Laryngeal Injury Research Articles

Effects of Vibratory Source on Auditory-Perceptual and Bio-Inspired Computational Measures of Pediatric Voice Quality

The vibratory source for voicing in children with dysphonia is classified into three categories including a glottal vibratory source (GVS) observed in those with vocal lesions or hyperfunction; supraglottal vibratory sources (SGVS) observed secondary to laryngeal airway injuries, malformations, or reconstruction surgeries; and a combination of both glottal and supraglottal vibratory sources called mixed vibratory source (MVS). This study evaluated the effects of vibratory source on three primary dimensions of voice quality (breathiness, roughness, and strain) in children with GVS, SGVS, and MVS using single-variable matching tasks and computational measures obtained from bio-inspired auditory models. A total of 44 dysphonic voice samples from children aged 4-11years were selected. Seven listeners rated breathiness, roughness, and strain of 1000-ms /ɑ/ samples using single-variable matching tasks. Computational estimates of pitch strength, amplitude modulation filterbank output, and sharpness were obtained through custom-designed MATLAB algorithms. Perceived roughness and strain were significantly higher in children with SGVS and MVS compared to children with GVS. Among the computational measures, only the modulation filterbank output resulted in significant differences among vibratory sources; a posthoc test revealed that children with SGVS had greater amplitude modulation than children with GVS, as expected from their rougher voice quality. The results indicate that the output of an auditory amplitude modulation filterbank model may capture characteristics of SGVS that are strongly related to the rough voice quality.

Method for Collecting Single Epithelial Cells from the Mouse Larynx.

The larynx is lined by specialized epithelial cell populations. Studying molecular changes occurring in individual epithelial cell types requires a reliable method for removing these cells from the larynx. Our objective was to develop a method to harvest individual epithelial cells from the mouse larynx while minimizing contamination from non-laryngeal sites and non-epithelial laryngeal cells. Mice were euthanized, and the larynx was carefully exposed and separated from non-laryngeal sites. A small dental brush was inserted into the laryngeal inlet and rotated to obtain epithelial cells. Cells were transferred to collection media, counted, and cytospin preparations stained for laryngeal epithelial (i.e., Pan-Keratin, EpCAM, NGFR, p63, K5, β-tubulin, MUC5AC) and non-epithelial (i.e., vimentin) cell markers. Histopathology was completed on brushed laryngeal tissue sections to evaluate the depth of cell collection. Preliminary Single-cell RNA sequencing (scRNA-seq) was performed to confirm this method can capture diverse laryngeal cell types. We collected 6000-8000 cells from a single larynx and 35000-40000 cells from combining brushings from three tissues. Histopathology demonstrated brushing removed the epithelial layer of the larynx and some underlying tissue. Immunofluorescence staining demonstrated the phenotype of harvested cells was primarily epithelial. Preliminary scRNA-seq was successfully conducted and displayed nine unique cell clusters. We developed a reliable method of harvesting individual epithelial cells from the mouse larynx. This method will be useful for collection of laryngeal cells for a variety of downstream cellular and molecular assays, including scRNA-seq, protein analyses, and cell-culture-based experiments, following laryngeal injury. NA Laryngoscope, 134:786-794, 2024.

PENETRATING NECK INJURY EVALUATION AND MANAGEMENT

Objective: To study the prevalence of penetrating neck injuries in north-west Rajasthan. Methods: This was a cross-sectional study on 50 patients with penetrating injury to the neck and of either sex fulfilling inclusion and exclusion criteria, who visit our Trauma Centre and ENT OPD at PBM hospital Bikaner during 01 Jan 2022 to 01 Jan 2023. Patients was evaluated and resuscitated as per Advanced Trauma Life Support Protocols. If the patient is stable a multi-detectorcomputed tomography (MDCT) Angiography will be done and treatment was done accordingly. All patients were observed for at least 48 hours prior to discharge. Follow up of all patients was done at 4 weeks and 3 months post discharge. Results: Mean age of study population was 31.53 ± 9.24 yr with age range of 18–70 yr. Maximum 90% caseswere male; 54% cases were urban. 48% cases were in II zone, followed by 24% in III rd zone, 16% in IVth Zone, whereasminimum 12% had injury in multiple zones. conservative treatment was done in 34% cases, 33 cases were treated by surgery out of which 57.57% were treated by surgical debridement and primary wound closure, 88% cases were cured and1(2%) case were died. Conclusion: A proper evaluation, rapid air way intervention and proper surgical repair are essential for a successful outcome. Early management of laryngeal injury within first 24 hours seems to bear the bestresults for air way and voice.

Endotracheal tube forces exerted on the larynx and a novel support device to reduce it.

Endotracheal tubes (ETTs) are commonly associated with laryngeal injury that may be short lasting and temporary or more severe and life altering. Injury is believed to result from forces that these ETTs exert on the larynx. Here we quantify the forces of ETTs of various sizes on the laryngotracheal complex to gain a more quantitative understanding of these potential damaging forces. Here we also perform preclinical testing of a novel support device to offload these forces. Endotracheal intubation was performed on a fresh human cadaver using various ETT sizes. A strain-sensitive graphene nanosheet sensor and a commercially available force sensing resistor were secured behind the larynx, anterior to the prevertebral fascia. The forces exerted on the larynx were measured for each of the commonly used ETTs. A novel support device, ETT clip (Endo Clip), was attached to the ETTs and changes in these forces were observed. Forces exerted on the laryngotracheal complex by various ETTs were observed to increase with increasing tube size. This pressure can be significantly reduced with a novel ETT clip. Here we demonstrate the first quantitative measurement of forces that ETTs exert on the larynx. We demonstrate a novel device that can easily clip onto an ETT reducing pressure on the laryngotracheal complex. This preclinical test paves the way for a human clinical trial. 5.

Acute Cricoarytenoid Joint Fixation Following Routine Intubation: A Case Report.

Prolonged intubation is a common cause of injury to the posterior larynx often resulting in cricoarytenoid joint (CAJ) fixation and posterior glottic stenosis (PGS). We present a case of respiratory failure due to acute bilateral CAJ fixation and PGS following only 2 days of intubation for routine cardiac surgery. A tracheostomy was placed due to critical airway obstruction. Clinicians should remain vigilant for laryngeal injury presenting as CAJ fixation and PGS. Prompt surgical consultation is advised as early intervention is associated with reduced morbidity.

CT Findings in Laryngeal Trauma and the Clinical Implications.

Acute traumatic osseous and cartilaginous injuries to the larynx are rare injuries presenting to the emergency department. Despite the low reported incidence, laryngeal trauma carries ahigh morbidity and mortality. The purpose of this study is to identify fracture and soft tissue injury patterns in laryngeal trauma and explore associations with patient demographics, mechanisms of injury, urgent airway and surgical intervention. Aretrospective review of patients with laryngeal injury who underwent multidetector computed tomography (MDCT) imaging was performed. The CT findings of laryngeal and hyoid fracture location, fracture displacement, and soft tissue injuries were recorded. Clinical data including patient demographics, mechanisms of injury, frequency of airway and surgical intervention were also recorded. Correlation of imaging characteristics with patient demographics, mechanism of injury and interventions were assessed for statistical significance using χ2 and Fisher's exact tests. The median patient age was 40years old with astrong male predominance. The most common mechanisms of injury included motor vehicle collisions and penetrating gunshot wounds. Thyroid cartilage fractures were the most common fracture type. Findings of fracture displacement and airway hematoma had ahigher correlation with requiring urgent airway management. Radiologists' early recognition and prompt communication of laryngeal trauma to the clinical service is important to reduce associated morbidity and mortality. Displaced fractures and laryngeal hematomas should be promptly conveyed to the clinical service as they are associated with more complex injuries and higher rates of urgent airway management and surgical intervention.

Under-reporting of forensic findings: craniocervical emergency imaging in cases of survived hanging

To determine the diagnostic bias between clinical and forensic radiology in cases of nonfatal hanging and determine and describe typical underreported imaging findings. In a retrospective, single-center study, all patients admitted for attempted suicide with near-hanging or fatal hanging between January 2008 and December 2020 who received CT or MRI of head and neck were reviewed and missed findings in the original report were documented. A binary regression with disagreement as dependent variable was fitted for the imaging modality, fatality, age, and sex. A total of 123 hanging incidents were retrospectively analyzed. The vast majority (n = 108; 87.8%) had attempted suicide with a nonfatal outcome. Fatal outcome occurred in 15 (12.0%). The extra- and intracranial injuries documented on CT and MRI scans were laryngeal (n = 8; 6.5%), soft tissue (n = 42; 34.1%), and vascular injuries (n = 1; 0.8%). Intracranial pathology was evident on 18 (14.6%) scans. Disagreement occurred in 36 (29.3%) cases and represented 52 (69.2%) of all cases with a radiological finding. Disagreement was strongly associated with fatality (OR: 2.7–44.9.4, p = 0.0012). In most cases, nonfatal hangings cause no or only minor injuries. Fatal cases are associated with a greater probability of missed minor imaging findings. This suggests that findings deemed clinically irrelevant are probably not reported in such severe emergency cases. This association indicates that minor abnormalities are underreported when major pathologies are evident on imaging in victims of strangulation.

Comparison of Total Thyroidectomy with Ligasure Small Jaw Device and Harmonic Scalpel

Objective: To compare our experience with the LigaSure small jaw device and Harmonic scalpel in total thyroidectomy regarding operative time and major complications associated with surgery.
 Study Design: Prospective comparative study.
 Place and Study Duration: General Surgery Department, Pak Emirates Military Hospital, Rawalpindi and Combined Military Hospital, Kohat Pakistan, from Oct 2017 to Apr 2020.
 Methodology: This study included 150 patients diagnosed with simple/toxic multinodular goitre, thyroid carcinoma, and diffuse thyroid enlargement. Eighty-one patients were randomly assigned to the LigaSure Group and 69 to the Harmonic Group who underwent total thyroidectomy. Mean operative time and major complications like blood loss, hematoma, hypocalcemia, recurrent laryngeal injury, and surgical site infection were compared.
 Results: Median (IQR) operative time of the LigaSure small jaw device was 55.00(11) minutes, and that of the Harmonic scalpel was 60.00 (11) (p<0.001). The postoperative hematoma formation in the LigaSure small jaw device was 1(1.2%), and that in the Harmonic scalpel Group was 0(0%) (p=0.35). There was no bilateral nerve injury in both Group. The percentage of hypocalcemia (second postoperative day to seventh postoperative day) in the LigaSure small jaw device was 2(2.5%), and that in the Harmonic scalpel Group was 2(2.9%) (p=0.9). 
 Conclusion: The mean operative time of Thyroid surgery with a LigaSure small jaw device is less than that with a Harmonic scalpel. There is no difference in intraoperative blood loss and postoperative complications between them.

Our Experience with Cut Throat Injury Cases in a Rural Tertiary Care Centre

ABSTRACT Background: Cut throat injuries are one of the most challenging surgical emergencies encountered by Ear, nose, throat (ENT) surgeons. If not treated in time, they may lead to death. Prevention of mortality depends on immediate resuscitation by securing the airway by tracheostomy or intubation, prompt control of bleeding, and wound closure. Aims and Objectives: Our study was conducted to observe and analyze: 1. The sociodemographic profile of cut throat injury patients admitted in our hospital. 2. The modes of cut throat injury cases admitted in our hospital. 3. Anatomical region and depth of the cut throat injury patients admitted in our hospital. 4. Treatment of cut throat injury patients given at our hospital. Materials and Methods: This is a prospective study of about 25 cases of cut throat injury presented to the emergency department in our tertiary care hospital situated in the rural area of Tamilnadu (India), between June 2021 and September 2022. Cut throat injury patients were managed by multidisciplinary approach headed by the ENT team. Results: In our study, 72% were males and 28% were females. The peak age of incidence is fourth decade (48%). People with lower socioeconomic status were affected more (40%). Eighty percent of the patients had Zone II injuries. Seventy-six percent of cases presented with active bleeding and 60% of cases came with breathing difficulty. The most common cause of cut throat injury had been found to be suicidal (52%). Sixty percent had laryngeal injuries. Seventy-two percent of the cases were managed with tracheostomy. Conclusion: Our study found that the majority of cut throat injury patients were males of age between 30 years to 40 years from poor socioeconomic status. Social involvement and political motivation, poverty reduction, individual awareness, increase in economic growth along with literacy rate will prevent the cut throat injuries. Early and improved proper management will reduce the mortality and morbidity.

Use of NMBA and reversal agent during thyroid surgery with intraoperative neuromonitoring

Neuromuscular blocking agent (NMBA) provides adequate muscle relaxation for intubation and surgery, but their use can interfere with the interpretation of intraoperative neuromonitoring (IONM) signals. Various strategies for the use of NMBA during thyroid surgery with IONM have been proposed for both safe anesthesia and surgery, and adequate quality of IONM. Relaxant-free anesthesia or use of succinylcholine is not recommended as a routine use due to the potential of fatal complications such as laryngeal injury or malignant. Instead, the use of a single dose of rocuronium for intubation with or without a reversal agent has been widely adapted. Though spontaneous recovery of neuromuscular blockade can be achieved without a reversal agent, use of a reversal agent can shorten the time for adequate IONM. Both neostigmine and Sugammadex can be used to reverse the neuromuscular blockade. Neostigmine reverses all types of non-depolarizing NMBA, but can accompany systemic cholinergic effect, and is not effective to deep or higher level of blockade. Sugammadex only reverses the effect of aminosteroid NMBAs, but effective to all levels of blockade. Overall, appropriate strategies for the use of NMBAs and reversal agents are needed to ensure effective IONM without increasing the risk of nerve injury during surgery.

Laryngotracheal Complications after Intubation for COVID-19: A Multicenter Study.

A prospective descriptive observational study was conducted from January 2021 to December 2021, including COVID-19 patients with laryngeal complications due to ETI diagnosed in several Spanish hospitals. We analyzed the epidemiological data, previous comorbidities, mean time to ICU admission and ETI, need for tracheostomy, mean time on invasive mechanical ventilation until tracheostomy or weaning, mean time in ICU, type of residual lesions, and their treatment. We obtained the collaboration of nine hospitals during the months of January 2021 to December 2021. A total of 49 patients were referred. Tracheostomy was performed in 44.9%, being late in most cases (more than 7-10 days). The mean number of days of ETI until extubation was 17.63 days, and the main post-intubation symptoms were dysphonia, dyspnea, and dysphagia, in 87.8%, 34.7%, and 42.9%, respectively. The most frequent injury was altered laryngeal mobility, present in 79.6%. Statistically, there is a greater amount of stenosis after late ETI and after delayed tracheostomy, not observing the data with the immobility alterations. The mean number of days of ETI was long, according to the latest guidelines, with the need for several cycles of pronation. This long ETI may have had an impact on the increase of subsequent laryngeal sequelae, such as altered laryngeal mobility or stenosis.

Evolving Endotracheal Tube Preferences and Practices: Intensivist Knowledge Gaps and Sex Disparities.

The complex management of intubation-related laryngeal injury makes prevention vital. The purpose of this study is to assess endotracheal tube (ETT) practices and preferences among intensivists at our institution. Chart review of intubated patients and intensivist survey were simultaneously performed in January 2016 and August 2022. A height-to-ETT size ratio (H:ETT) was calculated for each patient in the 2022 cohort. Intubated patients were followed until tracheostomy, extubation, or death occurred. Surveys assessed intensivist preferences for ETT size and management of intubated patients. 300 ICU patients were included. The mean ETT size for males decreased from 7.73 ± 0.30 in 2016 to 7.57 ± 0.25 in 2022 (p < 0.001). The average H:ETT of men was higher than females (p = 0.004), indicating that females in this population were intubated with larger ETTs relative to their height compared to males. Whereas the majority (66.7%) of intensivists endorse 7.0 ETTs as the standard for women, the majority (70%) of women at our institution are intubated with a 7.5 ETT or larger. Of intubated patients in the ICU, 23 (19.5%) were intubated for 11 days or longer. Compared to men, women are intubated with larger-than-preferred ETTs relative to height. Additionally, patients in our study were intubated for longer than preferred based on intensivist surveys, putting this population at higher risk for acute laryngeal injury (AlgI)-related laryngotracheal stenosis (LTS). Further studies should seek to identify similar trends and barriers to reducing ALgI-related LTS. 3 Laryngoscope, 133:3080-3086, 2023.

Effect of COVID-19 on the incidence of postintubation laryngeal lesions

Background Critically ill patients intubated in the intensive care unit experience prolonged intubation leading to increased frequency of laryngeal injuries. This study aimed to demonstrate a suspected increase in vocal fold injury in patients who were intubated with COVID-19 as compared with patients intubated for other reasons. Methods A retrospective review of medical records was performed to identify patients examined using flexible endoscopic evaluation of swallowing exams. The study included 25 patients with COVID-19 and 27 without COVID-19 at Baylor Scott & White Medical Center in Temple, Texas. Various injuries were evaluated, ranging from granulation tissue to vocal cord paralysis. Severe lesions were those causing clinically significant airway obstruction or requiring operative intervention. The incidence of laryngeal injury in patients intubated for COVID-19 was then compared with that of patients intubated for other reasons. Results The increased presence of severe injury in COVID-positive patients appeared clinically significant but was not statistically significant (P = 0.06). Interestingly, patients who received pronation therapy had 4.6 times the odds of more severe injury compared with patients who did not (P = 0.009). Conclusion Lower thresholds for performing flexible laryngoscopy on postintubated patients who are proned may allow for earlier intervention and reduce morbidity in an already at-risk population.

Pain in the neck: Bench press injury.

A 49-year-old man with a history of hepatitis C infection presented to the emergency department with neck pain and hoarseness immediately after a blunt neck injury. He was bench pressing a 100 kg barbell when the safety bar broke. The bar slowly landed on his neck and remained there for a few seconds. On examination, his vital signs were normal except for hypertension, 167/106 mm Hg. His neck was tender to palpation, without swelling or ecchymosis. He had hoarseness, but the airway was patent without stridor. He showed no signs of respiratory distress. Computed tomography (CT) scan showed thyroid cartilage fracture and right arytenoid hematoma (Figure 1). Flexible fiberoptic laryngoscopy performed in the emergency department confirmed a right arytenoid hematoma with intact airway (Figure 2). Platelet count and prothrombin time-international normalized ratio were normal. Due to concerns of an impending airway emergency from the hematoma, he stayed in the observation unit for 12 hours. A second fiberoptic laryngoscopy on the next day showed no enlargement of the hematoma. He was discharged with close follow-up and recovered without any adverse events. Blunt laryngeal trauma is a rare but potentially life-threatening condition often caused by motor vehicle collisions, sport-related injuries, physical assaults, and strangulation. Clinically, it can cause neck pain, hoarseness, dyspnea, stridor, ecchymosis, crepitus, and airway obstruction.1 The first step in management is to assess and, if necessary, secure the airway. CT scan and flexible fiberoptic laryngoscopy are the key diagnostic tests for suspected laryngeal injury.2 A high index of suspicion and judicious use of diagnostic modalities are required as some patients with significant injuries may not have obvious signs of trauma, as in this case. Patients with high-grade injuries may require surgical intervention.3 Early intervention is the key to a good functional outcome.4

Anatomical injury patterns, demographics and outcomes data for blunt and penetrating neck injuries on the Trauma Audit and Research Network database

Introduction Penetrating neck trauma is a relatively rare though potentially devastating mode of injury. To date, there has been no analysis on this subject using the Trauma Audit and Research Network (TARN) dataset for the population of England, Wales and Northern Island. Methods This was a retrospective observational study using the TARN dataset to identify all adult patients (≥16 years) presenting with neck trauma between January 2012 and March 2019. Results A total of 2,395 patients met the inclusion criteria for this study: 1,584 with blunt injuries to the neck (374 isolated injuries) and 811 with penetrating neck injuries (412 isolated injuries). The median age of the study population was 44.2 years and 73% were male. The unadjusted mortality rate was 18.2%. Seventy-nine per cent of patients with penetrating injuries required surgical exploration. The odds ratios (ORs) of injury to the trachea, pharynx/retropharynx, jugular vein and larynx were all significantly increased with penetrating injuries to the neck. There was significantly increased mortality for those patients suffering hyoid bone injury (OR: 3.07, 95% confidence interval [CI]: 2.10–4.49), carotid artery injury (OR: 1.81, 95% CI: 1.41–2.32) and laryngeal injury (OR: 1.25, 95% CI: 0.95–1.65). Conclusions Our data highlight the potentially devastating consequence of neck injury with associated injury patterns. Patients suffering penetrating neck trauma have complex care requirements needing appropriate specialty input.

Persistent Features of Laryngeal Injury Following Endotracheal Intubation: A Systematic Review.

This systematic review examined (i) prevalence, severity, and impact of persistent post-extubation laryngeal injury beyond hospital discharge and (ii) differences in persistent laryngeal injury between COVID-19 and non-COVID-19 populations. The review was completed following PRISMA-2020 guidelines. Four databases (PubMed, CINHAL complete, EMBASE, Web of Science) were searched (inception to March 2021). Screening, full text review and data extraction were completed by two reviewers. Primary outcomes were swallow, voice and cough and airway measures obtained after hospital discharge. Quality assessment was measured using Downs & Black Tool and Johanna Briggs Institute Checklist for Cohort Studies. Meta-analysis was not completed due to study heterogeneity. Six cohort studies were included. Total number of participants across the included studies was 436. ICU admission diagnoses included respiratory disease 46% (COVID-19 and non-COVID-19), sepsis 14%, non-sepsis-related organ dysfunction 9%, general medical 11%, general surgical 10%, trauma 2%, ENT 0.6% and other not specified by authors 7%. Outcomes were obtained between 2 and 60months post hospital discharge. Assessment methods included endoscopic evaluation, clinician ratings and patient-reported outcomes. Persistent features of laryngeal injury identified were airway abnormalities (18.9-27%), dysphonia (13.2-60%) and dysphagia (23-33%). Persistent laryngeal injury was associated with ICU length of stay, respiratory diagnosis and tracheostomy. Study quality ranged from poor-good. This is the first systematic review to examine post-extubation laryngeal injury beyond hospital discharge. Significant gaps in the literature were identified. Given the impact on clinical and patient outcomes, large scale, well-designed research is needed to guide post-ICU service delivery.

Two-rope method for dissecting esophagus in McKeown MIE.

Minimally invasive McKeown esophagectomy (McKeown MIE) is performed at many hospitals in esophageal cancer(EC) treatment. However, secure and quick methods for dissecting the esophagus and dissecting lymph nodes in this surgery are lacking. This study introduces a simple, secure and feasible esophagus dissecting technique named two-rope method. Two mobile traction ropes are placed around the esophagus and we tow these ropes to free the esophagus, dissect the lymph nodes, and decrease the operative trauma. Retrospective analysis was performed on 112 patients who underwent McKeown MIE in our center from January 2019 to September 2021. They were assigned into two groups based on the method of dissecting the esophagus: Group A (two-rope method, 45 cases) and Group B (regular method, 67 cases). Operation time, thoracic operation time, the number of dissected thoracic lymph nodes, and postoperative complications were compared between the two groups after propensity score matching. Using 1:1 nearest neighbor matching, we successfully matched 41 pairs of patients. Operation time, thoracic operation time, and the duration (ac to as) was significantly shorter and the size of the abdominal incision was significantly smaller in the Group A than Group B (p < 0.05). There was no statistically significant difference in the number of dissected thoracic lymph nodes, pulmonary infection, anastomotic leak, recurrent laryngeal (RLN) injury, and chylothorax between the two groups (p > 0.05). Two-rope method to free the esophagus and dissect thoracic lymph nodes in McKeown MIE has significant advantages compared with the regular method. The technique is, therefore suitable for widespread adoption by surgeons.

Диагностические критерии поражения гортани при манифестации ревматоидного артрита

Introduction. Rheumatoid arthritis is a systemic autoimmune inflammation of connective tissue involving the cartilage of the larynx. In this case, pathology of the larynx may be the only manifestation of this disease. The discomfort, foreign body sensation, and pain in the larynx noted by patients in the early stages of the disease are rarely associated by doctors with the manifestation of rheumatoid arthritis. In later stages, symptoms may be masked as comorbid pathology of the heart or upper respiratory tract. An analysis of the available literature revealed insufficient knowledge of issues related to the early diagnosis of inflammation of the larynx in autoimmune diseases, in particular, rheumatoid arthritis. Objective. To conduct a literature review to identify early symptoms of laryngeal damage in patients with the manifestation of rheumatoid arthritis. Materials and methods. Over the past 10 years, a literature review has been conducted in public databases using the following queries: laryngeal injury in autoimmune rheumatic diseases, dysphonia, voice impairment in rheumatoid arthritis, rheumatoid arthritis, and laryngeal joint injury. Data from literature sources, the authors of which made a significant contribution to the development of otorhinolaryngology and rheumatology, were included. Results. Summary data from the literature review are presented on the frequency of complaints made by patients, verification of characteristic symptoms, and their severity depending on the level of damage to the larynx. An early symptom of the manifestation of rheumatoid arthritis is dysphonia, which was observed with inflammation of the cricoarytenoid joints, arytenoid cartilage, and vocal fold nodules. A checklist of early symptoms of laryngeal injury has been compiled for routing patients with rheumatoid arthritis. Conclusion. Laryngeal involvement in rheumatoid arthritis is a fairly common symptom. Dysphonia as an early symptom is observed with polymorphism of inflammatory changes and manifests itself from single nodules to total fixation of the joints of the laryngeal cartilage. In diagnosing the manifestations of rheumatoid arthritis, an interdisciplinary approach of specialists is required.

Larynx and thyroid cartilage fracture after work accident and forensic medical evaluation

Laryngeal injuries are rare but can be fatal. Depending on the type and severity of the trauma, thyroid and laryngeal cartilage fractures, full-thickness mucosal tears, tracheolaryngeal separation, and injuries leading to pneumomediastinum may be observed. Laryngeal traumas can occur either bluntly or penetratingly. Blunt traumas typically result from traffic accidents, falls, and sports injuries, while penetrating injuries are often caused by gunshot wounds or sharp objects. In this particular case study, the case was a 24-year-old male who was brought to the emergency room after being struck by a forklift at In his physical examination, a 10x1 cm wound was observed on his right scapula, along with subcutaneous emphysema in the subclavicular region. As a result of the examinations, the patient was found to have fractures of the larynx, thyroid cartilage, 8th rib and pneumomediastinum. In this study, it was thought that the thyroid and larynx cartilage fractures occurred as a result of hyperflexion/hyperextension of the neck without a direct blow to the neck region. This case is being presented because it is a rare occurrence in the literature, primarily due to its unique mechanism of injury.

Stroboscopy while Lifting Weights: A New Assessment Technique for Observing the Larynx in Strength Athletes while Lifting Weights (with and without Valsalva maneuver)

Lifting weights is a popular exercise method for improving the physical characteristics underlying performance in a wide range of sports. In order to perform these lifts safely and efficiently, strength athletes use purposeful holding of breath, strong exhalation against closed vocal cords. These are commonly known as Valsalva Maneuvers (VM) or hard glottis closures to increase core stability and reduce some of the load on the spine, and to facilitate lifting by increasing glottis closure and subsequently increasing intra-thoracic and intra-abdominal pressure. This function may expose athletes to an increased risk of laryngeal irritation or injury due to excessive pressure on the vocal cords during VM performance. Despite extensive weight training exercises in sports, its effects on vocal cords and overall laryngeal health have not yet been systematically studied. This brief methodological report describes how to safely use sports stroboscopy in strength training with weightlifting. This technique was safe and allowed to receive high quality and stable images of the larynx with minimal impact on weightlifting.