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Journal of Speech, Language, and... May 2022Despite the high prevalence of primary muscle tension dysphonia (MTD-1), its underlying mechanisms and their interrelationships have yet to be fully identified. The... (Review)
Review
PURPOSE
Despite the high prevalence of primary muscle tension dysphonia (MTD-1), its underlying mechanisms and their interrelationships have yet to be fully identified. The objectives of this integrative review were (a) to describe and classify the suggested underlying mechanisms for MTD-1, (b) to appraise the empirical evidence supporting each of the proposed mechanisms, and (c) to summarize the information in an integrative model.
METHOD
PubMed, Scopus, and CINAHL were searched for all publications pertaining to muscle tension dysphonia. Papers were retained if they included theoretical or empirical data pertaining to underlying mechanisms of MTD-1. A total of 921 papers initially qualified for screening, of which 100 remained for consideration in this review. Underlying mechanisms of MTD-1 were extracted using a consensus approach.
RESULTS
Seven broad categories of putative mechanisms involved in MTD-1 were identified: psychosocial, autonomic, sensorimotor, respiratory, postural, inflammatory, and neuromuscular. These categories were further divided into 19 subcategories detailed in the body of this review article. Based on the reviewed evidence, our proposed integrative model presents MTD-1 as an idiosyncratic motor adaptation to physiological perturbation or perceived threat. Under this model, physiologically or psychologically aversive stimuli can instigate a series of motor adaptations at multiple levels of the nervous system, ultimately disturbing muscle activation patterns and their biomechanical outcomes. Importantly, these adaptations appear to have the potential to become chronic even after threatening stimuli are withdrawn.
CONCLUSIONS
The proposed model highlights the importance of personalized rehabilitation in MTD-1 treatment. Limitations of the literature are discussed to provide guidance for future research aimed at improving our understanding of MTD-1.
SUPPLEMENTAL MATERIAL
https://doi.org/10.23641/asha.19586065.
Topics: Dysphonia; Hoarseness; Humans; Muscle Tonus
PubMed: 35446683
DOI: 10.1044/2022_JSLHR-21-00575 -
BMC Anesthesiology Jul 2022Spray-as-you-go (SAYGo) airway topical anesthesia and nerve block are common techniques used during awake tracheal intubation. However, their effects have not been... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Spray-as-you-go (SAYGo) airway topical anesthesia and nerve block are common techniques used during awake tracheal intubation. However, their effects have not been described during double-lumen tube intubation. We report on a prospective randomized study that aimed to compare the intubation effects of SAYGo and nerve block patients undergoing thoracic surgery.
METHODS
Sixty-six American Society of Anesthesiologists (ASA) physical status I and II patients were scheduled to undergo double-lumen tube (DLT) tracheal intubation for thoracic surgery. The patients were randomly assigned into control (Group C), ultrasound (Group U), and flexible intubation scope (Group F) groups with 22 cases in each group. Patients in Group C were induced with a standard anesthetic regimen. Patients in Groups U and F were treated with superior laryngeal nerve (SLN) block combined with transtracheal injection (TTI) and given a SAYGo airway topical anesthesia before intubation. Hemodynamic variables during intubation process were recorded as the primary outcome. Additional patient data were recorded including the occurrence of adverse events, the level of hoarseness, the occurrence of sore throats, memory function and the level of patient satisfaction with anesthesia.
RESULTS
The blood pressure (BP) and heart rate (HR) of patients in group C was significantly increased 1 min after tracheal intubation (P < 0.05) compared to before anesthesia. The BP and HR of patients in Groups U and F remained stable. 10 cases of hypertension were observed in Group C, 6 cases in Group U and 1 case in Group F. In Group C, tachycardia was observed in 9 patients along with 9 cases in Group U and 4 cases in Group F. In Group U, 4 patients experienced puncture and bleeding were and 8 patients had a poor memory of TTI. No significant differences were found in the incidence of hoarseness, sore throats, and satisfaction with anesthesia in postoperative follow-up.
CONCLUSIONS
SAYGo airway topical anesthesia and SLN block combined with the TTI technique can inhibit the cardiovascular response during DLT tracheal intubation. The SAYGo technique has fewer complications and more advantages compared to other approaches.
Topics: Anesthesia, Local; Hoarseness; Humans; Intubation, Intratracheal; Pharyngitis; Prospective Studies
PubMed: 35780106
DOI: 10.1186/s12871-022-01749-8 -
HNO May 2023Laryngopharyngeal reflux (LPR) is characterized by backflow of gastric or gastroduodenal content and gases into the upper aerodigestive tract, which can damage the mucus... (Review)
Review
Laryngopharyngeal reflux (LPR) is characterized by backflow of gastric or gastroduodenal content and gases into the upper aerodigestive tract, which can damage the mucus membranes of the larynx and pharynx. It is associated with a variety of symptoms such as retrosternal burning and acid regurgitation, or other unspecific symptoms such as hoarseness, globus sensation, chronic cough, or mucus hypersecretion. Due to the lack of data and the heterogeneity of studies, diagnosis of LPR is problematic and challenging, as recently discussed. Moreover, the different therapeutic approaches are also discussed controversially in the face of the poor evidence base, and include pharmacologic and conservative dietary measures. Hence, in the following review, the available options for treatment of LPR are critically discussed and summarized for daily clinical use.
Topics: Humans; Laryngopharyngeal Reflux; Proton Pump Inhibitors; Larynx; Pharynx; Hoarseness
PubMed: 36795120
DOI: 10.1007/s00106-023-01280-3 -
BMJ Case Reports Feb 2022A 24-year-old woman visited the Ear Nose Throat (ENT) outpatient department with complaints of hoarseness for 2 months not responding to conservative management....
A 24-year-old woman visited the Ear Nose Throat (ENT) outpatient department with complaints of hoarseness for 2 months not responding to conservative management. Laryngoscopic examination revealed a whitish ulceroproliferative lesion in the anterior commissure and anterior two-thirds of bilateral true vocal cords with surrounding necrosis. In view of the above findings, the patient was planned for biopsy under general anaesthesia. Intraoperative findings showed multiple whitish necrotic friable tissue involving anterior two-thirds of bilateral false vocal cords, ventricle, bilateral true vocal cords, both aryepiglottic folds and laryngeal surface of epiglottis. Postoperative histopathology was consistent with tuberculosis. A pulmonology consultation was taken, and the patient was started on anti-tuberculosis chemotherapy. One month post therapy, the voice was symptomatically better. A flexible fibreoptic laryngoscopic examination was done, which revealed almost complete resolution of the lesion with minimal ulceration at the anterior one-third of right true vocal cord.
Topics: Adult; Female; Hoarseness; Humans; Laryngoscopy; Larynx; Tuberculosis, Laryngeal; Vocal Cords; Young Adult
PubMed: 35131802
DOI: 10.1136/bcr-2021-248095 -
Medicine Oct 2022To compare the effects of thermal softening of double-lumen endotracheal tubes (DLT) at different temperatures during fiberoptic bronchoscopy (FOB)-guided intubation. (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
To compare the effects of thermal softening of double-lumen endotracheal tubes (DLT) at different temperatures during fiberoptic bronchoscopy (FOB)-guided intubation.
METHODS
We randomly divided 144 patients undergoing thoracic surgery into 4 groups as follows: T1 (T = 24 ± 1°C, n = 36), T2 (T = 36 ± 1°C, n = 36), T3 (T = 40 ± 1°C, n = 36), and T4 (T = 48 ± 1°C, n = 36). All groups underwent FOB-guided double-lumen endotracheal intubation and positioning. We recorded the duration of positioning and intubation using DLT, intubation resistance (IR), the success rate of the first attempt at endotracheal intubation, and the incidence of postoperative vocal cord injury and hoarseness.
RESULTS
The time to intubation was longer in the T1 group than that in the T2, T3, and T4 groups (P < .05). The time for positioning was longer in the T4 group than that in the T1, T2, and T3 groups (P < .05). IR was lower in the T3 and T4 groups than those in T1 and T2 groups (P < .05). The success rate of the first attempt at endotracheal intubation was higher in the T2, T3, and T4 groups than that in the T1 group (P < .05). Postoperative glottic injury and hoarseness were higher in the T1 and T2 groups than those in the T3 and T4 groups (P < .05).
CONCLUSION
A thermally softened DLT shortened the time to intubation, reduced the IR, improved the success rate of the first attempt at endotracheal intubation, and lowered the incidence of postoperative glottic injury and hoarseness. The optimal tube temperature for FOB-guided intubation of thermally softened DLT was 40 ± 1°C.
Topics: Bronchoscopes; Bronchoscopy; Hoarseness; Humans; Intubation, Intratracheal; Temperature
PubMed: 36221346
DOI: 10.1097/MD.0000000000029999 -
Clinical Otolaryngology : Official... May 2021Current UK referral criteria stipulate that hoarseness should be persistent to merit 2 week wait (2WW) or urgent suspicion of cancer (USOC) referral. This study...
BACKGROUND
Current UK referral criteria stipulate that hoarseness should be persistent to merit 2 week wait (2WW) or urgent suspicion of cancer (USOC) referral. This study delineates patterns of hoarseness presentation with a view to assisting referral pathways, and whereby reassurance could be provided.
METHODS
A pre-existing database of patients referred with hoarseness under the urgent suspicion of cancer (USOC) category was analysed. Univariate and multivariate analyses were performed on a variety of demographic and comorbid features to produce odds ratios (OR) of features either related or not related to laryngeal cancer.
RESULTS
Of 698 consecutive hoarseness referrals were studied. In these referrals there were 506(73%) with persistent hoarseness and 192(27%) with intermittent hoarseness. The most significant patient variables related to laryngeal cancer were persistent hoarseness (OR 4.97), recreational drug use (OR 4.94), male gender (OR 4.01) and weight loss (OR 3.75). Significant patient variables present not related to laryngeal cancer diagnosis were intermittent hoarseness (OR 0.2), the presence of cough (OR 0.2), globus sensation (OR 0.25) and recent viral infection (OR 0.29).
CONCLUSION
The strongest association with cancer is seen in patients that are persistently hoarse. Patients with fluctuating hoarseness do not need an "urgent suspicion of cancer" referral. Additional demographic referral information could help to streamline the referral of these patients, and reassure others.
Topics: Adult; Aged; Aged, 80 and over; Early Detection of Cancer; Hoarseness; Humans; Laryngeal Neoplasms; Male; Middle Aged; Referral and Consultation; Risk Factors; United Kingdom
PubMed: 33404189
DOI: 10.1111/coa.13712 -
Trends in Neurosciences Sep 2018Is an amygdala necessary to experience and perceive fear? Intriguing evidence comes from patient S.M. who lost her left and right amygdalae to disease. Initial testing... (Review)
Review
Is an amygdala necessary to experience and perceive fear? Intriguing evidence comes from patient S.M. who lost her left and right amygdalae to disease. Initial testing suggested that S.M.'s most defining symptom was an inability to recognize fear in other people's facial expressions. A fascinating paper by Adolphs and colleagues in 2005 examined one potential mechanism for this impairment: a failure to spontaneously attend to widened eyes, the most distinctive physical feature portrayed in symbolic fear expressions. This study helped to invigorate debates about the brain basis of fear and paved the way for a more nuanced understanding of amygdalar function.
Topics: Amygdala; Atrophy; Facial Expression; Fear; Female; Humans; Lipoid Proteinosis of Urbach and Wiethe
PubMed: 30143181
DOI: 10.1016/j.tins.2018.06.009 -
Primary Care Respiratory Journal :... Apr 2006Always ask about hoarseness and quality of voice in a history of any child presenting with cough or asthma-like symptoms. Children presenting with what appears to be an...
Always ask about hoarseness and quality of voice in a history of any child presenting with cough or asthma-like symptoms. Children presenting with what appears to be an acute onset of hoarseness, without any physical signs of airways obstruction, should be reviewed after two weeks. If there is chronic hoarseness, referral to an ENT specialist should be considered with a view to laryngoscopy. If the child develops clinical signs of acute airway obstruction such as stridor or respiratory distress, prompt paediatric review is indicated. When referring, it is important to emphasise whether or not there is chronic hoarseness in order to differentiate the diagnosis from croup. Juvenile Laryngeal Papillomatosis may present with cough, pneumonia, dysphagia, or stridor, as well as hoarseness. These patients are often misdiagnosed as having asthma or allergies.
Topics: Airway Obstruction; Asthma; Child, Preschool; Diagnosis, Differential; Fatal Outcome; Female; Hoarseness; Humans; Laryngeal Neoplasms; Papilloma; Primary Health Care; Vocal Cords
PubMed: 16701772
DOI: 10.1016/j.pcrj.2006.02.004 -
The Journal of International Medical... Sep 2022Neurogenic tumors located in the larynx are extremely rare. Among them, schwannoma is a benign encapsulated tumor originating from Schwann cells, which form nerve fiber... (Review)
Review
Neurogenic tumors located in the larynx are extremely rare. Among them, schwannoma is a benign encapsulated tumor originating from Schwann cells, which form nerve fiber sheaths in the peripheral nervous system. We herein report a case of a schwannoma arising from a rare subsite of the larynx and review the literature on laryngeal schwannoma. The case involved a woman with a 1-month history of globus pharyngeus and dysphagia without dysphonia. Rigid laryngoscopy and magnetic resonance imaging showed a large submucosal bulge toward the medial wall of the right pyriform fossa, pushing the right false and true vocal cords and aryepiglottic fold inward. A transcervical approach was used to completely excise the tumor without incisional biopsy or preliminary tracheotomy. Histology confirmed a benign schwannoma originating from the right paraglottic space, which was extremely rare. During follow-up, no evidence of recurrence or a residual mass was found. The transcervical approach is a useful and less invasive treatment for laryngeal schwannoma located in the paraglottic space.
Topics: Female; Hoarseness; Humans; Laryngeal Neoplasms; Laryngoscopy; Larynx; Neurilemmoma
PubMed: 36113014
DOI: 10.1177/03000605221122497 -
Ear, Nose, & Throat Journal Jun 2019
Topics: Adult; Hemangioma; Hoarseness; Humans; Laryngeal Neoplasms; Laryngoscopy; Male; Vocal Cords
PubMed: 31020857
DOI: 10.1177/0145561319840135