Is Experience Better than Evidence? Tuberculous Laryngitis: A Case Report

Bilateral Cricoarytenoid Joint Ankylosis with a Perplexing Etiology

The incidence of laryngeal tuberculosis (TB), which had dropped dramatically after the institution of modern anti-TB chemotherapy, has shown recent reemergence. It is important to be aware of its possibility, especially as it can present with nonspecific upper airway symptoms and a frequent lack of constitutional manifestations. We report such a case presenting as acute epiglottitis, with diffuse involvement of the supraglottic larynx associated with reactivation lung TB.

Anti-tubercular therapy induced liver injury (ATTILI) is the most important risk for the past many years. Many pre-existing factors and conditions like persisting liver injury, female gender, alcohol abuse etc. are important risk factors for the ATT induce liver injury. I read many case reports and literature review for the drugs induce liver injury, and concluded the results, ATT drugs are the most responsible for the liver injury during the therapy periods. The present case was 42-year-old male patient and known case of pulmonary tuberculosis, patients were on the ATT drugs therapy in the last 14 days. After few days of therapy, he produced signs of vomiting (multiple episode), fever (high grade), abdomen pain, coughing, loss of appetite, epigastric discomforts & generalized weakness. On general examination the patient was found to produce signs of Jaundice with yellowish appearance of the sclera. Pulmonologist had firstly withdrawal the anti-tubercular drugs therapy and started the modified anti-tubercular drugs therapy. As a Clinical pharmacist we advise the patients & patients relatives, proper monitoring of liver and renal function test should also be carried out by the health care professional specialist from time to time in order to avoid critical situations.
 Keywords: Anti-tubercular therapy, Anti-tubercular therapy induced liver injury, Pulmonologist, Hepatotoxicity.

Laryngoscopes are widely used in the clinical diagnosis of laryngeal lesions, but such diagnosis relies heavily on the physician's subjective experience. The purpose of this study was to develop a computer-aided diagnostic system for the detection of laryngeal lesions based on objective criteria. This study used the distinct features of the image contour to find the clearest image in the laryngoscopic video. First to reduce the illumination problem caused by the laryngoscope lens, which could not fix the position of the light source, this study proposed image compensation to provide the image with a consistent brightness range for better performance. Second, we also proposed a method to automatically screen clear images from laryngoscopic film. Third, we used ACM to segment automatically them based on structural features of the pharynx and larynx, using hue and geometric analysis in the vocal cords and other zones. Finally, the support vector machine was used to classify laryngeal lesions based on a decision tree. This study evaluated the performance of the proposed system by assessing the laryngeal images of 284 patients. The accuracy of the detection for vocal cord polyps, cysts, leukoplakia, tumors, and healthy vocal cords were 93.15%, 95.16%, 100%, 96.42%, and 100%, respectively. The cross-validation accuracy for the five classes were 93.1%, 94.95%, 99.4%, 96.01% and 100%, respectively, and the average test accuracy for the laryngeal lesions was 93.33%. Our results showed that it was feasible to take the hue and geometric features of the larynx as signs to identify laryngeal lesions and that they could effectively assist physicians in diagnosing laryngeal lesions.

Bilateral recurrent laryngeal nerve palsy in a patient undergoing consecutive thyroid operations

Mucosal closure following laryngeal microsurgery can be challenging due to limited access, and incisions are often left to heal without formal closure. This study explores the hypothesis that a bioabsorbable microclip can be developed as an alternative method to close mucosal incisions in laryngeal microsurgery. Animal study. In vitro studies were performed to determine if a suitable clip could be designed using bioabsorbable materials. A porcine model was used to study behavior of the clip in vivo. We initially studied poly-ϵ-caprolactone but encountered difficulty creating a small clip with the necessary material strength. Using magnesium we were able to produce a clip sufficiently small to close vocal fold incisions. Magnesium is biocompatible, bioabsorbable, and malleable, and has been used to manufacture vascular stents and sutures. The magnesium microclip could be deployed rapidly using modified 2-mm micro-laryngeal cup forceps, which enable the clip to close in a circular shape. In vitro and in vivo tests showed the clip held securely to the vocal fold mucosa. Macroscopic and histologic studies showed no significant injury to the contralateral vocal fold. There was no evidence of lower airway injury after implanting clips into the lower airway. The bioabsorbable clip could be used to close selected incisions in laryngeal microsurgery. Currently we are working to further reduce the size of the clip and modify its bioabsorption properties to enable precise control of degradation.

Objectives: Observation of vocal fold vibration during semi-occluded vocal tract exercises (SOVTE) can help in understanding voice production due to semi-occlusion. This study aimed to investigate the differences in vocal fold vibration characteristics among various types of SOVTE. This study may provide valuable evidence to support more specific and effective methods in applying SOVTE to voice therapy. Methods: A total of 10 healthy young adults (5 males, 5 females) with a mean age of 24.28±4.54 years participated in the study. None of the participants had any voice-related diseases or were smokers. The participants performed various types of SOVTE including humming, voiced bilabial fricative, straw phonation, and water-resistance straw phonation. The authors measured the amplitude and contact speed of vocal fold using a vibration simulator and digital kymography (DKG). Results: The results showed that vocal fold amplitude was not significantly different among types of SOVTE, but there were significant differences in vocal fold contact speed (p=.046). In multiple comparisons, vocal fold contact speed was significantly faster in humming (p=.031) and water-resistance straw phonation (p=.018) compared to straw phonation. Conclusion: The difference in vocal fold contact speed indicates that the vocal fold vibration during SOVTE is affected by the shape of the vocal tract. The use of humming and water-resistance straw phonation can be an effective approach to improve voice quality by increasing vocal fold contact speed, which is a key factor in determining overall voice quality. These two methods can be useful in voice therapy after laryngeal microsurgery. In the field, conducting trial therapy rather than applying voice therapy according to the hierarchy of SOVTE may lead to successful results.

Background: Hoarseness of the voice or dysphonia is a commonly encountered vocal symptom among children. The etiological profiles of dysphonia among children are variable, and laryngoscopic examination is required for identification of the lesions. Objective: The objective of the study was to study the etiology, clinical presentations, and diagnosis of the hoarseness of voice among children. Materials and Methods: The children aged from 3 to 16 years presenting with dysphonia/hoarseness, were included in this study from October 2015 to September 2018. All the 132 children presented with hoarseness of voice were subjected to video laryngoscopy for voice assessment. Results: The majority of this study was male children (59.09%). Vocal fold nodules (36.36%) were the major cause for dysphonia. Other attributing causes include vocal fold polyp, vocal fold cyst, laryngopharyngeal reflux, hemorrhagic vocal fold polyp, laryngeal papilloma, vocal fold sulcus, and vocal fold paralysis. Voice abuse was an important cause for dysphonia and history of vocal abuse was reported among 61 children (46.21%). The duration of hoarseness ranged from 1 month to 2 years with a mean duration of 3.63±2.31 months. The larynx was examined by laryngeal mirror alone in 23 children (17.42%), fiber-optic laryngoscopy in 88 children (66.66%), and direct laryngoscopy under general anesthesia in 21 cases (15.90%). Voice therapy was done in all children along with vocal hygiene care and micro-laryngeal surgery in 64 cases. Conclusion: Pediatric dysphonia is a common cause for referral to pediatric otolaryngologists and management sometimes variable. Flexible nasopharyngolaryngoscopy is suitable for making an accurate diagnosis.

Comparison Between Early Glottic Carcinoma and Epithelial Dysplastic Lesions of the Vocal Fold Via Voice Analysis

PURPOSE: To analyse the clinical profile of hoarseness of voice and to find out the common etiological factors and associated pre disposing factors. METHODS : 100 patients with hoarseness of voice were selected for the study based upon the inclusion and exclusion criteria. A thorough clinical history along with examination with indirect and video laryngoscopy, if necessary with direct laryngoscopy with /without biopsy were performed. Histo-pathological examination was performed for the needful. DISCUSSION: In our present study incidence of hoarseness voice was 0.27 % of total ENT cases. Maximum number of cases (31%) were in the age group of 41-50 years, among males common age groups was 41-50 years and among females is 31-40 years of age group. Hoarseness was commonly found in labourer class (48%). Both among males and females this was commonest group. Lower socio economic group was commonly noted among patients (40.00%), also both in males and females. Majority patients were from rural area (59%). Smoking was commonly encountered substance abuse among males (30.00%) and no substance abuse among females. Along with hoarseness (100%) other symptom with which patient presented were dysphagia (25%), neck swelling (14%), dry cough (10%), foreign body sensation in throat (10%), stridor (5%) and Hemoptysis (5%). Maximum number of patients presented with hoarseness of voice with duration of <1 month. On indirect laryngoscopic examination commonest finding was ulcero proliferative growth (33.33%).Indirect laryngoscopic examination done in 97% and video laryngoscopic examination in 41%. Among 73% patients of histo-pathological studies, commonest finding was squamous cell carcinoma (45.2%). Laryngeal malignancy was the commonest cause of hoarseness of voice (33%) and males were commonly affected. Smoking was noted in all male patients with malignancy (80%), along with alcohol consumption in 70% and chewing tobacco preparation in 65% of cases. Vocal cord nodules were found in 22% of patient and was the second most common disease with male to female ratio 1:2. Vocal cord palsy was found in 15% of cases and was common in females (29%). Chronic laryngitis and GERD was found in 10% and was found in 23% among males and 18% among females, with male to female ratio 1:1. Tuberculosis was found in 8%, all cases were males, with pulmonary tuberculosis. Vocal cord papilloma presented in 5% of cases and females were commonly affected (66%) with male to female ration 1:2. Vocal fold polyp was found in 3% of cases, each one in male (33%) and two in female (67%). Vocal cord cyst was presented in 2% of cases. Two cases (2%) presented with laryngeal trauma. CONCLUSION: Thus from this study, we conclude that, the symptom of hoarseness of voice should never be ignored as it is the most common symptom in laryngeal malignancy. Any patient with hoarseness should be thoroughly investigated to rule out malignant conditions and conditions that might cause respiratory distress leading to life threatening complications.

Background: Vocal fold lesions are commonly found in the pediatric age group. The lesions of the vocal fold among children are variable. The laryngoscopic examination is needed for the identification of the vocal fold lesions. The objective of this study is to find out the different vocal fold lesions, clinical presentations, and diagnoses of the vocal fold lesions.Methods: The children aged from 5 to 18 years diagnosed with vocal fold lesions were included in this study. The study was conducted between June 2017 to July 2022. All the children with vocal fold lesions were subjected to video laryngoscopy for assessment of the larynx.Results: There were 156 children diagnosed with vocal fold lesions. The majority of this study's participants were male children (52.56%). The most common symptom was hoarseness. Most common vocal fold lesion was vocal fold nodule (43.58%). Voice abuse was the most common etiological factor behind the vocal fold lesions. Out of 156 children with vocal fold lesions, 72 children (46.15%) underwent microlaryngeal surgery under anesthesia. Voice therapy was given to all the children along with vocal hygiene care.Conclusions: Vocal fold lesions are often found among children. Dysphonia is the commonest clinical presentation of children with vocal fold lesions. Microlaryngeal surgery and voice therapy are two important options for the treatment of vocal fold lesions in pediatric patients.

This study introduces a new technique in laryngeal microsurgery that combines subepithelial saline infusion with photoangiolysis to safely and effectively coagulate vocal fold vessels while minimizing thermal damage. By expanding the volume of the superficial lamina propria with saline, the method allows for precise targeting of vessels with reduced energy needed for coagulation, thereby protecting the delicate microstructure of the vocal folds. The technique allows for a more comprehensive hemostatic approach by making an increased number of vessels accessible for treatment, which can lead to reduced intraoperative bleeding and fewer postoperative complications.

<bold>Objective</bold> To evaluate the clinical efficacy and safety of the traditional Chinese medicine compounds "Huoxue Yangyin" for promoting blood circulation and nourishing Yin in the treatment of postoperative discomfort of vocal cord polyp by Metaanalysis. <bold>Methods</bold> Data were searched from the databases of China National Knowledge Infrastructure (CNKI), Chinese Scientific Journal Database (VIP) ,Wanfang Database (Wanfang Data), China Biomedical Literature Database, PubMed, Embase, Web of science,Springer and Cochrane Library,etc. The patients with vocal cord polyp after surgery in the clinical randomized controlled trials (RCTs) were included who were treated with promoting blood circluation and nourishing Yin drugs. The retrieval time for each database was from January 2000 to May 2021. The outcome indicators including clinical efficacy, clinical symptom subsidence time, clinical symptom score, voice acoustic analysis, grade rough breathy asthenic strained (GRBAS), adverse reactions. RevMan 5.4.1 software was used for data analysis, continuous variables were expressed by weighted mean difference (<italic>WMD</italic>) and 95% confidence interval (<italic>CI</italic>); binary variables were expressed by odds ratio (<italic>OR</italic>) and 95% <italic>CI</italic>. If the included studies were homogeneous (<italic>I</italic>²&lt;50%), a fixed effects model would be used; if the included studies were heterogeneous (<italic>I</italic>²≥50%), a random-effects model would be used. <bold>Results</bold> A total of 1 628 patients were included in 15 RCTs, including 813 in the experimental group and 815 in the control group. Meta analysis results showed that the total effective rate of the experimental group was significantly higher than that of the control group [<italic>OR</italic>=4.79, 95% <italic>CI</italic> (3.15, 7.26), <italic>P</italic>&lt;0.000 01]; the symptom subsidence time in the experimental group was significantly lower than that of the control group [<italic>MD</italic>=-2.27, 95% <italic>CI</italic> (-2.48, -2.05), <italic>P</italic>&lt;0.000 01]; the scores of clinical symptoms of the experimental group such as hoarseness,foreign body sensation, pain, cough, and dryness were lower than those of the control group (<italic>P</italic>&lt;0.05); the voice acoustic parameters of the experimental group such as Jitter and Shimmer were significantly lower than those of the control group (<italic>P</italic>&lt;0.05); the GRBAS score of the experimental group after treatment was significantly lower than that of the control group, and the difference was statistically significant [<italic>MD</italic>=-0.64, 95% <italic>CI</italic> (-0.79, -0.49), <italic>P</italic>&lt;0.000 01]. There were no serious adverse reactions in both groups. <bold>Conclusion</bold> The traditional Chinese medicine compounds of promoting blood circulation and nourishing Yin has a good effect in the treatment of vocal cord polyp after surgery, which can effectively improve postoperative hoarseness, foreign body sensation, pain, cough, dryness and other symptoms, and shorten the recovery time of vocal cord function.

Flexible naso-pharyngo-laryngoscopy (NPL) has become an essential clinic tool for evaluating patients with upper airway disorders in otorhinolaryngology. It has been established to be a simple, cost-effective, and minimally invasive technique with good diagnostic yields. This study aimed to audit the procedure of flexible NPL done in our clinic over 2 years and analyse the technique, indications, and findings of the procedure. A retrospective cross-sectional study among all the patients who presented to our ENT clinic in ABUTH Zaria, from July 2021 to June 2023 with upper airway symptoms or neck swelling who had flexible NPL done in the clinic. The records of these patients were reviewed, and information extracted including age, sex, use of anaesthesia, indications and findings of the procedure were entered in SPSS and analysed. Flexible NPL was done in 266 patients aged 4 months to 85 years. Only 3% of the patients required local anaesthesia. The commonest indications were for preoperative evaluation of goitre (26.7%), suspected adenoid hypertrophy (18.4%), complaints of hoarseness (18.8%), and foreign body sensation (12%). The commonest diagnoses made were adenoid hypertrophy (19.9%), laryngeal tumour (5.3%), nasopharyngeal tumour (4.9%), vocal cord palsy (4.9%), rhinitis (4.5%) and pharyngitis (4.1%), laryngitis (3.0%), laryngopharyngeal reflux disease (3.0%) and vocal cord nodule (2.3%). Office flexible NPL was done commonly for preoperative evaluation of goitre, suspected adenoid hypertrophy, hoarseness, and foreign body sensation. The commonest pathologies were adenoid hypertrophy, laryngeal tumour, nasopharyngeal tumour, vocal cord palsy, rhinitis, pharyngitis, and laryngitis.

Coccidioidomycosis Lymphadenitis in a patient with lupus nephritis: a case report.