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Evaluation of the asthmas
Published in Vibeke Backer, Peter G. Gibson, Ian D. Pavord, The Asthmas, 2023
Vibeke Backer, Peter G. Gibson, Ian D. Pavord
Patients with vocal cord dysfunction (VCD) are often examined for refractory asthma. VCD severity can be seen via laryngoscopy, either by provocation with irritants or by exercise with closure of the laryngeal area. Moreover, measures of inspiratory obstruction, when measuring lung function, are diagnostic but are not always present. Among the most suitable questionnaires for identifying laryngeal hypersensitivity is the Newcastle Laryngeal Hypersensitivity Questionnaire (LHQ). The LHQ is a 14-item, self-administered questionnaire, using a 7-point ordinal scale, which assesses three domains: obstruction, pain/thermal and throat tickle. A cut-off for normal function is 17, with lower scores indicating increased laryngeal dysfunction.
Complications of Thyroid and Parathyroid Surgery and How to Avoid Them
Published in John C Watkinson, Raymond W Clarke, Louise Jayne Clark, Adam J Donne, R James A England, Hisham M Mehanna, Gerald William McGarry, Sean Carrie, Basic Sciences Endocrine Surgery Rhinology, 2018
Erin A. Felger, Dipti Kamani, Gregory W. Randolph
An analysis of 27 articles, reviewing more than 25 000 patients undergoing thyroidectomy, found the average post-operative vocal cord paralysis (VCP) rate was 9.8% and ranged from 0% to 18.6%.26 Post-operative laryngoscopy should be performed to reliably document post-operative glottic function and for early identification of VCP to initiate appropriate management.16 There are multiple methods for restoring voice quality in patients who have vocal cord dysfunction. In the first 3 months, cordal injections can enhance contact between the vocal cords and improve swallowing, voice and cough. If the injury is permanent, procedures like thyroplasty and medialization laryngoplasty can be performed.27 These methods rely on placement of a structural implant to reapproximate the injured cord with the normal cord. Finally, reinnervation is another option that can be accomplished by mobilizing a functioning nerve, typically the ansa cervicalis to the distal RLN stump. It may take several months to regain voice function after this procedure.27
Connective tissue
Published in Brian J Pollard, Gareth Kitchen, Handbook of Clinical Anaesthesia, 2017
Approximately 10%–40% of patients have associated interstitial pulmonary disease, predominantly fibrosis. Pulmonary compromise can also occur because of intercostal and diaphragmatic weakness or aspiration pneumonia. Vocal cord dysfunction may exist.
Bilateral Tapia’s syndrome secondary to cervical spine injury: a case report and literature review
Published in British Journal of Neurosurgery, 2023
Alexandros G. Brotis, Jiannis Hajiioannou, Christos Tzerefos, Christos Korais, Efthymios Dardiotis, Kostas N. Fountas, Kostantinos Paterakis
Even though unilateral TS is commonly described after strenuous airway management, there are only nine additional cases with bilateral involvement in the Medical Literature3,5–11 (Table 2). In comparison to the unilateral syndrome, the bilateral presentation is usually more dramatic and is associated with inability to maintain upper airway patency, dysphonia, and difficulty in swallowing. The diagnosis is suspected on clinical grounds and verified by documenting vocal cord dysfunction in laryngoscopy. Notably, a number of imaging modalities including cerebral CT and MRI and cervical CTA, usually offer no additional information. However, the diagnosis is frequently delayed in the comatose patient, and a high level of suspicion should be kept in patients with cervical spine trauma, as in the current case. Tracheostomy and nasogastric tube are frequently required for unobstructed breathing and safe feeding. In addition, a scheme of steroids with long tapering is frequently recommended, along with speech and swallowing rehabilitation. Most patients gradually improve, but to a variable extent.
Voice bubbling therapy for vocal cord dysfunction in difficult-to-treat asthma – a pilot study
Published in Journal of Asthma, 2022
S. C. Eindhoven, Y. Türk, T. van der Veer, M. Oosterbaan-Beks, B. Goes-de Graaff, S. A. Bendien, J. de Kluijver, J. W. Arendse, T. Hooft van Huysduynen, J. C. C. M. in ’t Veen, G. J. Braunstahl
Dysfunctional breathing often coexists with asthma and complicates asthma control, especially in difficult-to-treat asthma (1). Difficult-to-treat asthma is defined as persistent uncontrolled asthma despite the use of high dose inhalation corticosteroids (ICS) and long acting beta-agonist (LABA). This may be due to severity of the underlying asthma, but often results from other causative factors such as non-adherence, persistent exposure to allergens or toxins, chronic rhinosinusitis, gastro-oesophageal reflux (GERD), obstructive sleep apnea syndrome (OSAS) or serious psychosocial comorbidity (2). Vocal cord dysfunction (VCD) is also a co-morbid condition in difficult-to-treat asthma and is characterized by abnormal adduction of the vocal cords during respiration causing intermittent airway obstruction.
Determinants of exercise capacity in children and adolescents with severe therapy-resistant asthma
Published in Journal of Asthma, 2022
Cláudia Silva Schindel, Daniele Schiwe, João Paulo Heinzmann-Filho, Mailise Fátima Gheller, Natália Evangelista Campos, Paulo Márcio Pitrez, Márcio Vinícius Fagundes Donadio
Limitations of this study include the lack of assessment of the level of daily physical activity of the children and adolescents, which could influence the results of exercise capacity. Furthermore, the fact that some patients used omalizumab (nonspecific anti-IgE immunotherapy) may have contributed to an improved performance because of the well-known benefits of the medication for patients with STRA, which may have influenced the results of exercise capacity, pulmonary function, disease control, and EIB (45,46). However, it is deemed unethical to discontinue medication for study purposes. Vocal cord dysfunction and exercise-induced laryngeal obstruction were not directly evaluated and could play a role in the present results. In addition, the influence of obesity was not addressed, as only few patients with overweight were included.