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Functional Aphonia

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21. Diagnosis and Management of Gastroesophageal Reflux Disease

) had an increase in time off work and decrease in work productivity. Low scores on sleep scales were seen compared with patients with less frequent symptoms. A decrease in physical functioning was also seen ( 10 ). Nocturnal GERD has a greater impact on QOL compared with daytime symptoms. Both nocturnal symptoms and sleep disturbances are critical to eluci- date when evaluating the GERD patient ( 11 ). Th e balance of evidence suggests that symptom frequency does not change as we age, however (...) in this asso- ciation ( 123 ). Cohort studies suggest that GERD may be the cause in 21 – 41 % o f c hr o nic no n s p e cifi c cough ( 124 ). A large V A popula- tion case – control study found increased odds ratios for pharyngi- tis (OR 1.60), aphonia (OR 1.81), and chronic laryngitis (OR 2.01) in cases with esophagitis or esophageal stricture compared with controls ( 125 ). Th e Montreal Consensus recognized established associations between GERD and asthma, chronic cough, and laryngitis, while

2013 American College of Gastroenterology

22. Improving Voice Outcomes After Thyroid Surgery

of thyroid surgery remain: complete removal of the abnormal thyroid and any involved lymph nodes, preservation of parathyroid gland function, and maintenance or improvement of voice and swallowing. Reduction in quality of life (QOL) after thyroid surgery is multifactorial and may include need for lifelong medication, thyroid suppression, radioactive scanning/treatment, temporary and permanent hypoparathyroidism, temporary or permanent dysphonia postoperatively, and dysphagia. - Voice disturbance may (...) of the arytenoid cartilage. The vocal folds vibrate, modulating the flow of air being expelled from the lungs during phonation. They consist of epithelium and lamina propria overlying the vocalis muscle. Vocal fold mobility disorders as used in this document include paresis or hypomobility , which are synonymous with vocal fold weakness, and paralysis , which is immobility of the fold. Voice impairment can range from aphonia, which is absence of phonation, to dysphonia, which could include persistent

2013 American Academy of Otolaryngology - Head and Neck Surgery

23. Hoarseness

. Epidemiology Hoarseness is common, with a point as high as 7% for those <65 years old III. Pathophysiology Abnormal voice production (change in pitch, loudness or effort) Breathiness Harsh, rough or raspy voice Lack of smooth vocal cord approximation Laryngeal pathology Abnormal vocal cord mobility Usually caused by organic disorder (not functional) IV. Causes See V. Symptoms Abnormal voice quality (e.g. Breathy, Strained, Raspy, Weak) VI. History See VII. Evaluation: Laryngoscopy Indications (see (...) of the mucosa leading to VOICE DISORDERS such as APHONIA and HOARSENESS. Definition (CHV) an inflammation of the larynx (voice box) generally associated with hoarseness or loss of voice Definition (MSHCZE) Zánět hrtanu. Probíhá samostatně nebo častěji jako součást zánětu horních cest dýchacích. Nejčastěji má virový původ, ale může být způsobena i bakteriemi a zevními vlivy (dráždivé plyny, inverzní l. aj.). Projevuje se chrapotem až ztrátou hlasu (afonií) a kašlem. V těžkých případech, zejm. u malých dětí

2018 FP Notebook

24. Neurological History and Physical Examination (Diagnosis)

Neurological History and Physical Examination (Diagnosis) Neurological History and Physical Examination: Neurological History, Neurologic Examination, Examination of the Higher Functions Edition: No Results No Results Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache (...) , if possible.) Radiation (Pay attention to any dermatomal relationship.) Quality (stabbing, stinging, lightninglike, pounding, etc) Severity or quantity (Estimate functional limitation.) Precipitating factors (stress, periods, allergens, sleep deprivation, etc) Relieving factors (sleep, stress management, etc) Diurnal or seasonal variation Important miscellaneous factors of the history include the following: Results of previous attempts to diagnose the condition Any previous therapeutic intervention

2014 eMedicine.com

25. Communication Disorders (Overview)

the voice’s quality, pitch, or volume differs from that of other persons of similar age, culture, and geographic location. Dysphonia is classified as either an organic or a functional disorder of the larynx. [ , ] Another type of communication problem, dysarthria, encompasses a group of motor speech disorders caused by a disturbance in the neuromuscular control of speech. [ ] A second form of motor speech disorder, apraxia, occurs in the presence of significant weakness or incoordination of the muscles (...) (complexity). By varying the pitch, loudness, rate, and rhythm of voice (prosody), the speaker can convey additional meaning and emotion to words. A voice disorder exists when the quality, pitch, or volume differs from that of other persons of similar age, culture, and geographic location. Dysphonia is classified as either an organic or a functional disorder of the larynx. [ , , ] Organic dysphonia Organic disorders cause an interruption in the smooth approximation of the vocal folds. [ ] Such disorders

2014 eMedicine.com

26. Enteroviruses (Overview)

and weakness or paralysis of one or more extremities, along with weakness of one or more muscle groups Spinal polio comprises a prolonged prodrome, with features of aseptic meningitis followed in 1-2 days by weakness and, eventually, paralysis Bulbar polio involves cranial nerves, most commonly IX, X, and XII; patients accumulate pharyngeal secretions, have a nasal twang to the voice, and develop paralysis of vocal cords, causing hoarseness, aphonia, and, eventually, asphyxia Polioencephalitis (...) reduce poliovirus shedding; higher secretory IgA titers lead to better immunity. [ ] Immunoglobulin M (IgM) antibodies appear as early as 1-3 days after enteroviral challenge and disappear after 2-3 months. [ ] Immunoglobulin G (IgG) antibody, which is generally detected 7-10 days after infection, is mostly of the IgG 1 and IgG 3 subtypes. Serum neutralizing IgG antibodies persist for life after natural enteroviral infections. [ ] Macrophage function is also a critical component of the immune

2014 eMedicine.com

27. Conversion Disorders (Overview)

, 2015 Author: Scott A Marshall, MD; Chief Editor: David Bienenfeld, MD Share Email Print Feedback Close Sections Sections Conversion Disorders Overview Background Conversion disorder (Functional Neurological Symptom Disorder) is categorized under the new Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) category of Somatic Symptom and Related Disorders. [ ] It involves symptoms or deficits affecting voluntary motor or sensory function that suggest a neurologic or other (...) general medical condition. Yet, following a thorough evaluation, which includes a detailed neurologic examination and appropriate laboratory and radiographic diagnostic tests, no neurologic explanation exists for the symptoms, or the examination findings are inconsistent with the complaint. In other words, symptoms of an organic medical disorder or disturbance in normal neurologic functioning exist that are not referable to an organic medical or neurologic cause. [ ] Common examples of conversion

2014 eMedicine.com

28. Communication Disorders (Treatment)

the voice’s quality, pitch, or volume differs from that of other persons of similar age, culture, and geographic location. Dysphonia is classified as either an organic or a functional disorder of the larynx. [ , ] Another type of communication problem, dysarthria, encompasses a group of motor speech disorders caused by a disturbance in the neuromuscular control of speech. [ ] A second form of motor speech disorder, apraxia, occurs in the presence of significant weakness or incoordination of the muscles (...) (complexity). By varying the pitch, loudness, rate, and rhythm of voice (prosody), the speaker can convey additional meaning and emotion to words. A voice disorder exists when the quality, pitch, or volume differs from that of other persons of similar age, culture, and geographic location. Dysphonia is classified as either an organic or a functional disorder of the larynx. [ , , ] Organic dysphonia Organic disorders cause an interruption in the smooth approximation of the vocal folds. [ ] Such disorders

2014 eMedicine.com

29. Neurological History and Physical Examination (Treatment)

Neurological History and Physical Examination (Treatment) Neurological History and Physical Examination: Neurological History, Neurologic Examination, Examination of the Higher Functions Edition: No Results No Results Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache (...) , if possible.) Radiation (Pay attention to any dermatomal relationship.) Quality (stabbing, stinging, lightninglike, pounding, etc) Severity or quantity (Estimate functional limitation.) Precipitating factors (stress, periods, allergens, sleep deprivation, etc) Relieving factors (sleep, stress management, etc) Diurnal or seasonal variation Important miscellaneous factors of the history include the following: Results of previous attempts to diagnose the condition Any previous therapeutic intervention

2014 eMedicine.com

30. Neurological History and Physical Examination (Overview)

Neurological History and Physical Examination (Overview) Neurological History and Physical Examination: Neurological History, Neurologic Examination, Examination of the Higher Functions Edition: No Results No Results Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache (...) , if possible.) Radiation (Pay attention to any dermatomal relationship.) Quality (stabbing, stinging, lightninglike, pounding, etc) Severity or quantity (Estimate functional limitation.) Precipitating factors (stress, periods, allergens, sleep deprivation, etc) Relieving factors (sleep, stress management, etc) Diurnal or seasonal variation Important miscellaneous factors of the history include the following: Results of previous attempts to diagnose the condition Any previous therapeutic intervention

2014 eMedicine.com

31. Neurological History and Physical Examination (Follow-up)

Neurological History and Physical Examination (Follow-up) Neurological History and Physical Examination: Neurological History, Neurologic Examination, Examination of the Higher Functions Edition: No Results No Results Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache (...) , if possible.) Radiation (Pay attention to any dermatomal relationship.) Quality (stabbing, stinging, lightninglike, pounding, etc) Severity or quantity (Estimate functional limitation.) Precipitating factors (stress, periods, allergens, sleep deprivation, etc) Relieving factors (sleep, stress management, etc) Diurnal or seasonal variation Important miscellaneous factors of the history include the following: Results of previous attempts to diagnose the condition Any previous therapeutic intervention

2014 eMedicine.com

32. Glottic Stenosis

. A CT scan also allows for evaluation of the laryngeal framework in order to determine the presence of a fracture or other significant injury. Spiral CT scanning with 3-dimensional reconstruction is advisable for better surgical planning and outcome. [ ] Electromyography (EMG) can help to differentiate posterior glottic stenosis from bilateral vocal cord paralysis. It may also be used to evaluate the function of the intrinsic muscles of the larynx. Under anesthesia, direct laryngoscopy (...) stenosis in the form of laryngeal webs typically manifests with symptoms of airway distress or obstruction, a weak or husky cry, and, occasionally, aphonia. Patients may present with these lesions shortly after birth and may require emergent intubation or tracheotomy if the stenosis is severe. Seventy-five percent of congenital webs are located (usually anteriorly) at the glottic level, with the remainder located in supraglottic and subglottic areas. Occasional extension to the glottic level may occur

2014 eMedicine Surgery

33. Vocal Fold Cysts

complete aphonia, a significant functional component can be expected. Cysts rarely cause symptoms of stridor, aspiration, globus sensation, or . This patient had an essentially normal speaking voice but complained of fatigue and loss of vocal range. Note the translucent quality of the mucosal cover. Patients may be hoarse or may have normal speaking voices. Patients in the latter group often exhibit difficulty with the singing voice, including decreased range, easy fatigability, strain, and periods (...) . Generally, patients with intracordal lesions have dysphonia that becomes more severe with use. They may also describe periods of aphonia following vocal overuse. Sometimes a vocal fold cyst can affect only the singing voice and not the speaking voice or have little or no effect on voice quality. In the latter situation, no indication exists for treatment. However, for a patient to have a normal speaking and singing voice is not unusual, and a patient may be able to perform. When a patient reports

2014 eMedicine Surgery

34. Toxicity, Chlorine Gas (Treatment)

Intercostal retractions Decreased breath sounds Rales (pulmonary edema) Nasal flaring Aphonia, stridor, or laryngeal edema Ulceration or hemorrhage of the respiratory tract Rhinorrhea Lacrimation, salivation, and blepharospasm Chloracne or tooth enamel corrosion (with chronic exposure) Redness, erythema, and chemical burns to the skin from dose-dependent exposure to liquid See for more detail. Diagnosis Studies in patients with significant exposure to chlorine gas may include the following: Pulse oximetry (...) Serum electrolyte, blood urea nitrogen (BUN), and creatinine levels Arterial blood gases Chest radiography Electrocardiogram (ECG) CT scan of the chest Ventilation-perfusion scan Pulmonary function testing Laryngoscopy or bronchoscopy Abnormalities include hypoxia (from bronchospasm or pulmonary edema) [ ] and metabolic acidosis. The metabolic acidosis may be hyperchloremic (nonanion gap). Chest radiograph findings are frequently normal initially but later may show nonspecific abnormalities

2014 eMedicine Emergency Medicine

35. Chondronecrosis of the Larynx

: Jul 31, 2018 Author: Robert Dean, MD, PhD; Chief Editor: Arlen D Meyers, MD, MBA Share Email Print Feedback Close Sections Sections Chondronecrosis of the Larynx Overview Background The larynx has multiple functions, including the voice production, , and airway protection, and it also acts as a conduit for breathing. Pathologic conditions that affect normal laryngeal function can result in poor cough production, aspiration with subsequent , change in phonation, and dysphagia. Chondronecrosis (...) of chondronecrosis. Many patients with head and neck cancer receive radiation therapy, which attempts to preserve the larynx and its aerodigestive function. Radiation therapy has expected mild adverse effects, but the development of chondronecrosis can be devastating, with significant morbidity and even mortality. Once developed, laryngeal chondronecrosis generally is irreversible. Laryngectomy is often required because of life-threatening laryngeal instability. Any etiology resulting in chondronecrosis

2014 eMedicine Surgery

36. Communication Disorders (Follow-up)

the voice’s quality, pitch, or volume differs from that of other persons of similar age, culture, and geographic location. Dysphonia is classified as either an organic or a functional disorder of the larynx. [ , ] Another type of communication problem, dysarthria, encompasses a group of motor speech disorders caused by a disturbance in the neuromuscular control of speech. [ ] A second form of motor speech disorder, apraxia, occurs in the presence of significant weakness or incoordination of the muscles (...) (complexity). By varying the pitch, loudness, rate, and rhythm of voice (prosody), the speaker can convey additional meaning and emotion to words. A voice disorder exists when the quality, pitch, or volume differs from that of other persons of similar age, culture, and geographic location. Dysphonia is classified as either an organic or a functional disorder of the larynx. [ , , ] Organic dysphonia Organic disorders cause an interruption in the smooth approximation of the vocal folds. [ ] Such disorders

2014 eMedicine.com

37. Malignant Tumors of the Larynx

malignancies have given us knowledge in the evolution of this disease and have shown therapeutic potential. The main challenge in laryngeal cancer treatment is improving survival while preserving function by limiting treatment toxicities. Previous Next: Epidemiology Frequency According to the SEER Cancer Statistics Review of the National Cancer Institute, an estimated 12,260 men and women will be diagnosed with cancer of the larynx in 2013; of those, 3,670 patients will die. The age-adjusted incidence (...) , and the cancer’s sensitivity to radiotherapy, with higher expression of HDAC1 found in the low-sensitivity squamous cell cancer samples. Patients in whom HDAC1 was overexpressed and with low sensitivity to radiotherapy had a poorer overall 5-year survival rate. [ ] Previous Next: Pathophysiology The larynx is an essential organ that is responsible for the following vital functions: Maintaining an open air way Vocalizing Protecting the lungs from direct exposure to noxious fumes and gases of unsuitable

2014 eMedicine Surgery

38. Laryngeal Stenosis

is involved, symptoms of hoarseness or weak husky cry, aphonia, or dysphagia may be noted. In children, failure to thrive and feeding problems are often noted. Mild-to-moderate stenosis may be asymptomatic until an upper respiratory tract infection leads to airway edema and thickened secretions which further compromise the airway. Recurrent or persistent croup is also a typical finding in children with subglottic stenosis. Also, children may be asymptomatic but difficult to intubate for anesthesia, as may (...) . Endoscopic posterior cricoid split and costal cartilage graft placement in children. Otolaryngol Head Neck Surg . 2013 Mar. 148(3):494-502. . Timman ST, Schoemaker C, Li WWL, et al. Functional outcome after (laryngo)tracheal resection and reconstruction for acquired benign (laryngo)tracheal stenosis. Ann Cardiothorac Surg . 2018 Mar. 7 (2):227-36. . . Axtell AL, Mathisen DJ. Idiopathic subglottic stenosis: techniques and results. Ann Cardiothorac Surg . 2018 Mar. 7 (2):299-305. . . Media Gallery

2014 eMedicine Surgery

39. Laryngeal Fractures

posterior to the cricoid cartilage. This dislocation limits cricothyroid muscle function and therefore pitch control. Injury to the recurrent laryngeal nerve may also contribute to . Previous Next: Presentation Suspect upper-airway injury in any patient who has signs of cervical trauma. Common presenting symptoms in patients with laryngeal trauma include hoarseness, neck pain, dyspnea, dysphonia, aphonia, dysphasia, odynophonia, and odynophagia; however, no single symptom correlates well (...) vocal cord consists mainly of the thyroarytenoid muscle. The thyroarytenoid muscles connect the arytenoid cartilage to the inner aspect of the thyroid cartilage. The medial and lateral bellies of each muscle parallel each other. The medial belly is called the vocalis muscle, and the lateral belly extends superiorly and inserts in the thyroid cartilage. The cricoarytenoid muscles are important for proper laryngeal function. The lateral cricoarytenoid muscle stretches from the muscular process

2014 eMedicine Surgery

40. Communication Disorders (Diagnosis)

the voice’s quality, pitch, or volume differs from that of other persons of similar age, culture, and geographic location. Dysphonia is classified as either an organic or a functional disorder of the larynx. [ , ] Another type of communication problem, dysarthria, encompasses a group of motor speech disorders caused by a disturbance in the neuromuscular control of speech. [ ] A second form of motor speech disorder, apraxia, occurs in the presence of significant weakness or incoordination of the muscles (...) (complexity). By varying the pitch, loudness, rate, and rhythm of voice (prosody), the speaker can convey additional meaning and emotion to words. A voice disorder exists when the quality, pitch, or volume differs from that of other persons of similar age, culture, and geographic location. Dysphonia is classified as either an organic or a functional disorder of the larynx. [ , , ] Organic dysphonia Organic disorders cause an interruption in the smooth approximation of the vocal folds. [ ] Such disorders

2014 eMedicine.com

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