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BMJ Case Rep ; 13(12)2020 Dec 13.
Article in English | MEDLINE | ID: covidwho-975661


A 59-year-old man presented to the emergency department with recent onset biphasic stridor, dyspnoea and increased work of breathing on the background of prolonged intubation for the novel COVID-19 2 months previously. Flexible laryngoscopy revealed bilateral vocal fold immobility with a soft tissue mass in the interarytenoid region. The patient's symptoms improved with oxygen therapy, nebulised epinephrine (5 mL; 1:10 000) and intravenous dexamethasone (3.3 mg). The following morning, the patient was taken to theatre, underwent suspension microlaryngoscopy and found to have bilateral fixation of the cricoarytenoid joints and a large granuloma in the interarytenoid area. He underwent cold steel resection of the granuloma and balloon dilatation between the arytenoids, with the hope of mobilising the joints. This failed and CO2 laser arytenoidectomy was performed on the left side. The stridor had resolved postoperatively, with normalisation of work of breathing and the patient was discharged home on the first postoperative day.

COVID-19/therapy , Granuloma/surgery , Intubation, Intratracheal/adverse effects , Laryngeal Diseases/surgery , Constriction, Pathologic/etiology , Constriction, Pathologic/surgery , Dyspnea/etiology , Emergencies , Granuloma/etiology , Humans , Laryngeal Diseases/etiology , Larynx/pathology , Male , Middle Aged , Respiratory Sounds , SARS-CoV-2 , Work of Breathing
Ear Nose Throat J ; 100(1_suppl): 105S-112S, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-792910


BACKGROUND: The recent introduction of 445 nm blue laser to office-based laryngology presents potential advantages. These include a desirable combination of cutting and photoangiolytic qualities and a lightweight, shock-resistant design. Despite its increasing use, current evidence is limited to experimental data and case reports. OBJECTIVES: The authors present a case series and overview of office blue laser transnasal flexible laser surgery (TNFLS), considering indications, patient selection, safety, technique, and surgical outcomes. We also review the safety and relevance of TNFLS to the ongoing coronavirus pandemic. METHODS: Retrospective case series and narrative review. Our primary outcome measure was preoperative and postoperative Voice Handicap Index (VHI-10) score. Complications were documented by nature and severity. RESULTS: Thirty-six cases of office blue laser TNFLS were performed. A statistically significant improvement in VHI-10 score was demonstrated in cases of recurrent respiratory papillomatosis (RRP) and benign laryngeal lesions causing dysphonia (P < 0.01 and 0.045). Blue laser also proved effective in assisting office biopsy procedures. A minor and self-limiting complication was reported. CONCLUSIONS: Office blue laser TNFLS is safe and effective in the treatment of RRP and a range of benign laryngeal lesions. Future research should compare the efficacy and safety of blue laser with potassium titanyl phosphate laser in office-based treatment of these conditions. Further assessment of the cutting qualities of blue laser, initially in the theater environment, is necessary to refine our understanding of future applications.

COVID-19/prevention & control , Endoscopy/instrumentation , Laryngeal Diseases/surgery , Laser Therapy/instrumentation , Adult , Color , Endoscopy/adverse effects , Female , Humans , Laser Therapy/adverse effects , Male , Middle Aged , Personal Protective Equipment , Retrospective Studies , SARS-CoV-2