No abstract available.
Airway Management ; Laryngeal Edema

OBJECTIVE: To present a case of relapsing polychondritis initially presenting with hoarseness and difficulty breathing and to discuss the diagnostic criteria and typical CT scan findings of relapsing polychondritis.
METHODS:
Design: Case Report
Setting: Tertiary Private Hospital in Metro Manila
Patient: One
RESULT: A 21-year-old man who was initially managed as a case of bronchial asthma for persistent hoarseness and recurrent difficulty breathing was found to have severe laryngeal edema on endoscopy, and soft tissue expansion of the cricoid cartilage with calcifications and irregular first tracheal ring on CT scan. He also had recurrent eye redness and developed bilateral aural inflammation, and was subsequently diagnosed to have relapsing polychondritis.
CONCLUSION: Relapsing polychondritis is a rare autoimmune disease characterized by recurrent inflammation and eventual destruction of cartilage throughout the body. Typical manifestations may not always be present, causing a delay in diagnosis. It should be considered in patients with intractable respiratory symptoms not responsive to treatment for upper respiratory tract infections or asthma. A CT scan may reveal signs of cartilage destruction and help in diagnosis.                 

BACKGROUND AND OBJECTIVES: Benign vocal fold lesions are a common cause of voice dysfunction. Successful treatment of these diseases is primarily accomplished through voice therapy and surgical treatment. But many clinicians are faced with cases where problems persist in spite of treatment. The one cause of treatment failure in benign vocal fold lesions may be the bilateral lesions each vocal fold has different lesion. Authors studied to evaluate the possibility of persisted voice dysfunction in bilateral benign vocal fold lesions. MATERIALS AND METHODS: Strobovideolaryngoscopy findings of 128 patients with bilateral benign vocal fold lesions were reviewed. We evaluate to see if lesions in each vocal fold of one patient were the same or not. The treatment methods for each lesion were classified. We compare the treatment methods for each lesion with those already performed on the patients. RESULTS: In cases with nodule in one vocal fold, we observed 8 edema, 2 epidermoid cyst in the opposite vocal fold. In cases with reinke's edema on both vocal fold, we observed combined lesion, such as 1 epidermoid cyst, 1 hyperkeratosis. In cases with sulcus vocalis on both vocal fold, we observed combined lesion, such as 3 nodules, 4 polyps, 6 edema. We observed 2 cases with epidermoid cyst in one side and edema in opposite vocal fold, 5 cases with bilateral vocal nodule and combined varices in one side, 2 cases with bilateral laryngeal edema and combined hyperkeratosis in one side. CONCLUSION: Bilateral benign vocal fold lesions sometimes have more than 2 laryngeal diseases for which the treatment modality is different. Clinician should know the lesion precisely in each vocal fold, and treatment plan should be also made in according to the lesion in each vocal fold.
Edema ; Epidermal Cyst ; Humans ; Laryngeal Diseases ; Laryngeal Edema ; Polyps ; Treatment Failure ; Varicose Veins ; Vocal Cords* ; Voice

Sometimes, anesthesiologist may have get a chance as if he can not intubate with ordinary direct laryngoscopy. At that time he must decided that intubation technique will try to again or not. If we have a decision as we will try to continue for intubation and we can not use any other intubation technique, we can have a decision to use retrograde intubation technique so as to intubate in trachea instead of direct laryngoscopy. If patient have much secretion, blood clot and laryngeal edema after had many times of direct laryngoscopy, fiberoptic bronchoscopy will be impossible. Since Buttler and Cirillo on 1960, retrograde intubation technique was improved markedly. Especially, most important improved point about this technique is that what things are used for guide wire. Recently, most of authors have been used for guide wire as CVP catheter, Swan-Ganz introducer wire or epidural catheter. But I used to epidural catheter for guide wire and patients have not any complication with this retrograde intubation technique. Finally, we concluded that retrograde intubation technique is one of good intubation technique and can do without any complicaions.
Bronchoscopy ; Catheters* ; Humans ; Intubation* ; Laryngeal Edema ; Laryngoscopy ; Trachea

Arytenoid edema following radiation therapy of laryngeal cancer may persist and make careful inspection and evaluation of the larynx difficult. Moreover, it may have serious impacts on functions such as breathing, swallowing, speech and voice. Conservative management such as antibiotics and steroid may be attempted but may be ineffective in progressive and severe cases of edema. We present four cases of persistent postradiation arytenoid edema successfully treated with partial resection of the arytenoid mucosa using transoral CO2 laser.
Anti-Bacterial Agents ; Arytenoid Cartilage ; Deglutition ; Edema ; Laryngeal Edema ; Laryngeal Neoplasms ; Larynx ; Lasers, Gas ; Mucous Membrane ; Respiration ; Voice

The authors have experience of three cases of laryngeal edema after tracheal intubation for general anesthesia. Two cases have been treated by oxygen therapy, epinephrine spray on the larynx and dexamethasone injection. A case has been treated after tracheostomy. We find the etiology of laryrigeal edema as follows; trauma, infection and allergic response to the lubricant, rubber, plastic and to topical anesthetics. We should like to prevent and remedy complications of tracheal intubation.
Anesthesia, General* ; Anesthetics ; Dexamethasone ; Edema ; Epinephrine ; Intubation* ; Laryngeal Edema* ; Larynx ; Oxygen ; Plastics ; Rubber ; Tracheostomy

BACKGROUND AND OBJECTIVES: It is not uncommon in patients with benign vocal fold lesions with voice change to accompany sulcus. The authors postulated that the coexistence of such benign lesions with sulcus would result in numerous problems related with phonation. The aim of this study was to recognize through voice analysis any particular phonation characteristics in patients with benign vocal fold lesions with coexisting sulcus, and to aid in diagnosis and treatment. MATERIALS AND METHOD: The study involved 574 patients who had been diagnosed with benign vocal fold lesions that accompanied voice change from Jan. 2001 through Sept. 2002. The diagnosis was made by videostroboscopy. The benign vocal fold lesions were observed in patients with sulcus and those without sulcus. Also specific benign vocal fold lesions were grouped into pairs determined by the existence of sulcus. Thus, patients with vocal nodules accompanied with sulcus were grouped as group NS and those without sulcus as group N: similarly, patients with vocal polyp and sulcus were grouped as PS and those without sulcus as group P: patients with Reinke's edema and sulcus as group RS and those without sulcus as group R, and patients with laryngeal edema and sulcus were grouped as group LS and without sulcus as group L. Each individual group went through psychoacoustic, acoustic and aerodynamic analyses and were compared against each other. RESULTS: Among patients with benign vocal fold lesions, about 50.2% had sulcus. It was observed that the rate of finding patients with sulcus increased when we began to have keen interest in sulcus. Among patients with benign vocal fold lesions without the accompaniment of sulcus, the most common form of benign vocal fold lesions was the vocal nodule. With coexisting sulcus, the most common form was laryngeal edema. In the psychoacoustic analysis group, the group NS exhibited more hoarseness than the group N: the group R exhibited greater hoarseness than the group RS. However, these results did not have statistical significance. In the acoustic analysis, the group NS had significantly higher shimmer score than the group N. In the aerodynamic analysis, the group NS and PS had exhibited significanlyt higher MFR scores than the groups N and P. CONCLUSIONS: The existence of sulcus in patients with benign vocal fold lesions has a clinical significance regarding treatment and prognosis. Although some acoustic analytic references may be useful in discovering the accompanying sulcus, careful observation of all vocal cords remains the most important component of such discoveries.
Acoustics ; Diagnosis ; Edema ; Hoarseness ; Humans ; Laryngeal Edema ; Phonation ; Polyps ; Prognosis ; Psychoacoustics ; Vocal Cords* ; Voice

After thyroid surgery, voice change occurs very frequently, in more than 30% of cases. In addition to injury to the recurrent laryngeal nerve (RLN) or the external branch of superior laryngeal nerve (EBSLN), vocal fold edema due to excessive tracheal traction or disrupted laryngeal venous drainage, and laryngotracheal fixation following injury to extralaryngeal musculature can cause post-thyroidectomy voice change. Although complete recovery can be expected mostly in 3 months, dysphonic patients should be evaluated pre and postoperatively by laryngoscopy or laryngeal stroboscopy. The present review discusses the evaluation of voice change, the anatomy of RLN and EBSLN and common cause of voice change after thyroid surgery. Furthermore, we represent how to preserve RLN, SLN including intraoperative nerve monitoring.
Drainage ; Edema ; Humans ; Laryngeal Nerves* ; Laryngoscopy ; Recurrent Laryngeal Nerve ; Stroboscopy ; Thyroid Gland ; Thyroidectomy ; Traction ; Vocal Cords ; Voice*

BACKGROUND: Reinkes edema is characterized by swelling of the vocal folds, and its etiology and pathogenesis have not yet been established. OBJECTS AND METHODS: We reviewed medical records of 25 patients (14 male and 11 female) who had undergone operation from 1996 to 1998. Post-operative voice lab and skin prick tests were done after 3 months when patients visited hospital. Telephone questionnaires were carried out about smoking and laryngopharyngeal reflux. RESULTS: In the smoking pattern, most patients (18/25) smoked more than 10 packs a year. Twelve patients (48%) complained of laryngopharyngeal reflux symptoms and 4 patients were positive for the skin prick test, Pre- and post-operative voice lab results showed that shimmer and phonation time changed significantly in women patients. Jitter, shimmer, phonation time, mean flow rate, vocal efficiency and subglottic pressure changed significantly in men patients. CONCLUSION: Smoking and laryngopharyngeal reflux may play an important role in developing Reinkes edema and phonatory quality will be improved after proper surgical procedure.
Edema* ; Female ; Humans ; Laryngeal Edema ; Laryngopharyngeal Reflux ; Male ; Medical Records ; Phonation ; Surveys and Questionnaires ; Skin ; Smoke ; Smoking ; Telephone ; Vocal Cords ; Voice*

Following short-term intubation for general anesthesia, respiratory difficulty may result from laryngeal or subglottic edema after extubation. We have hypothesized that this problem could be pretreated by administering a high-dose of dexamethasone intravenously before extubation. After glottic injuries were made under direct laryngoscopic view, intubation was performed and maintained for 1 hour in 33 rabbits. The rabbits were divided into 3 groups; dexamethasone (1 mg/kg) was administered to group 1(n=12) immediately after intubation and group 2(n=10) just before extubation; group 3(n=11) received normal saline, just before extubation. After extubation, subglottic excursion pressure was measured for 4 hours. 15 injured rabbit larynges and 3 normal ones were extracted for histologic section. 2 of 12 rabbits in group 1; 3 of 10 in group 2; and 5 of 11 in group 3, showed mild stridor after extubation(p>0.05). All rabbits developed maximum increase in subglottic pressure within 2 hours after extubation. Group 1 and 2 showed less increase in pressure compared to group 3(p<0.05), but here was no statistical difference between group 1 and 2(p>0.05). Histologic sections of the larynges showed less submucosal edema, including other changes in group 1 and 2, than in group 3(p<0.05). In conclusion, administering a high-dose of dexamethasone before extubation, is effective in prophylaxis and treatment of laryngeal injuries following short-term intubation in rabbits. This is especially true in edema.
Animal ; Dexamethasone/administration & dosage/*therapeutic use ; Intubation, Intratracheal/*adverse effects ; Laryngeal Edema/etiology/*prevention & control ; Rabbits