RESUMEN
INTRODUCTION: Dysphonia in children is a common symptom, its prevalence varies between 6% and 23%. There is a broad differential diagnosis and the recommendation is to evaluate dysphonic children with an adequate laryngeal visualization method to achieve an accurate diagnosis and treatment. OBJECTIVE: To describe the experience in the diagnosis of dysphonia in children in the voice unit at Universidad Católica Clinical Hospital Santiago, Chile. METHODS AND MATERIALS: A retrospective chart review was conducted of all new pediatric patients treated in the voice unit at Universidad Católica Clinical Hospital between 2012 and 2019. Demographic data, diagnosis, and in-office laryngoscopies were reviewed. All patients were evaluated by the same work team consisting of two Otolaryngologists specialized in vocal pathology and a speech voice therapist. RESULTS: A total of 126 new pediatric patients between the ages of 0 to 18 years were evaluated in the voice unit at Universidad Católica Clinical Hospital Santiago, Chile. The majority were males (54%) with an average age of 9 years. 40% of the diagnosis corresponded to vocal nodules, 26% to vocal cord cysts, the remaining to a group of less frequent diagnosis. Two different groups were studied, the first group evaluated during the years 2012-2015 with flexible fibre-optic laryngoscopy and rigid videolaryngostroboscopy (VLS); the second group evaluated between the years 2015-2019 with distal chip flexible videolaryngoscopy, distal chip flexible VLS and rigid VLS. In the second group, the diagnosis of vocal nodules decreased, and the diagnosis of vocal cord cysts increased in comparison to the first group. CONCLUSION: Pediatric patients with dysphonia must be evaluated by a multidisciplinary team of experts and adequate equipment. VLS should be considered the gold standard in the diagnosis of vocal cord pathology in pediatric population.
Asunto(s)
Disfonía , Enfermedades de la Laringe , Trastornos de la Voz , Voz , Adolescente , Niño , Preescolar , Disfonía/cirugía , Disfonía/terapia , Hospitales , Humanos , Lactante , Recién Nacido , Enfermedades de la Laringe/diagnóstico , Laringoscopía , Masculino , Estudios Retrospectivos , Trastornos de la Voz/diagnóstico , Trastornos de la Voz/epidemiología , Trastornos de la Voz/terapiaRESUMEN
Introduction: Thyroid surgery rates have tripled over the past 3 decades. Currently, the main postoperative complications of this surgery are vocal fold paralysis because of recurrent laryngeal nerve dysfunction and hypocalcemia. Case report: We report the case of a 58 years old woman who presented with persistent dysphonia post total thyroidectomy. Laryngeal videostroboscopy evidenced unilateral vocal fold paralysis. We performed a percutaneous injection laryngoplasty with hyaluronic acid achieving significant improvement in voice. Conclusions: Percutaneous injection laryngoplasty with hyaluronic acid is a safe and effective procedure in the management of post thyroidectomy vocal cord paralysis.
Introducción: La tasa de cirugía tiroidea se ha triplicado en las últimas 3 décadas. Dentro de sus complicaciones se encuentra la parálisis de cuerda vocal unilateral secundaria a lesión transitoria o permanente del nervio laríngeo recurrente, lo que se presenta clínicamente como disfonía. Caso clínico: Paciente de 58 años, post tiroidectomía total evoluciona con disfonía persistente. Videoestroboscopia evidencia parálisis cuerda vocal izquierda en posición paramediana, con hiato fonatorio longitudinal amplio. Se maneja con laringoplastía por inyección con ácido hialurónico a cuerda vocal paralítica, logrando mejora significativa de voz. En videoestroboscopia de control al 7º día se evidencia cuerda vocal izquierda en línea media, con borde libre recto, sin presencia de hiato al fonar. Conclusiones: La laringoplastía por inyección percutánea con ácido hialurónico es un procedimiento seguro y eficaz para el tratamiento de la disfonía secundaria a parálisis cordal unilateral post cirugía tiroidea.
Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Ácido Hialurónico/administración & dosificación , Laringoscopía/métodos , Parálisis de los Pliegues Vocales/cirugía , Parálisis de los Pliegues Vocales/etiología , Tiroidectomía/efectos adversos , Disfonía/cirugía , Disfonía/etiología , InyeccionesRESUMEN
Dysphonia is common in children. Its main cause is the abuse or misuse of the voice. Congenital, neoplastic, infectious, neurological or iatrogenic causes are less frequent. The laryngeal web is a rare congenital anomaly resulting from an incomplete recanalization of the primitive larynx. This condition should be suspected in any newborn with dysphonic cry with or without stridor and respiratory distress. The diagnosis is confirmed by endoscopic examination. Therapy depends on the extent and thickness of the membrane and the severity of the symptoms. We describe our experience with 8 patients suffering this condition, and we emphasize the need to recognize voice disorders and to evaluate the airway for accurate diagnosis and appropriate treatment in every newborn, infant or child with persistent dysphonia.
Asunto(s)
Disfonía/etiología , Laringe/anomalías , Preescolar , Disfonía/cirugía , Femenino , Humanos , Lactante , Recién Nacido , Laringe/cirugía , MasculinoRESUMEN
La disfonía es frecuente en el niño. La causa principal es el abuso o mal uso de la voz. Con menor frecuencia puede ser de origen congénito, neoplásico, infeccioso, neurológico o iatrogénico. La membrana laríngea es una anomalía congénita rara que resulta de la recanalización incompleta de la laringe primitiva. Debe pensarse en esta patología en todo recién nacido con llanto disfónico, acompañado o no de estridor y difcultad respiratoria. El diagnóstico se confrma mediante el examen endoscópico. La conducta terapéutica dependerá de la extensión y espesor de la membrana, y de la gravedad de los síntomas. Describimos nuestra experiencia con 8 pacientes que presentaban esta patología, y enfatizamos la necesidad de reconocer los trastornos de la voz y de evaluar la vía aérea en todo recién nacido, lactante o niño con disfonía persistente, a fn de establecer el diagnóstico preciso y el tratamiento adecuado.
Dysphonia is common in children. Its main cause is the abuse or misuse of the voice. Congenital, neoplastic, infectious, neurological or iatrogenic causes are less frequent. The laryngeal web is a rare congenital anomaly resulting from an incomplete recanalization of the primitive larynx. This condition should be suspected in any newborn with dysphonic cry with or without stridor and respiratory distress. The diagnosis is confrmed by endoscopic examination. Therapy depends on the extent and thickness of the membrane and the severity of the symptoms. We describe our experience with 8 patients suffering this condition, and we emphasize the need to recognize voice disorders and to evaluate the airway for accurate diagnosis and appropriate treatment in every newborn, infant or child with persistent dysphonia.
Asunto(s)
Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Disfonía/etiología , Laringe/anomalías , Disfonía/cirugía , Laringe/cirugíaRESUMEN
La disfonía es frecuente en el niño. La causa principal es el abuso o mal uso de la voz. Con menor frecuencia puede ser de origen congénito, neoplásico, infeccioso, neurológico o iatrogénico. La membrana laríngea es una anomalía congénita rara que resulta de la recanalización incompleta de la laringe primitiva. Debe pensarse en esta patología en todo recién nacido con llanto disfónico, acompañado o no de estridor y difcultad respiratoria. El diagnóstico se confrma mediante el examen endoscópico. La conducta terapéutica dependerá de la extensión y espesor de la membrana, y de la gravedad de los síntomas. Describimos nuestra experiencia con 8 pacientes que presentaban esta patología, y enfatizamos la necesidad de reconocer los trastornos de la voz y de evaluar la vía aérea en todo recién nacido, lactante o niño con disfonía persistente, a fn de establecer el diagnóstico preciso y el tratamiento adecuado.(AU)
Dysphonia is common in children. Its main cause is the abuse or misuse of the voice. Congenital, neoplastic, infectious, neurological or iatrogenic causes are less frequent. The laryngeal web is a rare congenital anomaly resulting from an incomplete recanalization of the primitive larynx. This condition should be suspected in any newborn with dysphonic cry with or without stridor and respiratory distress. The diagnosis is confrmed by endoscopic examination. Therapy depends on the extent and thickness of the membrane and the severity of the symptoms. We describe our experience with 8 patients suffering this condition, and we emphasize the need to recognize voice disorders and to evaluate the airway for accurate diagnosis and appropriate treatment in every newborn, infant or child with persistent dysphonia.(AU)
Asunto(s)
Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Disfonía/etiología , Laringe/anomalías , Disfonía/cirugía , Laringe/cirugíaRESUMEN
Dysphonia is common in children. Its main cause is the abuse or misuse of the voice. Congenital, neoplastic, infectious, neurological or iatrogenic causes are less frequent. The laryngeal web is a rare congenital anomaly resulting from an incomplete recanalization of the primitive larynx. This condition should be suspected in any newborn with dysphonic cry with or without stridor and respiratory distress. The diagnosis is confirmed by endoscopic examination. Therapy depends on the extent and thickness of the membrane and the severity of the symptoms. We describe our experience with 8 patients suffering this condition, and we emphasize the need to recognize voice disorders and to evaluate the airway for accurate diagnosis and appropriate treatment in every newborn, infant or child with persistent dysphonia.
Asunto(s)
Disfonía/etiología , Laringe/anomalías , Preescolar , Disfonía/cirugía , Femenino , Humanos , Lactante , Recién Nacido , Laringe/cirugía , MasculinoRESUMEN
OBJECTIVES: Adductor spasmodic dysphonia (ADSD) is a focal laryngeal dystonia, which compromises greatly the quality of life of the patients involved. It is a severe vocal disorder characterized by spasms of laryngeal muscles during speech, producing phonatory breaks, forced, strained and strangled voice. Its symptoms result from involuntary and intermittent contractions of thyroarytenoid muscle during speech, which causes vocal fold to strain, pressing each vocal fold against the other and increasing glottic resistance. Botulinum toxin injection remains the gold-standard treatment. However, as injections should be repeated periodically leading to voice quality instability, a more definitive procedure would be desirable. In this pilot study we report the long-term vocal quality results of endoscopic laser thyroarytenoid myoneurectomy. STUDY DESIGN: Prospective study. METHODS: Surgery was performed in 15 patients (11 females and four males), aged between 29 and 73 years, diagnosed with ADSD. Voice Handicap Index (VHI) was obtained before and after surgery (median 31 months postoperatively). RESULTS: A significant improvement in VHI was observed after surgery, as compared with baseline values (P=0.001). The median and interquartile range for preoperative VHI was 99 and 13, respectively and 24 and 42, for postoperative VHI. Subjective improvement of voice as assessed by the patients showed median improvement of 80%. CONCLUSIONS: Because long-term follow-up showed significant improvement of voice quality, this innovative surgical technique seems a satisfactory alternative treatment of ADSD patients who seek a definite improvement of their condition.
Asunto(s)
Disfonía/cirugía , Músculos Laríngeos/cirugía , Laringoscopía , Terapia por Láser , Desnervación Muscular , Nervio Laríngeo Recurrente/cirugía , Calidad de la Voz , Adulto , Anciano , Evaluación de la Discapacidad , Disfonía/diagnóstico , Disfonía/fisiopatología , Femenino , Humanos , Músculos Laríngeos/inervación , Músculos Laríngeos/fisiopatología , Laringoscopía/instrumentación , Terapia por Láser/instrumentación , Láseres de Gas , Masculino , Persona de Mediana Edad , Desnervación Muscular/instrumentación , Fonación , Proyectos Piloto , Estudios Prospectivos , Recuperación de la Función , Nervio Laríngeo Recurrente/fisiopatología , Habla , Medición de la Producción del Habla , Factores de Tiempo , Resultado del TratamientoRESUMEN
HYPOTHESIS: The use of a material made of bacterial cellulose with the aim of obtaining vocal fold medialization has not hitherto been fully investigated. Although the material has been tested in other animal models, the evaluation did not include the larynx; hence, situations, such as tissue reaction, material absorption, and extrusion, need to be addressed to evaluate its usefulness as a material for laryngeal reconstruction. OBJECTIVE: To evaluate the medialization, tissue response, and healing of rabbit vocal folds, after the implantation of a membrane of bacterial cellulose. STUDY DESIGN: Experimental study. METHODS: A total of 32 rabbits were used, two of which were used to check out the adequacy of the implant location. The animals were followed for 4 months and grouped according to follow-up times of 2, 4, and 16 weeks. All test animals received an implant of bacterial cellulose in one vocal fold and the injection of distilled water in the other, both performed by videoendoscopic cervicotomy. At the end of the follow-up, the presence of inflammatory and medial displacement was evaluated. RESULTS: No statistically significant difference in the inflammatory parameters between the study and control vocal folds or among follow-up times was found. All animals receiving cellulose presented medial displacement of vocal folds, and all retained this material at the implant site up to study endpoint. CONCLUSION: Bacterial cellulose is a useful material for laryngeal medialization, showing no signs of rejection or absorption.
Asunto(s)
Celulosa , Laringe/cirugía , Implantación de Prótesis , Animales , Disfonía/cirugía , Masculino , Conejos , Cicatrización de HeridasRESUMEN
AIM: To describe the laryngeal configuration and the voice of male patients diagnosed with unilateral vocal fold paralysis (UVFP) before and after medialization. METHODS: A retrospective study involving the collection of data from medical records of 142 patients diagnosed with UVFP from January 2003 to April 2009, submitted to auditory-perceptual assessment of voices and visual perception of laryngeal images before and after medialization. RESULTS: The study included data from 24 male patients, with an average of 60.7 years, who underwent three surgical medialization techniques (injection of hyaluronic acid, type I thyroplasty, and injection of Teflon). Before treatment, the position of the paralyzed vocal fold was seen to have a significant influence to the passing of the healthy vocal fold beyond the midline and on the overall degree of dysphonia. After treatment, the complete glottic closure; the free margin of the linear vocal fold; paralyzed vocal fold in the median position, reduction of hoarseness, roughness and breathiness (more frequently mild), and asthenia (more frequently normal and mild); tension and instability (more frequency normal); and a decrease in the overall degree of dysphonia were found to be significant. CONCLUSION: The position of the paralyzed vocal fold influences the position of the healthy vocal fold in relation to the midline and the overall degree of dysphonia. All three treatments improved the glottic configuration and the voice of patients with UVFP.