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The Western Journal of Emergency... Dec 2015Airway management in critically ill patients involves the identification and management of the potentially difficult airway in order to avoid untoward complications.... (Review)
Review
Airway management in critically ill patients involves the identification and management of the potentially difficult airway in order to avoid untoward complications. This focus on difficult airway management has traditionally referred to identifying anatomic characteristics of the patient that make either visualizing the glottic opening or placement of the tracheal tube through the vocal cords difficult. This paper will describe the physiologically difficult airway, in which physiologic derangements of the patient increase the risk of cardiovascular collapse from airway management. The four physiologically difficult airways described include hypoxemia, hypotension, severe metabolic acidosis, and right ventricular failure. The emergency physician should account for these physiologic derangements with airway management in critically ill patients regardless of the predicted anatomic difficulty of the intubation.
Topics: Acidosis; Airway Management; Critical Illness; Glottis; Heart Failure; Humans; Hypotension; Hypoxia; Intubation, Intratracheal; Risk Factors
PubMed: 26759664
DOI: 10.5811/westjem.2015.8.27467 -
Otolaryngologia Polska = the Polish... Jun 2018Voice express the psyche and personality of a person. Psychogenic dysphonia is called Phononeurosis. Neurosis, depression or family, occupational and social conflicts...
INTRODUCTION
Voice express the psyche and personality of a person. Psychogenic dysphonia is called Phononeurosis. Neurosis, depression or family, occupational and social conflicts are the cause of voice disturbances. The most frequent type of dysphonia is hyperfunctional dysphonia, rarer - hypofunctional type.
AIM
The aim of this study is an analysis of voice quality and diagnosis of clinical type of psychogenic dysphonia.
MATERIAL AND METHODS
The analyzed group consisted of 50 patients with voice disorders treated in 2017 and the control group - 30 people with physiological voice. In the diagnosed group 60% of patients were treated for neurosis, 12% due to depression, the others reported conflict situations. In the diagnosis of clinical type of psychogenic dysphonia GRBAS scale was used, maximum phonation time (MPT) and type of breathing were assessed. The visualisation of the larynx was performed using High Speed Digital Imaging (HSDI) technique. The parametric acoustic evaluation of voice was conducted.
RESULTS
The most often clinical type of psychogenic dysphonia was hyperfunctional dysphonia, rarer hypofunctional type and vestibular voice. Dysphonia occurred the most often in women during the highest professional activity period. In the diagnosis of clinical type HSDI technique was especially useful allowing to visualization of the real vocal fold vibration and objective differentiation of hyper- and hypofunctional dysphonia. The acoustic analysis of the voice objectively confirmed the presence non-harmonic components - noise generated in the glottis in hypofunctional dysphonia. Disturbances in the way and breathing type caused irregularities in respiratory-phonic and articulation coordination.
Topics: Adult; Case-Control Studies; Dysphonia; Female; Glottis; Humans; Larynx; Male; Middle Aged; Occupational Diseases; Treatment Outcome; Voice Quality
PubMed: 30190444
DOI: 10.5604/01.3001.0012.0636 -
European Annals of Otorhinolaryngology,... Aug 2021
Topics: Glottis; Humans; Laryngomalacia
PubMed: 34144930
DOI: 10.1016/j.anorl.2021.05.016 -
Clinical Oncology (Royal College of... Jan 2017Recently, carotid-sparing intensity-modulated radiotherapy (IMRT) for early laryngeal glottis (T1/T2N0M0) cancer has generated interest in the hope of avoiding long-term... (Review)
Review
AIMS
Recently, carotid-sparing intensity-modulated radiotherapy (IMRT) for early laryngeal glottis (T1/T2N0M0) cancer has generated interest in the hope of avoiding long-term carotid toxicity, as well as concerns relating to geographical misses and long-term normal tissue toxicity. The aim of this review was to summarise the current literature on carotid-sparing IMRT for early glottis cancer, with particular focus on definitions of target volumes and the carotid arteries as organs at risk. In addition, we make suggestions for standardisation of these structures, dose constraints and dose reporting.
MATERIALS AND METHODS
From 73 references, 16 articles met the criteria for inclusion in this systematic review. These papers described two case reports, 11 planning studies and three prospective studies.
RESULTS
There was variation in all target volume definitions with no clear consensus. The greatest variability was in clinical target volume definition. Carotid artery and spinal cord delineation were not always defined and most studies did not use a carotid artery constraint. Of the eight studies that reported carotid artery delineation, no two studies delineated the same length of carotid artery, yet most studies reported mean doses. Most studies used IMRT with three to seven fields. Five studies used arc therapy and two studies used tomotherapy.
CONCLUSION
This review highlights a lack of consensus in target volume definitions in carotid-sparing IMRT. Ultimately, long-term prospective data are required to show the benefit of carotid-sparing IMRT. Pooled data will prove useful as most studies will report on small numbers of patients. Therefore, adopting a consensus now on target volume definition, dose constraints and dose reporting will be crucial.
Topics: Carotid Arteries; Glottis; Humans; Laryngeal Neoplasms; Male; Prospective Studies; Radiotherapy Dosage; Radiotherapy Planning, Computer-Assisted; Radiotherapy, Conformal; Radiotherapy, Intensity-Modulated
PubMed: 27815039
DOI: 10.1016/j.clon.2016.09.017 -
Indian Pediatrics Jun 2022
Topics: Glottis; Humans; Xanthogranuloma, Juvenile
PubMed: 35695144
DOI: No ID Found -
European Archives of... Sep 2022Transoral laser microsurgery (TOLMS) with carbon dioxide is a safe approach for laryngeal carcinoma. In literature there are three main methods for evaluating speech... (Review)
Review
PURPOSE
Transoral laser microsurgery (TOLMS) with carbon dioxide is a safe approach for laryngeal carcinoma. In literature there are three main methods for evaluating speech outcomes: acoustic and aerodynamics analysis, perceptual evaluation and patient-reported outcomes (PROs). The aim of this study was to systematically review the literature about the voice quality outcomes of TOLMS according to type of cordectomy.
METHODS
A systematic literature review was performed and all the results until December 2021 were extrapolated. We evaluated the acoustic and aerodynamics parameters (fundamental frequency, harmonics to noise ratio, jitter, shimmer and maximum phonation time), perceptual data (GRBAS scale) and patient-related outcomes (VHI scale).
RESULTS
24 studies met the inclusion criteria for a total number of 1207 patients enrolled. The number for each type of cordectomy are: 287 type I (23.78%), 311 type II (25.78%), 328 type III (27.14%), 129 type 4 (10.69%) and 152 type V (12.60%). Patients are grouped according to the type of cordectomy in: limited cordectomy (type I and II) and extended cordectomy (types III-IV-V). The difference between two groups is statistically significative in terms of acoustic analysis, perceptual data and patient-related outcomes (p < 0.05).
CONCLUSIONS
Patients who underwent type I or II cordectomy have significantly better quality of voice in terms of VHI, perceptual voice quality evaluations and acoustic parameters compared to type III, IV and V cordectomies. The effect of TOLMS on the voice should depend from the extent of the resection and in particular from the scar of the vocal muscle.
Topics: Carbon Dioxide; Glottis; Humans; Laryngeal Neoplasms; Laser Therapy; Lasers, Gas; Microsurgery; Retrospective Studies; Treatment Outcome; Voice Quality
PubMed: 35505113
DOI: 10.1007/s00405-022-07418-3 -
Cancer Reports (Hoboken, N.J.) Aug 2023The treatment of glottic cancer remains challenging, especially with regard to morbidity reduction and larynx preservation rates. The National Comprehensive Cancer... (Review)
Review
BACKGROUND
The treatment of glottic cancer remains challenging, especially with regard to morbidity reduction and larynx preservation rates. The National Comprehensive Cancer Network (NCCN) has published guidelines to aid decision-making about this treatment according to the tumor site, clinical stage, and patient medical status.
AIM
The present review was conducted to identify changes in the NCCN guidelines for glottic cancer treatment made between 2011 and 2022 and to describe the published evidence concerning glottic cancer treatment and oncological outcomes in the same time period.
METHODS AND RESULTS
Clinical practice guidelines for head and neck cancer published from 2011 up to 2022 were obtained from the NCCN website (www.NCCN.org). Data on glottic cancer treatment recommendations were extracted, and descriptive analysis was performed. In addition, a review of literature registered in the PubMed database was performed to obtain data on glottic cancer management protocols and treatment outcomes from randomized controlled trials, systematic reviews, and meta-analyses published from 2011 to 2022. In total, 24 NCCN guidelines and updates and 68 relevant studies included in the PubMed database were identified. The main guideline changes made pertained to surgical and systemic therapies, the consideration of adverse features, and new options for the treatment of metastatic disease at initial presentation. Early-stage glottic cancer received the most research attention, with transoral endoscopic laser surgery and radiotherapy assessed and compared as the main treatment modalities. Reported associations between treatment types and survival rates for this stage of glottic cancer appear to be similar, but functional outcomes can be highly compromised.
CONCLUSION
NCCN panel members provide updated recommendations based on currently accepted treatment approaches for glottic cancer, constantly reviewing new surgical and non-surgical techniques. The guidelines support decision-making about glottic cancer treatment that should be individualized and prioritize patients' quality of life, functionality, and preferences.
Topics: Humans; Laryngeal Neoplasms; Quality of Life; Larynx; Glottis; Head and Neck Neoplasms; Tongue Neoplasms
PubMed: 37288471
DOI: 10.1002/cnr2.1837 -
Seminars in Respiratory and Critical... Oct 2010Pulmonary aspiration is the consequence of abnormal entry of fluid, particulate material, or endogenous secretions into the airway. The two main types of aspiration... (Review)
Review
Pulmonary aspiration is the consequence of abnormal entry of fluid, particulate material, or endogenous secretions into the airway. The two main types of aspiration scenarios include anterograde aspiration, which occurs during swallowing, and retrograde aspiration, which can occur during gastroesophageal reflux (GER) events. The important structures that protect against aspiration include the aerodigestive apparatus: pharynx, upper esophageal sphincter, esophageal body, glottis and vocal cords, and airway. In this article we review the neuroanatomy, physiology, and pathophysiology pertinent to glottic reflexes and airway aspiration across the age spectrum from neonates to adults. We also discuss recent advances in our understanding of glottal reflexes and the relationship of these reflexes to developmental anatomy and physiology, the pathophysiology of aspiration, and aerodigestive interactions.
Topics: Adolescent; Adult; Aging; Child; Child, Preschool; Deglutition Disorders; Gastroesophageal Reflux; Glottis; Humans; Infant; Infant, Newborn; Respiratory Aspiration; Young Adult
PubMed: 20941656
DOI: 10.1055/s-0030-1265896 -
Forensic Science, Medicine, and... Dec 2022An 86-year-old woman with Alzheimer disease collapsed in her nursing home and was not able to be resuscitated. At autopsy, the major findings were in the larynx where a...
An 86-year-old woman with Alzheimer disease collapsed in her nursing home and was not able to be resuscitated. At autopsy, the major findings were in the larynx where a pedunculated oncocytic cystadenoma had occluded the glottis. Oncocytic cysts or cystadenomas of the larynx are rare histologically benign lesions that account for only 0.1-1% of laryngeal lesions. While the usual presentation is of a sensation of a mass in the throat, hoarseness, or stridor, very occasionally, there may be acute airway compromise and sudden death. Oncocytic cystadenoma should, therefore, be included in the differential diagnosis of potentially lethal obstructive laryngeal lesions.
Topics: Humans; Female; Aged, 80 and over; Laryngeal Neoplasms; Larynx; Cystadenoma; Glottis; Death, Sudden; Laryngeal Diseases
PubMed: 36136290
DOI: 10.1007/s12024-022-00530-0 -
Brazilian Journal of Otorhinolaryngology 2022Congenital laryngeal webs are rare, may be associated with other airway abnormalities and be one of many features of microdeletion 22q11. Meticulous evaluation is...
INTRODUCTION
Congenital laryngeal webs are rare, may be associated with other airway abnormalities and be one of many features of microdeletion 22q11. Meticulous evaluation is imperative when deciding which surgical technique to use. The choice of appropriate stenting may be decisive to avoid persistent anterior commissure synechia and poor voice results.
OBJECTIVE
To report outcomes for endoscopic and open surgical approaches in the treatment of congenital laryngeal webs and the challenges one may encounter while applying the current classification and deciding for the best treatment option.
METHODS
Retrospective review of medical and surgical charts for congenital laryngeal webs treated in two tertiary university centers.
RESULTS
Seven patients were included; following Cohen's classification there were: three type II webs, one of them with an atypical posterior synechia, two type III webs and two type IV webs. Six patients were submitted to laryngotracheal reconstruction and one was treated with an endoscopic approach. Description of precise glottic and subglottic involvement and tailored surgical options are presented. The LT mold® stent was used for long-term stenting that varied between 40 to 60 days. All patients were successfully decannulated with good voice quality and after follow-up of over one year, there were no complications associated with the surgeries.
CONCLUSION
Congenital laryngeal webs should be suspected and thoroughly evaluated in the presence of neonatal dysphonia and early onset of laryngitis. Otolaryngologists must be familiar with associated lesions and genetic conditions that may be associated to congenital laryngeal webs. Congenital laryngeal webs may be successfully treated at an early age. The correct choice of surgical technique after meticulous evaluation of glottic and subglottic components of the web, presence of concomitant lesions and appropriate stenting, is imperative to avoid persistent scarring and poor voice quality.
Topics: Dysphonia; Glottis; Humans; Infant, Newborn; Laryngostenosis; Larynx; Retrospective Studies; Treatment Outcome; Vocal Cords
PubMed: 32855093
DOI: 10.1016/j.bjorl.2020.06.018