resultados. Se practicaron 1.547 tiroidectomías y se produjeron 10 secciones del nervio laríngeo recurrente (0,64 %): dos (0,12 %) inadvertidas (p=0,0001) y 8 (0,51 %) advertidas por infiltración tumoral. En los exámenes de la calidad de voz, se encontraron: frecuencias fundamentales bajas con medias de 104,79 ± 0,29 Hz en hombres (valor de referencia, VR=141,74) y de 208,12 ± 22,72 Hz en mujeres (VR=241,08), que se correlaciona con un jitter de 1,39 ± 0,99 % (VR=1,04); y también, disminución del tiempo máximo de fonación (media=10,9 ± 3,07 s). El índice de percepción de calidad de la voz fue de discapacidad leve de la voz (22,7 ± 11,8). La estroboscopia mostró cierre completo de la glotis en nueve pacientes (90 %) (p=0,005), con una posición adecuada de los cartílagos aritenoides, en siete. Conclusiones. La tasa de lesión inadvertida del nervio laríngeo recurrente en el Hospital Militar Central es de 0,12 %. La técnica de Horsley tiene unos resultados funcionales satisfactorios en el 90 % de los casos


Background. The most feared complication of thyroidectomy is the vocal cord palsy secondary to injury of the recurrent laryngeal nerve. In this study we analize the Horsley technique for reconstruction for this surgical injury. Objective. The aim of this study was to describe the functional outcomes of the reconstruction of the recurrent laryngeal nerve by the Horsley technique. Materials and methods. A prospective study including patients with section of the recurrent laryngeal nerve and the use of the of the Horsley technique for reconstruction was carried out in the period January 2000 to December 2015. The outcomes evaluated were: a) acoustic voice analysis indexes (maximum phonation time, involuntary disturbance of frequency (jitter), disturbance of amplitude (shimmer), and fundamental frequency); b) stroboscopic findings; and c) vocal disability index. The Fisher's exact test and the SPSS™ program were used for the statistical analysis. Results.The study included 1,547 thyroidectomies with 10 complete sections of the recurrent laringeal nerve (0.64%), 2 unnoticed injuries (0.12%) (p=0,0001), and 8 injuries identified intraoperatively in patients with tumor infiltration. In the voice quality test we found: low fundamental frequencies with median values of 104.79 ± 0, Hz in the male population (reference value, RV=141,74) and 208,12 ± 22,72 Hz in the female population (RV=241,08), wich correlates with a jitter of 1,39 ± 0,99% (RV=1,04) and with a decrease in maximum phonation time (median=10,9 ±3,07s). Index of perception of voice quality was mild voice disability (22,7 ± 11,8). Stroboscopy showed complete clossure of glottis in 9 patients (90%) (p=0,005), with an adequate position of the arytenoid cartilages in 7 patients. Conclusions. The rate of unnoticed injuries of recurrent laringeal nerve at Central Military Hospital in Bogotá, Colombia, is 0.12%. The Horsley reconstruction technique demonstrated satisfactory functional results in 90% of cases


Subject(s)
Humans , Thyroidectomy , Recurrent Laryngeal Nerve , Recurrent Laryngeal Nerve Injuries , Vocal Cord Paralysis
19.
Article in Chinese | WPRIM | ID: wpr-775965

ABSTRACT

OBJECTIVES@#To analyze the clinical characteristics of paroxysmal laryngospasm in adult.@*METHODS@#A retrospective analysis was performed on 149 patients with paroxysmal laryngospasm in adult. All patients underwent the strobolaryngoscopy, completed the reflux symptom index (RSI) or the reflux finding score (RFS). Partial patients underwent an ambulatory 24-hour pH measurement.@*RESULTS@#Laryngospasm was diagnosed in 76 females and 73 males. The average age was 55.4±11.4. The episode time of 149 (98%) patients last from several seconds tominutes, and 139 (93.3%) episodes could have a spontaneous remission. 84 (56.4%) episodes occurred only in the daytime, 28 (18.8%) only in the nighttime. There were 45.6% over weight/obesity patients, including 40 males and 28 females. The smokers were 28.9% (43/149) including 40 males and 3 females, and the drinkers were 29.5% (44/149) with 39 males and 5 females. 76 (51.0%) patients had no induced factor, while some caused by irritable cough/bucking (53,35.6%), cold (15, 10.1%), excitant food/smell (10, 6.7%), or regurgitation (6.5, 4.0%). Strobolaryngoscopy revealed laryngopharyngeal lesions in 46.3% (69/149) patients, including the glottic lesions with 40 (26.8%), unilateral vocal fold paralysis (21, 14.1%) and supraglottic lesions (8,5.4%). RSI/RFS showed 74.5% (111/149) patients had laryngopharyngeal reflux. Two patients treated with dietary and lifestyle modifications get improved, and 15/16 of the patients responded to antireflux treatment.@*CONCLUSIONS@#Episode of paroxysmal laryngospasm occurs more in the daytime, and could have a spontaneous resolution. Paroxysmal laryngospasm is much easier to occur in the male who are overweight or obesity, or with a long-term history of smoking or drinking. Almost half of the patients have an induced factor; partial may have laryngopharyngeal lesions simultaneously. Paroxysmal laryngopharyngeal reflux may be closely related to laryngospasm.


Subject(s)
Adult , Aged , Female , Humans , Hypopharynx , Laryngismus , Laryngopharyngeal Reflux , Pathology , Male , Middle Aged , Retrospective Studies , Vocal Cord Paralysis , Pathology
20.
Article in Chinese | WPRIM | ID: wpr-775963

ABSTRACT

OBJECTIVES@#To identify diagnostic value of laryngeal electromyography (LEMG) in differentiating vocal fold paralysis (VFP) from arytenoid dislocation.@*METHODS@#The history, laryngeal morphologic characteristics and LEMG of 36 patients with VFP and 10 patients with arytenoid dislocation were compared and analyzed.@*RESULTS@#The most common cause of 36 VFP patients was surgical damage (24 cases), and the most common cause of 10 arytenoid dislocation patients was history of endotracheal intubation (9 cases). There was no statistical difference between the vocal fold and the fixed position of the vocal fold between the group of VFP patients and arytenoid dislocation patients. In the patients with VFP, 33 VFP patients (91.67%) had decreased recruitment; 9 cases (9/13) of denervation potential and 8 cases (8/9) of regeneration potential occurred within 1-6 months of the course of disease; 3 cases (3/4) of synkinesis occurred in the course of disease more than 6 months. In the patients with VFP, the amplitude (<0.01) and turns (<0.05) of thyroarytenoid muscles significantly decreased in the lesioned side comparing to the normal one, but the turns/amplitude ratio showed no statistical difference. In the patients with superior laryngeal nerve injury, the turns and amplitude analysis of cricothyroid muscles showed no statistical difference. All of 10 patients with arytenoid dislocation showed normal LEMG patterns.@*CONCLUSIONS@#LEMG can be used to differentiate the patients with vocal cord paralysis from arthrodesis dislocation, and can also carry out quantitative analysis to provide valuable help for the diagnosis.


Subject(s)
Arytenoid Cartilage , Electromyography , Humans , Laryngeal Muscles , Vocal Cord Paralysis , Diagnosis , Vocal Cords
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