ABSTRACT
Objective: To evaluate the clinical and demographic characteristics of patients with idiopathic and non-idiopathic
vocal cord paralysis (VCP).
Study Design: Descriptive cross sectional study.
Place and Duration of Study: Department of ENT Combined Military Hospital Quetta and Rawalpindi, from 10
Dec 2012 to 31 Dec 2015.
Material and Methods: The study was a descriptive cross sectional study. The study was conducted after
approval by the ethical committee. Patients with fixed vocal cords due to some growth of glottic region were
enrolled. All the patients presenting with hoarseness of voice in ENT outpatient department CMH Quetta and
Rawalpindi undergoing indirect laryngoscopy and the patients with vocal cord paralysis were selected. Informed
written consent was taken and gender, age, name, hospital record number, address and phone number of each
individual was noted. Every patient was evaluated by detailed history and thorough clinical examination.
Patients were not investigated further if cause were revealed after some investigation. Follow-up of patients was
done regularly in ENT OPD. CT scans/US neck was done by radiologist and FNAC/biopsy was reported by
histopathologist. Data collected were recorded on proforma.
Results: In our study, out of 245 cases, 47.76% (n=117) were 16-40 years old and 52.24% (n=128) were 41-80 years,
mean ± SD was calculated as 41.23 ± 11.25 years, 45.71% (n=112) male and 54.29% (n=133) were females.
Frequency of causes of vocal cord paralysis was recorded as 15.92% (n=39) for idiopathic, 46.53% (n=114) had
iatrogenic, 33.06% (n=81) had malignant neoplasm while 4.49% (n=11) had radiation.
Conclusion: Vocal cord paralysis is a common clinical condition with substantial morbidity. Awareness on the
clinical characteristics and identification of the underlying etiology are keystones for foreseeing complications
and determining the required therapeutic modality.
Keywords: Etiology, Iatrogenic, Idiopathic, Vocal cord paralysis.
Incidence of Recurrent Laryngeal Nerve Injury in Total Thyroidectomy Done for...QUESTJOURNAL
Objectives - To study the incidence of recurrent laryngeal nerve (RLN) palsy in Total thyroidectomy done for multinodular goitre. Surgical safety of total thyroidectomy in Multinodular goitre and type of vocal cord paralysisstudied. Voice changes in immediate post-operative period and within three weeks following total thyroidectomy are assessed. Materials &Methods: A prospective, longitudinal and an observational study. Patients between 18 and 65 years of age with multinodular goitre considered for study. Study conducted in hospitals attached to Kasturba Medical College, Mangalore. Pre op evaluation indirect laryngoscopy(IDL) to visualise B/L vocal cord movements was done. Postoperative voice changes and vocal cord mobility noted in immediate post op, postoperative day 3 and 3weeks following surgery. Results: During the study period 76 patients underwent total thyroidectomy for multinodular goitre. In the current study percentage proportion of hoarseness observed in total thyroidectomy done for Multinodular Goitre out of 76 subjects was 14.47% (11 patients). Unilateral palsy noticed by abnormal vocal cord movements in IDL (indirect laryngoscopy) was noted in 2 subjects out of 76 patients. Percentage proportion of temporary Recurrent Laryngeal Nerve Paralysis (RLN paralysis) presented in total thyroidectomy done in Multinodular Goitre out of 76 subjects was 2.6% (2 patients) while permanent paralysis incidence was nil. None of study subjects had stridor or laryngeal obstruction requiring tracheostomy. Conclusion: Total Thyroidectomy done for Multinodular Goitre is a safe procedure with minimal incidence of recurrent laryngeal nerve injury. Total Thyroidectomy for Benign Multinodular Goitre can be done as procedure of choice in all patients with minimal risks and nil recurrence rates.
Post-Thyroidectomy Laryngeal Diplegia in Mali: What Therapeutic Challenge? by Kone Fatogoma Issa in Experiments in Rhinology & Otolaryngology
Post-thyroidectomy laryngeal diplegia is the most common and most feared complication [1]. It occurs following a recurrent nerve lesion in 26 to 59% of cases [1,2]. Tracheotomy was considered until 1922 as the only reference treatment [3,4]. Therapeutic approaches have evolved over time, ranging from convention altranslaryngeal or extralaryngeal therapy to endoscopic laser approaches [5]. These endoscopic methods emphasized endoscopicary tenoidectomy and posterior transverse cordotomy [4,6]. Laser transverse posterior cordotomy has proved its efficacy, illustrated by the work of Denis and Kashima and Laccoureye & Merite Drancy [4,7].
Incidence of Recurrent Laryngeal Nerve Injury in Total Thyroidectomy Done for...QUESTJOURNAL
Objectives - To study the incidence of recurrent laryngeal nerve (RLN) palsy in Total thyroidectomy done for multinodular goitre. Surgical safety of total thyroidectomy in Multinodular goitre and type of vocal cord paralysisstudied. Voice changes in immediate post-operative period and within three weeks following total thyroidectomy are assessed. Materials &Methods: A prospective, longitudinal and an observational study. Patients between 18 and 65 years of age with multinodular goitre considered for study. Study conducted in hospitals attached to Kasturba Medical College, Mangalore. Pre op evaluation indirect laryngoscopy(IDL) to visualise B/L vocal cord movements was done. Postoperative voice changes and vocal cord mobility noted in immediate post op, postoperative day 3 and 3weeks following surgery. Results: During the study period 76 patients underwent total thyroidectomy for multinodular goitre. In the current study percentage proportion of hoarseness observed in total thyroidectomy done for Multinodular Goitre out of 76 subjects was 14.47% (11 patients). Unilateral palsy noticed by abnormal vocal cord movements in IDL (indirect laryngoscopy) was noted in 2 subjects out of 76 patients. Percentage proportion of temporary Recurrent Laryngeal Nerve Paralysis (RLN paralysis) presented in total thyroidectomy done in Multinodular Goitre out of 76 subjects was 2.6% (2 patients) while permanent paralysis incidence was nil. None of study subjects had stridor or laryngeal obstruction requiring tracheostomy. Conclusion: Total Thyroidectomy done for Multinodular Goitre is a safe procedure with minimal incidence of recurrent laryngeal nerve injury. Total Thyroidectomy for Benign Multinodular Goitre can be done as procedure of choice in all patients with minimal risks and nil recurrence rates.
Post-Thyroidectomy Laryngeal Diplegia in Mali: What Therapeutic Challenge? by Kone Fatogoma Issa in Experiments in Rhinology & Otolaryngology
Post-thyroidectomy laryngeal diplegia is the most common and most feared complication [1]. It occurs following a recurrent nerve lesion in 26 to 59% of cases [1,2]. Tracheotomy was considered until 1922 as the only reference treatment [3,4]. Therapeutic approaches have evolved over time, ranging from convention altranslaryngeal or extralaryngeal therapy to endoscopic laser approaches [5]. These endoscopic methods emphasized endoscopicary tenoidectomy and posterior transverse cordotomy [4,6]. Laser transverse posterior cordotomy has proved its efficacy, illustrated by the work of Denis and Kashima and Laccoureye & Merite Drancy [4,7].
Prehospital rapid sequence intubation improves functional outcome for patient...Emergency Live
In adults with severe TBI, prehospital rapid sequence intubation by paramedics increases the rate of favorable neurologic outcome at 6 months compared with intubation in the hospital.
Suboccipital lymphadenectomy for patients with occipital squamous cell carcin...Dr./ Ihab Samy
F. Fouad Saleep(1), I. Fayek(1), I. Farahat(2)
(1)National Cancer Institute - Cairo University, Surgical Oncology Department, Cairo, Egypt.
(2)National Cancer Institute - Cairo University, Pathology Department, Cairo, Egypt.
Poster presentation No.3224 at the 17th European Cancer Organization conference ECCO 17, Amsterdam-Netherlands, September 2013.
Background: Cerebellopontine Angle (CPA) meningiomas comprise 10% of all intracranial meningiomas and due to their location, are producing different surgical challenges. This study is evaluating surgical management and clinical outcome of CPA meningiomas operated during 15 years.
Management Outcomes of Post-Thyroidectomy Bilateral Recurrent Laryngeal Nerve Paralysis at National Hospital Abuja by Olusesi Abiodun Daud in Experiments in Rhinology & Otolaryngology
Bilateral recurrent laryngeal paralysis is an uncommon complication of total or subtotal thyroidectomy, observed in approximately 0.4 per cent of cases. This paralysis could be temporary or permanent. An audit of 5 cases referred to the ENT Department of National Hospital Abuja, between January 2010 and July 2017 is presented. All cases were referred already on tracheostomy tubes and were females aged 11 to 59 years. 4 of the cases had external arytenoidectomy, bilateral in 2 cases, and unilateral in 2 cases. 4 out of the 5 cases were successfully decannulated. The preferred approach to cases of post-thyroidectomy bilateral recurrent laryngeal nerve paralysis referred to ENT Specialists in resource-poor economy like ours is not very clear from existing literature and we discuss our adopted protocol for management of such cases in this case series.
https://crimsonpublishers.com/ero/fulltext/ERO.000511.php
ICN Victoria presents Dr Andrew Hilton, Intensivist at the Austin Hospital in Melbourne, talking on the use of ultrasound in ICU to evaluate and treat lung pathology. Recorded at our November 2014 ICN Victoria meeting.
Prehospital rapid sequence intubation improves functional outcome for patient...Emergency Live
In adults with severe TBI, prehospital rapid sequence intubation by paramedics increases the rate of favorable neurologic outcome at 6 months compared with intubation in the hospital.
Suboccipital lymphadenectomy for patients with occipital squamous cell carcin...Dr./ Ihab Samy
F. Fouad Saleep(1), I. Fayek(1), I. Farahat(2)
(1)National Cancer Institute - Cairo University, Surgical Oncology Department, Cairo, Egypt.
(2)National Cancer Institute - Cairo University, Pathology Department, Cairo, Egypt.
Poster presentation No.3224 at the 17th European Cancer Organization conference ECCO 17, Amsterdam-Netherlands, September 2013.
Background: Cerebellopontine Angle (CPA) meningiomas comprise 10% of all intracranial meningiomas and due to their location, are producing different surgical challenges. This study is evaluating surgical management and clinical outcome of CPA meningiomas operated during 15 years.
Management Outcomes of Post-Thyroidectomy Bilateral Recurrent Laryngeal Nerve Paralysis at National Hospital Abuja by Olusesi Abiodun Daud in Experiments in Rhinology & Otolaryngology
Bilateral recurrent laryngeal paralysis is an uncommon complication of total or subtotal thyroidectomy, observed in approximately 0.4 per cent of cases. This paralysis could be temporary or permanent. An audit of 5 cases referred to the ENT Department of National Hospital Abuja, between January 2010 and July 2017 is presented. All cases were referred already on tracheostomy tubes and were females aged 11 to 59 years. 4 of the cases had external arytenoidectomy, bilateral in 2 cases, and unilateral in 2 cases. 4 out of the 5 cases were successfully decannulated. The preferred approach to cases of post-thyroidectomy bilateral recurrent laryngeal nerve paralysis referred to ENT Specialists in resource-poor economy like ours is not very clear from existing literature and we discuss our adopted protocol for management of such cases in this case series.
https://crimsonpublishers.com/ero/fulltext/ERO.000511.php
ICN Victoria presents Dr Andrew Hilton, Intensivist at the Austin Hospital in Melbourne, talking on the use of ultrasound in ICU to evaluate and treat lung pathology. Recorded at our November 2014 ICN Victoria meeting.
Nasopharyngeal cancers: A retrospective comparative
analysis of radiotherapy alone versus chemo‑radiation
(Benghazi experience)
Indian journalofcancer 2015_52_3_391_176718
Endobronchial Ultrasound Guidance of TBNA. Current Approach To Lung Cancer St...Bassel Ericsoussi, MD
EBUS-TBNA, EUS-FNA or their combination have finally gained acceptance as the tests of first choice in mediastinal staging. In suspected non-small cell lung cancer, endobronchial ultrasound may be preferred in the histologic sampling of paratracheal and subcarinal mediastinal adenopathy because the diagnostic yield can surpass mediastinoscopy
These slides are from versions of a talk I gave at ESTRO in 2014 and again in Lille in 2015.
The talk aims to explain the importance of correctly defining the CTV with respect to nodes in curative radiotherapy planning.
The lecture makes some important points about the function of lymph glands and their potential to act as stem cell 'rests' for malignant cells: this fact might explain whilst lymph node failure rates don't necessarily equate to disease failure rates.
The lecture then goes on to emphasise the utility of the best imaging technologies may more accurately identify involved nodes.
Shrinking fields with confidence may be the best way to reduce radiation toxicity.
Encapsulate peritoneal dialysis after short term peritoneal dialysisNakisa Hooman
Encapsulated Peritoneal Sclerosis (EPS) is a devastating complication of long term CAPD. The diagnosis is based on structural and functional aspects of intestinal obstruction. The total imaging score at the time of diagnosis of EPS did not correlate with the clinical outcome. It is important to differentiate simple peritoneal sclerosis from EPS.The incidence increases from zero to 18% with time on peritoneal dialysis for 5-8 years. The risk of EPS increases exponentially when PD continues beyond 3 years. The other potential risk factors are high strength glucose exposure, icodextrin, young age, inflammation, chemical exposure, genetic factors, acidic PD fluid. Peritoneal injury and subsequent peritoneal inflammation are two hit hypothesis for EPS. But episodes of peritonitis, intense or repeated hemoperitoneaum, abdominal surgery, stopped PD, and genetic predisposition could be the potential risk factors. There is no authentic screening tool for early diagnosis. The combination of Ca-125<33 U/min and IL-6>350 pg/min with UFF suggest the possibility to identify patients at risk. High levels of cytokines in peritoneal effluent correlate with alteration peritoneal membrane transport status. The pathophysiology of EPS consists of inflammation, fibrin deposition and fibrinolysis, epithelial-mesenchymal transition, and growth factors. Ultrafiltration failure and high average transport status are very common in EPS. High awareness to detect the earliest stage of EPS might help to improve survival. Discontinuation of PD, nutritional support, immunosuppressive therapy, tamoxifen and surgery are medical options. There is no strategy to prevent EPS. In the case of PD catheter removal, dry peritoneum might lead to new fibrin deposition and accelerate sclerosing process. Periodic irrigation of peritoneal cavity for 6-12 months after cessation of PD therapy might prevent intestinal adhesion.
Clinical Study of Foreign Bodies in Tracheo-Bronchialtree with Specific Atten...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Frequency of Anastomotic Leak in Early Versus Dealyed Oral Feeding after Elec...semualkaira
Intestinal stoma is usually performed as component of other surgical intervention for small and large bowel
pathologies. Of these temporary colostomy are commonest stomas
created for de-functioning of the distal anastomotic site to minimise the chances of leak. Colostomy is usually reversed at 8 to 12
weeks and Ileostomy closure is often considered a minor procedure but it is associated with significant morbidity and mortality
Frequency of Anastomotic Leak in Early Versus Dealyed Oral Feeding after Elec...semualkaira
Intestinal stoma is usually performed as component of other surgical intervention for small and large bowel
pathologies. Of these temporary colostomy are commonest stomas
created for de-functioning of the distal anastomotic site to minimise the chances of leak. Colostomy is usually reversed at 8 to 12
weeks and Ileostomy closure is often considered a minor procedure but it is associated with significant morbidity and mortality
The Prognostic Value of Nucleolar Organiser Regions in Colorectal CancerMichelle Fynes
Nucleolar organiser regions (AgNORs) are loops of ribosomal DNA which reflect the cellular activity or malignant potential of the cell and are identified by a specific staining technique. The purpose of this study was to assess the prognostic value of AgNORs in colorectal cancer and to compare it with other accepted prognostic methods.
Similar to VOCAL CORD PARALYSIS: WHAT MATTERS BETWEEN IDIOPATHIC AND NONIDIOPATHIC CASES? (20)
Obesity and hyperlipidemia is international /worldwide problem causing heart disease leading to major predisposing factor for morbidity and death. Conventional medicine used in allopathy include statins, fibrates, niacin and resins but are going to defame due to their adverse effects. Herbal medicine ginger has proved itself as one of the potent anti hyperlipidemic and anti obesity herb with least adverse effects. We did try to compare its hypolipidemic effects with placebo effects when used in mild to moderate hyperlipidemic patients. It was placebo-controlled single blind research study. Research was conducted at National hospital, Lahore, from July to November 2016. Consent was taken from sixty hyperlipidemic patients age range from 25 to 60 years. Both gender male and female patients were enrolled. Patients were randomly divided in two groups, 30 patients were on drug ginger pasted-powder advised to take 5 grams in divided doses with their normal diet for the period of three months. Thirty patients were on placebo pasted-wheat powder, with same color as of ginger powder, advised to take 5 grams in divided doses with their normal diet for the period of three months. Their base line lipid profile and body weight was recorded at start of treatment and were advised to come for check-up, fortnightly.
International Journal of Medical Science in Clinical Research and Review Vol 03, Issue 02,April – 2020 Page |
229
When duration of study was over, their lipid profile and body weight was measured and compared statistically with pre-treatment values. Three months treatment with 5 grams of ginger decreased total cholesterol from 233.11±1.53 mg/dl to 198.44±1.23 mg/dl, LDL cholesterol reduced from 202.21±1.88 mg/dl to 187.72± 1.98 mg/dl, reduced body weight from 76.01±2.66 kg to 72.80±1.87 kg. Both plasma total cholesterol and LDL cholesterol reduction was statistically significant, but body weight decrease was non-significant when analyzed biostatistically.
Heart diseases due to hyperlipidemia (primary or secondary) can lead to cause chest pain, heart attacks,
strokes, cardiac arrhythmias, cardiac failure. Because of these risks, treatment is often recommended for people with
hyperlipidemia, because it is well known factor to increase incidence of heart diseases. This may lead to
development of atherosclerotic plaques which is major etiological factor for establishing coronary artery disease
(CAD). Hypolipidemic drugs used in allopathy include Statins, Fibric acids, Niacin, and Resins but all have their
low compliance due to frequent side effects. Medicinal herbs like Onion and Ginger are hypolipidemic agents
commonly used as flavoring agents and making foods spicy and tasty. We have compared hypolipidemic potential
between these two medicinal herbs. The study was conducted at Ghurki Trust teaching hospital, Lahore from
January to June 2018. Eighty secondary hyperlipidemic patients were enrolled after getting written consent which
was approved by Ethics committee of the hospital. They were divided in two equal groups comprising 40 patients in
each group. Group-I was treated by Ginger 10 grams daily in three divided doses for 2 months. Group-II was
advised to take Onion 200 grams daily in divided amount with each meal i.e.; breakfast, lunch, and dinner for two
months. After two months therapy it was observed by statistical analysis that 10 grams ginger reduced TC (total
cholesterol) of 38 hyperlipidemic patients 12.4 gm/dl and LDL-C (low density lipoprotein cholesterol) 27.3 mg/dl.
In group-II, onion reduced TC in 35 patients 17.9 mg/dl and LDL-C 14.8 mg/dl. Changes in tested parameters are
significant biostatistically with p-values <0.01 to <0.001. We concluded from this research work that Onion and
Ginger reduces risk of CAD by decreasing plasma total cholesterol and LDL cholesterol.
The effects of dietary fats on the risk of coronary artery disease (CAD) have traditionally
been estimated from their effects on LDL cholesterol. Fats, however, also affect HDL
cholesterol, and the ratio of total to HDL cholesterol is a more specific marker of CAD than is
LDL cholesterol. Hypolipidemic drugs and fruits can play a part to reduce LDL particles
decreasing chances of CAD development. This study was conducted to compare
hypolipidemic effects of Niacin and Jujube fruit in primary as well as secondary
hyperlipidemic patients. Study was conducted from November 2018 to February 2019 at
Jinnah Hospital Lahore. Sixty participants were enrolled of both gender male and female
patients age range from 20 to 70 years. Consent was taken from all patients. They were
divided in two groups. Group-I was advised to take 2 grams Niacin in divided doses for the
period of two months. Group-II was advised to take 500 grams of fruit Jujube daily for the
period of two months. Their baseline LDL and HDL cholesterol was determined by
conventional method of measuring Lipid Profile. After two months therapy, their post
treatment lipid profile was measured and mean values with ± SEM were analyzed
biostatistically. Group-I which was on Niacin their LDL cholesterol decreased significantly and
HDL cholesterol was increased significantly. In group-II patients LDL cholesterol was
decreased significantly but HDL increase was not significant with p-value of >0.05. It was
concluded from the research work that Niacin is potent in lowering LDL and increasing HDL
cholesterol, while Jujube has significant effect as LDL cholesterol lowering potential, but it
does not increase HDL cholesterol significantly.
In Pakistan, the overall prevalence of dyslipidemia in adolescents aged 10–18 years is 21.7~25.2%; prevalence is reported to be two times higher (53.1~56.1%) in obese adolescents. However, few studies have been conducted on the relationship between height and blood lipid concentrations in children and adolescents The recent emphasis on treatment of the dyslipidemia of the metabolic syndrome (hypertriglyceridemia, reduced high-density lipoprotein, and increased small, dense low-density lipoprotein particle number) has compelled practitioners to consider lipid-lowering therapy in a greater number of their patients, as one in two individuals over age 50 has the metabolic syndrome. Individuals with the metabolic syndrome typically have normal low-density lipoprotein cholesterol levels, and current lipid-lowering guidelines may underestimate their cardiovascular risk. Two subgroups of patients with the metabolic syndrome are at particularly high risk for premature CAD. One, individuals with type 2 diabetes, accounts for 20-30% of early cardiovascular disease. The second, familial combined hyperlipidemia, accounts for an additional 10-20% of premature CAD. Familial combined hyperlipidemia is characterized by the metabolic syndrome in addition to a disproportionate elevation of apolipoprotein B levels. The measurement of fasting glucose and apolipoprotein B, in addition to the fasting lipid profile, can help to estimate CAD risk in patients with the metabolic syndrome. In this research we compared allopathic medication and medicinal herb in treating hyperlipidemia.
Systemic administration of tranexamic acid could decrease blood loss and operative time intraoperatively, increasing the satisfaction of surgeons. It did not provoke intraoperative hemodynamic changes, postoperative vomiting or nausea and coagulation parameters abnorma-lity. We concluded that preoperative intravenous tranexamic acid significantly reduces operative estimated blood volume loss when compared to placebo in patients undergoing endoscopic para nasal sinus surgical procedures.
Intranasal adhesions formation was a troub-lesome complication following endoscopic sinus surgery. It can be advocated that silastic splints should be routinely used in endoscopic sinus surgery to reduce the occurrence of post-opera-tive adhesions with their associated morbidity regardless of patient’s age, gender and duration of symptoms.
COMPARISON OF TWO DIFFERENT SPINAL DOSES OF 0.75% BUPIVACAINE CAUSING MATERNA...Dr Tarique Ahmed Maka
Spinal dose of 7.5mg of 0.75% hyperbaric
bupivacaine caused less maternal hypotension as
compared to 15mg of 0.75% hyperbaric bupivacaine
in the cases of caesarean section” was justified
and these results were helpful for enabling
us to prevent significant hypotension in patients
with elective caesarean section under spinal
anaesthesia as well as to avoid harmful medication
like volume overload and use of vasopressors
for correction of drug induced
hypotension.
Hematidrosis or hematohidrosis is an extremely rare clinical phenomenonin which a spontaneous recurrent
painless and self-limited bleeding from skin in any part of the body, with diverse causal etiologies and inconstant
success to different current management modalities. Our case studies report the clinical finding of two cases of a
very rare ontological hematohidrosis. It is an extremely rare medical condition, with very few cases reported in
literature.
Evaluation of Medicated Pharyngeal Pack for Prevention of Postoperative Sore ...Dr Tarique Ahmed Maka
The use of soluble aspirin or ketorolac impregnated pharyngeal packing significantly reduced frequency
of post-operative sore throat, dysphagia, hoarseness
and cough as compared to simple normal saline
impregnated packing among patients undergoing
nasal surgery. Based on our findings, it is
recommended that either soluble aspirin or
ketorolac impregnated gauze packs may be used for
pharyngeal packing in various nasal and paranasal
sinuses surgeries to prevent incidence of postoperative
complications associated with pharyngeal
packing and intubation. Minimizing post-operative
complication rate will facilitate early recovery of the
patients and improve their quality of life.
INTRODUCTION
Lobular capillary haemangioma (Pyogenic
granuloma) is a well-known and commonly
occurring benign vascular lesion of the skin and
mucous membrane especially of oral cavity, but
rarely occurs at other places1. For many years the
lesion was considered to be a reactive or
infective process due to presence of extensive
inflammation and its association with trauma in
about 1/3rd of the cases2. Cawson et al., in
dermatologic literature has described it as
“granuloma telangiectacticum” due to the
presence of numerous blood vessels seen in
histological sections3. Recently it is established
that the lesion appears to be neoplastic in nature
and the underlying process is lobular vascular
proliferation with deep and intravascular
counterparts and is redesignated appropriately as
lobular capillary haemangioma instead of
pyogenic granuloma4.
frequency of hepatitis C virus infection in patients with type 2 diabetes mel...Dr Tarique Ahmed Maka
ABSTRACT
Objective: To determine the frequency of hepatitis C virus infection in patients with type 2 diabetes mellitus and to look for the common risk factors leading to this infection in diabetics. Study Design: Descriptive cross sectional study design. Place and Duration of Study: Department of Medicine, Combined Military Hospital (CMH) Kharian, from Jan 2015 to Jun 2015. Patients and Methods: This study was conducted in the department of Medicine, Combined Military Hospital Kharian. Through a descriptive cross sectional study design, a total of 140 patients with type 2 diabetes mellitus, admitted through casualty, OPD or private clinics were selected and tested for Hepatitis C virus infection. The common risk factors leading to such infection among positive cases were also scrutinized. Results: The mean age of patients was 48.82 ± 10.14 with 60.7% female gender predominating the overall sample of diabetics. Using 3rd generation ELISA method, hepatitis C virus was found in 45 (32.1%) of patients with 41-50 years of age group most commonly affected age group (34.7%) and female (57.8%) commonly affected gender. The distribution of risk factors leading to hepatitis C virus in diabetics are: 21 (46.7%) had history of surgery in the past, 13 (28.9%) had history of blood transfusion in the past, 7 (15.55%) had history of hemodialysis while only 4 (8.9%) had history of tattooing in the past. Conclusion: Hepatitis C virus infection is still a common problem in diabetic patients of our local population and we recommend further research work over its risk factors so that the guidelines for its control may be formulated. Keywords: Blood transfusion, Diabetes Mellitus, Haemodialysis, Hepatitis C virus infection, Risk Factors, Surgery, Tattooing.
This presentation outlines three commonly encountered scenarios and the ethical and legal issues that may affect the choice of contraceptive. Obstetricians and gynaecologists play a key role in counselling women. Decisions regarding contraceptive choices must take into account women’s preferences, cultural and religious beliefs as well as any co-existing medical issues.
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!
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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.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
VOCAL CORD PARALYSIS: WHAT MATTERS BETWEEN IDIOPATHIC AND NONIDIOPATHIC CASES?
1. Vocal Cord Paralysis Pak Armed Forces Med J 2017; 67 (6): 943-47
943
VVOOCCAALL CCOORRDD PPAARRAALLYYSSIISS:: WWHHAATT MMAATTTTEERRSS BBEETTWWEEEENN IIDDIIOOPPAATTHHIICC AANNDD NNOONN--
IIDDIIOOPPAATTHHIICC CCAASSEESS??
Muhammad Usman Akhtar, Sadaf Bashir, Zaheer Ul Hassan*, Tarique Ahmed Maka**, Muhammad Saleem Akhtar***,
Samiya Razzaq***
Combined Military Hospital Dera-Ismail Khan/ National University of Medical Sciences (NUMS) Pakistan, *Combined Military Hospital
Peshawar/ National University of Medical Sciences (NUMS) Pakistan, ** Frontier Corps Khyber Pakhtunkhwa Pakistan, ***Military Hospital/
National University of Medical Sciences (NUMS) Rawalpindi Pakistan
ABSTRACT
Objective: To evaluate the clinical and demographic characteristics of patients with idiopathic and non-idiopathic
vocal cord paralysis (VCP).
Study Design: Descriptive cross sectional study.
Place and Duration of Study: Department of ENT Combined Military Hospital Quetta and Rawalpindi, from 10
Dec 2012 to 31 Dec 2015.
Material and Methods: The study was a descriptive cross sectional study. The study was conducted after
approval by the ethical committee. Patients with fixed vocal cords due to some growth of glottic region were
enrolled. All the patients presenting with hoarseness of voice in ENT outpatient department CMH Quetta and
Rawalpindi undergoing indirect laryngoscopy and the patients with vocal cord paralysis were selected. Informed
written consent was taken and gender, age, name, hospital record number, address and phone number of each
individual was noted. Every patient was evaluated by detailed history and thorough clinical examination.
Patients were not investigated further if cause were revealed after some investigation. Follow-up of patients was
done regularly in ENT OPD. CT scans/US neck was done by radiologist and FNAC/biopsy was reported by
histopathologist. Data collected were recorded on proforma.
Results: In our study, out of 245 cases, 47.76% (n=117) were 16-40 years old and 52.24% (n=128) were 41-80 years,
mean ± SD was calculated as 41.23 ± 11.25 years, 45.71% (n=112) male and 54.29% (n=133) were females.
Frequency of causes of vocal cord paralysis was recorded as 15.92% (n=39) for idiopathic, 46.53% (n=114) had
iatrogenic, 33.06% (n=81) had malignant neoplasm while 4.49% (n=11) had radiation.
Conclusion: Vocal cord paralysis is a common clinical condition with substantial morbidity. Awareness on the
clinical characteristics and identification of the underlying etiology are keystones for foreseeing complications
and determining the required therapeutic modality.
Keywords: Etiology, Iatrogenic, Idiopathic, Vocal cord paralysis.
INTRODUCTION
Vocal cord paralysis (VCP) can result from
processes that alter normal function of recurrent
laryngeal nerve or vagus nerve. Clinicians should
know the vagus and recurrent laryngeal nerve
tract and to recognize clinical characteristics1.
It leads to a specific breathy voice which
is associated with difficulty in swallowing,
difficulty in breathing and cough2. This is a
common neurogenic cause of hoarseness of voice.
Normal voice can be restored if this paralysis is
properly treated. Paralysis of one or both vocal
cords occurs as a result of vagus nerve lesion3.
Most important cause of VCP is iatrogenic
injury linked to mediastinal and neck surgery.
Surgery accounts for 50% of bilateral and 40% of
unilateral vocal cord paralysis4. Other causes
include malignant neoplasms 31% (tumor of the
lung 7.4%, esophageal mass or tumors 9.5%,
thyroid carcinomas 14.1%) and radiation 6%5.
Surgical iatrogenic injury to the recurrent
laryngeal nerve or vagus nerve is most common
cause of unilateral voal cord paralysis. However,
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which
permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Correspondence: Dr Muhammad Usman Akhtar, Combined
Military Hospital, DI Khan Pakistan
Email: usman2224@gmail.com
Received: 18 Jan 2017; revised received: 20 Mar 2017; accepted: 20 Mar
2017
Original ArticleOpen Access
2. Vocal Cord Paralysis Pak Armed Forces Med J 2017; 67 (6): 943-47
944
cause remains idiopathic in approximately 22%
of cases6.
If no etiology is identified then vocal cord
paralysis is considered as idiopathic however
the term “idiopathic” indicates that vocal
cord paralysis is of unknown origin. The rate of
unilateral idiopathic VCP is 2% to 41% and
bilateral idiopathic cases is 3% to 13%7.
Unilateral vocal cord paralysis needs
treatment only if it causes dysphonia or risk
of aspiration in patients with respiratory
compromise. Surgery is required in case of
significant weakness of voice for permanent or
temporary medialization of vocal cords. The
injection of teflon, fat, glycerine, collagen or
silicon can be used for temporary medialization.
The laryngeal framework surgery including
medialization laryngoplasty (type 1 thyroplasty)
is permanent method of medialization8. Anti-
coagulant therapy or pulmonary and cardiac
diseases are contraindications for surgical
treatment9.
An extensive protocol of investigations is
required for diagnosis of vocal cord paralysis,
including ultrasound, CT scan, or MRI of
brainstem, neck and mediastinum10.
Current study is conducted with the aim to
evaluate clinical and demographic characteristics
of patients with idiopathic and non-idiopathic
vocal cord paralysis (VCP).
PATIENTS AND METHODS
The study was a descriptive cross sectional
study. All cases of vocal cord paralysis presenting
with hoarseness of voice of all age groups 16-80
years and of both genders were included. Patients
with bilateral vocal cord paralysis were excluded.
Total of 245 patients were taken by using
WHO sample size calculator, taking level of
significance 5%, absolute precision 3%, anti-
cipated population proportion 6% for a
Table-I: Frequency of causes of vocal cord paralysis (n=245).
Causes of Left vocal cord No. of patients Percentage (%)
Idiopathic 39 15.92
Iatrogenic 114 46.53
Malignant neoplasm 81 33.06
Radiation 11 4.49
Total 245 100
Table-II: Causes of vocal cord paralysis with regards to age.
Age (in years)
Idiopathic (n=39)
Yes No
16-40 13 104
41-80 26 102
Age (in years)
Iatrogenic (n=114)
Yes No
16-40 59 58
41-80 55 73
Age (in years)
Malignant neoplasm (n=81)
Yes No
16-40 40 77
41-80 41 87
Age (in years)
Radiation (n=11)
Yes No
16-40 5 112
41-80 6 122
3. Vocal Cord Paralysis Pak Armed Forces Med J 2017; 67 (6): 943-47
945
confidence interval of 95%. Sample technique was
non-probability consecutive sampling.
After taking approval by the ethical
committee the study was conducted. All the
patients presenting with hoarseness of voice
in ENT outpatient department Combined
Military Hospital, Quetta and CMH Rawalpindi
undergoing indirect laryngoscopy and the
patients with vocal cord paralysis were selected.
Informed written consent was taken. Age, name,
gender, hospital record number, serial number,
address and phone number of each patient was
recorded. Every patient was evaluated by
detailed history and thorough clinical
examination.
After selection, history and clinical
examination, patients underwent following
investigations to find out the cause of vocal cord
paralysis:
Chest X-ray PA view
Barium swallow
Ultrasound neck
CT scan with contrast – base of skull to
diaphragm
Fine needle aspiration cytology (FNAC) if
required
Esophagoscopy under general anesthesia for
any mass found and its histopathological
studies.
Patients were not investigated further, if
cause was revealed after some investigations.
Follow-up of patients was done regularly
fortnightly in ENT OPD. Principle investigator
for performed all procedures and record all data
of the patients enrolled in the study, whereas CT
scan/US neck was done by radiologist and
FNAC/biopsy was reported by histopathologist.
Data were analyzed by IBM (International
Business Machine) SPSS version 21. Mean and
standard deviation (SD) was used to describe
results of quantitative data like age. Frequency
and percentage was used to describe qualitative
data like gender and causes of left vocal cord
paralysis. Effect modifiers like age and gender
was controlled by stratification. Post stratification
chi-square test was applied, including level of
significance at <0.05.
RESULTS
Total 245 cases were enrolled who fulfilled
the inclusion/exclusion criteria among the
patients coming to Combined Military Hospital
Quetta and CMH Rawalpindi. In this study,
47.76% (n=117) out of 245 cases, were 16-40 years
Table-III: Causes of left vocal cord paralysis with regards to gender.
Gender
Idiopathic (n=39)
Yes No
Male 17 95
Female 22 111
Gender
Iatrogenic (n=114)
Yes No
Male 48 64
Female 66 67
Gender
Malignant neoplasm (n=81)
Yes No
Male 40 112
Female 41 133
Gender
Radiation (n=11)
Yes No
Male 7 105
Female 4 129
4. Vocal Cord Paralysis Pak Armed Forces Med J 2017; 67 (6): 943-47
946
of age where as 52.24% (n=128) were 41-80 years,
mean ± sd was calculated as 41.23 ± 11.25 years,
45.71% (n=112) male and 54.29% (n=133) were
females.
Frequency of causes of vocal cord paralysis
was recorded as 15.92% (n=39) for Idiopathic,
46.53% (n=114) had Itrogenic, 33.06% (n=81) had
malignant neoplasm while 4.49% (n=11) had
radiation (table-I).
Stratification for frequency of causes of vocal
cord paralysis with regards to age and gender
was calculated and presented in table-II and III.
DISCUSSION
Vocal cord paralysis can be result of
mechanical or neurogenic fixation of cords.
Sometimes VCP is symptom of underlying
disease. Therefore it is very important to find out
underlying cause. We planned the study with the
view to evaluate the clinical and demographic
characteristics of patients with idiopathic and
non-idiopathic vocal cord paralysis (VCP). This
may help to find out more common causes
of vocal cord paralysis coming across local
population and can be used for formulating
strategies for diagnosis and management of their
patients.
Our findings are in agreement with a study
showing that common causes for paralysis of
vocal cord were iatrogenic 48% (thyroid, radical
neck and mediastinal surgeries) followed by
malignant neoplasms (31%) and radiation (6%).
Surgical injury of the recurrent laryngeal or
vagus nerve is most common cause of unilateral
vocal cord paralysis. However, cause remains
idiopathic in number of cases (22%) significant6.
Yumoto et al11 reported surgery in 42.7%,
malignancy in 22.4%, idiopathic in 17.4% and
injuries of the neck in 2.2% of cases as unilateral
paralysis vocal cord etiology. Rosenthal et al,
stated surgery in 46.3%, malignancy in 13.5%,
idiopathic in 17.6% and neck trauma in 2.2% of
subjects as reason of unilateral vocal cord
paralysis12, these findings are slightly different
with our study.
Malignant infiltration must be regarded as a
potential cause of thickening or immobilization of
the vocal cord. Laryngoscopy is useful for vocal
cord focal lesions4. Contrast enhanced CT can be
used to locate any pathology along the recurrent
laryngeal and vagus nerves course, from the
midbrain to the aortic arch13. MRI can be used to
assess the medullary nuclei of vagus nerve14.
In Dworkin study idiopathic vocal cord
dysfunction was evaluated in 35 cases and 25%
patients showed spontaneous improvement in
long term15.
CT Scan must be performed after idiopathic
VCP is diagnosed, since 81% of these patients
were found to have malignancies16. CT work-up
is not required in patients with idiopathic paresis
not paralysis17.
However, different studies show different
causes and then frequency, while in our
population, these findings need further studies
need to be conducted for validation of these
observations.
CONCLUSION
Vocal cord paralysis is a common clinical
condition with substantial morbidity. Awareness
on the clinical characteristics and identification
of the underlying etiology are keystones for
foreseeing complications and determining the
required therapeutic modality.
CONFLICT OF INTEREST
This study has no conflict of interest to
declare by any author.
REFERENCES
1. Stager SV. Vocal fold paresis: etiology, clinical diagnosis and
clinical management. Curr Opin Otolaryngol Head Neck Surg
2014; 22(6): 444-49.
2. Spataro EA, Grindler DJ, Paniello RC. Etiology and time to
presentation of unilateral vocal fold paralysis. Otolaryngol Head
Neck Surg 2014; 151(2): 286-93.
3. Carpes LF, Kozak FK, Leblanc JG, Campbell AI, Human DG,
Fandino M, et al. Assessment of vocal fold mobility before and
after cardiothoracic surgery in children. Arch Otolaryngol Head
Neck Surg 2011; 137(6): 571-75.
4. Dankbaar JW, Pameijer FA. Vocal cord paralysis: anatomy,
imaging and pathology. Insights Imaging 2014; 5(6): 743-51.
5. Ko HC, Lee LA, Li HY, Fang TJ. Etiologic features in patients
with unilateral vocal fold paralysis in Taiwan. Chang Gung Med
J 2009; 32(3): 290-6.
5. Vocal Cord Paralysis Pak Armed Forces Med J 2017; 67 (6): 943-47
947
6. Seyed Toutounchi SJ, Eydi M, Golzari SE, Ghaffari MR,
Parvizian N. Vocal cord paralysis and its etiologies: A
prospective study. J Cardiovasc Thorac Res 2014; 6(1): 47-50.
7. Rosenthal LH, Benninger MS, Deeb RH. Vocal fold immobility:
A longitudinal analysis of etiology over 20 years. Laryngoscope
2007; 117(10): 1864-70.
8. Yung KC, Likhterov I, Courey MS. Effect of temporary vocal
fold injection medialization on the rate of permanent
medialization laryngoplasty in unilateral vocal fold paralysis
patients. Laryngoscope 2011; 121(10): 2191-4.
9. Sulica L, Rosen CA, Postma GN, Simpson B, Amin M, Courey
M, et al. Current practice in injection augmentation of the
vocal folds: Indications, treatment principles, techniques, and
complications. Laryngoscope 2010; 120(2): 319-25.
10. Mehlum CS, Faber CE, Grontved AM, Anderson P. Vocal fold
palsy investigation and follow-up. Ugeskr Leager 2009; 171(3):
113-17.
11. Yumoto E, Minoda R, Hyodo M, Yamagata T. Causes of
recurrent laryngeal nerve paralysis. Auris Nasus Larynx 2002;
29(1): 41-5.
12. Rosenthal LH, Benninger MS, Deeb RH. Vocal fold immobility:
A longitudinal analysis of etiology over 20 years. Laryngoscope
2007; 117(10): 1864-70.
13. Chin SC, Edelstein S, Chen CY, Som PM. Using CT to localize
side and level of vocal cord paralysis. AJR Am J Roentgenol
2003; 180(4): 1165-70.
14. Stimpson P, Patel R, Vaz F, Xie C, Rattan J, Beale T, et al.
imaging strategies for investigating unilateral vocal cord palsy:
How we do it. Clin Otolaryngol 2011; 36: 266-71.
15. Dworkin JP, Treadway C. Idiopathic vocal fold paralysis: clinical
course and outcomes. J Neurol Sci 2009; 284 (1-2): 56-62.
16. Tsikoudas A, Paleri V, El-Badawey MR, Zammit-Maempel I.
Recommendations on follow-up strategies for idiopathic vocal
fold paralysis: Evidence-Based Review. J Laryngol Otol 2012;
126(6): 570-73.
17. Badia PI, Hillel AT, Shah MD, Johns MM, Klein AM. Computed
tomography has low yield in the evaluation of idiopathic
unilateral true vocal fold paresis. Laryngoscope 2013; 123: 204-7.