ABSTRACT
Although xerostomia is associated with aging, studies have determined that salivary gland function is well preserved in the healthy geriatric population. Therefore, dry mouth is probably not a condition of aging, but most likely one of systemic or extrinsic origin. Saliva seems to undergo chemical changes with aging. As the amount of ptyalin decreases and mucin increases, saliva can become thick and viscous and present problems for the elderly. One of the most prevalent causes of xerostomia is medication. Anticholinergics, such as psychotropic agents and antihistamines, and diuretics can dry the oral mucosa. Chronic mouth breathing, radiation therapy, dehydration, and autoimmune diseases, such as Sjögren's, can also diminish salivation, as can systemic illness such as diabetes mellitus, nephritis, and thyroid dysfunction. Xerostomia can lead to dysgeusia, glossodynia, sialadenitis, cracking and fissuring of the oral mucosa, and halitosis. Oral dryness can affect denture retention, mastication, and swallowing. Dry mouth symptom can be treated with hydration and sialagogues or with artificial saliva substitutes. Because patients are at risk for dental caries, they should be referred to a dentist for preventive care. In patients with Sjögren's syndrome and in those who have undergone radiation therapy, pilocarpine has been used recently with good results.
Subject(s)
Xerostomia/diagnosis , Aged , Aged, 80 and over , Aging/physiology , Female , Geriatric Assessment , Humans , Male , Middle Aged , Prevalence , Xerostomia/epidemiologyABSTRACT
Vasculitis can involve the larynx in 4% to 10% of cases and can cause arthritis, edema, or upper airway obstruction within the larynx. Since most of these laryngeal manifestations are nonspecific, the clinician needs to keep a high index of suspicion when a patient complains of hoarseness or laryngeal discomfort and chronic constitutional symptoms. We present a case of crescentic glomerulonephritis associated with antineutrophil crytoplasmic autoantibody (ANCA). In addition, we discuss the usefulness and indications of ANCA serology and review multiple laryngeal manifestations that have been associated with common vasculitides and reported in the medical literature.
Subject(s)
Cough/etiology , Hoarseness/etiology , Laryngeal Diseases/diagnosis , Larynx/blood supply , Vasculitis/diagnosis , Antibodies, Antineutrophil Cytoplasmic/blood , Glomerulonephritis/diagnosis , Glomerulonephritis/immunology , Glomerulonephritis/pathology , Humans , Kidney Glomerulus/pathology , Laryngeal Diseases/immunology , Laryngeal Diseases/pathology , Larynx/pathology , Male , Middle Aged , Vasculitis/immunology , Vasculitis/pathologyABSTRACT
To determine the short-term effectiveness and outcome of office-based laser-assisted uvulopalatoplasty, a prospective statistically controlled study was done at the Department of Otolaryngology, Cleveland Clinic Florida. Thirty-eight consecutive snoring patients underwent a total of 98 laser-assisted uvulopalatoplasties, and data were gathered through examination, interview, and analog scales of snoring, pain, and other morbidity. In addition, a failure analysis was performed. Data were analyzed by descriptive statistics, confidence intervals, and adjusted analysis of variance (p < 0.008). Our results suggest that snoring decreased significantly around each laser-assisted uvulopalatoplasty treatment performed (4 to 8 weeks apart). Postoperative pain diminished after the first two laser-assisted uvulopalatoplasty treatments. The only morbidity in the series was the result of significant pain, causing 77% of laser-assisted uvulopalatoplasty failures.
Subject(s)
Laser Therapy , Palate, Soft/surgery , Snoring/surgery , Uvula/surgery , Adult , Ambulatory Surgical Procedures , Female , Follow-Up Studies , Humans , Male , Pain, Postoperative/etiology , Prospective Studies , Snoring/etiology , Treatment FailureABSTRACT
Hearing and/or balance disorders are symptoms that may be associated with tumors of the cerebellopontine angle (CPA). Between March 1988 and May 1995, 22 patients had diagnosis or evaluation of CPA tumors at Cleveland Clinic Florida. The most common presenting signs or symptoms included unilateral low-frequency tinnitus, unsteadiness, and/or asymmetric hearing loss. On the basis of our experience, we have constructed an algorithm to help identify and manage acoustic nerve dysfunction. We compare our findings with national epidemiologic data and current medical reports.
Subject(s)
Algorithms , Cerebellar Neoplasms/diagnosis , Cerebellopontine Angle , Adult , Aged , Aged, 80 and over , Audiometry , Cost-Benefit Analysis , Female , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Retrospective StudiesABSTRACT
Extraparotid Warthin's tumors continue to challenge the head and neck surgeon's diagnostic and therapeutic skills. A series of six extraporotid Warthin's tumors are presented to illustrate the need to keep a high index of suspicion for this lesion in the workup of cystic masses involving cervical levels II and III or in the event of a concomitant neck mass and a parotid Warthin's tumor. Discussion of the debate surrounding the embryogenesis and histogenesis of extraparotid Warthin's tumors follows. Clinical guidelines are suggested for the diagnosis, treatment, and follow-up of patients with extraparotid Warthin's tumors.
Subject(s)
Adenolymphoma , Head and Neck Neoplasms , Adenolymphoma/diagnosis , Adenolymphoma/surgery , Aged , Female , Head and Neck Neoplasms/diagnosis , Head and Neck Neoplasms/surgery , Humans , Male , Middle AgedABSTRACT
Sensorineural hearing loss (SNHL) is infrequently associated with peripheral neuropathy. When co-existent with peripheral neuropathy, it tends to present in the early adult years, is slowly progressive and is accompanied by optic atrophy or bowel abnormalities. The following case presents an unusual patient with severe and rapidly progressive SNHL and peripheral neuropathy.
