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Adverse effects of immunotherapeutic treatments like atezolizumab remain largely unknown due to limited experience. We present a 65-year-old man with sudden dyspnea and other symptoms, implicating immunotherapy. Prompt intervention and suspension were crucial. This study identifies a novel unreported adverse effect-bilateral vocal cord and velopalatine paralysis-associated with atezolizumab use.
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This case aims to report an unusual clinical situation with uncommon and severe side effects, which can even be life threatening for the patient. The ENT and Hematology specialist should be aware of diagnosing and treating adequately.
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OBJECTIVES: To investigate the long-term effectiveness of voice therapy in vocal outcomes of patients with unilateral vocal fold paralysis (UVFP) and vocal productions of patients with long-standing treatment-naïve UVFP treated with voice therapy. STUDY DESIGN: Prospective observational study. METHODS: A voice therapy protocol was applied individually in three stages. Fifteen sessions were scheduled twice a week in 70 patients with UVFP. Forty-seven patients were treated within a year of the diagnosis (group 1). The remaining patients had delayed therapy (at least 1 year after diagnosis) (group 2). Multidisciplinary assessment included nasofibroscopy, videostroboscopy, acoustic and aerodynamic parameters, and perception of voice impairment measures. A subgroup of the 70 patients (n = 32) was reassessed after 1 year of follow-up. RESULTS: Our voice therapy protocol significantly improved voice productions and perception of voice impairment in group 1 (P < 0.0001). Patients in group 2 experienced less hoarseness and had improved perception of voice impairment (P = 0.007). The improvement was long lasting and persisted at 1 year of follow-up in both groups. CONCLUSIONS: Voice therapy is effective in patients with UVFP and its benefits are sustained over time. Early referral for voice therapy seems to be associated with greater benefit, but quality of life also improves for patients despite delayed treatment.
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Disfonía/terapia , Fonación , Acústica del Lenguaje , Parálisis de los Pliegues Vocales/terapia , Pliegues Vocales/fisiopatología , Calidad de la Voz , Entrenamiento de la Voz , Acústica , Adulto , Anciano , Disfonía/diagnóstico , Disfonía/etiología , Disfonía/fisiopatología , Femenino , Humanos , Laringoscopía , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Recuperación de la Función , Autoimagen , Espectrografía del Sonido , Percepción del Habla , Medición de la Producción del Habla , Estroboscopía , Factores de Tiempo , Resultado del Tratamiento , Grabación en Video , Parálisis de los Pliegues Vocales/complicaciones , Parálisis de los Pliegues Vocales/diagnóstico , Parálisis de los Pliegues Vocales/fisiopatologíaRESUMEN
OBJECTIVE: To evaluate the value of different variables of the clinical history, auditory and vestibular tests and handicap measurements to define intractable or disabling Ménière's disease. METHODS: This is a prospective study with 212 patients of which 155 were treated with intratympanic gentamicin and considered to be suffering a medically intractable Ménière's disease. Age and sex adjustments were performed with the 11 variables selected. Discriminant analysis was performed either using the aforementioned variables or following the stepwise method. RESULTS: Different variables needed to be sex and/or age adjusted and both data were included in the discriminant function. Two different mathematical formulas were obtained and four models were analyzed. With the model selected, diagnostic accuracy is 77.7%, sensitivity is 94.9% and specificity is 52.8%. CONCLUSION: After discriminant analysis we found that the most informative variables were the number of vertigo spells, the speech discrimination score, the time constant of the VOR and a measure of handicap, the "dizziness index".
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Análisis Discriminante , Enfermedad de Meniere/diagnóstico , Enfermedad de Meniere/fisiopatología , Administración Tópica , Adulto , Antibacterianos/uso terapéutico , Diagnóstico Diferencial , Evaluación de la Discapacidad , Electrooculografía , Femenino , Gentamicinas/uso terapéutico , Humanos , Masculino , Enfermedad de Meniere/tratamiento farmacológico , Estudios Prospectivos , Rotación , Sensibilidad y Especificidad , Índice de Severidad de la Enfermedad , Encuestas y Cuestionarios , Pruebas de Función VestibularRESUMEN
OBJECTIVE: Laryngopharyngeal reflux (RFL) is diagnosed by the presence of laryngeal signs and symptoms. Some studies have noted that signs and symptoms may be non- specific and may have poor correlation. The goal of this study was to assess correlation of the reflux finding score (RFS) and reflux symptom index (RSI) as a fibroendoscopic assessment protocol. PATIENTS AND METHOD: A sample of 34 consecutive volunteers with no prior history of voice disorders were enrolled. All completed a self-administered laryngeal symptom questionnaire (amended RSI) and underwent a comprehensive transnasal fiberoptic laryngoscopy to document RFL findings in a reflux finding score (RFS). RESULTS: We found a statistically significant correlation between RSI and RFS. This correlation is greater when the RFS score reaches 7 or more points. CONCLUSIONS: In view of the cost and system overload implied by the use of pH-metry, empiric pharmacological therapy is warranted on the basis of a diagnosis of RFL based on RFS and RSI.
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Tecnología de Fibra Óptica/instrumentación , Reflujo Gastroesofágico/diagnóstico , Laringoscopía/métodos , Encuestas y Cuestionarios , Adulto , Anciano , Anciano de 80 o más Años , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Persona de Mediana Edad , Índice de Severidad de la EnfermedadRESUMEN
Objetivos: Algunos autores señalan que los síntomas y los signos del reflujo faringolaríngeo (RFL) son inespecíficos y no se correlacionan entre ellos. El objetivo de este estudio es determinar la correlación entre el Reflux Finding Score (RFS) como protocolo de valoración fibroendoscópica y el Reflux Symptom Index (RSI). Pacientes y método: Se estudió una muestra de 34 pacientes sin historia previa de alteraciones laríngeas, a quienes se entregó el cuestionario RSI (modificado) y se practicó una fibroendoscopia flexible para evaluar el RFS. Resultados: Hay correlación estadísticamente significativa entre el RFS y el RSI, especialmente si el resultado del RFS es $ 7 puntos. Conclusiones: Debido a los costes y la saturación asistencial que supone el uso de pH-metría, pensamos que el diagnóstico basado en la aplicación del RFS y el RSI justifica el tratamiento farmacológico empírico
Objective: Laryngopharyngeal reflux (RFL) is diagnosed by the presence of laryngeal signs and symptoms. Some studies have noted that signs and symptoms may be non- specific and may have poor correlation. The goal of this study was to assess correlation of the reflux finding score (RFS) and reflux symptom index (RSI) as a fibroendoscopic assessment protocol. Patients and method: A sample of 34 consecutive volunteers with no prior history of voice disorders were enrolled. All completed a self-administered laryngeal symptom questionnaire (amended RSI) and underwent a comprehensive transnasal fiberoptic laryngoscopy to document RFL findings in a reflux finding score (RFS). Results: We found a statistically significant correlation between RSI and RFS. This correlation is grater when the RFS score reaches 7 or more points. Conclusions: In view of the cost and system overload implied by the use of pH-metry, empiric pharmacological therapy is warranted on the basis of a diagnosis of RFL based on RFS and RSI
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Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Humanos , Encuestas y Cuestionarios , Tecnología de Fibra Óptica/instrumentación , Laringoscopía/métodos , Reflujo Gastroesofágico/diagnóstico , Diagnóstico DiferencialRESUMEN
Many people have never heard of Manuel García; others know him as an artist and singing teacher of exceptional qualities; yet others had heard of him as an extraordinary researcher and the first scientist to investigate the voice. Manuel Patricio García is chiefly known as the man who invented the laryngeal mirror, the first person to carry out a dynamic assessment of phonation, and therefore the founder of laryngology. The main facts in his extensive biography are reviewed, covering his career as a singer, a teacher and a scientist; The invention of the laryngoscope and the "failed attempts"; his famous family, including his father, Manuel García, and his sisters María Malibrán and Paulina Viardot; and his extensive oeuvre.