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Deutsches Arzteblatt International May 2015Hoarseness (dysphonia) is the reason for about 1% of all consultations in primary care. It has many causes, ranging from self-limited laryngitis to malignant tumors of... (Review)
Review
BACKGROUND
Hoarseness (dysphonia) is the reason for about 1% of all consultations in primary care. It has many causes, ranging from self-limited laryngitis to malignant tumors of the vocal cords.
METHODS
This review is based on literature retrieved by a selective search in PubMed employing the terms "hoarseness," "hoarse voice," and "dysphonia," on the relevant guideline of the American Academy of Otolaryngology -Head and Neck Surgery, and on Cochrane reviews.
RESULTS
Hoarseness can be caused by acute (42.1%) and chronic laryngitis (9.7%), functional vocal disturbances (30%), and benign (10.7-31%) and malignant tumors (2.2-3%), as well as by neurogenic disturbances such as vocal cord paresis (2.8-8%), physiologic aging of the voice (2%), and psychogenic factors (2-2.2 %). Hoarseness is very rarely a manifestation of internal medical illness. The treatment of hoarseness has been studied in only a few randomized controlled trials, all of which were on a small scale. Voice therapy is often successful in the treatment of functional and organic vocal disturbances (level 1a evidence). Surgery on the vocal cords is indicated to treat tumors and inadequate vocal cord closure. The only entity causing hoarseness that can be treated pharmacologically is chronic laryngitis associated with gastro-esophageal reflux, which responds to treatment of the reflux disorder. The empirical treatment of hoarseness with antibiotics or corticosteroids is not recommended.
CONCLUSION
Voice therapy, vocal cord surgery, and drug therapy for appropriate groups of patients with hoarseness are well documented as effective by the available evidence. In patients with risk factors, especially smokers, hoarseness should be immediately evaluated by laryngos - copy.
Topics: Diagnosis, Differential; Evidence-Based Medicine; Hoarseness; Humans; Laryngeal Neoplasms; Laryngitis; Laryngoscopy; Treatment Outcome; Vocal Cord Paralysis
PubMed: 26043420
DOI: 10.3238/arztebl.2015.0329 -
Journal of Voice : Official Journal of... Sep 2023While many occupations are at risk for vocal health issues much of the current research has focused on teachers. The prevalence of hoarseness among nurses has not...
While many occupations are at risk for vocal health issues much of the current research has focused on teachers. The prevalence of hoarseness among nurses has not received much attention. The aim of this study was to determine the current prevalence of hoarseness among nurses and also to identify potential environmental risk factors from their working environment. The health data was collected from Finnish healthcare workers. Our findings are based on 13,560 health questionnaires which were statistically analyzed. Our results suggest that the one-year period prevalence of hoarseness was 30% and all the environmental problems which we evaluated (draft, room temperature too high, variable room temperature, room temperature too low, dry air, stuffy indoor air, moist air/ high humidity, inadequate ventilation, smell of mold or cellar, sewer odor, other unpleasant odors, tobacco smoke, noise and detectable dust or dirt) had an increasing effect on hoarseness. In conclusion, clear associations were found between environmental problems and hoarseness in nurses. Furthermore, efforts should be made to repair defective ventilation systems, remediate indoor air problems due to moisture damage and improve overall maintenance to protect the vocal health of nurses.
Topics: Humans; Air Pollution, Indoor; Hoarseness; Humidity; Ventilation; Nurses
PubMed: 34016510
DOI: 10.1016/j.jvoice.2021.03.030 -
Cleveland Clinic Journal of Medicine Aug 2023The terms hoarseness and dysphonia are used interchangeably, and both describe a type of altered vocal quality affecting one-third of patients. While hoarseness may be... (Review)
Review
The terms hoarseness and dysphonia are used interchangeably, and both describe a type of altered vocal quality affecting one-third of patients. While hoarseness may be secondary to benign conditions such as reflux or viral laryngitis, it may suggest benign or malignant vocal-fold pathology. It is important for caregivers to know how to evaluate, treat, and when to refer patients for direct visualization via laryngoscopy. In this article, we review basic laryngeal anatomy and function, symptoms of vocal-fold pathology, and current guidelines from the American Academy of Otolaryngology-Head and Neck Surgery on the diagnosis and treatment of dysphonia, including patient referral.
Topics: Humans; United States; Hoarseness; Dysphonia; Laryngitis; Gastroesophageal Reflux; Laryngoscopy
PubMed: 37527869
DOI: 10.3949/ccjm.90a.23010 -
American Family Physician Dec 2017Hoarseness is a common presentation in primary care practices. Combined with other voice-related changes, it falls under the umbrella diagnosis of dysphonia. Hoarseness...
Hoarseness is a common presentation in primary care practices. Combined with other voice-related changes, it falls under the umbrella diagnosis of dysphonia. Hoarseness has a number of causes, ranging from simple inflammatory processes to less common psychiatric disorders to more serious systemic, neurologic, or cancerous conditions. Medication-induced hoarseness is common and should be considered. The initial evaluation begins with a targeted history and physical examination, while also looking for signs of potential systemic etiologies. Treatment should begin with voice rest, especially avoidance of whispering, and conservative management directed toward a presumptive cause. For example, proton pump inhibitors are appropriate for hoarseness due to reflux, and proper vocal hygiene is recommended for vocal abuse-related indications. In the absence of a clear indication, antibiotics, oral corticosteroids, and proton pump inhibitors should not be used for the empiric treatment of hoarseness. Direct visualization of the larynx and vocal folds, commonly mislabeled as vocal cords, should be performed within three months if an etiology has not been determined or if conservative management has been ineffective. Patients who experience symptoms lasting longer than two weeks and who have risk factors for dysplasia (e.g., tobacco use, heavy alcohol use, hemoptysis) may require earlier laryngoscopic evaluation. Voice therapy is effective for improving voice quality in patients with dysphonia if conservative measures are unsuccessful, and it can also be helpful for prophylaxis in high-risk individuals (e.g., vocalists, public speakers). Surgical management is indicated for laryngeal or vocal fold dysplasia or malignancy, airway obstruction, or benign pathology resistant to conservative treatment.
Topics: Adult; Airway Obstruction; Conservative Treatment; Conversion Disorder; Diagnosis, Differential; Dysphonia; Gastroesophageal Reflux; Hoarseness; Humans; Laryngeal Neoplasms; Laryngopharyngeal Reflux; Laryngoscopy; Multiple Sclerosis; Parkinson Disease; Physical Examination; Proton Pump Inhibitors; Rest; Vocal Cord Paralysis; Voice Quality; Voice Training
PubMed: 29431404
DOI: No ID Found -
Ugeskrift For Laeger Jun 2023Voice problems, also called hoarseness or dysphonia, can cause significant morbidity with communication difficulties and social isolation. This review summarises the... (Review)
Review
Voice problems, also called hoarseness or dysphonia, can cause significant morbidity with communication difficulties and social isolation. This review summarises the causes and treatment of voice problems. Common causes of voice problems are related to inflammation, non-physiological usage of the voice, benign lesions of the vocal cords and damage to the nerves innervating the larynx. Nonetheless, it is important to keep malignancy in mind as a differential diagnosis. Referral to an otorhinolaryngologist is recommended for voice problems in adults with a duration of more than two weeks.
Topics: Adult; Humans; Hoarseness; Communication; Diagnosis, Differential; Inflammation; Referral and Consultation
PubMed: 37381839
DOI: No ID Found -
The Cochrane Database of Systematic... Jul 2022This is an updated version of the Cochrane Review published in 2015. Epilepsy is a chronic neurological disorder, characterised by recurring, unprovoked seizures. Vagus... (Review)
Review
BACKGROUND
This is an updated version of the Cochrane Review published in 2015. Epilepsy is a chronic neurological disorder, characterised by recurring, unprovoked seizures. Vagus nerve stimulation (VNS) is a neuromodulatory treatment that is used as an adjunctive therapy for treating people with drug-resistant epilepsy. VNS consists of chronic, intermittent electrical stimulation of the vagus nerve, delivered by a programmable pulse generator.
OBJECTIVES
To evaluate the efficacy and tolerability of VNS when used as add-on treatment for people with drug-resistant focal epilepsy.
SEARCH METHODS
For this update, we searched the Cochrane Register of Studies (CRS), and MEDLINE Ovid on 3 March 2022. We imposed no language restrictions. CRS Web includes randomised or quasi-randomised controlled trials from the Specialised Registers of Cochrane Review Groups, including Epilepsy, CENTRAL, PubMed, Embase, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform.
SELECTION CRITERIA
We considered parallel or cross-over, randomised, double-blind, controlled trials of VNS as add-on treatment, which compared high- and low-level stimulation (including three different stimulation paradigms: rapid, mild, and slow duty-cycle), and VNS stimulation versus no stimulation, or a different intervention. We considered adults or children with drug-resistant focal seizures who were either not eligible for surgery, or who had failed surgery.
DATA COLLECTION AND ANALYSIS
We followed standard Cochrane methods, assessing the following outcomes: 1. 50% or greater reduction in seizure frequency 2. Treatment withdrawal (any reason) 3. Adverse effects 4. Quality of life (QoL) 5. Cognition 6. Mood
MAIN RESULTS
We did not identify any new studies for this update, therefore, the conclusions are unchanged. We included the five randomised controlled trials (RCT) from the last update, with a total of 439 participants. The baseline phase ranged from 4 to 12 weeks, and double-blind treatment phases from 12 to 20 weeks. We rated two studies at an overall low risk of bias, and three at an overall unclear risk of bias, due to lack of reported information about study design. Effective blinding of studies of VNS is difficult, due to the frequency of stimulation-related side effects, such as voice alteration. The risk ratio (RR) for 50% or greater reduction in seizure frequency was 1.73 (95% confidence interval (CI) 1.13 to 2.64; 4 RCTs, 373 participants; moderate-certainty evidence), showing that high frequency VNS was over one and a half times more effective than low frequency VNS. The RR for treatment withdrawal was 2.56 (95% CI 0.51 to 12.71; 4 RCTs, 375 participants; low-certainty evidence). Results for the top five reported adverse events were: hoarseness RR 2.17 (99% CI 1.49 to 3.17; 3 RCTs, 330 participants; moderate-certainty evidence); cough RR 1.09 (99% CI 0.74 to 1.62; 3 RCTs, 334 participants; moderate-certainty evidence); dyspnoea RR 2.45 (99% CI 1.07 to 5.60; 3 RCTs, 312 participants; low-certainty evidence); pain RR 1.01 (99% CI 0.60 to 1.68; 2 RCTs; 312 participants; moderate-certainty evidence); paraesthesia 0.78 (99% CI 0.39 to 1.53; 2 RCTs, 312 participants; moderate-certainty evidence). Results from two studies (312 participants) showed that a small number of favourable QOL effects were associated with VNS stimulation, but results were inconclusive between high- and low-level stimulation groups. One study (198 participants) found inconclusive results between high- and low-level stimulation for cognition on all measures used. One study (114 participants) found the majority of participants showed an improvement in mood on the Montgomery-Åsberg Depression Rating Scale compared to baseline, but results between high- and low-level stimulation were inconclusive. We found no important heterogeneity between studies for any of the outcomes.
AUTHORS' CONCLUSIONS
VNS for focal seizures appears to be an effective and well-tolerated treatment. Results of the overall efficacy analysis show that high-level stimulation reduced the frequency of seizures better than low-level stimulation. There were very few withdrawals, which suggests that VNS is well tolerated. Adverse effects associated with implantation and stimulation were primarily hoarseness, cough, dyspnoea, pain, paraesthesia, nausea, and headache, with hoarseness and dyspnoea more likely to occur with high-level stimulation than low-level stimulation. However, the evidence for these outcomes is limited, and of moderate to low certainty. Further high-quality research is needed to fully evaluate the efficacy and tolerability of VNS for drug-resistant focal seizures.
Topics: Adult; Anticonvulsants; Child; Cough; Drug Resistant Epilepsy; Drug Therapy, Combination; Dyspnea; Hoarseness; Humans; Pain; Paresthesia; Seizures; Vagus Nerve Stimulation
PubMed: 35833911
DOI: 10.1002/14651858.CD002896.pub3 -
Medical Education Aug 2020Straight out of the Diagnostic and Statistical Manual COVID‐19 edition comes Covido‐pedago‐phobia. Here the authors identify its manifestations and reflect on its...
Straight out of the Diagnostic and Statistical Manual COVID‐19 edition comes Covido‐pedago‐phobia. Here the authors identify its manifestations and reflect on its prevalence.
Topics: Dyspnea; Education, Distance; Hoarseness; Humans; Phobic Disorders; School Teachers
PubMed: 32473029
DOI: 10.1111/medu.14257 -
Brazilian Journal of Cardiovascular... Dec 2020To give an overview of the Ortner's syndrome caused by an aortic arch aneurysm. (Review)
Review
OBJECTIVE
To give an overview of the Ortner's syndrome caused by an aortic arch aneurysm.
METHODS
By comprehensive retrieval of the pertinent literature published in the past two decades, 75 reports including 86 patients were collected and recruited into this study along with a recent case of our own.
RESULTS
The aortic arch aneurysms causing hoarseness were most commonly mycotic aneurysms. In this patient setting, in addition to the left recurrent laryngeal nerve, trachea was the most commonly affected structure by the aortic arch aneurysm. Surgical/interventional/hybrid treatments led to a hoarseness-relieving rate of 64.3%, much higher than that of patients receiving conservative treatment. However, hoarseness recovery took longer time in the surgically treated patients than in the interventionally treated patients.
CONCLUSION
The surgical and interventional treatments offered similar hoarseness-relieving effects. Surgical or interventional treatment is warranted in such patients for both treatment of arch aneurysms and relief of hoarseness.
Topics: Aorta, Thoracic; Aortic Aneurysm; Hoarseness; Humans; Syndrome; Vocal Cord Paralysis
PubMed: 33306323
DOI: 10.21470/1678-9741-2019-0352 -
HNO Jan 2022Prolonged ulcerative laryngitis is a rare, benign inflammatory alteration of the larynx that persists for months. The laryngoscopic findings suggest a malignant... (Review)
Review
BACKGROUND
Prolonged ulcerative laryngitis is a rare, benign inflammatory alteration of the larynx that persists for months. The laryngoscopic findings suggest a malignant process and can therefore be a challenge for the treating ear, nose and throat (ENT) physician.
OBJECTIVES
Presentation of the current database to provide an overview of the etiology, progress and treatment for everyday clinical practice.
METHODS
Three case studies from the Department of Phoniatrics and Speech Pathology of the ENT Department, University Hospital Zurich, Switzerland, are presented. Analysis and discussion of the current literature base and of case reports in the English literature.
RESULTS
The etiology and predisposing factors for this disease are unclear. Previous respiratory infection with cough and dysphonia seems to be the most common cause. Biopsies should be avoided.
CONCLUSIONS
The typical laryngoscopic findings show corresponding circumscribed lancet-shaped ulcerations in the middle third of the vocal fold. The course of the disease appears to be self-limiting and without permanent structural consequences. Therefore, good patient education and close laryngoscopic follow-up should be performed.
Topics: Dysphonia; Hoarseness; Humans; Laryngitis; Laryngoscopy; Vocal Cords
PubMed: 34170335
DOI: 10.1007/s00106-021-01079-0 -
Anesthesia Progress 2018More than 100,000 general anesthetic procedures are conducted in United Kingdom every year for dental interventions, according to large survey of the National Health...
More than 100,000 general anesthetic procedures are conducted in United Kingdom every year for dental interventions, according to large survey of the National Health Services. The risk of mortality has reduced considerably in the past few decades because of the use of safe and effective techniques. However, adverse effects still exist and are dependent on patient, environmental, and operator factors. We present an uncommon complication of intubation that merits due awareness.
Topics: Dysphonia; Hoarseness; Humans; Hypoglossal Nerve Injuries; Intubation, Intratracheal; Male; Molar, Third; Recovery of Function; Risk Factors; Syndrome; Tooth Extraction; Treatment Outcome; Vagus Nerve Injuries; Young Adult
PubMed: 29952646
DOI: 10.2344/anpr-65-04-06