This document provides an overview of structural disorders of the vocal cords. It discusses various disorders including laryngitis, arytenoid granuloma, vocal fold polyps, nodules, pseudocysts, Reinke's edema, cysts, sulci, bridges, keratosis, papillomas, vocal cord palsy/paralysis, muscle tension dysphonia, and spasmodic dysphonia. For each disorder, it describes the symptoms, causes, diagnosis using laryngoscopy and stroboscopy, and treatment options including vocal hygiene, voice therapy, injections, and surgery. The goal of treatment is to restore normal vibration and function of the vocal cords through minimally invasive methods.
Spaces of middle ear and their surgical importanceDr Soumya Singh
one of the imp topics in ENT that should be understood very thoroughly if u want to pursue as an otologist.I tried to simplify the topic with simple diagrams and models for better understanding .
Spaces of middle ear and their surgical importanceDr Soumya Singh
one of the imp topics in ENT that should be understood very thoroughly if u want to pursue as an otologist.I tried to simplify the topic with simple diagrams and models for better understanding .
Cavity obliteration is a procedure done at the end of Mastoidectomy to get a cavity-less mastoid cavity thus solving the problem of discharging post-operative cavity.
Cavity obliteration is a procedure done at the end of Mastoidectomy to get a cavity-less mastoid cavity thus solving the problem of discharging post-operative cavity.
Non neoplstic and benign lesions of larynx is an important topic for both MBBS and MS ENT students in their final exam. Vocal nodule, polyps, Reinke's edema are the common problems in voice abusers and smokers. Dr. Krishna Koirala has discussed this topic thoroughly in this lecture.
DEFINATION
ATIOPATHOGENESIS
FEATURE AND PREDISPOSING FACTER
SYMPTOMS
DIAGNOSIS
DEFFERENTIAL DIAGNOSIS
TREATMENT
Also known as Singer’s or Screamer's Nodes
Vocal cord nodules are benign growths on both vocal cords that are caused by vocal abuse
They appear symmetrically on the free edge of vocal cord
At the junction of anterior 1/3 and posterior 2/3 *area of maximum vibration of vocal cord.
cancer of the larynx is also known as the cancer of voice box and basic knowledge about this is important to treat the patient and give better care for the patient this knowledge will help the nursing students to give better care, to improve their academic performance and to improve their skills in their clinical practice
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
1. Structural Disorders
Of The Vocal Cords
Dr.Khalil Nasr Elkahlout
R3 ENT , Alshifa hospital
Supervisor : Dr.Mohammad Khalil Murad
ENT & CI consultant
2. Introduction
The assessment of a patient with a voice disorder should be
done in a multidisciplinary clinic by a laryngologist and a speech
therapist.
Persistent or progressive dysphonia may suggest an organic
lesion in the larynx, while intermittent dysphonia may
suggest a functional disorder.
3. History
• Dysphonia/hoarseness : any impairment of voice or difficulty speaking
• Dysarthria : difficulty in articulating words
• Dysarthrophonia : dysphonia + dysarthria (e.g. CVA)
• Dysphasia : impairment of the comprehension of spoken or written
language
• Odynophonia : pain when talking
It is important to know the patient’s occupation and professional and
recreational voice usage
4. Examination
• Neck for previous surgery or masses
• Nasal cavity
• cranial nerve or neurological disease
Laryngoscopy with stroboscopy or digital acoustic voice analysis.
Videolaryngostroboscopy is the standard of care for a voice clinic.
5.
6. Categories of voice disorders:
• Inflammatory
• Structural or neoplastic
• Neuromuscular
• Muscle tension
7. Treatment overview:
• Vocal hygiene, lifestyle and dietary
advice
• Voice therapy
• Specialist therapy e.g. singing therapy or
osteopathy
• Medical treatment
• Phonosurgery
9. Laryngitis erythema, oedema, epithelial change
include ulceration,leukoplakia orstiffness of themucosa withincreased
amount of thickmucus.
Acute laryngitis , URTIs usually.
Chronic laryngitis with smoking, alcohol, reflux, occupational
exposures, social activities, allergies and throat hygiene.
The voice is hoarse .
Treatment:
• self-limiting in acute .
• Chronic , voice hygiene with avoid abuse and rest.
10. This video shows the function of the larynx in a 24 yr old patient with
acute laryngitis. Talking was painful and she only talked in a faint whisper.
11. Arytenoid Granuloma
•Benign inflammatory lesions arise from the perichondrium
of the vocal processes .
•Trauma-related injury, intubation .
•Reflux is important factor, it slow healing .
Symptoms:
• Dysphonia , vocal fatigue
• Tickling sensation
• Discomfort
12.
13. Management
•Reducing laryngeal irritants, stopping smoking, improving VH,
treating reflux.
•voice therapy (reducing hyper functional vocally abusive
behavior).
•Phonosurgery not cure in isolation as high rate of recurrence.
•Botulinum toxin into the thyroarytenoid muscle helpful to stop
impact, allow healing.
14. Vocal Fold Polyps
Benign swellings of > 3 mm arise from lamina propria of
vocal folds.
• MCC of structural dysphonia.
• solitary, occasionally bilateral.
• men > women.
• Smoking.
• age 30–50 years.
As a cause of polyp formation , contralateral vocal fold
examination is crucial as sulcus or intracordal cyst may
found.
16. Symptoms:
• Dysphonia
• Strain to speak
• seldom, dyspnoea and episodes of choking if large.
Management:
• VT, unlikely to resolve the polyp.
• concomitant inflammatory conditions.
• surgery , laser or cold steel.
• The goal, restore smooth edge of V.C to allow full closure and
normal vibration.
17. Vocal Fold Nodules
bilateral swellings < 3 mm develop on the free edge
of the vocal fold at the maximal contact area .
• Associated with teaching ,singing.
• In children, boys > girls.
• In adults, women < 30 years old.
Aetiology , voice abuse rather than overuse.
18.
19. Symptoms:
• husky, breathy voice , worse with use.
• discomfort on phonation.
• deeper in pitch and with breaks .
Management:
• If not significant problems > left alone.
• Aggravating as infections and reflux should treated.
• Mainstay is VT with VH, voice and function improve, but may
nodules persist.
• Surgery reserved for those who fail voice therapy and remain
symptomatic.
Aim precise excision of the nodule alone, no exposure of the
underlying ligament.
21. Pseudocysts
the lesion has no cyst wall but filled with
serous fluid.
• due to phonotrauma.
• Initial management is VH.
• PS if symptoms are recalcitrant to therapy .
22. Reinke’s Oedema
oedema of the subepithelial space (Reinke’s space).
• Almost smokers.
• may be , Hypothyroidism.
• equal gender, but the pitch-lowering effects more on women.
• Age 40–60 years.
Symptoms:
• Deepening of pitch in women
• Gruffness
• Inability to raise the pitch of the voice
• Choking episodes
• Reflux symptoms
23.
24. Management
Conservative , VH and smoking cessation .
underlying hypothyroidism, infections, or reflux.
VT help in a well-motivated patient.
Surgical if:
• Leukoplakia.
• choking episodes or airway compramize.
• inability to pitch elevation is problematic.
There is significant worsening by scarring after PS.
Reduction glottoplasty by cold steel or laser.
minimize epithelial excision due to the risk of permanent scar and
hoarseness.
“ myxematous material is aspirated or vaporized, epithelial edges apposed
after excision of redundant mucosa”
good results are obtained by treating one side.
25. Cysts
less frequently than polyps and nodules, and sulci and mucosal bridges even less so.
two types :
• A mucous retention cyst “ blocked minor salivary gland”
• Epidermoid cysts “ lined by squamous epithelium ,filled with keratin and cholesterol
debris”.
result of voice abuse .
For both types, a definitive diagnosis is only by microlaryngoscopy and cordotomy.
31. Ackermann’stumour
(verrucous carcinoma)
“ a slow-growingvariant of SCC
thatdoesnotmetastasize”
a completeendoscopic excisionis
recommendedto prevent
recurrence.
Thistumouris lessradiosensitive
thanothers.
32. Adult Laryngeal Papilloma
• Associated , HPV 6 and 11
• Bimodal incidence
• Juvenile: 2–4 years
• Adult: 20–40 years
• Small risk of malignant transformation in adult papilloma
Presentation:
• Progressive dysphonia
• Dyspnoea
• Stridor
33. Treatment:
Endoscopic excision : Cold steel, Microdebrider or Laser
Adjuvant treatments:
• Cidofovir— carcinogenic potential.
• Interferon-α—significant side effects and morbidity.
• Bevacizumab—antiangiogenic monoclonal antibody appears to work ,
undergoing RCTs.
• Photodynamic therapy—starting to emerge, need more evidence.
• HPV vaccineis now offered .
• Tracheostomy avoided if possible due to risk of seeding the stoma or
distal airways .
34. Vocal Cord Palsy/Paresis
• presents with breathy voice and symptoms of
aspiration.
• An obvious laryngeal paresis “ asymmetry of
movement on abduction and adduction” , affected side
‘lags behind’ the normal side.
• maybe subtle and apparent on prolonged endoscopic
observation while phonate and sniff .
• Bilateral palsies present with upper airway symptoms,
dyspnea, stridor, and respiratory compromise.
35. Causes include:
• Iatrogenic injury (surgery)
• Malignant disease
• Trauma
• Idiopathic
• Neurological disease
Rule out malignancy with CT skull base to
thorax.
36.
37. Management:
1- VT for compensation and decrease aspiration.
2- Surgery.
• Injection medialization procedure—absorbable semi-
permanent materials (e.g. hydroxyapatite, collagen)
• Laryngeal framework surgery—insertion of an implant
• Laryngeal reinnervation
3- Bilateral palsies may need a tracheostomy acutely,
may use other procedures to improve the airway, such as
a cordectomy.
38. Muscle Tension dysphonia (MTd )
Muscle tension imbalance causing MTD is one of the biggest
causes or contributors to voice disorders.
• diagnosis of exclusion (i.e. the vocal folds look normal and move
normally), laryngeal muscles try to overcome a deficiency in voice
production due to inflammatory or structural lesions.
• Lead to trauma and structural changes in the vocal fold mucosa.
•Muscles are hyperfunctional or hypofunctional, giving patterns of clinical
presentation and laryngeal appearance.
39. The degree of dysphonia variable, intermittent related to a
particular voice task (e.g. teaching) to constant hoarseness.
Other symptoms include:
• Pitch: too high or low
• Reduced range
• Sensation of tightness or lump in the throat
• Discomfort on speaking or singing
• Vocal fatigue
40. Treatment
precipitating causes and as:
• Vocal hygiene and lifestyle advice
• Voice therapy targeted at specific muscle
groups
• Laryngeal manipulation
• Behavioral therapy
• Medical treatment (e.g. reflux
management)
41. Spasmodic dysphonia
• a voice disorder arising from a focal dystonia involving certain
laryngeal muscles but reflecting central motor processing
abnormalities.
•It is a task-specific dystonia: occurs only on phonation, can
overridden by laughing, chanting, or singing.
•There is a background of normal speech overlaid with vocal
spasms not under voluntary control, leads to strained and
strangled speech pattern of adductor dysphonia (more common)
and breathy pattern of abductor dysphonia.
This patient is a 44 year old with a 35 pack year history of smoking and a 3 month history of a hoarse voice and mild aspiration of liquids. This video shows the patient's chest CT scan and the endoscopic video of the patient's larynx during vocalization. The patient has partially compensated vocal cord function and a paralyzed left true vocal cord in the paramedian position.