Objective:To analyze the acoustic characteristics of patients with hypopharyngeal cancer accompanied by vocal cord dysfunction. Methods:A retrospective analysis was conducted on the data of patients with hypopharyngeal cancer who were initially treated at The Second Affiliated Hospital of Xi'an Jiaotong University from January 2018 to April 2024. Patients who had completed electronic laryngoscopy, stroboscopic laryngoscopy, and voice analysis were selected from the data. Among them, patients with hypopharyngeal cancer who had unilateral vocal cord activity disorders were selected as the experimental group, while patients with symmetrical bilateral vocal cord activity were assigned to the control group. Then the clinical characteristics, the vocal parameters, and the stroboscopic laryngoscopy results of patients with hypopharyngeal cancer in the experimental group and the control group were analyzed and compared. Results:Compared with that in the control group, the proportion of lesions located on the inner wall of the piriform fossa in the experimental group increased（83.3% vs 53.8%）, and the difference was statistically significant（P<0.05）. There was no significant difference in vocal parameters such as SPL, Jitter, Shimmer, MPT, DSI, F0, sound intensity, electroglottic value and VHI between the experimental group and the control group（P>0.05）. However, the values of F0, Jitter, Shimmer and VHI in the experimental group were higher than those in the control group. In addition, in terms of the results of stroboscopic laryngoscopy, the proportion of glottic insufficiency（42.9% vs 18.8%） and asymmetric arytenoid cartilage（64.3% vs 0） in the experimental group was significantly higher than that in the control group（P<0.05）. However, the mucosal waves of the vocal cords on the affected side did not weaken in patients in both the experimental group and the control group. In the experimental group of 18 patients with hypopharyngeal cancer who received induction chemotherapy（nituzumab+nedaplatin+5-fluorouracil）, 13 of them had improved vocal cord activity（improvement rate of 72.2%）. Conclusion:Hypopharyngeal cancer in the medial wall of the pyriform fossa is more prone to vocal cord dysfunction, but vocal cord dysfunction has little effect on the vocal parameters of patients with hypopharyngeal cancer.
Humans ; Hypopharyngeal Neoplasms ; Retrospective Studies ; Male ; Female ; Laryngoscopy ; Middle Aged ; Vocal Cord Dysfunction/etiology* ; Vocal Cords/physiopathology* ; Stroboscopy ; Voice Quality ; Aged

Congenital laryngomalacia is the most common disease causing laryngeal stridor in infants. The pathogenesis has not yet been clearly concluded. It may be related to abnormal development of laryngeal cartilage anatomical structure, neuromuscular dysfunction, gastroesophageal and laryngeal reflux disease, etc. The typical manifestations of the disease are inspiratory laryngeal stridor and feeding difficulties, which can be divided into mild, moderate and severe according to the severity of symptoms. The diagnosis is mainly based on clinical symptoms, signs and endoscopy, among which endoscopy is an important diagnostic basis. The treatment of laryngomalacia depends on the severity of symptoms. Mild and some moderate congenital laryngomalacia children can be relieved by conservative treatment, and severe and some moderate congenital laryngomalacia children should be treated by surgery. Supraglottic plasty is the main surgical method, which can effectively improve the symptoms of laryngeal stridor, dyspnea, feeding difficulties and growth retardation in most children, and the surgical effect is good.
Infant ; Child ; Humans ; Laryngomalacia/therapy* ; Respiratory Sounds/etiology* ; Larynx/surgery* ; Laryngeal Diseases/surgery* ; Endoscopy/adverse effects* ; Laryngismus

Negative pressure pulmonary edema is a rare complication of general anesthesia. This paper presents a case of acute negative pressure pulmonary edema that occurred during general anesthesia resuscitation. The patient is a young male that underwent bimaxillary surgery under general anesthesia. Laryngospasm spasm ensued after extubation. The treatment for laryngeal spasm retained the smoothness of the nasopharyngal airway, and the pulse oxygen saturation rapidly decreased after anesthesia resuscitation. Pink foam sputum was sucked out from the cavity due to respiratory shortness from mouth and nose. Highly concentrated oxygen was immediately given to assist ventilation and as a symptomatic support (diuretics, hormones), and the condition evidently improved. The diagnosis and treatment of this case suggest that when acute pulmonary edema occurs during general anesthesia resuscitation, negative pressure pulmonary edema should be highly suspected. The first line of treatment is to relieve respiratory tract obstruction. Supplying highly concentrated oxygen to assist positive pressure ventilation is an effective treatment to alleviate pulmonary edema.
Airway Obstruction ; Anesthesia, General ; Humans ; Laryngismus ; Male ; Pulmonary Edema ; Treatment Outcome

PURPOSE: Various publications on the use of sedation and anesthesia for diagnostic procedures in children have demonstrated that no ideal agent is available. Although propofol has been widely used for sedation during esophagogastroduodenoscopy in children, adverse events including hypoxia and hypotension, are concerns in propofol-based sedation. Propofol is used in combination with other sedatives in order to reduce potential complications. We aimed to analyze whether the administration of midazolam would improve the safety and efficacy of propofol-based sedation in diagnostic esophagogastroduodenoscopies in children. METHODS: We retrospectively reviewed the hospital records of children who underwent diagnostic esophagogastroduodenoscopies during a 30-month period. Demographic characteristics, vital signs, medication dosages, induction times, sedation times, recovery times, and any complications observed, were examined. RESULTS: Baseline characteristics did not differ between the midazolam-propofol and propofol alone groups. No differences were observed between the two groups in terms of induction times, sedation times, recovery times, or the proportion of satisfactory endoscopist responses. No major procedural complications, such as cardiac arrest, apnea, or laryngospasm, occurred in any case. However, minor complications developed in 22 patients (10.7%), 17 (16.2%) in the midazolam-propofol group and five (5.0%) in the propofol alone group (p=0.010). CONCLUSION: The sedation protocol with propofol was safe and efficient. The administration of midazolam provided no additional benefit in propofol-based sedation.
Anesthesia ; Anoxia ; Apnea ; Child ; Conscious Sedation ; Endoscopy ; Endoscopy, Digestive System ; Endoscopy, Gastrointestinal ; Heart Arrest ; Hospital Records ; Humans ; Hypnotics and Sedatives ; Hypotension ; Laryngismus ; Midazolam ; Propofol ; Retrospective Studies ; Vital Signs

PURPOSE: To examine correlations among rating scales and findings suggestive of tracheal aspiration and pharyngeal residue between fiberoptic endoscopic evaluation of swallowing (FEES) and videofluoroscopic swallowing study (VFSS) in dysphagia patients. MATERIALS AND METHODS: We studied patients referred to our hospital for dysphagia assessment. Three raters judged the residue severity and laryngeal penetration or tracheal aspiration of FEES and VFSS. The raters applied the Penetration-Aspiration Scale (PAS) for tracheal aspiration and pixel-based circumscribed area ratio and Yale Pharyngeal Residue Severity for post-swallow residue in VFSS and FEES, respectively. Anatomy-physiologic findings during FEES associated with tracheal aspiration were also analyzed. RESULTS: A total of 178 participants were enrolled in our study. In correlation analysis, PAS (r=0.74), vallecula retention (r=0.76), and pyriform sinus retention (r=0.78) showed strong positive correlations between FEES and VFSS. Intra-rater agreement between VFSS and FEES was good for PAS (κ=0.65) and vallecula (κ=0.65) and pyriform sinus retention (κ=0.69). Among 72 patients who showed subglottic shelf residue, a suspected finding of aspiration, in FEES, 68 had concomitant tracheal aspiration during VFSS. Both vocal fold hypomobility and glottic gap during phonation were significantly associated with findings suggestive of tracheal aspiration during FEES (p<0.05). CONCLUSION: Quantitative and reliable aspiration and post swallow residue rating scales showed strong positive correlations and good agreement between VFSS and FEES.
Deglutition ; Deglutition Disorders ; Endoscopes ; Fees and Charges ; Fluoroscopy ; Humans ; Phonation ; Pyriform Sinus ; Vocal Cord Dysfunction ; Vocal Cords ; Weights and Measures

BACKGROUND: Endotracheal intubation often causes sore throat and coughing. The aim of this study was to decrease the incidence and severity of cough, sore throat, and hemodynamic changes after extubation by endotracheal administration of 1% lidocaine. METHODS: Sixty patients physical status American Society of Anesthesiologists classes I, II, and III who received a surgery under general anesthesia were randomly divided into two groups. L group was given 1% lidocaine 0.5 mg/kg by endotracheal administration. The other group, N group, received the same volume of normal saline. The number of cough, the severity of sore throat with numerical rating score (NRS), incidence of local anesthetic systemic toxic reaction, laryngospasm, and hoarseness were recorded. In addition, the number of coughs was divided into three levels by its severity, and it was converted into an indicator of cough score. RESULTS: L group had a significantly lower number of cough and sore throat NRS (P value < 0.05) than the N group, and also hoarseness did not occur. The changes in the hemodynamic parameters, before and after the emergence of anesthesia, were more stable in the L group than those in the N group, but not statistically significant. CONCLUSIONS: The results of this study suggest that endotracheal administration of 1% lidocaine is effective and safe method to reduce cough and sore throat caused by extubation.
Anesthesia ; Anesthesia, General ; Cough ; Hemodynamics ; Hoarseness ; Humans ; Incidence ; Intubation, Intratracheal ; Laryngismus ; Lidocaine ; Methods ; Pharyngitis

OBJECTIVES: To analyze the clinical characteristics of paroxysmal laryngospasm in adult. METHODS: A retrospective analysis was performed on 149 patients with paroxysmal laryngospasm in adult. All patients underwent the strobolaryngoscopy, completed the reflux symptom index (RSI) or the reflux finding score (RFS). Partial patients underwent an ambulatory 24-hour pH measurement. RESULTS: Laryngospasm was diagnosed in 76 females and 73 males. The average age was 55.4±11.4. The episode time of 149 (98%) patients last from several seconds tominutes, and 139 (93.3%) episodes could have a spontaneous remission. 84 (56.4%) episodes occurred only in the daytime, 28 (18.8%) only in the nighttime. There were 45.6% over weight/obesity patients, including 40 males and 28 females. The smokers were 28.9% (43/149) including 40 males and 3 females, and the drinkers were 29.5% (44/149) with 39 males and 5 females. 76 (51.0%) patients had no induced factor, while some caused by irritable cough/bucking (53,35.6%), cold (15, 10.1%), excitant food/smell (10, 6.7%), or regurgitation (6.5, 4.0%). Strobolaryngoscopy revealed laryngopharyngeal lesions in 46.3% (69/149) patients, including the glottic lesions with 40 (26.8%), unilateral vocal fold paralysis (21, 14.1%) and supraglottic lesions (8,5.4%). RSI/RFS showed 74.5% (111/149) patients had laryngopharyngeal reflux. Two patients treated with dietary and lifestyle modifications get improved, and 15/16 of the patients responded to antireflux treatment. CONCLUSIONS Episode of paroxysmal laryngospasm occurs more in the daytime, and could have a spontaneous resolution. Paroxysmal laryngospasm is much easier to occur in the male who are overweight or obesity, or with a long-term history of smoking or drinking. Almost half of the patients have an induced factor; partial may have laryngopharyngeal lesions simultaneously. Paroxysmal laryngopharyngeal reflux may be closely related to laryngospasm.
Adult ; Aged ; Female ; Humans ; Hypopharynx ; Laryngismus ; Laryngopharyngeal Reflux ; complications ; pathology ; Male ; Middle Aged ; Retrospective Studies ; Vocal Cord Paralysis ; complications ; pathology

Laryngospasm, an occlusion of the glottis, can occur at any time during anesthesia, and is associated with serious perioperative complications such as hypoxia, hypercabia, aspiration, bronchospasm, arrhythmia, prolonged recovery, cardiac collapse, and eventually catastrophic death. Importantly, postoperative negative pressure pulmonary edema (NPPE) is a rare, but well described life-threatening complication related to acute and chronic upper airway obstruction. Sugammadex well known for affirmatively reducing the postoperative pulmonary complications associated with residual neuromuscular blockade may have an indirect role in triggering the negative intrathoracic pressure by raising a rapid and efficacious respiratory muscle strength in acute upper airway obstruction. Herein, we report a case of postoperative NPPE following repetitive laryngospasm even after reversal of rocuronium-induced neuromuscular blockade using sugammadex.
Airway Obstruction ; Anesthesia ; Anoxia ; Arrhythmias, Cardiac ; Bronchial Spasm ; Delayed Emergence from Anesthesia ; Glottis ; Laryngismus* ; Neuromuscular Blockade* ; Pulmonary Edema* ; Respiratory Muscles

Bilateral vocal cord palsy (BVCP) is a rare complication of thyroid surgery, and it is confusing and frustrating for both patients and medical staff. We found postoperative vocal cord dysfunction using a McGrath videolaryngoscope from a patient with stridor and dyspnea after thyroidectomy performed with intraoperative recurrent laryngeal nerve monitoring. Soon after, the patient was diagnosed with BVCP by an ENT otolaryngologist using a laryngeal fiberscope. The patient underwent exploration and received a permanent tracheostoma. The possibility of false negative findings from intraoperative nerve monitoring should considered if there is suspicion of BVCP in a high risk patient after thyroidectomy. The McGrath video-laryngoscope can be useful for early discovery of postoperative vocal cord dysfunction.
Dyspnea ; Humans ; Medical Staff ; Recurrent Laryngeal Nerve ; Respiratory Sounds ; Thyroid Gland ; Thyroidectomy* ; Vocal Cord Dysfunction ; Vocal Cord Paralysis* ; Vocal Cords*

An irritable larynx syndrome is characterized by a sudden episodic dyspnea and dysphonia that is difficult to diagnose, and patients are often treated unnecessarily and/or too much. A correct diagnosis can be made by monitoring the larynx closing in the reversed direction during inhalation and posterior chink with videolaryngoscopy and by measuring a decrease in air flow volume during inhalation with a lung function test. Patients can be effectively treated with thorough differential diagnosis. Medications targeting precipitating factors, physical therapy sessions to improve abnormal larynx movement, counseling to reduce patients'anxiety rising from dyspnea, and etc. can effectively alleviate symptoms.
Behavior Therapy ; Counseling ; Diagnosis ; Diagnosis, Differential ; Dysphonia ; Dyspnea* ; Humans ; Inhalation ; Larynx* ; Precipitating Factors ; Respiratory Function Tests ; Vocal Cord Dysfunction