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PubMed1988

Laryngographic investigation of postoperative hoarseness.

This study investigates postoperative hoarseness by comparing the patient's subjective assessment of change in voice following intubation with objective measures made using the laryngograph. Twenty-five patients admitted for routine surgery were assessed pre- and postoperatively. An Fx histogram was recorded on the laryngograph. A linear analogue self-assessment scale was used to quantify hoarseness subjectively. The objective measure of hoarseness (spread or standard deviation of Fx histogram) correlated well with the patients' subjective assessment of hoarseness. Six patients showed a bi- or trimodal histogram following intubation. This is known to represent asymmetric muscular activity. It is concluded that change in voice following intubation correlates well with the measures of vocal fold trauma. These measures can be recorded as the change in spread, standard deviation of the Fx histogram. The transient postoperative hoarseness following intubation is due to laryngeal damage. This damage has 2 mechanisms; in most cases it is due to direct mucosal trauma but in other cases a deeper muscular damage occurs.

Adolescent↗

PubMedDate not supplied

Rechallenge of patients who developed oral candidiasis or hoarseness with beclomethasone dipropionate.

Of 158 asthmatic patients who were placed on inhaled beclomethasone, 15 (9.5%) developed either hoarseness (8), oral thrush (6), or both (1). When their adverse reactions subsided, seven of these 15 patients were rechallenged with inhaled beclomethasone. These included five cases who developed hoarseness and three who developed Candidiasis. One patient had both. Oral thrush did not recur, but 60% (3/5) of patients with hoarseness had recurrence. We conclude that patients may be restarted on inhaled beclomethasone when clinically indicated; however, because of the high recurrence rate, patients who develop hoarseness should not be re-challenged. Concomitant use of oral prednisone and topical beclomethasone may increase the risk of developing hoarseness or candidiasis.

Administration, Inhalation↗

PubMed1999

[Postoperative hoarseness and sore throat after tracheal intubation: effect of a low intracuff pressure of endotracheal tube and the usefulness of cuff pressure indicator].

Many clinical reports have described postoperative hoarseness and sore throat after general anesthesia. In most cases, these symptoms were attributed to high pressure of the endotracheal tube cuff. The recommended cuff pressure is less than 25 mmHg, as excessive pressure produces ischemia of the tracheal mucosa. However, within the safe pressure range, postoperative hoarseness and sore throat are still often observed. In this study, one hundred and ninety patients of ASA classes I or II were allocated randomly to two groups, low cuff pressure group (< 15 mmHg) or high cuff pressure group (15-25 mmHg), using continuous monitoring with a cuff pressure gauge. We investigated the incidence of postoperative hoarseness and sore throat at 24 hours after intubation and on the seventh postoperative day. The incidence of postoperative hoarseness and sore throat was significantly decreased in the low pressure group at 24 hours after intubation as compared with the high pressure group, but there was no significant difference between the two groups on the seventh postoperative day. These results suggest that keeping the cuff pressure under 15 mmHg can prevent postoperative hoarseness or sore throat at 24 hours after intubation, and that a cuff pressure gauge is thought to be one of the indispensable monitors during anesthesia.

Adult↗

PubMed2002

[Incidence and duration of hoarseness following endotracheal intubation].

The incidence and duration of hoarseness following tracheal intubation with general anesthesia were studied retrospectively from November 1998 to October 2000 in postanesthetic clinic of Nara Medical University. Total number of patients was 3977 and 37.1% of them complained of hoarseness. Most of there patients recovered within three days after surgery but in 4.2% the hoarshness persisted over ten days and in 0.7% persisted over one month after surgery. Most of these persistent hoarseness were considered to have originated from surgical procedures (such cervical, pulmonary, cardioaortic operation, etc.) and those following only tracheal intubation recovered within two months after surgery. The hoarseness decreased the satisfactory level for anesthesia in 1.0% of total patients and 12.8% of patients with persistent hoarseness. We consider that preoperative explanation and postoperative communication by anesthesiologists are important.

Adult↗

PubMed2003

[How to avoid hoarseness for operation of schwannoma of the cervical vagus nerve].

OBJECTIVE: To avoid hoarseness for operation of schwannoma of the cervical vagus nerve (SVN). METHODS: From Jan. 1997 to Sept. 2001, ten cases of SVN were operated. The procedures were as follows: Exposing the tumor and the vagus nerve, confirming its origin from the fascicle of recurrent laryngeal nerve (RLN) or the fascicle of non-RLN, making an small incision on the posterolateral surface of the tumor, usually posterior to the internal jugular vein, and then tearing and enlarging the small incision to enucleate the tumor. RESULTS: Two of the four cases of SVN originated from the fascicle of RLN happened temporary hoarseness and other two without hoarseness. All six cases of SVN originated from the fascicle of non-RLN, but one, happened no hoarseness. CONCLUSION: Above-mentioned technique is a good and reliable method to avoid hoarseness in the operation of SVN.

Adult↗

PubMed2004

Effectiveness of lubrication of endotracheal tube cuff with chamomile-extract for prevention of postoperative sore throat and hoarseness.

PURPOSE OF THE STUDY: To determine the efficacy of lubrication of the endotracheal tube cuff with Chamomile extract (Kamillosan M) before intubation on postoperative sore throat and hoarseness. MATERIAL AND METHOD: The authors randomly assigned 161 patients ASA (American Society of Anesthesiologists) physical status I, II elective surgical, orthopedic, gynecological or urological into 2 groups. The study group received 10 puffs of total 370 mg of Chamomile extract (Kamillosan M spray) lubricated at cuff of endotracheal tube while the control group did not receive any lubrication before intubation. Standard general anesthesia with tracheal intubation was given in both groups. Sore throat and hoarseness were recorded in post anesthetic care unit and at 24 h after operation. RESULTS: One hundred and sixty-one ASA physical status I, II elective surgical patients were recruited. Forty one out of 81 patients (50.6%) in the Chamomile group, scored no postoperative sore throat in the post-anesthesia care unit compared with 45 out of 80 patients (56.3%) in the control group p=0.386. Postoperative sore throat and hoarseness both in the postanesthesia care unit and at 24 h postoperation were not statistically different. There was no statistically significant relationship between sore throat or hoarseness and postoperative nausea or vomiting, ASA physical status, gender, history of smoking, grade of laryngoscopic view, number of intubation attempts, condition during intubation, use of oral airway and couching during extubation. CONCLUSION: Lubrication of endotracheal tube cuff with Chamomile extract spray before intubation can not prevent post operative sore throat and hoarseness.

Adult↗

PubMed2006

Determination of the incidence and severity of hoarseness after cardiac surgery.

BACKGROUND: The aim of the study was to determine the incidence and severity of hoarseness and vocal cord dysfunction in 200 patients undergoing open heart surgery in Shiraz-Iran. MATERIAL/METHODS: This study involved prospective evaluation of 200 patients who underwent open heart surgery during the year 2003 in Shiraz University hospitals. All patients received the same standard anesthetic technique. In post-operative course, all patients were electively ventilated for variable periods depending on several factors, at least until the morning after surgery. All patients underwent direct laryngoscopy immediately after extubation by the otolaryngologist, and the existence and grade of hoarseness was evaluated on a four-point scale 6 and 12 hours after extubation. RESULTS: Two hundred patients, 64.5% male and 35.5% female, with a mean age of 56.7 (S.D. = 5.2) were evaluated. CABG was performed most frequently and the mean duration of cold perfusion was 122 minutes (S.D. = 15). CVP insertion, endotracheal intubation, sternotomy, and hypothermia were performed in all patients. Hoarseness was found to be present in 17% of patients; all but one were rated to be grade one on the four-point scale. However, laryngoscopy did not reveal anything specific. CONCLUSIONS: The incidence of hoarseness in this study was 17%; similar series reported as high as 32%. Vocal cord dysfunction never occurred in our study and hoarseness probably resulted from intubation trauma. Although we found no case of nerve injury and cord dysfunction, vocal cord palsy as a rare cause of respiratory insufficiency in chest and neck surgeries must never be overlooked.

Aged↗

PubMedDate not supplied

[An overview of the symptoms and signs of voice disorders and the pathophysiology of hoarseness].

Voice disorders are due to organic and functional disturbances of the voice generator, activator and resonator. They appear as a consequence of different factors which lead to the development of hoarseness, and may as well be the result of disturbed phonatory patterns. Phonatory patterns refer primarily to the muscular activity of the vocal system, which is delicately balanced within the voice generator, activator and resonator. PATHOPHYSIOLOGY OF HOARSENESS: Basic causes of hoarseness are insufficient glottic closure during phonation (glottal gap), changes in the vocal fold stiffness and imbalance in mechanical properties between the two folds. Glottal gap leads to the excessive air leakage during phonalion and insufficient conversion of the expiratory air into pulses. Turbulence of the expiratory air particles is increased, leading to the development of noise. Excessively stiff or tax vocal folds, both disturb the vibration process and lead to the development of noise and hoarseness. Imbalance in tension between the two folds, and especially in their mass, may lead to the glottal gap, with the consecutive noise and hoarseness. PHONATORY PATTERNS: Phonatory patterns refer to habitual movements of the vocal organs during phonation and speech, which are acquired during the process of learning phonation and speech. This is primarily the muscular activity of generator, activator and resonator of the voice, which is so balanced to produce the optimal voice quality with the least effort and fatigue. The activity of the phonatory organs is not well balanced in cases of voice disorders. That is the primary cause of functional voice disorders, and a very frequent consequence of organic voice disturbances. Hyperkinetic dysphonia is the most common type of disturbed phonatory patterns, characterized by excessive vocal effort, while hypokinetic dysphonia is rarely seen. The third type of functional disorders of the phonatory patterns is an incorrect placement of the voice (imposlatio falsa), which is characterized by an imbalanced muscular activity of the vocal organs, but within the normal limits concerning the overall amount of activity.

Hoarseness↗

PubMedDate not supplied

[Characteristics of the voice in patients with glottic carcinoma evaluated with the RBH (Roughness, Breathiness, Hoarseness) and GIRBAS (Grade, Instability, Roughness, Breathiness, Asthenia, Strain) scales].

INTRODUCTION: Subjective voice analysis represents a diagnostic tool in phoniatry and is a part of everyday practice if a phoniatrist has a "trained ear". MATERIAL AND METHODS: This clinical prospective study included a sample of 20 male patients with malignant tumors involving one vocal cord-right or left. All patients underwent otorhinolaryngological and phoniatric examinations. Subjective acoustic analysis was done when patients pronounced numbers from 1 to 10. Afterwards, voice quality was evaluated separately by two professionals using a 4-levels scale: RBH scale (roughness-breathiness-hoarseness) and GIRBAS scale (grade-instability-roughness-breathiness-asthenia-strain). RESULTS: 60% of patients presented with vocal cord immobility. Subjective acoustic analysis revealed hoarseness in 100% of patients (the most frequent value was Mod = 3 intense hoarseness in 45% patients). Instability existed in 100% of patient (40% moderate, 40% intense). Strained voice existed in 100%, most frequently intense (45%). CONCLUSIONS: All patients with glottic carcinoma presented with hoarseness, strain and instability of phonation. Non vibration of vocal cord significantly affects the degree of dysphonia, roughness, strain and instability. Aerodycnamic changes affect voice hoarseness. RBH scale is simple, but GIRBAS scale described more psyhoacoustic phenomena most important in patients with glottic carcinoma.

Adult↗

PubMed1987

Harmonic emergence in formant zone of a sustained [a] as a parameter for evaluating hoarseness.

In order to test the value of the harmonic emergence in formant zone of a sustained (a) as a parameter for evaluating hoarseness, a multifactorial acoustical investigation was performed in 10 normal and 22 dysphonic subjects. The parameters were: a subjective evaluation (7-degree-scale) of the extent of the hoarseness by 3 trained specialists the phonation quotient the 0-6 kHz/6-10 kHz energy ratio, computed on a long--time--average--spectrum from a reading of a phonetically selected text the harmonic emergence in the bandwidth of the two first formants of a sustained (a). The harmonic emergence in the formant zone of a sustained (a) seems to be an interesting and complementary parameter, with respect to the previously investigated 0-6 kHz/6-10 kHz energy ratio, for evaluating hoarseness. Both of these parameters demonstrate highly significant differences between normal and pathological voices. Moreover, they show a high degree of correlation both with the subjective evaluation of the severeness of the hoarseness and with the mean transglottic air flow during phonation. The 0-6 kHz/6-10 kHz energy ratio seems to discriminate better in cases of severe dysphonia, while harmonic emergence seems more suitable in milder hoarseness. Both spectral parameters are suitable for automatic analysis.

Adolescent↗

PubMed2006

Effect of clonidine premedication on postoperative sore throat and hoarseness after total intravenous anesthesia.

To determine the effect of oral clonidine premedication on postoperative sore throat and hoarseness, we evaluated the incidence and severity of each of these complications in patients who underwent elective surgery in the supine position. The subjects were 82 patients, American Society of Anesthiologists (ASA) status I-III, aged 15-82 years. They were premedicated with either 150 microg oral clonidine and 20 mg raftidine (clonidine group; n = 41) or with 20 mg raftidine only (control group; n = 41) 2 h before anesthesia induction. General anesthesia was maintained with propofol, ketamine, fentanyl, and vecuronium, with or without epidural anesthesia. Postoperative sore throat and hoarseness were evaluated immediately after surgery and on the day after surgery. The incidences of sore throat and hoarseness tended to be higher in the clonidine group than in the control group; however, the difference did not reach statistical significance. There were no significant differences in the severity of these symptoms between the two groups. In conclusion, oral premedication with 150 microg clonidine did not prevent postoperative sore throat or hoarseness, and may have exacerbated these symptoms.

Adjuvants, Anesthesia↗

PubMed2006

Effectiveness of steroid treatment for hoarseness caused by idiopathic fibrosing mediastinitis: report of a case.

A 65-year-old woman was referred to our department for investigation and treatment of hoarseness. A chest computed tomography (CT) scan showed a mediastinal mass spreading into the aortopulmonary window. This finding and that of flexible laryngoscopy suggested that the hoarseness was being caused by left recurrent nerve involvement resulting in left vocal cord paralysis. Thus, we performed a mediastinoscopic biopsy via a parasternal incision. Pathological examination revealed dense fibrous tissue infiltrated with varied inflammatory cells. Because no etiological pathogen or neoplastic lesion was identified, we diagnosed idiopathic fibrosing mediastinitis and began treating the patient with prednisolone. After a course of treatment, the mediastinal lesion showed a remarkable response. The hoarseness resolved as the lesion became smaller. Laryngoscopy confirmed recuperation of vocal cord function. This report shows that steroid therapy is a treatment option for hoarseness caused by recurrent laryngeal nerve involvement of fibrosing mediastinitis, if administered under close observation.

Aged↗

PubMed1998

A case of mediastinal cystic hygroma whose only symptom was hoarseness.

Hoarseness caused by mediastinal cystic hygroma has not been reported before. The authors report a case of mediastinal cystic hygroma in which the patient's only symptom was hoarseness. A 6-year-old girl had hoarseness. Physical examination findings were normal except for indirect laryngoscopy, which showed unilateral vocal cord paralysis. The chest radiograph showed an opacification 3 cm wide in the left side of the superior mediastinum. Through a median sternotomy, a large multicystic mass was resected. During resection, left laryngeal recurrent nerve was seen to be intact, and its integrity was preserved. Six months later the left vocal cord was moving to a limited extent. A chest radiograph should be considered in a case of hoarseness caused by a peripheral nerve lesion to detect a mediastinal mass without any cervical component.

Child↗

PubMed2000

[Laryngeal amyloidosis: a rare cause of hoarseness].

INTRODUCTION: The larynx is a rare site of deposition for amyloidosis. Diagnosis may be delayed and evoked in patients with prolonged hoarseness. We have reported two cases of laryngeal amyloidosis. EXEGESIS: One man and one woman suffered from hoarseness during one and three years, respectively. Laryngoscopic examination showed diffuse infiltration of the larynx. Amyloidosis was confirmed by the characteristic Congo-red staining of laryngeal biopsies. The search for other localizations of amyloidosis was negative. No monoclonal plasma cell proliferation was detected. Both patients received endoscopic CO2 laser excision. In one case, chemotherapy was initially associated due to dystrophic plasma cells in bone marrow aspiration and then withdrawn because of clinical failure. With a 6-month follow-up, hoarseness remained stable. CONCLUSION: Laryngeal amyloidosis is an essentially localized disease revealed by hoarseness. Treatment is endoscopic by laser excision. In nearly half of the cases in the literature, it had to be repeated due to localized recurrent lesions. Long-term prognosis of localized laryngeal amyloidosis is better than systemic AL amyloidosis.

Amyloidosis↗

PubMed1999

Painless aortic dissection presenting as hoarseness of voice: cardiovocal syndrome: Ortner's syndrome.

Most of the neurological manifestations of the aortic dissection are due to neuronal ischemia secondary to either extension of the dissection process into a branch artery, or compression of an artery by the false lumen of the dissecting aortic hematoma. However, the enlarging false lumen may directly compress on an adjacent nerve, causing neuronal injury resulting in neurological symptoms. This may particularly take place when a distal intimal tear does not decompress the false lumen, resulting in formation of an expanding blind pouch. About 10% of aortic dissections are painless and may present with symptoms secondary to the complications of the dissection. Although cardiovocal syndrome, or Ortner's syndrome (hoarseness of voice due to involvement of recurrent laryngeal nerve in cardiovascular diseases) has been described with aortic dissection, it has not been reported as an initial presenting feature of this disorder. This report describes the first case of painless aortic dissection presenting with hoarseness of voice, the cardiovocal syndrome. The hoarseness remained the only symptom throughout the entire course of the disease. The aortic dissection was not suspected initially. During surgical exploration, the recurrent laryngeal nerve was found compressed by the false lumen at the level of aortic arch. Aortic root replacement was performed successfully, resulting in complete resolution of the hoarseness. The neurological manifestations of aortic dissection, and the cardiovocal syndrome, are discussed.

Aortic Dissection↗

PubMed2005

Effect of additives in lidocaine spray on postoperative sore throat, hoarseness and dysphagia after total intravenous anaesthesia.

BACKGROUND: Laryngo-tracheal lidocaine spray before intubation is associated with an increased risk of postoperative throat problems. Our study investigated the effect of additives contained in lidocaine spray on postoperative sore throat, hoarseness and dysphagia. METHODS: We compared the incidence and severity of postoperative throat complications after laryngo-tracheal application of lidocaine spray (40 mg), lidocaine (40 mg) or normal saline as placebo during laryngoscopy with total intravenous anaesthesia in 122 ASA I-III patients aged 15-87 years in a double-blinded, placebo-controlled study. The incidence and severity of postoperative sore throat, hoarseness and dysphagia were evaluated on the day of and the day after surgery. RESULTS: Sore throat and dysphagia were significantly more severe after lidocaine spray was used than after lidocaine or placebo was used. However, there was no significant difference in the incidence or severity of postoperative sore throat, hoarseness or dysphagia between the lidocaine group and the placebo group throughout the study. CONCLUSION: These results suggest that additives in lidocaine spray, not lidocaine itself, contribute to the increase in postoperative throat problems. Therefore, lidocaine spray should be avoided to prevent these unnecessary complications. Our findings also confirm that laryngo-tracheal lidocaine application does not prevent sore throat, hoarseness or dysphagia after total intravenous anaesthesia.

Adolescent↗

PubMed1982

Harmonics-to-noise ratio as an index of the degree of hoarseness.

Degree of hoarseness can be evaluated by judging the extent to which noise replaces the harmonic structure in the spectrogram of a sustained vowel. However, this visual method is subjective. The present study was undertaken to develop the harmonics-to-noise (H/N) ratio as an objective and quantitative evaluation of the degree of hoarseness. The computation is conceptually straightforward; 50 consecutive pitch periods of a sustained vowel /a/ are averaged; H is the energy of the averaged waveform, while N is the mean energy of the differences between the individual periods and averaged waveform. Recordings of 42 normal voices and 41 samples with varying degrees of hoarseness were analyzed. Two experts rated the spectrogram of each voice sample, based on the amount of noise relative to that of the harmonic component. The results showed a highly significant agreement (the rank correlation coefficient = 0.849) between H/N calculations and the subjective evaluations of the spectrograms. The H/N ratio also proved useful in quantitatively assessing the results of treatment for hoarseness.

Adult↗

PubMed1984

Harmonic-intensity analysis of normal and hoarse voices.

Objective evaluation of normal and hoarse voices is performed considering the characteristic that hoarse voices show a prominent fundamental frequency intensity compared with harmonics in the voice spectrum. The relative harmonic intensity Hr, obtained from a stable portion of the sustained vowel/a/, is defined as the intensity of the second and higher harmonics expressed as a percentage of the total voice intensity. Ninety-five percent of the normal voices examined have Hr larger than the critical value of 67.2%, whereas 90% of the hoarse voices have Hr smaller than the critical value. The harmonic-intensity analysis thus provides good discrimination between normal and hoarse voices.

Adolescent↗