MyMedR

Unusual cause of neuropathy: extensive dural spread of primary cervical osteosarcoma

Ponnampalam SN, Tan WY, Wazir NN, George J

Acta Radiol Short Rep, 2012;1(1):1-3.

PMID: 23986826 DOI: 10.1258/arsr.2012.110028

We report a very rare case of a high grade osteosarcoma of the cervical spine in a 62-year-old woman. She presented with a relatively short history of a swelling in the posterior neck and cervical lymphadenopathy. This was associated with hoarseness of the voice, significant weight loss, and right upper arm radicular symptoms initially, progressing to paraplegia. Based on MR and CT imaging of the neck and an excision biopsy of an enlarged right supraclavicular lymph node, the histology revealed a high grade primary osteosarcoma of the cervical spine.

Matched MeSH terms: Hoarseness

Fulltext Denture Induced Submandibular Hematoma in a Patient on Warfarin

Boon Tat Y, Muniandy RK, Ng Mooi Hang L

Case reports in anesthesiology, 2018;2018:4245809.

PMID: 30647972 DOI: 10.1155/2018/4245809

A 79-year-old lady, who was taking warfarin, presented to the Emergency Department with a painless anterior neck swelling, which was associated with hoarseness of voice, odynophagia, and shortness of breath. She first noticed the swelling after she removed her dentures in the evening. On examination, she had an increased respiratory rate. There was a large submandibular swelling at the anterior side of her neck. Upon mouth opening, there was a hematoma at the base of her tongue, which extended to both sides of the tonsillar pillars. The patient was intubated with a video laryngoscope due to her worsening respiratory distress. Intravenous vitamin K and fresh frozen plasma were given immediately. The patient was admitted to the ICU for ventilation and observation. The hematoma subsided after 2 days and she was discharged well.

Matched MeSH terms: Hoarseness

Fulltext Lessons of the month: A forgotten classic: Delayed diagnosis of mitral stenosis presenting initially as Ortner's syndrome

Shariff RER, Abidin HAZ, Kasim SS

Clin Med (Lond), 2020 11;20(6):e267-e268.

PMID: 33199335 DOI: 10.7861/clinmed.2020-0750

We present a rare case of delayed diagnosis of mitral stenosis, initially presenting with hoarseness in her voice due to left recurrent laryngeal nerve (LRLN) compression. A 60-year-old woman presented to the otorhinolaryngology department following complaints of progressive hoarseness in voice over a 6-month period. There was dysphonia but no additional evidence of a cranial nerve IX or X palsy on examination, with subsequent flexible nasopharyngolaryngoscopy demonstrating left vocal cord palsy. She was referred for a cardiology consult following findings of atrial fibrillation on electrocardiography. Transthoracic echocardiography revealed an enlarged left atrium with evidence of severe mitral stenosis. A diagnosis of Ortner's syndrome was made and the patient underwent mitral valve replacement. Common causes of Ortner's syndrome include mitral stenosis with left atrium compression of the LRLN, but it can occur due to other causes including pulmonary hypertension or aortic aneurysm compression, among others. There are few data at present to conclude that regression of left atrial enlargement and pulmonary arterial hypertension with symptoms are associated with Ortner's syndrome. Therefore, it remains pertinent for clinicians to be aware of clinical features linked to mitral stenosis including its more uncommon presentations, such as in our case, as earlier intervention may improve prognosis.

Matched MeSH terms: Hoarseness/etiology

The floppy vocal polyp

Rahmat O, Prepageran N

Ear Nose Throat J, 2008 Dec;87(12):668-9.

PMID: 19105136

Matched MeSH terms: Hoarseness/diagnosis; Hoarseness/etiology

Fulltext Stridor Secondary to Acquired Subglottic Cyst: Rarity Makes it Missed

See GB, Mesran I

Indian J Otolaryngol Head Neck Surg, 2019 Oct;71(Suppl 1):45-48.

PMID: 31741928 DOI: 10.1007/s12070-016-0992-2

Subglottic cysts (SGCs) are a rare cause of airway obstruction in children. Medical advances, higher survival rates for preterm infants, and improved diagnostic equipment have increased the number of reported cases of SGCs over the last three decades, the majority occurring in infants who had been extremely premature neonates and had suffered from respiratory distress, therefore having been intubated and managed in neonatal ICUs. Symptoms of laryngeal cysts depend on the size and the location of the cyst and include a change in the tone of voice, dysphonia, hoarseness, dysphagia, stridor, and dyspnea. This condition is often misdiagnosed as laryngomalacia, asthma, croup, or other diseases, due to the fact that it manifests as recurring respiratory infections, stridor, and wheezing. Death can occur in severe cases that are not treated. When present, it may account for severe inspiratory stridor that compromise the airway. The accepted gold standard treatment is direct laryngoscopy with marsupialization of the cyst to prevent recurrence. Two cases of subglottic cyst in our centre are described here. Although all cases presented differently, but in both of our cases, which have previous history of intubation with prematurity were initially diagnosed as laryngomalacia and croup.

Matched MeSH terms: Hoarseness

Fulltext Thoracic aortic aneurysm presenting as vocal cord paralysis

Norly, S., Noorizan, Y., Ros’aini, P.

International Medical Journal Malaysia, 2013;12(1):67-68.

MyJurnal

We present a case of 80-year-old man with two-year history of hoarseness of voice secondary to left vocal cord paralysis. CT scanning revealed a saccular thoracic aneurysm compressing the left recurrent laryngeal nerve. A review of literature on Ortner's or cardiovocal syndrome is presented.

Matched MeSH terms: Hoarseness

Fulltext Gore-tex medialisation thyroplasty for unilateral vocal cord palsy: a tertiary centre 7 years experience

Dayangku, N.P.S., Marina, M.B., Mawaddah, A., Sharifa Ezat, W.P., Abdullah, S.

International Medical Journal Malaysia, 2016;15(2):13-17.

MyJurnal

Background: The resultant dysphonia and aspiration in unilateral vocal cord palsy can be overcome with
medialisation thyroplasty. With this background, we aim to determine the aetiology of the unilateral vocal
cord palsy and effectiveness of the phonosurgical procedure with Gore-Tex as a sole treatment. Methods:
Within a seven year period, 37 Gore-Tex medialisation thyroplasty were performed for unilateral vocal cord
palsy at our institution and medical records were retrospectively reviewed. Results: There were 18
males and 19 females with mean age of 48.7 years (range 19–81 years). The predominant aetiology was
thyroidectomy (43.2%) with benign thyroid disease predominates (n=13) over thyroid malignancy (n=3). Voice
outcome was evaluated subjectively using visual analogue scoring system, results indicating that Gore-Tex
medialisation thyroplasty was effective in addressing dysphonia in 62.5% (n=15) patients. However it alone
cannot address aspiration seen in those with high vagal nerve lesion. Airway compromise occurred in two
cases postoperatively (5.4%) presenting as acute stridor. Conclusion: In unilateral vocal cord palsy, Gore-Tex
medialisation thyroplasty can effectively improve the resultant dysphonia and often accompanying aspiration
which would otherwise be disabling for the patients.

Matched MeSH terms: Hoarseness

Fulltext Isolated unilateral vocal fold palsy following skull base fracture: a case report

Marina M.B., Hazleigh N.M., Thean, Y.K., Sani A.

International Medical Journal Malaysia, 2018;17(3):95-98.

MyJurnal

Isolated lower cranial nerve (CN) palsy affecting the CN X resulting from a skull base fracture is very rare. The clinical manifestation and natural history is related closely to the complex anatomy of this region and mechanism of injury. Here, we report a case of a 54 year-old man who presented with a delayed onset of dysphonia and dysphagia with aspiration following a closed head injury sustained from a motor vehicle accident. Injection laryngoplasty was implemented to alleviate symptoms of his CN X palsy, which eventually almost completely resolved. High index of suspicion should be maintained when investigating possible skull base fractures, especially with a suggestive clinical presentation of lower CN palsies affecting one or all the lower CNs. Delayed onset of these CN palsies are likely to have more favourable outcomes.

Matched MeSH terms: Hoarseness

Dysphonia and reflux in children: A systematic review

Saniasiaya J, Kulasegarah J

Int J Pediatr Otorhinolaryngol, 2020 Dec;139:110473.

PMID: 33137676 DOI: 10.1016/j.ijporl.2020.110473

OBJECTIVE: Aim of this review is to evaluate the relation between reflux (either laryngopharyngeal or gastroesophageal) and dysphonia in children.

DATA SOURCES: PubMed, Scopus, Embase.

REVIEW METHODS: A literature search was conducted over a period from January 1990 to March 2020. The following search words were used either individually or in combination: voice disorders, laryngopharyngeal reflux, and gastroesophageal reflux. The search was conducted over a period of a month: April 2020.

RESULTS: Five clinical research were selected based on our objectives and selection criteria. Four studies were of level III evidence. Altogether, a total of 606 patients were pooled with male predominance of 63%. In all studies, reflux was suggested to have strong relation with dysphonia. Majority of cases used 24-h pH monitoring to confirm reflux which yielded positive results in 69%. The top three most common endoscopic findings include: interarytenoid erythema and edema (32/38), vocal cord erythema and edema (160/231) and postglottic edema (141/337). Vocal cord nodules were found in 28% of our patients. Acoustic analysis and perceptual assessment of voice was performed in only 1 study. No complication from any procedure was mentioned in any of the studies. Outcome of treatment was mentioned in 1 study, whereby after 4.5 months of follow-up, 68% of children showed improvement in symptoms.

CONCLUSION: Current evidence shows that there is strong relation between reflux and dysphonia in children. Most common laryngoscopic findings suggestive of reflux includes interarytenoid erythema and edema, vocal cord erythema and edema and postglottic edema.

Matched MeSH terms: Hoarseness

Fulltext An unusual first presentation of hypopharyngeal carcinoma as thyroid abscess: Case report of a diagnostic challenge

Tan HY, Sanudin SH, Lum SG, Wong EHC

Int J Surg Case Rep, 2021 Apr;81:105723.

PMID: 33713999 DOI: 10.1016/j.ijscr.2021.105723

BACKGROUND: Hypopharyngeal carcinoma can involve thyroid gland due to their close proximity. However, an initial presentation as a thyroid abscess is rare in this malignancy. To our knowledge, this is the second reported case in the English literature.

CASE PRESENTATION: We described a 45-year-old female who presented with dysphagia, hoarseness and anterior neck swelling. The initial CT scan revealed a right thyroid abscess which was incised and drained with no malignancy found in the biopsy of the thyroid tissue. Patient presented one month later with worsening dysphagia, weight loss and a fungating anterior neck mass. Further investigation revealed a locally advanced hypopharyngeal squamous cell carcinoma extending to the right thyroid, upper oesophagus, prevertebral muscles and bilateral cervical lymph nodes (T4bN2cM0). Unfortunately, the patient passed away prior to initiation of treatment.

CONCLUSION: Clinicians should have raised index of suspicion of a possible underlying hypopharyngeal carcinoma in patients presenting with thyroid abscess and proceed to further investigations in order to ensure early diagnosis and treatment of the malignancy.

Matched MeSH terms: Hoarseness

Primary Squamous Cell Carcinoma of the Thyroid Gland

Ibrahim MI, Jusoh YR, Adam NN, Mohamad I

Iran J Otorhinolaryngol, 2018 Jan;30(96):65-68.

PMID: 29387667

Introduction: Primary squamous cell carcinoma (SCC) of the thyroid gland is one of the rarest types of all reported thyroid malignancies worldwide. It is very aggressive in nature and carries a poor prognosis. The surgical resection with adjuvant radiotherapy and chemotherapy is the most recommended treatment despite its poor reported outcome.

Case Report: A 74-year-old woman presented with a rapidly progressive neck swelling, with hoarseness and compressive symptoms. Physical examination revealed a multilobulated firm thyroid mass with unilateral vocal cord palsy. Histopathological findings confirmed the diagnosis of SCC while radiological investigations and panendoscopy findings ruled out the possibility of other primary tumors. A surgical intervention was performed; however, the patient eventually succumbed to death prior to undergoing an oncological treatment.

Conclusion: With no standard consensus to guide the management plan, SCC of the thyroid gland presents a great challenge for the managing team to come up with the best treatment option, due to its unfavorable rate of survival.

Matched MeSH terms: Hoarseness

Fulltext Post-intubation airway related adverse effects: a aomparison between intra-cuff dexamethasone and intra-cuff alkalinized lignocaine

Kep, Kee W., Nadia, M.N., Melvin, K., Muhammad, M., Raha, R., Nurlia, Y.

Journal of Surgical Academia, 2013;3(2):26-31.

MyJurnal

Post-intubation airway related adverse effects such as coughing on the endotracheal tube (ETT), restlessness, hoarseness and sore throat are common and undesirable outcomes of anaesthesia using endotracheal intubation. This prospective randomized single blind study was carried out to compare the effectiveness of intra-cuff dexamethasone and alkalinized lignocaine in reducing the incidence of post-intubation airway related adverse effects. Eighty four patients aged 18 – 60 years, of ASA status I or II, were randomly allocated into three groups: air, dexamethasone and alkalinized lignocaine. Their ETT cuffs were inflated according to the group they were allocated to. The incidence of coughing on the ETT, restlessness, hoarseness and sore throat was assessed, postoperatively. The results showed a significant difference in the incidence of cough, restlessness, hoarseness and sore throat in the dexamethasone group compared to the air group. All the patients had minimal or no sore throat at all documented times. Both intra-cuff dexamethasone and alkalinized lignocaine significantly reduced the incidence of hoarseness. However, alkalinized lignocaine additionally lowered the incidence of restlessness, significantly.

Matched MeSH terms: Hoarseness

Laryngeal giant cell tumour presenting as a tongue base lesion causing severe dysphagia

Saud MRM, Salahuddin Z, Hassan A, Yunus MRM, Mohamad I, Zulkifli MM

J Taibah Univ Med Sci, 2018 Apr;13(2):201-204.

PMID: 31435324 DOI: 10.1016/j.jtumed.2017.10.002

Giant cell tumours are benign lesions that are uncommonly found in the larynx. Patients with these tumours may present with dysphagia, hoarseness and anterior neck swelling. Giant cell tumours are extremely rare and only a few cases have been reported. We present a case of an elderly woman who presented with severe dysphagia and a mass at the base of her tongue. The mass was found to be a laryngeal giant cell tumour and was successfully treated with chemotherapy.

Matched MeSH terms: Hoarseness

Fulltext Coughing on palpation: a rare complication of vagal schwannoma

Samarakkody, Z.M., Sayuti, K.A., Mat Zin, A.A., Wan Abdul Wahab, W.N.N., Mohamad, I.

Malaysian Family Physician, 2018;13(3):40-43.

MyJurnal

Cervical vagal schwannoma is an uncommon, benign neoplasm. It is usually asymptomatic and
presents as a painless, palpable mass in the neck. However, large schwannomas can cause dysphagia,
dysphonia or dyspnea as a result of compression. We report a case of an extremely rare complication
of vagal schwannoma in which neck palpation induced the patient to cough. As the patient refused
any surgical intervention, conservative management was used.

Matched MeSH terms: Hoarseness

Fulltext Pediatric laryngotracheal cases in Hospital Universiti Sains Malaysia

Irfan, M., Izani S.M., Adil, S.A.R., Suzina, S.A.H.

Malaysian Journal of Medicine and Health Sciences, 2012;8(1):55-59.

MyJurnal

There are many inherent challenges in the evaluation and management of children with laryngotracheal disorders, and it differs widely from one institution to another. The main challenges include access to suitable equipment, fully trained surgeon and, cooperation with the anesthetist and pediatrician. Material & Methods: The aim of the study was to analyze the pediatric laryngotracheal cases undergoing endoscopic examination in Hospital Universiti Sains Malaysia. A retrospective review of 73 cases undergoing microlaryngoscopy and bronchoscopy from 2004 to 2008 was done. Results: Laryngomalacia was the commonest diagnosis. The majority of the cases (45.2 %) were referred because of noisy respiration. Other reasons for referral were foreign body inhalation, unresolved lung disease, failed extubation, examination prior to decannulation and hoarseness. Conclusion: Management of pediatric laryngotracheal cases were varied and tailored to each problem. The endoscopic examination must be meticulous. The management include observation, medical treatment, closed (endoscopic)
techniques and open surgery.

Matched MeSH terms: Hoarseness

Juvenile onset respiratory papillomatosis : a theraputic challenge

Irfan Mohamad, Abdul Halim Shibgatullah, Rosdan Salim

Malaysian Journal of Paediatrics and Child Health, 2007;15(1):37-41.

MyJurnal

Respiratory papillomatosis is a disease of viral origin which is characterized by warty exophytic lesions in the aerodigestive tract. It is the most common benign lesion of larynx and the second most common cause of hoarseness in children. It has the tendency to recur and to spread through out the entire length of the aerodigestive tract. Although a benign disease, it has the potential of morbid consequences in view of airway complications and the risk of malignant transformation. We report a case of juvenile onset of respiratory papillomatosis and its therapeutic challenges.

Matched MeSH terms: Hoarseness

Fulltext Hoarseness as the sole symptom of an impending thoracic aneurysm rupture?

Jaafar R, Mohamad I

Malays Fam Physician, 2014;9(1):25-7.

PMID: 25606294 MyJurnal

Unilateral vocal cord palsy secondary to thoracic aortic aneurysm is a rare occurrence. Direct compression of the enlarging thoracic aneurysm on the left recurrent laryngeal nerve causes neuronal injury of the nerve, which is manifested as hoarseness. We present a rare case of unilateral vocal cord palsy in a 60-year-old healthy gentleman caused by a large thoracic aortic aneurysm. This rare presentation, with a serious underlying pathology might be misdiagnosed or delayed. Therefore, it is important for us to have high index of suspicion in cases with a rare presentation such as this.

Matched MeSH terms: Hoarseness

Fulltext Single rare central lesion with triple common aerodigestive symptoms

Mohamad I, Mohamad IS, Nik Hassan N

Malays Fam Physician, 2018;13(1):57-58.

PMID: 29796215 MyJurnal

An elderly gentleman with a known history of
well-controlled hypertension presented with
a three-week history of hoarseness associated
with mild breathlessness. There was no episode
of cyanosis, no noisy breathing, and no
reduction in effort tolerance. There was also no
history of chest pain or orthopnea. He denied
any feeling of food stuck in his throat or chest,
and he had no history of choking sensations
during meals. He, however, was unable to
count from 1 to 10 in one breath, and lung
auscultation revealed reduced air entry on both
sides. A chest radiograph was then obtained. (Copied from article).

Matched MeSH terms: Hoarseness

Fulltext Coughing on palpation: A rare complication of vagal schwannoma

Samarakkody ZM, Sayuti KA, Mat Zin AA, Wan Abdul Wahab W, Mohamad I

Malays Fam Physician, 2018;13(3):40-43.

PMID: 30800234

Cervical vagal schwannoma is an uncommon, benign neoplasm. It is usually asymptomatic and presents as a painless, palpable mass in the neck. However, large schwannomas can cause dysphagia, dysphonia or dyspnea as a result of compression. We report a case of an extremely rare complication of vagal schwannoma in which neck palpation induced the patient to cough. As the patient refused any surgical intervention, conservative management was used.

Matched MeSH terms: Hoarseness

Fulltext Covido-pedago-phobia

Eachempati P, Ramnarayan K

Med Educ, 2020 08;54(8):678-680.

PMID: 32473029 DOI: 10.1111/medu.14257

Matched MeSH terms: Hoarseness/etiology*

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