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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 -
Kulak Burun Bogaz Ihtisas Dergisi : KBB... 2016This study aims to evaluate the demographic and clinical characteristics of patients with idiopathic and non-idiopathic vocal cord paralysis (VCP).
OBJECTIVES
This study aims to evaluate the demographic and clinical characteristics of patients with idiopathic and non-idiopathic vocal cord paralysis (VCP).
PATIENTS AND METHODS
This retrospective cohort was performed on data extracted from medical files of 92 consecutive patients (43 males, 49 females; median age 52.1±23.1 years; min. 1 - max. 87) with VCP diagnosed in the otorhinolaryngology department between April 2012 and December 2015. Diagnoses associated with VCP, side of involvement (right, left or bilateral) and previous medical histories were noted and compared between patients with idiopathic and non-idiopathic VCP.
RESULTS
Vocal cord paralysis occurred on the left side (n=56, 60.9%), right side (n=28, 30.4%) or bilaterally (n=8, 8.7%). A clinical entity related with VCP was identified in 63 patients (68.5%), while 29 (31.5%) patients had idiopathic VCP. Most common etiologies for VCP were thyroid surgery (n=32, 34.8%), cardiovascular surgery (n=9, 9.8%), lung cancer (n=6, 6.5%) and cardiac anomalies (n=4, 4.3%), respectively. Patients with idiopathic VCP were significantly older (p<0.001), while gender distribution (p=0.121) and side of involvement (p=0.340) did not differ between two groups.
CONCLUSION
Vocal cord paralysis is a relatively common clinical entity with substantial rate of morbidity. Identification of the underlying etiology and awareness on the clinical characteristics are keystones for foreseeing complications and determining the appropriate therapeutic modality.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Female; Humans; Infant; Lung Neoplasms; Male; Middle Aged; Retrospective Studies; Thyroid Gland; Vocal Cord Paralysis; Young Adult
PubMed: 27405079
DOI: 10.5606/kbbihtisas.2016.03185 -
Medicine Jan 2022To review our experience with endoscopic coblation-assisted and partial arytenoidectomy (ECPA) in treating idiopathic bilateral vocal cord paralysis (BVCP).A...
To review our experience with endoscopic coblation-assisted and partial arytenoidectomy (ECPA) in treating idiopathic bilateral vocal cord paralysis (BVCP).A retrospective analysis of thirty-three infants (19 boys and 14 girls, aged 1-10 months) with idiopathic BVCP undergoing ECPA was performed. The therapeutic process and outcomes (surgical success, swallowing function, and voice) were reviewed. The follow-up period was >33 months.Among the thirty-three infants with idiopathic BVCP, surgery was successful in twenty-nine cases but failed in four cases. Twenty-one, nine, and three patients underwent right, left, and bilateral ECPA, with surgical success rates of 90.5%, 100.0%, and 33.3%, respectively. In addition, four and six cases were combined with subglottic stenosis (SGS) and laryngomalacia, respectively. The surgical success rates of BVCP alone and BVCP+ other airway abnormalities were 95.6% and 70.0%, respectively. During the follow-up, five infants had slight difficulty swallowing, 12 infants had partial or complete recovery movement of at least one vocal cord with satisfactory voice outcome, and five infants had early granuloma formation, which disappeared spontaneously.ECPA appears to be a promising alternative to tracheostomy and initial management in infants with idiopathic BVCP who are free of other airway abnormalities.
Topics: Endoscopy; Female; Humans; Infant; Laryngeal Muscles; Laryngoplasty; Laryngoscopy; Male; Retrospective Studies; Vocal Cord Paralysis
PubMed: 35089194
DOI: 10.1097/MD.0000000000028593 -
Brazilian Journal of Otorhinolaryngology 2020
Topics: Aged; Humans; Injections, Intralesional; Laryngoplasty; Meta-Analysis as Topic; Secondary Prevention; Treatment Outcome; Vocal Cord Paralysis
PubMed: 31892508
DOI: 10.1016/j.bjorl.2019.11.001 -
Journal of Otolaryngology - Head & Neck... Sep 2015Vocal cord paralysis (VCP) is found in both benign and malignant thyroid disease. This study was performed to determine if the presence of preoperative VCP predicts...
BACKGROUND
Vocal cord paralysis (VCP) is found in both benign and malignant thyroid disease. This study was performed to determine if the presence of preoperative VCP predicts malignancy.
METHODS
A retrospective analysis was performed on a cohort of 1923 consecutive patients undergoing thyroid surgery. The incidence of preoperative VCP was recorded. Patient and nodule characteristics were correlated with final pathology.
RESULTS
1.3% of our cohort was found to have preoperative VCP. Malignant pathology was discovered in 76% of patients with preoperative VCP. Among these patients, 72% had a left sided paralysis. 10.5% of patients with preoperative VCP had perineural invasion (PNI) on final pathology, compared to 1.1% of patients with normal VC function.
CONCLUSION
Preoperative VCP appears to be a strong, though not an absolute, indicator of malignancy. Most VCP were on the left side. Assessing for preoperative VCP is crucial in all patients who need thyroid surgery, as even benign nodules can be accompanied by preoperative vocal cord paralysis.
Topics: Adult; Aged; Aged, 80 and over; Female; Follow-Up Studies; Humans; Incidence; Laryngoscopy; Male; Middle Aged; Preoperative Period; Quebec; Retrospective Studies; Thyroid Diseases; Thyroid Gland; Thyroid Neoplasms; Thyroidectomy; Vocal Cord Paralysis; Vocal Cords; Voice Quality
PubMed: 26362432
DOI: 10.1186/s40463-015-0087-1 -
BioMed Research International 2016. Treatment for bilateral vocal fold paralysis (BVFP) has evolved from external irreversible procedures to endolaryngeal laser surgery with greater focus on anatomic and... (Review)
Review
. Treatment for bilateral vocal fold paralysis (BVFP) has evolved from external irreversible procedures to endolaryngeal laser surgery with greater focus on anatomic and functional preservation. Since the introduction of endolaryngeal laser arytenoidectomy, certain modifications have been described, such as partial resection procedures and mucosa sparing techniques as opposed to total arytenoidectomy. . The primary outcome measure in studies on BVFP treatment using total or partial arytenoidectomy is avoidance of tracheotomy or decannulation and reported success ranges between 90 and 100% in this regard. Phonation is invariably affected and arytenoidectomy worsens both aerodynamic and acoustic vocal properties. Recent reports indicate that partial and total arytenoidectomies have similar outcome in respect to phonation and swallowing. We use CO laser assisted partial arytenoidectomy with a posteromedially based mucosal flap for primary cases and reserve total arytenoidectomy for revision. Lateral suturing of preserved mucosa provides tension on the vocal fold leading to better voice and leaves no raw surgical field to unpredictable scarring or granulation. . Arytenoidectomy as a permanent static procedure remains a traditional yet sound choice in the treatment of BVFP. Laser dissection provides a precise dissection in a narrow surgical field and the possibility to perform partial arytenoidectomy.
Topics: Deglutition; Female; Humans; Laser Therapy; Male; Phonation; Recovery of Function; Vocal Cord Paralysis
PubMed: 27830141
DOI: 10.1155/2016/3601612 -
Laryngo- Rhino- Otologie May 2022Vocal fold paralysis is one of the diseases that particularly affect quality of life. While unilateral paralysis leads to glottis closure insufficiency and hoarseness,...
Vocal fold paralysis is one of the diseases that particularly affect quality of life. While unilateral paralysis leads to glottis closure insufficiency and hoarseness, bilateral paralysis compromises respiration and limits the exercise tolerance. Bioimplants have been used to treat persistent paralysis for over 100 years. The spectrum ranges from autologous tissue transfer and resorbable or permanent injection materials to composite thyroplasty implants and active electrical implants for neurostimulation of the larynx. If bioimplants are used in accordance with the recommendations, the quality of life of affected patients can be significantly improved today.
Topics: Humans; Laryngoplasty; Larynx; Quality of Life; Vocal Cord Paralysis; Vocal Cords
PubMed: 35605617
DOI: 10.1055/a-1708-2881 -
Paediatric Respiratory Reviews Jun 2018Extremely premature (EP) infants are at increased risk of left vocal cord paralysis (LVCP) following surgery for patent ductus arteriosus (PDA). (Review)
Review
CONTEXT
Extremely premature (EP) infants are at increased risk of left vocal cord paralysis (LVCP) following surgery for patent ductus arteriosus (PDA).
OBJECTIVE
A Systematical Review was conducted to investigate the incidence and outcomes of LVCP after PDA ligation in EP born infants.
DATA SOURCES
Searches were performed in Cochrane, Medline, Embase, Cinahl and PsycInfo.
STUDY SELECTION
Studies describing EP infants undergoing PDA surgery and reporting incidence of LVCP were included.
DATA EXTRACTION AND SYNTHESIS
Study details, demographics, incidence of LVCP, diagnostic method and reported outcomes were extracted. DerSimonian and Laird random effect models with inverse variance weighting were used for all analyses.
STUDY APPRAISAL
The Newcastle-Ottawa scale for observational studies was used for quality assessment.
RESULTS
21 publications including 2067 infants were studied. The overall pooled summary estimate of LVCP incidence was 9.0% (95% CI 5.0, 15.0). However, the pooled incidence increased to 32% when only infants examined with laryngoscopy were included. The overall risk ratio for negative outcomes was higher in the LVCP group (2.20, 95% CI 1.69, 2.88, p = 0.01) compared to the non-LVCP-group.
CONCLUSIONS
Reported incidence of LVCP varies widely. This may be explained by differences in study designs and lack of routine vocal cords postoperative assessment. LVCP is associated with negative outcomes in EP infants. The understanding of long-term outcomes is scarce. Routine laryngoscopy may be necessary to identify all cases of LVCP, and to provide correct handling for infants with LVCP.
Topics: Ductus Arteriosus, Patent; Humans; Infant; Infant, Extremely Premature; Ligation; Observational Studies as Topic; Postoperative Complications; Risk Assessment; Vocal Cord Paralysis
PubMed: 29336933
DOI: 10.1016/j.prrv.2017.11.001 -
BMJ Case Reports Feb 2022Receptor conversion in breast cancer occurs in up to 32% of patients, resulting in ineffective therapy in the absence of corresponding biomarkers. We report a case of a...
Receptor conversion in breast cancer occurs in up to 32% of patients, resulting in ineffective therapy in the absence of corresponding biomarkers. We report a case of a middle-aged woman who presented with a 2-month history of hoarseness. Laryngoscopy demonstrated right vocal cord paralysis. Whole body positron emission tomography-CT (PET-CT) scan showed a hypermetabolic cervical lymph node, worrisome for metastasis. Biopsy of the cervical lymph node was consistent with metastatic carcinoma of the breast (GATA3 and mammaglobin positive, oestrogen receptor (OR)-positive, progesterone receptor-negative and human epidermal growth factor receptor 2 (HER2)-positive). She underwent targeted therapy with ado-trastuzumab emtansine every 3 weeks. Repeat PET-CT scan after 6 months showed stable disease. Reassessment of receptor status in metastatic breast cancer is encouraged to rule out receptor conversion. There is significant cross-talk between OR and HER2 signalling pathways, leading to treatment resistance. Close collaboration and teamwork among various subspecialties facilitate prompt management of patients with suspected metastatic breast cancer.
Topics: Breast Neoplasms; Female; Humans; Lymph Nodes; Middle Aged; Positron Emission Tomography Computed Tomography; Positron-Emission Tomography; Vocal Cord Paralysis
PubMed: 35140078
DOI: 10.1136/bcr-2021-243700 -
Ear, Nose, & Throat Journal Mar 2021
Topics: Dysphonia; Humans; Hyaluronic Acid; Larynx; Lipectomy; Male; Medical Illustration; Middle Aged; Vocal Cord Paralysis
PubMed: 31550934
DOI: 10.1177/0145561319863366