Cases reported "Respiratory Sounds"

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1/10. Goitre presenting as an oropharyngeal mass: an unusual finding in the elderly.

    Thyroid goitre presentation in the neck with extension inferiorly to the mediastinum is well-known. Extension superiorly into the retropharyngeal space is very rare and may be accompanied by change in voice and/or airway compromise. A case is described of a patient with change in voice and mild airway compromise secondary to a goitre presenting in the oropharynx. Computed tomography (CT) and physical findings are discussed with the need to recognize this rare entity.
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2/10. Bilateral vocal fold paresis and multiple system atrophy.

    OBJECTIVE: To review a case series of patients with systemic neurodegenerative disease presenting to a laryngologist for workup of dysphonia and found to have bilateral vocal fold paresis. DESIGN: Case series. SETTING: Tertiary care voice center. patients: Series of patients with neurodegenerative disorders examined for dysphonia. MAIN OUTCOME MEASURES: history and physical examination including fiberoptic laryngoscopy were performed on all patients. Some patients underwent polysomnography. RESULTS: Seven patients during a 2-year period were noted to have bilateral abductor vocal fold paresis. Five of 7 (71%) had the diagnosis of multiple system atrophy proposed by the laryngologist. All 7 patients described sleep-disordered breathing with stridor. CONCLUSIONS: patients with systemic neurodegenerative disorders such as parkinson disease should be examined for multiple system atrophy and for evidence of bilateral vocal fold paresis. Workup for stridor should include polysomnography. Treatment of glottic obstruction in these patients includes constant positive airway pressure at night or tracheotomy. The finding of bilateral vocal fold paresis can be life threatening.
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3/10. Report of an obstructive goiter and its surgical treatment during delivery.

    We report a case of a morbidly obese young woman in her third trimester of pregnancy presenting with a history of goiter and respiratory disease. The recent history of this patient was significant for worsening respiratory symptoms over a period of 2 weeks, and, on presentation at 36 weeks gestation, she was stridorous, dyspneic at rest, and had a hoarse voice. Evaluation revealed a morbidly obese individual with a large goiter. She was biochemically euthyroid. Fiberoptic laryngoscopy revealed a left true vocal cord paresis, and ultrasound evaluation was significant for diffuse multinodular enlargement, with each lobe measuring greater than 10 cm and the isthmus measuring 5. Pulmonary function testing revealed a significant degree of upper airway obstruction without significant lower airway disease. Given the patient's clinical signs and symptoms, her tenuous airway, poor candidacy for urgent tracheotomy, and her proximity to delivery, it was agreed that the patient should undergo elective cesarean section and at its completion undergo subtotal thyroidectomy for the obstructive goiter.
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4/10. Recurrent respiratory papillomatosis in a survivor of extreme prematurity.

    Recurrent respiratory papillomatosis (RRP) is a rare disease in children. Previous reports suggested that prematurity and early age of presentation were poor prognostic factors. We report on a 24-week premature infant who presented with stridor, weak cry, and hoarseness of voice at age 9 months (corrected age), in whom the diagnosis of RRP was not made until age 21 months (corrected age). Laser excision of RRP was subsequently performed, and the child is still surviving at age 2.5 years. RRP should be considered in the differential diagnosis of airway problems in survivors of extreme prematurity; the prognosis is not uniformly poor in premature infants.
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5/10. A Christmas tree in the larynx.

    A 2 year-old boy presented with acute upper airway obstruction following a 15-month history of noisy breathing and hoarseness. An urgent laryngotracheal bronchoscopy was performed following inhalational induction of anesthesia. Using a fiberoptic bronchoscope, visualization of the larynx through a laryngeal mask airway revealed a flat plastic Christmas tree embedded within granulomatous cords causing almost complete obstruction and requiring tracheostomy prior to extraction. Twelve days later, the tracheostomy was successfully decannulated with the child's voice beginning to normalize. The family remembered the decoration from Christmas celebrations 2 years prior and recalled a coughing episode that predated the onset of hoarseness.
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6/10. Blunt laryngeal trauma resulting in arytenoid dislocation and dysphonia.

    We present a case of left arytenoid dislocation due to blunt laryngeal trauma causing a subsequent large granuloma formation resulting in dysphonia and stridor. The patient underwent emergency excision of the obstructive granuloma and speech therapy was started post-operatively. A few weeks after surgery, the granuloma started to recur and laryngeal manipulation by a specialist osteopath was performed. A few weeks after the conservative management, the recurred granuloma resolved completely and patient's voice improved remarkably. Dislocation of the arytenoid cartilage due to blunt trauma is relatively rare and a consequent spontaneous granuloma formation has not been reported so far in the literature. This is also the first report about efficacy of speech therapy combined with laryngeal manipulation in the management of the arytenoid dislocation and the subsequent laryngeal granuloma.
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7/10. dyspnea, wheezing, and airways obstruction: is it asthma?

    dyspnea, wheezing, and decreased FEV1 with bronchodilator response are characteristic of asthma. However, when standard asthma therapy fails, a broad differential must be considered to avoid a catastrophic outcome. This article presents a case report of a 48-year-old Filipino woman, who was referred for evaluation of cough, dyspnea and wheezy respiration, changes in voice quality, nasal and palatal pruritus, and postnasal drainage. She was found to have mold spore hypersensitivity and abnormal spirometry with an obstructive pattern and a 15% reversibility postnebulized albuterol. An initial diagnosis of allergic rhinitis and adult-onset asthma was made, and therapy was initiated which included: salmeterol, budesonide, montelukast, and pirbuterol. Her symptoms persisted and rabeprazole was added to treat possible laryngopharyngeal reflux. Repeat spirometry demonstrated worsening obstruction. There was no improvement with systemic corticosteroids. High-resolution computed tomography of the chest demonstrated a left paratracheal mass, obstructing 60% of the airway. bronchoscopy revealed a tumor 4-5 cm below the vocal cords with the appearance of adenoid cystic carcinoma, which was confirmed by pathology. All symptoms resolved and spirometry normalized with resection of mass and radiation therapy. Adenoid cystic carcinoma (ACC) is an uncommon form of malignant neoplasm that arises from salivary glands. Tracheobronchial ACC typically presents with symptoms of cough, dyspnea, and hoarseness. ACC has a relatively indolent course. Standard therapy is surgical resection often followed by radiotherapy. In patients who fail conventional therapies for asthma, it is important to consider other diagnoses to avoid fatal outcomes.
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8/10. Central vocal cord paralysis and paresis presenting as laryngeal stridor in children.

    vocal cord paralysis or paresis as the initial presenting symptom for intracranial tumors in children are rare. Recently, two pediatric patients who were later diagnosed as having intracranial tumors presented with the symptom of voice changes and stridor. Telescopic examination revealed bilateral vocal cord paresis and paralysis as demonstrated by video recordings. The majority of pediatric brain tumors present with both generalized and localized complaints; however, by discussing these two rare cases, we hope to underscore the importance of a thorough workup of the paralyzed or paretic vocal cords.
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9/10. carbon dioxide laser in removal of polytef paste.

    Teflon injection is the most popular surgical technique for improvement of voice in patients with a unilaterally paralyzed larynx. The results with this method usually are good, but cases of overinjection with resultant poor voice, airway compromise, or both, do occur. The carbon dioxide laser has become a standard instrument for laryngeal surgery, and it might reasonably be used in attempts to correct the overinjected vocal cord. Realizing that Teflon could share flammable characteristics with other polymers, such as rubber and polyvinylchloride, we investigated the effect of the carbon dioxide laser on fresh polytef paste (Mentor O & O Inc, Hingham, Mass) before using it in a patient with an overinjected hemilarynx. Fresh paste was found to ignite after exposure to standard laser power at normal time settings, both in room air and in an oxygen-enriched atmosphere. To determine the effect of the laser on Teflon in situ, the paste was injected subcutaneously and intramuscularly into a rat. After a suitable interval of time, the Teflon was found to glow but not ignite when exposed to the laser under standard operating conditions. Only under high power in an oxygen-enriched environment did ignition occur. In our patient, the laser was used to incise the mucosa over the polytef granuloma, and standard microsurgical (nonlaser) techniques were used to complete the removal with good results. Laryngologists should be aware of the dangers of using the carbon dioxide laser on or near Teflon, especially in freshly injected vocal cords.
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10/10. Poor breath sounds with good voice sounds. A sign of bronchial stenosis.

    The auscultatory finding of disparity in breath and voice sounds, the former being absent or faint whereas the latter are easily heard when compared to the corresponding site over the opposite lung, predicts stenosis of a main, intermediate, or lobar bronchus. Stenosis limits airflow and consequently reduces turbulence, causing diminution or absence of breath sounds over the poorly ventilated region; however, flow-independent voice sounds are not significantly impaired. This sign was present in ten patients, in each of whom bronchial stenosis was confirmed by bronchoscopy.
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