Cases reported "Laryngismus"

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1/5. Clinical investigations of adductor spastic dysphonia.

    Spastic (spasmodic) dysphonia (SD) may coexist with or reflect certain neurologic or psychogenic illnesses. The present study of four patients with adductor SD (ASD) revealed several consistent clinical findings and characteristics that could be differentiated, while other findings were not distinguishable. Oscillographic and spectral analyses suggested voice tremor as a component of the dysphonia in all ASD patients studied. Clinical neurologic and otolaryngologic findings were nonconfirmatory regarding a disease process or state.
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ranking = 1
keywords = voice
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2/5. Study of spastic dysphonia using videofiberoptic laryngoscopy.

    Spastic dysphonia is a speech disorder, characterized by a "strangled voice quality," irregularly occuring phonatory arrests, and a jerky pattern of speech. This is often extremely disruptive to the patient's ability to communicate. Two cases are presented in which a new technique, videofiberoptic laryngoscopy, was employed in the study of these patients. The characteristic laryngeal behavior of this disorder is documented and recorded, particularly noting the increase in supraglottic activity and how different vocal maneuvers alter this activity.
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ranking = 1
keywords = voice
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3/5. Respiratory distress after recurrent laryngeal nerve sectioning for adductor spastic dysphonia.

    Adductor spastic dysphonia is a voice sign associated with various neurologic and psychologic disorders. Treatment of spastic dysphonia in selected patients is unilateral recurrent laryngeal nerve sectioning. Except for voice change or, in some patients, return of phonatory spasticity, there have been no long-term sequelae or complications of this treatment. We describe three patients with adductor spastic dysphonia who underwent recurrent laryngeal nerve sectioning and who, 3 to 38 months later, suffered respiratory distress that required tracheostomy. The respiratory distress in all three patients was due to episodic jerky vocal cord hyperadductions that caused stridor during inspiration and expiration. These repetitive laryngospasms during respiration and phonation were progressive. Two patients needed an arytenoidectomy to achieve a useful voice, and all three required a permanent tracheostomy to alleviate inspiratory laryngeal obstruction.
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ranking = 3
keywords = voice
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4/5. recurrent laryngeal nerve section in the treatment of spastic dysphonia.

    Spastic dysphonia is a severe vocal disability in which the patient speaks with hyperadducted vocal folds. The resulting abnormality is characterized by excessively low pitch, vocal tremor, laryngospasms, and strain-strangle voice quality. Until recently the disorder was regarded as psychogenic and treated unsuccessfully with speech therapy and psychotherapy. New evidence supports the theory that the etiology is neurologic, requiring management designed to alter neurophysiologic function. Section of the recurrent laryngeal nerve provides immediate results and a new voice virtually free of the previous unpleasant characteristics.
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ranking = 2
keywords = voice
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5/5. Episodic paroxysmal laryngospasm: voice and pulmonary function assessment and management.

    Episodic paroxysmal laryngospasm (EPL) is a sign of laryngeal dysfunction, often without a specific organic etiology, which can masquerade as asthma, vocal fold paralysis, or a functional voice disorder. The intermittent respiratory distress of EPL may precipitate an apparent upper airway obstructive emergency, resulting in unnecessary endotracheal intubation, cardiopulmonary resuscitation, or tracheostomy. During 27 months, seven women and three men, age 30-76 years, were assessed by a high diagnostic index of suspicion, an intensive history including psychosocial factors, physical examination of the airways, provocative asthma testing, and swallowing studies. Videolaryngoscopy, stroboscopy, and pulmonary flow-volume loop testing were definitive. The classic appearance was paradoxic inspiratory adduction of the anterior vocal folds with a posterior diamond-shaped glottic gap. During an attack of stridor or wheezing, attenuation of the inspiratory flow rate as depicted by the flow-volume loop suggested partial extrathoracic upper airway obstruction. Swallowing evaluation by videolaryngoscopy and videosophagography may uncover gastroesophageal reflux disease. Hallmarks of management include patient and family education by observation of laryngoscopic videos, a specific speech therapy program, psychotherapy, and medical treatment of associated disorders. electromyography may become a valuable future adjunct. Unlike laryngeal dystonia, patients with EPL do not benefit from botulinum toxin type A.
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ranking = 5
keywords = voice
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