Humans ; Hoarseness/etiology* ; Larynx

No abstract available.
Evaluation Studies as Topic* ; Hoarseness*

Introduction: During a thyroidectomy, the neck is hyperextended. This position may inverse the tracheal axis to the endotracheal tube (ET), can cause damage to the vocal cords and tracheal wall. We propose a simple turn of the ET corresponding with the laryngo-tracheal axis to reduce of post-operative sore throat (PST) and hoarseness (H) in thyroidectomy patients. Methods: 122 patients undergoing general anesthesia were prospectively randomized divided into 4 groups. Gp1 (n=31): normal ET tube placement. Gp2 (n=30): normal ET tube rotated 180o following insertion. Gp3 (n=30): armoured tube. Gp4 (control, n=31): Normal ET tube in operations other than thyroidectomy, that require hyperextension. Cuff pressure (CP) and inspiratory peak pressure (IPP) were monitored during anesthesia. PST and H were evaluated by a VAS (0-10mm). Results: The 4 groups were similar in age, gender and intubation duration. IPP remained stable in all 4 groups. However, CP increased significantly in Gp1 and Gp4 after hyperextension. GP1 had the most PST and H (p<0.05). Tube rotation achieved the same results as the Armoured tube. Discussion: Rotating ET tube 180o reduced PST and H as much as intubation with a armoured tube. This rotation did not interfere with ventilation during anesthesia.
Thyroidectomy, Hoarseness, Pharyngitis, Intubation, Intratracheal

INTRODUCTION: Sore throat and hoarseness often follow general anesthesia administered via a single-lumen endotracheal tube (SLT). Numerous studies have investigated the role of factors as contributing causes, but the influence of double-lumen endobronchial tube (DLT) has not been examined systemically. The goal of this study was to examine the incidence of sore throat and hoarseness after DLT insertion. METHODS: 70 patients who were intubated with SLT or DLT were studied. Sore throat and hoarseness were evaluated after 24~48 hr from extubation of each tubes. RESULTS: In SLT and DLT group, the incidence of sore throat and hoarseness was 14 patients (40%) vs 16 patients (45.7%) and 8 patients (22.8%) vs 10 patients (28.5%), respectively. CONCLUSIONS: There are no statistical differences in incidence of sore throat and hoarseness between SLT and DLT.
Anesthesia, General ; Hoarseness* ; Humans ; Incidence* ; Intubation* ; Pharyngitis*

OBJECTIVE: Vocal cord paralysis or immobility is debilitating condition that may result from neural or mechanical fixation of the vocal cord (VC). When permanent, therapy is aimed at improving closure by modifying the position of the vocal cord. Whatever surgical intervention is chosen, pre-and post-operative voice evaluation is important. This study aimed to investigate the usefulness of the Glottal Function Index (GFI) and Grade, Roughness, Breathiness, Asthenia, Strain (GRBAS) Scale in the evaluation of treatment outcomes in patients with unilateral vocal cord paralysis (UVCP) who underwent medialization thyroplasty type 1 with a modified lock-in soft silicone implant.

METHODS:
Design: Descriptive Case Series
Setting: Tertiary Government Hospital
Patient: Five

RESULTS: Five patients (3 females, 2 males) consulted due to hoarness underwent rigid endoscopy. Four (2 right, 2 left) had unilateral paramedian VC paralysis while one had bilateral paresis with bowing of the left vocal cord. One of those with left VC paralysis was diagnosed as idiopathic; the four were iatrogenic (3 form thyroid surgery, 1 from multiple surgical procedures). All patients underwent medialization thyroplasty type 1 using locked-in soft silicone implant. The GFI and GRBAS scale were utilized for pre-operative and post-operative perceptual evaluation of voice. The GFI showed severe glottic insufficiency among all five patients prior to surgery with improvement of the subjective symptoms one day and one week post-surgery in four patients. Likewise, the Hirano GRBAS scale showed improvement of voice quality and correlated the improvement of the patient's subjective symptoms from the from GFI scores. However, 5 cases with bilateral vocal cord paresis, showed no improvement of voice quality despite recovery from subjective symptoms.

CONCLUSIONS: For glottal insufficiency, perceptual voice evaluation using self-administered GFI and GRBAS scale assessment are important parameters in determining the quality of life among patients with glottal insufficiency undergoing medialization laryngoplasty.

OBJECTIVES: To present a rare case of primary laryngeal aspergillosis manifesting with hoarseness in a seemingly healthy, immunocompetent, postpartum patient and discuss the probable contributing factors leading to this unusual disease process.

METHODS
Design: Case Report

Setting: Tertiary Private University Hospital

Subjects:  One

RESULTS: A 28-year-old previously healthy postpartum woman presented with hoarseness of a few weeks duration and recent intake of antibiotics and steroids. Videolaryngoscopy revealed a creamy, exophytic mass overlying both vocal folds. Microscopic examination revealed septated, dichotomously branching hyphae with acute angles characteristic of Aspergillus sp. The patient recovered with anti fungal medications.

CONCLUSION: The clinical presentation of laryngeal aspergillosis can be very non-specific and should not be disregarded merely on the basis of immune competence. It should be considered, together with other host and environmental factors when a patient responds poorly to conventional treatment. There is a need for quick and accurate diagnosis as the disease responds quite rapidly with appropriate anti fungal medications.

Objectives: The purpose of this study was to determine the efficacy of proton pump inhibitor (PPI) therapy in treating the symptoms and laryngeal findings of laryngopharyngeal reflux (LPR). Methods: Placebo-controlled, randomized clinical trials published after June 2001 to January 2021 which used PPI as the sole intervention and the RSI or RFS as outcome measures were eligible for inclusion. Studies that were published prior to June 2001, those which only made use of questionnaires other than the RSI or RFS, those which used PPI in combination with other treatments, or those with unavailable full-text manuscripts were excluded. These studies were identified from MEDLINE, Scopus, Cochrane Library, Embase, and HERDIN Plus databases which were searched from May 21 to 26, 2020. The primary outcome was the mean difference between baseline/pre-treatment and post-treatment RSI scores for both PPI and placebo groups. The secondary outcome was the mean difference between pre-treatment and post-treatment RFS scores for PPI and placebo groups. Aggregate results of these outcomes were analyzed using forest plots. Heterogeneity was determined through prediction intervals. Risk of bias of individual studies was assessed using the Cochrane Collaboration’s Tool in Assessing Risk of Bias. Results: Nine randomized control trials were included with a total of 737 patients randomized and 595 patients analyzed – 294 from the PPI group and 301 from the placebo group. There were notable variations among the studies in terms of choice of PPI, dosage and frequency. Out of nine studies, four used both RSI and RFS in their analysis. Two studies used RSI alone and three used the RFS in combination with symptom questionnaires other than the RSI. There was a significant decrease in the RSI of the PPI group versus the placebo group with a mean difference of -2.83 (95% CI, -5.13 to -0.53, p = .02). However, there was no significant decrease in the RFS between PPI and placebo groups with a mean difference of -0.84 (95% CI, -2.66 to 0.98, p = .37). For two clinical trials which only reported post-treatment RFS, there was also no significant difference between the two treatment groups with a mean difference of 1.27 (95% CI, -0.22 to 2.76, p = .10). Conclusion This meta-analysis found that, although a statistically significant benefit in RSI was noted with PPI therapy, this difference may not translate to a clinically significant change in symptoms; therefore, there is insufficient evidence to recommend for or against the treatment of LPR with PPIs.
Laryngopharyngeal Reflux ; Proton Pump Inhibitors ; Laryngitis ; Hoarseness

Introduction: Ortner’s syndrome encompasses any intrathoracic process resulting to stretching of the recurrent laryngeal nerve. The stress to this nerve weakens the intrinsic muscles of the larynx and manifests as vocal hoarseness. Case: A 46-year-old female was admitted due to progressive hoarseness. She tolerated this for six months until the onset of other symptoms like orthopnea, bipedal edema, and chest pain. She consulted various doctors and was initially diagnosed with chronic laryngitis from gastroesophageal reflux disease. She was given omeprazole and spironolactone that afforded little help. On examination, the precordium was dynamic with heaves and thrills, PMI was displaced, and systolic murmurs were heard. The ECG revealed left ventricular hypertrophy with left atrial abnormalities. Chest radiograph showed leftsided cardiomegaly. A 2D-echocardiogram divulged severe mitral regurgitation, anterior mitral valve leaflet thickening, and dilated left atrium. Therefore, the impression was Ortner’s syndrome, rheumatic heart disease. The patient underwent mitral valve replacement. She was given warfarin, bisoprolol, losartan, spironolactone, and vitamin B complex. At subsequent visits, she reported improvement in her voice. Penicillin injections were also given as secondary prophylaxis. A repeat 2D-echocardiogram displayed a decrease in size of the left atrium. Conclusion This case has emphasized three important points: First, a comprehensive history and physical examination is vital to reach the correct diagnosis. Second, once the common causes of hoarseness have been excluded yet symptoms persist, it is therefore prudent to look beyond the larynx. And third, the vocal cord paralysis experienced by the patient is just the tip of the iceberg. Her heart is the one dying to be heard.
Vocal Cord Paralysis ; Hoarseness ; Heart Failure

Accidents, Traffic ; Forensic Medicine ; Hoarseness ; Humans

Diagnostic Errors ; Hoarseness ; diagnosis ; Humans ; Hypothyroidism ; diagnosis