Abnormal Laryngeal Findings Research Articles

Upper airway and tracheostomy management in patients with COVID-19: A long-term acute care hospital (LTACH)

ObjectiveDescribe the tracheostomy and ventilation management of patients admitted due to COVID-19 as facilitated by speech language pathologists (SLPs) and otolaryngologists within the long-term acute care hospital (LTACH) setting. Study designRetrospective cohort study. SettingLong-term acute care hospital. Subjects and methodsA retrospective chart review was conducted on all patients admitted to RML Specialty Hospital for respiratory failure secondary to COVID-19 from April 1, 2020 to November 30, 2021. Demographic information, laryngeal findings, and tracheostomy management was reviewed. Descriptive statistics and chi-square analysis were performed. ResultsAmongst the 213 subjects, 80.0 % arrived on mechanical ventilation. 23.0 % required otolaryngology consultation during LTACH stay due to poor Passy Muir Valve (PMV) or tracheostomy capping tolerance. 35 (71.4 %) of those consulted had abnormal laryngeal findings on exam with subglottic/tracheal stenosis and laryngeal edema being most common at 38.8 % and 20.4 %, respectively. 28.6 % of those with laryngeal findings were decannulated by discharge. Mechanical ventilator weaning and decannulation success were 86.6 % and 62.5 %, respectively. No association (p > 0.05) between number of intubations and abnormal laryngeal findings were found. No association (p > 0.05) between number of intubations or prone-positioning and decannulation success at discharge were found. ConclusionLTACHs can serve a specific role in upper airway rehabilitation and tracheostomy care in the post COVID-19 period. SLPs and otolaryngologists should be involved in the care of these patients to help facilitate decannulation and return to normal laryngeal function.

Dysphonia in Performers: Prevalence of Vocal Lesions and Voice Emergencies in a Private Otorhinolaryngology Practice

To determine the prevalence of abnormal laryngeal findings during videostroboscopy in performers presenting to clinic or when having an acute vocal emergency. Retrospective study of professional singers and actors who presented for a vocal evaluation. A chart review of singers or professional actors who presented in a private otorhinolaryngology clinic between 2014 and 2016. The prevalence of laryngeal lesions noted on stroboscopy were reviewed. The RFS (reflux finding score) was calculated and the exams that presented RFS greater than or equal to seven were considered suspicious of laryngopharyngeal reflux (LPR). A total of 140 records of actors and singers were evaluated either for routine evaluation or for an acute emergency. Sulcus vocalis was the most prevalent lesion 36% (n=33), followed by cyst 27% (n=25) and acute laryngitis, 14% (n=13). Thirty-seven (26.4%) performers were treated for emergence due to dysphonia, Emergency dysphonia, mostly due to viral infection, was treated with steroids and speech therapy, with improvement of symptoms after treatment. Of these professionals, 83.8% (31) presented with a structural lesion or infection in the vocal folds, while 16.2% presented with dysphonia, which required emergency care without a structural lesion in the vocal folds. (P<0.05) Eighty-nine percent (33) of the professionals presenting with a voice emergency with dysphonia (37) were treated with corticosteroids. Thirty-three percent (n=47) of the professionals presented with RFS scores ≥7. Nineteen professionals (40%) with signs of LPR were treated for emergency due to dysphonia. The professionals with signs of LPR had more emergency dysphonia than those who did not suspect LPR. (19.4%) (P=0.008). Vocal emergencies in professionals are common in a private laryngology practice and require specialized assessment. The most prevalent lesions in the study were vocal sulcus. LPR is common in this group as noted both by findings with videostroboscopy and the RFS.

Prevalence and Risk Factors of Benign Laryngeal Lesions among Teachers

Introduction: Subjects using their voice as the main professional instrument oftendevelop vocal disorders. Teachers present a high prevalence of vocal problems incomparison to other professional categories depending on their voice as professionaltool; voice changes could be assigned to the interaction between occupational (vocalloading), behavioral and lifestyle factors. Voice disorders due to professional overuseare usually chronic and can lead to an increase in sick absenteeism. Aim of work:To determine the prevalence of abnormal laryngeal findings among public-schoolteachers in Menoufia Governorate, Egypt using strobovideolaryngoscopy. Materialsand methods: A case-control nested into a cross-sectional study was held from March1st to May 1st, 2019. The sample is composed of four hundred and fifty-seven (457)teachers of public schools in Menoufia Governorate, Egypt. Results: The prevalence ofvocal lesions among the studied group was 22.1% with (17.79-26.41) 95% confidenceinterval. On stroboscopic evaluation, vocal nodules were the most common structurallesion affecting the larynx; it was present in 42 (9.1%) of teachers. Other structuralabnormalities included the presence of swollen arytenoids, vocal cords paresis,vocal polyps, vocal cord cyst, and epiglottic mass in a percentage of (5.9, 3.7, 1.7,1.1, 0.4) respectively. There was higher prevalence of vocal cord lesions amongolder teachers with increase duration of employment/years, number of classes /days,smokers and teachers of primary school; although it didn’t show statistically significantdifference. A significant relationship was reported between laryngoscopic findings and laryngopharyngeal reflux (15.1% vs 28.7% with 0.002 p-value) and water intake/day (t = 2.41, df = 2, p =.047). Conclusion: Results of the current work highlighted the needfor large-scale regular educational programs to minimize vocal cord lesions amongteachers.

Influence Disease Activity on Voice and Laryngeal Findings of Rheumatoid Arthritis Patients

To reveal and to compare the voice pathologies and the detectable laryngeal findings in different phases of rheumatoid arthritis (RA). Prospective clinical study. Sixty-seven consecutive patients with RA, followed up at our Physical Therapy and Rehabilitation Clinic, were included in the study. Disease activity indices of patients were calculated with Disease Activity Score-28 Index. With Voice Handicap Index (VHI), patients answered 30 questions of functional, physical, and emotional aspects. Videolaryngostroboscopy was performed by the same physician for all patients with a 70° rigid telescope (Karl Storz, Tuttlingen, Germany), and then acoustic voice analysis (PRAAT program) was performed. Reflux Finding Score was used in evaluating the laryngopharyngeal reflux. Posterior comissure hypertrophy (25.3%) and hyperemia/edema in arytenoid mucosa (22.3%) were detected as the most frequent findings. Other common findings were thick endolaryngeal mucus, vocal cord varices. Twenty-two patients had reflux findings (32.8%). Fundamental frequency, shimmer, maximum phonation time and VHI value were not significantly different between active and remission phases of the disease (P > 0.05). In remission phase, the jitter value and the noise to harmonic ratio value were significantly higher (P < 0.05) than active phase of the disease (P < 0.05). Abnormal laryngeal findings are higher in active phase (28% in remission phase, 54% in active phase). The mean VHI score of patients in remission phase was lower than that in active phase. RA should be included in the differential diagnosis of patients with voice disorders. Nonspecific pathologies are more prevalent in the picture. There are more objective findings and subjective complaints of patients in active phase of the disease than in the remission phase.

Evaluation of laryngotracheal alterations associated with intubation

Background: Laryngeal injuries following intubation have a reported incidence from 63 to 94% and permanent sequelae are reported to be about 10 to 22% in the world literature. While several studies assessing the laryngeal complications are available in Western populations, minimal data is available in the literature regarding Indian population. Aim: The aim of this study is to evaluate laryngeal lesions in patients after prolonged intubation (>24 h), to correlate these lesions with the variables involved in the process of intubation and to determine the risk factors. Materials and Methods: The study was undertaken at the ICU of a Tertiary Care Hospital. AU patients extubated at the intensive care unit of our hospital after at least 24 h of intubation were included in the study. Fibreoptic Bronchoscopy was done on day of extubation, and weekly for 03 weeks. Result: 100 patients were included in the study. Laryngeal abnormalities were seen in 88 patients on the day of extubation. At the end of third week after extubation, only 09 patients had abnormal laryngeal findings. A multivariate stepwise regression model showed that bigger tube size and longer duration of intubation was associated with higher incidence of laryngeal complications on the day of extubation. At the end of third week laryngeal findings were influenced only by the duration of intubation and size of Endotracheal tube. Conclusion: Laryngeal alterations after extubation are directly associated with duration of intubation and size of Endotracheal tube.

Prevalence of Abnormal Laryngeal Findings in Healthy Singing Teachers

To determine the prevalence of abnormal laryngeal findings during strobovideolaryngoscopy and objective voice measurement in healthy singers without significant voice complaints. Prospective evaluation of professional singing teachers. A quiet room in a hotel during a convention of the National Association of Teachers of Singing. Seventy-two volunteers (60 females and 12 males), all of whom were trained singers without significant voice complaints. Abnormalities observed on strobovideolaryngoscopy. Abnormalities identified during acoustic analysis. Abnormalities were found during strobovideolaryngoscopy in 86.1% (62 of 72 of subjects, many of whom had more than one abnormality. For the purpose of this study, the authors defined "normal" as having no structural pathology (masses, cysts, ectasias, and so on) and a reflux finding score (RFS) of less than 7. Subjects' evaluations were considered "abnormal" if they had at least one documented laryngeal pathology and/or an RFS≥7. The most common findings were signs associated with laryngopharyngeal reflux (LPR). Subjects were also identified with prominent varicosities or ectasias, incomplete glottic closure, and structural abnormalities. LPR was observed in 72% of patients using the physical findings (arytenoid erythema and/or edema) relied on typically to establish the clinical diagnosis as well as using the RFS (16.7% in women and 25% in men). Posterior laryngeal mucosal hypertrophy was also demonstrated in 64% of the participants. Acoustic analysis of female subjects showed that shimmer, relative average perturbation, and maximum fundamental frequency differed significantly from widely used norms. Laryngeal abnormalities occur commonly in asymptomatic patients. Physicians must exercise caution in establishing a causal relationship between an observed abnormality and a patient's voice complaint. Baseline examinations of voice patients when they are healthy and asymptomatic should be encouraged to establish each individual's "normal" condition.

Exercise induced dyspnea in the young. Larynx as the bottleneck of the airways

Exercise induced asthma may symptomatically be difficult to differentiate from exercise related obstruction in the upper airways, sometimes leading to diagnostic confusion and inappropriate treatment. Larynx accounts for a significant fraction of total airway resistance, but its role as a limiting factor for airflow during exercise has been hampered by lack of diagnostic tools. We aimed to study laryngeal function in exercising humans by transnasal laryngoscopy. Continuous video recording of the larynx was performed in parallel with continuous film recording of the upper part of the body and recording of breath sounds in subjects running to respiratory distress or exhaustion on a treadmill. A successful examination was obtained in 20 asymptomatic volunteers and 151 (91%) of 166 young patients with a history of inspiratory distress or stridor during exercise. At rest, six patients had abnormal laryngeal findings. During exercise, a moderate or severe adduction of laryngeal structures was observed in parallel with increasing inspiratory distress in 113 (75%) patients. In 109 of these, adduction started within supraglottic structures, followed by adduction of the vocal cords in 88. In four patients, laryngeal adduction started in the vocal cords, involving supraglottic structures secondarily in three. Larynx can safely be studied throughout a maximum intensity exercise treadmill test. A characteristic laryngeal response pattern to exercise was visualised in a large proportion of patients with suspected upper airway obstruction. Laryngoscopy during ongoing symptoms is recommended for proper assessment of these patients.

Late laryngeal findings in sulfur mustard poisoning

Introduction. Sulfur mustard is an alkylating warfare agent and its inhalation results in early and late toxic effects. This agent was used widely against both military and civilian population by Iraqi forces in the Iran–Iraq war (1983–88). The purpose of the study was to describe abnormal laryngeal findings in a group of chemical war injury patients (soldiers) 20 years after an acute exposure to sulfur mustard. Methods. In this observational case series study, 50 male patients who were suffering from chronic respiratory symptoms and because of exacerbation of these problems, were consecutively selected and clinically examined for dysphonia by a speech-language pathologist, and then underwent fiberoptic laryngobronchoscopy to describe anatomical and functional pathologic findings of the larynx. Results. In objective speech evaluation, different degrees of dysphonia including harshness and hoarseness were observed in 46% of patients. Inflammation was present in supraglottic and subglottic regions of 9 (18%) and 3 (6%) patients, respectively. Hyperfunction of the false vocal cords was observed in 24 (48%) patients. Conclusion. Chronic laryngitis was seen in a considerable number of exposed victims nearly 20 years after exposure, in spite of different treatments received.

Preoperative Laryngeal Nerve Screening for Revision Anterior Cervical Spine Procedures

Anterior cervical spine procedures carry an inherent risk of recurrent laryngeal nerve (RLN) injury. Patients with persistent RLN paresis may be asymptomatic because of compensation from the opposite side. If such patients undergo an opposite-side anterior approach for revision surgery, they are at risk for a second RLN injury, creating the potential for bilateral vocal fold paresis and possible need for tracheotomy. A program of routine screening for laryngeal paresis was implemented for these patients. This retrospective study reviews the results of this screening process. Patients referred for preoperative laryngeal nerve screening were identified. Their charts were reviewed for the results of the videolaryngoscopic examination, and for any recommendations made based on the findings. Relevant history and other physical findings were recorded. Fifty screening laryngeal examinations were performed in 47 patients, of whom 31 (66%) had previously undergone a single anterior cervical approach procedure, and 16 (34%) had undergone more than one. Thirteen of the examinations (26%) revealed abnormal laryngeal findings, including paresis or paralysis in 11 cases (22%), of which 5 were asymptomatic. The findings resulted in a recommendation of a cervical approach from the already-involved side. None of the revision procedures resulted in bilateral vocal fold paralysis. The risk of laryngeal nerve injury appears to increase as higher cervical levels are approached. Minimally symptomatic injuries of the laryngeal nerves from prior neck surgery create a potential serious risk of bilateral vocal fold paralysis with subsequent procedures. Preoperative laryngeal screening is a simple and effective method for reducing this risk.

Videostroboscopic findings in unilateral superior laryngeal nerve paralysis and paresis

Our aim was to present laryngovideostroboscopic findings in unilateral superior laryngeal nerve paresis and paralysis. Retrospective case review, academic voice clinic. Blinded retrospective review of videostroboscopic recordings from cases confirmed by laryngeal electromyography. Three cases of unilateral superior laryngeal nerve paresis and paralysis were identified. At rest, there were no common abnormal laryngeal findings. Upon phonation, common findings were ipsilateral vocal fold bowing and shortening, vocal process height asymmetry with the ipsilateral vocal process overriding the normal, and ipsilateral hyperadduction of the false vocal fold. The common features noted in these cases of laryngeal electromyography-proved uSLNp could be used to make a presumptive diagnosis of this disorder.

Laryngeal sequelae following prolonged intubation: A prospective study

Background: Laryngeal injuries following intubation have a reported incidence from 63 to 94% and permanent sequelae are reported to be about 10 to 22% in the world literature. While several studies assessing the laryngeal complications are available in Caucasoid populations, minimal data is available in the literature regarding south Indian population. Aim: The aim of this study was to evaluate laryngeal lesions in patients after prolonged intubation (>24 h), to correlate these lesions with the variables involved in the process of intubation and to determine the risk factors. Materials and Methods: This is a prospective study for 1 year of patients who were intubated for more than 24 h in our critical care unit. Patients underwent laryngeal video endoscopy on the day of extubation and after 3 weeks by an ENT surgeon who was blinded to the intubation variables. Result: About 51 patients were included in the study. Laryngeal abnormalities were seen in 41 patients on the day of extubation. At the end of third week after extubation, only 10 patients had abnormal laryngeal findings. A multivariate stepwise regression model showed that bigger tube size ( P =0.02), longer duration of intubation ( P =0.01) and emergency intubation ( P = 0.02) was associated with higher incidence of laryngeal complications on the day of extubation. At the end of third week laryngeal findings were influenced only by the duration of intubation ( P =0.001). Conclusion: Laryngeal sequelae after extubation is directly associated with duration of intubation.

Incidence of abnormal laryngeal findings in asymptomatic singing students

Objective: Abnormalities in the mucosal lining of the vocal folds may interfere with the normal vibratory patterns and result in vocal limitations, especially for singers whose demands are great. A prospective, longitudinal study was undertaken to investigate the incidence of laryngeal abnormalities in asymptomatic singing students. Methods: Sixty-five singing students at the school of music underwent videostroboscopic evaluation and completed a comprehensive questionnaire. Videos were rated by 3 experienced clinicians, and interrater reliability was calculated. Results were correlated with demographic factors, background medical history, and singing history. Results: Five students (8.3%) exhibited early signs of benign vocal fold lesions (2 with nodules and 3 with cysts). A high incidence of posterior erythema (n = 44; 73.4%), suggesting possible reflux, was found. Conclusions: A surprisingly high number of otherwise asymptomatic singing students demonstrated abnormal laryngeal findings. Their relationship with vocal performance will be addressed as well as implications for preventative measures. (Otolaryngol Head Neck Surg 1999;121:69-77.)

Incidence of abnormal laryngeal findings in singing students

Incidence of abnormal laryngeal findings in singing students

36: Incidence of Abnormal Laryngeal Findings in Singing Students

36: Incidence of Abnormal Laryngeal Findings in Singing Students

Association of Esophageal Reflux and Globus Symptom: Comparison of Laryngoscopy and 24‐Hour pH Manometry

Thirty-one patients with globus sensation were examined by dual probe pH manometry and videolaryngoscopy to investigate the role of gastroesophageal reflux disease in association with globus. Abnormal laryngeal findings, which included grossly abnormal and subtle changes, were seen in 17 patients. These findings included pharyngeal erythema (12 patients), interarytenoid pachydermia (11), laryngeal edema (11), arytenoid erythema (9), and thick mucus (3). Twenty-one of the 31 pH probe studies showed gastroesophageal reflux disease (14 grossly abnormal, 6 borderline abnormal) with Johnson and DeMeester composite scores for the distal probe. There was no correlation between the upright and supine position, nor was there correlation between positive laryngeal findings and a positive pH probe study. We conclude that globus sensation is often a nonspecific symptom of laryngopharyngeal irritation in which gastroesophageal reflux disease plays a significant role. Combining careful laryngoscopic examination with pH probe studies can help to differentiate between patients with organic pathology caused by gastroesophageal reflux disease and patients with other nonspecific laryngopharyngeal disorders.

Association of esophageal reflux and globus symptom: Comparison of laryngoscopy and 24-hour pH manometry

Thirty-one patients with globus sensation were examined by dual probe pH manometry and videolaryngoscopy to investigate the role of gastroesophageal reflux disease in association with globus. Abnormal laryngeal findings, which included grossly abnormal and subtle changes, were seen in 17 patients. These findings included pharyngeal erythema (12 patients), interarytenoid pachydermia (11), laryngeal edema (11), arytenoid erythema (9), and thick mucus (3). Twenty-one of the 31 pH probe studies showed gastroesophageal reflux disease (14 grossly abnormal, 6 borderline abnormal) with Johnson and DeMeester composite scores for the distal probe. There was no correlation between the upright and supine position, nor was there correlation between positive laryngeal findings and a positive pH probe study. We conclude that globus sensation is often a nonspecific symptom of laryngopharyngeal irritation in which gastroesophageal reflux disease plays a significant role. Combining careful laryngoscopic examination with pH probe studies can help to differentiate between patients with organic pathology caused by gastroesophageal reflux disease and patients with other nonspecific laryngopharyngeal disorders. (Otolaryngol Head Neck Surg 1996;115:502-7.)

Round table discussion on food allergy in children: Ratner, B., Hill, L. W., and Donnally, H. H.: J. Pediat. 16: 653, 1940

Thirty-one patients with globus sensation were examined by dual probe pH manometry and videolaryngoscopy to investigate the role of gastroesophageal reflux disease in association with globus. Abnormal laryngeal findings, which included grossly abnormal and subtle changes, were seen in 17 patients. These findings included pharyngeal erythema (12 patients), interarytenoid pachydermia (11), laryngeal edema (11), arytenoid erythema (9), and thick mucus (3). Twenty-one of the 31 pH probe studies showed gastroesophageal reflux disease (14 grossly abnormal, 6 borderline abnormal) with Johnson and DeMeester composite scores for the distal probe. There was no correlation between the upright and supine position, nor was there correlation between positive laryngeal findings and a positive pH probe study. We conclude that globus sensation is often a nonspecific symptom of laryngopharyngeal irritation in which gastroesophageal reflux disease plays a significant role. Combining careful laryngoscopic examination with pH probe studies can help to differentiate between patients with organic pathology caused by gastroesophageal reflux disease and patients with other nonspecific laryngopharyngeal disorders. (Otolaryngol Head Neck Surg 1996;115:502-7.)