[Show abstract][Hide abstract] ABSTRACT: Authors present a rare case of isolated hyoid bone fractures as a result of a traffic accident. Ten hours before the exam, the patient injured his neck by hitting it against a metal pole which he did not notice while riding a bicycle. Immediately afterwards he felt the pain, and came for an examination due to pain with swallowing. ENT examination discovered no signs of trauma in the oral cavity, oropharynx, hypopharynx, larynx and visible part of trachea. Computed tomography discovered an isolated fracture of hyoid bone. After 24 hour observation, patient was discharged for home care, and was shown a swallowing technique which significantly reduces swallowing pain. At control ENT examination 10 days later patient had no complaints. Control CT examination was not performed, as patient refused it.
No preview · Article · Oct 2012 · Central European Journal of Medicine
[Show abstract][Hide abstract] ABSTRACT: The aim of this study is to analyze the impact of various parameters on the course and treatment outcome in patients with laryngotracheal stenosis and recurrent stenosis. Two groups of patients were compared: Group I included 29 patients with primary stenosis, and Group II included 22 patients with recurrent stenosis. The most frequent etiological factor for the development of stenosis was prolonged endotracheal intubation (79.3:77.3%), with subglottic-tracheal (44.8:45.5%) and tracheal (48.3:36.4%) localization being the most affected. Subglottic-tracheal stenosis was more common in men. There were no significant differences between the groups in regard to the grade of lumen obstruction and the length of the resected segment. In male patients, the length of the resected stenotic segment was significantly longer. Subglottic-tracheal stenoses were longer than tracheal ones. Various surgical procedures were performed, with additional management of recurrent laryngeal nerve paralysis, if necessary. Laryngotracheal reconstruction (LTR) with costal cartilage grafting (CCG) was statistically significantly more often performed in Group II, while cricotracheal resection (CTR) was more common in Group I. The incidence of complications in Group I was 24.1%, and in Group II it was 31.8%. Satisfactory airway lumen with undisturbed breathing was achieved in 93.1% of patients in Group I, and in 95.3% in Group II. Since the success rate was similar in both groups of the patients, it could be concluded that treatment outcome depends less on the factors associated with the stenosis, and more on adequate choice of surgical procedure and surgical team know-how.
No preview · Article · Feb 2012 · Archives of Oto-Rhino-Laryngology
[Show abstract][Hide abstract] ABSTRACT: The primary form of tracheal dyskinesia in early childhood is a rare congenital malformation of unknown origin. The degree of the posterior membranous tracheal wall involvement determines the intensity of obstruction and the severity of the clinical picture. The aim of this paper is to present a case of a 14-month-old child with severe tracheal dyskinesia that required surgical treatment. Fascia lata graft fixated with fibrin glue was used in strengthening the posterior tracheal wall. Three years following the surgery, the child is without breathing difficulties. In severe cases of primary dyskinesia, surgical treatment using fascia lata graft, fixated with fibrin glue is recommended in strengthening the posterior tracheal wall.
[Show abstract][Hide abstract] ABSTRACT: The aim of this study is to show our experience in using the endo-extralaryngeal laterofixation of vocal cords in treatment of bilateral recurrent laryngeal nerve palsy, and to point out the difficulties and complications of this procedure and the ways of their managing.
During the period from 2003 to 2006, 14 patients with bilateral palsy of the recurrent laryngeal nerve were treated with method of Lichtenberger's endo-extra laryngeal laterofixation of the vocal cord The patients were 12 female and 2 male from 26 to 78 (average 57.4) years old. The earliest intervention was performed 8 day after the onset of paresis and not later than 40 days.
In 11/14 (78.6%) of the patients bilateral palsy of the recurrent laryngeal nerve occured as a result of thyroid gland surgery. At the admission 2 (14.3%) patients had tracheostomy while 12 (85.7%) had no tracheostomy. Edema was the most often complication of the endo extra laryngeal laterofixation and it appeared in 8/14 (57.1%) patients. The earliest swelling of the laryngeal tissue was recorded on the first postoperative day and the latest one started 7 days after the intervention. Edema developed in 7/11 (63.6%) after total thyreoidectomy, in 1/3 (33.3%) with traumatic injuries in the neck Because of progression of the edema which provoked narrowing of the airway at the laryngeal level tracheostoma was peformed in 2 patients. Inflammation of laryngeal tissue with sudden obstruction of the airway resulted in death in one patient. Malposition of the thread toward the midle part of the vocal cord happened very often if intervention was not performed in JET ventilation anesthesia. The vocal card function was repaired bilaterally in 2 patients and unilaterally in 1 patient (the total being 3 out of 14 patients, i.e. 21.4%) four months after the laterofixation, and the threads were removed. Lung functional test showed the increase in average value PEF% from 26.53 before to 39.43 after laterofixation, and PIF from 0.83 before to 1.19 after intervention. Resistance R% in the upper airway decreased from the average 257.95 as before to 215.83 after the intervention, while the index FEV1.0/PEF (ml/L/min) remained almost the same before 13.25 and after the intervention 13.50 and that showed that the upper airway obstruction, in spite of good clinical tolerance by the patients, still persisted in all patients after the laterofixation.
Lichtenberger's endo-extra laryngeal laterofixation of the vocal cord is a good alternative method for bilateral palsy of the recurrent laryngeal nerve which provide sufficient upper airway without tracheostomy.
No preview · Article · Feb 2008 · Medicinski pregled
[Show abstract][Hide abstract] ABSTRACT: INTRODUCTION: External laryngeal trauma, blunt or penetrating, is rare but potentially life-threatening. Most frequently it occurs in motor vehicle accidents. The most common symptoms of external laryngeal injuries are: dysphagia, odynophagia, dysphonia, odynophonia, reduction of the laryngeal prominence, hemoptysis and neck crepitation. TWO CASE REPORTS: This paper reviews two cases of blunt laryngeal injury caused by a direct blow to the neck. After admission, both patients underwent clinical examination, as well as radiography of the neck, and computer tomography of the neck and larynx. GIRBAS scale was used for voice analysis. In the first case, computer tomography showed a fracture of the right thyroid cartilage in the posterior lamina where it is attached to the upper horn. In the other case, the presence of air was confirmed by radiography of the upper aperture. Computerized tomography showed the presence of air in the neck, underneath the skin, which was probably the consequence of the larygeal valve mechanism trauma. Both patients were treated conservatively. DISCUSSION AND CONCLUSION: The symptomatology of external larygeal trauma may include: hoarseness, swallowing difficulties and/or painful swallowing, painful phonation, neck pain, bloody sputum and breathing difficulties. The clinical symptoms of blunt laryngeal trauma may be hidden and non-specific, but also clear, indicating a larynx trauma, and vice versa. Quick diagnosis using computerized tomography, hospitalization and adequate therapy, can reduce the consequences of these injuries and increase the chances for a complete recovery of larygeal musculature and function.
[Show abstract][Hide abstract] ABSTRACT: The paper describes a patient who ingested a piece of bone during his meal. A Jbreign body was suspected and admission to the hospital was recommended as well as esophagoscopy, which he refused. Approximately 48 hours after the meal, the patient was admitted to the hospital for increased temperature, neck pain, and swollen right side of neck. Assuming that the condition was a result of hypopharyngeal perforation cased by a foreign body, computed tomography was performed A collection oJ'pus was found in the lateral and anterior neck compartments with subcutaneous tissue edema, and a foreign body was found in the projection of the hypopharynx. A wide incision was made under general anesthesia and drainage was performed using surgical drains and nasogastric tube. Antibacterial therapy was also applied. The patient was dismissed from the hospital in good general condition. Complications involving a foreign body in the hypopharynx and/or esophagus require urgent attention and adequate diagnosis and therapy. A correct indication, good choice of surgical procedure and intensive antibacterial therapy increase the chance of cure in such patients.
[Show abstract][Hide abstract] ABSTRACT: INTRODUCTION: Spontaneous recurrent epistaxis is the most common clinical manifestation of hereditary hemorrhagic teleangiectasia (HHT). It occurs in more than 90% of HHT patients and is the most distressing symptom. Nasal teleangiectasias tend to increase with age both in size and number, so epistaxis is heavier and more frequent. For patients with mild to moderate disease, there are many adequate treatment options. For those with severe disease, most treatments offer just a hemorrhage-free interval. Experienced otorhinolaryngologists who treat epistaxis in these patients often use the adage "to do as little as possible for as long as possible". MANAGEMENT OF ACUTE EPISTAXIS: The recommendations for the management of acute epistaxis include: compression, use of topical antifibrinolytics, laser therapy, argon plasma coagulation therapy, fibrin sealant spray or gelatin sponge soaked in adrenaline. In cases of heavy acute epistaxis, an epistaxis balloon combined with artery ligation and/or embolization is the most effective treatment. Nasal packing and electrocauterisation should be avoided to prevent further trauma to the blood vessels. TREATMENT OF RECURRENT EPISTAXIS: Management of recurrent epistaxis includes topical application of laser energy (argon, Nd:YAG, KTP/532 and diode, not CO2), argon plasma coagulation in combination with 0.1% estriol ointment, caustics, antifibrinolytics, bleomycin and sclerosing substances. Systemic estrogen-progesterone at doses used for oral contraception may eliminate bleeding in women with heavy epistaxis. Systemic antifibrinolitics (used with extreme precaution) and septal dermoplasty give good results. The only method which successfully and permanently solves the problem of severe refractory epistaxis in hereditary hemorrhagic teleangiectasia is closure of the nasal cavities.
[Show abstract][Hide abstract] ABSTRACT: Dysphagia aortica is a swallowing condition caused by external compression of the esophagus due to aortic aneurysm or atherosclerotic changes affecting the aorta. The case report on this rare cause of dysphagia should contribute to better diagnosis of dysphagia aortica and swallowing difficulties in general.
A 63-year-old male patient was hospitalized duo to a four month history of intermittent swallowing difficulties. Chest radiography showed a widened mediastinum and an enlarged aortic arch. Rigid esophagus endoscopy was done in general endotracheal anesthesia. At 28 cm from the upper incisors, a difficulty in passing the endoscope appeared, revealing an external compression as a probable cause, since the whole esophagus had no intraluminal pathological changes. Contrast esophagography revealed an aortic aneurysm. The esophagus had a normal lumen width, wall tension and elasticity, and smooth contours. After cardiovascular examination and magnetic resonance imaging, a giant aneurysm of the aortic arch was diagnosed.
Patients with dysphagia aortica as well as patients with any other swallowing difficulties should be managed by multidisciplinary "dysphagia team". The team should include an otorhinolaryngologist, neurologist, radiologist, gastroenterologist, surgeon, dietitian, speech and language therapist and specially trained nurses.
Aneurysm of the thoracic aorta is a very rare cause of dysphagia. Mild to moderate symptoms can be in great disproportion with the severe condition which causes them.
[Show abstract][Hide abstract] ABSTRACT: The goal of psycho acoustic or subjective voice analysis, in a phoniater's everyday work, is to describe a subjective experience based on the physical parameters created in the process of phonation. The work was a clinical prospective study and the sample consisted of 80 people of both sexes, 40 people with benign and pseudo tumors of vocal cords and 40 people with malign tumors of vocal cords. All the patients were otorinolaringologically and phoniatrically examined. The subjective acoustic analysis was done with the patients pronouncing numbers from 1 to 10 in the comfortable zone. Afterwards, the quality of the voices was estimated in RBH scale. The subjective acoustic analysis found roughness in the voices of 87.50% patients in the first group and the most frequent value was Mod = 3 (intense roughness), 62.50% patients. Hoarseness was present in 90.00% cases, with largest value Mod = 2 (moderate hoarseness), 55.00% patients. In the second group, roughness existed in the voices of 70.00% patients, most often intense one (Mod = 3), 30.00% patients. Hoarseness existed in 95.00% cases, 45.00% with moderate (Mod = 2) and 35.00% with intense one. T test showed that there is a statistically significant difference between the strength of the roughness determined by the subjective acoustic analysis in the first and the second group, with p < 0.01. The difference between the strength of the hoarseness in the first and the second group is also statistically significant, with p < 0.01. All the growths on vocal cords irrespective of their nature change the characteristics of the voice, most of all its clearness. In cases of vocal cords tumors, by the subjective acoustic analysis, i.e. the perception of the psycho physiological characteristics of voice, a human ear can register pathological phenomena of the voice but cannot determine the character of the growth on the vocal cords.
Preview · Article · Jan 2003 · Srpski arhiv za celokupno lekarstvo
[Show abstract][Hide abstract] ABSTRACT: As yet there is no single reliable and accurate method for detection of neck lymph node metastases. Therapeutic approaches differ from one author to other. The aim of this paper was to establish the extent to which, with good control of primary process, we can control spreading of malignant disease by means of selective neck dissection.
This retrospective study included 595 surgically treated patients in the period 1990-1998. There were 525 patients with malignant laryngeal tumors, and 70 patients with malignant hypopharyngeal tumors. Preoperative diagnostics of enlarged lymph nodes was based on palpation of the neck, without CT, US, NMR diagnostics. With all risky N0 patients, selective neck dissection was performed for presence of occult metastases. Intraoperative frozen section analysis was not performed. Adjuvant radiatitherapy was performed in all patients in whom presence of neck lymph node metastases was histologically proved.
Selective lateral neck dissection was performed in 389 (65.4%) patients. In 78 (20%) patients, lymph node metastases were pathohistologically detected. In 5 (6.4%) transitional cellular cancer was histologically diagnosed, and the remaining 73 (93.6%) presented with squamous cell cancer. Postoperative radiation therapy was applied in 54 patients (69.2%) while 24 (30.8%) were not irradiated. 5-year survival was achieved in 18 (23.1%), and 3-year survival was achieved in 15 (19.2%) patients. Out of 45 patients who lived less than tree year, 18 (40%) presented with metastatic relapse and fatal outcome. Relapse of neck metastases appeared in 12 (11.9%) on the side and in the zones of lymph nodes which were included in neck dissection. Recurrence of neck metastases appeared in 8.3% of patients who were not irradiated postoperatively and in 32.1% of cases irradiated postoperatively.
This study includes comparison of our results with results of literature data.
Neck lymph node metastases point to advanced malignant process of the third or forth stage of the disease when results are the worst and 5-year survival decreases with or without adjuvant radiotherapy.
[Show abstract][Hide abstract] ABSTRACT: Phoniatric rehabilitation is mainly aimed at restoring satisfactory phonation. Voice quality depends on the capacity of intact vocal cords to compensate the deficiency involved, as well as on automatism of phonation.
The study included 50 patients. All subjects underwent history taking, reported symptoms that urged them to visit a phoniatrician; they were submitted to a clinical otorhinolaryngologic and phoniatric examinations, voice assessment by subjective acoustic analysis, spectral analysis by digital sonography and laryngostroboscopy. All patients underwent Seeman's method of laryngeal compression.
The examined group of 50 subjects included 17 males (34%) and 33 females (66%). Vocal cord palsy was most often due to neck surgery (strumectomy) in 19 patients (38%), followed by an idiopathic palsy involved in 12 patients (24%). Disocclusion of 1-2 mm and 3-3 mm was registered in 54% and 24% patients, respectively. After treatment total occlusion was established in 20% of patients, while disocclusion of up to 1 mm, 1-2 mm or 2-3 mm persisted in 36%, 20% and 2% of patients, respectively. T-test revealed a statistically significant difference in glottic incompetence prior to and after treatment (p < 0.01). After treatment, using Seeman's method of digital compression of the larynx, 48% of patients regained satisfactory speech and voice clarity and 50% of them still presented mild dysphonia. Moderate dysphonia was registered in 2%, but none of the patients had severe dysphonia.
Central laryngeal palsies made 4% of our examined group, while according to the literature they make 1.2-8.7% of all laryngeal palsies. In majority of cases, paralysis of the recurrent laryngeal nerve was due to neck surgery (38%), but literature reports indicate that iatrogenic palsies are mostly due to operation of the thyroid. The well known fact that the left recurrent nerve is more frequently paralysed, has been confirmed in our study as well.
Accurate and efficient treatment of unilateral laryngeal palsies requires team work. Phoniatric rehabilitation of the disorder using Seeman's method has proved efficient in diminishing the glottic incompetence and dysphonia. Patients who fail to respond to phoniatric rehabilitation should be treated using other therapeutic modalities.
[Show abstract][Hide abstract] ABSTRACT: INTRODUCTION: A phoniatrist analyzes the professional's voice at the beginning of his vocal studies or career but also later, in cases of voice disorder. Phoniatric examination of professional singers must be done according to "all inclusive" protocols of examination. Such protocols must establish the status of basic elements of phonatory system: activator, generator and resonator of voice and articulatory space. ANAMNESIS: All patients requiring phoniatric examination no matter if they are candidates for professional singers, need to provide anamnestic data about their previous problems regarding voice or singing. CLINICAL EXAMINATION: This examination is necessary and it must include: examination of nose, cavum oris, pharynx, ears and larynx. SUBJECTIVE ACOUSTIC ANALYSIS: This analysis is based on evaluation of physiological and pathophysiological manifestations of voice. MUSICAL VOICE RANGE: Determination of musical voice range during phoniatric examination does not intend to make any classification of voice, nor to suggest to vocal teacher what he should count upon from future singers. Musical range can be determined only by a phoniatrist skilled in music or with musical training, but first of all vocal teacher. OBJECTIVE ACOUSTIC ANALYSIS: These methods are used for examination of phonatory function, or laryngeal pathology. They are not invasive and give objective and quantitative information. They include: laryngostroboscopy, spectral analysis of voice (sonography) and fundamental parameters of voice signal (computer program). SPEECH EXAMINATION: Articulation is very important for solo singers, because good articulation contributes to qualitative emission of sound and expression of emotions. HEARING TESTS: Tonal-threshold audiometry is performed as a hearing test. ADDITIONAL TESTS: They include rhinomanometry, vital capacity measurements, maximal phonation time and phonation quotient. CONCLUSION: Phoniatric examination is a necessary proceeding which must be performed before admission to the academy of solo singing, and then during singers' education and career. The phoniatric protocol must include a minimal number of parameters, which can be increased if required. All parameters of phoniatric examination must be adequately evaluated by experts.
No preview · Article · Jan 2002 · Medicinski pregled
[Show abstract][Hide abstract] ABSTRACT: Introduction A phoniatrist analyzes the professional's voice at the beginning of his vocal studies or career but also later, in cases of voice disorder. Phoniatric examination of professional singers must be done according to "all inclusive" protocols of examination. Such protocols must establish the status of basic elements of phonatory system: activator generator and resonator of voice and articulatory space. Anamnesis All patients requiring phoniatric examination no matter if they are candidates for professional singers, need to provide anamnestic data about their previous problems regarding voice or singing. Clinical examination This examination is necessary and it must include: examination of nose, cavum oris, pharynx, ears and larynx. Subjective acoustic analysis This analysis is based on evaluation of physiological and pathophysiological manifestations of voice. Musical voice range Determination of musical voice range during phoniatric examination does not intend to make any classification of voice, nor to suggest to vocal teacher what he should count upon from future singers. Musical range can be determined only by a phoniatrist skilled in music or with musical training, but first of all vocal teacher. Objective acoustic analysis These methods are used for examination of phonatory function, or laryngeal pathology. They are not invasive and give objective and quantitative information. They include laryngostroboscopy, spectral analysis of voice (sonography) and fundamental parameters of voice signal (computer program). Speech examination Articulation is very important for solo singers, because good articulation contributes to qualitative emission of sound and expression of emotions. Hearing tests Tonal-threshold audiometry is performed as a hearing test. Additional tests They include rhinomanometry, vital capacity measurements maximal phonation time and phonation quotient. Conclusion Phoniatric examination is a necessary proceeding which must be performed before admission to the academy of solo singing, and then during singers' education and career. The phoniatric protocol must include a minimal number of parameters, which can be increased if required. All parameters of phoniatric examination must be adequatly evaluated by experts.
[Show abstract][Hide abstract] ABSTRACT: The aim of this article was to evaluate, through a retrospective study, the epidemiological situation of in the province of Vojvodina during the twelve-year period of 1985-1996. The data regarding larynx carcinoma were regularly collected and classified in the Cancer Registry of Vojvodina at the Institute of Oncology in Sremska Kamenica. During the observed period 2,076 patients with malignant tumors of the larynx were registered. The average incidence was 16.1/100 000 in male patients and 1.4/100 000 in female patients; the morbidity index according to sex was 11.2:1 (male:female). The study indicated that laryngeal carcinoma was a disease of elderly people, with the peak age in the seventh (65-69) decade of life in men. The average mortality in men was 10.1/100,000 and in females O.7/100 000. The mortality trend by age showed peaks in males of 65-69, 75-79, 85-89 years of age; in females it had an increasing tendency after the sixth decade of life and was linear in the group of older patients. This study showed an unsatisfactory epidemiological situation for this disease because laryngeal carcinoma is a disease that with adequate prevention (anti-smoking campaign) and early detection can be reduced as a mortality factor and extend life expectancy.
[Show abstract][Hide abstract] ABSTRACT: Subjective voice analysis represents a diagnostic tool in phoniatry and is a part of everyday practice if a phoniatrist has a "trained ear".
This clinical prospective study included a sample of 20 male patients with malignant tumors involving one vocal cord-right or left. All patients underwent otorhinolaryngological and phoniatric examinations. Subjective acoustic analysis was done when patients pronounced numbers from 1 to 10. Afterwards, voice quality was evaluated separately by two professionals using a 4-levels scale: RBH scale (roughness-breathiness-hoarseness) and GIRBAS scale (grade-instability-roughness-breathiness-asthenia-strain).
60% of patients presented with vocal cord immobility. Subjective acoustic analysis revealed hoarseness in 100% of patients (the most frequent value was Mod = 3 intense hoarseness in 45% patients). Instability existed in 100% of patient (40% moderate, 40% intense). Strained voice existed in 100%, most frequently intense (45%).
All patients with glottic carcinoma presented with hoarseness, strain and instability of phonation. Non vibration of vocal cord significantly affects the degree of dysphonia, roughness, strain and instability. Aerodycnamic changes affect voice hoarseness. RBH scale is simple, but GIRBAS scale described more psyhoacoustic phenomena most important in patients with glottic carcinoma.
[Show abstract][Hide abstract] ABSTRACT: Candidiasis is usually a superficial infection of the moist areas of the body and is generally caused by Candida albicans. Visceral infections occur in diabetes, lymphomas and leukemias, malnutrition, avitaminosis and they are associated with antibiotic, corticosteroid and immunosuppressive therapy. Candida albicans was isolated from middle ear inflammation. The diagnosis is made on the basis of microscopic appearance of colonies and characteristic smell. Candidiasis is successfully treated with nystatin, imidazol derivatives (fluconazole, ketoconazole and intraconazole), amphotericin B, 5-fluorocystosine and 1% iodine solution.
This is a case report of a 46-year-old patient with a persistent nasal, sinus and ear infection of unknown origin. The patient first received antibiotic and steroid therapy and trepanation of the right maxillary sinus was performed. As the patient's condition aggravated with increase of temperature and bad laboratory findings, he was hospitalized. Radiography revealed a pathological process in both maxillary sinuses and both mastoids, so mastoidectomy and left maxillary sinus trepanation were performed. Histopathological examination of the right mastoid revealed a mould infection. The immunologic status pointed to hypogammaglobulinemia IgG. The following diseases were excluded: systemic diseases, blood diseases, Reiter's syndrome, AIDS, Hepatitis B, other viral diseases, toxoplasmosis, trichinellosis, borreliosis, typhus, paratyphus and exanthematous typhus. The diagnosis of candidiasis caused by Candida crusei and Candida kefyr was made on the basis of macroscopic and microscopic findings and biochemical identification. Ketoconazole was introduced (400 mg/per day) as well as high doses of vitamins and povidone-iodine locally. After a period of remission the patient died due to myocarditis, sepsis, acute kidney failure associated with severe mucosal necrosis of the mouth, esophagus and throat. Differential diagnosis in fever of unknown origin must include the possibility of mycotic infection, whereas the therapy of mycotic diseases must include two antimycotics at the same time.
Candida albicans is often found in the oral cavity and skin as well as in intestines of 18% of healthy subjects. It is unknown why it causes clinical illness. Antibiotic therapy of bacterial infections enables candida colonization especially in immunosuppressed patients. In our patient two types were found: Candida krusei and Candida kefyr. It is of special importance to perform differential diagnosis in cases with fever of unknown origin in order to include the possibility of mycotic infections, whereas treatment of systemic fungal infections requires a team of physicians.
[Show abstract][Hide abstract] ABSTRACT: INTRODUCTION: Phonation is a complex integral function of the organism. Regular phonation is characterized by: clarity and adequate pitch. Dysphonia is a disorder of phonation. It may have many acoustic forms, but hoarseness is the best known symptom of dysphonia. Acoustic phenomena are caused by: aperiodicity of vocal vibration, turbulent air flow in the glottis and incomplete glottis closure. PREVIOUS CLASSIFICATIONS OF DYSPHONIAS: The best known classification of dysphonias was introduced by Perello. There are two groups: organic dysphonias and functional dysphonias. On the 8th Congress of Union of European Phoniatricians, in Koszeg (Hungary, 1979), Majdevac proposed a new classification. CLASSIFICATION OF DYSPHONIAS: We are proposing a new classification, made according to the primary etiologic factor in dysphonias. In this paper, we shall consider the first four. I DYSPHONIAS CAUSED BY PRIMARY FUNCTIONAL DISORDERS: This group includes: 1. Hyperkinetic dysphonia grade I 2. Hyperkinetic dysphonia grade II 3. Hypokinetic dysphonia 4. Contact hyperplastic dysphonia 5. Dysodic dysphonia II DYSPHONIAS CAUSED BY PRIMARY NEUROGENIC DISORDERS: This group includes: 1. Central dysphonias 2. Spasmodic (spastic) dysphonia 3. Dysphonia caused by myasthenia gravis 4. Dysphonia within skull base syndromes 5. Dysphonia caused by unilateral palsy of the inferior laryngeal nerve 6. Dysphonia caused by bilateral palsy of the inferior laryngeal nerve 7. Dysphonia caused by palsy of the superior laryngeal nerve III DYSPHONIAS CAUSED BY PRIMARY PSYCHOGENIC DISORDERS: This group includes: 1. Psychogenic aphonia 2. Psychogenic dysphonia 3. False mutation IV DYSPHONIAS CAUSED BY PRIMARY SOMATIC DISORDERS: This group includes: 1. Dysphonia caused by insufficiency of vocal cords 2. Dysphonia caused by oedema of vocal cords 3. Dysphonia caused by laryngitis (secondary functional) 4. Cord-ventricular voice 5. Posttraumatic dysphonia 6. Arthrogenic dysphonia 7. Presbyphonia CONCLUSION: Dysphonia is a disorder of phonation which originates at the glottis level. When disorders of phonation are concerned it is necessary to study the organism as a whole as well as all mechanisms which take part in voice production. In that case the damaged part of the phonation system can be diagnosed, which enables efficient medical treatment of the disorder.
[Show abstract][Hide abstract] ABSTRACT: INTRODUCTION: Phonation is a complex integral function of an organism. Regular phonation is characterized by: clearness and adequate pitch. Dysphonia is a disorder of phonation. It can have many acoustic forms, but hoarseness is the best known symptom of dysphonia. Acoustic phenomena in regard to voice are caused by: irregularities in vocal cord vibration, turbulent airflow in the glottis and obstruction of glottis. PREVIOUS CLASSIFICATIONS OF DYSPHONIAS: The best known classification of dysphonias was introduced by Perello. There are two groups: 1. organic dysphonias and 2. functional dysphonias. On the 8th Congress of the Union of European Phoniatrists, in Köszeg (Hungary, 1979), Majdevac proposed a new classification. CLASSIFICATION OF DYSPHONIAS: We are proposing a new classification according to the primary etiologic factor of dysphonias. In this paper, we shall consider four gropus: from the fifth to eighth. V DYSPHONIAS CAUSED BY PRIMARY ENDOCRINE DISORDERS: This group includes: 1. Dysphonia caused by pituitary disorders 2. Dysphonia caused by thyroid gland disorders 3. Dysphonia caused by parathyroid glands disorders 4. Dysphonia caused by pancreatic function disorders 5. Dysphonia caused by suprarenal function disorders 6. Dysphonias caused by sexual glands function disorders 7. Intersexuality. VI DYSPHONIAS CAUSED BY COMPLEX PROFESSIONAL REASONS: This group includes: 1. Permanent hyperkinetic dysphonia 2. Permanent hyperkinetic dysphonia with vocal cord nodules 3. Dysphonia caused by myogenic imperfect closure of vocal cords 4. Phonastenia. VII DYSPHONIAS CAUSED BY PRIMARY DISPLASTIC DISORDERS: This group includes: 1. Dysphonia caused by laryngeal hypoplasia 2. Dysphonia caused by laryngeal asymmetry 3. Dysphonia caused by epiglottal anomalies 4. Dysphonia caused by laryngeal diaphragm. VIII DYSPHONIAS CAUSED BY LARYNGEAL TUMORS: This group includes: 1. Dysphonia caused by benign tumors 2. Dysphonia caused by malignant tumors. CONCLUSION: Dysphonia is a disorder of phonation which originates from glottal level. Disorders of phonation require observation of an organism as a whole and studying all mechanisms which take part in voice production. This provides examination of voice disorders, their establishment and adequate treatment.
[Show abstract][Hide abstract] ABSTRACT: Angioedema (angioneurotic edema) is often associated with urticaria, but edema is located deeper in the skin and mucous membranes. There are limited, painless, soft and medium hard swellings. Lack of general symptoms is evident, except if mucous membranes of the gastrointestinal system are affected and pain appears. It is particularly dangerous if located in the brain or larynx when there is a risk of suffocation. In 20% cases with laryngeal involvement intubation or tracheotomy is necessary.
This is a case report of a patient hospitalized at the Clinic, having a swelling at the front side of neck, lower lip and difficulties with deglutition. Occasionally the patient had similar difficulties in the main joints whereas periodical swellings are characteristic for his father, sister, and sister's daughter. Clinical check-up indicated a greyish swelling, of the oropharynx structure, with 1 cm respiratory space. Larynx was not visible due to swelling of epiglottis. The patient received intravenous steroid therapy, followed by infusion of physiologic solution with calcium. As his condition become very bad half an hour after admittance he was transported to the operation room. He received adrenaline but within the excepted time his respiration did not improve. Emergency tracheotomy was performed and afterwards his respiration and skin colour became normal. Regarding family anamnesis, clinical picture and laboratory results, hereditary angioedema was diagnosed.
Hereditary angioedema is a rare form of angioedema which is an inherited autosomal dominant disorder. The disease is a result of deficit in C esterase inhibitor, which is a serum glycoprotein of SERPIN family (serum protease inhibitors), that is usually synthesized in hepatocytes. All the diseased are heterozygotes. There are two genetic variantions of the disease: I--patients with decreased quantity of inhibitor level in serum due to decreased synthesis and II--patients that have normal protein concentrations, but with abnormal protein, which is functionally inactive. Laryngeal edema can very soon cause narrowing of respiratory space, and if tracheotomy is not performed on time, suffocation occurs. Tracheotomy is one of the most urgent surgical interventions with the purpose to make patient's breathing easier to prevent suffocation and sometimes to save thr patient from certain death.
In differential diagnosis of laryngeal edema, hereditary angioedema should be considered. Therapy of acute hereditary angioedema attacks should involve antihistamines, corticosteroids and adrenaline, as well as administration of fresh frozen plasma or infusion of C 1 inhibitor concentrate. Hereditary angioedema of the head and neck causing airway obstruction, is an indication for emergency tracheotomy.