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Pulmonary – Treatable traits
Published in Vibeke Backer, Peter G. Gibson, Ian D. Pavord, The Asthmas, 2023
Vibeke Backer, Peter G. Gibson, Ian D. Pavord
Dysphonia commonly occurs due to deposition of inhaled corticosteroid particles locally in the oropharynx, around the vocal cords, and local side effects such as oral candidiasis and hoarseness of voice may also develop. Use of a large volume spacer device and careful rinsing of the mouth after the use of inhaled corticosteroids reduces the risk of these local effects. Systemic side effects include bruising and atrophy of the skin, cataract formation, glaucoma and reduced bone mineral density. Suppression of the adrenocortical axis can occur with high-dose inhaled corticosteroids and specific advice on use of corticosteroid replacement therapy during intercurrent illness should be considered in patients who genuinely require long-term high-dose therapy. Systemic effects occur partly due to gastrointestinal absorption of swallowed particles and partly due to systemic absorption via the airways. The use of spacer devices, dry powder mechanisms and mouth rinsing after inhaler use minimise adverse effects. Another approach to minimise local side effects is to use Ciclesonide, a pro-drug which is activated by contact with the lower airway epithelium. Drugs with high first-pass metabolism in the liver such as budesonide and fluticasone have less systemic side effects than beclomethasone, but at high doses (>800–1,000 mcg daily of budesonide or >500 mcg daily of fluticasone) systemic absorption through the buccal and airway mucosa becomes increasingly important.
The spectrum of voice disorders – classification
Published in Stephanie Martin, Working with Voice Disorders, 2020
The early symptoms of some disorders such as myasthenia gravis, Parkinson’s disease, multiple sclerosis or even carcinoma have the possibility of a misdiagnosis of psychogenic dysphonia. It is therefore critical that although many patients may present with what appear to be classic symptoms of psychogenic dysphonia, this diagnosis should not be made lightly and a diagnosis should be reached after exclusion of laryngeal pathology through detailed and thorough examination, such as videostroboscopic and stroboscopic examination, and only when thorough assessment has been completed and other possibilities excluded should the clinician arrive at a diagnosis of psychogenic dysphonia.
Neck
Published in A. Sahib El-Radhi, Paediatric Symptom and Sign Sorter, 2019
Pathologies in the larynx in children are caused by four main groups: acute infection, airway stenosis, tumours and foreign body. The term dysphonia includes any impairment of the voice or alteration in the sound of the voice. Hoarseness subsequent to an acute upper airway obstruction (causing croup) in association with a viral upper respiratory tract infection (URTI) is by far the most common presentation in children. Croup is characterised by abrupt onset at night, with barking cough, inspiratory stridor and respiratory distress. Mild obstruction usually causes transient symptoms (hoarseness and stridor). More severe degrees of obstruction cause more persistent symptoms of stridor and hoarseness, nasal flaring and subcostal and intercostal recession. Recovery within a few days is usually the rule. On rare occasions such an obstruction is caused by more serious underlying causes, such as Staphylococcal aureus (causing bacterial tracheitis) and Haemophilus influenzae type b (causing epiglottitis). The obstruction is more serious in infants and young children than in older children because of the smaller airway and the more likely obstruction. Persistent hoarseness usually suggests cord paralysis or tumours. In this section, abnormal or unusual voices are included.
Patient reported voice handicap and auditory-perceptual voice assessment outcomes in patients with COVID-19
Published in Logopedics Phoniatrics Vocology, 2023
Emel Tahir, Esra Kavaz, Senem Çengel Kurnaz, Fatih Temoçin, Aynur Atilla
Nonetheless, the infection can also have a significant impact on the upper airway [2]. Olfactory and taste dysfunctions, in particular, have been widely described as characteristic and early signs of COVID-19. Patients infected with COVID-19 may experience typical and non-specific upper airway infection symptoms such as rhinorrhea, nasal congestion, and symptoms due to laryngeal involvement in the inflammatory process [3]. Dysphonia be caused by anything that restricts the vocal chords from vibrating normally, such as edema or inflammation. The most common cause of dysphonia is acute laryngitis prompted by an upper respiratory tract infection [3,4]. Dysphonia has previously been reported in 26.8% of patients with mild-to-moderate COVID-19 [4]. The occurrence of dysphonia with upper respiratory infections is well described in the literature. Also, it is a known fact that viral pathogens may cause vagal neuropathy and vocal cord paralysis [5]. A vagal neuropathy that results in vocal fold paresis or paralysis can impair voice quality due to paradoxical vocal fold movement, persistent coughing, laryngeal paresthesia, laryngospasm, and vocal fatigue. COVID-19 affects the same systems and structures used for voice production; therefore, it may decrease voice quality [4,5].
Electrophysiological predictors of hyperfunctional dysphonia
Published in Acta Oto-Laryngologica, 2023
Agata Szkiełkowska, Paulina Krasnodębska, Andrzej Mitas, Monika Bugdol, Marcin Bugdol, Patrycja Romaniszyn-Kania, Anita Pollak
A crucial factor in our work is that the subjects had no history of voice complaints. The VHI questionnaire also did not indicate any risk of endoscopic abnormalities. Nevertheless, on physical examination abnormalities were found in 26 subjects (12 singers and 14 controls) in the form of distinct features of hyperfunctional dysphonia, which we call subHD. Functional dysphonia describes all types of dysphonia that are not due to structural or neurological pathology or to organic alterations. The term ‘functional’ implies that there is a voice problem due to a physiological malfunction rather than to morphological alteration of the larynx [11]. The incidence of functional dysphonia in those seeking treatment is 30%, predominantly young adults, mature women, and the elderly [12]. Teachers and other professional voice users are at a much higher risk of developing functional dysphonia. In one study, hyperfunctional dysphonia was found in 17.4% of teachers compared with 7.2% of controls [4]. In terms of the opportunity for early prevention, interventions on professional voice users have the greatest likelihood of being successful and saving expenditure.
A real-world pharmacovigilance study of axitinib: data mining of the public version of FDA adverse event reporting system
Published in Expert Opinion on Drug Safety, 2022
Yamin Shu, Yufeng Ding, Bing Dai, Qilin Zhang
It is noteworthy that the long-term use of axitinib is associated with a risk of neurological AEs, and the most common is dysphonia [27]. The study showed that the dysphonia incidence rate was up to 48.1% treated with axitinib and pembrolizumab in patients with advanced RCC [28]. At present, the mechanism of axitinib-induced dysphonia is not completely understood. The possible potential mechanism of dysphonia caused by TKI drugs is the decrease of mucosal vascular density or microvascular permeability, which leads to ischemia due to vessel rarefaction with mucosal necrosis [29]. In addition, reductions in mucosal vascularization may result in a decrease in hydration in the submucosal layer or in the mucosa itself, leading to a rigidification of the vocal fold [30]. Physicians can advise patients to drink plenty of water to avoid irritants (such as dust, smoking, alcohol, and industrial chemicals) when taking axitinib. Adequate drinking water can not only reduce the risk of dysphonia but also improve pronunciation.