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PubMed2006

Effect of hemodialysis on the thickness of vocal folds: a possible explanation for postdialysis hoarseness.

BACKGROUND: Determining the dry weight of chronically hemodialysed patients is a common problem. Patients on intermittent hemodialysis often experience transient hoarseness at the end of dialysis. The vocal folds may be affected by the hydration state. AIM: To test the hypothesis that postdialysis hoarseness may be related to changes in the thickness of the vocal folds. METHODS: Twenty-five stable chronic hemodialysis patients underwent endoscopic nasopharyngeal laryngoscopy before and after dialysis. Pictures of the vocal folds were taken and the folds were measured using computer software. Eighteen vocal folds from 16 patients were technically adequate for analysis. The change in the width/length ratio of the vocal folds (W/L) was used as a measurement of the folds' thickness. RESULTS: W/L decreased from 0.175 +/- 0.011 before dialysis to 0.152 +/- 0.009 after dialysis (p < 0.01, mean reduction 10.9 +/- 3.8%). Patients' weight decreased by 4.7 +/- 0.3% (p < 0.0001), systolic blood pressure decreased by 15.0 +/- 3.1% (p < 0.001), diastolic blood pressure decreased by 13.0 +/- 3.6% (p < 0.01), and mean blood pressure decreased by 14.1 +/- 3.1% (p < 0.001). Sixty percent of the patients had postdialysis hoarseness, and in 72% of the patients a decrease in the vocal folds' thickness was observed. CONCLUSIONS: Chronic hemodialysis patients may experience transient postdialysis hoarseness, and a decrease in the vocal folds' thickness. The latter may result from dehydration.

Adult↗

PubMed2003

Dysphagia, hoarseness, and unilateral true vocal fold motion impairment following anterior cervical diskectomy and fusion.

The charts of 100 patients who underwent anterior cervical diskectomy with fusion performed at our institution between January 1996 and February 1999 were reviewed. The incidences of hoarseness, dysphagia, and unilateral true vocal fold motion impairment were calculated. Univariate logistic regression was used to estimate the relationship of several patient and technical factors to the rates of occurrence of hoarseness and dysphagia. Patient age was found to be a significant predictor of postoperative dysphagia (p < .006), with an odds ratio of 1.113 (95% confidence limits, 1.04, 1.21) per year of age. Other factors studied were not found to be significant predictors. The overall incidence of these complications from the world literature was also calculated. The overall incidences of dysphagia, hoarseness, and unilateral true vocal fold motion impairment in the literature were calculated as 12.3%, 4.9%, and 1.4%, respectively. We conclude that dysphagia, hoarseness, and unilateral vocal fold motion impairment continue to remain significant complications of anterior cervical diskectomy with fusion. Older patients may be at higher risk for dysphagia.

Adult↗

PubMed2000

Postoperative sore throat and hoarseness following tracheal intubation using air or saline to inflate the cuff--a randomized controlled trial.

Sore throat and hoarseness following tracheal intubation is common. The aetiology may include high tracheal cuff pressures. We performed a double-blind, randomized controlled trial in 126 intubated patients to compare the incidence and severity of sore throat and hoarseness following inflation of the cuff using air or saline. Intra-cuff pressures were compared to assess any change due to inward diffusion of nitrous oxide. The incidence of significant sore throat and/or hoarseness overall was 15.0%. There was no statistically significant difference between the groups (air 15.9%, saline 14.5%). In the air group mean intra-cuff pressure increased significantly (start 14.0 mmHg, end 40.9 mmHg), while in the saline group there was no significant increase (start 12.7 mmHg, end 14.6 mmHg). The substitution of saline reliably results in sustained low intra-cuff pressures but high tracheal cuff pressure is not an important factor in the development of sore throat or hoarseness postoperatively within the pressure range and duration of operation studied.

Double-Blind Method↗

PubMed2000

[Hoarseness after endotracheal intubation caused by submucosal hemorrage of the vocal cord and recurrent nerve palsy].

Hoarseness often follows endotracheal intubation. A 58 year old man suffered from hoarseness due to recurrent nerve palsy and submucosal hemorrhage of the right vocal cord after general anesthesia. He was scheduled for resection of chronic pyoderma of the buttocks and atheroma of the right retroauricular region. Anesthesia was induced with thiopental 300 mg and endotracheal intubation was facilitated with vecuronium 6 mg. A spiral tube with 8 mm of inner diameter (Mallinckrodt Medical) was inserted with no problems. The tube was fixed at left side of the mouth. The cuff was inflated with air but the cuff pressure was not monitored. Anesthesia was maintained with sevoflurane (1-3%) and 67% N2O in 33% O2. Respiration was controlled mechanically. The patient was turned to the prone position and his head was turned to the right. The duration of surgery was one hour and forty minutes. Extubation of the tube involved no problems. He complained of hoarseness after surgery. Right recurrent nerve palsy and submucosal hematoma were observed. Without any treatment, hematoma disappeared in 70 days and hoarseness in 183 days. These hematoma and recurrent nerve palsy might be due to the compression of the vocal cord and recurrent nerve by tracheal tube and traction of the recurrent nerve by rotation of the neck.

Anesthesia, General↗

PubMedDate not supplied

Dual-probe pH monitoring for the assessment of gastroesophageal reflux in the course of chronic hoarseness in children.

The purpose of our study was to assess gastroesophageal reflux (GER) by dual-probe pH monitoring in children suffering from chronic hoarseness for more than six months. Seventeen children (aged between 2 and 12 years, 10 boys and 7 girls) were enrolled. All children underwent a laryngoscopy and a 24-hour dual-probe pH monitoring. At both sensor, distal and proximal esophageal, a pathological GER was defined as the presence of episodes of acid reflux with pH < 4 during a fraction of the total recording time greater than 5.2 percent. The computer considered the child was supine when asleep and upright when awake. Laryngoscopy revealed interarytenoid erythema and/or edema with vocal cord nodules or granulomas in 13 cases (76.4%), isolated vocal nodules or granulomas in three cases (17.6%) and a normal appearance in one case (5.8%). At both sensors, the majority of refluxes occurred when the child was upright, as analyzed by the percentage of time the intra-esophageal pH was below four (% time pH < 4), number of refluxes, reflux episodes/hour and longest reflux episode, p < 0.05 between upright and supine for each parameter. The median total % time pH < 4 on the proximal and distal probes was respectively 1.62 percent (95% CI 1.50-3.79) and 11.49 percent (95% CI 8.81-27.17), p < 0.0003. Among the 17 hoarse children, a pathological GER was observed in 12 (70.5%) at the distal sensor and in three (17.5%) at both sensors. Among the 16 hoarse children with abnormal findings on laryngoscopy, two (12.5%) had diagnosed pathological GER at the proximal and 11 (68.7%) at the distal sensor. The only child with normal findings on laryngoscopy exhibited a pathological GER at both sensors. Our results suggest that chronic hoarseness is associated with a pathological GER. The majority of these documented refluxes occurred when the child was awake.

Child↗

PubMed1988

[Hoarseness after removing a cervical schwannoma--a case report].

A 54-year-old man complained of asymptomatic lump in the right parotid gland region. The lump was well movable and had no fixation to the adjacent tissue. The lump was surgically extirpated and histological sections of the lump revealed benign schwannoma. In view of postoperative evidence of hoarseness, it was thought the tumor might be arose from the cervical vagal nerve. The hoarseness has been observed for one year after operation without any improvement. A statistic study on the hoarseness after removing the cervical tumor was done by sending out questionnaires to the members of the council of the Japan Surgical Society. Of 270, 180 replies were obtained and 67.2% of the members answered that they did not have any knowledge about the hoarseness after removing the cervical tumor.

Cranial Nerve Diseases↗

PubMed1983

[Hoarseness from the viewpoint of primary care].

Hoarseness is a symptom that is constantly encountered by doctors in primary care. It is the leading symptom in acute laryngitis and is often present as one of the symptoms in, for example, respiratory tract infections, influenza, and bronchitis. For the general practitioner, the infection factor as the cause of hoarseness is so dominant that other possible causes may fail to be taken into consideration. The general practitioner's possibilities for diagnosing the cause of this symptom are largely determined by habit, and by his ability to observe and assess the vocal chords. Examination of the vocal chords is often technically difficult, and patients in whom inspection presents difficulties should be remitted to an ear specialist. Hoarse smokers constitute a special group at risk, and these patients should be remitted for further examinations, if the general practitioner finds it hard to make a complete inspection of the chords. The article also describes an investigation on how hoarseness is handled at a health centre.

Hoarseness↗

PubMed1995

[Hoarseness].

Hoarseness is a cardinal symptom of laryngeal disease. It is a disturbance of the normal voice pitch that can be evaluated acoustically using the 'RBH scale' [R for roughness, B for breathiness, H for hoarseness]. Hoarseness lasting longer than three weeks or recurring must be evaluated by an ENT specialist or a phoniatrist. Causes of hoarseness include functional disorders of the voice, inflammation of the larynx, secondary changes of the vocal folds, polyps, cysts, edema, papillomas, tumors, trauma, or palsies of the vocal cords due to different reasons. Early diagnosis of malignant laryngeal tumors is a prerequisite for preserving voice quality. Functional disorders and unilateral palsies of the vocal folds are treated by logopedists. The therapy of choice for inflammations is relief of symptoms, and surgery is employed for organic lesions.

Diagnosis, Differential↗

PubMedDate not supplied

[Subjective acoustic analysis of dysphonia caused by tumor using the RBH (roughness, breathiness, hoarseness) scale].

The goal of psycho acoustic or subjective voice analysis, in a phoniater's everyday work, is to describe a subjective experience based on the physical parameters created in the process of phonation. The work was a clinical prospective study and the sample consisted of 80 people of both sexes, 40 people with benign and pseudo tumors of vocal cords and 40 people with malign tumors of vocal cords. All the patients were otorinolaringologically and phoniatrically examined. The subjective acoustic analysis was done with the patients pronouncing numbers from 1 to 10 in the comfortable zone. Afterwards, the quality of the voices was estimated in RBH scale. The subjective acoustic analysis found roughness in the voices of 87.50% patients in the first group and the most frequent value was Mod = 3 (intense roughness), 62.50% patients. Hoarseness was present in 90.00% cases, with largest value Mod = 2 (moderate hoarseness), 55.00% patients. In the second group, roughness existed in the voices of 70.00% patients, most often intense one (Mod = 3), 30.00% patients. Hoarseness existed in 95.00% cases, 45.00% with moderate (Mod = 2) and 35.00% with intense one. T test showed that there is a statistically significant difference between the strength of the roughness determined by the subjective acoustic analysis in the first and the second group, with p < 0.01. The difference between the strength of the hoarseness in the first and the second group is also statistically significant, with p < 0.01. All the growths on vocal cords irrespective of their nature change the characteristics of the voice, most of all its clearness. In cases of vocal cords tumors, by the subjective acoustic analysis, i.e. the perception of the psycho physiological characteristics of voice, a human ear can register pathological phenomena of the voice but cannot determine the character of the growth on the vocal cords.

Adult↗

PubMed2004

Lack of association between esophageal biopsy, bronchoalveolar lavage, and endoscopy findings in hoarse children.

OBJECTIVE: To determine the prevalence of esophagitis (based on esophageal biopsy results) and aspiration (based on bronchoalveolar lavage [BAL]) in children with hoarseness. DESIGN: Retrospective medical chart review spanning 24 months of 127 consecutive children (mean age, 6.9 years; range, 1.8-17 years) who presented with hoarseness to 2 attending otolaryngologists. SETTING: Tertiary care children's hospital.Intervention All subjects underwent direct laryngoscopy, rigid bronchoscopy with BAL, and rigid or flexible esophagoscopy with biopsy. MAIN OUTCOME MEASURES: The BAL result was considered positive if the number of lipid-laden macrophages was "moderate" or "large," and the esophageal biopsy result was considered positive if any 2 of the following 3 histologic criteria were present: basal cell hyperplasia, increased papillary height, and intraepithelial inflammatory infiltrate. Comparisons between subjective endoscopic findings and objective test results were made using the t test and contingency table analysis, where appropriate. RESULTS: Of the 127 children, 104 (82%) had vocal nodules; 53 (43%) had endoscopically visualized laryngitis; 36 (28%) had tracheobronchial inflammatory changes; 60 (47%) had abnormal esophagoscopy findings; 47 (37%) had a positive BAL result; and 38 (30%) had a positive esophageal biopsy result. There was no significant correlation between BAL and esophageal biopsy results (P = .11). The odds of having positive BAL or esophageal biopsy results were unaffected by the presence of vocal nodules; endoscopically visualized inflammation of the larynx, trachea, or esophagus; or symptoms or previous clinical history of gastroesophageal reflux disease. CONCLUSION: Positive esophageal biopsy and BAL results are prevalent among children with hoarseness, regardless of subjective upper aerodigestive tract endoscopic findings.

Adolescent↗

PubMed1998

[Objective description of voice quality using the hoarseness diagram].

The need for an objective assessment of voice quality can be seen in the increasing use of acoustic analysis methods for clinical diagnosis and research. The hoarseness diagram allows clinicians to objectively describe even highly disturbed or aphonic votes. Its application possibilities are illustrated in three case studies in which changes in voice quality were monitored during voice rehabilitation. The distributions of voice groups that were defined on the basis of specific pathophysiological phonation conditions were then compared for their acoustic differences. The groups comprised various phonation conditions after the resection of laryngeal tumors and different types of laryngeal paralyses. Interpretation of the results suggests a direct correspondence of the hoarseness diagram coordinates and the irregularity of vibration on the one side and the degree of glottal closure on the other. This illustrates the potential usefulness of the hoarseness diagram in a clinical context.

Adult↗

PubMed1996

Perturbation and hoarseness: a pilot study of six children's voices.

Fundamental frequency (FO) perturbation has been found to be useful as an acoustic correlate of the perception of dysphonia in adult voices. In a previous investigation, we showed that hoarseness in children's voices is a stable concept composed mainly of three predictors: hyperfunction, breathiness, and roughness. In the present investigation, the relation between FO perturbation and hoarseness as well as its predictors was analyzed in running speech of six children representing different degrees of hoarseness. Two perturbation measures were used: the standard deviation of the distribution of perturbation data and the mean of the absolute value of perturbation. The results revealed no clear relation.

Child↗

PubMed1983

Hoarseness in tuberculosis.

A study has been made of hoarseness in 26 tuberculous patients in Kandy (Sri Lanka). Tuberculous inflammation of the vocal cord or ventricular fold was its cause in 18 of them, in 17 of whom the laryngeal infection was due to direct implantation of tubercle bacilli from lung cavities through cough; in one it was probably haematogenous. Hoarseness in the other eight patients was due to recurrent laryngeal nerve palsy, the nerve being involved in tuberculous lesions, in six instances in the mediastinum and in three instances in the right apical pleura. However caused, hoarseness associated with active inflammatory disease cleared with anti-tuberculous chemotherapy, whereas that associated with fibrosis persisted.

Adolescent↗

PubMed1998

Hoarseness and gastroesophageal reflux in children.

The importance of a hoarse voice or voice change in children has not been stressed in the literature in the same way as it has been in adults. We present 21 children who had been suffering from chronic hoarseness for more than three months and had on fibre-optic laryngoscopy findings suggestive of gastroesophageal reflux. None of them had complained of gastroesophageal symptoms. Twenty-four hour pH monitoring revealed that 13 (62 per cent) of these children had gastroesophageal reflux, seven (33 per cent) having gastroesophageal reflux more than three times the upper limit of normal. The pH graphs highlighted frequent refluxes, ranging from 0.4 to 37.4 refluxes per hour (median of 7.3 refluxes/hour). The majority of these refluxes occurred when the child was awake as opposed to asleep, with a median of 14.8 refluxes/hour and 0.9 refluxes/hour respectively (p = 0.0009). The refluxes were classically of short duration. This study suggests that gastroesophageal reflux plays a direct role in the pathogenesis of chronic laryngitis and hoarseness in children.

Child↗

PubMed2005

Hoarseness due to bilateral vocal cord paralysis as an initial manifestation of familial amyotrophic lateral sclerosis.

Bulbar palsy is unusual as an initial manifestation of amyotrophic lateral sclerosis (ALS), although common in the advanced stages. In terms of bulbar palsy as a presenting symptom, dysarthria and dysphagia are of common features. Hoarseness, however, is an initial symptom of ALS in only a small number of patients. We report a 43-year-old female with hoarseness due to bilateral vocal cord paralysis as the first manifestation of ALS. Gene analysis revealed a heterozygous missense mutation in the SOD1 gene, which resulted in an amino acid substitution of isoleucine 149 by threonine. Hoarseness can be the initial symptom of ALS. Therefore, in cases of bilateral vocal cord paralysis of unknown etiology, ALS should be taken into consideration.

Adult↗

PubMed1992

Hoarseness in a child with gastroesophageal reflux.

Hoarseness is not generally appreciated to be a manifestation of pediatric gastroesophageal reflux. We describe a case in which treatment of well-documented gastroesophageal reflux and esophagitis in a young girl with hoarseness and nocturnal cough led to resolution of these symptoms. Possible pathogenetic mechanisms and the difficulty in associating hoarseness with reflux by standard reflux testing are discussed.

Child↗

PubMed1995

Aetiologic factors associated with hoarseness in ten-year-old children.

The parents of 55 10-year-old children answered questionnaires concerning 51 elements of potential relevance to voice function such as vocal habits, speech and language development, medical history, social history, physical environment and family relations. In addition, personality profiles of each child were assessed by its teacher and parents. The results were compared to an expert listening panel's evaluation of hoarseness and vocal-fold status as determined by a visual examination by a phoniatrician. Eight boys were identified as being chronically hoarse. Gender, personality and hours spent per day in large groups were highly significant factors associated with hoarseness. A discriminant analysis based on the significant background variables correctly grouped 86.3% of the children.

Child↗

PubMed1998

Cause of hoarseness in elderly patients.

Hoarseness is a common symptom in older individuals and may reflect a wide variety of pathologic, medical, physiologic, and/or functional causes. Although vocal fold atrophy is one of the more common reported findings in the elderly, inconclusive information is known about the differential diagnosis and cause of dysphonia in older individuals. The purpose of this investigation was to review the cause of hoarseness in all patients older than 65 years and to determine any correlation with advancing age and other demographic factors. Additionally, we wanted to determine the effect vocal pathology has on objective voice measures with advancing age. The two most common causes of hoarseness found in 393 patients older than 65 years were vocal fold bowing and unilateral vocal fold paralysis, followed by benign vocal fold lesions, voice tremor, and spasmodic dysphonia. Although objective measures of vocal function were abnormal compared with reported normative data, they did not increase in severity with advancing age. Apparently, the compounding effect of age on underlying vocal pathology does not increase the severity of the vocal disturbance, at least as represented by objective voice measures. The high incidence of medical illnesses seen in this population also needs to be kept in mind because it may further affect the underlying voice disturbance. It might be interesting to compare data on the patients' perceptions of their vocal disturbance for each disorder as a function of age. It would also be helpful to know whether patients responded to treatment differentially based on age.

Aged↗