Cases reported "Laryngeal Diseases"

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1/13. Exercise-induced laryngochalasia: an imitator of exercise-induced bronchospasm.

    BACKGROUND: patients with exercise-induced laryngochalasia present with dyspnea and stridor during exercise. Symptoms are due to a subtotal occlusion of the larynx resulting from mucosal edema from the aryepiglottic folds being drawn into the endolarynx. methods: We report on three patients with exercise-induced bronchospasm, refractory to standard therapy. RESULTS: spirometry with flow-volume loops revealed truncation of the inspiratory limb. Abnormal movement of the arytenoid region was visualized on laryngoscopy. A diagnosis of exercise-induced laryngochalasia was made. CONCLUSIONS: Evaluation of laryngeal motion in patients with refractory exercise-induced bronchospasm is important. Surgical correction with laser laryngoplasty is effective in carefully selected cases.
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2/13. Paradoxical vocal cord adduction mimicking as acute asthma in a pediatric patient.

    We report an adolescent girl with paradoxical vocal cord adduction who presented with acute onset of hyperventilation, wheezing and stridor that did not respond to bronchodilator and anti-inflammation therapy. The paradoxical vocal cord motion was confirmed by flexible fiberoptic bronchoscopic examination. We found the stridor was induced by hyperventilation, and was caused by paradoxical vocal cord movement. The abnormal cord motion may be psychogenic and could be misdiagnosed as asthma. It is important to investigate the underlying background and social history and to avoid unnecessary use of beta-agonists, steroids, and even endotracheal intubation or tracheostomy.
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3/13. Abnormal movement of the arytenoid region as a cause of upper airway obstruction.

    A 75 year old woman presented with a three week history of severe dyspnoea and cough. auscultation and spirometry suggested extrathoracic inspiratory airway obstruction, and bronchoscopy showed abnormal motion of the arytenoid region (supraglottic area), causing upper airway obstruction only during forced inspiratory efforts. Sedatives improved the symptoms within a week. It is suggested that reversible malfunction of the arytenoid region can be responsible for upper airway obstruction.
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4/13. Multidisciplinary management of the airway in a trauma-induced brain injury patient.

    laryngomalacia occurs in some brain injury patients secondary to global muscle hypotonia. Surgical therapies for epiglottis prolapse have centered around removal or reshaping of the epiglottis. This approach has brought mixed success and frequent complications. We present a case that demonstrates successful nonsurgical treatment of a 33-year-old male brain injury patient with moderate obstructive sleep apnea that is believed to be a consequence of post-brain injury nocturnal epiglottis prolapse. The presence of a tracheostomy performed at the time of emergency surgery had become an emotional and physical barrier to our patient's recovery. The tracheostomy could only be reversed if the obstructive sleep apnea disorder could be managed in an alternative fashion. A titratable mandibular repositioning appliance was prescribed and its effectiveness was demonstrated with nasolaryngoscopy and polysomnography. After initially fitting the oral appliance, a period of accommodation and gradual protrusive adjustments was allowed. Subsequent confirmation polysomnography demonstrated improvement, but not suitable resolution, of disordered breathing events. However, an additional 1.25-mm protrusive titration of the oral appliance during the course of the confirmation polysomnogram led to therapeutic success. The patient's tracheostomy was subsequently reversed with significant quality of life benefits.
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5/13. Laryngeal dystonia in xeroderma pigmentosum.

    We report on three patients with xeroderma pigmentosum group A (XPA) who showed laryngeal stridor in their 20s. The stridor appeared on feeding and emotional excitation, was exaggerated during respiratory infection and was life-threatening on some occasions. Adduction of the vocal cords during inspiration, observed by laryngoscopy, confirmed laryngeal dystonia in all cases. This type of focal dystonia may be characteristic in XPA and requires special attention during the management of these patients to avoid serious complications.
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6/13. Inspiratory muscle training in exercise-induced paradoxical vocal fold motion.

    The purpose of the study was to determine if inspiratory muscle training (IMT) would result in increased inspiratory muscle strength, reduced perception of exertional dyspnea, and improved measures of maximal exercise effort in an athlete with exercise-induced paradoxical vocal fold motion (PVFM). The participant, an 18-year-old woman, had a 2-year history of acute dyspnea with exertion during soccer games. spirometry, transnasal flexible laryngoscopy, and patient history supported a PVFM diagnosis. The ABAB within-subject withdrawal design study comprised IMT treatment and withdrawal phases, each lasting 5 weeks. The participant trained 5 days per week, completing five sets of 12 breaths at 75% maximum inspiratory pressure (MIP) per session. Data consisted of MIP, exertional dyspnea ratings, and maximal exercise measures. IMT resulted in increased MIP and decreased dyspnea ratings across both treatment phases. No change in MIP or dyspnea ratings occurred in response to treatment withdrawal. The maximal exercise test revealed minimal changes across phases. At end of the study, the participant reported experiencing no PVFM symptoms when performing the outcome measurement tasks and when playing soccer. Transnasal flexible laryngoscopy, after strenuous exercise and during rapid breathing and phonation tasks, revealed normal laryngeal findings. The findings suggest that IMT may be a promising treatment approach for athletes with exercise-induced PVFM.
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7/13. An unexpected functional cause of upper airway obstruction.

    A case of acute respiratory obstruction in the immediate postoperative period is described in a young woman who emerged from general anaesthesia after a Caesarean section for fetal distress. She had a pregnancy complicated by disabling polyhydramnios and anxiously anticipated the birth of a child with a diaphragmatic hernia, diagnosed antenatally. The cause of the airway obstruction was functional in nature as confirmed by flexible fibreoptic laryngoscopy. The diagnosis, paradoxical vocal cord motion, has to be considered as an infrequent cause of postoperative airway obstruction; its recognition and treatment are discussed. The patient did not have a history which might have indicated its possible occurrence. It is suggested that paradoxical vocal cord movement in a more mild form may be overlooked as cause for postoperative stridor and airway obstruction.
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8/13. Stridor caused by vocal cord malfunction associated with emotional factors.

    We describe two adolescent patients in whom a disorder of the vocal cords associated with emotional factors resulted in acute episodes of stridor. Adduction of the vocal cords on inspiration and abduction on expiration was found on indirect laryngoscopy. The problem responded to either placebo treatment or psychotherapy. The similarity between vocal cord dysfunction presenting as stridor and that presenting as asthma is discussed. The importance of diagnosing these functional problems in children is emphasized in order to avoid unnecessary diagnostic procedures and hazardous treatment.
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keywords = motion
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9/13. Evaluation of computerized tomography, cinelaryngoscopy, and laryngography in determining the extent of laryngeal disease.

    A prospective study of over 100 cases comparing computerized tomography (CT) and correlating these studies with photographic motion picture studies of the larynx, conventional tomography and contrast laryngography has been performed. The authors give illustrative examples of cases in which the CT scan has been documented as providing equal and often times greater information concerning not only tumors, but also cystic lesions and traumatic lesions. With the newer technology, the reduced radiation (which is less than one half that of conventional tomography), and the decreased expense (now comparable to that of laryngography alone), eliminates the need for conventional laryngography and tomography examinations. The incorporation of motion picture documentation of the lesions allowing future comparative studies between the original lesion and the CT are recommended for a more accurate retrospective classification and assessment of therapeutic results.
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keywords = motion
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10/13. Spectrum of presentation of paradoxical vocal cord motion in ambulatory patients.

    BACKGROUND: Paradoxical vocal cord motion (PVCM) frequently masquerades as asthma. Atypical presentations of asthma or situations in which asthma does not respond to traditional therapies mandate the consideration of PVCM in the differential diagnosis. OBJECTIVE: Evaluate the demographics and spectrum of presentation of PVCM in an ambulatory outpatient population. methods: Retrospective survey of medical records of 164 consecutive patients (86 males, 78 females) who underwent fiberoptic rhinolaryngoscopy over a 3-year period. RESULTS: Twenty patients (16 females, 4 males) with PVCM diagnosed by direct visualization were identified. Mean age at diagnosis was 33 years (range, 14-58 years). asthma was the most common presenting diagnosis (15/20, 75%), while the remaining 25% had other unusual presentations including two patients (10%) with PVCM masquerading as anaphylaxis. When PVCM masqueraded as asthma, 44% of those patients were inappropriately treated with oral steroids. Nine patients (45%) had a readily identifiable psychologic trigger of their PVCM. CONCLUSIONS: Our data confirm previous observations indicating that PVCM is most common in young females and is often associated with psychologic problems. PVCM frequently masquerades as asthma, resulting in overtreatment with corticosteroids. PVCM may also masquerade as stridor, resulting in mimicry of anaphylaxis in the appropriate clinical setting. Thus, PVCM should be considered in any patient presenting with atypical upper and lower respiratory tract symptoms.
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keywords = motion
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