Percutaneous dilatational tracheostomy (PDT) has become an increasingly popular method of establishing an airway for patients in need of chronic ventilator assistance. We report a rare case of a 42-year-old female who developed extensive subcutaneous emphysema, bilateral pneumothoraces, pneumomediastinum, and pneumoperitoneum after percutaneous dilatational tracheostomy. The patient suffered from amyotrophic lateral sclerosis, and underwent PDT after a period of mechanical ventilation. During PDT, tracheostomy tube was inserted into the paratracheal space. Follow-up chest radiography and computed tomography of chest and abdomen revealed extensive subcutaneous emphysema, bilateral pneumothoraces, pneumomediastinum, and pneumoperitoneum. The patient was treated successfully with insertion of the thoracostomy tube and conservative care.
Abdomen ; Adult ; Amyotrophic Lateral Sclerosis ; Female ; Follow-Up Studies ; Humans ; Mediastinal Emphysema ; Methods ; Pneumoperitoneum ; Radiography ; Respiration, Artificial ; Subcutaneous Emphysema ; Thoracostomy ; Thorax ; Tracheostomy* ; Ventilators, Mechanical

Surgical fires require an ignition source, oxidizer, and fuel. The pulsed dye laser (PDL) has been shown to be effective in the treatment of hypertrophic scars and keloids in dermatology. With the increasing number of applications of CO2, laser as ignition source has been associated with operating room fires in the otorhinolaryngologic field. There have been many case reports on PDL-induced fires in dermatology, but until now, there were no reports in the larynx. We describe a 57-year-old patient diagnosed with laryngeal hyperkeratosis treated by PDL-assisted laryngomicrosurgery. In this case, we experienced incidental PDL tip flaring during pulsed dye laser vaporization.
Cicatrix, Hypertrophic ; Dermatology ; Fires ; Humans ; Keloid ; Larynx ; Lasers, Dye* ; Microsurgery ; Middle Aged ; Operating Rooms ; Volatilization

BACKGROUND AND OBJECTIVES: This study aims to conduct post-voice therapy to patients with unilateral vocal fold paralysis for vocal improvement, motility recovery and analyze the results. MATERIALS AND METHODS: Voice therapy was conducted to 13 patients who had shown response to voice therapy amongst 98 patients diagnosed with unilateral vocal fold paralysis. In order to be able compare before and after perceptual, acoustic and aerodynamic evaluations were conducted after voice therapy. Also, by using dysphagia checklist, we have verified whether if the patient had dysphagia prior to voice therapy. The therapy was conducted by improving the larynx movement and glottal contact, whilst removing hypertension of the supraglottic. RESULTS: All 13 patients who underwent voice therapy had shown improvements that are statistically significant from 4 scales excluding the S scale from auditory perception evaluation (p<0.05), with enhanced glottal contact. In acoustic evaluation, Jitter, Shimmer and NHR had shown significant improvement after voice therapy. MPT was also notably improved among aerodynamical evaluation (p<0.001). All 11 patients had with dysphagia prior to voice therapy reported to have improved swallowing functions. CONCLUSION: Application of adequate voice therapy to patients with unilateral vocal fold paralysis, is an effective method that might be employed in the initial phase. Especially, the voice therapy proposed in this study is expected to be useful for patients in hypertension status due to secondary compensation after initial paralysis, since it focuses on improving vocal symptoms in a calm state with the supraglottis sufficiently relaxed. Also, the therapy is expected to be effective for improving swallowing functions.
Acoustics ; Auditory Perception ; Checklist ; Compensation and Redress ; Deglutition ; Deglutition Disorders ; Humans ; Hypertension ; Larynx ; Methods ; Paralysis* ; Vocal Cords* ; Voice* ; Weights and Measures

BACKGROUND AND OBJECTIVES: Surgery is considered the primary treatment for intracordal cyst. However, patients who had undergone surgery are still subject to recurrence and continued voice changes. Intracordal cysts naturally disappear in some patient population. Cyst does not always recur in patients who had received partial surgical removal, too. Contradicting results raises a question whether complete surgical removal of intracordal cyst is necessary and demonstrate need for better treatment. Herein, the author proposes novel surgical method technique intralaryngeal needle technique (INT), a technique using surgical needle for not only injection but also for aspiration and excision of cyst. This study aims to examine the potential of intralaryngeal needle technique in treating intracordal cysts. MATERIALS AND METHODS: Surgical procedures were done on in-patients diagnosed with intracordal cyst. 23 patients received follow-up screening after the surgery for one year. Patients' subjective satisfaction levels, acoustic measures, aerodynamic measures, laryngeal stroboscopic results were compared before and after the treatment. RESULTS: Overall patients were satisfied with novel surgical excision method. In terms of aerodynamic measures, maximum phonation time, mean air flow rate improved after the surgery. In terms of acoustic measures, Jitter, Shimmer, NHR, and voice pitch changes after the treatment showed statistically significant differences. Laryngeal stroboscopy results showed significant decreases in cyst sizes. Post-surgery patients had improved mucosal waves and amplitudes values. CONCLUSION: The results show the validity of intralaryngeal needle technique in reducing intracordal cyst size by excision, aspiration, and injection. The author believes this novel technique can be used as an alternative surgical method for intracordal cysts.
Acoustics ; Follow-Up Studies ; Humans ; Mass Screening ; Methods ; Needles* ; Phonation ; Recurrence ; Stroboscopy ; Voice

BACKGROUND AND OBJECTIVES: Voice therapy is proven to be effective, but patients are reluctant to receive the therapy when physicians recommend it. This phenomenon may due to patients'lack of trust in or low satisfaction level of the therapy. This study aimed to evaluate patients'satisfaction level after voice therapy and identify factors that could increase the satisfaction. MATERIALS AND METHODS: First, the fraction of patients who were recommended voice therapy ahead and completed it was studied, and survey was conducted on those who finished ten voice therapy sessions. The patients'1) satisfaction level during the therapy, 2) satisfaction level about physician's explanation about the therapy, 3) willingness to recommend, 4) satisfaction level about the results were assessed, and was correlated with overall satisfaction level. In each category, patients' gender-, age-, and disease type-related differences were analyzed. RESULTS: Patients under 19 years old were most satisfied during the voice therapy; patients above 40 years old showed statistically significantly higher satisfaction level regarding satisfaction with physician explanation about treatments and with treatment results compared to other ages groups. Patients above 40 also showed the highest willingness to recommend. 26.5% of patients either refused to or discontinued voice therapy. 84.3% were satisfied with treatment results. Considering variabilities among factors, patients'satisfaction with physician explanation about treatment and willingness to recommend had positive correlation. CONCLUSION: Though 26.3% of patients received voice therapy when physicians recommended, patients who completed the therapy were overall satisfied.
Humans ; Voice Disorders* ; Voice*

Vocal polyps are benign laryngeal lesions which arise from the Reinke's space abd hoarseness is the most common symptom. However, airway compromised is rarely presented in the vocal polyp. A rare case of large subglottic polyp causing dyspnea is reported. Tracheostomy was performed under local anesthesia and then the mass was resected under general anesthesia using a laryngofissure approach. The dyspnea and hoarseness disappeared after surgery immediately. The histopathological findings indicated a diagnosis of vocal cord polyp with chronic inflammatiuon. We consider that tracheostomy is the safest and most useful procedure to guarantee the upper airway in cases of large vocal polyp showing dyspnea. We hereby report a case of huge subglottic polyp in which a tracheostomy and laryngofissure was required for removing the subglottic mass successfully.
Anesthesia, General ; Anesthesia, Local ; Diagnosis ; Dyspnea ; Hoarseness ; Polyps* ; Tracheostomy ; Tracheotomy* ; Vocal Cords

Candida exists in the oral cavity as normal flora, which is cultured in 7% of the population. And the development of candidiasis is usually related to the systemic or local immunosuppressed status such as diabetes, long-term antibiotics, steroid, radiation therapy or chemotherapy. However, isolated laryngeal candidiasis in immunocompetent patients is a rare entity with fewer than 40 cases reported in the world. Symptoms of laryngeal candidiasis are variable such as hoarseness, dysphagia, or odynophagia according to its extent, but it has clinical importance because of its resemblance with laryngeal premalignant or malignant lesions. Diagnosis is made by biopsy under direct laryngoscopy with special staining to identify the hyphae. In this article, we report a case of laryngeal candidiasis presented as leukoplakia localized on vocal fold with literature reviews.
Anti-Bacterial Agents ; Biopsy ; Candida ; Candidiasis* ; Deglutition Disorders ; Diagnosis ; Drug Therapy ; Hoarseness ; Humans ; Hyphae ; Laryngoscopy ; Larynx ; Leukoplakia* ; Mouth ; Vocal Cords

Laryngopharyngeal reflux disease (LPRD) is common in laryngologic practice. In Korea, up to 1 out of every 5 patients who visit otorhinolaryngology clinic is supposed to have LPRD with symptoms and physical findings. Major symptoms of LPRD include hoarseness, cough, reflux symptom and mild dysphagia. Even though LPRD is common, its diagnosis may be difficult, because its symptoms are nonspecific and the laryngeal findings are not always associated with symptom severity. In Recent study, 66.4% of Patient who has LPRD also associated with esophageal motility disorders. Esophageal achalasia is a disease of unknown etiology characterized by an absence of peristalsis in the body of esophagus and nonrelaxing hypertension of the lower esophageal sphincter. Common cause is loss of ganglion cells in Auerbachs plexus. The classic triad of symptoms in achalasia includes dysphagia, regurgitation and weight loss. LPRD and esophageal achalasia have similar symptoms but have different treatment of choice. The Differentiation diagnosis of theses disease is important and should be established by history, radiologic examination and endoscopic examination. We recently assessed a 59-year-old female patient who complained of an epigastric pain, dysphagia and chronic cough. LPRD was initially diagnosed on Laryngoscopic examination and Reflux Symptom Index, but patient was not relieved of any symptoms after treatment of Proton Pump Inhibitor for 3 months. After high resolution manometry, esophageal achalasia was finally diagnosed. We report this case regarding the diagnosis and treatment with review of literatures because we have to think about esophageal motility disorders as a differential diagnosis in laryngology.
Cough ; Deglutition Disorders ; Diagnosis ; Diagnosis, Differential ; Esophageal Achalasia* ; Esophageal Motility Disorders ; Esophageal Sphincter, Lower ; Esophagus ; Female ; Ganglion Cysts ; Hoarseness ; Humans ; Hypertension ; Korea ; Laryngopharyngeal Reflux* ; Manometry ; Middle Aged ; Myenteric Plexus ; Otolaryngology ; Peristalsis ; Proton Pumps ; Weight Loss

BACKGROUND AND OBJECTIVES: Globus pharyngeus is a sensation of foreign body in the throat. There are many studies evaluate relationships between globus pharyngeus and organic diseases such as laryngopharyngeal reflux, esophageal motility disorders as well as psychotic causes. But, Also many patients without etiologic causes complain of globus sensation. The authors performed a study that evaluate association between oral water intake and symptoms of globus sensation on the basis of a belief that pharyngeal dehydration due to lack of oral water intake causes globus sensation. MATERIALS AND METHODS: A survey using visual analogue scale to evaluate symptoms was performed with 73 patients with globus pharyngeus. RESULTS: Patients who drink water less than 500 mL per day (p=0.04) and less than five times per day (p=0.02) were improved after 6 months due to education and doctor's recommendation. CONCLUSION: Frequent and enough water intake should be recommended to resolve symptoms of globus sensation.
Dehydration ; Drinking* ; Education ; Esophageal Motility Disorders ; Foreign Bodies ; Humans ; Laryngopharyngeal Reflux ; Pharynx ; Sensation ; Water*

BACKGROUND AND OBJECTIVES: This study evaluated the efficacy of combination therapy of proton pump inhibitor (PPI) and steroid inhaler (SI), with or without botulinum toxin injection (BTX) for contact granuloma. SUBJECTS AND METHODS: Fourteen contact granuloma patients were enrolled in this study. Combination therapy of PPI and SI were used for the first line treatment. When combination therapy was not effective, BTX was performed as the second method. Treatment results were recorded as responsible or non-responsible. Farwell grade, size, history of voice abuse, gender, and reflux finding score (RFS) were compared between responsible group and non-responsible group. RESULTS: Initial response rate was 28.6% after treatment of PPI and SI. BTX was performed on three un-responsible patients. After BTX injection, three patients had complete remission of granuloma. Final response rate was 50.0%. Un-responsible group had significantly higher RFS than responsible group. CONCLUSION: The efficacy of PPI and SI was limited for contact granuloma in this study. Botulium toxin injection was recommended in early phase when PPI and SI did not effective for contact granuloma. Prospective studies evaluating the effects of PPI and SI are warranted.
Botulinum Toxins ; Granuloma* ; Humans ; Methods ; Nebulizers and Vaporizers* ; Prospective Studies ; Proton Pumps* ; Protons* ; Vocal Cords ; Voice