Unilateral Laryngeal Paralysis Secondary to Otitis Media/Interna in Two Cats

ABSTRACT Two adult cats were presented for coughing, gagging, dysphonia, exaggerated swallowing attempts, unilateral vestibular dysfunction, and/or Horner syndrome. In both cats, unilateral laryngeal paralysis was identified on the side ipsilateral to other neurological deficits. Cross-sectional imaging was consistent with otitis media/interna. In both cats, there also was extensive cellulitis surrounding the tympanic bulla and dissecting through tissue planes to involve the opening of the tympano-occipital fissure on the side ipsilateral to the laryngeal paralysis. Laryngeal paralysis was presumed secondary to involvement of the vagus nerve as it emerged from the tympano-occipital fissure. Antibiotic therapy resulted in resolution of clinical signs in both cats and restored laryngeal function as evidenced by visual examination of the larynx in one cat.

Predictive indicators of an unfavorable prognosis for the restoration of laryngeal functions in unilateral lesions of the recurrent laryngeal nerve in thyroid surgery

Recurrent laryngeal nerve (RLN) damage in thyroid surgery is a very dangerous complication. An otolaryngologist, especially at pri­mary care institutions,should administer conservative or surgical treatment in a timely manner and depending on the type of nerve damage (transient, permanent), i. e., to analyze possible prognosis of the disease. Only few studies to predict disease developmentin RLN have been performed. One of the most modern and informative methods is laryngeal electromyography using needle electrodes, but despite the sufficient number of patients with this pathology, in most medical institutions in Ukraine it is not performed, given the technical difficulties of implementation, invasiveness and difficulty in interpreting the results of this method.Aim — to analyze the laryngoscopic signs of paresis and paralysis of the larynx in thyroid surgery and to identify the most significant from them, which together can serve as prognostic criteria of the lack of recovery of laryngeal mobility (paralysis).Materials and methods. A single-site prospective study was conducted in the years 2018—2021 that involved 164 patients with postoperative laryngeal movement disorders, who were divided into two groups: subjects with laryngeal paralysis (n = 33) and patients with laryngeal paresis (n = 131). All patients underwent phoniatric examination. The following signs have been identified: general signs, including age, number of operations, scope of surgical intervention, and 18 laryngoscopicsigns, each of them had two to seven grades. For the convenience, the grades were coded with numbers and, if possible, arranged in ascending order of severity. The obtained results were processed with Fisher angular transformation.Results. Among 18 laryngoscopic and general signs, 10main (predictors) were identified, that affect the absence or presence of laryngeal paralysis. They included:elements of mobility of the paralyzed vocal cords (VC) (absent), flotation of the «paralyzed» VC (insignificant and pronounced), mobility of the arytenoid cartilage (absent), closure of the VC (complete non-closure), synchronicity of oscillations VC (absence of movement of the paralyzed VC), restriction of the movement of the «paralyzed» VC (absent (the GE is motionless), level of the VC in the vertical plane (not on the same level), the tension of the median edge of the VC (incurvate), patient’s age > 45 years, the position of the «paralyzed» VC (median and intermedian). The mathematical analysis showed that none of the isolated laryngoscopic signs can be used as an independent criterion in assessing the predictions of the laryngeal mobilityrestoration.Conclusions. Prognostic laryngoscopic signs of recurrent laryngeal nerve damage in the thyroid surgery allow to create a prognostic model of recovery or lack of recovery of laryngeal motility, which is important for the appointment of timely adequate treatment.

Anatomic characterization of the location of the esophageal ostium relative to the rima glottidis on CT in adult Labrador Retrievers

OBJECTIVE To characterize the anatomic location of the esophageal ostium relative to the rima glottidis in adult Labrador Retrievers with the use of CT. ANIMALS 98 CT scans of 75 adult Labrador Retrievers. PROCEDURES A search of the medical records database identified records of Labrador Retrievers that underwent CT of the head and neck between January 1, 2015, and December 31, 2018. Evaluators, blinded to each other's results, reviewed CT images and measured esophageal area at the level of the rima glottidis. For each dog, the left esophageal percentage (LEP) was calculated as the esophageal area left of the rima glottidis midline divided by the overall esophageal area at that level. Variables (age, sex, patient position, intubation status, and maxillary support during CT) were evaluated for association with LEP. The CT images of dogs that had multiple scans were assessed for within-patient variance. RESULTS Mean LEP was 56.2 ± 18.1% for all dogs. Only right lateral recumbency was significantly associated with LEP, with a lower LEP for dogs positioned in right lateral recumbency (42.4 ± 12.7%), compared with left lateral (63.0 ± 7.4%) or sternal (57.3 ± 18.8%) recumbency. No association was detected between LEP and other variables assessed. Eleven dogs had multiple CT scans; within-patient variance for LEP was ± 26.6%. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that, although most dogs had an LEP > 50%, the esophageal ostium was fairly centrally located in most dogs and may be more mobile than previously thought. Additional research is warranted to assess this mobility and whether the esophageal ostium location, relative to the larynx, affects the incidence of aspiration pneumonia in dogs undergoing surgical treatment for geriatric-onset laryngeal paralysis and polyneuropathy.

Acoustic Analysis of Voice Signal of Patients with Unilateral Laryngeal Paralysis a View to Objective Evaluation after Rehabilitation

We propose in this study an acoustic analysis called objective, based on physical measurements, to extract the acoustic characteristics of the voice of patients with Unilateral Laryngeal Paralysis. Our experiments were made at the Otorhinolaryngology service of the hospital of Bab El Oued. Algiers. (Algeria). In this work, an acoustic analysis of the vocal signal is based on measurements of the instability of the amplitude and frequency of the vibrations of the vocal cords. The results obtained are compared with those of a group of reference of subjects who normally speak. The study of the results obtained by the acoustic analysis of the pathological voice during the rehabilitation phase shows a strong correlation of the acoustic parameters between the pathological voice and the reference one. The exclusive use of hearing to evaluate the effect of voice rehabilitation in the Algerian hospital environment remains insufficient. It is important to correlate the perceptual information with the interpreted acoustic measurements, in a manner to be able to develop a therapeutic project appropriate to the patient’s expectations and difficulties.

Determining Medical Urgency of Voice Disorders Using Auditory-Perceptual Voice Assessments Performed by Speech-Language Pathologists

Objective: This study examined whether speech-language pathologist auditory-perceptual voice assessments can predict the medical urgency of voice disorders. Methods: Twenty speech-language pathologists (SLPs) evaluated 25 voice samples recorded during initial voice evaluations. Voice samples represented a range of dysphonia severity (mild-severe) balanced across patient diagnoses. Diagnoses included: benign lesions, laryngeal cancer, non-organic voice disorders, laryngeal edema (associated with LPR), and laryngeal paralysis or paresis. Laryngeal cancer and severe unilateral laryngeal paralysis were considered urgent disorders. While blinded to patient information, SLPs rated severity of voice quality, predicted patient diagnosis, and determined whether the patient should be seen urgently by a laryngologist. SLPs were then given basic medical history information and rated medical urgency of voice disorder a second time. Results: On average, SLPs correctly identified 65% of urgent voices and 87% of nonurgent voices when blinded to patient information. Accuracy improved significantly to 86% for urgent voices with medical history information ( P < .001) and decreased to 77% for nonurgent voices. Accuracy was better when severity of voice quality was severe for urgent voices and mild for nonurgent voices ( P < .001). SLPs indicated that patient smoking history and severity of dysphonia were most influential in their decision making. Diagnostic accuracy of auditory-perceptual assessments was poor. Conclusions: SLPs identified 86% of medically urgent voice disorders when auditory perceptual assessments were combined with medical history information. Further work is needed to determine what medical history information is most crucial to rating accuracy and what speech tasks might best separate urgent and nonurgent patients.

Laryngeal Paralysis Recovered Two Years after a Head Trauma by Growth Hormone Treatment and Neurorehabilitation

The aim of this study was to describe the cognitive and speech results obtained after growth hormone (GH) treatment and neurorehabilitation in a man who suffered a traumatic brain injury (TBI). Seventeen months after the accident, the patient was treated with growth hormone (GH), together with neurostimulation and speech therapy. At admission, the flexible laryngoscopy revealed that the left vocal cord was paralyzed, in the paramedian position, a situation compatible with a recurrent nerve injury. Clinical and rehabilitation assessments revealed a prompt improvement in speech and cognitive functions and, following completion of treatment, endoscopic examination showed recovery of vocal cord mobility. These results, together with previous results from our group, indicate that GH treatment is safe and effective for helping neurorehabilitation in chronic speech impairment due to central laryngeal paralysis, as well as impaired cognitive functions.

Laryngeal Paralysis Recovered Two Years After a Head Trauma by Growth Hormone Treatment and Neurorehabilitation

The aim of this study is to describe the cognitive and speech results obtained after growth hormone (GH) treatment and neurorehabilitation in a man that suffered a traumatic brain injury (TBI). 17 months after the accident, the patient was treated with growth hormone (GH), together with neurostimulation and speech therapy. At admission, the left vocal cord revealed paralyzed, in the paramedian position, a situation compatible with a recurrent nerve injury. Clinical and rehabilitation assessments revealed a prompt improvement in speech and cognitive functions, and following completion of treatment, endoscopic examination showed recovery of vocal cord mobility. These results, together with previous results from our group, indicate that GH treatment is safe and effective for helping neurorehabilitation in chronic speech impairment due to central laryngeal paralysis, as well as impaired cognitive functions.