1/12. Unilateral vocal cord paralysis following endotracheal intubation--a case report.A 41-year-old man of ASA physical status class I was scheduled to receive the video-assisted thoracoscopic T2 sympathectomy for hyperhidrosis palmaris. The elective surgery was performed smoothly under general anesthesia with endotracheal intubation. However, the patient complained of hoarseness in the postoperative period. A stroboscopic examination showed that the left vocal cord remained stationary in the paramedian position, signifying left vocal cord paralysis. In the case, we believed it was most likely that endotracheal intubation might be responsible for the unilateral vocal cord paralysis. The possible cause was that during placement or thereafter during positioning, the endotracheal tube was malposed or slipped upward, rendering its inflated cuff to rest against the vocal cords. Another reason was that the cuff which was over inflated made the vocal cords under constant pressure. Both conditions may cause damage to the anterior branch of the recurrent laryngeal nerve. We also discussed the general management and prophylaxis for the unilateral vocal cord paralysis.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/12. 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.- - - - - - - - - - ranking = 7.8074691326076keywords = physical examination, physical (Clic here for more details about this article) |
3/12. Psychophysiologic treatment of vocal cord dysfunction.BACKGROUND: vocal cord dysfunction (VCD) is an obstructive upper airway syndrome that frequently mimics asthma and for which there is no empirical treatment of choice. OBJECTIVE: To describe two military service members experiencing VCD who were treated with psychophysiologic self-regulation training. methods: Both cases were active-duty military members with VCD confirmed by laryngoscopy They each received biofeedback self-regulation training to decrease tension in the extrinsic laryngeal musculature. RESULTS: Both patients responded to the treatment, denied the presence of dsypnea, and had resumed military physical training. CONCLUSIONS: Psychophysiologic self-regulation strategies both with and without concurrent speech therapy positively impacted VCD symptoms.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/12. west nile virus induced vocal fold paralysis.OBJECTIVE: west nile virus has recently become a public health concern in the united states, after an outbreak in new york city in 1999. It is a mosquito-borne virus that causes a spectrum of disease from flu-like symptoms to encephalopathy, muscle weakness, and, in some cases, death. STUDY DESIGN: Case Report. methods: A patient infected with west nile virus presented with progressive muscle weakness, and later developed bilateral vocal fold paresis. His clinical presentation, physical and laboratory examination findings, and course of illness will be discussed. RESULTS: After a prolonged hospital stay, and presumptive treatment for Guillain-Barre, repeat CSF analysis revealed infection with the west nile virus. The patient developed bilateral vocal fold paralysis during his hospital course. At long-term follow-up, the patient's left vocal fold paralysis persisted, while the right vocal fold paralysis had resolved. CONCLUSIONS: Although several viruses have been associated with recurrent laryngeal nerve injury, this is the first report of west nile virus induced vocal fold paralysis.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/12. Evaluation and management of stridor in the newborn.Stridor in a newborn should necessitate an immediate work-up to rule out a life-threatening airway obstruction. Three cases of newborns with stridor are presented. These cases emphasize the need for an immediate and thorough physical examination of any stridorous newborn, followed by radiologic studies and direct laryngoscopy. While other invasive procedures are frequently required for a precise diagnosis, a careful examination with special attention to the quality of the stridor often permits a more effective diagnostic approach in an atmosphere of appropriate urgency.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
6/12. Bilateral abductor paresis masquerading as asthma.Rare upper airway lesions may be mistaken for asthma. A 16-year-old Hispanic male athlete presented to our allergy clinic with a 4-month history of wheezing and snoring with hoarseness and progressive fatigue on exertion or during sleep. His mother taped periods of harsh stridor and sleep apnea. There was no family history of vocal cord abnormalities. A year before the onset of symptoms, he suffered injury to his oral cavity with a loss of consciousness during a wrestling match. He denied dysphagia or dysphonia. He failed to respond to bronchodilators, cromolyn, or prednisone therapy during 4 weeks. On referral to our clinic, his physical examination and tape recording were characterized by harsh inspiratory stridor. His pulmonary function tests were significant for peak flow depressed out of proportion to FEV1 with reduced FVC, no response to bronchodilator, and flattened inspiratory loop unresponsive to cough or panting. fluoroscopy and endoscopy of the upper airway was consistent with "marked bilateral limitation of vocal cord abduction." sleep study demonstrated desaturation with CO2s in the 60s during sleep. He was started on continuous positive airway pressure, 10 cm at night, with no desaturation or sleep disturbance on follow-up.- - - - - - - - - - ranking = 7.8074691326076keywords = physical examination, physical (Clic here for more details about this article) |
7/12. Bilateral abductor vocal cord paralysis in charcot-marie-tooth disease.This report descirbes the unusual association of bilateral abductor vocal cord paralysis (BAbVCP) and charcot-marie-tooth disease in a boy and his natural mother who have been followed for eight years. The boy initially presented with life-threatening respiratory distress at age ten years; BAbVCP was documented by direct laryngoscopy. Mirror laryngoscopy confirmed BAbVCP in the mother. Neurological diagnosis was made by history, physical examination, electromyography, and nerve conduction velocity studies. The BAbVCP may represent an additional genetic marker within the spectrum of heredodegenerative disorders. Of clinical importance is examination of voice and respiratory symptomatology of patients with heredodegenerative diseases and neurological work-up of patients with familial vocal cord paralysis. Further genetic and clinical studies of X cranial nerve involvement in heredodegenerative disorders are warranted.- - - - - - - - - - ranking = 7.8074691326076keywords = physical examination, physical (Clic here for more details about this article) |
8/12. diagnosis and management of complications of self-injection injuries of the neck.When IVDUs who lose peripheral access turn to their necks, they invite a spectrum of unique complications that require particular management and treatment. While many of these complications are infectious, other possibilities include vocal cord paralysis and needle fragment foreign bodies. work-up of these patients must include a very thorough history and physical exam, particularly of the head and neck, complete with a laryngeal exam. All patients should undergo imaging studies, including plain films, CT or MRI of the neck, and other studies as appropriate. Laboratory studies should include hiv and hepatitis serologies. Because of the risks to the surgical team, neck explorations, when indicated, should be performed under general anesthesia with strict adherence to universal precautions. Further management includes early referrals to methadone clinics, although unfortunately poor patient compliance is usual. Public campaigns aimed at prevention are useful, although limited, and should be encouraged.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
9/12. The pediatric psychologist's role in differential diagnosis: vocal-cord dysfunction presenting as asthma.Presented the case of an 11-year-old boy with vocal-cord dysfunction (VCD) as an example of a rare clinical phenomenon that may result in clinical and systemic challenges for the pediatric psychologist. VCD presents as highly similar to asthma, yet is best treated with speech therapy and psychosocial intervention. The physical symptomatology of VCD and its conceptualization as a psychosomatic disorder are described. Difficulties inherent in integrating psychological factors into medical case formulation are discussed, and possible pitfalls and strategies are delineated.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
10/12. Treatment efficacy: voice disorders.This article reviews the literature on the efficacy of treatment for voice disorders primarily using studies published in peer-reviewed journals. voice disorders are defined, their frequency of occurrence across the life span is reported, and their impact on the lives of individuals with voice disorders is documented. The goal of voice treatment is to maximize vocal effectiveness given the existing disorder and to reduce the handicapping effect of the voice problem. Voice treatment may be (a) the preferred treatment to resolve the voice disorder when medical (surgical or pharmacological) treatments are not indicated; (b) the initial treatment in cases where medical treatment appears indicated; it may obviate the need for medical treatment; (c) completed before and after surgical treatment to maximize long-term post-surgical voice; and (d) a preventative treatment to preserve vocal health. Experimental and clinical data are reviewed that support these roles applied to various disorder types: (a) vocal misuse, hyperfunction and muscular imbalance (frequently resulting in edema, vocal nodules, polyps or contact ulcers); (b) medical or physical conditions (e.g., laryngeal nerve trauma, parkinson disease); and (c) psychogenic disorders (e.g., conversion reactions, personality disorders). Directions for future research are suggested which maximize clinical outcomes and scientific rigor to enhance knowledge on the efficacy of voice treatment.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
| | Next -> |