An eye on the vocal cords: family practitioner and hoarseness]

In four patients with hoarseness, men aged 53 and 67 years, and women aged 8 and 37 years, indirect laryngoscopy revealed, respectively, a squamous cell carcinoma of the vocal cord, recurrent nerve paralysis due to pulmonary carcinoma, irritative noduli due to forced use of the voice, and psychic stress as the cause. In a patient with existing hoarseness over a period of 3 to 6 weeks, the vocal cords will have to be examined with indirect laryngoscopy. Where the general practitioner is not equipped to handle this procedure, he can make a referral to an ear, nose and throat specialist. It would, however, be to the benefit of the patient and the general practitioner if the latter were to master the technique of indirect laryngoscopy. This would enable the patient to be treated without further delay, and it might also make selective referral possible.     

烟酒对声带影响的临床分析

目的通过临床分析烟酒嗜好者的声带病变,观察烟酒对声带的影响。方法电子纤维喉镜检查所见,一些声带疾病经术后病理确诊。结果烟酒嗜好组的声带发生病变的情况多于对照组。结论烟酒嗜好对人类的声带具有不同程度的损害作用。     

Prevention of bilateral vocal cord paralysis due to thyroid surgery and microsurgical management of the developed paralysis

INTRODUCTION: Following the great tradition established in the St.Rókus Hospital and Institutions by author's predecessor Prof. Aurel Réthi, there have been more than 300 patients operated on for treatment of laryngotracheal stenosis. The vast majority of the cases admitted to the department suffering from bilateral vocal cord paralysis were the consequences of thyroid surgery and its complications, which may develop even after operation by the best surgeon. OBJECTIVES: Confronted with this challenging clinical scenario, the author became determined to focus not only on reconstruction but also on prevention. METHODS: A new method, the neuromonitoring has been introduced first time in Hungary in the St.Rókus Hospital for thyroidectomies to simplify the identification and preservation of the recurrent nerves. As the author's department is a center for laryngotracheal reconstruction, patients from different institutions and countries were treated with larynx dilating operations, benefiting the newly developed additional techniques. With the goal of refined alternatives to previous glottis dilating operations, new methods have been worked out for the management of bilateral vocal cord paralysis based on the author's endo-extralaryngeal suture technique, mostly without tracheostomy. RESULTS: They introduced in the last 5 years the neuromonitoring by performing thyroidectomies in 57 cases mostly for the management of malignant thyroid diseases. The recently popularized methods of the author for the management of bilateral vocal cord paralysis they were performed in the last 20 years consist of two operations, a reversible one and an irreversible one. The first operation was the reversible endo-extralaryngeal lateralization, which was carried out in 63 patients, 61 of which were successful. In the reversible technique the sutures were not removed if the cords remained paralyzed. If there was evidence of return of vocal cord function, the sutures were removed, thus eliminating the need for further dilating operations. The second operation is performed on patients whose vocal cords are paralyzed. This irreversible operation can be performed with and without arytenoidectomy. These operations were successful in 94 out of 99 patients. CONCLUSIONS: The author feels that these two operations are quite successful because the medial mucous membrane of the vocal cord is preserved, avoiding scar and granuloma formation. The operations may be performed without any kind of tracheostomy. These are significant advantages over most other glottic dilating operations.     

纤维喉镜与间接喉镜手术治疗声带良性病变的比较

目的:对纤维喉镜与间接喉镜手术治疗声带良性病变进行比较.方法:观察纤维喉镜手术治疗声带良性病变72例,间接喉镜手术治疗54例.结果:纤维喉镜组72例,治愈64例,好转8例;间接喉镜组54例,治愈37例,好转11例,无效6例.纤维喉镜组与间接喉镜组的疗效比较,差异有统计学意义(P＜0.001).结论:纤维喉镜手术是治疗声带良性病变的有效方法.     

声带后联合慢性炎性反应对阻塞型睡眠呼吸暂停低通气综合征影响的相关研究

目的 分析声带后联合慢性炎性反应与阻塞型睡眠呼吸暂停低通气综合征（OSAHS）的相关性及对OSAHS的预测价值.方法 选择OSAHS患者156例,均行多导睡眠图（PSG）和纤维喉镜检查,根据声带后联合慢性炎性反应情况进行分度,分为轻度32例,中度70例,重度36例,极重度18例,比较不同程度患者呼吸暂停低通气指数（AHI）、最低血氧饱和度、平均血氧饱和度.对患者根据病因行对症治疗,于治疗后1,3个月判定疗效.结果 治疗前随着声带后联合慢性炎性反应程度的加重,AHI逐渐升高[轻度、中度、重度、极重度分别为（11.23±4.13）,（21.23±13.29）,（44.53±10.11）,（56.56±12.31）次/h],最低血氧饱和度和平均血氧饱和度逐渐下降（轻度、中度、重度、极重度分别为0.914 4±0.053 1和0.955 0±0.041 2,0.834 2±0.098 6和0.913 5±0.033 2,0.626 8±0.0904和0.863 1±0.053 2,0.601 1±0.101 1和0.752 1±0.040 1）,差异均有统计学意义（P＜0.05）.治疗后1个月总有效率为75.64％ （118/156）,治疗后3个月总有效率为88.46％（138/156）.结论 声带后联合慢性炎性反应程度与OSAHS程度呈正相关,OSAHS患者根据病因治疗有明显的效果.     

342例电视监视纤维喉镜下声带息肉小结摘除术结果分析

目的报告电视监视纤维喉镜下进行声带息肉,声带小结切除的疗效。方法在电视监视下应用光导纤维喉镜,以活检钳取声带息肉和声带小结。结果全部病例,痊愈328例(96％),好转14 例(5％),术后2周声音恢复正常,随访2-8个月,无一复发。结论电视监视纤维喉镜下行声带息肉,声带小结摘除术,疗效确切。安全经济,适应症广泛,值得临床推广使用。