Laryngeal framework surgery for the management of aspiration in high vagal lesions.
Pou AM. Carrau RL. Eibling DE. Murry T.
Department of Otolaryngology, University of Pittsburgh School of Medicine, PA 15213, USA.
PURPOSE: The purpose of this study is to ascertain the effectiveness of laryngeal framework surgery, including medialization thyroplasty (MT), with or without arytenoid adduction (AA), on preventing aspiration, improving diet, and aiding in the subsequent decannulation of individuals with high vagal lesions. PATIENTS AND METHODS: A retrospective chart review was performed on each patient presenting with a high vagal lesion who was treated with laryngeal framework surgery from June 1992 to April 1996 at a university medical center. Thirty-five patients were identified; there were 20 women and 15 men, with a median age of 51. Information regarding etiology of the lesion, characteristics of the vocal cord deficits, degree of aspiration, the presence of other neurologic deficits and concurrent pulmonary disease, treatment, and outcome was obtained. The final outcome regarding voice, the presence and degree of aspiration, diet, and decannulation following MT, with or without AA, was assessed to determine the effectiveness of these procedures. RESULTS: Thirty-five patients underwent 40 MTs and 19 AAs. Ninety-four percent of patients who experienced aspiration improved, and 79% who had required tracheotomy were decannulated. Ninety percent of patients were noted to have subjective improvement in voice postoperatively. CONCLUSION: Laryngeal framework surgery improves airway, deglutition, and voice in individuals suffering from high vagal lesions, and facilitates the rehabilitation of these patients.
Aspiration in unilateral recurrent laryngeal nerve paralysis after surgery.
Perie S. Laccourreye O. Bou-Malhab F. Brasnu D.
Service d'ORL et de Chirurgie Cervico-Faciale Hopital Tenon, Paris, France.
PURPOSE: Dysphonia with hoarseness and breathiness are the key symptoms of unilateral recurrent laryngeal nerve (RLN) paralysis, whereas aspiration is not usually described. The aim of this prospective study was to assess the incidence of aspiration in patients with unilateral recurrent laryngeal nerve paralysis after head and neck or thoracic surgery. PATIENTS AND METHODS: Five patients were included and evaluated within the first week and again 2 months postoperatively. Position, tone, and tension of the true vocal cord as well as assessment of the glottic axis, arytenoid position, laryngeal sensation, status of the pyriform sinus, and salivary stasis were studied. Swallowing evaluation was performed using flexible fiberoptic laryngoscopy during dry swallowing, thick cream, methylene blue liquid as well as with swallowing videofluoroscopy. RESULTS: Three patients had no aspiration, one patient had silent aspiration, and one had symptomatic aspiration. CONCLUSION: We conclude that aspiration may occur in unilateral recurrent laryngeal nerve paralysis and have to be systematically evaluated after pneumonectomy.
Autoimmune sensorineural hearing loss: a human temporal bone study.
Hoistad DL. Schachern PA. Paparella MM.
Department of Otolaryngology, School of Medicine, University of Minnesota, Minneapolis, USA.
PURPOSE: To describe histopathologic findings in temporal bones of a patient whose clinical history suggests a sensorineural hearing loss (SNHL) of autoimmune origin. MATERIALS AND METHODS: Temporal bones from a patient with a history of ulcerative colitis, leukemia, and SNHL were examined by light microscopy. RESULTS: Histopathologic findings included: (1) organs of Corti missing or absent in all cochlear turns; (2) cells decreased in spiral ganglia, and lymphocytic infiltration; (3) absence of portions of the spiral prominence; (4) endolymphatic hydrops in basal, middle, and apical cochlear turns and in the saccule and utricle; (5) fibrosis and osteoneogenesis of a scala tympani of the basal turn of the cochlea, the posterior semicircular canal, and the canal of Cotugno; (6) fibrosis of the vestibular aqueduct and endolymphatic sac; and (7) lymphocytes in the endolymphatic sac, perisaccular area, inferior cochlear vein, and Rosenthal's canal. CONCLUSION: Histopathologic findings in the temporal bones of this patient with ulcerative colitis, sensorineural hearing loss, and vestibular symptoms closely parallel those in a previously reported animal study of autoimmunity and suggest the possibility of a SNHL of autoimmune origin.