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   2014| January-June  | Volume 4 | Issue 1  
    Online since September 22, 2014

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Laryngeal ultrasound in diagnosis of vocal cord palsy: An underutilized tool?
Inita R Matta, Kanupriya B Halan, Ramesh H Agrawal, Mandar S Kalwari
January-June 2014, 4(1):2-5
Background: Despite the prevalence of ultrasonography in medical practice, its use in laryngeal disorders appears underutilized. It provides a simple, easy, cheap and non-invasive method to diagnose vocal cord palsy in real time, dynamic 2 or 3-dimensional image mode. It can be an alternative diagnostic tool where flexible fibreoptic laryngoscopy is limited by an uncooperative patient, xylocaine sensitivity or where stroboscopy is not available due to cost restraints. Especially it is useful in the preoperative workup of a patient undergoing thyroid surgery. Aims: The present study evaluates the accuracy of ultrasonography in diagnosis of vocal cord palsy in 25 patients. We have used fibreoptic laryngoscopy purely as a comparative tool for purposes of this study. Materials and Methods: It was a prospective study carried out in 25 patients presenting with hoarseness. Patients underwent laryngeal ultrasound followed by flexible fibreoptic laryngoscopy. Results: We were able to accurately diagnose vocal cord palsy by ultrasound in all but two patients where the examination was limited by extensive laryngeal cartilage calcification. Discussion and Conclusion: There is every evidence to suggest that ultrasonography has a place in diagnosis of vocal cord palsies. It is easy, cheap, available, and non-invasive. It is a useful tool where fibreoptic laryngoscopy is limited by an uncooperative patient and where strobolaryngoscopy is not available. Further study and more familiarity would extend its use to other laryngeal disorders.
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Bilateral pneumothorax: Perils of emergency tracheostomy
Shraddha Jain, Sunil Kumar, Prasad Deshmukh, Sagar Gaurkar
January-June 2014, 4(1):36-38
Tracheostomy is a life-saving procedure performed in both emergency and elective setting. Development of bilateral pneumothorax in adults following tracheostomy is a rare complication. We report a case of bilateral iatrogenic pneumothorax in 33-year-old woman from rural Maharashtra in central India, immediately following emergency mid-level tracheostomy done for post- radiotherapy fibrosis with laryngeal perichondritis and retropharyngeal infection associated with prolonged dyspnea. No pleural injury or posterior tracheal wall injury had occurred. Sudden left-sided chest pain with immediate reoccurrence of dyspnea prompted us to do urgent chest X-ray. Bilateral pneumothorax was identified, more on the left side. The patient was treated with tube thoracostomy. The case is being reported to highlight the possibility of occurrence of this rare life-threatening complication due to the underlying mechanism in any case of emergency tracheostomy.
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Comparison of esophageal and tracheoesophageal speech modes in dual-mode alaryngeal speakers
Santosh Maruthy, Marie Karla Mallet, Rajashekhar Bellur
January-June 2014, 4(1):6-11
Objective: The main purpose of this study was to compare different speech related parameters in dual-mode esophageal and tracheoesophageal speakers. A second purpose was to compare the speech characteristics of these (tracheo) esophageal speakers with age- and gender matched controls. Materials and Methods: Four male laryngectomees who were proficient esophageal and tracheoesophageal speakers provided audio recordings of sustained vowels and connected speech using both alaryngeal methods. The participants from the control group also followed the same procedure. From the recorded samples, fundamental frequency (F0), maximum phonation duration (MPD), formant frequencies, and speech rate related parameters were extracted. Results: Although there was no statistically significant difference between the two alaryngeal modes for any of the measured parameters, the absolute fundamental frequency and MPD values were higher in TE mode. However, when compared to controls, both the alaryngeal modes depicted significantly shorter MPD values, higher first formant frequency values, slower speech rate, and higher frequency of pauses. Conclusion: The results suggest that most group differences found between esophageal and tracheoesophageal speech in the past may be due to large inter-subject variability, and that within speakers, similarity is more between esophageal and tracheoesophageal speech than with laryngeal speech. These results have implications for understanding the pseudoglottic voice mechanism.
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Cricopharyngeal dysfunction in lateral medullary syndrome
C.S. Meera Priya, Jayakumar R Menon
January-June 2014, 4(1):21-27
Background: Dysphagia is a common consequence of medullary stroke, and it is particularly true in Lateral medullary syndrome (LMS). Aims: To compare the lateral medullary syndrome (LMS) to the middle cerebral artery infarct (MCA) population to study the swallowing dysfunction at the oral, pharyngeal, and esophageal level using flexible endoscopic evaluation of swallowing (FEES) and video-flouroscopic swallowing study (VFS). Materials and Methods: The swallowing characteristics in 16 patients (11 men and five women) with a mean age of 61.8 (range 44-78 years), with left LMS were compared with 18 patients (13 men and five women) with unilateral hemispheric infarction (left MCA), with a mean age of 58.2 (range 37-75). The swallowing characteristics were recorded and analysed. Results and Discussion: All LMS patients considered for this study had pharyngeal and proximal esophageal stage dysphagia. Swallowing difficulties noted were delayed pharyngeal swallow reflex, cricopharyngeal dysfunction, pooling in post-cricoid region (left > right side), and multiple swallows to clear bolus. All patients with L MCA infarct had difficulty with oral and pharyngeal stage dysphagia. All left MCA infarct patients showed delay in oral transit time, laryngeal penetration and aspiration. Conclusion: A substantial uniformity of pathophysiological characteristics was found. The pharyngeal and proximal esophageal stage of swallowing was affected in left LMS, but both oral and pharyngeal stage of swallowing was affected in left MCA infarct. Cricopharyngeal dysfunction was a typical finding in LMS, although severity varied. Because severe dysphagia is very common in stroke, active swallowing diagnostic and therapeutic approaches are needed.
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Laryngeal framework surgery for adductor spasmodic dysphonia
Akshat Malik, Satish Nair, Ajith Nilakantan
January-June 2014, 4(1):28-31
Adductor spasmodic dysphonia is difficult to diagnose and treat. Botulinum toxin is considered to be treatment of choice for adductor spasmodic dysphonia. We present a case here, who had become refractory to the effects of botulinium toxin. He subsequently underwent type II thyroplasty and had satisfactory improvement in voice with it.
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The savior becomes the devil
Rakesh Datta
January-June 2014, 4(1):1-1
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Pneumopericardium - an unusual complication of broken tracheostomy tube presenting as foreign body trachea
Jayita Poduval, F Benazir, Preety Ninan
January-June 2014, 4(1):32-35
Foreign bodies in the trachea may be of various kinds and usually present as acute respiratory emergencies, which if not treated expediently, may prove fatal. A broken tracheostomy tube is an unusual foreign body and defeats the purpose for which a tracheostomy is done, namely to facilitate breathing. We present here yet another similar case, but with an impending pneumopericardium, and suggest remedial measures, along with a review of literature.
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Voice acoustic profile of males exposed to occupational infrasound and low-frequency noise
Ana P Mendes, Iris Bonanca, Ana Jorge, Mariana Alves-Pereira, Nuno A.A. Castelo Branco, Marlene Caetano, Nadia Oliveira, Andreia Graca, Carolina Santos, Renata Ferraria
January-June 2014, 4(1):12-20
Background: Vibroacoustic disease (VAD) is a systematic pathology characterized by the abnormal growth of extra-cellular matrices in the absence of inflammatory processes, namely collagen and elastin, both of which are abundant in the basement membrane zone of the vocal folds. VAD can develop due to long-term exposure to infrasound and low-frequency noise (ILFN, < 500 Hz). Mendes et al. (2006, 2008 and 2012) revealed that ILFN-exposed males and females presented an increased fundamental frequency (F 0 ), decreased jitter %, and reduced maximum phonation frequency range, when compared with normative data. Temporal measures of maximum phonation time and S/Z ratio were generally reduced. Study Aims: Herein, the same voice acoustic parameters of 48 males, 36 airline pilots and 12 cabin crewmembers (age range 25-60 years) were studied, and the effects and interaction of age and years of ILFN exposure were investigated within those parameters. ILFN-exposure time (i.e. years of professional activity) ranged from 3.5 to 36 years. Materials and Methods: Spoken and sung phonatory tasks were recorded with a DA-P1 Tascam DAT and a C420III PP AKG head-worn microphone, positioned at 3 cm from the mouth. Acoustic analyses were performed using KayPENTAX Computer Speech Lab and Multi-Dimensional Voice Program. Results: Results revealed that even though pilots and cabin crewmembers were exposed to occupational environments with distinct (ILFN-rich) acoustical frequency distributions and sound pressure levels, differences in the vocal acoustic parameters were not evident. Analyzing data from both professional groups (N = 48) revealed that F 0 increased significantly with the number of years of professional activity. Conclusion: These results strongly suggest that the number of years of professional activity (i.e. total ILFN exposure time) had a significant effect on F 0 . Furthermore, they may reflect the histological changes specifically observed on the vocal folds of ILFN-exposed professionals.
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