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Functional Aphonia

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41. 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

42. 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

43. 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

44. 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

45. 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

46. 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

47. Toxicity, Chlorine Gas (Follow-up)

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

48. Toxicity, Chlorine Gas (Overview)

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, pulmonary edema

2014 eMedicine Emergency Medicine

49. Pilot Study of Stem Cell Treatment of Patients With Vocal Fold Scarring

Research Council Laryngfonden Karolinska Institutet Information provided by (Responsible Party): Stellan Hertegård, Karolinska University Hospital Study Details Study Description Go to Brief Summary: This is a pilot-study of 16 selected Swedish patients which all have severe hoarseness or aphonia due to vocal fold scarring (from previous surgery, radiation therapy, inflammation or possibly hereditary). The patients are operated with phonomicrosurgical dissection of the scarred vocal folds, removal (...) and at the Karolinska Institute. The laryngeal status, vocal fold function, and voice function will be followed individually with an advanced battery of examinations performed before and up to 1 year postoperatively. Side effects and complications are noted and reported during surgery and following surgery at regular intervals during at least 1 year Since spring 2015 no new patients have been recruited and no treatments are given during 2016 or 2017. The monitoring authority was changed from Swedish National Board

2013 Clinical Trials

50. Comparison of the Effect of Magnesium Sulfate and Dexamethasone on Postoperative Sore Throat After Spinal Surgery in Prone Position With Tracheal Intubation: a Double-blind, Randomized, Noninferiority Clinical Trial

hoarseness Severity of post operative hoarseness ( four-graded scale, 0= no hoarseness, 1= mild hoarseness, 2= severe hoarseness, 3= aphonia) Secondary Outcome Measures : The effect of dexamethasone on postoperative sore throat after spinal surgery in prone position with tracheal intubation [ Time Frame: Change of post operative sore throat level from 1 to 48 hours after surgery ] Incidence of post operative sore throat Severity of post operative sore throat (10 cm-visual analogue scale ) Incidence (...) of post operative hoarseness Severity of post operative hoarseness ( four-graded scale, 0= no hoarseness, 1= mild hoarseness, 2= severe hoarseness, 3= aphonia) Eligibility Criteria Go to Information from the National Library of Medicine Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided

2013 Clinical Trials

51. 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

2015 FP Notebook

52. A Note on Treatment of “Functional Aphonia” in Soldiers from the Front (PubMed)

A Note on Treatment of “Functional Aphonia” in Soldiers from the Front 19979267 2010 06 24 2010 06 24 0035-9157 9 Laryngol Sect 1916 Proceedings of the Royal Society of Medicine Proc. R. Soc. Med. A Note on Treatment of "Functional Aphonia" in Soldiers from the Front. 83-5 Milligan W W eng Journal Article England Proc R Soc Med 7505890 0035-9157 2009 12 9 6 0 1916 1 1 0 0 1916 1 1 0 1 ppublish 19979267 PMC2017491

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1916 Proceedings of the Royal Society of Medicine

53. Conversion Disorder

to a stressful event. Typically, symptoms involve apparent deficits in voluntary motor or sensory function but sometimes include shaking movements and impaired consciousness (suggesting seizures) and abnormal limb posturing (suggesting another neurologic or general physical disorder). For example, patients may present with impaired coordination or balance, weakness, paralysis of an arm or a leg, loss of sensation in a body part, seizures, unresponsiveness, blindness, double vision, deafness, aphonia (...) for Patient Education NOTE: This is the Professional Version. CONSUMERS: Conversion disorder consists of neurologic symptoms or deficits that develop unconsciously and nonvolitionally and usually involve motor or sensory function. The manifestations are incompatible with known pathophysiologic mechanisms or anatomic pathways. Onset, exacerbation, or maintenance of conversion symptoms is commonly attributed to mental factors, such as stress. Diagnosis is based on history after excluding physical disorders

2013 Merck Manual (19th Edition)

54. Stridor

surgery. Presentation A careful history gives helpful clues as to the aetiological cause of the stridor. Examination may occasionally help confirm the diagnosis. It is important to consider the age of the patients and whether the stridor is acute or chronic. History Children: Age of onset. Duration, progression and severity of stridor. Precipitating factors (feeding, crying). Whether positional (worse right/left, prone/supine). Whether aphonia is present. Other symptoms (cough, aspiration, drooling (...) masses). MRI scanning (particularly for upper airway and vascular abnormalities). Virtual bronchoscopy. [ ] Other tests and procedures: Pulmonary function tests (differentiating restrictive/obstructive lesions and upper/lower airway obstruction). Laryngoscopy and bronchoscopy (after oxygen saturations are stable and acute epiglottitis excluded). Management This depends on the cause of the stridor. Management of the particular causes may be very different. However, the following general points can

2008 Mentor

55. Lipoid proteinosis

infiltration may cause upper respiratory tract infections, hoarseness or aphonia, dysphagia, and airway obstruction. Dystonia, seizures, behavioral changes, learning difficulties and short stature have been reported in affected children. Less commonly, the disease manifests in adulthood with subtle skin findings and possible complications due to visceral deposition. Heterozygous carriers are generally asymptomatic but may have a mild presentation including abnormal dentition. Etiology LP is caused (...) by deposition of an amorphous hyaline material in the skin, mucosa, and viscera. Causative loss-of-function mutations have been found in the ECM1 gene (1q21) encoding extracellular matrix protein 1, which has a role in physiology and homeostasis of the skin and many other tissues. Diagnostic methods Diagnosis is based on the clinical signs (particularly hoarseness and skin manifestations). Histological findings on biopsy of affected cutaneous or mucosal sites show periodic acid-Schiff-positive deposition

2005 Orphanet

56. Brain Mapping of Voice Control

in this study. Condition or disease Voice Disorders Detailed Description: The neural organization of laryngeal motor and somatosensory function will be investigated in adults with idiopathic voice disorders using functional magnetic resonance imaging. Brain activation will be compared in normal volunteers and patients with spasmodic dysphonia (SD), muscle tension dysphonia (MTD) and vocal tremor. While each voice disorder is characterized by strained vocalization, the disorders are distinguished by other (...) differences in voice symptoms. Accordingly, the brain correlates of vocalization in these disorders may both differ from each other and that of normal vocal function. Because sensory feedback has been identified as a factor in SD, the role of afferent input in vocalization will be investigated by comparing brain activation before and after topical anesthesia of the laryngeal mucosa. The afferent blockade is expected to significantly suppress dysphonic symptoms in SD patients for the duration of the block

2003 Clinical Trials

57. Hemicricoidectomy as the primary diagnosis and treatment for cricoid chondrosarcomas. (PubMed)

. This procedure allows sufficient tissue for histological study and provides good long-term breathing and phonatory function without compromising long-term survival. This procedure is appropriate for patients with 1) mobility of one vocal fold, 2) dysphonia or aphonia, and 3) an adequate subglottic airway. (...) Hemicricoidectomy as the primary diagnosis and treatment for cricoid chondrosarcomas. The objective was to present a new approach for the diagnosis and treatment of chondrosarcoma involving the cricoid cartilage. The technique involved an extramucosal resection of the ipsilateral half of the involved cricoid cartilage, providing enough tissue to be sent for pathological study, and resulted in good laryngeal function without jeopardizing patients' long-term survival.Retrospective study.A

2003 Laryngoscope

58. Polydimethylsiloxane particles for permanent injection laryngoplasty. (PubMed)

assessment before and after operation. Friedrich's dysphonia index (DI), a score system combining subjective and objective parameters, was used to describe voice quality. A DI of 0 reflects a normal voice, and a DI of 3 stands for complete aphonia. The PDMS particles were injected into the paraglottic space by microlaryngoscopy under general anesthesia.The median follow-up was 4.1 months. There was no complication attributable to the injection of PDMS particles. The mean DI was 2.8 before operation (...) . After the operation, voice quality improved significantly in each patient, as reflected by a mean postinjection DI of 1.4.Particles of PDMS provide a relatively safe and minimally invasive option for permanent vocal fold augmentation. The functional results in terms of voice improvement are comparable to those obtained with other techniques, including thyroplasty. In the European Community, PDMS particles are officially approved for use in the human larynx.

2006 Rhinology and Laryngology

59. Laser microsurgical bilateral posterior cordectomy for the treatment of bilateral vocal fold paralysis. (PubMed)

Laser microsurgical bilateral posterior cordectomy for the treatment of bilateral vocal fold paralysis. We performed a prospective study to assess respiratory function and voice quality before and after laser microsurgical bilateral posterior cordectomy performed for chronic airway obstruction in patients with bilateral vocal fold paralysis.In 17 patients a laser microsurgical posterior cordectomy was performed as an immediate bilateral approach. Roughness, breathiness, hoarseness, and dyspnea (...) were evaluated both subjectively (on a scale from 0 to 3) and objectively (body plethysmography, computerized voice analysis: Göttingen Hoarseness Diagram).After laser surgery, the patients' respiratory function was significantly increased and was sufficient for all activities of daily living. The body plethysmographic measure of airway resistance had superior descriptive power and correlated significantly with the clinical degree of dyspnea (scale 0 to 3). Pretreatment and posttreatment impairment

2005 Rhinology and Laryngology

60. Tracheoesophageal voice restoration following laryngotracheal separation procedure. (PubMed)

Tracheoesophageal voice restoration following laryngotracheal separation procedure. Laryngeal dysfunction leading to incompetence and intractable aspiration can be a life-threatening problem. Laryngotracheal separation (LTS) can be used to prevent aspiration, but results in aphonia. The options for laryngeal speech following LTS are limited.We performed tracheoesophageal puncture (TEP) and insertion of a Blom-Singer valve in 3 patients in an attempt to restore their voice after LTS for chronic (...) safe, and allows for the control of aspiration while maintaining vocal function.

2005 Rhinology and Laryngology

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