Surgical management of laryngeal paralysis varies depending on whether the vocal cords are in abduction, adduction or paramedian position. Various surgical techniques have been described including partial arytenoidect...Surgical management of laryngeal paralysis varies depending on whether the vocal cords are in abduction, adduction or paramedian position. Various surgical techniques have been described including partial arytenoidectomy which is reported to give good surgical results that are stable over time. The objective of the study was to analyze the surgical therapeutic elements of bilateral paralysis, especially to assess partial arytenoidectomy, one of the most performed techniques. This was a descriptive retrospective study of cases of bilateral immobility admitted between January 1<sup>st</sup> 2008 and March 31<sup>st</sup> 2018 and treated surgically. Socio-demographic and therapeutic data were collected. The survey involved 46 patients, with an equal number of male and female (23) with 50% of male patients and 23 patients were female, or a sex ratio of 1. The average age of the patients was 56 ± 17 years ranging between 14 and 89 years. Posterior partial arytenoidectomy was the most widely performed surgical technique (26 patients or 56.5%), followed by cordopexia or lateral-fixing of a vocal cord (19.6%) and posterior cordectomy (17.4%). Patients who received a partial arytenoidectomy and cordopexia had their vocal cords either in adduction or in the paramedian position. Those who received a posterior cordectomy had their vocal cords in adduction. 18 patients (39.13%) were taken to the operating theatre in less than 6 hours, 28 (60.9%) had no post-operative complications, and 9 patients received a surgical enlargement resumption. In post-operative follow-up, 11 patients suffered pulmonary aspiration corrected after speech therapy;26 patients (56.5%) did not. Partial arytenoidectomy remains the most performed surgical procedure in the management of closed bilateral laryngeal paralysis at the Mont-Godinne University Hospital. It allows a reliable and durable breathing function over time with less impact on the voice.展开更多
Vocal cord paralysis can occur as a complication o surgery or anaesthesia,if permanent is a significant clinica problem.Early detection is important to optimize the chance o repair,and avoid complications associated w...Vocal cord paralysis can occur as a complication o surgery or anaesthesia,if permanent is a significant clinica problem.Early detection is important to optimize the chance o repair,and avoid complications associated with an impaired swallow.An algorithm to detect altered vocal cord function was presented based on wavelet packet analysis(WPA) and suppor vector machines(SVM),and compared with the Hoarseness Diagram method(HDm),which was reported as an objective voice quality evaluation approach and could be used for pathological voice discrimination.Experiments using voice signals recorded from subjects before and after the procedure show high classification accuracy with the new algorithm,whereas HDm fails in the detection of a hoarse voice.This finding would help to develop a screening tool to detect the vocal structure damage during surgery.展开更多
This paper deals about a quantitative and qualitative study of the sustained vibration pat-terns of vocal cords with a mulfifunctional glottograph developed by the authors.The glottogramsand their parameters for the m...This paper deals about a quantitative and qualitative study of the sustained vibration pat-terns of vocal cords with a mulfifunctional glottograph developed by the authors.The glottogramsand their parameters for the modal,falsetto,breathy and pressed voices are presented.This paper al-so sets out to explore the influence of the changes in the properties of the vocal tract andfundamental frequency,on vocal cord vibration.Typical clinical results show that the glottographicmethod may be used in the diagnosis and treatment of laryngeal diseases,phonation physiology andevaluation of artistic voice.展开更多
Right vocal cord paralysis in our present case was diagnosed on clinical and radiological examination which is precipitated by an anomalous right aortic arch with diverticulum. This is a very uncommon vascular etiolog...Right vocal cord paralysis in our present case was diagnosed on clinical and radiological examination which is precipitated by an anomalous right aortic arch with diverticulum. This is a very uncommon vascular etiology of hoarseness and is extremely rare. Because of this rarity, the practicing otolaryngologist may miss this finding while evaluating a case of idiopathic right vocal cord paralysis. Thus, the authors feel that idiopathic or unexplained right vocal cord paralysis should be routinely investigated with a CT or MRI of neck and chest with or without contrast to avoid such shortcomings. There is only one such case of right vocal cord paralysis by right aortic which has been reported earlier in literature.展开更多
Background and Objective: Vocal cord paralysis results in impairment of breathing and/or speech. One of the causes of vocal cord paralysis is the disruption of vagus nerve innervation to the vocal cords by the mass ef...Background and Objective: Vocal cord paralysis results in impairment of breathing and/or speech. One of the causes of vocal cord paralysis is the disruption of vagus nerve innervation to the vocal cords by the mass effect of a neighbouring structure. We report a rare case of vocal cord paralysis secondary to internal carotid artery dissection. Method: The diagnosis was based on clinical history, physical examination and imaging studies. Literature review was done. Case Report: This was a 53-year-old female with a history of unremitting, progressive hoarseness and mild dysphagia to liquid, who was clinically found to have impaired left vocal cord mobility, a left-sided pulsatile neck mass and left carotid artery dissection based on imaging studies. Symptoms abated after conservative treatment with Aspirin and she has remained symptom free since two years of follow-up. Conclusion: Vocal cord paralysis can be a consequence of carotid artery dissection causing mass effect on the vagus nerve. Thus, carotid artery dissection should not be forgotten as a possible cause of vocal cord paralysis in some cases of vocal cord paralysis of uncertain etiology. Treatment with anti-platelet drug can bring about resolution of symptoms and return of vocal cord mobility.展开更多
Introduction: Chemotherapy is a rare cause of iatrogenic vocal fold dysfunction. It has been reported in three main classes of chemotherapy agents and often occurs during the treatment interval. We present a case of b...Introduction: Chemotherapy is a rare cause of iatrogenic vocal fold dysfunction. It has been reported in three main classes of chemotherapy agents and often occurs during the treatment interval. We present a case of bilateral vocal cord paresis with delayed presentation after completion of chemotherapy. Methods: One case, managed with observation and serial exams, is presented. A review of previous case reports of chemotherapy-induced vocal cord paresis and possible mechanisms of injury was performed. Results: Patient improved both symptomatically and through objective findings over the one-year course of observation. Conclusion: Diagnosis of chemotherapy-induced vocal cord paresis is dependent on a thorough history and physical exam. Management is predicated in that the dysfunction is often dose dependent and reversible, necessitating both cessation of the offending agent and the knowledge that any treatment is likely needed for only a temporary time. Chemotherapy-induced vocal fold paresis should be in the differential for patients presenting with hoarseness, dysphonia, stridor and a positive chemotherapy展开更多
Central venous catheter insertion in the internal jugular vein(IJV)is frequently performed in acute care settings,facilitated by its easy availability and increased use of ultrasound in healthcare settings.Despite the...Central venous catheter insertion in the internal jugular vein(IJV)is frequently performed in acute care settings,facilitated by its easy availability and increased use of ultrasound in healthcare settings.Despite the increased safety profile and insertion convenience,it has complications.Herein,we aim to inform readers about the existing literature on the plethora of complications with potentially disastrous consequences for patients undergoing IJV cannulation.展开更多
BACKGROUND Since its description in 1790 by Hunter,the nasogastric tube(NGT)is commonly used in any healthcare setting for alleviating gastrointestinal symptoms or enteral feeding.However,the risks associated with its...BACKGROUND Since its description in 1790 by Hunter,the nasogastric tube(NGT)is commonly used in any healthcare setting for alleviating gastrointestinal symptoms or enteral feeding.However,the risks associated with its placement are often underes-timated.Upper airway obstruction with a NGT is an uncommon but potentially life-threatening complication.NGT syndrome is characterized by the presence of an NGT,throat pain and vocal cord(VC)paralysis,usually bilateral.It is poten-tially life–threatening,and early diagnosis is the key to the prevention of fatal upper airway obstruction.However,fewer cases may have been reported than might have occurred,primarily due to the clinicians'unawareness.The lack of specific signs and symptoms and the inability to prove temporal relation with NGT insertion has made diagnosing the syndrome quite challenging.AIM To review and collate the data from the published case reports and case series to understand the possible risk factors,early warning signs and symptoms for timely detection to prevent the manifestation of the complete syndrome with life-threatening airway obstruction.METHODS We conducted a systematic search for this meta-summary from the database of PubMed,EMBASE,Reference Citation Analysis(https://www.referencecitation-analysis.com/)and Google scholar,from all the past studies till August 2023.The search terms included major MESH terms"Nasogastric tube","Intubation,Gastrointestinal","Vocal Cord Paralysis",and“Syndrome”.All the case reports and case series were evaluated,and the data were extracted for patient demographics,clinical symptomatology,diagnostic and therapeutic interventions,clinical course and outcomes.A datasheet for evaluation was further prepared.RESULTS Twenty-seven cases,from five case series and 13 case reports,of NGT syndrome were retrieved from our search.There was male predominance(17,62.96%),and age at presentation ranged from 28 to 86 years.Ten patients had diabetes mellitus(37.04%),and nine were hypertensive(33.33%).Only three(11.11%)patients were reported to be immunocompromised.The median time for developing symptoms after NGT insertion was 14.5 d(interquartile range 6.25-33.75 d).The most commonly reported reason for NGT insertion was acute stroke(10,37.01%)and the most commonly reported symptoms were stridor or wheezing 17(62.96%).In 77.78%of cases,bilateral VC were affected.The only treatment instituted in most patients(77.78%)was removing the NG tube.Most patients(62.96%)required tracheostomy for airway protection.But 8 of the 23 survivors recovered within five weeks and could be decannulated.Three patients were reported to have died.CONCLUSION NGT syndrome is an uncommon clinical complication of a very common clinical procedure.However,an under-reporting is possible because of misdiagnosis or lack of awareness among clinicians.Patients in early stages and with mild symptoms may be missed.Further,high variability in the presentation timing after NGT insertion makes diagnosis challenging.Early diagnosis and prompt removal of NGT may suffice in most patients,but a significant proportion of patients presenting with respiratory compromise may require tracheostomy for airway protection.展开更多
背景新生儿声带麻痹(VCP)的临床特点和近期预后的影响因素不确切。目的探讨新生儿VCP出院结局的影响因素。设计回顾性队列研究。方法新生儿VCP诊断根据病史、体征和支气管镜检查结果,纳入2013年4月至2022年1月在济南市儿童医院NICU确诊...背景新生儿声带麻痹(VCP)的临床特点和近期预后的影响因素不确切。目的探讨新生儿VCP出院结局的影响因素。设计回顾性队列研究。方法新生儿VCP诊断根据病史、体征和支气管镜检查结果,纳入2013年4月至2022年1月在济南市儿童医院NICU确诊为新生儿VCP的病例,以出院时是否需有创通气和自行吸吮分为好转出院组和非好转出院组,采集如下临床资料用于本文单因素分析。①孕母资料:年龄、妊娠期高血压、妊娠期糖尿病、分娩方式、胎膜早破、脐带绕颈、脐带扭转、羊水情况;②新生儿资料:性别、胎龄、出生体重、1 min Apgar评分、伴发畸形、喉梗阻;③VCP病因:产伤、神经源性、医源性、特发性;④支气管镜下所见:单侧VCP和双侧VCP(完全麻痹和不全麻痹);⑤出院时预后。以单因素分析P<0.10的变量为自变量行多因素Logistics回归分析。主要结局指标影响好转出院的因素。结果133例新生儿VCP进入本文分析,首次行支气管镜检查日龄为6(4,12)d,入院日龄13.0(3.0,20.5)d,胎龄39.0(38.0,40.0)周,伴发畸形71例(53.4%,94例次),单侧VCP 43例(32.3%);双侧VCP 90例,其中不全麻痹57例,完全麻痹33例。好转出院组96例(72.2%)。非好转出院组37例,其中撤机困难28例,气管切开8例(双侧不全麻痹7例,双侧完全麻痹1例),气管切开后均成功脱离正压通气并出院,4例声带运动于9个月内恢复,4例失访;吸吮-吞咽-呼吸协调障碍37例。纳入单因素分析P<0.10的变量(剖宫产、羊水多、出生体重、低Apgar评分、神经源性损伤、喉梗阻、声带麻痹类型)行多因素Logistics回归分析,结果显示,双侧不全麻痹为新生儿VCP好转出院的不利因素(OR=6.785,95%CI:2.191~21.013,P=0.001)。结论双侧VCP、尤其是双侧声带不全麻痹新生儿的近期预后差,气管切开可以作为一种姑息治疗手段。展开更多
文摘Surgical management of laryngeal paralysis varies depending on whether the vocal cords are in abduction, adduction or paramedian position. Various surgical techniques have been described including partial arytenoidectomy which is reported to give good surgical results that are stable over time. The objective of the study was to analyze the surgical therapeutic elements of bilateral paralysis, especially to assess partial arytenoidectomy, one of the most performed techniques. This was a descriptive retrospective study of cases of bilateral immobility admitted between January 1<sup>st</sup> 2008 and March 31<sup>st</sup> 2018 and treated surgically. Socio-demographic and therapeutic data were collected. The survey involved 46 patients, with an equal number of male and female (23) with 50% of male patients and 23 patients were female, or a sex ratio of 1. The average age of the patients was 56 ± 17 years ranging between 14 and 89 years. Posterior partial arytenoidectomy was the most widely performed surgical technique (26 patients or 56.5%), followed by cordopexia or lateral-fixing of a vocal cord (19.6%) and posterior cordectomy (17.4%). Patients who received a partial arytenoidectomy and cordopexia had their vocal cords either in adduction or in the paramedian position. Those who received a posterior cordectomy had their vocal cords in adduction. 18 patients (39.13%) were taken to the operating theatre in less than 6 hours, 28 (60.9%) had no post-operative complications, and 9 patients received a surgical enlargement resumption. In post-operative follow-up, 11 patients suffered pulmonary aspiration corrected after speech therapy;26 patients (56.5%) did not. Partial arytenoidectomy remains the most performed surgical procedure in the management of closed bilateral laryngeal paralysis at the Mont-Godinne University Hospital. It allows a reliable and durable breathing function over time with less impact on the voice.
基金National Natural Science Foundation of China (No.60971016)
文摘Vocal cord paralysis can occur as a complication o surgery or anaesthesia,if permanent is a significant clinica problem.Early detection is important to optimize the chance o repair,and avoid complications associated with an impaired swallow.An algorithm to detect altered vocal cord function was presented based on wavelet packet analysis(WPA) and suppor vector machines(SVM),and compared with the Hoarseness Diagram method(HDm),which was reported as an objective voice quality evaluation approach and could be used for pathological voice discrimination.Experiments using voice signals recorded from subjects before and after the procedure show high classification accuracy with the new algorithm,whereas HDm fails in the detection of a hoarse voice.This finding would help to develop a screening tool to detect the vocal structure damage during surgery.
基金The project was supported by the National Natural Science Foundation of China No.6881030
文摘This paper deals about a quantitative and qualitative study of the sustained vibration pat-terns of vocal cords with a mulfifunctional glottograph developed by the authors.The glottogramsand their parameters for the modal,falsetto,breathy and pressed voices are presented.This paper al-so sets out to explore the influence of the changes in the properties of the vocal tract andfundamental frequency,on vocal cord vibration.Typical clinical results show that the glottographicmethod may be used in the diagnosis and treatment of laryngeal diseases,phonation physiology andevaluation of artistic voice.
文摘Right vocal cord paralysis in our present case was diagnosed on clinical and radiological examination which is precipitated by an anomalous right aortic arch with diverticulum. This is a very uncommon vascular etiology of hoarseness and is extremely rare. Because of this rarity, the practicing otolaryngologist may miss this finding while evaluating a case of idiopathic right vocal cord paralysis. Thus, the authors feel that idiopathic or unexplained right vocal cord paralysis should be routinely investigated with a CT or MRI of neck and chest with or without contrast to avoid such shortcomings. There is only one such case of right vocal cord paralysis by right aortic which has been reported earlier in literature.
文摘Background and Objective: Vocal cord paralysis results in impairment of breathing and/or speech. One of the causes of vocal cord paralysis is the disruption of vagus nerve innervation to the vocal cords by the mass effect of a neighbouring structure. We report a rare case of vocal cord paralysis secondary to internal carotid artery dissection. Method: The diagnosis was based on clinical history, physical examination and imaging studies. Literature review was done. Case Report: This was a 53-year-old female with a history of unremitting, progressive hoarseness and mild dysphagia to liquid, who was clinically found to have impaired left vocal cord mobility, a left-sided pulsatile neck mass and left carotid artery dissection based on imaging studies. Symptoms abated after conservative treatment with Aspirin and she has remained symptom free since two years of follow-up. Conclusion: Vocal cord paralysis can be a consequence of carotid artery dissection causing mass effect on the vagus nerve. Thus, carotid artery dissection should not be forgotten as a possible cause of vocal cord paralysis in some cases of vocal cord paralysis of uncertain etiology. Treatment with anti-platelet drug can bring about resolution of symptoms and return of vocal cord mobility.
文摘Introduction: Chemotherapy is a rare cause of iatrogenic vocal fold dysfunction. It has been reported in three main classes of chemotherapy agents and often occurs during the treatment interval. We present a case of bilateral vocal cord paresis with delayed presentation after completion of chemotherapy. Methods: One case, managed with observation and serial exams, is presented. A review of previous case reports of chemotherapy-induced vocal cord paresis and possible mechanisms of injury was performed. Results: Patient improved both symptomatically and through objective findings over the one-year course of observation. Conclusion: Diagnosis of chemotherapy-induced vocal cord paresis is dependent on a thorough history and physical exam. Management is predicated in that the dysfunction is often dose dependent and reversible, necessitating both cessation of the offending agent and the knowledge that any treatment is likely needed for only a temporary time. Chemotherapy-induced vocal fold paresis should be in the differential for patients presenting with hoarseness, dysphonia, stridor and a positive chemotherapy
文摘Central venous catheter insertion in the internal jugular vein(IJV)is frequently performed in acute care settings,facilitated by its easy availability and increased use of ultrasound in healthcare settings.Despite the increased safety profile and insertion convenience,it has complications.Herein,we aim to inform readers about the existing literature on the plethora of complications with potentially disastrous consequences for patients undergoing IJV cannulation.
文摘BACKGROUND Since its description in 1790 by Hunter,the nasogastric tube(NGT)is commonly used in any healthcare setting for alleviating gastrointestinal symptoms or enteral feeding.However,the risks associated with its placement are often underes-timated.Upper airway obstruction with a NGT is an uncommon but potentially life-threatening complication.NGT syndrome is characterized by the presence of an NGT,throat pain and vocal cord(VC)paralysis,usually bilateral.It is poten-tially life–threatening,and early diagnosis is the key to the prevention of fatal upper airway obstruction.However,fewer cases may have been reported than might have occurred,primarily due to the clinicians'unawareness.The lack of specific signs and symptoms and the inability to prove temporal relation with NGT insertion has made diagnosing the syndrome quite challenging.AIM To review and collate the data from the published case reports and case series to understand the possible risk factors,early warning signs and symptoms for timely detection to prevent the manifestation of the complete syndrome with life-threatening airway obstruction.METHODS We conducted a systematic search for this meta-summary from the database of PubMed,EMBASE,Reference Citation Analysis(https://www.referencecitation-analysis.com/)and Google scholar,from all the past studies till August 2023.The search terms included major MESH terms"Nasogastric tube","Intubation,Gastrointestinal","Vocal Cord Paralysis",and“Syndrome”.All the case reports and case series were evaluated,and the data were extracted for patient demographics,clinical symptomatology,diagnostic and therapeutic interventions,clinical course and outcomes.A datasheet for evaluation was further prepared.RESULTS Twenty-seven cases,from five case series and 13 case reports,of NGT syndrome were retrieved from our search.There was male predominance(17,62.96%),and age at presentation ranged from 28 to 86 years.Ten patients had diabetes mellitus(37.04%),and nine were hypertensive(33.33%).Only three(11.11%)patients were reported to be immunocompromised.The median time for developing symptoms after NGT insertion was 14.5 d(interquartile range 6.25-33.75 d).The most commonly reported reason for NGT insertion was acute stroke(10,37.01%)and the most commonly reported symptoms were stridor or wheezing 17(62.96%).In 77.78%of cases,bilateral VC were affected.The only treatment instituted in most patients(77.78%)was removing the NG tube.Most patients(62.96%)required tracheostomy for airway protection.But 8 of the 23 survivors recovered within five weeks and could be decannulated.Three patients were reported to have died.CONCLUSION NGT syndrome is an uncommon clinical complication of a very common clinical procedure.However,an under-reporting is possible because of misdiagnosis or lack of awareness among clinicians.Patients in early stages and with mild symptoms may be missed.Further,high variability in the presentation timing after NGT insertion makes diagnosis challenging.Early diagnosis and prompt removal of NGT may suffice in most patients,but a significant proportion of patients presenting with respiratory compromise may require tracheostomy for airway protection.
文摘背景新生儿声带麻痹(VCP)的临床特点和近期预后的影响因素不确切。目的探讨新生儿VCP出院结局的影响因素。设计回顾性队列研究。方法新生儿VCP诊断根据病史、体征和支气管镜检查结果,纳入2013年4月至2022年1月在济南市儿童医院NICU确诊为新生儿VCP的病例,以出院时是否需有创通气和自行吸吮分为好转出院组和非好转出院组,采集如下临床资料用于本文单因素分析。①孕母资料:年龄、妊娠期高血压、妊娠期糖尿病、分娩方式、胎膜早破、脐带绕颈、脐带扭转、羊水情况;②新生儿资料:性别、胎龄、出生体重、1 min Apgar评分、伴发畸形、喉梗阻;③VCP病因:产伤、神经源性、医源性、特发性;④支气管镜下所见:单侧VCP和双侧VCP(完全麻痹和不全麻痹);⑤出院时预后。以单因素分析P<0.10的变量为自变量行多因素Logistics回归分析。主要结局指标影响好转出院的因素。结果133例新生儿VCP进入本文分析,首次行支气管镜检查日龄为6(4,12)d,入院日龄13.0(3.0,20.5)d,胎龄39.0(38.0,40.0)周,伴发畸形71例(53.4%,94例次),单侧VCP 43例(32.3%);双侧VCP 90例,其中不全麻痹57例,完全麻痹33例。好转出院组96例(72.2%)。非好转出院组37例,其中撤机困难28例,气管切开8例(双侧不全麻痹7例,双侧完全麻痹1例),气管切开后均成功脱离正压通气并出院,4例声带运动于9个月内恢复,4例失访;吸吮-吞咽-呼吸协调障碍37例。纳入单因素分析P<0.10的变量(剖宫产、羊水多、出生体重、低Apgar评分、神经源性损伤、喉梗阻、声带麻痹类型)行多因素Logistics回归分析,结果显示,双侧不全麻痹为新生儿VCP好转出院的不利因素(OR=6.785,95%CI:2.191~21.013,P=0.001)。结论双侧VCP、尤其是双侧声带不全麻痹新生儿的近期预后差,气管切开可以作为一种姑息治疗手段。
