Hoarseness due to Mycobacterium kansasii

2008 ◽  
Vol 123 (5) ◽  
pp. 569-571 ◽  
Author(s):  
D Wray ◽  
M O Oko ◽  
D A R Boldy ◽  
M T Butt
Keyword(s):  
Weight Loss ◽  
World Literature ◽  
Vocal Fold ◽  
Sputum Sample ◽  
Vocal Folds ◽  
Vocal Fold Paralysis ◽  
Mycobacterium Kansasii ◽  
Unilateral Vocal Fold Paralysis ◽  
Abnormal Chest ◽  
History Of

AbstractObjective:To present a case of unilateral vocal fold paralysis due to Mycobacterium kansasii induced pressure on the left recurrent laryngeal nerve, a specific aetiology not previously reported in the world literature.Case report:A 57-year-old Caucasian man presented with a short history of productive cough, fever, hoarseness and 14-kg weight loss. He was a smoker, had an abnormal chest X-ray and was human immunodeficiency virus negative. A sputum sample was positive on direct microscopy for acid fast bacilli. Initially, the patient was treated with Rifater (rifampicin, isoniazid and pyrazinamide) and ethambutol. Mycobacterium kansasii was isolated and proved sensitive to this antimycobacterial treatment. Nasoendoscopy revealed diminished movement of the left vocal fold, and a computed tomography scan showed enlarged mediastinal lymph nodes anterior to the aortic arch. After three months of antimycobacterial treatment, the vocal folds were fully mobile at repeat nasoendoscopy, and this coincided with gradual resolution of the patient's hoarseness and weight loss.Conclusions:There are many causes of unilateral vocal fold paralysis. This case illustrates the importance of anatomical knowledge in reaching a diagnosis, and also presents the first reported case of Mycobacterium kansasii creating this clinical picture.

Vocal Evaluation of Thyroplasty Type I in the Treatment of Nonparalytic Glottic Incompetence

1998 ◽  
Vol 107 (2) ◽  
pp. 113-119 ◽  
Author(s):  
Fang-Ling Lu ◽  
Donna S. Lundy ◽  
Roy R. Casiano ◽  
Jun-Wu Xue
Keyword(s):  
Vocal Fold ◽  
Vocal Folds ◽  
Vocal Fold Paralysis ◽  
Perceptual Judgment ◽  
Function Evaluation ◽  
Type I ◽  
Unilateral Vocal Fold Paralysis ◽  
Vocal Function ◽  
Voice Outcome ◽  
Minimal Improvement

This study investigated the prethyroplasty and postthyroplasty voices of patients with glottic incompetence of mobile vocal folds related to vocal fold bowing and scarring. Seventeen patients underwent vocal function evaluation preoperatively and 1 month postoperatively with videostrobolaryngoscopic examination, acoustic and aerodynamic analysis, and perceptual judgment of voice characteristics. The postoperative voice outcome in this group of patients was compared to that of a group of patients with unilateral vocal fold paralysis. Patients with vocal fold bowing showed significant improvement in glottic gap size and hoarseness after the surgery. There was minimal improvement on other test measures. Patients with vocal fold scarring exhibited worse preoperative and postoperative vocal functions, with little voice improvement after surgery. The outcome of thyroplasty type I in cases of vocal fold bowing or scarring is not as good as that in unilateral vocal fold paralysis.

The role of stroboscopy in the management of a patient with a unilateral vocal fold paralysis

1996 ◽  
Vol 110 (2) ◽  
pp. 141-143 ◽  
Author(s):  
Meredydd Lloyd Harries ◽  
Murray Morrison
Keyword(s):  
Surgical Treatment ◽  
Diagnostic Tool ◽  
Vocal Fold ◽  
Speech Therapy ◽  
Muscle Tone ◽  
Vocal Folds ◽  
Vocal Fold Paralysis ◽  
Unilateral Vocal Fold Paralysis

AbstractStroboscopy is well established as an essential diagnostic tool in the assessment of the vocal folds during phonation. This paper analyses the stroboscopic findings in 100 patients with a unilateral vocal fold paralysis. Reliable stroboscopic signals were only obtained in patients with the paralysed fold close to the midline. These patients seldom require surgery however, usually responding to speech therapy with laryngeal compensation giving a good voice. Most patients that require surgery have a large glottal deficiency, but in this series these patients did not give an adequate signal for analysis. Although useful in the assessment of the muscle tone of the paralysed fold, the influence of stroboscopy on the surgical treatment in this series was limited.

scholarly journals Unilateral Laryngeal Pacing System and Its Functional Evaluation

2017 ◽  
Vol 2017 ◽  
pp. 1-8 ◽  
Author(s):  
Taiping Zeng ◽  
Zhiping Zhang ◽  
Weiwei Peng ◽  
Fei Zhang ◽  
Baker Y. Shi ◽  
...  
Keyword(s):  
Vocal Fold ◽  
Vocal Folds ◽  
Electronic System ◽  
Vocal Fold Paralysis ◽  
Functional Evaluation ◽  
Unilateral Vocal Fold Paralysis ◽  
Ipsilateral Side ◽  
Instrumental System ◽  
Healthy Side ◽  
Opening And Closing

Goal. To establish a reliable instrumental system for synchronized reactivation of a unilaterally paralyzed vocal fold and evaluate its functional feasibility.Methods. Unilateral vocal fold paralysis model was induced by destruction of the left recurrent laryngeal nerve (RLN) in anesthetized dogs. With a micro controller-based electronic system, electromyography (EMG) signals from cricothyroid (CT) muscle on the ipsilateral side were recorded and used to trigger pacing of paralyzed vocalis muscles. The dynamic movement of vocal folds was continuously monitored using an endoscope, and the opening and closing of the glottis were quantified with customized imaging processing software.Results. The recorded video images showed that left side vocal fold was obviously paralyzed after destructing the RLN. Using the pacing system with feedback triggering EMG signals from the ipsilateral CT muscle, the paralyzed vocal fold was successfully reactivated, and its movement was shown to be synchronized with the healthy side.Significance. The developed unilateral laryngeal pacing system triggered by EMG from the ipsilateral side CT muscle could be successfully used in unilateral vocal fold paralysis with the advantage of avoiding disturbance to the healthy side muscles.

scholarly journals A computational study of the role of the aortic arch in idiopathic unilateral vocal-fold paralysis

2015 ◽  
Vol 118 (4) ◽  
pp. 465-474 ◽  
Author(s):  
Megan J. Williams ◽  
Avinash Ayylasomayajula ◽  
Reza Behkam ◽  
Andrew J. Bierhals ◽  
M. Eileen Jacobs ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Material Properties ◽  
Vocal Fold ◽  
Computational Study ◽  
Peak Stress ◽  
Vocal Folds ◽  
Vocal Fold Paralysis ◽  
Stress And Strain ◽  
Unilateral Vocal Fold Paralysis ◽  
Element Analysis

Unilateral vocal-fold paralysis (UVP) occurs when one of the vocal folds becomes paralyzed due to damage to the recurrent laryngeal nerve (RLN). Individuals with UVP experience problems with speaking, swallowing, and breathing. Nearly two-thirds of all cases of UVP is associated with impaired function of the left RLN, which branches from the vagus nerve within the thoracic cavity and loops around the aorta before ascending to the larynx within the neck. We hypothesize that this path predisposes the left RLN to a supraphysiological, biomechanical environment, contributing to onset of UVP. Specifically, this research focuses on the identification of the contribution of the aorta to onset of left-sided UVP. Important to this goal is determining the relative influence of the material properties of the RLN and the aorta in controlling the biomechanical environment of the RLN. Finite element analysis was used to estimate the stress and strain imposed on the left RLN as a function of the material properties and loading conditions. The peak stress and strain in the RLN were quantified as a function of RLN and aortic material properties and aortic blood pressure using Spearman rank correlation coefficients. The material properties of the aortic arch showed the strongest correlation with peak stress [ρ = −0.63, 95% confidence interval (CI), −1.00 to −0.25] and strain (ρ = −0.62, 95% CI, −0.99 to −0.24) in the RLN. Our results suggest an important role for the aorta in controlling the biomechanical environment of the RLN and potentially in the onset of left-sided UVP that is idiopathic.

Unilateral vocal fold paralysis: can laryngoscopy predict recovery? A prospective study

2014 ◽  
Vol 128 (12) ◽  
pp. 1095-1104 ◽  
Author(s):  
J K R Menon ◽  
R M Nair ◽  
S Priyanka
Keyword(s):  
Prospective Study ◽  
Vocal Fold ◽  
Reliability Assessment ◽  
Vocal Folds ◽  
Vocal Fold Paralysis ◽  
Unilateral Vocal Fold Paralysis ◽  
Observer Reliability ◽  
Arytenoid Dislocation ◽  
A Prospective Study ◽  
Good Agreement

AbstractObjective:To determine the prognostic value of laryngoscopy in predicting the recovery of unilateral vocal fold paralysis.Method:A prospective study was carried out of all patients with unilateral vocal fold paralysis without a progressive lesion or arytenoid dislocation.Results:Among the 66 candidates, 15 recovered. Patients with interarytenoid paralysis (p < 0.001) or posterolateral tilt of the arytenoid (p = 0.028) had less chance of recovery. Among 51 patients who did not recover, 25.49 per cent regained phonatory function by compensatory movement of the normal side; the rest required an intervention. Intervention requirement was significantly less for those patients who had isolated glottic level compensation. The paralysed vocal fold was at the same level in 32.35 per cent of patients, higher in 38.23 per cent and lower in 29.42 per cent. In those in whom vocal folds were in the abducted position (46.67 per cent), the affected vocal fold was at a lower position on phonation. Inter-observer reliability assessment revealed excellent to good agreement for all criteria.Conclusion:Interarytenoid paralysis and posterolateral tilt of the arytenoid were predictors of poor recovery.

scholarly journals Does laryngeal reinnervation or type I thyroplasty give better voice results for patients with unilateral vocal fold paralysis (VOCALIST): study protocol for a feasibility randomised controlled trial

BMJ Open ◽  
2017 ◽  
Vol 7 (9) ◽  
pp. e016871 ◽  
Author(s):  
Helen Blackshaw ◽  
Paul Carding ◽  
Marcus Jepson ◽  
Marina Mat Baki ◽  
Gareth Ambler ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Vocal Fold ◽  
Controlled Trial ◽  
Vocal Folds ◽  
Vocal Fold Paralysis ◽  
Type I ◽  
Unilateral Vocal Fold Paralysis ◽  
Laryngeal Reinnervation ◽  
Randomised Controlled ◽  
Type I Thyroplasty

IntroductionA functioning voice is essential for normal human communication. A good voice requires two moving vocal folds; if one fold is paralysed (unilateral vocal fold paralysis (UVFP)) people suffer from a breathy, weak voice that tires easily and is unable to function normally. UVFP can also result in choking and breathlessness. Current treatment for adults with UVFP is speech therapy to stimulate recovery of vocal fold (VF) motion or function and/or injection of the paralysed VF with a material to move it into a more favourable position for the functioning VF to close against. When these therapies are unsuccessful, or only provide temporary relief, surgery is offered. Two available surgical techniques are: (1) surgical medialisation; placing an implant near the paralysed VF to move it to the middle (thyroplasty) and/or repositioning the cartilage (arytenoid adduction) or (2) restoring the nerve supply to the VF (laryngeal reinnervation). Currently there is limited evidence to determine which surgery should be offered to adults with UVFP.Methods and analysisA feasibility study to test the practicality of running a multicentre, randomised clinical trial of surgery for UVFP, including: (1) a qualitative study to understand the recruitment process and how it operates in clinical centres and (2) a small randomised trial of 30 participants recruited at 3 UK sites comparing non-selective laryngeal reinnervation to type I thyroplasty. Participants will be followed up for 12 months. The primary outcome focuses on recruitment and retention, with secondary outcomes covering voice, swallowing and quality of life.Ethics and disseminationEthical approval was received from National Research Ethics Service—Committee Bromley (reference 11/LO/0583). In addition to dissemination of results through presentation and publication of peer-reviewed articles, results will be shared with key clinician and patient groups required to develop the future large-scale randomised controlled trial.Trial registration numberISRCTN90201732; 16 December 2015.

Myasthenia gravis mimicking unilateral vocal fold paralysis at presentation

2006 ◽  
Vol 121 (2) ◽  
pp. 174-178 ◽  
Author(s):  
D M Hartl ◽  
S Leboulleux ◽  
P Klap ◽  
M Schlumberger
Keyword(s):  
Myasthenia Gravis ◽  
Vocal Fold ◽  
Current Knowledge ◽  
Voice Quality ◽  
Vocal Folds ◽  
Flexible Endoscopy ◽  
Clinical Analysis ◽  
Vocal Fold Paralysis ◽  
Motor Deficits ◽  
Unilateral Vocal Fold Paralysis

Objectives: To demonstrate the importance of detailed clinical analysis in the differential diagnosis of unilateral vocal fold paralysis, and to provide an update on current knowledge and treatment of myasthenia gravis.Case report: A female patient presented with left unilateral vocal fold immobility. Diagnostic investigation revealed a 10 mm thyroid adenoma, but no other abnormality likely to cause unilateral vocal fold paralysis. Follow-up flexible endoscopy at three months showed laryngeal remobilisation with persistent left vocal fold bowing and vertical asymmetry of the vocal folds on phonation. Over the following months, voice quality varied between normal and breathy, with the breathy periods lasting from three days to one month. Laryngeal electromyography (EMG) showed a slight bilateral paradoxical activation of both posterior crico-arytenoid muscles on phonation. Magnetic resonance imaging of the brain and brainstem was normal. A diagnostic test for myasthenia gravis with intravenous edrophonium bromide (Tensilon®) lead to an immediate improvement in voice quality. The patient was subsequently treated with pyridostigmine bromide, with complete resolution of dysphonia.Conclusions: Myasthenia gravis affecting the larynx may mimic unilateral vocal fold paresis or paralysis. A personal or family history of auto-immune disease, fluctuating symptoms, motor deficits in cranial nerve territories, and normal or subnormal laryngeal EMG results should lead the physician to reconsider a diagnosis of idiopathic unilateral vocal fold paralysis and to perform specific testing.

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