Life-Threatening Stridor due to Laryngeal Tuberculosis in the COVID-19 Era: Report of a Case

Laryngeal tuberculosis is the most frequent granulomatous disease of the larynx and it is prone to be diagnosed as cancer. COVID-19 pandemic caused considerable disruption in tuberculosis service provisions both in the primary care and hospital settings. This report describes a rare case of life-threatening stridor in a patient who presented with an ulceroproliferative laryngeal mass later confirmed as laryngeal tuberculosis. Urgent tracheostomy was performed. The patient’s sputum and the computed tomography of the chest revealed a pulmonary, as well as laryngeal tuberculosis. The patient was commenced on a 24 week course of anti-tuberculous treatment which was interrupted because of a mild course of hospital-acquired coronavirus infection. 3 months after initial treatment for tuberculosis, his sputum cultures became negative. Flexible laryngoscopy was performed at our department 4 months after commencement of treatment, demonstrating complete regression of the lesion and symmetrical laryngeal mobility, hence the patient was successfully decannulated and discharged to be followed up to his community hospital. In the time of COVID-19 pandemic, we should never underestimate other severe infectious diseases.

Effects of Bolus Holding on Respiratory–Swallow Coordination in Parkinson's Disease

Purpose: The aim of this study was to examine the effects of bolus holding on respiratory–swallow coordination (RSC) in people with Parkinson's disease (PD). Method: People with PD were prospectively recruited to undergo RSC assessment using simultaneous respiratory inductive plethysmography and flexible laryngoscopy. During RSC assessment, participants swallowed 5-ml thin liquid boluses during held and nonheld swallowing tasks. Measures of RSC were analyzed for each swallow, which included respiratory pause duration, lung volume at swallow initiation, respiratory phase patterning, and the presence of paradoxical respiratory movements. Multilevel statistical modeling was used to determine if differences in RSC were present between the held and nonheld tasks. Results: Thirty-three participants were enrolled. When compared to the nonheld swallows, the held swallows exhibited shorter respiratory pauses ( p = .001, R 2 = .019), lower lung volumes at swallow initiation ( p < .001, R 2 = .116), more frequent exhale–swallow–exhale patterns ( p < .001, OR = 4.30), and less frequent paradoxical respiratory movements ( p = .001, OR = 0.43). Conclusions: Findings from this study revealed that bolus holding significantly influences RSC in people with PD. This demonstrates that bolus holding may be an efficacious strategy to immediately improve RSC in PD. However, clinicians and researchers should consider avoiding bolus holding during swallowing evaluations if attempting to assess RSC behaviors that are most typical for the examinee.

Teratoma of larynx: case report

<p class="abstract">Teratomas are embryonal neoplasm arises from totipotent germ cells. They are having tissues from all the three blastodermic layers. There are various locations of congenital teratoma. Naso-oropharyngeal site teratoma are either sessile or pedunculated. We describe a rare case of laryngeal teratoma in a five years old patient presented with change in voice and breathing difficulty. On flexible laryngoscopy, it appeared like supraglottic cyst but on CT scan it was confirmed as teratoma. Pre-operative tracheostomy and transoral carbon dioxide laser assisted excision done. Histopathological examination showed osteoid trabeculae, chondroid tissue with loose myxoid islands and adipose tissue. No recurrence of tumor on 18 months follow-up. This is the first case report of pediatric larynx teratoma reported in present century.</p>

Predicting Gag, Discomfort, and Laryngeal Visualization in Patients Undergoing Flexible Laryngoscopy with Stroboscopy

Objective: To investigate potential associations between the Predictive Gagging Survey (PGS) with patient experience of gag and discomfort as well as provider perception of patient gag and level of laryngeal visualization during flexible laryngoscopy with stroboscopy (FL-S). Methods: A total of 53 adult patients undergoing FL-S were recruited for this prospective non-controlled study. PGS was completed before FL-S. Patients rated perceived level of gag and discomfort on a 10-point severity scale after FL-S. Additionally, providers completed a Gagging Severity Index (GSI) reflecting their impression of patient gag and level of laryngeal visualization following FL-S. Spearman rank correlation coefficients were used to assess associations. Results: There was a positive association with PGS score and patient perception of gagging (0.34; P = .013) and patient perception of discomfort (0.38; P = .005). No significant association was found between PGS score and provider GSI (−0.12; P = .39) or level of laryngeal visualization (0.15; P = .29). A negative association was found between level of laryngeal visualization and patient perception of gagging (−0.34; P = .012) and discomfort (−0.44; P = .001). No significant differences were found between current and former smokers compared to never smokers for GSI or patient-perceived gag or discomfort. Conclusions: While not predictive of GSI or level of laryngeal visualization, the PGS was found to be a useful tool in predicting patient experience of gagging and discomfort during FL-S, further reinforcing the subjective experience of this procedure. Use of the PGS may be helpful in identifying specific candidates who may struggle with subjective discomfort or gagging during FL-S for future studies considering interventions to manage and meaningfully decrease discomfort. Having such an instrument is important given the low number of individuals who struggle with discomfort during the exam.

Postcricoid haemangioma with laryngomalacia in infancy

Infantile haemangioma represents a congenital vascular anomaly commonly observed in the head and neck region. Such an occurrence over the postcricoid region, however, is rather unusual. Herein, the authors report a case of a synchronous postcricoid haemangioma in a 7-week-old newborn diagnosed with severe laryngomalacia. In addition to the floppy redundant arytenoid mucosa, flexible laryngoscopy revealed a lobulated bluish mass at the postcricoid. The lesion was hyperintense on T1-weighted sequence and was enhanced with contrast, supporting the diagnosis of a haemangioma. She underwent surgical excision of the haemangioma with intralesional steroid injection. Surveillance at 6-month postoperation did not show disease recurrence.

Epiglottic abscess as a rare cause of muffled voice

A 42-year-old male presented with fever and symptoms of impending upper airway obstruction on the day of presentation. He required immediate intubation due to swollen epiglottis. The condition responded to antibiotic and steroids, and he was able to be extubated after 3 days. Two days later, however, the epiglottis started to swell up again, this time with pus discharge. Emergency exploration and drainage of the epiglottic abscess were executed, and the patient was kept intubated for a few days afterwards for the swollen epiglottis to reduce in size. Daily flexible laryngoscopy was commenced to monitor the disease status. After completing the antibiotic therapy the patient was discharged in good general condition.

Incidentally Found Killian-Jaimeson Diverticulum During Thyroidectomy: A Case Report

The aim of this case study is to demonstrate the very rare coincidental existence and management of a Killian-Jamieson diverticulum (KJD) during thyroid surgery. A 57-year-old woman was referred to our clinic with a malignant thyroid nodule and the complaint of a sore throat. There were no suspicions concerning a diverticulum on examining her with flexible laryngoscopy or ultrasound imaging. During the right central neck dissection, we noticed a 3 × 3 cm KJD and resected it while preserving the recurrent laryngeal nerve. After the successful operation, we questioned the patient and learned that for 1 year she had an occasional complaint of dysphagia. Postoperatively, there was no vocal cord palsy or hypocalcemia, and there was no pharyngoesophageal leak after oral alimentation. There was no recurrence or complaint for KJD or papillary carcinoma for 8 years follow-up. Nonspecific symptoms like a sore throat should be investigated, and patients should be questioned for all aerodigestive symptoms. If necessary, further investigation should be undertaken for a differential diagnosis.