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Kim, Hyunjee, Hoon Jung, Seong Min Hwang, and Woo Seok Yang. "Preoperative rigid laryngoscopic examination and modified jaw thrust manoeuver during fibreoptic-assisted tracheal intubation for general anaesthesia." BMJ Case Reports 14, no. 5 (2021): e232826. http://dx.doi.org/10.1136/bcr-2019-232826.
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Preoperative laryngoscopic examination of the airway informs general anaesthesia management and planning. However, the same glottic opening view cannot always be obtained during direct laryngoscopy of anaesthetised patients. In this case report, a patient underwent preoperative rigid laryngoscopy due to medical history, and no problems were anticipated in performing tracheal intubation; however, the direct laryngoscopic view was a Grade 4 on the Cormack-Lehane Scale after anaesthesia induction. A jaw thrust manoeuvre to facilitate fibreoptic-assisted nasotracheal intubation was not feasible. In order to compensate, a modified method of jaw thrust was implemented, where both thumbs were placed on the floor of the patient’s mouth, leading to a successful result. Safe airway management should be implemented with proper planning based on a careful preoperative evaluation.
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Jahn, Anthony, and Andrew Blitzer. "A short history of laryngoscopy." Logopedics Phoniatrics Vocology 21, no. 3-4 (1996): 181–85. http://dx.doi.org/10.3109/14015439609098887.
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Paul, Benjamin C., Si Chen, Shaum Sridharan, Yixin Fang, Milan R. Amin, and Ryan C. Branski. "Diagnostic accuracy of history, laryngoscopy, and stroboscopy." Laryngoscope 123, no. 1 (2012): 215–19. http://dx.doi.org/10.1002/lary.23630.
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Mishra, Prasun, Deeksha Agrawal, and Purva Artham. "Screening Test for LPRD: History Versus Video Laryngoscopy." Indian Journal of Otolaryngology and Head & Neck Surgery 72, no. 4 (2020): 422–27. http://dx.doi.org/10.1007/s12070-020-01828-7.
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Kheterpal, Sachin, David Healy, Michael F. Aziz, et al. "Incidence, Predictors, and Outcome of Difficult Mask Ventilation Combined with Difficult Laryngoscopy." Anesthesiology 119, no. 6 (2013): 1360–69. http://dx.doi.org/10.1097/aln.0000435832.39353.20.
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Abstract Background: Research regarding difficult mask ventilation (DMV) combined with difficult laryngoscopy (DL) is extremely limited even though each technique serves as a rescue for one another. Methods: Four tertiary care centers participating in the Multicenter Perioperative Outcomes Group used a consistent structured patient history and airway examination and airway outcome definition. DMV was defined as grade 3 or 4 mask ventilation, and DL was defined as grade 3 or 4 laryngoscopic view or four or more intubation attempts. The primary outcome was DMV combined with DL. Patients with the primary outcome were compared to those without the primary outcome to identify predictors of DMV combined with DL using a non-parsimonious logistic regression. Results: Of 492,239 cases performed at four institutions among adult patients, 176,679 included a documented face mask ventilation and laryngoscopy attempt. Six hundred ninety-eight patients experienced the primary outcome, an overall incidence of 0.40%. One patient required an emergent cricothyrotomy, 177 were intubated using direct laryngoscopy, 284 using direct laryngoscopy with bougie introducer, 163 using videolaryngoscopy, and 73 using other techniques. Independent predictors of the primary outcome included age 46 yr or more, body mass index 30 or more, male sex, Mallampati III or IV, neck mass or radiation, limited thyromental distance, sleep apnea, presence of teeth, beard, thick neck, limited cervical spine mobility, and limited jaw protrusion (c-statistic 0.84 [95% CI, 0.82–0.87]). Conclusion: DMV combined with DL is an infrequent but not rare phenomenon. Most patients can be managed with the use of direct or videolaryngoscopy. An easy to use unweighted risk scale has robust discriminating capacity.
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Bruins, Benjamin B., Natasha Mirza, Ernest Gomez, and Joshua H. Atkins. "Anesthetic Management for Laser Excision of Ball-Valving Laryngeal Masses." Case Reports in Anesthesiology 2015 (2015): 1–3. http://dx.doi.org/10.1155/2015/875053.
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A 47-year-old obese woman with GERD and COPD presents for CO2-laser excision of bilateral vocal fold masses. She had a history of progressive hoarseness and difficulty in breathing. Nasopharyngeal laryngoscopy revealed large, mobile, bilateral vocal cord polyps that demonstrated dynamic occlusion of the glottis. We describe the airway and anesthetic management of this patient with a topicalized C-MAC video laryngoscopic intubation using a 4.5 mm Xomed Laser Shield II endotracheal tube. We examine the challenges of anesthetic management unique to the combined circumstances of a ball-valve lesion and the need for a narrow-bore laser compatible endotracheal tube.
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Gálvez, Jorge A., Samuel Acquah, Luis Ahumada, et al. "Hypoxemia, Bradycardia, and Multiple Laryngoscopy Attempts during Anesthetic Induction in Infants." Anesthesiology 131, no. 4 (2019): 830–39. http://dx.doi.org/10.1097/aln.0000000000002847.
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Abstract Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background The infant airway is particularly vulnerable to trauma from repeated laryngoscopy attempts. Complications associated with elective tracheal intubations in anesthetized infants may be underappreciated. We conducted this study of anesthetized infants to determine the incidence of multiple laryngoscopy attempts during routine tracheal intubation and assess the association of laryngoscopy attempts with hypoxemia and bradycardia. Methods We conducted a retrospective cross-sectional cohort study of anesthetized infants (age less than or equal to 12 months) who underwent direct laryngoscopy for oral endotracheal intubation between January 24, 2015, and August 1, 2016. We excluded patients with a history of difficult intubation and emergency procedures. Our primary outcome was the incidence of hypoxemia or bradycardia during induction of anesthesia. We evaluated the relationship between laryngoscopy attempts and our primary outcome, adjusting for age, weight, American Society of Anesthesiologists status, staffing model, and encounter location. Results A total of 1,341 patients met our inclusion criteria, and 16% (n = 208) had multiple laryngoscopy attempts. The incidence of hypoxemia was 35% (n = 469) and bradycardia was 8.9% (n = 119). Hypoxemia and bradycardia occurred in 3.7% (n = 50) of patients. Multiple laryngoscopy attempts were associated with an increased risk of hypoxemia (adjusted odds ratio: 1.78, 95% CI: 1.30 to 2.43, P < 0.001). There was no association between multiple laryngoscopy attempts and bradycardia (adjusted odds ratio: 1.23, 95% CI: 0.74 to 2.03, P = 0.255). Conclusions In a quaternary academic center, healthy infants undergoing routine tracheal intubations had a high incidence of multiple laryngoscopy attempts and associated hypoxemia episodes.
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Hendrix, Robert A., Aliya Ferouz, and Charles K. Bacon. "Admission Planning and Complications of Direct Laryngoscopy." Otolaryngology–Head and Neck Surgery 110, no. 6 (1994): 510–16. http://dx.doi.org/10.1177/019459989411000607.
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Increasingly, third party payers are challenging the necessity of a hospital admission for endoscopic procedures. Direct laryngoscopy (DL), with or without open, rigid esophagoscopy or flexible, fiberoptic bronchoscopy, was evaluated for the incidence of perioperative complications and associated risk factors. A retrospective review of 200 in-patient admissions between 1987 and 1990 for direct laryngoscopy or panendoscopy is presented. Complications were classified as major for untoward events that required hospitailzation for proper management. Complications were otherwise considered minor. The incidence of major complications was at least 19.5%, with minor complications occurring in 21% of patients. The total population was partitioned into subsets according to the occurrence of major complications, minor complications, and no complications. For the total population and each subset, distributions were developed by age, sex, habitus, physical status level, diagnosis of molignancy, presence of a malignant lesion in the aerodigestive tract, or medical history of head and neck surgery or radiation therapy. Statistical analysis indicates that these parameters do not offer reliable predictors of which patients are at risk for minor or major complications. It is concluded that all patients who undergo direct laryngoscopy are most safety managed in an in-hospital setting for a period on the order of 24 hours.
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Tsang, Trylon Matthew, Oliver Brett, and Amanda Hu. "Patient Perception and Duration of Pain after Microdirect Laryngoscopy." Otolaryngology–Head and Neck Surgery 162, no. 5 (2020): 702–8. http://dx.doi.org/10.1177/0194599820907904.
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Objective Postoperative pain is an important part of the patient’s surgical experience. The objective was to evaluate patient perception and duration of pain after microdirect laryngoscopy (MDL). Study Design Case series with planned data collection. Setting Tertiary care, academic center. Subjects and Methods Adult patients undergoing MDL were administered the short-form McGill Pain Questionnaire (SF-MPQ) before surgery and on postoperative days (PODs) 1, 3, and 7. Demographic and clinical data were collected. Results In total, 130 patients (mean age 52.6 years, 84 male) participated in the study. About 46.2% required analgesia on POD 1, but only 23.1% required opioids. Overall, mild levels of pain were reported on the SF-MPQ: sensory score, affective score, total score, present pain intensity (PPI), and visual analog scale (VAS). Patients reported a significant increase in pain on POD 1, with decreases in pain on PODs 3 and 7. Pain score returned to preoperative values for total score and affective score on POD 7 but remained significantly elevated for PPI, VAS, and sensory score. None of the following factors were associated with increased pain: age, sex, body mass index, Mallampati score, Cormack score, laryngoscope used, type of MDL, time under anesthesia, employment status, intubation, Voice Handicap Index 10, and chronic pain history. Conclusion Although mild levels of pain were reported after MDL, the pain persisted for up to 7 days. No demographic or clinical factors were found to be associated with increased pain. This study was one of the few prospective studies evaluating pain after MDL.
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Huston, Molly N., Rouya Kamizi, Tanya K. Meyer, Albert L. Merati, and John Paul Giliberto. "Current Opioid Prescribing Patterns after Microdirect Laryngoscopy." Annals of Otology, Rhinology & Laryngology 129, no. 2 (2019): 142–48. http://dx.doi.org/10.1177/0003489419877912.
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Background: The prevalence of opioid abuse has become epidemic in the United States. Microdirect laryngoscopy (MDL) is a common otolaryngological procedure, yet prescribing practices for opioids following this operation are not well characterized. Objective: To characterize current opioid-prescribing patterns among otolaryngologists performing MDL. Methods: A cross-sectional survey of otolaryngologists at a national laryngology meeting. Results: Fifty-eight of 205 physician registrants (response rate 28%) completed the survey. Fifty-nine percent of respondents were fellowship-trained in laryngology. Respondents performed an average of 13.3 MDLs per month. Thirty-four percent of surgeons prescribe opioids for over two-thirds of their MDLs, while only 7% of surgeons never prescribe opioids. Eighty-eight percent of surgeons prescribed a combination opioid and acetaminophen compound, hydrocodone being the most common opioid component. Many surgeons prescribe non-opioid analgesics as well, with 70% and 84% of surgeons recommending acetaminophen and ibuprofen after MDL respectively. When opioids were prescribed, patient preference, difficult exposure and history of opioid use were the most influential patient factors. Concerns of opioid abuse, the physician role in the opioid crisis, and literature about postoperative non-opioid analgesia were also underlying themes in influencing opioid prescription patterns after MDL. Conclusions: In this study, over 90% of practicing physicians surveyed are prescribing opioids after MDL, though many are also prescribing non-opioid analgesia as well. Further studies should be completed to investigate the needs of patients following MDL in order to allow physicians to selectively and appropriately prescribe opioid analgesia postoperatively.
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Chauhan, Neha, Balaji Ramamourthy, Manjul Muraleedharan, and Ramandeep Singh Virk. "Laryngeal lymphangioma as a cause of respiratory distress in an adult with Down’s syndrome: an extremely rare presentation." BMJ Case Reports 14, no. 1 (2021): e240130. http://dx.doi.org/10.1136/bcr-2020-240130.
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A 32-year-old man with Down’s syndrome was referred to the ear, nose and throat (ENT) department in view of failed attempts at extubation, and subsequently, at decannulation of tracheotomy tube. He had previously required ventilatory support and had history of intubation for 1 week. A flexible fibre-optic laryngoscopy showed a smooth mass covering the laryngeal inlet which moved with respiration. Direct laryngoscopy under general anaesthesia revealed a smooth mucosa covered fleshy mass arising from the left aryepiglottic fold and arytenoid, obstructing the laryngeal inlet. The mass was removed using controlled plasma ablation, and histopathological examination of the same was consistent with lymphangioma. Endoscopic examinations during the regular follow-up visits revealed well-healed supraglottic area with adequate glottic chink and the patient could be successfully decannulated.
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Birben, Birkan, Sabri Özden, Sadettin Er, and Bariş Saylam. "Is Vocal Cord Assessment before Total Thyroidectomy Required for All Patients?" American Surgeon 85, no. 11 (2019): 1265–68. http://dx.doi.org/10.1177/000313481908501134.
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We investigated whether laryngoscopy should be performed before total thyroidectomy on all patients without a history of neck surgery. A total of 2523 patients who underwent total thyroidectomy between January 1, 2013, and March 18, 2018, were retrospectively examined. Pre-operative vocal cord examination was performed on 2070 of these patients by the otorhinolaryngology department using indirect laryngoscopy. Patients with a history of neck or thyroid surgery were not included in the study. The patients were evaluated in terms of age, gender, symptom (hoarseness/dyspnea), comorbidity, surgical history, biopsy, nodule diameter, pathological diagnosis, and tracheal deviation. Preoperative vocal cord paralysis was detected in 0.8 per cent of the patients (17/2070). Four patients (23.5%) were male and 13 patients (76.5%) were female. The mean age was 62 (range, 25–82) years. Seven of the 17 patients (41%) were symptomatic, with complaints of dyspnea in five and hoarseness in two. The univariate analysis revealed that a nodule diameter >30 mm and the presence of dyspnea were associated with vocal cord damage. Furthermore, the multivariate analysis showed that dyspnea alone was an independent variable ( P = 0.011). It is recommended that preoperative vocal cord evaluation should be performed only in patients with severe symptoms, such as dyspnea.
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Matioc, Adrian A. "An Anesthesiologist’s Perspective on the History of Basic Airway Management." Anesthesiology 128, no. 2 (2018): 254–71. http://dx.doi.org/10.1097/aln.0000000000001975.
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Abstract This third installment of the history of basic airway management discusses the transitional—“progressive”—years of anesthesia from 1904 to 1960. During these 56 yr, airway management was provided primarily by basic techniques with or without the use of a face mask. Airway maneuvers were inherited from the artisanal era: head extension and mandibular advancement. The most common maneuver was head extension, also used in bronchoscopy and laryngoscopy. Basic airway management success was essential for traditional inhalation anesthesia (ether, chloroform) and for the use of the new anesthetic agents (cyclopropane, halothane) and intravenous drugs (thiopental, curare, succinylcholine). By the end of the era, the superiority of intermittent positive pressure ventilation to spontaneous ventilation in anesthesia and negative pressure ventilation in resuscitation had been demonstrated and accepted, and the implementation of endotracheal intubation as a routine technique was underway.
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Garg, Sunil. "Correlation between Rigid Laryngoscopy and Histopathology of Laryngeal Lesions at Our Voice Clinic." International Journal of Phonosurgery & Laryngology 1, no. 1 (2011): 29–31. http://dx.doi.org/10.5005/jp-journals-10023-1007.
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ABSTRACT Introduction In today's world of rapid technological advances, the medical field is developing at a rapid speed. Various sophisticated tools are available for the diagnostic work-up of patients with voice disorders. These are stroboscopy, optical coherence tomography (OCT), contact endoscopy and laryngeal USG, which gives sophisticated details of the larynx. However, at present most of these modalities are expensive and available only at few research centers. Rigid laryngoscopy is a noninvasive, easily available and fairly accurate diagnostic tool in patients with voice disorders. Aims and objectives The aim of our study was to assess the diagnostic potential of rigid laryngoscopy in different laryngeal lesions and its correlation with histopathology. This is a one year retrospective study at our voice clinic at Bombay Hospital, Mumbai. Patients and methods We examined 720 patients at our voice clinic from January 2008 to December 2008. Microlaryngeal surgery was performed on 59 of these. The clinical diagnosis was made after detailed history taking and clinical examination by a 70 degree Hopkins rod telescope. Results In our study, clinical diagnosis was 100% accurate in vocal fold subepithelial cyst, vocal fold nodules, laryngeal papilloma and contact granuloma. The clinical diagnosis had a reliability of 30% for Vocal fold polyps, 50% for leukoplakia, and 66% for malignant lesion. In suspected laryngeal polyps, leukoplakia and malignancy, our study indicates that we need to excise the lesion surgically and prove the histopathology. Conclusion Every tissue removed during laryngeal surgery should be sent for histopathology. Rigid Laryngoscopy is a safe and accurate tool to diagnose nodules and cysts.
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Sterrett, Emily C., Charles M. Myer, Jennifer Oehler, Bobby Das, and Benjamin T. Kerrey. "Critical Airway Team: A Retrospective Study of an Airway Response System in a Pediatric Hospital." Otolaryngology–Head and Neck Surgery 157, no. 6 (2017): 1060–67. http://dx.doi.org/10.1177/0194599817719400.
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Objective Study the performance of a pediatric critical airway response team. Study Design Case series with chart review. Setting Freestanding academic children’s hospital. Subjects and Methods A structured review of the electronic medical record was conducted for all activations of the critical airway team. Characteristics of the activations and patients are reported using descriptive statistics. Activation of the critical airway team occurred 196 times in 46 months (March 2012 to December 2015); complete data were available for 162 activations (83%). For 49 activations (30%), patients had diagnoses associated with difficult intubation; 45 (28%) had a history of difficult laryngoscopy. Results Activation occurred at least 4 times per month on average (vs 3 per month for hospital-wide codes). The most common reasons for team activation were anticipated difficult intubation (45%) or failed intubation attempt (20%). For 79% of activations, the team performed an airway procedure, most commonly direct laryngoscopy and tracheal intubation. Bronchoscopy was performed in 47% of activations. Surgical airway rescue was attempted 4 times. Cardiopulmonary resuscitation occurred in 41 activations (25%). Twenty-nine patients died during or following team activation (18%), including 10 deaths associated with the critical airway event. Conclusion Critical airway team activation occurred at least once per week on average. Direct laryngoscopy, tracheal intubation, and bronchoscopic procedures were performed frequently; surgical airway rescue was rare. Most patients had existing risk factors for difficult intubation. Given our rate of serious morbidity and mortality, primary prevention of critical airway events will be a focus of future efforts.
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Murray, Susan C., Christopher SG Thompson, David L. Walker, and Miles Bannister. "Extreme laryngeal candidiasis: airway obstruction." BMJ Case Reports 14, no. 8 (2021): e242910. http://dx.doi.org/10.1136/bcr-2021-242910.
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We describe the case of a 33-year-old female smoker who presented to the Accident and Emergency department with a 1-day history of rapidly evolving airway compromise. She had no preceding illness or other objective signs/symptoms on presentation, had a history of Chronic Obstructive Pulmonary Disease (COPD) and a previous opioid addiction. Following failed endotracheal intubation, the airway was secured with an emergency surgical tracheostomy. Subsequent direct laryngoscopy revealed a severely diseased glottis and supraglottic area, from which biopsy samples revealed a multiple drug-resistant strain of Candida albicans requiring specialist microbiology input and antifungal treatment. We describe the presentation, investigation, management and outcome of this rare case, along with a literature review of the subject.
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Vardar, Rukiye, Ahmet Varis, Berna Bayrakci, Serdar Akyildiz, Tayfun Kirazli, and Serhat Bor. "Relationship between history, laryngoscopy and esophagogastroduodenoscopy for diagnosis of laryngopharyngeal reflux in patients with typical GERD." European Archives of Oto-Rhino-Laryngology 269, no. 1 (2011): 187–91. http://dx.doi.org/10.1007/s00405-011-1748-y.
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Benson-Mitchell, R., N. Tolley, C. B. Croft, and A. Gallimore. "Aspergillosis of the larynx." Journal of Laryngology & Otology 108, no. 10 (1994): 883–85. http://dx.doi.org/10.1017/s0022215100128403.
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AbstractPrimary infection of the larynx with Aspergillus spp. is rare. It is more commonly seen as part of a wider infection involving the respiratory system in an immunocompromised host. In noncompromised patients laryngeal aspergillosis may represent colonization rather than invasion requiring no systemic anti-fungal treatment. The diagnosis is important as the presenting symptoms are suggestive of malignant laryngeal disease.We present a 62-year-old man with a short history of hoarseness. Direct laryngoscopy and biopsy confirmed the diagnosis of aspergillosis. Clinical presentation, diagnosis and the important pathological characteristics of this infection are discussed.
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Khoddami, Seyyedeh Maryam, Noureddin Nakhostin Ansari, Farzad Izadi, and Saeed Talebian Moghadam. "The Assessment Methods of Laryngeal Muscle Activity in Muscle Tension Dysphonia: A Review." Scientific World Journal 2013 (2013): 1–6. http://dx.doi.org/10.1155/2013/507397.
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The purpose of this paper is to review the methods used for the assessment of muscular tension dysphonia (MTD). The MTD is a functional voice disorder associated with abnormal laryngeal muscle activity. Various assessment methods are available in the literature to evaluate the laryngeal hyperfunction. The case history, laryngoscopy, and palpation are clinical methods for the assessment of patients with MTD. Radiography and surface electromyography (EMG) are objective methods to provide physiological information about MTD. Recent studies show that surface EMG can be an effective tool for assessing muscular tension in MTD.
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Hajian, Pouran, Shabnaz Sharifi, Mahshid Nikooseresht, and Abbas Moradi. "The Effects of Intravenous Nitroglycerin Bolus Doses in Reducing Hemodynamic Responses to Laryngoscopy and Endotracheal Intubation." BioMed Research International 2021 (August 3, 2021): 1–7. http://dx.doi.org/10.1155/2021/6694150.
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Background. Hemodynamic responses to laryngoscopy and endotracheal intubation are transient in most patients. However, in some patients with a history of heart disease, systemic hypertension, or cerebrovascular disease, these may lead to dangerous complications. This study is aimed at determining the effectiveness of intravenous nitroglycerin bolus doses in reducing hemodynamic responses to laryngoscopy and endotracheal intubation. Material and Method. In this double-blind randomized controlled trial, 78 patients aged 18 to 65 years were randomly divided into three groups: 1 μg/kg dose of nitroglycerin (first group), 2 μg/kg dose of nitroglycerin (second group), and normal saline or placebo (third group). 26 samples were allocated for each group. Patients’ hemodynamic responses to laryngoscopy and endotracheal intubation were measured at different times. Data were analyzed using SPSS V 16. Results. Patients in the three study groups were similar in terms of age, sex, and weight. There was no significant difference between the mean saturation of peripheral oxygen (SPO2) and the mean heart rate between the three groups before endotracheal intubation and 1 to 10 minutes after intubation ( P > 0.05 ). The difference of mean arterial blood pressure between study groups was only significant in the first and fifth minutes after intubation. Mean systolic and diastolic blood pressure in the first, third, and fifth minutes after intubation was significantly lower in the intervention groups than the control group ( P < 0.05 ). However, no significant difference was observed between the intervention groups. The frequency of systolic blood pressure decrease was significantly different in the first and fifth minutes after intubation in the three study groups ( P < 0.05 ). Conclusion. Bolus doses of 1 and 2 μg/kg nitroglycerin in noncardiac elective surgery prevents the increase of mean systolic, diastolic, and arterial blood pressure but has no significant effect on heart rate after intubation.
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Trinidad, Connie Angel J., Michael Joseph C. David, and Antonio H. Chua. "Extranasopharyngeal Angiofibroma of the Larynx." Philippine Journal of Otolaryngology-Head and Neck Surgery 25, no. 1 (2010): 23–25. http://dx.doi.org/10.32412/pjohns.v25i1.655.
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Objective: To present a rare case of laryngeal extranasopharyngeal angiofibroma, discussing its diagnosis, treatment and differences from the more typical juvenile angiofibroma.
 
 Methods:
 Design: Case Report
 Setting: Tertiary Government Hospital
 Patient: One
 
 Result: A 51-year-old male with a two-year history of hoarseness developed difficulty of breathing. Direct laryngoscopy showed a 2x2x1cm glistening, multinodular, pedunculated, firm, pink mass attached to the posterior half of the right true vocal fold obstructing the glottic opening and extending superiorly to the ventricle. Microlaryngeal excision was done. Histopathology showing numerous vascular channels surrounded by dense paucicellular fibrous tissue was consistent with angiofibroma. 
 Conclusion: Primary extranasopharyngeal angiofibroma is rare, with only 4 previously reported cases occurring in the larynx. We presented what may possibly be the first locally reported case. Although histopathologically similar to the more common juvenile nasopharyngeal angiofibroma, this was atypically seen in the larynx of an older adult patient. Direct laryngoscopy provided excellent exposure for identification as well as complete surgical resection. Unlike the nasopharyngeal type, no massive bleeding was encountered. Prognosis for this extranasopharyngeal angiofibroma is excellent as recurrence is noted to be rare, however, long term follow-up is recommended.
 Keywords: extranasopharyngeal angiofibroma, laryngeal angiofibroma
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Stachler, Robert J., David O. Francis, Seth R. Schwartz, et al. "Clinical Practice Guideline: Hoarseness (Dysphonia) (Update) Executive Summary." Otolaryngology–Head and Neck Surgery 158, no. 3 (2018): 409–26. http://dx.doi.org/10.1177/0194599817751031.
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Objective This guideline provides evidence-based recommendations on treating patients presenting with dysphonia, which is characterized by altered vocal quality, pitch, loudness, or vocal effort that impairs communication and/or quality of life. Dysphonia affects nearly one-third of the population at some point in its life. This guideline applies to all age groups evaluated in a setting where dysphonia would be identified or managed. It is intended for all clinicians who are likely to diagnose and treat patients with dysphonia. Purpose The primary purpose of this guideline is to improve the quality of care for patients with dysphonia, based on current best evidence. Expert consensus to fill evidence gaps, when used, is explicitly stated and supported with a detailed evidence profile for transparency. Specific objectives of the guideline are to reduce inappropriate variations in care, produce optimal health outcomes, and minimize harm. For this guideline update, the American Academy of Otolaryngology—Head and Neck Surgery Foundation selected a panel representing the fields of advanced practice nursing, bronchoesophagology, consumer advocacy, family medicine, geriatric medicine, internal medicine, laryngology, neurology, otolaryngology–head and neck surgery, pediatrics, professional voice, pulmonology, and speech-language pathology. Action Statements The guideline update group made strong recommendations for the following key action statements (KASs): (1) Clinicians should assess the patient with dysphonia by history and physical examination to identify factors where expedited laryngeal evaluation is indicated. These include but are not limited to recent surgical procedures involving the head, neck, or chest; recent endotracheal intubation; presence of concomitant neck mass; respiratory distress or stridor; history of tobacco abuse; and whether the patient is a professional voice user. (2) Clinicians should advocate voice therapy for patients with dysphonia from a cause amenable to voice therapy. The guideline update group made recommendations for the following KASs: (1) Clinicians should identify dysphonia in a patient with altered voice quality, pitch, loudness, or vocal effort that impairs communication or reduces quality of life (QOL). (2) Clinicians should assess the patient with dysphonia by history and physical examination for underlying causes of dysphonia and factors that modify management. (3) Clinicians should perform laryngoscopy, or refer to a clinician who can perform laryngoscopy, when dysphonia fails to resolve or improve within 4 weeks or irrespective of duration if a serious underlying cause is suspected. (4) Clinicians should perform diagnostic laryngoscopy, or refer to a clinician who can perform diagnostic laryngoscopy, before prescribing voice therapy and document/communicate the results to the speech-language pathologist (SLP). (5) Clinicians should advocate for surgery as a therapeutic option for patients with dysphonia with conditions amenable to surgical intervention, such as suspected malignancy, symptomatic benign vocal fold lesions that do not respond to conservative management, or glottic insufficiency. (6) Clinicians should offer, or refer to a clinician who can offer, botulinum toxin injections for the treatment of dysphonia caused by spasmodic dysphonia and other types of laryngeal dystonia. (7) Clinicians should inform patients with dysphonia about control/preventive measures. (8) Clinicians should document resolution, improvement or worsened symptoms of dysphonia, or change in QOL of patients with dysphonia after treatment or observation. The guideline update group made a strong recommendation against 1 action: (1) Clinicians should not routinely prescribe antibiotics to treat dysphonia. The guideline update group made recommendations against other actions: (1) Clinicians should not obtain computed tomography (CT) or magnetic resonance imaging (MRI) for patients with a primary voice complaint prior to visualization of the larynx. (2) Clinicians should not prescribe antireflux medications to treat isolated dysphonia, based on symptoms alone attributed to suspected gastroesophageal reflux disease (GERD) or laryngopharyngeal reflux (LPR), without visualization of the larynx. (3) Clinicians should not routinely prescribe corticosteroids in patients with dysphonia prior to visualization of the larynx. The policy level for the following recommendation about laryngoscopy at any time was an option: (1) Clinicians may perform diagnostic laryngoscopy at any time in a patient with dysphonia. Differences from Prior Guideline (1) Incorporating new evidence profiles to include the role of patient preferences, confidence in the evidence, differences of opinion, quality improvement opportunities, and any exclusion to which the action statement does not apply (2) Inclusion of 3 new guidelines, 16 new systematic reviews, and 4 new randomized controlled trials (3) Inclusion of a consumer advocate on the guideline update group (4) Changes to 9 KASs from the original guideline (5) New KAS 3 (escalation of care) and KAS 13 (outcomes) (6) Addition of an algorithm outlining KASs for patients with dysphonia
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Schmidt, U., K. A. Metz, M. Schrader, and L. D. Leder. "Well-differentiated (oncocytoid) neuroendocrine carcinoma of the larynx with multiple skin metastases: a brief report." Journal of Laryngology & Otology 108, no. 3 (1994): 272–74. http://dx.doi.org/10.1017/s0022215100126519.
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AbstractA 63-year-old woman presented with a history of increasing dysphagia of about two weeks duration. Laryngoscopy revealed a nonulcerated supraglottic epitheliomatous lesion that morphologically appeared well-differentiated and distinctly oncocytoid. Although the tumour lacked any criteria for malignancy such as cellular atypia, pleomorphism or necroses, it recurred twice after primary surgery and later gave rise to multiple painful skin metastases. The diagnosis of an oncocytoid differentiated neuroendocrine carcinoma of the larynx (laryngeal carcinoid) was made. Misinterpretation of laryngeal carcinoids is common, but can be avoided if one is familiar with this rare variant of laryngeal neoplasms
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Hubbard, Richard Marshall, Gabrielle Santiago, Santosh Uppu, Soham Roy, and Nischal Gautam. "Diagnosis of Extrinsic Upper Esophageal Compression Utilizing Video Laryngoscopy in an Infant Following Failed Transesophageal Echocardiogram Probe Placement." Seminars in Cardiothoracic and Vascular Anesthesia 24, no. 4 (2020): 360–63. http://dx.doi.org/10.1177/1089253220954692.
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Anesthesiologists are frequently responsible for placement of transesophageal echocardiography probes prior to cardiac surgery in children. A number of potential complications are possible, including placement failure. This report documents one such failed attempt at probe placement in a 3-month-old patient with a history of ventricular septal defect, and the utilization of video laryngoscopy by the anesthesiologist to diagnose a previously unknown extrinsic esophageal compression likely caused by an aberrant right subclavian artery. This case highlights the multiple vascular anomalies that may act as a source of esophageal obstruction in children undergoing transesophageal echocardiography for cardiac surgery.
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Kryukov, A. I., S. G. Romanenko, O. G. Pavlikhin, E. V. Lesogorova, D. I. Krasnikova, and O. V. Eliseev. "Common mistakes in the diagnosis of laryngeal pathology." Russian Otorhinolaryngology 19, no. 2 (2020): 93–99. http://dx.doi.org/10.18692/1810-4800-2020-2-93-99.
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The article The article describes in detail the main stages of the diagnosis of voice disorders with an indication of the methods and major errors leading to an incorrect diagnosis. Since in some cases, impaired voice quality is the first and/ or only symptom of concomitant diseases of organs or systems of various etiologies, an expanded diagnostic search is required to make a correct diagnosis. The features of receiving of complaints and medical history from patients with laryngeal diseases, the guidelines for laryngoscopy are described. A description of the laryngoscopic vew is presented, which helps in the diagnosis of the initial stages of Reinke’s edema, hyperplastic laryngitis and early stages of laryngeal cancer. The relationship between the functional and organic pathology of the larynx is very close, it can be difficult to understand the root cause of voice disorder, this leads to incorrect treatment tactics, the progression and relapse of the disease. The causes of laryngeal diseases of an organic and functional nature, the features of the clinical picture and the differential diagnosis of voice disorders are considered. Cases of diagnosis, a clinic of chronic laryngitis, laryngomycosis, and laryngeal cancer are described; the main approaches to the treatment of laryngeal diseases are presented. The article will be useful to otorhinolaryngologists, phoniatricians of outpatient and inpatient care.
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Annigeri, Venkatesh M., Bahubali D. Gadgade, Rashmi V. Annigeri, and Anil B. Halgeri. "Upper gastro intestinal foreign bodies in pediatrics patients." Journal of Health and Allied Sciences NU 05, no. 04 (2015): 040–44. http://dx.doi.org/10.1055/s-0040-1703933.
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Abstract Aim: Analyzeexperience with presentation, diagnosis and management of accidental ingested upper digestive tract foreign bodies in children. Materials: A prospective study of 60 pediatric patients from July 2009 to July 2014 with history of accidental ingested upper gastro intestinal foreign bodies. All patients were studied for age, gender, complaints, duration, site of impaction, type and complications. Radiological investigations were taken according to the case. Direct laryngoscopy and Magill forceps or flexible esophagoscopy has been used for retrieval of foreign bodies. Result: Sixty cases were analyzed age between 6 months to 13 years. Male 42 and female 18. Age group 6 months to 6 years constitutes 85%. Thirty six (60%) patients arrived to hospital within 24 hours. Difficultly in swallowing (70%) was the most frequent symptom. Most foreign bodies were coin in the upper esophagus (70%). Preexisting esophageal disease was present in 20%. Out of 60 patients twenty four (40%) FB retrieved using Magill forceps and rest with Flexible esophagoscopy (60%). Foreign bodies were successfully removed without major complication in all cases. Mucosal erosions were seen in four patients after extraction. All patients except 4 were discharged within 24 hours after the procedure. Conclusion: Children between 6 month to 6 years is the commonest age group affected. Magill forceps with the aid of a direct laryngoscope is a safe and effective method for proximal esophageal foreign body removal. But flexible esophagoscopy remains the safest method of upper digestive tract foreign body extraction.
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Czubak, Jacek, Marcin Frączek, and Krzysztof Morawski. "A CASE OF RARE LARYNGEAL NEUROGENIC TUMOR." Wiadomości Lekarskie 72, no. 7 (2019): 1413–14. http://dx.doi.org/10.36740/wlek201907132.
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Laryngeal schwannoma is a rare benign tumour of the larynx. Schwannomas derive from the Schwann cells. Magnetic resonance imaging (MRI) is the best imaging tool for suggesting the diagnosis. We report case of laryngeal schwannoma. The case was a 61-year-old man with a 1-year history of dysphonia and stridor. Laryngoscopy revealed a submucosal mass of the glottic area. A computed tomography scan of the larynx showed an 26(CC) x 18 (TR) x 24 (AP)mm expansile mass in the glottic area. Histopathological examination diagnosed a schwannoma of the larynx. External surgeries were successfully performed. Diagnosis and specific treatment are discussed.
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Kelleher, Eoin M., Lars Nolke, and Colin J. McMahon. "Successful slide tracheoplasty and partial atrioventricular septal defect repair following extracorporeal membrane oxygenation support." Cardiology in the Young 25, no. 3 (2014): 573–75. http://dx.doi.org/10.1017/s1047951114000468.
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AbstractA two-year-old boy with a background history of Down syndrome and partial atrioventricular septal defect presented with acute respiratory distress requiring intubation and mechanical ventilation. He continued to deteriorate, despite ventilation; direct laryngoscopy, bronchoscopy, and computed tomography demonstrated severe long segment tracheal stenosis. He was placed on extracorporeal membrane oxygenation to stabilise his condition. A slide tracheoplasty and complete repair of the partial atrioventricular septal defect was successfully undertaken. His post-operative recovery was complicated by myocardial infarction and stroke but he made a full recovery. This represents the first report of slide tracheoplasty and partial atrioventricular septal defect repair in a child following extracorporeal membrane oxygenation support.
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Fuse, Takeo, Shin Yoshida, Akira Sakakibara, and Teiichi Motoyama. "Angiomyoma of the retropharyngeal space." Journal of Laryngology & Otology 112, no. 3 (1998): 290–93. http://dx.doi.org/10.1017/s0022215100158384.
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AbstractWe encountered a 59-year-old man with angiomyoma of the retropharyngeal space. He had been referred to our hospital because of a six-month history of a sensation of a narrowed pharynx. A smooth-surfaced tumour arising from the posterior wall in the hypopharynx was observed by indirect laryngoscopy. Radiographical imaging revealed a solitary tumour with homogenous contents in the retropharyngeal space. The tumour was successfully removed via a lateral pharyngotomy approach under general anaesthesia. Histopathologically, the tumour was composed of numerous veins with thick muscular walls. To the best of our knowledge, this is the first report of an angiomyoma arising in the retropharyngeal space.
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Nishiike, Suetaka, Miki Nagai, Aya Nakagawa, et al. "Laryngeal tuberculosis following laryngeal carcinoma." Journal of Laryngology & Otology 120, no. 2 (2005): 151–53. http://dx.doi.org/10.1017/s0022215105005955.
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Laryngeal tuberculosis is a rare entity and the disease related to laryngeal cancer is extremely rare. We describe a case of laryngeal tuberculosis in a 74-year-old man with a history of radiotherapy for laryngeal carcinoma four months earlier. Laryngoscopy demonstrated a white mass on the right vocal fold at the site carcinoma had previously occupied. Recurrence of the cancer was suspected, but the biopsy result showed histological features of tuberculosis. We discuss the derangement of the host's mucosal barrier by the malignancy as a contributing factor in secondary tuberculous infection. Tubercular bacilli may be reactivated due to the immunosuppression associated with the therapy.
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Goico-Alburquerque, Ana, Beenish Zulfiqar, Ranae Antoine, and Mohammed Samee. "Diffuse Idiopathic Skeletal Hyperostosis: Persistent Sore Throat and Dysphagia in an Elderly Smoker Male." Case Reports in Medicine 2017 (2017): 1–4. http://dx.doi.org/10.1155/2017/2567672.
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Diffuse idiopathic skeletal hyperostosis (DISH) is rarely symptomatic. However, it can present with dyspnea, hoarseness, dysphagia, and stridor. An 80-year-old chronic smoker male presented with 6-month history of sore throat and progressive dysphagia. Computed tomography of the neck revealed bulky anterior bridging syndesmophytes along the anterior aspect of the cervical spine and facet effusion involving four contiguous vertebrae consistent with DISH. Dysphagia secondary to DISH was diagnosed. Fiberoptic laryngoscopy showed bilateral vocal cord paralysis. Patient’s airway became compromised requiring tracheostomy tube placement. After discussion of therapeutic options, patient agreed on a percutaneous endoscopic gastrostomy tube insertion for nutritional support. Osteophytectomy was left to be discussed further.
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Vera-Sempere, Francisco, Diego Collado-Martín, and Beatriz Vera-Sirera. "Solitary Polypoid Laryngeal Xanthoma." Case Reports in Otolaryngology 2013 (2013): 1–4. http://dx.doi.org/10.1155/2013/967536.
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We report the case of a 51-year-old male smoker with diabetes mellitus and hyperlipidaemia and a long history of human immunodeficiency virus (HIV)/hepatitis C virus (HCV) infection treated with various antiretroviral regimes, who was referred to the otolaryngology department with progressive dysphonia. Fibre-optic laryngoscopy showed a solitary, yellowish-white pedunculated polyp on the anterior third of the left cord, with no other abnormality. Pathological analysis revealed a polypoid laryngeal xanthoma that was immunoreactive against CD68, perilipin, and adipophilin. This unusual laryngeal lesion in the clinical context of our patient suggests a possible role of antiretroviral treatment in the pathogenesis of these xanthomas.
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Nambiar, Rakul, Dae Dalus, and Anjali Srikumar. "Cardiovocal Syndrome: A rare cause of hoarseness in a patient with a history of pulmonary tuberculosis." Sultan Qaboos University Medical Journal [SQUMJ] 17, no. 4 (2018): 481. http://dx.doi.org/10.18295/squmj.2017.17.04.019.
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Hoarseness is a common clinical condition with underlying causes which can vary from reversible and benign to life-threatening and malignant. Cardiovocal syndrome may cause hoarseness secondary to left recurrent laryngeal nerve palsy when the recurrent laryngeal nerve is mechanically affected due to enlarged cardiovascular structures. We report a 28-year-old male who presented to the Government Medical College, Thiruvananthapuram, India, in 2013 with hoarseness. He had undergone irregular treatment for pulmonary tuberculosis (TB) two years previously. Fiber-optic laryngoscopy indicated left vocal cord palsy and a computed tomography scan of the chest revealed features of pulmonary hypertension with extensive enlargement of the pulmonary arteries. An echocardiogram confirmed severe pulmonary arterial hypertension with severe tricuspid regurgitation. He was diagnosed with left recurrent laryngeal palsy secondary to cardiovocal syndrome. Although reports exist of recurrent laryngeal palsy in TB, this case appears to be the first to report cardiovocal syndrome in a patient treated for pulmonary TB.
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Tsunoda, Koichi, Minako Takanosawa, Yukiko Kurikawa, Kenji Nosaka, and Seiji Niimi. "Hoarse voice resulting from premature ageing in Werner’s syndrome." Journal of Laryngology & Otology 114, no. 1 (2000): 61–63. http://dx.doi.org/10.1258/0022215001903708.
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Werner’s syndrome is characterized by clinical signs of premature ageing. A 42-year-old man presented with three-year history of hoarseness. Also noted were skin atrophy of the face and hands, ulcerations around the ankles, and a history of cataracts. A clinical diagnosis of Werner’s syndrome was made. Laryngoscopy revealed bowed vocal folds resulting in a spindle-shaped defect with glottal incompetence during phonation. Examination also revealed decreased maximum phonation time and vocal fatigue. At surgery, atrophy of the vocalis muscle was noted. Furthermore, degeneration of muscle fibres was noted in the temporalis muscle. The atrophic changes in the vocal folds that occur with ageing and result in an increased fundamental frequency were seen in this patient. The characteristic hoarseness of Werner’s syndrome appears to be the result of premature ageing of the vocal folds.
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Stachler, Robert J., David O. Francis, Seth R. Schwartz, et al. "Clinical Practice Guideline: Hoarseness (Dysphonia) (Update)." Otolaryngology–Head and Neck Surgery 158, no. 1_suppl (2018): S1—S42. http://dx.doi.org/10.1177/0194599817751030.
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Objective This guideline provides evidence-based recommendations on treating patients who present with dysphonia, which is characterized by altered vocal quality, pitch, loudness, or vocal effort that impairs communication and/or quality of life. Dysphonia affects nearly one-third of the population at some point in its life. This guideline applies to all age groups evaluated in a setting where dysphonia would be identified or managed. It is intended for all clinicians who are likely to diagnose and treat patients with dysphonia. Purpose The primary purpose of this guideline is to improve the quality of care for patients with dysphonia, based on current best evidence. Expert consensus to fill evidence gaps, when used, is explicitly stated and supported with a detailed evidence profile for transparency. Specific objectives of the guideline are to reduce inappropriate variations in care, produce optimal health outcomes, and minimize harm. For this guideline update, the American Academy of Otolaryngology—Head and Neck Surgery Foundation selected a panel representing the fields of advanced practice nursing, bronchoesophagology, consumer advocacy, family medicine, geriatric medicine, internal medicine, laryngology, neurology, otolaryngology–head and neck surgery, pediatrics, professional voice, pulmonology, and speech-language pathology. Action Statements The guideline update group made strong recommendations for the following key action statements (KASs): (1) Clinicians should assess the patient with dysphonia by history and physical examination to identify factors where expedited laryngeal evaluation is indicated. These include, but are not limited to, recent surgical procedures involving the head, neck, or chest; recent endotracheal intubation; presence of concomitant neck mass; respiratory distress or stridor; history of tobacco abuse; and whether the patient is a professional voice user. (2) Clinicians should advocate voice therapy for patients with dysphonia from a cause amenable to voice therapy. The guideline update group made recommendations for the following KASs: (1) Clinicians should identify dysphonia in a patient with altered voice quality, pitch, loudness, or vocal effort that impairs communication or reduces quality of life (QOL). (2) Clinicians should assess the patient with dysphonia by history and physical examination for underlying causes of dysphonia and factors that modify management. (3) Clinicians should perform laryngoscopy, or refer to a clinician who can perform laryngoscopy, when dysphonia fails to resolve or improve within 4 weeks or irrespective of duration if a serious underlying cause is suspected. (4) Clinicians should perform diagnostic laryngoscopy, or refer to a clinician who can perform diagnostic laryngoscopy, before prescribing voice therapy and document/communicate the results to the speech-language pathologist (SLP). (5) Clinicians should advocate for surgery as a therapeutic option for patients with dysphonia with conditions amenable to surgical intervention, such as suspected malignancy, symptomatic benign vocal fold lesions that do not respond to conservative management, or glottic insufficiency. (6) Clinicians should offer, or refer to a clinician who can offer, botulinum toxin injections for the treatment of dysphonia caused by spasmodic dysphonia and other types of laryngeal dystonia. (7) Clinicians should inform patients with dysphonia about control/preventive measures. (8) Clinicians should document resolution, improvement or worsened symptoms of dysphonia, or change in QOL of patients with dysphonia after treatment or observation. The guideline update group made a strong recommendation against 1 action: (1) Clinicians should not routinely prescribe antibiotics to treat dysphonia. The guideline update group made recommendations against other actions: (1) Clinicians should not obtain computed tomography (CT) or magnetic resonance imaging (MRI) for patients with a primary voice complaint prior to visualization of the larynx. (2) Clinicians should not prescribe antireflux medications to treat isolated dysphonia, based on symptoms alone attributed to suspected gastroesophageal reflux disease (GERD) or laryngopharyngeal reflux (LPR), without visualization of the larynx. (3) Clinicians should not routinely prescribe corticosteroids for patients with dysphonia prior to visualization of the larynx. The policy level for the following recommendation about laryngoscopy at any time was an option: (1) Clinicians may perform diagnostic laryngoscopy at any time in a patient with dysphonia. Disclaimer This clinical practice guideline is not intended as an exhaustive source of guidance for managing dysphonia (hoarseness). Rather, it is designed to assist clinicians by providing an evidence-based framework for decision-making strategies. The guideline is not intended to replace clinical judgment or establish a protocol for all individuals with this condition, and it may not provide the only appropriate approach to diagnosing and managing this problem. Differences from Prior Guideline (1) Incorporation of new evidence profiles to include the role of patient preferences, confidence in the evidence, differences of opinion, quality improvement opportunities, and any exclusion to which the action statement does not apply (2) Inclusion of 3 new guidelines, 16 new systematic reviews, and 4 new randomized controlled trials (3) Inclusion of a consumer advocate on the guideline update group (4) Changes to 9 KASs from the original guideline (5) New KAS 3 (escalation of care) and KAS 13 (outcomes) (6) Addition of an algorithm outlining KASs for patients with dysphonia
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Unadkat, Samit N., Rishi Talwar, and Neil Tolley. "The Eye in the Neck: Removal of a Sewing Needle from the Posterior Pharyngeal Wall." Case Reports in Medicine 2010 (2010): 1–3. http://dx.doi.org/10.1155/2010/608343.
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Foreign body ingestion is a frequent presenting complaint to most emergency departments but the finding of a sewing needle in the posterior pharynx particularly is a rare finding. We report a case of a male patient with a sewing needle lodged in the posterior pharynx despite a history suggestive of chicken bone ingestion, absent clinical features, and negative flexible endoscopic examination. The needle was only identified through cervical spine radiographs. Even subsequent pharyngoscopy, laryngoscopy, and upper oesophagoscopy all proved to be unremarkable with the patient eventually requiring a left neck exploration to remove the needle. The case outlines the importance of simple radiography in suspected foreign body ingestion, even though clinical and endoscopic findings may be unremarkable.
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Ohki, Masafumi. "Dysphagia due to Diffuse Idiopathic Skeletal Hyperostosis." Case Reports in Otolaryngology 2012 (2012): 1–3. http://dx.doi.org/10.1155/2012/123825.
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Diffuse idiopathic skeletal hyperostosis (DISH) is usually asymptomatic. However, rarely, it causes dysphagia, hoarseness, dyspnea, snoring, stridor, and laryngeal edema. Herein, we present a patient with DISH causing dysphagia. A 70-year-old man presented with a 4-month history of sore throat, dysphagia, and foreign body sensation. Flexible laryngoscopy revealed a leftward-protruding posterior wall in the hypopharynx. Computed tomography and magnetic resonance imaging revealed a bony mass pushing, anteriorly, on the posterior hypopharyngeal wall. Ossification included an osseous bridge involving 5 contiguous vertebral bodies. Dysphagia due to DISH was diagnosed. His symptoms were relieved by conservative therapy using anti-inflammatory drugs. However, if conservative therapy fails and symptoms are severe, surgical treatments must be considered.
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Bayram, Ali, Ebru Akay, Sema S. Göksu, and İbrahim Özcan. "Primary Small Cell Carcinoma of the Hypopharynx: A Case Report of a Rare Tumor." Case Reports in Otolaryngology 2015 (2015): 1–4. http://dx.doi.org/10.1155/2015/934926.
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Introduction. Primary hypopharynx involvement of small cell carcinoma is very rare and very few cases have been reported in the literature. Here, we report a case of primary small cell carcinoma of the hypopharynx in a male patient.Case Report. A 50-year-old man presented with a 6-month history of sore throat and swellings in the right side of the neck. Direct laryngoscopy and biopsy revealed small cell carcinoma of the hypopharynx located in the right pyriform sinus.Discussion. Small cell carcinoma of the hypopharynx has no clear treatment modality due to the rarity of the disease. Systemic chemotherapy and radiotherapy should have priority among the therapy regimens because of the high metastatic potential of the tumor.
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Kumar, MC Anup, and Lavanya Karanam. "Upper Gastrointestinal Endoscopy in ENT Practice: How Worth is It?" International Journal of Phonosurgery & Laryngology 3, no. 2 (2013): 35–38. http://dx.doi.org/10.5005/jp-journals-10023-1058.
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ABSTRACT Objective The need for upper gastrointestinal (GI) endoscopy in the evaluation of hoarseness. Study design Prospective study, conducted during the period from June 2012 to February 2013. Setting Tertiary referral center. Results A total of 125 patients were selected for the study and they were evaluated with appropriate history and clinical examination. Out of 125 patients, 41 (32.8%) patients showed laryngeal findings leading to hoarseness, 13 (10.4%) patients showed features of suspected malignancy in other adjacent regions which was confirmed later, two (1.6%) patients showed phonetic gap and 69 (55.2%) patients showed normal laryngeal inlet on indirect laryngoscopy examination. Of the 69 normal patients which were treated conservatively and since they did not show any response they were subjected to upper GI endoscopy. Out of 69 patients, 41 (60%) patients showed features of gastritis, 28 (40%) patients showed features of duodenitis. Conclusion It is estimated that more than 50% of patients presenting to the ENT OPD for hoarseness are because of GI problems. We strongly advise upper GI endoscopy for the symptomatic otorhinolaryngological patients with a normal laryngeal finding on indirect laryngoscopy for treating the condition accurately or near accurately. Adding to this upper GI endoscopy has the additional advantages of documentation and medicolegal aspect in the present day scenario. How to cite this article Santosh UP, Kumar MCA, Karanam L. Upper Gastrointestinal Endoscopy in ENT Practice: How Worth is It? Int J Phonosurg Laryngol 2013;3(2):35-38.
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Lundstrøm, Lars H., Ann M. Møller, Charlotte Rosenstock, Grethe Astrup, and Jørn Wetterslev. "High Body Mass Index Is a Weak Predictor for Difficult and Failed Tracheal Intubation." Anesthesiology 110, no. 2 (2009): 266–74. http://dx.doi.org/10.1097/aln.0b013e318194cac8.
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Background Previous studies have failed to detect high body mass index (BMI) as a risk factor for difficult tracheal intubation (DTI). BMI was investigated as a risk factor for DTI in patients planned for direct laryngoscopy. Methods A cohort of 91,332 consecutive patients planned for intubation by direct laryngoscopy was retrieved from the Danish Anesthesia Database. A four-point scale to grade the tracheal intubation was used. Age, sex, American Society of Anesthesiologists physical status classification, priority of surgery, history of previous DTI, modified Mallampati-score, use of neuromuscular blocker, and BMI were retrieved. Logistic regression to assess whether BMI was associated with DTI was performed. Results The frequency of DTI was 5.2% (95% confidence interval [CI] 5.0-5.3). In multivariate analyses adjusted for other significant covariates, BMI of 35 or more was a risk for DTI with an odds ratio of 1.34 (95% CI 1.19-1.51, P &lt; 0.0001). As a stand alone test, BMI of 35 or more predicted DTI with a sensitivity of 7.5% (95% CI 7.3-7.7%) and with a predictive value of a positive test of 6.4% (95% CI 6.3-6.6%). BMI as a continuous covariate was a risk for failed intubation with an odds ratio of 1.031 (95% CI 1.002-1.061, P &lt; 0.04). Conclusions High BMI is a weak but statistically significant predictor of difficult and failed intubation and may be more appropriate than weight in multivariate models of prediction of DTI.
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Munjal, Manish, and Bindia Ghera. "Hoarseness of voice – an institutional study." International Journal of Otorhinolaryngology and Head and Neck Surgery 2, no. 4 (2016): 220. http://dx.doi.org/10.18203/issn.2454-5929.ijohns20163469.
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<p class="abstract"><strong>Background:</strong> Hoarseness is one of the earliest signal of local and systemic disease. It should be emphasized that hoarseness is not a disease in itself but a symptom of disease or disturbance of larynx or laryngeal innervation. The aim of the study was to analyse various causes and conditions associated with hoarseness of voice.</p><p class="abstract"><strong>Methods:</strong> We studied 150 patients in a prospective randomised study with inclusion criteria of hoarseness of voice, attending otolaryngology outpatient department of Dayanand medical college and hospital, Ludhiana, irrespective of their age, sex and duration of disease. No exclusion criteria were applied. All the routine investigations like Hb, BT, CT, TLC, DLC, urine-for albumin and sugar were carried out in all patients. X-ray chest- PA view and X-Ray soft tissue neck- AP and lateral view were done when required. Larynx was examined by flexible fibreoptic laryngoscopy followed by biopsy if suspicious looking area was seen. 4% lignocaine spray was used orally and nasally to provide local anaesthesia.</p><p class="abstract"><strong>Results:</strong> In the present study of 150 cases 87 were males and 63 were females with M:F ratio of 1.4:1 and age ranged from 10–90 years with majority of cases in 4th and 6th decade of their life. All patients had history of hoarseness of voice with most of patients having duration of disease between one month to one year. On flexible fibreoptic laryngoscopy 27% of cases showed normal study, vocal nodule was most common, seen in 20% of cases, 10% showed vocal cord palsy and 10% had laryngopharyngeal reflux disease. Bilateral lesion (72.6%) predominated overall, with left sided (15.2%) of larynx affected more as compared to right side (12%).</p><p><strong>Conclusions:</strong> Flexible fibreoptic laryngoscopy is an effective alternative for diagnosis of laryngeal lesions and various causes of hoarseness of voice. Vocal nodule has been found as the commonest cause of hoarseness of voice followed by vocal cord palsy and laryngopharyngeal reflux disease. </p>
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Thomas, Martyn. "Thomas James Walker (1835–1916): Surgeon and general practitioner." Journal of Medical Biography 26, no. 1 (2016): 2–10. http://dx.doi.org/10.1177/0967772016637973.
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Thomas James Walker was a surgeon and general practitioner who worked in the city of Peterborough at a time when there were changes and innovations in the practice of medicine. After training in medicine and surgery at Edinburgh University, he qualified in London in 1857. He was a pioneer of laryngoscopy. He played an important role in introducing antiseptic surgery to the Peterborough Infirmary and was instrumental in the development of the operating theatre which opened in 1894. He was a philanthropist and collector of Roman and Saxon artefacts. In 1915, he was recognized as an outstanding member of the Peterborough community when he was offered the Freedom of the City.
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Creswell, Caleb H., Tony L. Kille, Matthew R. Hoffman, Tabassum Kennedy, and Seth H. Dailey. "Delayed Presentation of Submucosal Retained Toothbrush from Self-Inflicted Injury in Patient with Schizophrenia." Case Reports in Emergency Medicine 2017 (2017): 1–4. http://dx.doi.org/10.1155/2017/2480140.
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Foreign body ingestion occurs in not only children but also adults, particularly those with history of neurologic disease, alcohol use, or psychiatric disease. We present the case of a 40-year-old male with schizophrenia who presented to the emergency room with a long history of pharyngeal foreign body sensation which had recently progressed to include trismus, odynophagia, and dyspnea. Flexible laryngoscopy demonstrated fullness of the right posterior pharyngeal wall and computed tomography (CT) showed a linear opaque foreign body extending from the level of the oropharynx to the thyroid ala. Further history elicited that he stabbed himself in the pharynx two years prior with a toothbrush following a command hallucination. The toothbrush was removed uneventfully via an external approach. The patient was discharged with psychiatry follow-up. This case is unusual due to the submucosal location of the foreign body and the length of retention. It demonstrates the atypical nature which patients with comorbid psychiatric illness may present following foreign body injury and the use of an external surgical approach for the removal of a retained foreign body based on CT reconstruction.
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Fox, Daniel P., and Julina Ongkasuwan. "Safety and Utility of Direct Laryngoscopy and Bronchoscopy in Patients Hospitalized with Croup." Ear, Nose & Throat Journal 97, no. 8 (2018): E25—E30. http://dx.doi.org/10.1177/014556131809700805.
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Acute croup is a common admitting diagnosis for pediatric patients. If a patient is not responding to medical management for presumed croup, the otolaryngology team is occasionally consulted for direct laryngoscopy and bronchoscopy (DLB) to rule out tracheitis or another airway pathology. We conducted a study to determine if inpatient DLB in acute croup is safe and efficacious and to correlate preoperative vital signs with intraoperative findings. We reviewed the charts of 521 patients with an admitting diagnosis of acute tracheitis, acute laryngotracheitis, or croup. Of this group, 18 patients—11 boys and 7 girls, aged 1 month to 3.3 years (mean: 1.3 yr)—had undergone inpatient DLB. Comorbidities, complications, and level of care were also analyzed. Five patients (28%) had gastrointestinal reflux disease (GERD), and 4 had previously undergone intubation (22%). Eleven patients (61%) had concurrent airway pathology, 7 of whom (39%) required operative intervention. Preoperative mean body temperature and the increase in mean temperature were significantly higher in tracheitis patients than in the non-tracheitis patients. Preoperative change in respiratory rate was elevated when another airway pathology was present (p = 0.047). Only patients who were in the intensive care unit (ICU) preoperatively were intubated in the operating room, and only 1 patient required a postoperative escalation in the level of care. Our study found that performing inpatient DLB in patients hospitalized with croup is reasonably safe and provides a sufficient yield for identifying tracheitis or other airway pathology in selected populations. Preoperative vital signs can be suggestive of tracheitis or additional unexpected airway pathology. Recurrent croup, a history of GERD or previous intubation, and preoperative admission to the ICU increase the yield of DLB.
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Cruz, Melanie Grace Y., and Natividad A. Almazan. "Adult Acute Epiglottitis: An Eight - Year Experience in A Philippine Tertiary Government Hospital." Philippine Journal of Otolaryngology-Head and Neck Surgery 31, no. 2 (2016): 20–23. http://dx.doi.org/10.32412/pjohns.v31i2.227.
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Objective: To review cases of adult acute epiglottitis in a tertiary government hospital and describe the clinical presentations, diagnostics performed, management and outcomes.
 Methods:
 Study Design: Retrospective Chart Review
 Setting: Tertiary Government Hospital
 Subjects: Records of patients admitted by or referred to the Department of Otolaryngology Head and Neck Surgery with a diagnosis of acute epiglottitis from January 2008 to August 2014 were identified from the department census and charts were retrieved from the Hospital Record Section and evaluated according to inclusion and exclusion criteria. Information regarding demographic data, clinical features, laboratory and other diagnostic examinations, medical management, and length of hospital stay were collected.
 Results: There were 20 cases in seven years and eight months. Most were male, 18 to 37-years-old, presenting with dysphagia, odynophagia and a swollen epiglottis on laryngoscopy. Abnormal soft-tissue lateral radiographs of the neck and leukocytosis were seen in 73 % and 83% respectively. Intravenous antibiotics and corticosteroids were administered in all cases, and mean hospital stay was 11.2 days.
 Conclusion: Adult acute epiglottitis should be highly suspected in patients presenting with dysphagia, odynophagia, and muffling of the voice even with a normal oropharyngeal examination. History of respiratory infection, co-morbidities, smoking and alcohol intake, concomitant laryngeal pathology and supraglottic structure insults contribute to development of the disease. Laryngoscopy is still the gold standard in diagnosis. Airway protection is mandatory but prophylactic intubation or tracheostomy are not advised. Intravenous antibiotics are necessary and corticosteroids may be of benefit. 
 Keywords: epiglottitis, supraglottitis, epiglottis, adult, Philippines
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Smith, J., J. Douglas, B. Smith, T. Dougherty, and C. Ayshford. "Assessment of recurrent laryngeal nerve function during thyroid surgery." Annals of The Royal College of Surgeons of England 96, no. 2 (2014): 130–35. http://dx.doi.org/10.1308/003588414x13814021676594.
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Introduction There is disparity in the reported incidence of temporary and permanent recurrent laryngeal nerve (RLN) palsy following thyroidectomy. Much of the disparity is due to the method of assessing vocal cord function. We sought to identify the incidence and natural history of temporary and permanent vocal cord palsy following thyroid surgery. The authors wanted to establish whether intraoperative nerve monitoring and stimulation aids in prognosis when managing vocal cord palsy. Methods Prospective data on consecutive thyroid operations were collected. Intraoperative nerve monitoring and stimulation, using an endotracheal tube mounted device, was performed in all cases. Endoscopic examination of the larynx was performed on the first postoperative day and at three weeks. Results Data on 102 patients and 123 nerves were collated. Temporary and permanent RLN palsy rates were 6.1% and 1.7%. Most RLN palsies were identified on the first postoperative day with all recognised at the three-week review. No preoperative clinical risk factors were identified. Although dysphonia at the three-week follow-up visit was the only significant predictor of vocal cord palsy, only two-thirds of patients with cord palsies were dysphonic. Intraoperative nerve monitoring and stimulation did not predict outcome in terms of vocal cord function. Conclusions Temporary nerve palsy rates were consistent with other series where direct laryngoscopy is used to assess laryngeal function. Direct laryngoscopy is the only reliable measure of cord function, with intraoperative monitoring being neither a reliable predictor of cord function nor a predictor of eventual laryngeal function. The fact that all temporary palsies recovered within four months has implications for staged procedures.
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Bhinder, Prabhjot, Michael Chahin, and Lara Zuberi. "Concurrent Squamous Cell Carcinoma and Chronic Lymphocytic Leukemia Presenting as an Enlarging Neck Mass." Journal of Investigative Medicine High Impact Case Reports 7 (January 2019): 232470961984290. http://dx.doi.org/10.1177/2324709619842904.
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Chronic lymphocytic leukemia (CLL) patients are at an increased risk for developing more aggressive lymphomas via Richter’s transformation and of developing secondary malignancies. Despite the known association for secondary cancers, oropharyngeal cancers occur rarely. We present a case of a woman with a history of CLL who presented to our facility via transfer for impending airway compromise. Her initial workup was consistent with CLL; however, biopsies were taken of the neck mass because of its aggressive nature. She was treated with rituximab with good response. Final pathology showed evidence of CLL and tonsillar squamous cell carcinoma (SCC). Direct laryngoscopy and further biopsies yielded a diagnosis of unresectable oropharyngeal SCC. She was to be treated with chemotherapy and radiation for her SCC while holding treatment for CLL. This case demonstrates a rare and unexpected concurrent diagnosis.
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Mahbub, Shawhely, Ali Zaheer Al Amin, Sudhangshu Shekhar Biswas, and Mohammad Shah Jamal. "A Study on Diagnostic Importance of Fiber Optic Laryngoscopy (FOL) in Patients with Upper Airway Disorders." Journal of Bangladesh College of Physicians and Surgeons 32, no. 4 (2015): 200–205. http://dx.doi.org/10.3329/jbcps.v32i4.26082.
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Background: Upper airway symptoms are quite common. Many of these symptoms underlie serious upper airway pathologies which should be diagnosed at an early stage so that optimum treatment can be given. Often it seems to be difficult to diagnose upper air way pathology by conventional indirect laryngoscopy (I/L), especially when the lesion is at an early stage. In this situation fiber optic laryngoscopy (FOL) is very helpful.Objective: To identify lesions in the larynx in patients with persistent upper airway disorders and to compare the diagnostic yield of FOL over I/L.Method: This was a cross-sectional study conducted partly in department of ENT and Head & neck surgery, BIRDEM General Hospital and partly at the same department of BSMMU during the period of July to December 2012. 100 adult patients were taken having upper airway symptoms. Study subjects were evaluated by history, physical examinations, and ENT examinations. All patients underwent indirect laryngoscopy and FOL. Data were recorded and analyzed.Results: Age of the respondents was between 18-72 years. The mean ± SD was 54 ±11.79 years. Common symptoms among the participants were hoarseness, sore throat, neck swelling, breathless ness, cough, odynophagia, earache etc. On I/L examinations 30% were vocal cord polyps, 14% v. cord edema, 17% v. cord growths, 11% v. cord nodules, 6 % v. cord palsy, 4% ulcerated lesions, 13 % poor vision and 5% were normal. On FOL examinations, 30% were vocal cord polyp, 18% v. cord edema, 21% v. cord growth, 14% v. cord nodule, 8 % v. cord palsy, 5% ulcerated lesion, 2% laryngeal web, 2 % were normal study and there were no poor vision. A comparison was made between the findings of I/L and FOL which showed that FOL is superior to I/L in diagnosing upper airway disorders as evidenced by findings of 2% lesions among 5% patients having normal I/L findings. Chi-square test was done between I/L and FOL findings which was statistically significant; (P value was .002) i.e. FOL procedure is valuable diagnostically in comparison to I/L.Conclusion: In many occasions I/L findings are inconclusive in daily ENT practice. Moreover, in some cases there is poor vision to identify the lesion. Therefore, Routine FOL evaluation is valuable in patients with significant, chronic and progressive upper airway symptoms. It should always be considered in patients with persisting and progressive symptoms even though I/L appeared normal.J Bangladesh Coll Phys Surg 2014; 32: 200-205
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Khatua, Rabindra Kumar. "Fish in Hypopharynx: A Rare Case Report." An International Journal of Otorhinolaryngology Clinics 7, no. 2 (2015): 81–82. http://dx.doi.org/10.5005/jp-journals-10003-1195.
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ABSTRACT We present a case of a 10 years old child who swallowed a live fish, which resulted in severe upper airway obstruction. The child presented to the casuality with severe airway obstruction with a history of accidental slippage of a live Koi fish into the throat. He was restless, dysphasic, dyspneic, typically placing his hands in front of his neck. On physical examination, there was suprasternal retraction and bilateral decreased breath sound. Direct laryngoscopy was done and fish was removed from hypopharynx as an emergency procedure. We outline our emergency airway management strategies and focus our discussion on the technique used to remove the impacted fish from the upper airway, which was paramount for the successful outcome of this case. How to cite this article Khatua RK. Fish in Hypopharynx: A Rare Case Report. Int J Otorhinolaryngol Clin 2015;7(2):81-82.
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Jones, N. S., F. J. Lannigan, and N. Y. Salama. "Foreign bodies in the throat: a prospective study of 388 cases." Journal of Laryngology & Otology 105, no. 2 (1991): 104–8. http://dx.doi.org/10.1017/s0022215100115063.
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AbstractWe present the results of a prospective study of 388 patients presenting with a history of swallowing a foreign body. We indicate whether the patients' symptoms and signs were associated with a retained foreign body. While tenderness on palpation was an unreliable sign, pooling at indirect laryngoscopy invariably predicted a retained object. In many patients, initial careful examination of the oropharynx by casualty officers would have shown a retained fishbone in the tonsil or tongue and would have resulted in 16 per cent fewer radiographs and 17 per cent fewer referrals to the ENT department. Radiography only improved management in a small minority and 35 per cent of films were interpreted incorrectly by casualty officers. A follow-up barium swallow disclosed a pathological lesion in a significant proportion of patients with bolus obstruction, whether or not this was passed spontaneously.