Cancer
Jahangir Moini, Matthew Adams, Anthony LoGalbo in Complications of Diabetes Mellitus, 2022
Papillary carcinoma often is detected as a painless mass, with enlargement of the cervical lymph nodes. However, some patients may complain about neck pain, hoarseness, and dysphagia. Patients have also nodal metastases in the lateral neck. Follicular thyroid carcinoma is often a painless tumor, from less than 1 cm in diameter up to several centimeters. Large tumors cause dyspnea or dysphagia, and throat or neck soreness and pain. There may be unintended weight loss and night sweats. Cervical lymph node enlargement at diagnosis is not common. Sometimes, the first symptom is metastasis that can be signified by a lung nodule or a bone fracture. If a metastasis is diagnosed as being from the thyroid, a neck examination will usually reveal a thyroid mass. In certain cases, findings of bone metastases prompt reexamination of an earlier resected thyroid mass that was believed to be an adenoma. There are also rare cases of functional follicular thyroid carcinoma related to hyperthyroidism. The majority of MTCs are painless. Extensive localized tumor growth causes upper airway obstruction plus dysphagia. With metastases, some patients experience flushing and severe diarrhea because of high circulating calcitonin levels and other products that result from the tumor. Patients may present with a firm neck mass that is fixed in one location. The tumor is widely infiltrative. Hoarseness, breathing problems, dysphagia, and pain are common symptoms, as well as dyspnea and vocal cord paralysis. Approximately 35% of patients initially present with distant metastasis to the lungs and bones.
Medical Management of Chemical Warfare Agents
Brian J. Lukey, James A. Romano, Salem Harry in Chemical Warfare Agents, 2019
Inhalation is a major route of entry into the body. Thus, it is frequently involved in toxic exposures. The irritant gas toxidrome, also known as lung-damaging agents, has two major types and an in-between blended variety. The distinction has to do with the degree of water solubility of the involved gases. Gases that are strongly water soluble react immediately with the moist mucous membranes of the upper airway, above the vocal cords, and the eyes. Common industrial gases in this group are sulfur dioxide and ammonia. Also included are formaldehyde and hydrogen chloride. When these gases interact with the water in the mucous membranes, they cause a corrosive effect, resulting in irritation and inflammation. The resulting symptoms are almost immediate and predictable. Moving from the exterior to deeper in, you get inflammatory changes such as conjunctivitis, rhinitis, and pharyngitis. As this inflammation increases, there can be resulting edema, which can get quite severe. In the area of the larynx, not only do you get the inflammation and edema, but you may also get laryngospasm. The end result of all this is severe irritation such as lacrimation and blurring, rhinorrhea and sneezing, and drooling if unable to swallow. With involvement of the vocal cords, there can be changes in phonation that range from hoarseness to loss of voice. Laryngospasm and severe edema can interfere with airflow through the upper airway, producing severe dyspnea. The exposed are very uncomfortable, and the victims will try to remove themselves rapidly from the environment.
Physiology of the respiratory system
Louis-Philippe Boulet in Applied Respiratory Pathophysiology, 2017
The distribution network of air encompasses the upper and lower airways dedicated to the filtration, heating, and humidification of ambient air to play a major role in smelling, swallowing, and speech. The upper airways include the nose, the para-nasal sinuses, the pharynx, and the larynx. The lower airways start at the junction between the larynx and the trachea at the level of the vocal cords and include the trachea, bronchi, bronchioles, and alveoli. The lower airways may be divided into two components: (1) the conduction zone, which is proximal to the terminal bronchioles and forms the anatomical dead space and not involved in gaseous exchanges. From the trachea to the terminal bronchioles, the bronchi dichotomically divide about 16 times. This contributes to increase the transversal area from 2 to 5 cm2 in the trachea to 300 cm2 at the terminal bronchioles level and (2) the respiratory zone, distal to the respiratory bronchioles down to the alveoli. This respiratory zone is responsible for the alveolar ventilation that contributes to the gas exchange of oxygen and carbon dioxide.
Effect of COVID-19 on the incidence of postintubation laryngeal lesions
Published in Baylor University Medical Center Proceedings, 2023
Madison Buras, Nicole DeSisto, Randall Holdgraf
Although recent research has examined the specific incidence of mild to severe vocal cord lesions, the data vary greatly among studies. Data suggest that the incidence of postextubation laryngeal injury ranges from 41% to 83%, with a variety of factors identified as increasing risk.1–3 This variability suggests that additional investigation into the prevalence and possible causes of laryngeal injury is needed so that prevention guidelines can be established. Previous studies have demonstrated that patients with COVID-19 are more susceptible to mucosal injuries. Mechanisms that may increase risk include pronation, prothrombotic and antifibrinolytic states affecting laryngotracheal microcirculation, weakened mucosa due to high viral replication and chronic high-dose steroid use, lower arterial oxygen partial pressure to fractional inspired oxygen ratio causing increased hypoxia of the laryngotracheal mucosa, and comorbidities.4
Impact of pregnancy on voice: a prospective observational study
Published in Logopedics Phoniatrics Vocology, 2022
Burak Ulkumen, Burcu Artunc-Ulkumen, Onur Celik
Many significant anatomic and metabolic changes occur throughout the course of pregnancy [1]. These changes peak by the end of the third trimester. During pregnancy, total body water seriously increases due to increased cardiac output and blood volume. Composition of this excess fluid changes according to the trimester. Specifically, plasma volume increases during the first and second trimester while extravascular fluid increases during the last trimester [2]. Therefore, edema peaks in the third trimester, which is expected to enhance the mass of mucosal membranes of the upper airway, including the larynx. We already know that vocal cords play a direct role in voice production, while the remaining upper airway plays a role in the resonance characteristics of a human voice. For this reason, it is expected that the voices of pregnant women would be affected by edema of the vocal cord mucosa and remaining upper respiratory tract mucosa. During the postpartum period, plasma volume decreases abruptly while interstitial fluid decreases gradually, which may cause gradual recovery of subjective and objective voice parameters. Although edema of the upper airway is the main factor paving the way for gestational voice changes, some other pregnancy related factors like diaphragmatic elevation and increased chest diameter may also affect voice quality [1].
Preliminary dynamic observation of wound healing after low-temperature plasma radiofrequency ablation for laryngeal leukoplakia
Published in Acta Oto-Laryngologica, 2022
Fang Hao, Liyan Yue, Xiaoyan Yin, Chunguang Shan
The vocal folds are composed of epithelium, lamina propria, and muscularis. The lamina propria is rich in extracellular matrix. The abundance and distribution of proteins and glycans in this extracellular matrix maintain the biomechanical properties of vocal folds vocalization, while injury to the extracellular matrix often affects postoperative pronunciation [17]. The arrangement and content of fibronectin and other components in the extracellular matrix of the wound after vocal fold surgery determine the formation of vocal fold lamina propria scars. Damage to the adult skin can lead to scar formation, which increases as the depth of the injury increases [18]. Although the skin and vocal folds tissue structures are different, there are similarities, and the vocal folds mucosa is a special tissue with unique repair and regeneration requirements [19]. The scars of the vocal folds are not evident after the LTPA treatment of LL wounds. Because the wound was in the mucosal layer, the lamina propria was not damaged or slightly damaged, and did not reach the muscle layer, which is consistent with the observation of postoperative wound healing in the later stage of scar formation. Similarly, Zhang et al. [20] summarized the healing of the vocal folds after treatment with LTPA in patients with early glottic laryngeal cancer and found that postoperative vocal folds scar formation was not apparent.