The case history is presented of a 75 year old man with chronic asthma who was treated with inhaled fluticasone propionate in a daily dose of 2 mg using a Diskhaler. After three years of treatment he developed progressive hoarseness. Both vocal cords were colonised by Aspergillus fumigatus which formed a white slough on the surface. Biopsy specimens showed changes suggestive of laryngeal aspergillosis with an ulcerated epithelium, fibrinopurulent debris, and colonies of fungal hyphae. A slow recovery occurred after three months of treatment with topical amphotericin and with cessation of inhaled corticosteroids. Laryngoscopy is recommended if hoarseness occurs during treatment with fluticasone. (+info)
(2/196) Angled telescopic surgery, an approach for laryngeal diagnosis and surgery without suspension.
CONTEXT: Many methods have been used successfully for the diagnosis and treatment of laryngeal diseases. Microscopic and, recently, telescopic surgery represent the state of the art in endoscopic laryngeal surgery but drawbacks are possible during their application. To keep the suspension apparatus adequately positioned, excessive force is sometimes placed on the upper teeth and tongue with the laryngoscope tube causing damage. Complications in relation to the pharynx, larynx and cardiovascular system have also been reported. OBJECTIVE: In order to reduce complications resulting from the manipulation or stimulation of the upper aerodigestive tract and from torque forces on the upper teeth. We present a method of larynx surgery in which laryngeal suspension is not required. DESIGN: Technical report. TECHNIQUES: We have devised a fiber-optic telescope with its 40mm distal portion deviated 60 degrees from the direction of the proximal portion. This angle was taken by measuring patients immediately before standard microlaryngeal surgery was performed. The surgical instruments have the same angle as the telescope, in order to work on the larynx. This technique provides an image that is not limited by the distal aperture of the laryngoscope and has an advantage in that magnification and illumination may be provided by changing the distance of the lesion from the tip of the instrument. we have operated on four patients with laryngeal diseases and have had no complications as a result of this approach. We feel that this technique gives us the freedom to view the lesions better and helps to minimize the drawbacks caused by laryngeal suspension. (+info)
(3/196) Inspiratory vocal cord dysfunction, a new approach in treatment.
Vocal cord dysfunction is a well recognized respiratory condition in which adduction of the vocal cords during either inspiration or expiration, or both, causes functional airways obstruction. Diagnosis is usually made by laryngofibreoscopy, however treatment of this condition has generally been unsatisfactory, requiring a multi-disciplinary approach consisting of speech therapy, psychological counselling, sedatives and anaesthetic agents. Here we use an innovative approach which requires relatively inexpensive and simple anaesthetic equipment in order to manipulate airways resistance and thus reduce any vocal cord dysfunction as it occurs. The patient involved found instant relief when using this simple device which is easy to use and is portable. (+info)
(4/196) Primary amyloidosis of the larynx.
Primary laryngeal amyloidosis is a rare benign disease of unknown aetiology. It can present with dysphonia or stridor. A woman presenting with airway compromise, who required a tracheostomy, is reported. (+info)
(5/196) Amyloidosis of the larynx: a clinicopathologic study of 11 cases.
Laryngeal amyloidosis (LA) is uncommon and poorly understood, with limited long-term clinicopathologic and immunophenotypic studies in the literature. Eleven cases of LA were retrieved from the files of the Otorhinolaryngic-Head & Neck Tumor Registry from 1953 to 1990. The histology, histochemistry, immunohistochemistry, and follow-up were reviewed. All patients (three women and eight men) presented with hoarseness at an average age of 37.8 years. The lesions, polypoid or granular, measured an average of 1.6 cm and involved the true vocal cords only (n = 4), false vocal cord only (n = 1), or were transglottic (n = 6). An acellular, amorphous, eosinophilic material was present in the stroma, often accentuated around vessels and seromucous glands, which reacted positively with Congo red. A sparse lymphoplasmacytic infiltrate was present in all cases that demonstrated light chain restriction by immunohistochemistry in three cases (kappa = 2, lambda = 1). Serum and urine electrophoreses were negative in all patients. Treatment was limited to surgical excision, including a single laryngectomy. Six patients manifested either recurrent and/or multifocal/systemic disease: two patients with light chain restriction were dead with recurrent disease (mean, 11.1 years); two patients were dead with no evidence of disease (mean, 31.7 years); and two patients were alive, one with light chain restriction and recurrent and multifocal disease (41.6 years) and one with no evidence of disease after a single recurrence (43.4 years). The remaining five patients were either alive or had died with no evidence of disease an average of 32.4 years after diagnosis. No patient developed multiple myeloma or an overt B-cell lymphoma. LA is an uncommon indolent lesion that may be associated with multifocal disease (local or systemic). The presence of an associated monoclonal lymphoplasmacytic infiltrate and recurrent/multifocal disease in the respiratory or gastrointestinal tract of a few cases and the lack of development of a systemic plasma cell dyscrasia or overt systemic B-cell malignancy suggest that some LA may be the result of an immunocyte dyscrasia or tumor of mucosa-associated lymphoid tissue. (+info)
(6/196) Beyond heartburn: extraesophageal manifestations of gastroesophageal reflux disease.
A variety of extraesophageal presentations of chronic acid reflux disease may be encountered in practice, and it is important to diagnose and manage them appropriately. Some of these patients are asymptomatic; others have symptoms most commonly associated with a pulmonary or otolaryngologic disorder. An aggressive trial of antireflux medication can often improve or resolve these symptoms, indicating that gastroesophageal reflux disease is the primary contributing component. In cases where such medication trials fail, additional diagnostic methods may be needed to determine the source of the symptoms. (+info)
(7/196) Paradoxical vocal cord adduction mimicking as acute asthma in a pediatric patient.
We report an adolescent girl with paradoxical vocal cord adduction who presented with acute onset of hyperventilation, wheezing and stridor that did not respond to bronchodilator and anti-inflammation therapy. The paradoxical vocal cord motion was confirmed by flexible fiberoptic bronchoscopic examination. We found the stridor was induced by hyperventilation, and was caused by paradoxical vocal cord movement. The abnormal cord motion may be psychogenic and could be misdiagnosed as asthma. It is important to investigate the underlying background and social history and to avoid unnecessary use of beta-agonists, steroids, and even endotracheal intubation or tracheostomy. (+info)
(8/196) Spontaneous supraglottic haemorrhage in a patient receiving warfarin sodium treatment.
A case of spontaneous, isolated supraglottic haemorrhage in a patient recently started with warfarin sodium treatment is described. The symptoms of sore throat, dysphonia, stridor, dysphagia or a neck swelling in a patient taking anticoagulants should alert the clinician to the possibility of this rare but potentially fatal complication. (+info)