1/21. Inspiratory pressure threshold training for glottal airway limitation in laryngeal papilloma.A single-subject design was used to determine if inspiratory pressure threshold training increases inspiratory muscle strength and reduces the sensation of dyspnea during exercise and speech. The subject was a 23-year-old female with congenital juvenile papilloma which has been in remission for 10 years. A 4-week inspiratory muscle training program was implemented using an inspiratory pressure threshold trainer. The pressure threshold of the trainer was set by the experimenter. The pressure threshold setting of the trainer was based on a percentage of the subject's maximum inspiratory pressure measured prior to training. The average range of the pressure threshold was 40 to 70 cmH2O. In order for inspiratory air to flow, the subject generated inspiratory pressure, independent of airflow rate. Maximum inspiratory pressure (MIP) was the dependent variable used as the index of inspiratory muscle strength. exercise dyspnea was a dependent variable rated by the subject during a progressive treadmill test. dyspnea associated with speech was rated following production of a comfortable and loud speech task. MIP increased by 57% following the training program with a 2-scale point reduction in the perception of dyspnea during exercise. dyspnea during loud speech decreased from moderate to mild. The changes in dyspnea, both during exercise and speech, are directly related to inspiratory muscle strengthening. The results suggest that inspiratory muscle training may improve respiratory related function in patients with restrictive upper airway disorders.- - - - - - - - - - ranking = 1keywords = upper (Clic here for more details about this article) |
2/21. Tracheo-oesophageal puncture by retrograde passage of a gastroscope via mini-laparotomy and gastrotomy.Secondary tracheo-oesophageal puncture is frequently used for voice restoration after laryngectomy. A method utilizing a flexible gastroscope passed via a mini-laparotomy and gastrotomy in a retrograde manner is described in a patient where extensive pharyngeal resection made it impossible to cannulate the upper aerodigestive tract. The patient suffered minimal morbidity and produced reasonable speech.- - - - - - - - - - ranking = 1keywords = upper (Clic here for more details about this article) |
3/21. Midline lateralization thyroplasty for adductor spasmodic dysphonia.Midline lateralization thyroplasty was successfully performed on a patient with adductor spasmodic dysphonia. The thyroid cartilage was incised at the midline, and a 3 x 2-mm perforation was made at the anterior commissure to widen it. The perforation was closed with a free composite graft taken from the upper edge of the thyroid ala, and the incised thyroid cartilage edges were kept separated 4 mm apart with silicone wedges. A part of the sternohyoid muscle was rotated to seal any leak from the perforation. The postoperative course was uneventful. The voice has been restored to normal, and there is no sign of recurrence of the symptom so far, as of 1 year 5 months postoperative. Although a longer follow-up is needed, this case indicates that midline type II thyroplasty could be a useful treatment for adductor spasmodic dysphonia.- - - - - - - - - - ranking = 1keywords = upper (Clic here for more details about this article) |
4/21. Upper sternal cleft associated with unusual symptoms.We report a rare case of upper sternal cleft in a 20-year-old adult with associated unusual symptoms such as dysphagia, restricted lingual movements and a voice problem. The strap muscles causing unusual symptoms were divided from their abnormal insertion site on the lower edge of the cleft. Direct complete closure without compromising the cardiac function was achieved in this patient.- - - - - - - - - - ranking = 1keywords = upper (Clic here for more details about this article) |
5/21. Vocal tremor reduction with deep brain stimulation: a preliminary report.Vocal tremor has been a challenging problem for patients and their physicians. In some cases, it has been possible to lesson the symptom's tremor through medications and/or voice therapy. However, in most cases no good treatment has been available. Chronic stimulation of the thalamus has been successful in controlling tremors of the upper limb and other portions of the body. Our preliminary experience suggests that it may also be helpful in controlling vocal tremor.- - - - - - - - - - ranking = 1keywords = upper (Clic here for more details about this article) |
6/21. Multidimensional voice program analysis (MDVP) and the diagnosis of pediatric vocal cord dysfunction.BACKGROUND: vocal cord dysfunction (VCD) can present with signs and symptoms that mimic asthma. This may lead to unnecessary pharmacologic treatment or more invasive measures including intubation. Presently, the diagnosis of VCD can only be confirmed when a patient is symptomatic, via pulmonary function testing (PFT) or visualization of adduction of the vocal cords during inspiration by direct laryngoscopy. OBJECTIVE: Multidimensional voice Program (MDVP) analysis. a computer program which analyzes various aspects of voice, can detect abnormal voice patterns of patients with upper airway pathology. We determined whether MDVP analysis was useful in the diagnosis of VCD. methods: We conducted chart reviews of patients referred to our department from 1995 to 1998 with the presumed diagnosis of VCD who had undergone MDVP analysis. The diagnosis of VCD was based on the presenting history, PFT results, laryngoscopy results, as well as voice evaluation conducted by a speech-language pathologist. We analyzed six consecutive patients referred for this investigation. We delineated common trends in the variables measured on MDVP analysis in VCD patients. and compared these with controls and other vocal cord pathology. RESULTS: Five cases of possible VCD had abnormalities in the MDVP variable of soft phonation index (SPI). All five also had abnormalities in the variation in fundamental frequency (vFo). In one case, MDVP analysis was conducted pre- and posttreatment for VCD, and SPI and vFo both normalized. In a sixth case of possible VCD. the diagnosis was not confirmed as the patient had normal PFTs and laryngoscopy. MDVP analysis was normal in this individual. The pattern of abnormal SPI and vFo was not seen in a group of normal controls or in patients with vocal cord nodules. CONCLUSIONS: MDVP analysis may be a useful tool when diagnosingVCD, as well as in evaluating response to treatment.- - - - - - - - - - ranking = 1keywords = upper (Clic here for more details about this article) |
7/21. polymyositis masquerading as motor neuron disease.BACKGROUND: Several conditions have been reported to mimic motor neuron disease (MND), and misdiagnosis remains a common clinical problem. OBJECTIVE: To report a case of bulbar-onset polymyositis where the initial clinical presentation was suggestive of MND. CASE DESCRIPTION: A 73-year-old woman was admitted for investigation of acute-onset dysphagia without dysarthria. Examination revealed nasal dysphonia and severe oropharyngeal weakness. Subtle upper-limb weakness, brisk tendon reflexes, and fasciculations in the right deltoid muscle were also demonstrated. A clinical diagnosis of MND was entertained. The serum creatine kinase value was within the reference range. Findings from electromyographic studies, however, were suggestive of a myopathic rather than a neurodegenerative process, and a muscle biopsy specimen was diagnostic of polymyositis. The dysphagia rapidly resolved upon treatment with corticosteroids and azathioprine. CONCLUSIONS: Bulbar-onset polymyositis may mimic MND, particularly in the absence of inflammatory markers or elevated muscle enzyme levels. Caution should be exercised in the clinical diagnosis of bulbar dysfunction, and further investigations such as electromyography and muscle biopsy are indicated to confirm the diagnosis.- - - - - - - - - - ranking = 1keywords = upper (Clic here for more details about this article) |
8/21. Bilateral high-frequency electrical impulses to the thalamus reduce voice tremor: acoustic and electroglottographic analysis. A case report.An 81-year-old female patient suffering from disabling Holmes' tremor affecting both upper extremities, the head and additionally the vocal apparatus underwent bilateral thalamic ventralis intermedius nucleus (v.i.m.) stimulation. With the stimulation ON, the patient experienced complete suppression of the limb and head tremor and thorough voice normalization. Acoustic and electroglottographic (EGG) analysis showed a tendency towards hyperfunctional phonation with the stimulation ON as well as OFF, but a less disturbed vocal cord vibration pattern with the stimulation ON in comparison with a group of normal female speakers. This example shows that long-term monitoring of the vocal apparatus under deep brain stimulation therapy (DBS) of movement disorders must be planned in order to modify the stimulation parameters, if necessary, or to initiate logopaedic treatment.- - - - - - - - - - ranking = 1keywords = upper (Clic here for more details about this article) |
9/21. lingual thyroid causing dysphonia: evaluation and management. Case report.CONTEXT: lingual thyroid gland is a rare clinical entity that is caused by the failure of the thyroid gland to descend to a normal cervical location during embryogenesis. The occurrence of an ectopic thyroid gland located at the base of the tongue may cause problems for the patient, with symptoms of dysphagia, dysphonia, upper airway obstruction or even hemorrhage at any time from infancy through adulthood. CASE REPORT: We report on a case of lingual thyroid gland in a 41-year-old female patient. The embryology and diagnosis of ectopic thyroid are discussed and its management is outlined. Features of the diagnostic and therapeutic evaluation are described with attention to the clinical findings, laboratory tests, thyroid scan and computed tomography imaging studies employed in the confirmation of diagnosis and planning of appropriate treatment. The history of the condition is reviewed and a treatment strategy is outlined. Surgical excision of the gland is reserved for cases of gland enlargement that result in compromised airways (dysphagia or dysphonia) or recurrent hemorrhage.- - - - - - - - - - ranking = 1keywords = upper (Clic here for more details about this article) |
10/21. Rosai-Dorfman disease revealed in the upper airway: a case report and review of the literature.Rosai-Dorfman disease (RDD) is a systemic disease and its etiology is not well understood. It is a very rare but established disease. We report a case of RDD diagnosed in the upper airway that became a life-threatening condition because of the stricture of the subglottic space. A 49-year-old female complained of nasal obstruction, hoarseness and lacrimation. After evaluation following by fiberscopic examination and CT scanning of the head and neck, sinusitis and laryngeal masses were detected. Endoscopic sinus surgery and endolaryngeal microsurgery were performed simultaneously. The masses in the nasal cavity and larynx showed the same histological findings. Proliferative large histiocytes with voluminous clear cytoplasm and rounded nuclei, and lymphophagocytosis known as emperipolesis are the characteristic features of RDD. In this case, extranodal manifestations in the subglottic space gradually emerged postoperatively. tracheotomy was performed to ensure an airway and prevent suffocation. An extensive treatment is not required in most patients with RDD, however, some patients who have extranodal manifestations involving the airway may detoriorate into a life-threatening condition.- - - - - - - - - - ranking = 5keywords = upper (Clic here for more details about this article) |
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