1/47. Surgical management of acquired laryngopharyngeal fistulae.Pathological communication between the food and air passages in the neck region due to malignant disease is known. However, such a pathology arising as a result of a non malignant process is relatively uncommon, and only a handful of reports exists in the literature. The authors describe and discuss the management of two patients with laryngopharyngeal fistula of nonmalignant etiology.- - - - - - - - - - ranking = 1keywords = pharyngeal (Clic here for more details about this article) |
2/47. Supraesophageal complications of gastroesophageal reflux.Supraesophageal complications of GERD have become more commonly recognized or suspected by physicians. However, the direct association between these complications and GERD has often been difficult, if not impossible, to establish. Furthermore, the majority of patients with suspected supraesophageal complications of GERD do not have either the characteristic symptoms of heartburn and regurgitation or the definitive findings of esophageal inflammation, which would help reinforce the suspicion of a connection between the supraesophageal complications and GERD. Frequent acid reflux has been shown in patients with various bron-chopulmonary, laryngopharyngeal, or oral cavity disorders. GERD is one of the most common gastrointestinal complaints in the population. It is possible that the supraesophageal problems and acid reflux are mutually independent disorders that occur in the same person. The suspected mechanisms of GERD-related supraesophageal complications appear to be directed through two pathways: by a vagal reflex between the esophagus and tracheobronchial tree triggered by acid reflux or by microaspiration that causes contact damage to mucosal surfaces. The most useful diagnostic modality available to the clinician to aid in the diagnosis of supraesophageal GERD complications is the ambulatory pH recording technique. However, the sensitivity and specificity of this test for recording esophageal or pharyngeal acid reflux events has been critically challenged. Despite the many clinical studies that support the theory that GER has a role in suspected supraesophageal complications, only 1 long-term prospective controlled study of a large group of patients with asthma has shown the positive effects of the elimination of acid reflux. With the focus now on "outcomes medicine," there is a serious need for appropriately designed, controlled studies to answer the many questions surrounding a cause-and-effect association between acid reflux and supraesophageal disorders. Because of the lack of convincing proof between acid reflux and suspected supraesophageal complications, the physician must resort to an intent-to-treat strategy as both a primary therapy and a diagnostic trial. High-dose PPI therapy for prolonged periods is the recognized conservative therapy. Operative therapy (i.e., fundoplication operation) is the procedure of choice when overt regurgitation occurs or when medical therapy, although successful, is not practical for long periods. Controlled, well-designed clinical trials and more sophisticated techniques to measure and quantify acid reflux are crucial in the future to help determine which patients with suspected supraesophageal complications actually have acid reflux as a primary cause. The medical community needs to be alerted to the possibility of an association between GERD and supra-esophageal complications so that patients with a GERD-related complication will be recognized and effectively treated.- - - - - - - - - - ranking = 0.4keywords = pharyngeal (Clic here for more details about this article) |
3/47. hypnosis as a diagnostic modality for vocal cord dysfunction.vocal cord dysfunction (VCD) is a condition of paradoxical adduction of the vocal cords during the inspiratory phase of the respiratory cycle. VCD often presents as stridorous breathing, which may be misdiagnosed as asthma. The mismanagement of this disorder may result in unnecessary treatment and iatrogenic morbidity. An association with psychogenic factors has been reported, and a higher incidence of anxiety-related illness has been demonstrated in patients with VCD. Definitive diagnosis of VCD is made by visualization of adducted cords during an acute episode using nasopharyngeal fiber-optic laryngoscopy. Diagnosis can be problematic, because it may be difficult to reproduce an attack in a controlled setting. To maximize diagnostic yield during laryngoscopy, provocation of symptoms using methacholine, histamine, or exercise challenges have been used. We report a case of an 11-year-old boy, wherein hypnotic suggestion was used as an alternative method to achieve a diagnosis of VCD. The patient was admitted to the pediatric intensive care unit for elective fiber-optic laryngoscopy to confirm a diagnosis of VCD. The patient had a 4-year history of refractory asthma, severe gastroesophageal reflux disease (GERD) for which he had undergone a Nissen fundoplication, and suspected VCD. At 9 years of age the patient began manifesting monthly respiratory distress episodes of a severe character different from those that had been attributed to his asthma. Typically, he awoke from sleep with shortness of breath and difficulty with inhalation. He described a "neck attack" during which he felt as if the walls of his throat were "beating together." The patient was at times noted by his mother to exhibit a "suckling" behavior before onset of his respiratory distress episodes. On 4 occasions the patient became unconscious during an attack and then spontaneously regained consciousness after a few minutes. On these occasions, he was transported by ambulance to the hospital and the severe difficulty with inhalation resolved within a few minutes on treatment with oxygen and bronchodilators. Sometimes he was noted to manifest wheezing for several hours, which was responsive to bronchodilator therapy. Given the severity of the patient's disease, it was imperative to determine whether VCD was a complicating factor. It was proposed that an attempt be made to induce VCD by hypnotic suggestion while the patient underwent a fiberscopic laryngoscopy to establish a definitive diagnosis. The patient and his mother gave written consent for this procedure. He was admitted for observation to the pediatric intensive care unit for the induction attempt. The patient requested that no local anesthesia be applied in his nose before passage of the laryngoscope because he wanted to eat right after the procedure. Therefore, the nasopharyngeal laryngoscope was inserted while he used self-hypnosis as the sole form of anesthesia. He demonstrated no discomfort during its passing. Once the vocal cords were visualized, the patient was instructed to develop an episode of respiratory distress while in a state of hypnosis by recalling a recent "neck attack." His vocal cords then were observed to adduct anteriorly with each inspiration. The patient then was asked to relax his neck. When he did, the vocal cords immediately abducted with inspiration, and he breathed easily. After removal of the laryngoscope, the patient alerted from hypnosis and said he felt well. He reported no recollection of the procedure, thus demonstrating spontaneous amnesia that sometimes is associated with hypnosis. Because the diagnosis of VCD was confirmed, the patient was encouraged to use self-hypnosis and speech therapy techniques to control his symptoms. He also was referred for counseling. To our knowledge this is the first description in the medical literature of the use of hypnotic suggestion for making a diagnosis of VCD. (ABSTRACT TRUNCATED)- - - - - - - - - - ranking = 0.4keywords = pharyngeal (Clic here for more details about this article) |
4/47. Thorotrast (thorium dioxide) granuloma of the neck: Surgical considerations.Summary--Thorotrast (thorium dioxide) is a contrast material which was first used for angiography about 40 years ago. Its use was discontinued because of the reported incidences of malignancy following injection. Its long-term effects are related to its long half-life and slow excretion rate. Following extravasation into the soft tissues of the neck, the prolonged radiation effect results in tissue breakdown with formation of granulomas. There can also be cranial nerve palsies, occlusion of the major blood channels, laryngeal edema, pharyngeal and esophageal ulceration, and fistula formation. To avoid these late consequences, it is suggested that Thorotrast granuloma in the neck be excised radically. Partial or limited resections are inadequate.- - - - - - - - - - ranking = 0.2keywords = pharyngeal (Clic here for more details about this article) |
5/47. transillumination laryngoscopy: a new way of evaluating vocal fold and hypopharyngeal lesions.Conventional methods of observing the larynx and the hypopharynx use reflected light to illuminate the larynx. The aim of this study was to see whether transilluminating the larynx was possible in subjects with and without disease. The larynx and the hypopharynx were observed by means of a rigid scope with a low-light charge-coupled device camera without the light guide inserted. Illumination was provided by a second rigid scope attached to a light source that was held at the neck by an assistant. The larynx and hypopharynx were observed by transillumination using both constant lighting and stroboscopy in 3 subjects with pharyngeal or laryngeal lesions and in 4 normal controls. The tumors were translucent or nontranslucent in appearance. A translucent polyp became nontranslucent when overlapping the vocal fold, thus indicating that a lesion the size of a polyp could be evaluated with this method. Mucosal waves could be observed during stroboscopy with transillumination, thus allowing observation of waves and lesions that cannot be observed with conventional stroboscopy.- - - - - - - - - - ranking = 1keywords = pharyngeal (Clic here for more details about this article) |
6/47. Cowden's disease with vocal fold involvement.Cowden's disease is a hereditary disorder characterized by oropharyngeal fibrosis and multiple hamartomas with potential malignant changes. We treated a 47-year-old man who had fibrotic lesions on the left vocal fold and an extensive amount of papillomatous lesions on the mucosa of the lips, tongue, and pharyngeal wall and on the skin of the axillae and buttocks. The pattern of distribution and the histopathologic features of these mucocutaneous lesions were diagnostic of Cowden's disease. To the best of our knowledge, this is the first reported case of Cowden's disease involving a vocal fold.- - - - - - - - - - ranking = 0.4keywords = pharyngeal (Clic here for more details about this article) |
7/47. Lipoid proteinosis. A case report.Lipoid proteinosis caused specific changes in the brain, larynx, and cervical esophagus of a young adult man. Laryngography clearly depicts the distribution and degree of pharyngeal and laryngeal pathology. Florid calcification, conforming to the classical temporal lobe distribution, is documented by plain films and tomography. The clinical picture and the pertinent literature are reviewed.- - - - - - - - - - ranking = 0.2keywords = pharyngeal (Clic here for more details about this article) |
8/47. Antenatal diagnosis and management of a vallecular cyst.Vallecular cysts are rare. It is important to be aware of their presence as they can cause upper airway obstruction. We describe a case of congenital vallecular cyst diagnosed at 28 weeks of gestation. This early diagnosis enabled us to plan careful perinatal management. We believe that, in cases of suspected oropharyngeal tumors, elective delivery should be carried out in a tertiary referral center in which emergency ventilation and tracheostomy are possible.- - - - - - - - - - ranking = 0.2keywords = pharyngeal (Clic here for more details about this article) |
9/47. Laryngopharyngeal dysfunction from the implant vagal nerve stimulator.OBJECTIVES/HYPOTHESIS: The objective of the study was to examine the side-effect profile of the vagal nerve stimulator. Vagal nerve stimulators have been used to treat intractable seizures in all age groups. They provide relief to the patient with a seizure disorder by decreasing the overall number and severity of seizure activities. Although significant complications are rare, many patients have some complaint, usually of their voice. STUDY DESIGN: A retrospective evaluation of four patients with intractable epilepsy. methods: Evaluation of charts and medical records and endoscopic examination of the larynx. RESULTS: In this small series, all four patients had implantation-related paresis. Three of the four appear to have side effects from device activation. CONCLUSIONS: patients in whom a vagal nerve stimulator is placed can have adverse side effects. These can be related to the surgical manipulation of the vagus nerve, resulting in a temporary paresis of the vocal folds. A second set of side effects is related to the actual electrical stimulation of the device, and these side effects can directly affect the laryngeal musculature.- - - - - - - - - - ranking = 0.8keywords = pharyngeal (Clic here for more details about this article) |
10/47. Acquisition of esophageal speech subsequent to learning pharyngeal speech: an unusual case study.Laryngectomees who are delayed in obtaining alaryngeal voice therapy may develop pharyngeal voice, an undesirable type of alaryngeal voice. Pharyngeal voice is usually self-developed; however, it may also be acquired in the clinical setting when the patient is being taught to inject air for esophageal sound production. This report describes the principal findings involving a laryngectomee who had developed and used pharyngeal speech as his primary method of communication for two years prior to enrollment in alaryngeal voice therapy. A clinical technique that was found to be successful in altering the pharyngeal voice to esophageal voice is reported. Findings pertaining to the overall intelligibility as well as vocal fundamental frequency of the two different types of alaryngeal speech are included.- - - - - - - - - - ranking = 1.4keywords = pharyngeal (Clic here for more details about this article) |
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