Cases reported "Laryngeal Diseases"

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1/17. Vascular ring formed by right aortic arch with aberrant left subclavian artery and left ligamentum arteriosum: a rare cause of respiratory distress in newborn infants.

    Vascular ring, in which the trachea and esophagus are completely surrounded by vascular structures, is one of the causes of respiratory distress in children. Right aortic arch with aberrant left subclavian artery is a common aortic arch anomaly; however, respiratory distress due to vascular ring is seldom associated with this anomaly. We report herein a newborn infant treated surgically because of severe respiratory distress caused by vascular ring formed by right aortic arch with aberrant left subclavian artery and left ligamentum arteriosum. As laryngomalacia was first thought to be the reason for respiratory distress, we suggest that patients with respiratory distress diagnosed with laryngomalacia be evaluated for possible vascular ring.
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2/17. 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.
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keywords = esophagus
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3/17. Giant polypoid tumor of the esophagus.

    A patient with a giant polypoid tumor of the esophagus, measuring 22 cm in length is described in this report. The patient presented with cough attacks and respiratory distress. Diagnostic and therapeutic intervention required aggressive airway management, radiographic and endoscopic evaluation, and definitive surgical treatment. Benign esophageal tumors are rarely seen and originate from the upper third of esophagus, frequently close to the cricopharyngeus muscle. They may attain giant proportions. A variety of clinical presentations are described, the most serious being asphyxia secondary to laryngeal obstruction. We observed a giant esophageal tumor which was interpreted as angiofibromyolipoma that caused laryngeal obstruction. We present the clinical picture and histopathological findings of the tumor.
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keywords = esophagus
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4/17. 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.
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5/17. Severe epiglottic prolapse and the obscured larynx at intubation.

    laryngomalacia is the most common congenital anomaly of the larynx and usually involves prolapse of the arytenoids, so-called 'posterior laryngomalacia'. Most cases resolve with growth of the child and maturation of the larynx, although, rarely, significant airway obstruction can be present. Severe laryngomalacia preventing intubation is rarely encountered. We report a case of a difficult emergency intubation secondary to 'anterior laryngomalacia' in a 4-month-old boy in whom the epiglottis prolapsed posteriorly and became trapped in the laryngeal introitus. The child was referred with a diagnosis of laryngeal atresia on the basis of the intubating laryngoscopic view of no apparent epiglottis or laryngeal inlet. The child was transferred with a tube in the oesophagus that kept the child oxygenated. At the time, oxygenation was felt to be due to a coexisting tracheo-oesophageal fistula, although this was eventually found not to be the case.
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keywords = esophagus
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6/17. Junctional epidermolysis bullosa of the larynx. Report of a case and literature review.

    epidermolysis bullosa (EB) is a group of rare inherited disorders in which minor trauma causes blister formation in the skin and mucosa, including the esophagus. morbidity varies with the type of disease and ranges from occasional trivial skin blisters to death in infancy. Laryngeal involvement presenting as hoarseness and respiratory distress has been reported in nine patients, five of whom had junctional EB. We present the sixth case of junctional EB with laryngeal involvement, and offer guidelines for otolaryngologists and anesthesiologists caring for these fragile patients.
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keywords = esophagus
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7/17. Upper aerodigestive tract complications in a neonate with linear iga bullous dermatosis.

    linear iga bullous dermatosis (LABD) is a rare immunobullous condition known to affect the skin and mucous membranes of the eye and oral cavity in adults and young children. We describe a newborn with skin involvement who had life-threatening respiratory compromise from disease affecting the larynx, subglottis, trachea, and esophagus. Management with both tracheostomy and gastrostomy tube placement was necessary. Treatment included systemic steroids, dapsone, and intravenous immunoglobulin. We compare our neonatal case to the only other report in the literature highlighting involvement of the mucous membranes of multiple levels of the aerodigestive tract leading to respiratory compromise.
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keywords = esophagus
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8/17. Inlet patch of gastric mucosa in upper esophagus causing chronic cough and vocal cord dysfunction.

    BACKGROUND: An inlet patch of gastric mucosa in the upper esophagus is usually an incidental, congenital finding found during upper gastrointestinal tract endoscopy. Although it has been reported to cause dysphagia, strictures, adenocarcinoma, and webs, it has never been associated with cough and vocal cord dysfunction. OBJECTIVE: To report the first case of a patient with an inlet patch of gastric mucosa in the upper esophagus as the cause of a particularly troublesome, chronic cough that was initially missed on 2 upper endoscopies. methods: The patient is a 50-year-old man with a 7-year history of chronic cough associated with hoarseness, shortness of breath, and globus sensation. For diagnostic evaluation, pulmonary function tests, chest computed tomography, rhinolaryngoscopy, upper gastrointestinal tract endoscopy, and histologic examinations were performed. RESULTS: A multidisciplinary approach revealed several possible causes for the chronic cough, including vocal cord dysfunction, postnasal drip syndrome, allergic rhinitis, and mild gastroesophageal reflux disease that was only partially responsive to therapy. The results of 2 initial upper gastrointestinal tract endoscopies were interpreted as normal. A third endoscopy detected an inlet patch of gastric mucosa in the upper esophagus. Treatment with a high-dose histamine type 2 receptor antagonist and a proton pump inhibitor alleviated the patient's symptoms. CONCLUSIONS: An inlet patch of gastric mucosa in the upper esophagus is not uncommon, but it is often overlooked or believed to be an incidental, congenital finding. This is the first report, to our knowledge, of an inlet patch resulting in a troublesome, chronic cough.
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ranking = 8
keywords = esophagus
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9/17. vocal cord dysfunction concurrent with a nutcracker esophagus and the role of gastroesophageal reflux disease.

    BACKGROUND: Psychological disorders were originally thought to be the sole cause of vocal cord dysfunction (VCD). Subsequently, other organic diseases, including structural laryngeal abnormalities, have also been reported to be associated with VCD. OBJECTIVES: To describe the first patient with VCD concurrent with a nutcracker esophagus and to establish the association between VCD and gastroesophageal reflux disease (GERD) by using the Bernstein test. methods: Symptom assessments, neuropsychiatric evaluations, fiberoptic laryngoscopy, pulmonary function tests, allergic skin prick tests, radiographs of the chest and sinuses, esophageal manometry (including 24-hour ambulatory esophageal ph monitoring), and the Bernstein test were performed. RESULTS: A 36-year-old woman had dyspnea, hoarseness, chest pain, and wheezes without relief for a decade. Neuropsychiatric evaluations disclosed mild depression. Fiberoptic laryngoscopy showed posterior laryngitis and paradoxical vocal cord adduction with audible inspiratory stridor. Pulmonary function tests showed attenuation of the inspiratory limb with notching in both flow-volume loops and a mid-vital capacity expiratory to inspiratory flow ratio of 4. All the symptoms except chest pain were improved dramatically by speech therapy and empirical treatment for GERD. Esophageal manometry revealed a nutcracker esophagus; 24-hour ambulatory esophageal ph monitoring demonstrated multiple short reflux episodes. The Bernstein test was conducted, and all the manifestations were reproduced with 0.1 N hydrochloric acid but not with isotonic sodium chloride infusion. CONCLUSIONS: This is the first human case report confirming that GERD can trigger an acute attack of VCD and may induce chest pain as a nutcracker esophagus in patients with VCD. It strengthens this association and expands our knowledge of diverse manifestations of this clinical entity.
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ranking = 7
keywords = esophagus
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10/17. Upper aerodigestive tract manifestations of cicatricial pemphigoid.

    Cicatricial pemphigoid is a chronic mucosal blistering disorder with a predilection for subsequent scar formation. Many physicians may be unaware of the various presentations and sequelae of this uncommon disease. This report of the largest series to date focuses on the upper aerodigestive tract manifestations of this disease. During the years 1975 to 1985, 142 patients with cicatricial pemphigoid were seen at the Mayo Clinic. There were 93 women and 49 men; the age range was 21 to 92 years. Mucosal lesions occurred most often in the mucous membranes of the oral cavity and conjunctiva. Involvement of the pharynx, larynx, and esophagus was less common. Stenosis of the nasopharynx or larynx necessitated surgical repair in several persons and caused obstructive sleep apnea in two. The otolaryngologist can make an important contribution to the early recognition, diagnosis, and management of the complications of cicatricial pemphigoid.
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keywords = esophagus
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