中西医结合治疗肥厚性喉炎的声学检测

过度用嗓及用嗓不当,特别是嗓音病变的早期,得不到合理的休息和治疗,使嗓音病发病率越来越高,严重影响他们的正常工作[1].嗓音疾病的防治在我国日益受到重视.这类疾病常以慢性喉炎、声带小结、声带息肉为多见.我们这次选择对肥厚性喉炎(hypertrophic laryngitis)进行中西医结合治疗,并利用嗓音声学分析进行治疗结果分析.现报告如下.     

会厌逐瘀汤加味治疗慢性肥厚性喉炎临床观察

目的 探讨会厌逐痰汤加味治疗慢性肥厚性喉炎的疗效。方法 80例患者分两组，治疗组用会厌逐瘀汤加味治疗，对照组用金嗓散结丸，比较疗效差异。结果 治疗组治愈率30％；总有效率87．5％，与对照组比较差异有显著性意义。结论 会厌逐瘀汤加味治疗慢性肥厚性喉炎有确切疗效。     

声带注射得保松治疗慢性肥厚性喉炎

目的探讨声带注射得保松治疗慢性肥厚性喉炎的疗效.方法回顾分析慢性肥厚性喉炎55例在电子喉镜引导下经环甲膜穿刺声带内注射得保松的临床资料.结果痊愈率为50.9%,总有效率为100%,随访8～30月,疗效稳定,无并发症发生.结论声带注射得保松是治疗慢性肥厚性喉炎的有效方法,不仅能缓解或改善患者的声嘶症状,而且能部分逆转肥厚的声带黏膜.     

转移因子配合中药治疗肥厚性喉炎42例报告

我科自1994年12月至1996年4月采用转移因子配合中药治疗肥厚性限炎42例，疗效满意，现报告如下。一股资料42例中男性28例（667％），女性14例（33．3％）；年龄30～56岁，平均年龄42．5岁；症状发声粗糙、声嘶，候都分泌物多、粘稠、不易喷出，间接喉镜所见：喉粘膜呈晗红色，声、室带肥厚，串门闭合不全；病程均在2～3年，全部病例均通过其它各种治方未能奏效。治疗方法转移因子使用武汉扬子江生物化学制药厂生产的针剂．每支含量为ig，加入无菌注射用水3d，取其Zml，肌肉注射月余Ind再加入0．9％生理盐水ZOtnl作超声雾化吸入。每周H次，…     

必可酮联合增液响声饮治疗慢性肥厚性喉炎的疗效观察

近年来,因声带炎性肥厚致声嘶、喉痛患者增多,通常使用雾化吸入、口服中成药等治疗,因疗程长,疗效欠佳,所以患者并不满意.我们采用必可酮气雾剂联合“增液响声饮”治疗声带肥厚,方法简便,疗效满意.现报告如下.     

中西医结合治疗慢性肥厚性喉炎疗效观察（附42例报告）

报告自1994年以来．采用α-糜蛋白酶肌注,同时口服金嗓散结丸治疗慢性肥厚性喉炎42例,并以单纯口服金嗓散结九及单纯肌注α-糜蛋白酶做对照组,疗程1月,随访2月～2年。结果显示：治疗组总有效率达92．86％,治愈率11．90％,疗效明显优于对照组P＜0．01。表示α-糜蛋白酶协同金嗓散结丸治疗慢性肥厚性候炎有较好的疗效。     

微波治疗慢性肥厚性鼻炎

慢性肥厚性鼻炎是一种常见病多发病。各种治疗方法很多 ,如注射、冷冻、电凝、激光、手术等 ,但这些方法疗程长 ,病人有痛苦 ,疗效也不肯定。我科自1995年以来应用微波治疗慢性肥厚性鼻炎 2 32例 ,取得了满意效果 ,报告如下。临床资料 :2 32例中 ,男 4 0例 ,女 92例 ;年龄 5～ 60岁 ;双侧 2 0 2例 ,单例 32例 ;病程 1～ 30年。临床症状主要为持续性鼻塞 ,嗅觉减退 ,可伴有耳鸣、听力减退、头昏、失眠等。检查可见鼻粘膜充血、增生、肥厚等。治疗方法 :采用珠海和佳系统工程有限公司研制的ＥＢＨ -Ⅲ型耳鼻喉综合治疗仪 ,连接能伸入鼻腔的辐…     

等离子机治疗慢性肥厚性鼻炎

慢性肥厚性鼻炎是临床常见病,治疗方法很多。自1997年我科应用等离子机治疗肥厚性鼻炎,取得了良好的效果,现介绍如下。1临床资料52例中,男34例,女18例,年龄11～57岁。患者均有鼻塞病史,伴头痛者19例,长期张口呼吸致慢性咽炎者20例,下鼻甲肥厚者42例,中鼻甲肥厚者10例。经鼻甲粘膜下注射硬化剂治疗12例,经过冷冻治疗5例,效果欠佳。病程2月至30年。2治疗方法患者取坐位,常规剪鼻毛,特别紧张者术前可肌注苯巴比妥钠0．1。用1％地卡因棉片置人鼻甲周围行表面麻醉,采用南京台华高新技术研究所生产的台华牌THYD－3型等离子机多功…     

硬化剂注射治疗慢性肥厚性鼻炎

1 临床资料 采用下鼻甲粘膜下注射硬化剂治疗慢性肥厚性鼻炎60例，其中男性42例，女性18例，年龄16～62岁，平均33岁。主要症状：鼻阻60例，脓涕46例，头昏头痛36例。局部检查60例均见下鼻甲肥大，其中双侧肥大者54例，单侧肥大者6例；合并鼻中隔偏曲者45例，占75％。     

中西医结合治疗慢性肥厚性咽炎

我科自１９９７年以来，采用ＹＺＹ－Ⅱ型冷光咽炎治疗仪 配合中药治疗慢性肥厚性咽炎，取得了显著疗效，现报告如 下。１资料与方法１．ｌ临床资料 根据慢性肥厚性咽炎诊断标准［１］，选择诊断明确的慢性肥厚性咽炎１２６例，按不同的治疗方法分为３组：①咽炎治疗仪配合中药治疗组（联合治疗组），共６２例，男３５例，女２７例；年龄２５～５８岁；病程３～１１年。②单纯中药治疗组（对照组Ｉ），共３８例，男２０例，女１８例；年龄２２～６４岁；病程１～５年。③单纯咽炎治疗仪组（对照组Ⅱ），共２６例，男 １６例，女１０例；年龄…     

Absence of bacterial infection in the mucosal secretion in chronic laryngitis

OBJECTIVES: To examine whether an infectious process is present in the laryngeal secretion in patients with chronic laryngitis. STUDY DESIGN: Mucosal secretion from vocal cords and ventricular folds from 14 patients with chronic laryngitis was examined. Twelve patients with healthy larynxes served as control subjects. METHODS: Secretion from the laryngeal mucosa was sampled with an imprint technique during general anesthetic. The samples were stained and examined by light and fluorescence microscopy. The numbers of leukocytes and bacteria and the extension of phagocytosis were estimated. RESULTS: In the secretion from eight of the patients with chronic laryngitis we could observe huge numbers of bacteria, whereas only few bacteria were seen in the secretion from the control subjects. However, in both groups, only a few neutrophils were observed and phagocytosis was not present, indicating that the bacteria were present as colonizers. CONCLUSIONS: No infectious process is present in the secretion in chronic laryngitis. Further studies concerning the pathogenesis should focus on the pathological processes or conditions of the mucosa.     

黏膜的色彩分析在慢性喉炎中应用的初步探讨

目的用计算机色彩分析软件测定正常人喉黏膜的红色指数和慢性喉炎患者喉黏膜的红色指数,客观、定量分析喉黏膜的充血程度。方法回顾性研究美国西北大学医学院耳鼻咽喉科硬管喉镜录像资料,用计算机图像分析软件对其进行定量分析,其中正常组18例,慢性喉炎组27例,分别选取双侧杓区、杓间区、双侧声带5个区域的图像进行分析,计算各区域黏膜的红色指数。结果正常组和慢性喉炎组之间,双侧杓区、双侧声带、杓间区黏膜红色指数均有显著性差异（P〈0．05）。慢性喉炎组,杓区黏膜、双侧声带、杓间区黏膜红色指数之间均有显著性差异（P〈0．05）。计算机软件可以将慢性喉炎组和正常对照组的喉镜图像有效区分,并对黏膜的充血程度进行定量。结论通过计算机软件对黏膜图像进行色彩分析是一种客观、定量的方法,可以克服肉眼判断黏膜颜色所造成的误差,并且可以进行充血程度的判断。     

Membranous laryngitis in a child

The most common etiologies for acute infectious airway obstruction include epiglottitis, croup, and bacterial tracheitis. We present a unique cause of upper airway obstruction in a child not previously described. To our knowledge this is the first case in the literature of membranous laryngitis in a child due to Methicillin-resistant Staphylococcus Aureus (MRSA). The diagnosis was made by endoscopy and culture and treated with culture directed antibiotics and debridement of membranes from the larynx. The patient did not present with clinical symptoms consistent with epiglottitis as the disease course was not abrupt, and the patient did not present with classic posturing and drooling. Croup-like symptoms were described, but there was no evidence of subglottic involvement radiographically or on endoscopy. Additionally, there was no evidence of membranous plaques within the trachea or subglottis which would be suggestive of bacterial tracheitis. This unique finding is likely the result of MRSA superinfection in a child with Influenza type B.     

Herpes zoster laryngitis with intractable hiccups

A 73-year-old man presented to our hospital with a sore throat (left-sided) and hiccups. The patient had mucosal swelling and erosions affecting the left posterior pillar, base of tongue, epiglottis, arytenoid, and aryepiglottic fold. As the laryngeal mucosal edema became worse, herpetic vesicles and erosions developed on the left cavum conchae, external auditory canal, and palate. The patient was treated with acyclovir and a steroid. His hiccups were treated with metoclopramide, but it had little effect, and hiccups only subsided gradually after the disappearance of erosions. His hiccups relapsed transiently with vomiting, and then resolved completely. Elevation of the CF titer after 2 weeks confirmed the diagnosis of herpes zoster. This condition should be considered in patients with unilateral sore throat and intractable hiccups, and treatment with acyclovir should be provided.     

Endoscopic laterofixation in bilateral vocal cords paralysis in children

Introduction

Vocal cords paralysis is the second most frequent cause of laryngeal stridor in children. Symptoms of congenital vocal cords paralysis can occur shortly after birth or later. Vocal cords paralysis can be unilateral or bilateral. Symptoms of unilateral paralysis include hoarse weeping or stridor during a deep inhalation. In children unilateral vocal cords paralysis often retreats spontaneously or can be completely compensated. Children with bilateral vocal cords paralysis present mainly breathing disorders while phonation is normal. Symptoms are different, starting from complete occlusion of respiratory tracts and ending on small symptoms connected with the lack of effort tolerance. When symptoms are severe, patients from this group require a tracheotomy. The lack of restoration of normal function of vocal cords or lack of complete compensation and maintenance of symptoms are an indication for surgical treatment.

Objective

The aim of this study is to present results of the treatment of bilateral vocal cords paralysis in children using the endoscopic method of laterofixation of vocal cords.

Material and methods

In the Pediatric ENT Department between 1998 and 2009 sixty four children with dyspnoea and/or phonation disorders caused by vocal cords paralysis were treated.

Results

In ten cases laterofixation of vocal cords was performed, in most cases with good result. In this article the authors present the method of endoscopic laterofixation and achieved results.

Conclusions

Endoscopic laterofixation of vocal cords in children is a safe and an easy method of surgical treatment of bilateral vocal cords paralysis. This method can be used as a first and often as a one stage treatment of vocal cords paralysis. In some cases this procedure is insufficient and has to be completed with other methods.     

吸烟与喉炎

目的探讨吸烟与喉炎的关系.方法通过随机抽样调查,分析吸烟者的喉炎发病率及其治疗和预防措施.结果调查3580人,有吸烟者1163人,其中363人患喉炎;不吸烟2417人,208人患喉炎.结论吸烟者比不吸烟者喉炎发病率显著增高(P＜0.01).     

Infectious granulomatous laryngitis: a retrospective study of 24 cases

The diagnostic and treatment of verrucous lesions of the larynx involves a high level of suspicion by the physician attending the patient. The causes may go from unspecific laryngitis to neoplasia and granulomatous diseases. This kind of lesion is uncommon and the presentation aspects may vary broadly. The lesions in larynx are significant source of morbidity. The onset of symptoms is insidious and the diagnosis is usually delayed. Symptoms include dysphonia, dyspnea, dysphagia and odynophagia. Proper treatment depends upon tissue biopsy, identification of the causative organism, and the appropriate pharmacotherapy. As there are few papers presenting the clinical features of infectious granulomatous laryngitis (IGL) as leishmaniasis, tuberculosis and paracoccidiodomycosis affecting the larynx, we considered important to show the experience of a big Brazilian Laryngology Service in dealing with this potential worldwide problem. We present a retrospective chart review showing our institution’s experience with IGL focusing in the diagnostic, treatment and prognosis aspects. Twenty-four patients were identified. Mycobacterium tuberculosis and Paracoccidiodis brasiliensis accounted for ten cases each, and Leishmania braziliensis the remaining four. Hoarseness was the most common symptom of infection. Up to one-third of patients with laryngeal involvement lacked laryngeal symptoms. The average delay from onset of symptoms to diagnosis was 7 months. All patients underwent direct laryngoscopy and biopsies. Caseating granulomas was the key histopathologic finding. Identification of the causative organism was uncommon. No evidence of concomitant malignancy was seen on biopsy. Despite treatment, almost 40% of patients had permanent sequelae of infection, including hoarseness, dyspnea, and dysphagia. Mycobacterium tuberculosis, P. brasiliensis, and L. braziliensis accounted for all cases of IGL. Patients may have laryngeal infection but lack laryngeal symptoms. Prompt diagnosis relies upon a high index of suspicion, especially when evaluating patients from endemic areas. Given the degree of tissue destruction, which accompanies infection, timely intervention may be important in the prevention of late sequelae. Despite appropriate therapy, a significant number of patients may have permanent sequelae of infection.     

Transcutaneous injection laryngoplasty through the cricothyroid space in the sitting position: anatomical information and technique

A variety of approaches have been introduced to perform injection laryngoplasty under local anesthesia. Among these reported methods, transcutaneous injection through the cricothyroid space offers many advantages, but it possesses some technical difficulties during access to the vocal fold. The aim of this study was to assess the anatomic references related to transcutaneous injection laryngoplasty through cricothyroid space using 3-dimensionally reconstructed computed tomography to provide guidelines and to achieve higher efficacy during the procedure. The study group consisted of 14 patients (7 male, 7 female) with unilateral vocal fold paralysis and who had undergone multi-detector array computed tomography (MDCT) between January 2004 and December 2005. Assumption was made that transcutaneous injection is approached from the surface at lower margin of the thyroid cartilage and 7 mm lateral to the midline through the cricothyroid membrane and spot at the posterior 1/3 of true vocal cord is the target for injection laryngoplasty. From the surface of the injection point to the target, a line was drawn. Its length and the angle formed between it and the approach direction of needle was measured. Based on these measurements, 15 patients (8 male, 7 female) with unilateral vocal fold paralysis received 15 trials of transcutaneous injection laryngoplasty through the cricothyroid space. The average length from the surface of the injection point (7 mm lateral to the midline) to the posterior 1/3 of the true vocal cord (target of the injection) was 15.75 mm in men and 13.91 mm in women. The average of the angle in medial direction at the surface needed to reach the target of the injection was 10.57° in men and 12.71° in women, and in superior direction was 47.57° in men and 47.43° in women. Injection laryngoplasty performed under acquired reference measurements were successful in 14 trials (93.3%) out of 15 trials in 15 patients. We suggest that knowledge of the anatomic references regarding the transcutaneous injection laryngoplasty through cricothyroid space will provide guidelines for beginners and improve the understanding of the procedure, eventually leading to easier and more precise access to the vocal cord.