Kursat Yelken

Paradoxical vocal fold motion dysfunction in asthma patients.

Background and objective:  Paradoxical vocal fold motion dysfunction (PVFMD) is a disorder of the larynx characterized by adduction of the vocal cords during the respiratory cycle leading to symptoms of extrathoracic airway obstruction. PVFMD mimics asthma and patients with PVFMD (PVFMD+) are often diagnosed incorrectly as refractory asthma and receive unnecessary treatment. This study determined the prevalence of PVFMD in asthma patients and describedthe relationship between asthma and PVFMD.

Impairment of Voice Quality in Paradoxical Vocal Fold Motion Dysfunction

OBJECTIVES/HYPOTHESIS To compare subjective and objective voice-quality parameters between asymptomatic paradoxical vocal fold motion dysfunction (PVFMD) patients and healthy individuals. STUDY DESIGN Prospective. METHODS A total number of 12 patients with PVFMD and 12 healthy control subjects had voice evaluations by means of laryngostroboscopy, acoustic analysis (jitter, shimmer, and harmonics-to-noise ratio [HNR]), aerodynamic measurements (maximum phonation time [MPT], s/z ratio), and perceptual analysis (Grade, Roughness, Breathiness, Asthenicity, and Strain Scale [GRBAS] and Voice Handicap Index-10 [VHI-10] scales). Evaluations were conducted when all the patients were asymptomatic. RESULTS False vocal cord adduction, anteroposterior constriction of the supraglottic larynx, decreased amplitude, and decreased mucosal wave were observed in the great majority of the PVFMD patients during laryngostroboscopy. Mean jitter and shimmer rates were significantly high in PVFMD patients and there was no significant difference in mean HNR between groups (P<0.05). Mean MPT was significantly long in control subjects (P<0.05) and mean s/z ratio was nearly equal between patients and control subjects. There was a statistically significant difference between groups about GRBAS and VHI-10 scales (P<0.05). CONCLUSIONS Based on the subjective and objective voice parameters, voice quality is significantly impaired in asymptomatic PVFMD patients when compared with the healthy control subjects.

Erosive Esophagitis Worsens Reflux Signs and Symptoms in Asthma Patients Without Affecting Pulmonary Function Tests

Objectives. To determine whether erosive esophagitis (EO) worsens reflux signs and symptoms and affects pulmonary function test in asthma patients. Methods. Sixty asthma patients with gastroesophageal and laryngopharyngeal reflux symptoms were included. Spirometry, reversibility test, esophagogastroscopy, laryngoscopy, and esophagogastroscopic biopsies were conducted. Results. EO was diagnosed in 25% (n = 15) of the patients. The remaining 45 patients were placed into the non-erosive esophagitis (NEO) group. Of the 15 EO patients, grade 1 esophagitis was identified in 75% (n = 9), grade 2 in 12.5% (n = 3), and grade 3 in 12.5% (n = 3). Pulmonary function test results were not significantly different between the EO and NEO groups. Gastroesophageal and laryngopharyngeal reflux symptoms such as regurgitation, dysphagia, dyspnea, globus sensation, dysphonia, and sore throat were more frequent in EO patients than in the NEO group. The reflux finding score (RFS) was 7.33 and 4.55 in EO and NEO patients, respectively (p □ .001). Posterior commissure hypertrophy was the most common laryngoscopic finding in both of the groups followed by diffuse laryngeal edema, erythema, and pseudosulcus. Conclusions. Gastroesophageal and laryngopharyngeal reflux symptoms were more frequent in EO patients than in the NEO group. The laryngoscopic findings of laryngopharyngeal reflux were more severe and the RFS was significantly higher in EO patients than in NEO patients. The presence of EO seems to be associated with an increase in reflux without affecting pulmonary function as EO did not cause a significant decrease in pulmonary function tests.

Hypopharyngeal pharyngoplasty for the management of piriform fossa sinus

INTRODUCTION Piriform fossa sinus (PFS) is a rare congenital anomaly of the third or fourth branchial pouch. Failure of the pharyngobranchial duct to degenerate causes a persistant connection between the piriform sinus and the lateral neck. Presentation age ranges from infancy to adulthood and may occur as a neck mass, thyroid abscess, recurrent deep space neck infection, or with iatrogenic fistula formation. Of these anomalies 97% are left sided. The current standard for management of these lesions is complete surgical resection of the fistula. Transcervical resection can be complicated by inflammation, obliteration of normal tissue planes, and failure to identify the sinus tract. Complete surgical resection, therefore, can be difficult and incomplete, leading to further recurrence of infections. Here we present a new surgical approach for the management of PFS termed hypopharyngeal pharyngoplasty, describing the technique and reporting preliminary outcomes in three cases.