We investigated whether laryngeal images can be used to determine the pathological condition and effects of treatment in daily observations. Fifty-four patients underwent intracordal fat injection with autologous fat between December 2003 and December 2012 at the Tokyo Hospital of Tokai University. The pre-operative laryngeal findings of these cases were assessed retrospectively. In terms of the association between the laryngeal images and the pre- and post-operative maximum phonation times, a significant relationship was noted with both pre- and post-operative maximum phonation times in cases in which a gap was found on the posterior portion of the glottis. In particular, the presence of a gap in the posterior region of the glottis was related to the maximum phonation time, and significantly related to improvements in voice following autologous fat injection.
Bilateral vocal cord paralysis can result in a loss of voice function, dyspnea and dysphagia, and hoarseness. Between 2003 and 2013, there were twenty-six patients (9% of all vocal cord paralysis cases) diagnosed with bilateral vocal cord paralysis at our hospital. Thyroid surgery was the most frequent cause. Lateralization of the vocal cord was undertaken in nine patients, and tracheotomy was performed in 21 patients. In nine cases that underwent a glottal abduction surgery, six were able to undergo closure of the trachea aperture. Securing the respiratory tract is the most important aspect of treatment. After securing the airway, it is necessary to determine the best treatment based on the lifestyle and the QOL of the patient, and their demand for deglutition.
Laryngeal allergy is a familiar condition for otolaryngologists. However, little is known about laryngeal allergies in children. We herein report the case of a 10-year-old girl diagnosed with seasonal laryngeal allergies following a history of Japanese cedar pollinosis since 3 years of age. The patient visited our clinic during the pollen season complaining of a dry cough lasting for two weeks, without wheezing. She also reported foreign body sensations in her throat. The F-scale, a questionnaire regarding gastro esophageal reflux symptoms, which was completed by the child, showed no abnormalities. However, serum IgE specific to Japanese cedar pollen was positive. Neither a chest X-ray examination nor respiratory function test were performed. On the laryngeal endoscopy examination, the arytenoid region was found to be edematous and pale. No other abnormalities that may cause coughing were found on a general examination. We therefore diagnosed the patient with a laryngeal allergy according to the criteria proposed by the Society for the Study of Laryngeal Allergy in Japan (2005). Oral histamine H1-receptor blocker therapy subsequently cured her of the cough and resolved the laryngeal findings. Attention should be paid to the potential for laryngeal allergies when treating children with symptoms of coughing.
We herein report a case of thermal epiglottitis in a 4-year-old boy who swallowed hot tea. The previously healthy patient presented to our outpatient clinic complaining of swallowing pain one day after swallowing hot tea from the spout of a tea pot. On the initial physical examination, he exhibited smalls areas of slight scalding on the tongue and soft palate. Although the damage to the oral cavity was not severe, a fiberscopic examination revealed an erythematous and edematous epiglottis partially covered with a whitish coating. The patient was therefore hospitalized and received treatment with ceftriaxone and predonine. He was able to tolerate soft foods within 24 hours and subsequently discharged from the hospital after 48 hours of observation. A history of swallowing a hot beverage from the spout of kettle or tea pot is an important clue suggesting a thermal burn of the larynx. In order to prevent overlooking a potential diagnosis of thermal epiglottitis, which may cause dyspnea on occasion, the importance of conducting a laryngoscopic examination should be emphasized in patients with a history of any of the following findings: 1) swallowing from the spout of kettle; 2) eating unequally cooled hot foods, the exterior of which is cooled, while the interior is not, such as spring rolls or pastries; 3) consuming microwave heated foods or beverages; 4) mental impairment.
Tetanus is generally diagnosed on the basis of presenting typical symptoms and a trauma incident. It often begins with mild spasms in the jaw muscles, or so called lockjaw. However, if the initial symptoms are not typical, accurate diagnosis is rather difficult. We observed generalized tetanus of a 76-year-old female who complained of progressive dysphagia without an obvious history of trauma. During the initial visit to our hospital, there was no definite evidence of cervical pain nor dysphagia. Eventually dysphagia and neck pain as well as stiffness gradually appeared and worsened. When she was no longer able to eat, she was admitted to our hospital. Videofluoroscopic findings revealed residue in both pyriform sinuses due to reduced pharyngeal contraction. The day after she was admitted, she had whole body convulsions for ten minutes. At this point, she was clinically diagnosed with tetanus. Immunoglobulin and an antibiotic were immediately administrated. Ten days later, her critical symptoms including severe dysphagia gradually improved. The experience of our rare case indicate that tetanus should be included in the differential diagnoses for progressive dysphagia even if there was no definite history of injury.
Type I thyroplasty is a surgery performed for unilateral vocal cord paralysis to reduce hoarseness and aspiration. We herein report the case of a 69-year-old male whose implant was removed (Gore-Tex®) after type I thyroplasty. The patient complained of hoarseness and aspiration after aortic aneurysm surgery, and was diagnosed with left vocal cord paralysis. He underwent type I thyroplasty 11 months after aortic dissection. Although his voice and swallowing disorders were improved, he had persistent cervical discomfort. The Gore-Tex® was therefore removed two years and 10 months after the thyroplasty. The extraction was easily performed without adhesion of the implant, and did not affect the phonetic functions of the patient. Our case shows that with Gore-Tex® thyroplasty, improved phonetic function is maintained if the implant is left in place for at least six months, as discussed in previous reports.
Malignant lymphoma rarely occurs in the larynx and sometimes presents with symptoms similar to those of acute epiglottitis. We experienced a case of malignant lymphoma that was difficult to diagnose based on atypical local findings. The patient was a 66-year-old male who had complained of a sore throat for one week and consulted a nearby otolaryngologist. He was diagnosed with acute epiglottitis and referred to our hospital. Upon presentation, his epiglottis was reddish and swollen, similar to the findings of acute epiglottitis, although there were no laboratory data indicative of acute inflammation. The patien’s symptoms and local findings were subsequently improved by treatment with antibiotics and an intravenous steroid drip for three days. However, seven months later，the same symptoms recurred and a white mass appeared on the surface of the oropharynx (anterior palatine arch and root of the tongue)with cervical lymph node swelling. No inflammatory reactions were observed on laboratory studies, and the finding of CT, MRI and PET examinations did not suggest any malignant tumors. Therefore, biopsies of the larynx, oropharynx and cervical lymph nodes were performed several times, and the patient was ultimately diagnosed with peripheral T-cell lymphoma. He was subsequently treated with chemoradiotherapy and completely recovered. However, the disease recurred in the intestines two years later, and he died of aspiration pneumonia and ileus. Although malignant lymphoma that occurs in the larynx is rare, it is necessary to consider this disease in the differential diagnosis in patients with symptoms similar to acute epiglottitis.