1/17. Asphyxiation by laryngeal edema in patients with hereditary angioedema.OBJECTIVE: To describe the occurrence of fatal laryngeal edema in patients with hereditary angioedema due to C1 esterase inhibitor deficiency. patients AND methods: We describe 6 patients from various regions of germany who died from laryngeal edema within the last 10 years. Furthermore, we conducted a retrospective survey of 58 patients with hereditary angioedema, originating from 46 affected families. The data were obtained from the attending physicians and from the patients' relatives. RESULTS: Among the 6 reported patients, aged 9 to 78 years, hereditary angioedema had been diagnosed in 3 and was undiagnosed in 3. None of them had an emergency cricothyrotomy or received C1 inhibitor concentrate. The interval between onset of the laryngeal edema and asphyxiation was 20 minutes in a 9-year-old boy, and in the other patients, the interval was 1 to 14 hours (mean for all, 7 hours). The retrospective survey of 58 patients with hereditary angioedema revealed 23 deaths by asphyxiation (40%). The average age of all 29 patients at the time of asphyxiation was 39 years. CONCLUSION: laryngeal edema in hereditary angioedema may be fatal. Most of the patients asphyxiated between their 20th and 50th years of life, but asphyxiation can occur even in children. The possibility that the first episode of laryngeal edema may be fatal must be emphasized to the relatives, and attending physicians must have a high degree of awareness.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/17. vocal cord dysfunction mimics asthma and may respond to heliox.vocal cord dysfunction (VCD), an under appreciated cause of wheezing, may be mistaken for or coexist with asthma. The vocal cords involuntarily adduct during inspiration, leading to inspiratory or biphasic wheezing. asthma therapy offers no benefit and may result in injury. Proof of diagnosis requires endoscopy during an episode. Definitive therapy involves voice training by a speech pathologist, but heliox (20% to 40% oxygen in helium) has been used to reduce symptoms, resulting in dramatic improvement in wheezing and less anxiety. A retrospective review of recent experience with heliox treatment for patients with VCD was conducted, using a search of computerized inpatient and outpatient physician dictation reporting at Scott & White Memorial Hospital and Clinic. Five patients age 10 to 15 years were treated with a favorable response in four. There were no complications of therapy. A high index of suspicion can lead to the diagnosis of VCD, avoiding expensive, inappropriate, and harmful therapy. A trial of heliox inhalation for patients with symptomatic VCD may prove beneficial, analogous to the "reliever" role of beta agonists for asthma. Home or school use of heliox may reduce acute care visits, while voice training ("controller" therapy) is instituted.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
4/17. Laryngeal involvement in systemic lupus erythematosus.Laryngeal involvement in systemic lupus erythematosus (SLE) can range from mild ulcerations, vocal cord paralysis, and edema to necrotizing vasculitis with airway obstruction. In this report, four cases showing the range of severity of this disease manifestation are presented, accompanied by a comprehensive review of the literature. The clinical course of 97 patients with laryngeal involvement with SLE are reviewed, of whom 28% had laryngeal edema and 11% had vocal cord paralysis. In the majority of cases, symptoms such as hoarseness, dyspnea, and vocal cord paralysis resolved with corticosteroid therapy. Other, less common causes of this entity included subglottic stenosis, rheumatoid nodules, inflammatory mass lesions, necrotizing vasculitis, and epiglottitis. The clinical presentation of laryngeal involvement in patients with SLE follows a highly variable course, ranging from an asymptomatic state to severe, life-threatening upper airway compromise. With its unpredictable course and multiple causations, this complication remains a diagnostic and therapeutic challenge to physicians involved in the care of patients with SLE.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
5/17. vocal cord dysfunction mimicking bronchial asthma.vocal cord dysfunction is a possible cause of wheezing and dyspnea in patients who do not respond to conventional asthma therapy. A carefully taken history, pulmonary function testing, and, most important, direct visualization with a flexible laryngoscope during an acute attack allow physicians to differentiate vocal cord dysfunction from asthma. speech therapy, inhalation of helium and oxygen, and psychiatric counseling play a role in management.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
6/17. hamartoma of the larynx: an unusual cause of upper airway obstruction.Hamartomas are rare lesions in the larynx. Both clinical and histopathological findings may be misleading to both the physician and the pathologist in terms of diagnosis. A 51-year-old female with the complaints of nonproductive cough and severe dyspnea lasting for a year was found to have a subglottic, submucosal mass almost totally obstructing the laryngeal lumen. Excisional biopsy was performed under suspensory direct laryngoscopy. Histopathological examination showed numerous, large, distended blood vessels, some of which had prominent thickened walls and mature adipose tissue beneath the surface epithelium. The final diagnosis was hamartoma, but we discussed its validity and other possible identifications in accordance with the literature.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
7/17. Upper airway obstruction masquerading as exercise induced bronchospasm in an elite road cyclist.This case concerns an elite road cyclist who complained of occasional dyspnoea and inspiratory difficulty during intense exercise. Clinical examination was normal and the final diagnosis was vocal cord dysfunction, a paradoxical closure of the vocal cords during inspiration which is highly associated with inspiratory stridor at high rates of ventilation. awareness by the sports physician of this not uncommon condition is important to avoid misdiagnosis.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
8/17. Laryngeal obstruction and obstructive sleep apnea syndrome.Obstructive sleep apnea syndrome has been studied intensively since it was introduced in the 1970's; these studies have shown that the site of upper airway obstruction appears to vary among patients. snoring is typically defined as the sound created by rhythmic oscillations of the soft palate in the inspiratory air stream during sleep. snoring occurs in 100% of patients with obstructive sleep apnea and, for selected patients, is treatable by surgery. snoring can, however, mean different things to different patients and physicians. Five atypical cases of obstructive sleep apnea syndrome are presented in which laryngeal dysfunction played a role in producing symptoms of obstructive sleep apnea syndrome. Recording nocturnal sounds during sleep and examining the entire upper respiratory tract may be important in determining appropriate medical or surgical management.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
9/17. 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.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
10/17. herpes zoster of the larynx after intubational trauma.Multiple or prolonged endotracheal intubations may result in laryngeal trauma. This case illustrates that recrudescence of latent varicella-zoster virus as herpes zoster of the larynx, with subsequent laryngeal paralysis, can complicate intubation. Consequently, physicians should strive to minimize laryngeal injury in this setting. It is advised that careful laryngeal examination follow extubation.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
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