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Biomedical subjects

D M Hartl

Publications and source records attributed to D M Hartl.

11 recordsLinked to original sources
PubMed2006

Myasthenia gravis mimicking unilateral vocal fold paralysis at presentation.

OBJECTIVES: To demonstrate the importance of detailed clinical analysis in the differential diagnosis of unilateral vocal fold paralysis, and to provide an update on current knowledge and treatment of myasthenia gravis. CASE REPORT: A female patient presented with left unilateral vocal fold immobility. Diagnostic investigation revealed a 10 mm thyroid adenoma, but no other abnormality likely to cause unilateral vocal fold paralysis. Follow-up flexible endoscopy at three months showed laryngeal remobilisation with persistent left vocal fold bowing and vertical asymmetry of the vocal folds on phonation. Over the following months, voice quality varied between normal and breathy, with the breathy periods lasting from three days to one month. Laryngeal electromyography (EMG) showed a slight bilateral paradoxical activation of both posterior crico-arytenoid muscles on phonation. Magnetic resonance imaging of the brain and brainstem was normal. A diagnostic test for myasthenia gravis with intravenous edrophonium bromide (Tensilon) lead to an immediate improvement in voice quality. The patient was subsequently treated with pyridostigmine bromide, with complete resolution of dysphonia. CONCLUSIONS: Myasthenia gravis affecting the larynx may mimic unilateral vocal fold paresis or paralysis. A personal or family history of auto-immune disease, fluctuating symptoms, motor deficits in cranial nerve territories, and normal or subnormal laryngeal EMG results should lead the physician to reconsider a diagnosis of idiopathic unilateral vocal fold paralysis and to perform specific testing.

Adult↗
PubMed2006

Free flap reconstruction in the treatment of tumors involving the hard palate.

AIM: To report our experience in free flap reconstruction of the hard palate after malignant tumor resection, in terms of reconstruction method, immediate post-operative course and subjective functional results. PATIENTS AND METHODS: Files from 1988 to 1999 were reviewed for patients having undergone microvascular reconstruction of the hard palate. The immediate post-operative course (during the first month) was reviewed to determine the occurrence of complications. The surgeon's evaluation 1 year post-operatively was used to determine the intelligibility of speech, type of diet and the quality of nasal permeability. RESULTS: Thirty eight patients (28 men and 10 women) with malignant tumors involving the hard palate had undergone surgical reconstruction using microvascular free flap techniques: free radial forearm flap (13 cases), scapular flap (24 cases) or fibular flap (five cases). Two different flaps were employed in two cases (scapula plus fibula). A second flap was used with success in two cases of failure of the first flap, for a total of 42 free flaps for 38 patients. Complications occurred in seven cases, with two cases of flap necrosis. At 1 year, 33 patients achieved a normal diet and 35 normal or easily intelligible speech. CONCLUSIONS: Microsurgical reconstruction using free tissue transfer allows reconstruction of large defects of the hard palate, with low morbidity and an excellent functional outcome. We propose criteria for free flap reconstruction and choice of flap.

Adult↗
PubMed2005

[Dysphonia: current methods of evaluation].

OBJECTIVES: The aim of this review article was to provide an update on current techniques for evaluation of dysphonia in routine clinical practice. MATERIALS AND METHODS: Recent medical and other scientific literature was reviewed and pertinent current theories concerning the physiology of laryngeal function described. RESULTS: Perceptual voice quality evaluation by a professional jury of listeners is still considered to be the most reliable and complete means of evaluating pathologic voice, even though it is difficult to perform in routine and the results lack reproducibility. The objective evaluation of the vocal fundamental frequency and its variations and the spectral characteristics of voice has the advantage of being simple to perform, reproducible and quantifiable. However, automatic measurements need to be analyzed with precaution for severe dysphonia, the computer algorithms being designed for voices retaining a certain periodicity. Aerodynamic measurements are quantifiable and reproducible and provide information as to the quality of laryngeal function as a transducer of aerodynamic energy into acoustic energy. Videostroboscopy and electroglottography provide information as to the quality of the laryngeal vibrations, the source of sound production. CONCLUSIONS: All of these types of analysis are complementary, informing as to different aspects of vocal quality and laryngeal function. No one measurement alone can diagnose or characterize dysphonia.

Electrodiagnosis↗
PubMed2002

[Carbon dioxide laser transoral microsurgery for glottic carcinoma in situ].

OBJECTIVE: To evaluate the oncologic results of glottic carcinoma in situ (CIS) treated with transoral carbon dioxide laser microsurgery. METHODS: A retrospective review of 12 patients with glottic CIS previously untreated, treated with carbon dioxide laser transoral microsurgery between January 1990 and December 1999 was conducted. RESULTS: Initial and ultimate local control rates were 75%, and 100%, respectively. Three local failures occurred: two glottic CIS were treated by carbon dioxide laser transoral microsurgery, one squamous cell glottic carcinoma was treated by supracricoid partial laryngectomy with cricohyoidoepiglottopexy. The ultimate rate of laryngeal preservation rate was 100%. CONCLUSIONS: Based on the material of this study, recommended treatment for glottic CIS should be carbon dioxide laser transoral microsurgery. Difficulties in endoscopic exposure of the larynx is a contraindication. Further studies are necessary to confirm these preliminary results.

Adult↗
PubMed2001

Objective voice quality analysis before and after onset of unilateral vocal fold paralysis.

This study was designed to investigate objective voice quality measurements in unilateral vocal fold paralysis (UVFP) by eliminating intersubject variability. To our knowledge this is the first report objectively analyzing paralytic dysphonia as compared to the same voice before onset of UVFP. The voices of two male subjects were prospectively recorded before and after the onset of iatrogenic UVFP (thoracic surgery). The following acoustic measurements of the vowel /a/ were performed using the CSL and MDVP (Kay Elemetrics): jitter, shimmer, harmonics-to-noise ratio, cepstral peak prominence, the relative energy levels of the first harmonic, the first formant and the third formant, the spectral slope in the low-frequency zone (0-1 kHz and 0-2 kHz), and the relative level of energy above 6 kHz. Distribution of spectral energy was analyzed from a long-term average spectrum of 40 seconds of text. Laryngeal aerodynamic measurements were obtained for one patient before and after onset of paralysis using the Aerophone II (Kay Elemetrics). Pitch and amplitude perturbation increased secondary to UVFP, while the harmonics-to-noise ratio and the cepstral peak prominence decreased. A relative increase in the mid-frequency and high-frequency ranges and a decrease in the low-frequency spectral slope were observed. Mean airflow rate and intraoral pressure increased, and glottal resistance and vocal efficiency decreased secondary to UVFP. The findings of this self-paired study confirm some but not all the results of previous studies. Measures involving the fundamental and the formants did not corroborate previous findings. Further investigation with vocal tract modeling is warranted.

Aged↗
PubMed2001

Objective voice analysis after autologous fat injection for unilateral vocal fold paralysis.

This study was designed to objectively compare a patient's voice after onset of unilateral vocal fold paralysis (UVFP) to his or her own normal voice, and to compare the results after treatment by intrafold injection of autologous fat. Acoustic recordings were obtained for 2 male patients before thoracic surgery and after the onset of iatrogenic left UVFP. Vocal fold augmentation was performed 10 days after UVFP. The acoustic recordings were repeated within 3 days and at 1 month. The phonation quotient, pitch perturbation quotient, amplitude perturbation quotient, harmonics-to-noise ratio, cepstral peak prominence, and long-term average spectrum were analyzed. All parameters improved after treatment, with a return to preparalytic values for most. During the first month, some deterioration was noted. This is the first study comparing a subject's own normal voice to his or her voice after vocal fold augmentation. We recommend overinjection of fat if vocal fold atrophy is expected.

Acoustics↗
PubMed2000

Extensive lymphangioma presenting with upper airway obstruction.

OBJECTIVE: To describe the results of an outcome survey of 18 cases of pediatric lymphangioma with dyspnea from encroachment on the tongue base, parapharyngeal space, and/or larynx. DESIGN: Retrospective review of files from January 1983 to September 1998. SETTING: Pediatric otolaryngology departments from 2 referral centers. PATIENTS: Eighteen patients were treated. The average age at initial surgery was 22 weeks (median, 5 weeks). All presented with at least unilateral suprahyoid and infrahyoid cavernous (microcystic) lymphangioma. The tongue base was involved in 11 patients, the parapharyngeal space in 12, and the larynx in 8. INTERVENTIONS: Neck dissection was performed initially in all patients. Tracheotomy was performed in 9 patients (50%). Macroglossia was treated by V glossoplasty. Parapharyngeal extensions were treated by cervicotomy or endoscopy, and larynx and tongue base extensions by carbon dioxide laser photocoagulation. Supraglottic laryngectomy was performed in 2 patients. MAIN OUTCOME MEASURES: Residual disease, decannulation, duration of tracheotomy, and persistent respiratory symptoms. RESULTS: The average follow-up was 4 years postoperatively. One postoperative death occurred. Sixteen (94%) of the remaining 17 patients had residual lymphangioma. Eight (89%) of the 9 patients with tracheotomy underwent decannulation (average duration, 22 months). Ten patients had persistent symptoms, and 6 were asymptomatic. CONCLUSIONS: Involvement of the upper airway seems to be the determining prognostic factor in extensive lymphangioma. Patients with dyspnea by external compression of cervical lymphangioma on the airway responded well to surgery. Aggressive surgical treatment did not seem to significantly improve the prognosis in patients with intrinsic involvement of the upper airway. The natural evolution of untreated massive lymphangioma has not been documented. Less aggressive, symptomatic therapy may be an alternative to avoid mutilating surgery in patients with intrinsic involvement of the airway.

Airway Obstruction↗
PubMed2000

[Recurrent laryngeal nerve paralysis: current knowledge and treatment].

The aim of this report is to summarize current concepts in unilateral recurrent laryngeal nerve paralysis (URLNP). Important aspects of laryngeal phylogenesis, physiology and anatomy are reviewed. Recent advances in the neurophysiology of URNLP are discussed. Revised and updated principles of diagnosis and treatment are provided. Glottic configuration and prognosis vary according to the type of neural lesion (neurapraxia, axonotmesis or neurotmesis). Therapeutic indications depend on glottic configuration and prognosis. Treatment options include voice therapy, vocal fold augmentation by intrafold injection, medialization thyroplasty, arytenoid adduction, and laryngeal reinnervation. Each treatment option is summarized, and the results reported in the medical literature are reviewed.

Arytenoid Cartilage↗
PubMed1998

Silent gastroesophageal reflux disease in patients with pharyngolaryngeal cancer: further results.

BACKGROUND: Gastroesophageal reflux disease is associated with various head and neck manifestations. The aim of this retrospective study was to determine the incidence of asymptomatic, or "silent," gastroesophageal reflux disease (GERD) in patients treated for pharyngolaryngeal squamous cell carcinoma. METHODS: Twenty-four-hour pH monitoring was performed in 72 consecutive patients without digestive manifestations (pyrosis, retrosternal heartburn) of GERD treated for pharyngolaryngeal carcinoma. Statistical analysis of the relationship between reflux scores achieved and various patient parameters (age, tobacco and alcohol consumption, gastric ulcers, medications which decrease esophageal sphincter pressure), tumor parameters (staging), and therapeutic parameters (drugs administered during neo-adjuvant chemotherapy) was performed. RESULTS: Incidence of silent GERD varied from 36% to 37% according to the reflux scores. No relationship was found between the reflux scores and the patient or tumor parameters. Among the therapeutic parameters, a statistical relation was noted between the total dose of Cisplatin and the reflux scores (p = .005). CONCLUSIONS: Silent GERD is a common finding in patients treated for squamous cell carcinoma of the pharyngolarynx. Additionally, chemotherapy including Cisplatin may aggravate GERD during the course of therapy.

Adult↗