phenylephrine-hydrochloride and Laryngeal-Diseases

Upper airway disorders in children may be divided into those that are congenital in origin and those that are acquired. The presentation and management of these disorders is significantly influenced both by the anatomic location of the pathology, which is usually obstructive in nature, and by the severity of the obstruction. This discussion provides an overview of the presentation, diagnosis, management, and potential complications of the most commonly seen upper airway disorders. These disorders are presented within an anatomic framework, progressing from proximal at the nares to distal at the carina.

Topics: Airway Obstruction; Child; Choanal Atresia; Constriction, Pathologic; Hemangioma; Humans; Laryngeal Diseases; Larynx; Nose; Retrognathia; Trachea

Localized amyloidosis is a benign rare process in the head and neck. From 1972 to 1992, 12 patients with amyloid deposits of the head and neck were treated at the ENT Department of the University of Erlangen-Nürnberg. Negative congo red staining of rectal biopsy specimens established that the amyloidosis was not systemic. Localized amyloidosis appeared as a diffuse grey-to-yellow mass in the nose (n = 1) or larynx (n = 11). In 10 of the 12 cases excision of amyloid was possible with preservation of adjacent functional structures. Two patients refused surgery and underwent only symptomatic treatment with clinical followup investigations. Amyloid deposits completely excised did not recur during a mean postoperative period of 10 years. When not operated, the amyloid tumors showed a slowly progressive growth pattern.

Topics: Adolescent; Adult; Aged; Amyloidosis; Female; Humans; Laryngeal Diseases; Larynx; Laser Therapy; Male; Middle Aged; Nose; Nose Diseases; Retrospective Studies

The upper airways are a complex structure with multiple functions; many of the muscles participate in the act of respiration. The neural control of upper airway muscles is distinct from that of chest wall muscles under a variety of circumstances. Coordinated activation of upper airway muscles, both regionally and inter-regionally, results in changes in upper airway size and resistance, alterations in the route of airflow, and increases in the ability of the airways to resist collapse. Several disorders have now been described in which neuromuscular drive abnormalities and/or mechanical dysfunction of the upper airways occur, resulting in clinical disease.

Topics: Afferent Pathways; Behavior; Blood Pressure; Bronchial Spasm; Humans; Hypercapnia; Hypoxia; Laryngeal Diseases; Larynx; Lip; Mechanoreceptors; Muscles; Neuromuscular Diseases; Nose; Palate, Soft; Pharynx; Pulmonary Stretch Receptors; Reflex; Respiration; Respiratory Physiological Phenomena; Respiratory System; Sleep Apnea Syndromes; Vagus Nerve; Vocal Cords

Topics: Cardiac Surgical Procedures; Humans; Infant; Infant, Newborn; Intubation, Intratracheal; Laryngeal Diseases; Methods; Nose; Positive-Pressure Respiration; Respiratory Distress Syndrome, Newborn; Tracheal Stenosis; Tracheotomy; Ventilators, Mechanical

Transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) is an intraoperative ventilatory technique that allows avoidance of tracheal intubation (TI) or jet ventilation (JV) in selected laryngologic surgical cases. Unimpeded access to all parts of the glottis may improve surgical precision, decrease operative time, and potentially improve patient outcomes. The objective of this prospective, randomized, patient-blinded, 2-arm parallel pilot trial was to investigate the safety and efficacy of THRIVE use for adult patients undergoing nonlaser laryngologic surgery of short-to-intermediate duration.. Compared to TI/SHFJV, THRIVE use was associated with significantly lower intraoperative oxygenation (SpO. We confirm the safe intraoperative oxygenation profile of THRIVE for selected patients undergoing nonlaser laryngologic surgery of short-to-intermediate duration. THRIVE facilitated surgical exposure and improved early patient recovery, suggesting a potential economic benefit for outpatient laryngologic procedures. The results of this exploratory study provide a framework for designing future adequately powered THRIVE trials.. ClinicalTrials.gov (NCT03091179).. II Laryngoscope, 2020.

Topics: Adult; Aged; Female; Humans; Humidity; Insufflation; Intraoperative Care; Laryngeal Diseases; Male; Middle Aged; Nose; Pilot Projects; Prospective Studies; Respiration, Artificial; Single-Blind Method; Time Factors; Treatment Outcome

Topics: Anesthesia, Local; Female; Fiber Optic Technology; Humans; Laryngeal Diseases; Laser Therapy; Lasers, Solid-State; Male; Middle Aged; Natural Orifice Endoscopic Surgery; Nose; Polyps; Prospective Studies; Treatment Outcome; Vocal Cords

The objective of this work is to evaluate the safety, feasibility and efficacy of trans-nasal fiberendoscopic injection laryngoplasty (IL) with centrifuged autologous fat, performed under local anaesthesia, in the treatment of glottic insufficiency due to unilateral vocal fold paralysis (UVFP). It is a within-subject study with follow-up 1 week after phonosurgery and after 6 months. A total of 22 patients with chronic dysphonia caused by glottic insufficiency due to UVFP were enrolled. Each patient underwent trans-nasal IL with centrifuged autologous fat through flexible operative endoscope under local anaesthesia and was evaluated before and twice (1 week and 6 months) after phonosurgery, using a multidimensional set of investigations. The assessment protocol included videolaryngostroboscopy, perceptual evaluation of dysphonia, maximum phonation time and patient's self-assessment on voice-related quality of life (QOL) with the Voice Handicap Index-10 and the comparative self-assessment on vocal fatigue and voice quality pre-post treatment. Trans-nasal IL with centrifuged autologous fat was performed in all 22 patients and there were no complications in any case. Significant improvements in videolaryngostroboscopic findings, perceptual evaluation of dysphonia, maximum phonation time and QoL self-assessment were reported after 1 week and were maintained at 6 months. In one patient, the result after 6 months was not satisfactory and this patient then underwent a medialization laryngoplasty (thyroplasty type I) with satisfactory long-term results. In conclusion, trans-nasal fiberendoscopic IL with centrifuged autologous fat seems to be a safe, feasible and efficacious phonosurgical procedure for treatment of glottic insufficiency due to unilateral vocal fold paralysis.. Efficacia della laringoplastica iniettiva fibroendoscopica trans-nasale con grasso autologo centrifugato nel trattamento dell’insufficienza glottica da paralisi cordale monolaterale.. L’obiettivo di questo lavoro è quello di valutare la sicurezza, la fattibilità e l’efficacia della laringoplastica iniettiva (LI) fibroendoscopica trans-nasale con grasso autologo centrifugato, effettuata in anestesia locale, nel trattamento della insufficienza glottica da paralisi cordale monolaterale (PCML). È uno studio intra-individuale con controlli a una settimana e 6 mesi dopo la fonochirurgia. Riguardo ai metodi, sono stati arruolati nello studio 22 pazienti con disfonia cronica causata da insufficienza glottica da PCML. Ogni paziente è stato sottoposto a LI trans-nasale con grasso autologo centrifugato mediante endoscopio flessibile operativo in anestesia locale ed è stato valutato prima e a distanza di una settimana e 6 mesi dall’intervento di fonochirurgia, utilizzando una serie di indagini multidimensionale. Il protocollo valutativo comprendeva la videolaringostroboscopia, la valutazione percettiva della disfonia, il tempo massimo fonatorio e l’autovalutazione da parte del paziente sulla qualità della vita in relazione al problema vocale mediante il Voice Handicap Index-10 e l’Autovalutazione Comparativa pre-post trattamento riguardo alla fatica fonatoria e alla qualità della voce. I risultati hanno mostrato che la LI trans-nasale con grasso autologo centrifugato effettuata nei 22 pazienti non ha avuto complicanze. Sono stati riportati miglioramenti significativi dei rilievi laringostroboscopici, della valutazione percettiva della disfonia, del tempo massimo fonatorio e dell’autovalutazione sulla qualità della vita ad una settimana dall’intervento di fonochirurgia, che si sono mantenuti anche a distanza di 6 mesi. In un paziente il risultato dopo 6 mesi non è stato soddisfacente ed è stato operato di laringoplastica di medializzazione cordale (tiroplastica di tipo I) con soddisfacenti risultati a lungo termine. In conclusione, la LI fibroendoscopica trans-nasale con grasso autologo centrifugato sembra essere una procedura fonochirurgica sicura, fattibile ed efficace per il trattamento dell’insufficienza glottica da paralisi cordale monolaterale.

Topics: Adipose Tissue; Adult; Aged; Centrifugation; Feasibility Studies; Female; Fiber Optic Technology; Glottis; Humans; Injections; Laryngeal Diseases; Laryngoplasty; Laryngoscopy; Male; Middle Aged; Natural Orifice Endoscopic Surgery; Nose; Treatment Outcome; Vocal Cord Paralysis

Office-based procedures have been proposed for the treatment of vocal polyps, including indirect laryngoscopic surgery and angiolytic laser photocoagulation. Our previous report documented good treatment outcomes by combining the two aforementioned procedures. This study was intended to further compare the treatment outcomes of office transnasal vocal fold polypectomy (VFP) with those of microlaryngoscopic surgery (MLS).. A matched cohort study.. This study retrospectively enrolled 50 age-, gender-, and size-matched patients with vocal polyps treated by VFP or MLS at a tertiary teaching hospital from January 2012 to October 2013. Treatment outcomes were evaluated before, 2 weeks, and 6 weeks after the procedures via perceptual rating of voice quality, acoustic measurement of the speech signal, 10-item voice-handicap index, maximal phonation time, subjective rating of voice quality, and videolaryngostroboscopic evaluation.. Both VFP and MLS resulted in significant clinical improvements 2 and 6 weeks postoperatively. Study results exhibited similar objective outcomes between VFP and MLS, whereas patients who received VFP reported higher subjective voice quality than those receiving MLS 2 weeks postoperatively. Six weeks after the procedures, the objective and subjective treatment outcomes were not significantly different between the two treatment groups.. This study shows that transnasal VFP may be used as an effective alternative treatment for small vocal polyps. Patients who received office VFP experienced rapid symptomatic relief with a higher degree of subjective effectiveness than MLS 2 weeks postoperatively, whereas the overall treatment outcomes showed a comparable level of effectiveness for both modalities.. 3B.

Topics: Adult; Aged; Female; Follow-Up Studies; Humans; Laryngeal Diseases; Laryngoscopy; Male; Microsurgery; Middle Aged; Natural Orifice Endoscopic Surgery; Nose; Polyps; Retrospective Studies; Treatment Outcome; Vocal Cords; Voice Quality

The objective of this study was to evaluate the role of transnasal fiber-optic injection laryngoplasty in the treatment of glottic insufficiency.. Video recordings of 16 patients who underwent fiber-optic injection laryngoplasty for the treatment of glottic insufficiency were reviewed. Outcome measures included perceptual evaluation using the GRBAS (grading, roughness, breathiness, asthenia, straining) classification, laryngeal videostroboscopy, and frame-by-frame analysis to assess the extent, shape, and duration of glottic closure.. Nine patients were ultimately included in this study. Their mean age was 66.2 years, with 7 men and 2 women. The most common symptoms were dysphonia and aspiration, and the most common diagnosis was vocal fold paralysis. Patients underwent transnasal fiber-optic injection laryngoplasty with hyaluronic acid as a filling material (0.2-0.8 mL). The procedure was well tolerated by all patients, with improvement in the phonatory symptoms and aspiration in 66.66% and 50% of patients, respectively. There were significant decreases in the mean scores of all perceptual parameters (P<.05 for all). All subjects had glottal gap preoperatively that was closed completely in 66.66% and reduced to <2 mm in 33.33%. The mean closed quotient significantly increased from 0.10 to 0.51 (P<.05).. Transnasal fiber-optic injection laryngoplasty is a safe procedure well tolerated by patients with good results.

Topics: Adult; Aged; Aged, 80 and over; Female; Fiber Optic Technology; Follow-Up Studies; Humans; Hyaluronic Acid; Injections; Laryngeal Diseases; Laryngoplasty; Male; Middle Aged; Nose; Retrospective Studies; Video Recording; Viscosupplements

Topics: Barrett Esophagus; Esophagoscopy; Granuloma; Humans; Laryngeal Diseases; Laryngopharyngeal Reflux; Nose; Vocal Cords

Relapsing polychondritis is a rare systemic disease. Clinical manifestations are variable and the condition is frequently associated with other diseases. Chondritis typically involves ears, nose, costal cartilages and upper airways. Other classical features include scleritis and episcleritis, mucocutaneous lesions, arthralgia and constitutional symptoms. Repeated inflammation of cartilaginous structures may lead to deformities of the ears, the nose and the airways. Tracheobronchomalacia and aortitis of the ascending portion resulting in aortic regurgitation or aneurysm are feared complications. Treatment is mainly based on systemic corticosteroids alone or in association with immunosuppressants. Several biological immunosuppressive agents are reported effective in refractory disease.

Topics: Adrenal Cortex Hormones; Aneurysm; Anti-Inflammatory Agents, Non-Steroidal; Aortic Valve Insufficiency; Aortitis; Diagnosis, Differential; Drug Therapy, Combination; Ear, External; Humans; Immunosuppressive Agents; Laryngeal Diseases; Nose; Polychondritis, Relapsing; Scleritis; Skin; Tracheal Diseases; Tracheobronchomalacia; Treatment Outcome

Extranasal manifestations of rhinosporidiosis are relatively uncommon. Laryngeal involvement is extremely rare, as only 3 cases have been previously reported. We describe a new case, which occurred in a patient with coexisting nasal rhinosporidiosis who presented with inspiratory stridor. Both lesions were completely excised under general anesthesia without the need for preliminary tracheostomy.

Topics: Endoscopy; Female; Humans; Laryngeal Diseases; Laryngoscopy; Larynx; Middle Aged; Nose; Nose Diseases; Rhinosporidiosis; Rhinosporidium

Vocal cord dysfunction (VCD) has been reported in adolescents only rarely. Two patients are described whose initial diagnosis was exercise-induced bronchospasm (EIB). However, evaluation revealed inspiratory stridor and flattening of the inspiratory limb of the flow-volume curve. Flexible fiberoptic rhinolaryngoscopy revealed adduction of vocal cords during inspiration. Patients were treated with speech therapy and have remained free of symptoms. VCD should be considered in adolescents who are unresponsive to treatment for EIB.

Topics: Adolescent; Bronchial Spasm; Child; Diagnosis, Differential; Endoscopy; Female; Fiber Optic Technology; Follow-Up Studies; Forced Expiratory Volume; Humans; Inhalation; Laryngeal Diseases; Laryngoscopy; Nose; Physical Exertion; Pulmonary Ventilation; Respiratory Sounds; Speech Therapy; Vital Capacity; Vocal Cords

Post kala-azar dermal leishmaniasis (PKDL) involving the mucus membranes is relatively rare on the Indian sub-continent. We describe 3 cases of PKDL presenting with hoarseness of voice. In one case the skin, nasal, oral, oropharyngeal and laryngeal mucosa had nodular and nodulo-ulcerative lesions; in the 2 other cases, genitalia and anorectal mucosa were also affected. Laryngoscopic examination revealed nodular lesions on the vocal cords. Biopsy smear and culture confirmed their leishmanial origin.

Topics: Adolescent; Genitalia; Hoarseness; Humans; India; Laryngeal Diseases; Laryngeal Mucosa; Leishmaniasis, Visceral; Male; Middle Aged; Mouth; Nose; Oropharynx; Rectum; Skin; Vocal Cords

An auricular or nasal chondritis or a saddle nose deformity are the initial manifestation in half of cases of relapsing polychondritis; the other initial manifestations are various and less evocative; polyarthritis, laryngo-tracheal symptoms, episcleritis which delay the diagnosis. From 15 cases of relapsing polychondritis, the diagnosis time from the first symptom are studied; this one is long, about 3 years and 6 months (from 3 months to 17 years) in 13/15 of the cases even if the first manifestation is typical (external chondritis). In two cases only, the diagnosis was established after the first attack. This late of diagnosis had socioeconomical impact and exposed to severe complications like tracheal chondritis.

Topics: Adult; Aged; Cartilage Diseases; Diagnostic Errors; Ear Cartilage; Female; Humans; Laryngeal Diseases; Male; Middle Aged; Nose; Polychondritis, Relapsing; Retrospective Studies; Time Factors; Trachea

Thirty eight horses with epiglottal entrapment were examined. In 29 the dorsally displaced mucosa was split axially with a curved hook knife, per nasum. The condition was also treated by subepiglottal mucosal resection (4 horses) and solely by the administration of an anti-inflammatory throat spray (4 horses). All surgical cases were treated with an anti-inflammatory throat spray and parenteral phenylbutazone. Those horses treated via a laryngotomy incision were box rested until the laryngotomy incision healed. The other horses were restricted to walking and trotting exercise for 10 days before endoscopic re-assessment. If the condition had resolved by this stage the horse was then returned to full exercise. Epiglottal entrapment was alleviated in 22 horses treated by axial section but it recurred in 4 and 3 cases were lost to follow up. Two of 4 cases were treated successfully but mucosal resection and 2 of 4 cases by Nd:YAG laser. Three out of the 4 horses treated medically also recovered. Of the 38 horses, 6 required a second operation and 2 had a third surgical procedure. Of the horses treated by axial section of the displaced mucosa, 14 ran successfully without a respiratory sound or obstruction and 4 won races. In conclusion, using the hook knife inserted via the nasal passages offers a safe, relatively inexpensive and successful method of treating epiglottal entrapment.

Topics: Animals; Endoscopy; Epiglottis; Female; Horse Diseases; Horses; Laryngeal Diseases; Male; Nose; Surgical Instruments

To determine the mechanism for obstructive sleep apnea in two patients with clinical abnormalities of laryngeal function, airflow dynamics during sleep were analyzed. The site of airway obstruction was assessed by examining pressure gradients across specific airway segments. The relation between maximal inspiratory airflow and nasal pressure was analyzed to determine (1) the critical pressure, a measure of the collapsibility of the laryngeal airway, and (2) the effect of nasal continuous positive airway pressure on airflow during sleep. Large inspiratory pressure gradients developed during sleep between the supraglottic and pleural spaces, indicating that collapse had occurred in the larynx. Elevated critical pressures of -6.4 and +1.2 cm H2O, respectively, occurred in the two patients. When the nasal pressure was raised to 10 cm H2O, normal levels of tidal airflow occurred, and obstructive apneas were eliminated. These findings indicate that sleep apnea was caused by laryngeal airflow obstruction that resulted from elevations in the collapsibility of the larynx. The response to nasal continuous positive airway pressure suggested that laryngeal sleep apnea was similar to pharyngeal sleep apnea in pathophysiologic characteristic and response to treatment.

Topics: Adult; Airway Obstruction; Arnold-Chiari Malformation; Humans; Inhalation; Laryngeal Diseases; Male; Middle Aged; Nose; Positive-Pressure Respiration; Pressure; Pulmonary Ventilation; Respiratory Sounds; Shy-Drager Syndrome; Sleep Apnea Syndromes; Sleep Stages; Tidal Volume

Nasolaryngoscopy is easy to learn and safe and convenient to perform. It is readily accepted by patients and is a rich source of clinical information. The flexible nasolaryngoscope allows the physician to directly observe the anatomy of the nasal passages, pharynx and larynx. The procedure is helpful for identifying the etiology of chronic nasal complaints and hoarseness. Other possible indications for nasolaryngoscopy include suspected nasal foreign body, recurrent nasal or pharyngeal bleeding, and epiglottitis. With the use of this instrument, treatment of otolaryngologic conditions may be more specific, thereby reducing unnecessary referral or delay in treatment.

Topics: Endoscopy; Family Practice; Fiber Optic Technology; Humans; Laryngeal Diseases; Laryngoscopy; Nose; Nose Diseases; Pharyngeal Diseases; Pharynx

Four rare cases of congenital saddle-nose deformity and slowly progressive degeneration of laryngeal cartilages with stenosis are described. The term inherited degenerative chondropathy is suggested for this disease entity. To our knowledge this is the first article on such a disease.

Topics: Adolescent; Child; Female; Humans; Laryngeal Diseases; Laryngostenosis; Male; Nose; Nose Diseases; Pedigree; Polychondritis, Relapsing

Topics: Biopharmaceutics; Chemistry, Pharmaceutical; Eye Diseases; Humans; Laryngeal Diseases; Larynx; Nose; Nose Diseases

Topics: Child; Humans; Intubation, Intratracheal; Laryngeal Diseases; Mucous Membrane; Nose; Time Factors

Topics: Animals; Ear; Ear Diseases; Haplorhini; Humans; Laryngeal Diseases; Larynx; Neck; Nose; Nose Diseases; Otorhinolaryngologic Diseases

Topics: Child; Epiglottis; Humans; Intubation, Intratracheal; Laryngeal Diseases; Nose; Tracheotomy

Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Female; Hoarseness; Humans; Infant; Infant, Newborn; Intubation, Intratracheal; Laryngeal Diseases; Male; Middle Aged; Mucous Membrane; Nasal Mucosa; Necrosis; Nose; Nose Diseases; Pharyngeal Diseases; Polyps; Respiratory Tract Diseases; Time Factors

Topics: Asphyxia Neonatorum; Child, Preschool; Female; Humans; Infant; Infant, Newborn; Intubation, Intratracheal; Language Development; Laryngeal Diseases; Laryngoscopy; Nose; Speech Disorders; Thorax; Time Factors; Vocal Cords

Topics: Bites and Stings; Bronchi; Burns; Foreign Bodies; Humans; Inflammation; Laryngeal Diseases; Laryngeal Neoplasms; Larynx; Nose; Otorhinolaryngologic Diseases; Pharyngeal Neoplasms; Respiratory Insufficiency

Topics: Carcinoma, Basal Cell; Chromium; Humans; Laryngeal Diseases; Laryngitis; Nose; Nose Neoplasms; Occupational Diseases; Pharyngitis; Pharynx; Toxicology

Topics: Conjunctiva; Disease; Humans; Laryngeal Diseases; Larynx; Nose; Nose Diseases; Oxytetracycline; Radiotherapy; Rhinoscleroma; Streptomycin

Topics: Brain; Humans; Laryngeal Diseases; Larynx; Meningeal Neoplasms; Meningioma; Nose