RESUMEN
Postpoliomyelitis syndrome (PPS) is a disease that may occur in survivors of acute poliomyelitis several decades after their initial infection. It can present as dysphonia, with vocal weakness and fatigue. Swallowing, respiratory, and other laryngopharyngeal symptoms may be manifestations of the disease or they may represent worsening of previously stable and compensated deficits. Three cases of laryngeal changes in PPS with videostroboscopic and laryngeal electromyography findings highlight the features of this disorder. We review possible etiologies of laryngeal PPS, diagnostic criteria, and treatment, as well as the current literature.
Asunto(s)
Laringe/fisiopatología , Síndrome Pospoliomielitis/complicaciones , Trastornos de la Voz/etiología , Trastornos de la Voz/fisiopatología , Enfermedad Aguda , Anciano , Electromiografía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Índice de Severidad de la Enfermedad , Trastornos de la Voz/diagnósticoRESUMEN
Vocal fold scar disrupts the mucosal wave and interferes with glottic closure. Treatment involves a multidisciplinary approach that includes voice therapy, medical management, and sometimes surgery. We reviewed the records of the first eight patients who underwent autologous fat implantation for vocal fold scar. Information on the etiology of scar, physical findings, and prior interventions were collected. Videotapes of videostroboscopic findings and perceptual voice ratings [Grade, Roughness, Breathiness, Asthenia, Strain (GRBAS)] were randomized and analyzed independently by four blinded observers. Etiology of scar included mass excision (7), vocal fold stripping (3), congenital sulcus (2), and hemorrhage (1). Prior surgical procedures performed included thyroplasty (1), autologous fat injection (9), excision of scar (2), and lysis of adhesions (2). Strobovideolaryngoscopy: Statistically significant improvement was found in glottic closure, mucosal wave, and stiffness (P = 0.05). Perceptual ratings (GRBAS): Statistically significant improvement was found in all five parameters, including overall Grade, Roughness, Breathiness, Asthenia, and Strain (P = 0.05). Patients appear to have improved vocal fold function and quality of voice after autologous fat implantation in the vocal fold. Autologous fat implantation is an important adjunctive procedure in the management of vocal fold scar, and a useful addition to the armamentarium of the experienced phonomicrosurgeon.
Asunto(s)
Tejido Adiposo/trasplante , Cicatriz/complicaciones , Cicatriz/fisiopatología , Pliegues Vocales/fisiopatología , Trastornos de la Voz , Adulto , Femenino , Estudios de Seguimiento , Humanos , Inyecciones Intramusculares , Masculino , Estudios Retrospectivos , Trasplante Autólogo , Trastornos de la Voz/etiología , Trastornos de la Voz/fisiopatología , Trastornos de la Voz/terapiaRESUMEN
Otolaryngologists, nurses, and psychological professionals should be familiar with the potential psychiatric side effects of medications that are commonly prescribed by otolaryngologists. Because some of these side effects are atypical, their relationship to medications might not be obvious. An awareness of the potential for psychiatric side effects caused by adrenocorticoids, antihistamines and decongestants, and antisecretory medications will help the clinician avoid or detect and treat drug-induced disorders, as will an awareness of the potential for side effects caused by combinations of medications. Identification of individual risk factors such as age, pre-existing organic brain disease, a history of drug abuse or dependence, or coexisting or pre-existing psychiatric disorders is important in preventing and detecting drug-induced psychiatric disorders. The drugs discussed in this article can have serious, even fatal, interactions with certain psychiatric medications.
Asunto(s)
Prescripciones de Medicamentos , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos , Otolaringología , Psicosis Inducidas por Sustancias/etiología , Antiinflamatorios/efectos adversos , Antiulcerosos/efectos adversos , Quimioterapia/métodos , Utilización de Medicamentos , Antagonistas de los Receptores Histamínicos H1/efectos adversos , Humanos , Anamnesis , Descongestionantes Nasales/efectos adversos , Otolaringología/métodos , Pautas de la Práctica en Medicina , Psicosis Inducidas por Sustancias/prevención & control , Factores de Riesgo , EsteroidesAsunto(s)
Quistes/diagnóstico , Granuloma Piogénico/diagnóstico , Enfermedades de la Laringe/diagnóstico , Pliegues Vocales/patología , Quistes/patología , Quistes/cirugía , Diagnóstico Diferencial , Granuloma Piogénico/patología , Granuloma Piogénico/cirugía , Humanos , Enfermedades de la Laringe/patología , Enfermedades de la Laringe/cirugía , Masculino , Persona de Mediana Edad , Recurrencia , Reoperación , Resultado del TratamientoAsunto(s)
Queratosis/complicaciones , Queratosis/diagnóstico , Pliegues Vocales/patología , Trastornos de la Voz/etiología , Anciano , Biopsia , Diagnóstico Diferencial , Ronquera/etiología , Humanos , Queratosis/patología , Laringoscopía , Leucoplasia/diagnóstico , Masculino , Pliegues Vocales/fisiopatologíaAsunto(s)
Cicatriz Hipertrófica/diagnóstico , Quistes/diagnóstico , Hemorragia/diagnóstico , Enfermedades Profesionales/diagnóstico , Pliegues Vocales , Adulto , Cicatriz Hipertrófica/cirugía , Quistes/cirugía , Femenino , Estudios de Seguimiento , Hemorragia/cirugía , Ronquera/diagnóstico , Ronquera/etiología , Humanos , Laringoscopía , Enfermedades Profesionales/cirugíaAsunto(s)
Carcinoma de Células Escamosas/diagnóstico , Neoplasias Laríngeas/diagnóstico , Pliegues Vocales/patología , Trastornos de la Voz/etiología , Enfermedad Aguda , Biopsia con Aguja , Carcinoma de Células Escamosas/complicaciones , Carcinoma de Células Escamosas/radioterapia , Diagnóstico Diferencial , Humanos , Neoplasias Laríngeas/complicaciones , Neoplasias Laríngeas/patología , Neoplasias Laríngeas/radioterapia , Laringoscopía , Masculino , Persona de Mediana Edad , Factores de Riesgo , Resultado del Tratamiento , Trastornos de la Voz/patologíaAsunto(s)
Neoplasias Laríngeas/patología , Pólipos/patología , Pliegues Vocales/patología , Adulto , Humanos , Neoplasias Laríngeas/diagnóstico , Neoplasias Laríngeas/cirugía , Laringoscopía , Masculino , Pólipos/diagnóstico , Pólipos/cirugía , Pliegues Vocales/cirugía , Trastornos de la Voz/etiologíaAsunto(s)
Cicatriz/etiología , Enfermedades de la Laringe/cirugía , Terapia por Láser/efectos adversos , Pliegues Vocales/cirugía , Adolescente , Cicatriz/diagnóstico , Cicatriz/cirugía , Femenino , Estudios de Seguimiento , Humanos , Laringoscopía , Reoperación , Pliegues Vocales/patología , Calidad de la VozAsunto(s)
Quistes/patología , Hemorragia/etiología , Enfermedades de la Laringe/patología , Pliegues Vocales/patología , Adulto , Quistes/complicaciones , Quistes/cirugía , Femenino , Hemorragia/cirugía , Humanos , Enfermedades de la Laringe/cirugía , Persona de Mediana Edad , Pliegues Vocales/cirugía , Trastornos de la Voz/etiología , Trastornos de la Voz/terapia , Entrenamiento de la VozAsunto(s)
Cartílago Aritenoides , Luxaciones Articulares/diagnóstico , Cartílago Aritenoides/fisiopatología , Cartílago Aritenoides/cirugía , Humanos , Lactante , Recién Nacido , Luxaciones Articulares/complicaciones , Luxaciones Articulares/fisiopatología , Nervios Laríngeos/fisiopatología , Masculino , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Pliegues Vocales/fisiopatologíaRESUMEN
Vocal fold surgical technique has advanced substantially because of increased knowledge regarding anatomy and physiology of phonation and because of technological improvements. However, many new techniques have been based on anecdote and "common sense," largely because there is no good experimental model for vocal fold surgery since the human is the only species with a vocal ligament. Consequently, our earlier pronouncements require careful reexamination especially as new research adds to our fund of knowledge. Review of the principles and results of laryngeal microflap surgery suggests that there may be important shortcomings in the technique. A new mini-microflap technique appears better, as does limited mucosal resection. This is a preliminary report, and further investigation is needed.