A RARE CASE OF NEUROFIBROMATOSIS WITH SQUAMOUS CELL CARCINOMA OF EPIGLOTTIS

INTRODUCTION: The neurofibroma is a nonmalignant new growth of neuroectodermal origin. neurofibromas appear at the end of a nerve, often in the skin, producing small nonencapsulated nodules which may have pigmentation in the overlying skin. Neurofibromatosis with laryngeal involvement presents with dyspnea, followed by hoarseness, stridor, dysphagia, and voice change. most common sites involved in the larynx are the arytenoids and the aryepiglottic folds. CASE REPORT: 65-year-old female with previously diagnosed of neurofibromatosis since 10 years of age manifested by multiple cutaneous nodules The patient had symptoms of dysphagia, hoarseness of voice for past 2 months. Direct laryngeal examination using flexible endoscope showed a edematousulceroproliferative growth in the laryngeal surface of epiglottis and fullness in the left pyriform fossa. Hisopathological examination revealed squamous cell carcinoma from epiglottis and fibromatosis changes from pyriform fossa. CONCLUSION: All neurofibromatosis patient and their family members should under go regular oral and laryngeal examination to rule out complications at the earliest.

Evaluating the utility of pre-operative airway assessment for intubation management in difficult airway patients

ObjectiveTo assess intubation management in difficult airway patients by performing a multidisciplinary pre-operative examination of the airway using a flexible fibre-optic laryngoscope.MethodsPatients with a known but stable difficult airway were evaluated prior to surgery in the pre-operative holding suite by both an ENT surgeon and an anaesthesiologist via a fibre-optic laryngeal examination.ResultsPerforming a pre-operative fibre-optic examination of the difficult airway led to a change in intubation strategy in 6 out of 12 cases. Intubation ‘first-pass’ success occurred in 9 out of 12 (75 per cent) of our patients.ConclusionBy performing a multidisciplinary airway examination immediately prior to surgery, a safe plan to intubate on the initial attempt was developed. This resulted in improved first-pass success at intubation compared to historical data.

Prognostic indicators of short-term outcome in dogs undergoing surgery for brachycephalic obstructive airway syndrome

BackgroundThe aims of this study were to assess the impact of epidemiological variables, severity of presurgical respiratory signs, diagnostic findings from pharyngeal and laryngeal examination using a new grading scheme and CT scan images, on postsurgical outcome in dogs undergoing surgery for brachycephalic obstruction airway syndrome (BOAS).MethodsAn owner-based questionnaire was used to grade dogs based on their respiratory signs before surgery and at least six weeks after surgery. Epidemiological data and results from presurgical pharyngeal and laryngeal examination and CT scan findings for 75 dogs undergoing airway surgery were collected from the medical records.Results70.7 per cent of dogs showed an improvement in respiratory signs following rhinoplasty and palatoplasty. This improvement was associated with the severity of inspiratory efforts and the Poncet score on presentation, but not with any other clinical sign or anatomical abnormality found during BOAS assessment, nor by the degree of craniofacial shortening as determined by CT-scan. Presurgical snoring was positively associated with the degree of narrowing of pharyngeal dimensions.ConclusionsDogs presenting with clinical signs of BOAS benefit from rhinoplasty and palatoplasty alone. The degree of narrowing of pharyngeal dimensions appears to be associated with severity of snoring while soft palate length alone was not.

The Influence of Anaesthetic Drugs on the Laryngeal Motion in Dogs: A Systematic Review

Anaesthetic drugs are commonly used during the evaluation of laryngeal function in dogs. The aim of this review was to systematically analyse the literature describing the effects of anaesthetic drugs and doxapram on laryngeal motion in dogs and to determine which drug regime provides the best conditions for laryngeal examination. PubMed, Google Scholar, and EMBASE databases were used for the literature search up to November 2019. Relevant search terms included laryngeal motion, anaesthetic drugs and dogs. Studies were scored based on their level of evidence (LoE), according to the Oxford Centre for Evidence-based Medicine, and the quality was assessed using the risk-of-bias tool and SIGN-checklist. In healthy dogs, premedication before laryngeal examination provided better examination conditions and maintained overall adequate laryngeal motion in 83% of the studies. No difference in laryngeal motion between induction drugs was found in 73% of the studies but the effects in dogs with laryngeal paralysis remain largely unknown. Doxapram increased laryngeal motion in healthy dogs without serious side effects, but intubation was necessary for some dogs with laryngeal paralysis. Methodological characteristics varied considerably between studies, including the technique and timing of evaluation, number of assessors, study design, drug dose, combinations, route and speed of administration.

Voice changes associated with inhaled steroids 1n obstructive lung disease patients

Background/Aims: The widespread use of inhaled corticosteroids (ICS) for the treatment of obstructive lung disease may be associated with both systemic and local side effects. These local side effects; including voice problems, oropharyngeal candidiasis, throat clearing, sense of fullness, pharyngitis, and cough, are generally viewed as minor complications of therapy in what is called steroid inhaler laryngitis (SIL). Few studies have been performed to specifically evaluate local side effects of ICS. However, they can be clinically significant, affect patient's quality of life, hinder compliance with therapy, and mask symptoms of more serious disease. The aim of this study is to examine the effect of ICS on the larynx and subsequent voice changes, and highlighting if these voice problems related to the type of inhaled corticosteroids in order to determine the importance of regular laryngeal examination in those patients. Methods: 40patients with bronchial asthma and 40 patients with COPD admitted to Chest department in Menoufia and Zagazig University Hospitals during the period from March 2017 to March 2019 were included in the study. They were divided according to the type of cortisone used into four groups; group (I): beclomethasone dipropionate (BDP) users, group (II): budesonide (BUD) users, group (III): Ciclesonide users and group (IV): fluticasone propionate (FP) users. They were evaluated as regards videolaryngoscopic examination and acoustic analysis Results: The age of the patients with bronchial asthma ranged from 29 to 42years and the age of the patients with COPD ranged from 31 to 43years. There was a statistically significant difference among the four groups of cortisone inhalation regarding laryngoscopic findings; as presence of congestion (diffuse and local), mucus spills on VF and glottis gap were all higher in frequency among the group of patients used fluticasone FP, while least signs found among ciclesonide users. Also, average pitch, Jitter, H/N ratio and MPT were more worsen in fluticasone group when compared with Ciclesonide group. Conclusion: obstructive lung disease patients may suffer from voice problems related to the type of inhaled corticosteroids that could be fade when therapy is stopped. So, regular laryngeal examination in those patients is important.

Reinke’s oedema and hypothyroidism: a correlation in an old woman

A 71-year-old woman presented fatigue, hoarse voice, swelling of the face and eyelids and psychomotor slowdown on admission. She had history of smoking and she was postmenopausal. Lab studies revealed hypothyroidism. By the laryngeal examination we diagnosed Reinke’s bilateral oedema. After 30 days of levotiroxina therapy we observed reduction of Reinke’s bilateral oedema.