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Otolaryngologia Polska = the Polish... Apr 2024<b><br>Introduction:</b> Electromyography (EMG) of the larynx provides information on the electrophysiological condition of laryngeal muscles and...
<b><br>Introduction:</b> Electromyography (EMG) of the larynx provides information on the electrophysiological condition of laryngeal muscles and innervation. Integration of information obtained from the EMG exams with the clinical parameters as obtained by other methods for laryngeal assessment (endoscopy, perceptual and acoustic analysis, voice self-assessment) provides a multidimensional picture of dysphonia, which is of particular importance in patients with vocal fold (VF) mobility disorders accompanied by glottic insufficiency.</br> <b><br>Aim:</b> The aim of this study was to evaluate laryngeal EMG records acquired in subjects with unilateral vocal fold immobilization with signs of atrophy and glottic insufficiency.</br> <b><br>Material and methods:</b> From the available material of 74 EMG records of patients referred for the exam due to unilateral laryngeal paralysis, records of 17 patients with endoscopic features suggestive of complete laryngeal muscle denervation were selected. The EMG study of thyroarytenoid muscles of mobile and immobile VFs was evaluated qualitatively and quantitatively at rest and during volitional activity involving free phonation of vowel /e/ [ε].</br> <b><br>Results:</b> In all patients, the EMG records from mobile VFs were significantly different from those from immobile VFs. Despite endoscopic features of paralysis, no VF activity whatsoever was observed in as few as 2 patients so as to meet the neurophysiological definition of paralysis. In 88% of cases, electromyographic activity of the thyroarytenoid muscle was observed despite immobilization and atrophy of the vocal fold. In these patients, neurogenic type of record was observed with numerous high- -amplitude mobility units. On the basis of the results, quantitative features of EMG records indicative of paralysis and residual activity of the thyroarytenoid muscle were determined.</br> <b><br>Conclusions:</b> Qualitative and quantitative analysis of laryngeal EMG records provides detailed information on the condition of vocal fold muscles and innervation. EMG records of mobile vs immobile VFs differ significantly from each other. Endoscopic evaluation does not provide sufficient basis for the diagnosis of complete laryngeal muscle denervation.</br>.
Topics: Humans; Vocal Cords; Vocal Cord Paralysis; Electromyography; Laryngeal Muscles; Endoscopy; Dysphonia; Atrophy
PubMed: 38623857
DOI: 10.5604/01.3001.0053.8704 -
International Journal of Molecular... Mar 2024A neurological condition called dystonia results in abnormal, uncontrollable postures or movements because of sporadic or continuous muscular spasms. Several varieties... (Review)
Review
A neurological condition called dystonia results in abnormal, uncontrollable postures or movements because of sporadic or continuous muscular spasms. Several varieties of dystonia can impact people of all ages, leading to severe impairment and a decreased standard of living. The discovery of genes causing variations of single or mixed dystonia has improved our understanding of the disease's etiology. Genetic dystonias are linked to several genes, including pathogenic variations of VPS16, TOR1A, THAP1, GNAL, and ANO3. Diagnosis of dystonia is primarily based on clinical symptoms, which can be challenging due to overlapping symptoms with other neurological conditions, such as Parkinson's disease. This review aims to summarize recent advances in the genetic origins and management of focal dystonia.
Topics: Humans; Dystonia; Dystonic Disorders; Movement; Parkinson Disease; Molecular Chaperones; DNA-Binding Proteins; Apoptosis Regulatory Proteins; Anoctamins
PubMed: 38612382
DOI: 10.3390/ijms25073571 -
Heliyon Apr 2024Amyotrophic lateral sclerosis (ALS) is a devastating neurodegenerative disorder, characterized by progressive limb weakness, dysphagia, dysphonia, and respiratory...
BACKGROUND
Amyotrophic lateral sclerosis (ALS) is a devastating neurodegenerative disorder, characterized by progressive limb weakness, dysphagia, dysphonia, and respiratory failure due to degeneration of upper and lower motor neurons. The pathogenesis of ALS is still unclear. Neuroinflammation has been found to be involved in its development and progression. Cytokines play a significant role in the inflammatory process. This study aims to identify novel biomarkers that may assist in the diagnosis of ALS.
METHODS
In Fujian Medical University Union Hospital and Huashan Hospital Fudan University, two independent centers, we prospectively recruited 50 ALS patients, and 41 healthy controls (25 ALS and 26 controls in the first stage and 25 ALS and 15 controls in the validation stage). An 18-plex Luminex kit was used to screen the serum cytokines levels in the first stage. Commercial ELISA kits were used to measure the levels of target cytokines in the validation stage. A single-molecule array HD-X platform was applied to assess the levels of serum neurofilament light chain (NFL).
RESULTS
The levels of serum IL-18 were markedly increased in patients with ALS in the first stage (). The ROC curve showed an area under the curve at 0.695 (95% CI 0.50-0.84) in distinguishing ALS patients from healthy controls. The IL-21 was decreased in elderly patients when grouped by 55 years old (the medium age). Furthermore, the IL-5, IL-13, IL-18, and NFL had a positive relationship with the disease progression of ALS. We also found that serum IL-18 was markedly increased in ALS patients in the validation stage (167.67 [148.25-175.59] vs 116.44 [102.43-122.19]pg/ml, ).
CONCLUSION
In this study, we identified systemic cytokine profile changes in the serum of ALS patients, especially the elevated IL-18, as well as the decreased IL-21 in elder patients. These changes in serum cytokine profiles may shed new light on an in-depth understanding of the immunopathogenic characteristics of ALS.
PubMed: 38596011
DOI: 10.1016/j.heliyon.2024.e28553 -
OTO Open 2024The onset of the coronavirus disease 2019 (COVID-19) pandemic changed practice patterns throughout medicine. The purpose of this study is to evaluate changes in the...
OBJECTIVE
The onset of the coronavirus disease 2019 (COVID-19) pandemic changed practice patterns throughout medicine. The purpose of this study is to evaluate changes in the volume and location setting of laryngology procedures after the onset of COVID-19.
STUDY DESIGN
Retrospective database cohort study.
SETTING
Reg-ENT registry.
METHODS
Retrospective review from 2017 to 2022 of patients who underwent a laryngology procedure identified by procedure code categorized by site of service code-"ambulatory surgical" versus "office" setting. Based on March 2020 as the cutoff point, the procedures were designated as pre-COVID versus COVID time period.
RESULTS
A total of 5989 patients underwent laryngology procedures. Forty-two percent more procedures were performed in the COVID period (n = 3780) versus pre-COVID (n = 2209). Pre-COVID, the procedure distribution between office and ambulatory surgical setting was 70% (n = 1546) compared with 30% (663). This shifted to 77% (n = 2920) and 23% (n = 860) during COVID, = .9. The most common diagnoses associated with laryngology procedures during the study period were vocal fold paralysis 47% (n = 2831), dysphonia 33% (n = 1392), and laryngotracheal stenosis 14% (n = 838). These trends remained in both pre-COVID and COVID time periods. After the start of the pandemic, among patients undergoing laryngology procedures, there was a 93% increase (n = 284-549) in the diagnosis of laryngotracheal stenosis, 70% increase (n = 520-882 patients) in dysphonia and 69% increase (n = 1054-1777) in vocal fold paralysis.
CONCLUSION
An increase in laryngology procedures performed after the onset of the COVID-19 pandemic was identified with an overall procedural shift to the office-setting.
PubMed: 38590586
DOI: 10.1002/oto2.128 -
Cureus Mar 2024Paragangliomas (PGLs) are tumors that are rarely malignant; the majority of them are benign. Similar to pheochromocytoma, they develop from the autonomic nerve system....
Paragangliomas (PGLs) are tumors that are rarely malignant; the majority of them are benign. Similar to pheochromocytoma, they develop from the autonomic nerve system. This system originates from neural crest cells and can undergo neoplastic transformation. PGLs can arise either inside or outside the adrenal glands. Head and neck PGLs are very scarce. The primary locations where this tumor commonly originates within this region are the carotid body, jugular bulb, and vagal body. Hence, in our case report, we attempt to highlight the uncommon presentation of this disease in a 46-year-old female, who initially presented with hypertension and persistent dysphonia. The patient underwent successful external radiotherapy. This case report aims to raise awareness of the characteristics of these rare malignancies.
PubMed: 38586626
DOI: 10.7759/cureus.55720 -
European Journal of Case Reports in... 2024We present a 30-year-old male who sustained a mild traumatic brain injury and then was intubated due to deterioration of consciousness. A head CT scan revealed mild...
UNLABELLED
We present a 30-year-old male who sustained a mild traumatic brain injury and then was intubated due to deterioration of consciousness. A head CT scan revealed mild brain oedema, a fractured nasal bone and mild left thoracic wall haematoma. Despite complete clinical and radiological normalisation within 36 hours, he failed to wean off the ventilator. The patient was found to have subtle bulbar manifestations including dysphonia, dysarthria, and dysphagia, with recurrent left lung collapse. He responded to an empirical pyridostigmine trial despite negative biochemical tests for myasthenia gravis (MG). The patient was weaned successfully from the ventilator, transferred to a long-term care facility, and then discharged home. Classic symptoms and signs of a disease may be absent, but the presence of dysarthria, dysphagia, transient vocal cord palsy, nasal speech, absent gag reflex and respiratory failure in difficult-to-wean patients, with no definitive diagnosis, may warrant an empirical trial of therapy for suspected MG and for the benefit of any doubt.
LEARNING POINTS
"Hidden" cranial injuries may account for subtle bulbar symptoms in victims of traumatic brain injury and should be searched for.Myasthenia gravis has been reported in association with trauma, which comes first and is often difficult to ascertain.A trial of pyridostigmine may be reasonable in difficult-to-wean patients when all other causes have been excluded for the benefit of the doubt.
PubMed: 38584891
DOI: 10.12890/2024_004363 -
Journal of Voice : Official Journal of... Apr 2024Elevated hearing thresholds cause disturbances in auditory control of voice. This leads to voice disorders that are described by changes in acoustic parameters of voice...
Elevated hearing thresholds cause disturbances in auditory control of voice. This leads to voice disorders that are described by changes in acoustic parameters of voice measured objectively. Voice changes can also be detected by perceptive assessment with GRBAS scale. This article presents the results of the study performed to analyze voice characteristics in a group of children with prelingual partial deafness (PD), a condition with normal hearing at low frequencies and deep hypoacusis (near deafness) at high frequencies. Voice disorders accompanying PD were not a subject of the intensive study before, therefore our study provides valuable data and help to understand more complex clinical aspects of PD. The study showed that voice characteristics in children with PD differs from children with normal hearing and shows some differences compared to voice of children with other types of hearing impairment. Major changes in PD are seen in frequency (F0, vF0), amplitude (vAm, sAPQ), noise (NHR), and tremor (FTRI) parameters. The changes were present in all groups of objective measures, which makes a difference versus normal hearing; however, the most significant changes were seen in a narrower range of parameters compared to children in other types of hearing impairment. Objective parameters correlate with the subjective features of voice of children with PD. With use of GRBAS scale, subjective voice assessment showed elevated indices of grade, roughness, breathy, asthenic, and strained voice, which described slightly harsh, breathy, dull, and a little tensed voice.
PubMed: 38584025
DOI: 10.1016/j.jvoice.2024.03.021 -
Annals of Medicine and Surgery (2012) Apr 2024This case report describes a rare occurrence of an epidermal inclusion cyst (EIC) being found in the thyroid gland and highlights the importance of considering uncommon...
INTRODUCTION AND IMPORTANCE
This case report describes a rare occurrence of an epidermal inclusion cyst (EIC) being found in the thyroid gland and highlights the importance of considering uncommon entities like EIC in the differential diagnosis of thyroid lesions.
CASE PRESENTATION
A 68-year-old male presented with a large, painless swelling in the anterior neck, causing dysphagia and dysphonia. Imaging and cytology confirmed a benign EIC involving the left lobe of the thyroid, which was successfully removed via hemithyroidectomy, resulting in resolution of symptoms.
CLINICAL DISCUSSION
Epidermoid inclusion cysts are rare in the thyroid gland, with only 16 reported cases worldwide. The cyst was diagnosed through ultrasound-guided fine needle aspiration and confirmed by surgical pathology. Treatment involves complete removal of the cyst and its capsule, which was successfully performed in this case under local anaesthesia with sedation due to the patient's medical history of COPD.
CONCLUSION
it is important to consider the possibility of EIC when benign squamous cells are detected in a thyroid aspirate without any follicular cells. In such cases, hemithyroidectomy can be a successful management strategy.
PubMed: 38576964
DOI: 10.1097/MS9.0000000000001825 -
Cureus Mar 2024A deep neck abscess is a relatively rare bacterial infection in infants that can rapidly progress to life-threatening complications. Mostly, the patients present...
A deep neck abscess is a relatively rare bacterial infection in infants that can rapidly progress to life-threatening complications. Mostly, the patients present with fever and neck pain. Some may present with dysphonia, sore throat, torticollis, trismus, or neck swelling. Early diagnosis and management can prevent life-threatening complications, such as airway obstruction, mediastinitis, and tracheitis. In this report, we present a case of a six-month-old infant presenting with retropharyngeal and parapharyngeal abscesses with prompt diagnosis leading to complete recovery of the patient.
PubMed: 38576697
DOI: 10.7759/cureus.55543 -
Noise & HealthFunctional dysphonia can impair the language expression ability and adversely affect the career development of some patients. Therefore, an active exploration of...
OBJECTIVE
Functional dysphonia can impair the language expression ability and adversely affect the career development of some patients. Therefore, an active exploration of effective treatment options is imperative. This study investigated the effect of Akson therapy on acoustic parameters in patients with functional dysphonia.
MATERIALS AND METHODS
In this retrospective analysis, 79 patients with functional dysphonia who received conventional voice correction training from June 2020 to June 2021 were included in the reference group (RG). Our hospital has implemented Akson therapy since July 2021. Correspondingly, 72 patients with functional dysphonia who underwent Akson therapy from July 2021 to July 2022 were enrolled in the observation group (OG). The acoustic parameters such as fundamental frequency (F0), jitter, shimmer, and normalized noise energy (NNE); the aerodynamic parameters including maximum phonation time (MPT), mean airflow rate (MFR), and Voice Handicap Index-10 (VHI-10) score; and the Grade, Roughness, Breathiness, Asthenia, and Strain scale (GRBAS) score were measured before and after treatment and compared between the two groups.
RESULTS
The F0, jitter, shimmer, NNE, MPT, and MFR values as well as the VHI-10 score and the grade (G), roughness (R), and breathiness (B) scores on the GRBAS did not significantly differ between the two groups before treatment (P > 0.05). However, significantly lower F0, jitter, shimmer, NNE, and MFR values and higher MPT levels were found in the OG compared to the RG after treatment (P < 0.001). Furthermore, the VHI-10 score and the G, R, and B scores were significantly lower in the OG than in the RG after treatment (P < 0.001), whereas the asthenia (A) and strain (S) scores remained at 0 before and after treatment.
CONCLUSION
Akson therapy can improve the acoustic parameters of patients with functional dysphonia to a certain extent, indicating its potential application value.
Topics: Humans; Dysphonia; Retrospective Studies; Asthenia; Voice Quality; Acoustics
PubMed: 38570303
DOI: 10.4103/nah.nah_99_23