Vocal Cord Edema Research Articles

Laryngopharyngeal reflux disease with vocal cord oedema treated with individualised homoeopathic medicine: A case report

Laryngopharyngeal reflux disease with vocal cord oedema treated with individualised homoeopathic medicine: A case report

Analysis of clinical characteristics of children with adenoid hypertrophy and pharyngolaryngeal reflux

Objectives: To explore the clinical characteristics of children with adenoid hypertrophy (AH) and laryngopharyngeal reflux (LPR) by detecting the expression of pepsin in adenoids as a standard for AH with LPR. Methods: A total of 190 children who were admitted for surgical treatment due to AH were included in the study. The main clinical symptoms of the patients were recorded, and the degree of adenoid hypertrophy was evaluated. Before the surgery, Reflux Symptom Index (RSI) and Reflux Finding Score (RFS) were used to evaluate the reflux symptoms. After the surgery, pepsin immunohistochemical staining was performed on the adenoid tissue, and according to the staining results, the patients were divided into study group (pepsin staining positive) and control group (pepsin staining negative). SPSS 19.0 software was used for statistical analysis. Quantitative data conforming to normal distribution between the two groups were tested by two-independent sample t test, and quantitative data with skewed distribution were tested by Mann-Whitney U test. Results: The positive rate of pepsin staining in the 190 AH patients was 78.4% (149/190). The study group had higher levels of preoperative symptoms such as erythema and/or congestion of the pharynx(2.1±0.7 vs. 1.8±0.6,t=2.23), vocal cord edema[1.0(0, 1.0) vs. 1.0(0, 1.0), Z=2.00], diffuse laryngeal edema[0(0, 1.0) vs. 0(0, 0), Z=2.48], posterior commissure hypertrophy[(1.4±0.6 vs. 1.1±0.5), t=2.63], and a higher total score on the RFS scale than the control group(6.2±2.7 vs. 5.0±2.6, t=2.47), with statistical differences (P<0.05). The sensitivity and specificity of RFS score in diagnosing AH with LPR were 24.8% and 80.5%, respectively. When RFS>5 was used as the positive threshold, the sensitivity and specificity of RFS score in diagnosing AH with LPR were 61.1% and 58.5%, respectively. There was a statistical difference in the number of positive cases of RFS score between the study group and the control group(91 vs. 17,χ2=5.04,P=0.032). Conclusions: LPR is common in AH children. Children with AH and LPR have specific performance in electronic laryngoscopy, such as erythema with edema in the pharynx, posterior commissure hypertrophy, and vocal cord edema.

Abstract 13566: Voice as a Biomarker to Detect Acute Decompensated Heart Failure: Pilot Study for the Analysis of Voice Using Deep Learning Models

Acute decompensated heart failure (ADHF) is a systemic congestion state requiring timely management. Admission for ADHF is closely related to the readmission and post-discharge mortality in patients, which makes it imperative to detect ADHF in its early stage. Body fluid overload due to ADHF can change voice characteristics by causing edema of lung, larynx, and vocal cord. Voice is a noninvasive and accessible biomarker which can be monitored even in telemedicine practices, but there are few studies in the area. We hypothesized that there would be certain differences of voice characteristics in patients with ADHF when admitted to the hospital and at discharge. This was a prospective study conducted in a tertiary hospital in Korea. Patients with ADHF needed admission were eligible for enrollment, and those with respiratory infection, sepsis, lung/vocal cord disease, acute coronary syndrome, or serum creatinine&gt;3mg/dL were excluded. A total of 112 patients were enrolled between July 1, 2020 and December 31, 2022. Voice was recorded two times: at admission for ADHF, and at discharge. Patients were asked to phonate five Korean vowels (‘a/e/i/o/u’) for 3 seconds each, and then to repeat the sentence ‘daehan minkook manse’ five times. Voice was classified by Convolutional Neural Networks (CNNs). Mel-Spectrogram was conducted to convert the audio from waveform to the spectrogram, and then, transfer learning was done to further classify the voice characteristics. Deep learning models including DenseNet, InceptionNet, and ResNet were conducted to classify voice samples and identify potential characteristics associated with ADHF. We trained the models to classify whether certain voice belongs to ADHF state or recovered state. We treated it as a binary classification task, and the best performing model achieved a classification accuracy of 79% with DenseNet. Interestingly, the classification accuracy conducted with CNNs was highest for ‘u’ achieving 72%, compared to other vowels. To the best of our knowledge, this is the first study to try to detect ADHF with voice using deep learning models, especially with CNNs. We achieved a best classification accuracy of 79%. Our results proposed the possibility of voice as a useful biomarker to detect ADHF in its early stage.

A Comparative Study of Fiberoptic Laryngoscopy (FOL) and Indirect Laryngoscopy in the Diagnosis of Patients with Vocal Cord Lesions

Background: Change of voice is one of the common complaints in ENT practice and hoarseness of voice is the commonest symptom of changed voice quality. Hoarseness is invariably the earliest manifestation of conditions directly or indirectly affecting the voice apparatus. Though most common causes of hoarseness are benign and vocal abuse is the commonest among them, but we should always investigate for more sinister pathology like malignancy. The aim of this study was to compare the diagnostic yields of fibreoptic laryngoscopy (FOL) with that of indirect laryngoscopy in the diagnosis of vocal cord lesions. Objectives: To compare fibreoptic laryngoscopy (FOL) and indirect laryngoscopy in the diagnosis of vocal cord lesions as the cause of voice change. Methods: This is a cross-sectional study which has been conducted in the Department of ENT and Head Neck Surgery, SSMC Mitford Hospital with a sample size of 87 cases for a period of six months from 10th February’ 2020 to 9th August’ 2020. The patients with vocal cord lesions were selected according to the eligibility criteria by purposive sampling. Results : On indirect laryngoscopic examinations, 29.89% were vocal cord polyp, 16.09% suspected vocal cord neoplasm, 14.94% vocal cord edema, 11.49% vocal cord nodule, 5.74% vocal cord palsy and 2.61 were ulcerative lesion of vocal cords whereas poor view were in 18.39% cases. On fibreoptic laryngoscopy (FOL), 29.89% were vocal cord polyp, 19.54% suspected vocal cord neoplasm, 17.24% vocal cord edema, 16.09% vocal cord nodule, 8.04% vocal cord palsy and 6.90% were ulcerative lesion of vocal cord. 2.30% revealed normal study. Study showed that fibreoptic laryngoscopic examination is superior to indirect laryngoscopy in diagnosing vocal cord lesions. Conclusion : Fibreoptic laryngoscopy (FOL) is significantly superior to indirect laryngoscopy in the diagnosis of vocal cord lesions. Indirect laryngoscopy sometimes may miss to diagnose a sinister disease like malignancy. Bangladesh J Otorhinolaryngol 2023; 29(1): 24-31

Laryngeal Complications of Prolonged Cricothyroidotomy by Misplaced Percutaneous Dilatational Tracheostomy

Despite several advantages, percutaneous dilatational tracheostomy (PDT) performed by physicians who are unfamiliar with head and neck anatomy can result in malpractice and cause significant complications although laryngeal complications due to prolonged cricothyroidotomy caused by malpractice PDT have not been reported. Here we report a 64-year-old female who complained of dysphonia while receiving a fenestrated tube. The tube was mispositioned tube caused by malpractice PDT; the tube was placed at the cricothyroid membrane for four months without awareness. To correct subglottic stenosis and vocal cord edema, the patient underwent tracheostomy conversion and suspension laryngomicrosurgery. Although her voice slightly improved after the operation, she was unable to decannulate the tube and developed laryngeal web and subglottic stenosis. To reduce complications, PDT must be performed with accurate knowledge of anatomy

Difficulty in tracheal extubation due to vocal cord edema

Difficulty in tracheal extubation due to vocal cord edema - IJCA- Print ISSN No: - 2394-4781 Online ISSN No:- 2394-4994 Article DOI No:- 10.18231/j.ijca.2023.023, Indian Journal of Clinical Anaesthesia-Indian J Clin Anaesth

Clinical Manifestations and Treatment Outcome of Laryngopharyngeal Reflux on Larynx and Symptom-Sign Correlation.

To evaluate various clinical signs and symptoms of Laryngopharyngeal reflux on the Larynx along with treatment outcome and to establish symptom-sign correlation. Prospective interventional study. 50 patients with symptoms and signs of LPR were enrolled in the study and were followed up for 9months. Patients were evaluated with a 70° Hopkins rigid laryngoscope and the Reflux Symptom Index and Reflux Finding Score scales were used to grade the sign and symptoms and to diagnose LPR and to compare pre and post-treatment conditions. Patients were given treatments including PPI and diet modification. The most common laryngeal symptom based on the RSI score was sore throat (40%). Other common symptoms were hoarseness of voice (30%) and cough (20%). The most common laryngeal sign based on RFS (Reflux finding score) was Posterior Commissure Hypertrophy (40%). The other common signs were Pseudosulcus (30%), Vocal cord oedema (20%), and Granulomas (10%). Out of the 50 patients, 21 patients (42%) had an RFS score of less than 7. Rest 29 patients (58%) had RFS scores of more than 7. Out of these 29 patients, 19 patients (65.52%) had partial relief from symptoms after 3weeks of treatment and were advised to take treatment for 3 more weeks, and rest 10 (34.48%) patients were completely unresponsive to treatment. The improvement in symptoms does not always manifest in improvement in signs and there is no correlation between the symptoms and signs of LPR.

Vocal Cord Edema Leading to Complete Airway Obstruction in a Case of Traumatic Difficult Airway

A 31-year-old male had presented to the emergency department after road traffic accident. Primary investigation revealed presence of right clavicle fracture, bilateral LeFort 2 and 3 fractures along with displaced mandible. He was intubated in view of poor GCS and threatened airway.

Hypopharynx, oropharynx morphology and histology in severe Coronavirus 2 patients treated by noninvasive ventilation: comparison between full-face mask and helmet strategies.

Non-invasive ventilation may alter the morphology and histology of the upper airway mucosa. This study aimed to investigate the alterations of hypopharynx and oropharynx mucosa, identified during oro-tracheal intubation procedure via video-assisted laryngoscopy, in severe acute respiratory syndrome Coronavirus 2 related, treated by non-invasive ventilation via full-face mask or helmet. Data of patients affected by Coronavirus 2 admitted to COVID Hospital of L'Aquila (Italy), presenting hypopharynx and oropharynx morphology alterations, requiring oro-tracheal intubation for invasive ventilation and initially treated with non-invasive ventilation were included in the study. The study aimed to investigate the upper airway mucosa alterations using oropharyngeal and hypopharyngeal images and biopsies taken during video-assisted-laryngoscopy. Data from the hypopharynx and oropharynx morphology and histology alterations between non-invasive ventilation via a full-face mask or helmet used during hospitalization were compared. From 220 data recorded, 60 patients were included in the study and classified into non-invasive ventilation full-face mask group (30/60) and via helmet group. Comparing data between groups, significant differences were found with respect to hyperemia (77% vs. 20%), laryngeal bleeding ulcerations (87% vs. 13%), and vocal cord edema with >50% narrowing of the tracheal lumen (73% vs. 7%), respectively. The histology examination revealed fibrin-necrotic exudate with extensive necrotic degenerative changes in the sample tissue of the groups. There were not any differences in the duration time of non-invasive ventilation, time from hospitalization and the start of ventilation between groups. The data from this research suggested that there were differences in airway mucosa damages among patients treated with a full-face mask or helmet. Further studies should be planned to understand which non-invasive ventilation support may mitigate upper airway mucosa damages when oro-tracheal intubation is requested for invasive respiratory support.

Bilateral vocal cords paralysis requiring urgent tracheostomy on COVID-19 patient: a case report

BackgroundSARS-CoV-2 infection has many manifestations, including otolaryngological symptoms.Case presentationA 60-year-old man with severe dyspnea underwent endotracheal intubation followed by 68 h of mechanical ventilation. After extubation, he left the ICU without any significant complications. Four days after the extubation, he developed dyspnea, which deteriorated the next 2 days, and stridor became evident. A fiberoptic laryngoscope revealed bilateral vocal cord edema and paralysis, which required an emergency airway. We decided to perform an awake tracheostomy under local anesthesia while considering protection for airborne infection to healthcare providers. The tracheostomy was closed when the edema and paralysis of the vocal cords were ameliorated.ConclusionsA COVID-19 patient who underwent injurious ventilation developed vocal cord paralysis and edema 6 days after extubation, leading to an emergency tracheostomy. Close attention to the upper airway of COVID-19 patients is essential since the pathophysiology of the present incident may be specific to the viral infection.

527. A RIGHT CERVICOTOMIC APPROACH TO RETRIEVE A DENTAL PROSTHESIS FROM THE ESOPHAGUS

Abstract Foreign body (FB) ingestion in the upper gastrointestinal (GI) tract is a relatively common emergency presenting numerous diagnostic and therapeutic challenges. Adults most frequently ingest FBs accidentally while eating solid food. The esophagus accounts for 57% to 75% of all FBs impactions in GI tract. More than 80% FB pass spontaneously, around 10-20% require an endoscopic removal, and less than 1% have to be treated surgically, depending on the nature and location of the FB. A 68 years old man presented to the Emergency Department complaining of a mild dysphagia since two days before. A laryngeal endoscopy showed edema of the right aryepiglottic fold; salivary stagnation hiding the pyriform sinus; edema of the right vocal cord; the airway caliber was adequate. A chest radiograph showed a dental prosthesis, probably ingested during a seizure, in the upper esophageal tract. The patient developed dyspnea and phonation difficulty due to neck swelling. An urgent CT scan showed signs of esophageal perforation and diffuse edema. A multidisciplinary equipe was assembled to properly treat the patient. In the operating room, two attempts of retrieval with a flexible and a rigid endoscope failed because the dental prosthesis was stuck in the right pyriform sinus. After a careful evaluation of the FB location, the surgeon performed a right cervicotomy, uncommon when compared with the traditional left side approach to the neck, and retrieved it through an esophagotomy. A nasogastric tube was inserted and a paraesophageal 19 Ch drain in aspiration was placed in situ. Over time, no signs of esophageal leakages were detected post-operatively and eventually the patient was able to feed with solid foods without complications. Any esophageal FB may cause potentially fatal injuries, therefore it must be retrieved within 12 to 24 hours. An endoscopic approach should be attempted first, with surgery being the extrema ratio. The surgical approach depends on the nature and location of the FB. A left cervical approach should not be regarded as dogmatic, and a right-sided approach, being equally safe and effective from a surgical point of view, could be appropriately chosen when clinically indicated.

Globus Sensation And Retching In A 21-year-old Male Football Player.

HISTORY: 21 year old male football player presents with a tightness in his throat and dry heaving during football activity. He had similar symptoms 4 years ago that resurfaced 5 months ago without inciting event. Symptoms occur with strenuous activity on the field and cause a sensation of throat tightness that makes him want to vomit. He immediately loses focus on the game when symptoms occur, negatively affecting his performance. Denies stridor, dysphagia, dysphonia, unsteady gait, history of psychological disorder or treatment. PHYSICAL EXAM: GEN: NAD, well-appearing. HEENT: Oropharynx clear, normal tongue protrusion and palate elevation. Neck: No lymphadenopathy, no thyromegaly. CV: RRR, no murmur. Lungs: CTAB.GI: Normal bowel sounds, nontender. NEURO: No focal deficits, CN II-XII grossly intact. PSYCH: Appropriate mood and affect. Appropriate insight and judgment. DIFFERENTIAL DIAGNOSIS: 1. GERD 2. Vocal cord dysfunction 3. Esophageal spasm 4. Exercise-induced bronchospasm 5. Anxiety disorder TEST AND RESULTS: Barium swallow study: Small transient sliding hiatal hernia. Laryngoscopy with stroboscopy: Mild edema of bilateral vocal cords. Normal vocal fold mobility and morphology bilaterally. Exercise bike test with fiberoptic laryngoscopy: No paradoxical motion of vocal cords at rest or with bike testing. No evidence of vocal cord dysfunction. Esophageal manometry: Normal manometry but ineffective esophageal motility with viscous/solid consistencies indicating minor disorder of esophageal motility not classifiable. FINAL/WORKING DIAGNOSIS: Mild esophageal spasm complicated by unspecified anxiety disorder. TREATMENT AND OUTCOMES: He was started on empiric PPI therapy, which was discontinued after one week given no response. He was referred to a sports psychologist and engaged in cognitive behavioral therapy including psychoeducation, cognitive restructuring, exposure therapy, and mindfulness training to assist with reduction of his physiological symptoms. He practiced swallowing exposures during physical exertion over 3 weeks. Following exposure therapy, he reported being able to distract himself and reduce his concern about the sensation. He had significant improvement in his symptoms and finished the season at a highly competitive level without any recurrence of episodes.

Comparing the efficacy and safety of atomization of traditional Chinese medicine Kai Hou Jian and budesonide suspension in adult acute laryngitis: a randomized control trial.

BackgroundKai Hou Jian has an outstanding therapeutic effect and clinical use against pharyngeal infection for many years, while a few studies reported it also had an effect in laryngitis. This study aimed to evaluate the efficacy and safety of short-course oral inhalation of traditional Chinese medicine Kai Hou Jian in adults with acute laryngitis.MethodsA total of 86 patients with acute laryngitis who met the inclusion criteria were randomly assigned according to the random number table method into a Kai Hou Jian treatment group or a budesonide control group. Patients received 2.5 mL of Kai Hou Jian via transoral atomization twice daily for 1 week, while the control group received budesonide nebulization (1 mg, bid) for 1 week. The change of symptoms scores of acute laryngitis and laryngoscopy scores before and after treatment were performed to value the effect of Kai Hou Jian and the safety was assessed by the patient's discomfort and the incidence and self-reported adverse events during treatment.ResultsThe symptoms of acute laryngitis were significantly reduced in patients treated with Kai Hou Jian on day-3. Forty-two patients from the Kai Hou Jian and 40 patients from budesonide treated groups both experienced notable clinical improvement after 1 week. There was no difference in the two groups at the baseline. For individual symptoms, Kai Hou Jian could significantly improve sore throat [95% confidence interval (CI): –1.81 to –0.14, P=0.03], while budesonide yielded better improvement in hoarseness (95% CI: 0.67 to 0.20, P=0.001). For laryngoscopic parameters, the scores of laryngeal mucosa were significantly decreased in both groups from baseline, and there were no statistical differences in vocal cord hyperemia, edema, sputum congestion, edema, mucus adhesion, or epiglottic congestion between the groups after 1 week. We also found that the treatment of Kai Hou Jian nebulization could reduce the extent or range of vocal cord leukoplakia after 1 week.ConclusionsThe short-course treatment of Kai Hou Jian atomization had significant effect in improving adult acute laryngitis and it was also possibly exhibiting a positive effect on vocal cord leukoplakia.Trial RegistrationChinese Clinical Trial Registry identifier: ChiCTR1900026660.

Analysis of symptoms and clinical signs of laryngopharyngeal reflux depending on pepsia in saliva

In the last fifty years, an epidemic of reflux disease has occurred as a result of poor eating habits, stress, and activities of the food industry. Part of this disease is laryngopharyngeal reflux, a disease characterized by the return of gastric contents to the throat and surrounding organs, leading to hoarseness, coughing, difficulty in swallowing and breathing, and ultimately the development of benign and malignant changes in the larynx. This study is aimed to examine the symptoms and signs of laryngopharyngeal reflux in the study group before and after therapy and to compare the concentration of pepsin in saliva with the above. The prospective longitudinal cohort study included 50 subjects, divided into two groups. The first group consisted of 25 subjects with laryngopharyngeal reflux. The second group consisted of 25 healthy subjects without symptoms and signs of laryngopharyngeal reflux. Symptoms and signs before and after therapy were collected using RSI and RFS questionnaires. Pepsin in saliva was measured with Peptest before and after therapy. The most pronounced symptoms are hoarseness, postnasal drip, and a feeling of "a lump in the throat". The median RSI score after three months of therapy was reduced from 20 to 8. From the first group, 7 subjects had measurable levels of pepsin in saliva, and none after therapy. In the control group, no subjects were found to have pepsin in their saliva. Significant improvement was observed in clinical findings (subglottic edema, posterior commissure hypertrophy, vocal cord edema, dense endolaryngeal secretion) after three months of therapy in subjects with LPR. No association of pepsin with LPR symptoms was observed but there is a significant positive association between pepsin and the clinical finding of erythema/hyperemia. In most cases, we start therapy with medication. It is, therefore, important to emphasize that laryngopharyngeal reflux treatment must always begin with a change in diet, lifestyle, and stress regulation. Treatment must be individual and should include a multidisciplinary team with a nutritionist, psychologist, and psychiatrist.

Clinical Efficacy Analysis of Budesonide Suspension in Patients with Pharyngitis and Vocal Cord Edema

Clinical Efficacy Analysis of Budesonide Suspension in Patients with Pharyngitis and Vocal Cord Edema

Clinical assessment of laryngo-pharyngeal reflux disease by reflux symptom index and reflux finding score in a tertiary care hospital, Madhya Pradesh

Background: Laryngopharyngeal reflux (LPR) or LPR disease (LPRD) is a commonly diagnosed clinical entity caused by the back-flow of gastric contents into the laryngo-pharynx. Diagnosis was made by a set of non-specific clinical symptoms, endoscopic laryngeal examination signs, reflux symptom index (RSI), and reflux finding score (RFS). Aims and Objectives: The aims and objectives of the present study were to establish the diagnosis and treatment of LPR by assessment of the RSI and RFS and also evaluate the impact of proton pump inhibitor (PPI) therapy on LPR. Materials and Methods: A total of 60 clinically suspected patients attending the ENT outpatient department presenting LPRD signs and symptoms were enrolled in the present study. LPR symptoms were assessed using the RSI, and LPR signs were assessed by laryngoscopic examination of the larynx using the RFS. Patient having an RSI score of ≥13 and an RFS of &gt;7 was included in the present study and it was also considered for starting LPR treatment. We have again calculated the both the score (RSI and RFS) after 3 months of successful PPI therapy and compared them with the initial scores. Results: Out of total 60 patients, 50 (83.4%) had RSI score &gt;13 and RFS &gt;7 indicating severe LPRD. Most common symptoms were troublesome/annoying cough (95%), sensation of something sticking in throat (95%), heartburn(95%), frequent throat clearing (91%), and excess throat mucous (87.9%), whereas the most common sign noted on laryngoscopic examination were arytenoids erythema (86.66%), partial ventricular obliteration (83.33%), vocal cord edema (56.7%), posterior commissure hypertrophy (51.7%), and diffuse laryngeal edema (50%). Majority of the patients significantly responded on 3 months PPI therapy. Reduction of clinical signs, symptoms of LPR and also observed significant reduction of RSI and RFS score after successful PPI therapy. Conclusions: In the present study, most of the patients suffering from severe LPRD who presented in our hospital RSI and RFS scored that were clinically significant in current study. After 3 months of proton-pump inhibitor therapy, there was a significant reduction in clinical signs and symptoms of LPR as well as RSI/RFS scores, indicating that PPI therapy was the mainstay of LPRD treatment in the current era.

Enlarging the spectrum of cluster headache: Extracranial autonomic involvement revealed by voice analysis.

BackgroundPeople with cluster headache (CH) are frequently burdened by misdiagnosis or diagnostic delay. The peculiar somatic and behavioral changes characterizing patients with CH are not useful to improve diagnostic accuracy. In our clinical experience, we noticed a typical voice quality with low and croaking tone in patients with CH.In this cross‐sectional study, we evaluated, by digital voice analysis, whether it is possible to identify typical voice quality characterizing patients with CH compared with healthy controls (HCs). Furthermore, to investigate whether putative differences in voice characteristics could be underpinned by constitutional aspects or pathological processes of vocal cords, subjects underwent a videolaryngostroboscopy. Smoking habits and alcohol consumption were specifically investigated.MethodsAfter conducting digital recording of the voices from both patients with CH and HCs in a soundproof insulated cabin in the laboratory of the Audiology Department, a set of voice parameters was analyzed. We included the measures of fundamental frequency, calculations of jitter and shimmer, and noise‐to‐harmonics ratios as well as quantities related to the spectral tilt (i.e., H1–H2, H1–A1, H1–A2, and H1–A3) in 20 patients with CH and in 13 HCs. A videolaryngostroboscopy was performed in all subjects.ResultsPatients with CH, explored during the cluster bout period, showed significantly lower second harmonic (H1–H2) values compared with HCs (−6.9 ± 7.6 vs. 2.1 ± 6.7, p = 0.002), usually characterizing the so‐called creaky voice. By using a laryngoscopy investigation, a significantly higher prevalence of mild to moderate vocal cord edema and laryngopharyngeal reflux signs were found in patients with CH (100% of patients with CH vs. 15% of HC, p < 0.001).ConclusionCreaky phonation is a “physiological mode of laryngeal operation” usually underpinned by shortened and thickened vocal folds. Creaky voice phonation can be due to a vocal fold's reduced capability to become slack or flaccid secondary to vocal cord edema underpinned by laryngopharyngeal reflux affecting the phonatory mechanisms in patients with CH. The laryngopharyngeal reflux may represent a dysautonomic sign related to the increased parasympathetic tone during in‐bout period, reinforcing the hypothesis of an extracranial autonomic dysfunction as part of CH clinical picture.

Pediatric-onset refractory relapsing polychondritis with respiratory tract involvement

A 17-year-old, previously healthy girl presented with a 6-month history of hoarseness of voice, which progressed to stridor and difficulty breathing. Laryngoscopy at a local hospital showed vocal cord palsy and edema. Neck X-ray revealed narrowing of the subglottic region. Intubation with a 5 mm endotracheal tube was performed due to impending respiratory failure, and the patient was then transferred to a tertiary medical center. Upon admission, saddle nose (Fig. 1A) and erythematous change with tenderness over the left auricular region (Fig. 1B) were found.

Laryngopharyngeal reflux disease, prevalence and clinical characteristics in ENT department of a tertiary hospital Tanzania.

BackgroundLaryngopharyngeal reflux disease (LPRD) is a condition with nonspecific symptoms and most of times patients present late with advanced disease which may predispose to malignancy. The magnitude and clinical characteristics of this condition are not well known among patients attending Otorhinolaryngology services in Tanzania.Materials and methodsThis was a hospital based descriptive cross sectional study, conducted in the wards and clinics of Otorhinolaryngology department of Muhimbili National Hospital. Patients with symptoms of Laryngopharyngeal reflux disease were included in the study. Data was collected using questionnaires and clinical examination forms, were processed and analysed by using SPSS. Results presented in frequency tables, cross tabulations and figures.ResultsThis study recruited 256 participants among them males were 131(51.2%).The mean age was (41.38 ± 13.94) years. Prevalence of Laryngopharyngeal reflux disease was 18.4% without gender predilection. The commonest symptoms were globus sensation, hoarseness of voice and excessive urge to clear the throat with 95.7%, 88.1% and 83.0% respectively while the most observed signs were thick endolaryngeal mucus, Vocal cord oedema and partial ventricular obliteration with 90.9%, 88.6% and 72.7% respectively. Lying down less than two hours after meal and spices foods consumption were the leading risk factors. Hypertension and Diabetes Mellitus type 2 were the most prevalent co morbid conditions associated with Laryngopharyngeal reflux disease.ConclusionThe prevalence of Laryngopharyngeal reflux disease is high among patients attending Otorhinolaryngology services at Muhimbili national hospital. All patients with Laryngopharyngeal reflux disease related symptoms should get thorough evaluation for early diagnosis and treatment.

YOU HAD STRIDOR FOR HOW LONG? IT'S TIME WE DO SOMETHING ABOUT IT

SESSION TITLE: Medical Student/Resident Critical Care Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Post-extubation stridor is defined as inspiratory stridor occurring within 24 hours of extubation. It is associated with significant morbidity and mortality related to re-intubation, prolonged duration of mechanical ventilation, and longer length of ICU stay (3). The same complications are increased in those undergoing unplanned extubation (1). The rapid onset of stridor following extubation is usually caused by vocal cord edema and presents within hours of extubation (2). There are few published reports describing stridor secondary to tracheal stenosis. The objective of this report is to describe the unique etiology of post-extubation stridor related to tracheal stenosis. CASE PRESENTATION: In this case report, we describe a 70-year-old male with a past medical history of asthma, liver cirrhosis, CKD, COPD, obstructive sleep apnea, peripheral vascular disease, dyslipidemia, DM, HTN and GERD presenting with increasing shortness of breath and orthopnea for the past week. 3 months prior he was intubated for a severe COPD exacerbation. He then had to undergo unplanned extubation and re-intubation due to a mucous plug causing respiratory arrest and atrial fibrillation with a rapid ventricular response. During his current emergency department visit the patient was found to have significant respiratory distress and stridor on examination. The audible stridor was notably worse on inspiration but present on both phases of the respiratory cycle indicating a fixed intrathoracic obstruction. Objective data included: tachypnea (27 breaths/min) and hypotension (69/33) which resolved after placing patient on a nasal cannula at 2L/min and giving a fluid challenge. Labs revealed a leukocytosis (12.0 x10(3)/mcL Chest x-ray was unremarkable except for some hyperinflation of the lungs. Narrowing of the subglottic trachea to 5 mm along an 8 mm segment was visualized on CT of soft tissues of the neck. A balloon dilation via fiberoptic bronchoscopy was attempted but results were deemed unsuccessful. As a result, the patient was transferred to an accepting facility where he underwent an uncomplicated tracheal resection. DISCUSSION: Traumatic extubation is associated with significant mortality and morbidity in critically ill patients. Post-extubation stridor is also associated with poor outcomes. The patient, in this report, experienced a traumatic extubation and had an unusual presentation of stridor and respiratory distress that became critical 3 months following extubation. This presentation was unique in that the patient attributed his “mild symptoms” post-extubation to COPD. CONCLUSIONS: It is critical to establish proper follow-up with patient’s PCP following extubation to monitor for complications. Reference #1: Epstein SK, Nevins ML, Chung J. Effect of unplanned extubation on outcome of mechanical ventilation. Am J Respir Crit Care Med 2000; 161:1912. Reference #2: Hartley M, Vaughan RS. Problems associated with tracheal extubation. Br J Anaesth. 1993;71:561–568. doi: 10.1093/bja/71.4.561 Reference #3: Schnell D, Planquette B, Berger A, et al. Cuff Leak Test for the Diagnosis of Post-Extubation Stridor. J Intensive Care Med 2017; :885066617700095. DISCLOSURES: No relevant relationships by Rafael Otero, source=Web Response No relevant relationships by Abaigeal Thompson, source=Web Response