Endoscopic laryngeal findings in patients undergoing thyroid and parathyroid surgery

2021 ◽  
Vol 135 (3) ◽  
pp. 264-268
Author(s):  
E S Burckardt ◽  
B J Baird ◽  
J H Van Stan ◽  
J A Burns
Keyword(s):  
Practice Guideline ◽  
Vocal Fold ◽  
Tertiary Care ◽  
Common Finding ◽  
Endocrine Surgery ◽  
Parathyroid Surgery ◽  
Voice Change ◽  
Endoscopic Findings ◽  
Before And After ◽  
Vocal Fold Immobility

AbstractObjectivesThis study aimed to report the pre- and post-operative laryngeal endoscopic findings in patients referred by non-otolaryngologists who are undergoing thyroid and/or parathyroid surgery, and to determine the number and nature of referrals before and after the release of the clinical practice guideline for improving voice outcomes after thyroid surgery.MethodsThis retrospective cohort study, conducted at a tertiary care academic hospital, comprised adult patients referred by the endocrine surgery service for laryngoscopy from 2007 to 2018 (n = 166). Data regarding patient demographics, reason for referral and endoscopic findings were recorded.ResultsThe number of referrals increased significantly after the release of the practice guideline. The most common indication for referral pre- and post-operatively was voice change. The most common finding during laryngoscopy was normal examination findings (pre-operatively) and unilateral vocal fold immobility (post-operatively).ConclusionPeri-operative thyroid and/or parathyroid patients have laryngoscopic findings other than vocal fold immobility. Laryngoscopy to detect structural and functional pathology is warranted.

Unilateral transverse cordotomy for bilateral abductor vocal fold immobility

2012 ◽  
Vol 126 (9) ◽  
pp. 913-917 ◽  
Author(s):  
J M Bernstein ◽  
S M Jones ◽  
P H Jones
Keyword(s):  
Vocal Fold ◽  
Case Series ◽  
University Hospital ◽  
Symptom Scale ◽  
Voice Change ◽  
Airway Function ◽  
Scale Scores ◽  
Before And After ◽  
Vocal Fold Immobility

AbstractObjective:We present a case series with airway compromise due to bilateral abductor vocal fold paralysis or fixation, treated with unilateral transverse cordotomy.Methods:Of eight consecutive patients with dyspnoea due to bilateral paramedian vocal fold immobility, seven underwent unilateral transverse cordotomy between August 2006 and April 2010 at University Hospital of South Manchester, UK. Airway and voice outcomes were compared before and after surgery.Results:All seven treated cases derived subjective airway function improvement; there was no aspiration. The eighth case had inadequate access. None of the seven treated patients required contralateral cordotomy or permanent tracheostomy. One treated case required a temporary tracheostomy; unilateral transverse cordotomy facilitated eventual decannulation. Two patients died of cancer at five and six weeks, variously. At a mean follow up of 22 months, four cases showed unchanged or slightly worse Voice Symptom Scale and Grade-Roughness-Breathiness-Asthenia-Strain scale scores.Conclusion:In patients with bilateral abductor vocal fold immobility, unilateral transverse cordotomy results in improved dyspnoea with either no voice change or only slight worsening. This is a more conservative procedure than bilateral transverse cordotomy, with the potential for better preservation of voice and breath support.

scholarly journals Pattern of upper gastrointestinal diseases: an audit of 1000 cases based on endoscopic findings from a tertiary care hospital in Mysore

2018 ◽  
Vol 5 (7) ◽  
pp. 2412
Author(s):  
Shashikumar H. B. ◽  
Madhu B. S. ◽  
Motati Harshini
Keyword(s):  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Gastrointestinal Symptoms ◽  
Gastrointestinal Diseases ◽  
Cross Sectional Study ◽  
Common Finding ◽  
Care Hospital ◽  
Cross Sectional ◽  
Endoscopic Findings ◽  
Upper Gastrointestinal

Background: Fibreoptic endoscopy is a highly efficient diagnostic tool, which is now increasingly being used in the diagnosis of upper gastrointestinal diseases. This study has been carried out to evaluate the distribution of various upper gastrointestinal diseases based on endoscopic findings in a tertiary care hospital in Mysore.Methods: A cross-sectional study was conducted based on data from endoscopic register of 1000 subjects who underwent endoscopy for various upper gastrointestinal symptoms from 1st January 2017 to 31st December 2017(one year).Results: Mean age of the study population was 50.23 years (SD-15.46). Minimum age was 12 years and maximum was 88 years. About 44.7% of the study subjects belonged to 40-60 age group.61.6% of the study subjects were males. Most common indication was pain abdomen (32.1%) followed by dysphagia (22.2%). Of the 1000 study subjects 18.6% had normal findings. Most common finding was Gastritis / Duodenitis /Gastric erosions (28%). Malignant lesions were noted among 11.1%, of which esophagus and stomach are 5.4% and 4.9% respectively.Conclusions: Endoscopic diagnosis is useful for early detection of UGI diseases and helpful for their management.

scholarly journals Acute Contained Ruptured Aortic Aneurysm Presenting as Left Vocal Fold Immobility

2015 ◽  
Vol 2015 ◽  
pp. 1-3
Author(s):  
Sharon H. Gnagi ◽  
Brittany E. Howard ◽  
Joseph M. Hoxworth ◽  
David G. Lott
Keyword(s):  
Aortic Aneurysm ◽  
Ct Scan ◽  
Vocal Fold ◽  
Recurrent Laryngeal Nerve Palsy ◽  
Tertiary Care ◽  
Care Facility ◽  
Aortic Aneurysms ◽  
Ruptured Aortic Aneurysm ◽  
Tertiary Care Facility ◽  
Vocal Fold Immobility

Objective. To recognize intrathoracic abnormalities, including expansion or rupture of aortic aneurysms, as a source of acute onset vocal fold immobility.Methods. A case report and review of the literature.Results. An 85-year-old female with prior history of an aortic aneurysm presented to a tertiary care facility with sudden onset hoarseness. On laryngoscopy, the left vocal fold was immobile in the paramedian position. A CT scan obtained that day revealed a new, large hematoma surrounding the upper descending aortic stent graft consistent with an acute contained ruptured aortic aneurysm. She was referred to the emergency department for evaluation and treatment by vascular surgery. She was counseled regarding surgical options and ultimately decided not to pursue further treatment. Her vocal fold immobility was subsequently treated via office-based injection medialization two weeks after presentation and again 5 months after the initial injection which dramatically improved her voice. Follow-up CT scan at 8 months demonstrated a reduction of the hematoma. The left vocal cord remains immobile to date.Conclusion. Ortner’s syndrome, or cardiovocal syndrome, is hoarseness secondary to left recurrent laryngeal nerve palsy caused by cardiovascular pathology. It is a rare condition and, while typically presenting gradually, may also present with acute symptomatology.

Lessons Learned From a Single-Surgeon Experience of More Than 1700 Parathyroidectomies

2020 ◽  
Vol 163 (4) ◽  
pp. 729-736
Author(s):  
David J. Terris ◽  
Ahmad Eltelety ◽  
Zachary Zimmerman ◽  
Luke Edelmayer
Keyword(s):  
Learning Curve ◽  
Demographic Data ◽  
Tertiary Care ◽  
Lessons Learned ◽  
Endocrine Surgery ◽  
Parathyroid Surgery ◽  
Data Set ◽  
Systematic Analysis ◽  
Initial Surgery ◽  
Surgeon Experience

Objective To define critical elements that contribute to successful parathyroidectomy based on a high-volume single-surgeon experience and explore learning curve characteristics. Study Design Systematic analysis of prospectively maintained quality assurance database. Setting Academic tertiary care endocrine surgery practice. Subjects and Methods In total, 4737 consecutive patients who underwent thyroid or parathyroid surgery from 2004 to 2020 were identified. Demographic data acquisition was undertaken on a subset of these patients who had initial surgery for primary hyperparathyroidism during the academic years 2005 to 2018. Patients with renal or syndromic hyperparathyroidism and those undergoing reoperative surgery were excluded. Results From 1710 patients who underwent parathyroid surgery, 1082 met inclusion criteria in order to focus on a homogeneous data set. These patients had a mean age of 60.1 ± 12.5 years and 76.4% were female. The overall cure rate was 98.3%, reflecting a success rate that increased from 95.5% during the first 200 cases to 99.7% over the final 300 cases. The complication rate was 1.7%. Over 2 decades, the patient phenotype evolved toward milder disease and smaller adenomas. A learning curve of 200 cases was required to become a proficient parathyroid surgeon; to achieve exceptional results required several hundred additional cases. Parathyroid surgery represents a higher proportion of an endocrine surgery practice than previously (54.0% in 2019 compared with 25.5% in 2004). Conclusion A focused practice dedicated to endocrine surgery yields surgical volumes exceeding 500 cases annually. There has been a steady shift toward parathyroid surgery. A lengthy learning curve can be shortened by pursuit of several specific strategies that are outlined in detail.

scholarly journals A study on evaluation of upper gastrointestinal endoscopic findings in established acute pancreatitis patients in tertiary care hospital

2019 ◽  
Vol 6 (7) ◽  
pp. 2336
Author(s):  
G. V. Prakash ◽  
A. Satish Kumar ◽  
M. Vijay Kumar ◽  
S. Nagamuneiah ◽  
G. Rajaram ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Ct Scan ◽  
Tertiary Care ◽  
Common Finding ◽  
Common Symptom ◽  
Care Hospital ◽  
Duodenal Ulcers ◽  
Ulcer Disease ◽  
Endoscopic Findings ◽  
Upper Gastrointestinal

Background: The objective of the study was to enumerate the different mucosal lesions in established acute pancreatitis on upper gastrointestinal endoscopy.Methods: We prospectively conducted a study on patients with acute pancreatitis above the age of 18 year having aute onset of typical abdominal pain consistent with acute pancreatitis, or Serum amylase and/ or lipase level >2 times the upper limit of normal or characteristic findings of acute pancreatitis on an abdominal computed tomography (CT) scan or on ultrasonography. Patients who are unfit or not willing for endoscopy or had endoscopy –proved peptic ulcer disease in the recent 3 months were excluded.Results: In the present study, the most common age group presenting with acute pancreatitis was between 30 to 60 years. In present study, alcohol is the more common cause for acute pancreatitis, accounting for 90% of the study group and pain abdomen is the most common symptom. In the present study, CT scan is most (100%) confirmatory diagnostic investigation of acute pancreatitis. In the present study, out of 80 patients with acute pancreatitis who were subjected to OGD, 72 patients had positive upper gastrointestinal finding. In patients having significant OGD findings, gastritis (42 cases, 52.5%) accounted for the most common finding. In the present study the prevalence of H. pylori infection is only 26.3%. Enlarged pancreas is the only CT finding in most cases.Conclusions: Esophagitis and gastric and duodenal ulcers are common endoscopic findings in acute pancreatitis. They are not correlated with the severity of pancreatitis. 

scholarly journals The utility of surgeon performed transcutaneous laryngeal ultrasound for the assessment of vocal cords in post-thyroidectomy patients

2018 ◽  
Vol 5 (11) ◽  
pp. 3505 ◽  
Author(s):  
Dhalapathy Sadacharan ◽  
Jabamalai Ferdinant ◽  
Kaharin Rakeshchandru ◽  
Sundarram Thalavai
Keyword(s):  
Vocal Cord ◽  
Tertiary Care ◽  
Standard Technique ◽  
Vocal Cord Palsy ◽  
Endocrine Surgery ◽  
Invasive Technique ◽  
Vocal Cords ◽  
Non Invasive ◽  
Before And After ◽  
A Prospective Study

Background: Post-thyroidectomy vocal cord palsy is a significant procedure associated complication and a notable contributor for medico-legal litigation. The standard technique for vocal cord evaluation and the most commonly used tool is direct laryngoscopy. Endocrine surgeons generally address the patients to otolaryngologist for laryngoscopy, leading to extra expense and time loss. Laryngoscopy causes patient annoyance and could potentially contribute to poor patient compliance. Ultrasonography is a non-invasive technique that is regularly used by endocrine surgeons to examine the thyroid region.Methods: A prospective study conducted on patients who underwent thyroidectomy between September 2016 and August 2017 at endocrine surgery department in a tertiary care institute (South India), Surgeon performed ultrasound (SPU) and Video laryngoscopy (VDL) was performed before and after elective thyroidectomy.Results: 155 patients who consented were categorized in the study, 2 of the patients included in the study had preoperative vocal cord palsy and 12 of them had unilateral postoperative vocal cord palsy detected using VDL. In general, the postoperative vocal cord palsy rate was 6.45%. Postoperative SPU was ineffective in assessing vocal cords in 16(10.32%) of patients. SPU had a sensitivity of 83.33% and negative predictive value of 97.90%, for the visualization of vocal cords in the postoperative period.Conclusions: SPU is convenient and non-invasive technique which could provide our speciality with cheap yet powerful diagnostic tool for vocal cord assessment in post-thyroidectomy patients and can potentially decrease the requirement of difficult and cumbersome VDL.

Application of a Computer Vision Tool for Automated Glottic Tracking to Vocal Fold Paralysis Patients

2021 ◽  
pp. 019459982198960
Author(s):  
Tiffany V. Wang ◽  
Nat Adamian ◽  
Phillip C. Song ◽  
Ramon A. Franco ◽  
Molly N. Huston ◽  
...  
Keyword(s):  
Vocal Fold ◽  
Assessment Tool ◽  
Medical Center ◽  
Characteristic Curve ◽  
Academic Medical Center ◽  
Vocal Fold Paralysis ◽  
Control Group ◽  
Large Patient ◽  
Patient Reported ◽  
Before And After

Objectives (1) Demonstrate true vocal fold (TVF) tracking software (AGATI [Automated Glottic Action Tracking by artificial Intelligence]) as a quantitative assessment of unilateral vocal fold paralysis (UVFP) in a large patient cohort. (2) Correlate patient-reported metrics with AGATI measurements of TVF anterior glottic angles, before and after procedural intervention. Study Design Retrospective cohort study. Setting Academic medical center. Methods AGATI was used to analyze videolaryngoscopy from healthy adults (n = 72) and patients with UVFP (n = 70). Minimum, 3rd percentile, 97th percentile, and maximum anterior glottic angles (AGAs) were computed for each patient. In patients with UVFP, patient-reported outcomes (Voice Handicap Index 10, Dyspnea Index, and Eating Assessment Tool 10) were assessed, before and after procedural intervention (injection or medialization laryngoplasty). A receiver operating characteristic curve for the logistic fit of paralysis vs control group was used to determine AGA cutoff values for defining UVFP. Results Mean (SD) 3rd percentile AGA (in degrees) was 2.67 (3.21) in control and 5.64 (5.42) in patients with UVFP ( P < .001); mean (SD) 97th percentile AGA was 57.08 (11.14) in control and 42.59 (12.37) in patients with UVFP ( P < .001). For patients with UVFP who underwent procedural intervention, the mean 97th percentile AGA decreased by 5 degrees from pre- to postprocedure ( P = .026). The difference between the 97th and 3rd percentile AGA predicted UVFP with 77% sensitivity and 92% specificity ( P < .0001). There was no correlation between AGA measurements and patient-reported outcome scores. Conclusions AGATI demonstrated a difference in AGA measurements between paralysis and control patients. AGATI can predict UVFP with 77% sensitivity and 92% specificity.

scholarly journals Surgical outcome of primary intradural spinal arachnoid cysts: a series of 10 cases

2021 ◽  
Vol 57 (1) ◽  
Author(s):  
Essam Abdelhameed ◽  
Ahmed Ali Morsy
Keyword(s):  
Tertiary Care ◽  
Outer Wall ◽  
Arachnoid Cysts ◽  
Neurophysiological Monitoring ◽  
Japanese Orthopedic Association ◽  
Common Location ◽  
Before And After ◽  
Microsurgical Resection ◽  
Tertiary Care Centers ◽  
Intradural Arachnoid Cysts

Abstract Background Primary intradural spinal arachnoid cysts are rare pathologies of uncertain etiology and variable presentation from no symptoms to myelopathy or radiculopathy according to cord or root compression. MRI with diffusion and contrast differentiates them from many pathologies. There is a lot of debate regarding when to treat and how to treat such rare pathologies. Objective We present a series of 10 primary intradural arachnoid cysts and evaluate outcome after surgery. Methods This retrospective study includes patients having primary intradural spinal arachnoid cysts operated in two tertiary care centers from October 2012 till October 2019. Symptomatic cysts were subjected to microsurgical resection or outer wall excision and inner wall marsupialization under neurophysiological monitoring. The Japanese Orthopedic Association Score was used for clinical evaluation while MRI with contrast and diffusion was used for radiological evaluation before and after surgery. Results This series included 10 patients, 4 males and 6 females, with mean age of 40 years. Pain was the most common presentation. The most common location was dorsal thoracic region. Total excision was achieved in 2 cases and marsupialization in 8 cases. All symptoms improved either completely or partially after surgery. No neurological deterioration or recurrence was reported during the follow-up period in this series. Conclusion Treatment of symptomatic primary intradural spinal arachnoid cysts should be microsurgical resection, when the cyst is adherent to the cord, microscopic fenestration can be safe and effective.

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