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The Israel Medical Association Journal... Jan 2024Laryngopharyngeal reflux (LPR) refers to the backflow of acidic stomach content into the larynx, pharynx, and upper aerodigestive tract. The diagnosis of LPR is based on...
BACKGROUND
Laryngopharyngeal reflux (LPR) refers to the backflow of acidic stomach content into the larynx, pharynx, and upper aerodigestive tract. The diagnosis of LPR is based on the patient's history and findings of the laryngoscopy associated with LPR. Other possible manifestations consistent with LPR symptoms include laryngeal cancer, vocal fold granulomas, Reinke's space edema, and vocal polyps. In this study, we compared the characteristics of patients with LPR symptoms and incidental laryngeal findings (ILF) in the laryngoscopic evaluation to those without ILF (WILF).
OBJECTIVES
Determine the characteristics of LPR-symptomatic patients with ILF versus WILF.
METHODS
In this retrospective study, we examined 160 medical charts from patients referred to the otolaryngology clinic at Galilee Medical Center for LPR evaluation 2016-2018. The reflux symptoms index (RSI), reflux finding score (RFS), and demographics of the patient were collected. All patients with a positive RSI score for LPR (RSI > 9) were included, and the profiles of patients with versus without ILF on laryngoscopy examination were compared.
RESULTS
Of the 160 patients, 20 (12.5%) had ILF during laryngoscopy. Most had vocal cord findings such as leukoplakia (20%), polyps (15%), and nodules (20%). Hoarseness, throat clearing, swallowing difficulty, breathing difficulties, and total RSI score were significantly higher in patients with ILF.
CONCLUSIONS
Evaluation of LPR symptoms may provide otolaryngologists with a tool to identify patients with other findings on fiberoptic laryngoscopy. A laryngoscopic examination should be part of the examination of every patient with LPR to enable diagnosis of incidental findings.
Topics: Humans; Laryngopharyngeal Reflux; Retrospective Studies; Larynx; Laryngeal Edema; Laryngoscopy
PubMed: 38420641
DOI: No ID Found -
Endocrinology and Metabolism (Seoul,... Feb 2024Active surveillance (AS) has been introduced as a management strategy for low-risk papillary thyroid carcinoma (PTC) due to its typically indolent nature. Despite this,...
BACKGRUOUND
Active surveillance (AS) has been introduced as a management strategy for low-risk papillary thyroid carcinoma (PTC) due to its typically indolent nature. Despite this, the widespread adoption of AS has encountered several challenges. The aim of this systematic review was to evaluate the safety of AS related to disease progression and its benefits compared with immediate surgery (IS).
METHODS
Studies related to AS in patients with low-risk PTC were searched through the Ovid MEDLINE, Embase, Cochrane Library, and KoreaMed databases. Studies on disease progression, surgical complication, quality of life (QoL), and cost-effectiveness were separately analyzed and narratively synthesized.
RESULTS
In the evaluation of disease progression, the proportions of cases with tumor growth ≥3 mm and a volume increase >50% were 2.2%-10.8% and 16.0%-25.5%, respectively. Newly detected lymph node metastasis was identified in 0.0%-1.4% of patients. No significant difference was found between IS and delayed surgery in surgical complications, including vocal cord paralysis and postoperative hypoparathyroidism. AS was associated with better QoL than IS. Studies on the cost-effectiveness of AS reported inconsistent data, but AS was more cost-effective when quality-adjusted life years were considered.
CONCLUSION
AS is an acceptable management option for patients with low-risk PTC based on the low rate of disease progression and the absence of an increased mortality risk. AS has additional benefits, including improved QoL and greater QoL-based cost-effectiveness.
Topics: Humans; Thyroid Cancer, Papillary; Thyroid Neoplasms; Quality of Life; Thyroidectomy; Watchful Waiting; Disease Progression
PubMed: 38417830
DOI: 10.3803/EnM.2023.1794 -
A&A Practice Mar 2024Hereditary neuropathy with liability to pressure palsy (HNPP) is a rare peripheral neurological disorder that manifests with increased sensitivity to pressure. In people...
Hereditary neuropathy with liability to pressure palsy (HNPP) is a rare peripheral neurological disorder that manifests with increased sensitivity to pressure. In people with this disorder, the peripheral nerves are unusually sensitive to pressure. Minor trauma or compression causing paralysis in the extremities is a hallmark of this disorder. Ensuring there is no pressure on the extremities is recommended as a preventive measure. We describe for the first time, postoperative vocal cord paralysis in a patient with HNPP due to left recurrent laryngeal nerve palsy. Anesthesiologists and surgeons should be aware of this possible complication in patients with HNPP.
Topics: Humans; Vocal Cord Paralysis; Anesthesiologists; Arthrogryposis; Awareness; Hereditary Sensory and Motor Neuropathy
PubMed: 38411991
DOI: 10.1213/XAA.0000000000001752 -
Journal of Ayub Medical College,... 2023Causes of vocal cord palsy (VCP) can be identified even before its clinical presentation if a radiologist has knowledge about signs of vocal cord palsy, its various...
When The Silence Prevails, Images Talk: The Characteristic Ct Features Of Vocal Cord Paralysis, Causes Of Missed Palsy By Radiologists And Mimics Of Vocal Cord Palsy Unveiled.
BACKGROUND
Causes of vocal cord palsy (VCP) can be identified even before its clinical presentation if a radiologist has knowledge about signs of vocal cord palsy, its various mimics and the anatomy of recurrent laryngeal nerve. Objectives are to know the signs and underlying causes leading to VCP and various mimics which may lead to the false positive diagnosis of VCP.
METHODS
A retrospective cross-sectional pilot study comprising 54 patients with vocal cord palsy proven by IDL was conducted. 3 groups were identified. The first group comprised missed VCP on cross-sectional imaging. The second group was, of missed cause of VCP in patients with clinical diagnoses. The third group was patients with mimics of the palsy.
RESULTS
Thirteen (76.5%) patients had missed diagnosis due to lack of knowledge of signs and 23.5% due to lack of time, overwork and tiredness. A vigilant search for the cause was not done in 31.6% of patients and in 68.4% of patients, the cause was identified but not correlated. A total of 8 patients had false positive diagnoses due to failure to differentiate from mimics.
CONCLUSIONS
There is an increasing trend of missed diagnosis of vocal cord palsy on cross-sectional imaging in patients with established clinical diagnosis due to a lack of knowledge of VCP signs and missed causes along the course of recurrent laryngeal nerve.
Topics: Humans; Vocal Cord Paralysis; Retrospective Studies; Pilot Projects; Recurrent Laryngeal Nerve; Radiologists; Thyroidectomy
PubMed: 38406936
DOI: 10.55519/JAMC-04-11853 -
Cureus Jan 2024Foreign body (FB) inhalation in the pediatric population is a common emergency referral in otolaryngology practice. Mismanagement can lead to significant morbidity or...
Foreign body (FB) inhalation in the pediatric population is a common emergency referral in otolaryngology practice. Mismanagement can lead to significant morbidity or even mortality. Anesthesiologists conventionally use the Cook® airway exchange catheter (CAEC) during endotracheal tube exchange in the intensive care unit, but its usage as an oxygen conduit is beneficial in other airway procedures. A healthy two-year-old boy was brought to casualty for allegedly choking on a boneless chicken meat bolus during mealtime. The initial presentation showed that the child was comfortable with soft audible stridor without signs of respiratory distress. Bedside video laryngoscopy revealed a whitish FB in the proximity of the vocal cord. The patient was subjected to emergency direct laryngoscopy and bronchoscopy to retrieve the FB. Under general anesthesia, the true nature of FB was revealed, which was an embedded chicken bone into the laryngeal ventricle, causing a significant reduction of the rima glottis opening. CAEC was used to maintain oxygenation during the complex extraction process, and the child was discharged without any morbidity. Eyewitness history is an essential component in diagnosing FB inhalation in the pediatric population. Despite that, identifying potential difficulty is important to provide backup, especially in the case of unexpected events during managing airway emergencies.
PubMed: 38406054
DOI: 10.7759/cureus.52918 -
Sheng Wu Yi Xue Gong Cheng Xue Za Zhi =... Feb 2024Parkinson's disease patients have early vocal cord damage, and their voiceprint characteristics differ significantly from those of healthy individuals, which can be used...
Parkinson's disease patients have early vocal cord damage, and their voiceprint characteristics differ significantly from those of healthy individuals, which can be used to identify Parkinson's disease. However, the samples of the voiceprint dataset of Parkinson's disease patients are insufficient, so this paper proposes a double self-attention deep convolutional generative adversarial network model for sample enhancement to generate high-resolution spectrograms, based on which deep learning is used to recognize Parkinson's disease. This model improves the texture clarity of samples by increasing network depth and combining gradient penalty and spectral normalization techniques, and a family of pure convolutional neural networks (ConvNeXt) classification network based on Transfer learning is constructed to extract voiceprint features and classify them, which improves the accuracy of Parkinson's disease recognition. The validation experiments of the effectiveness of this paper's algorithm are carried out on the Parkinson's disease speech dataset. Compared with the pre-sample enhancement, the clarity of the samples generated by the proposed model in this paper as well as the Fréchet inception distance (FID) are improved, and the network model in this paper is able to achieve an accuracy of 98.8%. The results of this paper show that the Parkinson's disease recognition algorithm based on double self-attention deep convolutional generative adversarial network sample enhancement can accurately distinguish between healthy individuals and Parkinson's disease patients, which helps to solve the problem of insufficient samples for early recognition of voiceprint data in Parkinson's disease. In summary, the method effectively improves the classification accuracy of small-sample Parkinson's disease speech dataset and provides an effective solution idea for early Parkinson's disease speech diagnosis.
Topics: Humans; Parkinson Disease; Algorithms; Neural Networks, Computer; Recognition, Psychology; Speech
PubMed: 38403600
DOI: 10.7507/1001-5515.202304011 -
Cureus Jan 2024This report details a challenging case of difficult extubation due to a lodged tracheal tube following surgery, presenting an unexpected and complex clinical situation....
This report details a challenging case of difficult extubation due to a lodged tracheal tube following surgery, presenting an unexpected and complex clinical situation. An inspection of the airway using videolaryngoscopy revealed an over-inflated cuff beneath the vocal cords. Initial efforts to deflate the cuff with various methods were unsuccessful. The situation was ultimately resolved through the intervention of an otolaryngology surgeon. This case not only reviews various mechanisms of difficult endotracheal tube removal reported in the literature, but also underscores the potential for serious complications and highlights the critical role of multidisciplinary collaboration in managing extubation challenges. Additionally, our manuscript discusses alternative strategies that can be employed in scenarios where an otolaryngology surgeon is not available, offering practical guidance for anesthesiologists confronted with similar situations.
PubMed: 38389610
DOI: 10.7759/cureus.52787 -
International Journal of Surgery... May 2024To explore the effect of lower baseline amplitude on its predictive accuracy of postoperative vocal cord paralysis (VCP) in monitored thyroid surgery.
Noticeable effect of lower baseline amplitude on the predictive accuracy of intraoperative amplitude changes for postoperative vocal cord palsy: a prospective cohort study.
BACKGROUND
To explore the effect of lower baseline amplitude on its predictive accuracy of postoperative vocal cord paralysis (VCP) in monitored thyroid surgery.
MATERIALS AND METHODS
Clinical and electrophysiological data were collected during thyroid surgeries performed between November and December 2021 at China-Japan Union Hospital. Univariate/multivariate regression analysis were applied to these data to examine a possible correlation. A receiver operating characteristic curve was used to evaluate predictive efficacy.
RESULTS
A total of 631 nerves-at-risk (NAR) were identified in 460 patients who were divided into two groups according to postoperative development of VCP. The VCP group included a higher percentage of NAR with V1<1000 (68.2 vs. 40.7%, respectively; P =0.014) and NAR with R1<1400 (77.3 vs. 47.0%, respectively; P =0.005) compared with the non-VCP group. Multivariate regression analysis further identified V1<1000 [odds ratio (OR)=2.688, P =0.038], R1<1400 (OR=3.484, P =0.018) as independent risk factors for postoperative temporary VCP. The receiver operating characteristic curve showed the AUC value of V signal decline for predicting VCP was 0.87. The diagnostic efficiency of R signal decline reached as high as 0.973. A multivariate logistic regression analysis identified independent risk factors for V1<1000 and these included: higher BMI (OR=1.072, P =0.013), hypertension (OR=1.816, P =0.015), smoking (OR=1.814, P =0.031), and male sex (OR=2.016, P =0.027).
CONCLUSION
In our cohort, lower baseline amplitude was an independent risk factor for developing transient postoperative VCP. It also affected the predictive efficacy of intraoperative amplitude changes on VCP. Higher BMI, hypertension, smoking, and male sex may also be closely associated with lower initial amplitude. Thus, maintaining a higher initial amplitude is critical for patient safety during thyroid surgery.
Topics: Humans; Vocal Cord Paralysis; Male; Female; Middle Aged; Prospective Studies; Postoperative Complications; Adult; Thyroidectomy; Risk Factors; Predictive Value of Tests; Aged; ROC Curve
PubMed: 38385971
DOI: 10.1097/JS9.0000000000001203 -
American Journal of Veterinary Research Apr 2024The aim of this study was to investigate whether plasma neurofilament light chain (pNfL) concentration was altered in Labrador Retrievers with idiopathic laryngeal...
OBJECTIVE
The aim of this study was to investigate whether plasma neurofilament light chain (pNfL) concentration was altered in Labrador Retrievers with idiopathic laryngeal paralysis (ILP) compared to a control population. A secondary aim was to investigate relationships between age, height, weight, and body mass index in the populations studied.
ANIMALS
123 dogs: 62 purebred Labrador Retrievers with ILP (ILP Cases) and 61 age-matched healthy medium- to large-breed dogs (Controls).
METHODS
Dogs, recruited from August 1, 2016, to March 1, 2022, were categorized as case or control based on a combination of physical exam, neurologic exam, and history. Blood plasma was collected, and pNfL concentration was measured. pNfL concentrations were compared between ILP Cases and Controls. Covariables including age, height, and weight were collected. Relationships between pNfL and covariables were analyzed within and between groups. In dogs where 2 plasma samples were available from differing time points, pNfL concentrations were measured to evaluate alterations over time.
RESULTS
No significant difference in pNfL concentration was found between ILP Cases and Control (P = .36). pNfL concentrations had moderate negative correlations with weight and height in the Control group; other variables did not correlate with pNfL concentrations in ILP Case or Control groups. pNfL concentrations do not correlate with ILP disease status or duration in Labrador Retrievers.
CLINICAL RELEVANCE
There is no evidence that pNfL levels are altered due to ILP disease duration or progression when compared with healthy controls. When evaluating pNfL concentrations in the dog, weight and height should be considered.
Topics: Dogs; Animals; Vocal Cord Paralysis; Intermediate Filaments; Dog Diseases
PubMed: 38382190
DOI: 10.2460/ajvr.23.12.0292