Methicillin-resistant and methicillin-sensitive Staphylococcus aureus laryngitis
Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, U.S.A. The Laryngoscope
(Impact Factor: 2.14).
11/2012; 122(11). DOI: 10.1002/lary.23537
Despite the fact that a wide variety of head and neck methicillin-resistant Staphylococcus aureus (MRSA) infections have been described, only four cases of MRSA laryngitis are reported in the literature. Our clinical experience suggests that this diagnosis is more common and can be more subtle that previously reported. The objective of this study was to identify and describe the clinical presentation, diagnosis, treatment, and outcomes of MRSA and methicillin-sensitive S aureus (MSSA) laryngitis, highlighting the in-office workup of these patients.
Retrospective case series.
All patients with a culture-proven diagnosis of S aureus laryngitis treated within the Emory Voice Center, Department of Otolaryngology–Head and Neck Surgery at Emory University between 2007 and 2011. Demographic, diagnostic, and treatment data were retrospectively collected from the patients' hospital records.
Three patients with culture-proven MRSA laryngitis were identified. Three further cases of MSSA were also identified. Patients ranged in age from 34 to 74 years. All three patients with MRSA were diabetics. All six patients in the study were current or past users of cigarettes. The most common presenting symptoms were vocal roughness, vocal fatigue, and decreased vocal endurance. There were no symptoms of airway or swallowing compromise. The duration of symptoms at the time of initial assessment ranged from 3 months to 5 years, and most patients had undergone numerous previous treatments. Common signs on laryngeal examination included thickened vocal fold epithelium, whitish debris or the appearance of leukoplakia, edema, and crusting. Signs and symptoms were similar in MRSA and MSSA patients. The diagnosis was made in all patients via awake in-office culture of the larynx. All patients were treated with a prolonged course of trimethoprim-sulfamethoxazole (2–4 weeks). Although repeated courses of treatment were required, most patients had an excellent response to treatment.
This is the largest, single, case series of patients with MRSA laryngitis. Our study findings suggest that the diagnosis may be more common than previously recognized, and that the presenting signs and symptoms may be subtle and similar to MSSA. Diagnosis can be made via in-office laryngeal culture. Clinicians must have a high index of suspicion for this diagnosis. Laryngoscope, 2012
Available from: Nelson Roy
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To examine how primary care physicians (PCPs) and otolaryngologists use proton pump inhibitors (PPIs), antibiotics, antihistamines, oral and inhaled steroids, and histamine 2 antagonists in the treatment of laryngeal disorders.Study Design and SettingRetrospective analysis of data from a large, national administrative US claims database.Subjects and Methods
Patients with laryngeal disorders based on ICD-9-CM codes from January 1, 2004, to December 31, 2008, seen as an outpatient by a PCP, otolaryngologist, or both and continuously enrolled for 12 months were included. Pharmacy claims, age, gender, geographic location, comorbid conditions, provider type, and laryngeal diagnosis were collected. Random-effects logistic regression and multinomial logistic regression analyses were performed.ResultsOf approximately 55 million individuals, 135,973 had a laryngeal diagnosis, 12 months post-index date follow-up, and an outpatient encounter with a PCP, otolaryngologist, or both. Acute laryngitis was one of the most common reasons PCPs prescribed each medication class. Nonspecific dysphonia was the most common reason otolaryngologists prescribed each medication class. Patients seen by a PCP had a higher odds ratio for receiving an antibiotic and antihistamine, and patients seen by an otolaryngologist had a greater odds ratio for receiving a PPI and inhaled steroids. After adjusting for other variables in the model, the probability that a patient seen by a PCP would receive an antibiotic was .55 and a PPI .13. If seeing an otolaryngologist, it was .44 and .22, respectively.Conclusion
Differences exist regarding the prescribing patterns of PCPs and otolaryngologists in treating patients with laryngeal disorders.
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ABSTRACT: Acute laryngitis is one of the most common ENT disorders. Membranous laryngitis is the rare type of laryngitis usually observed in laryngopharyngitis caused by Corynebacterium Diphtheriae or laryngotracheobronchitis caused by bacterial superinfection. Up to now, only one report has described membranous, laryngitis mainly localized to false vocal cord. We reported a case of membranous supuraglottitis caused by Straphylococcus Aureus. A 30-year-old female with sore throat for 2days was referred to our department. Endoscopic examination revealed membrane overlying the false vocal cord and the laryngeal surface of the epiglottis. With deterioration of dysphagia and dysphoria, she was hospitalized on the next day. The patient was administered ceftriaxone intravenously and discharged on hospital day 9.
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ABSTRACT: Laryngeal abscesses are rare but potentially life-threatening infections due to potential airway obstruction. Most abscesses occur in the epiglottis or preepiglottic space as a sequela of acute supraglottitis. Abscesses in the posterior larynx are extremely rare and typically due to instrumentation or trauma. Appropriate workup and management of the airway are essential for optimizing outcomes in these patients. We present an interesting case and our management of a spontaneous posterior laryngeal abscess due to methicillin-resistant Staphlococcus aureus. Laryngoscope, 2014
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