Subglottic stenosis as a clinical manifestation of Wegener's granulomatosis in adolescents: report of a case and review of literature

Wegener's Granulomatosis is a well-characterized systemic vasculitis and necrotising granulomatous inflammation of the upper, lower respiratory tracts and the kidneys. The initial manifestations of the disease usually occur in patients over than twenty years old. The otolaryngologic symptoms like rhinorrhea, recurrent sinusitis and epistaxis are commonly present in early course of the disease. It seems that subglottic stenosis is correlated to Wegener's granumatosis in adolescents. We describe a case of a patient that developed subglottic stenosis associated with Wegener's granulomatosis in childhood during the course of the disease.A Granulomatose de Wegener é uma patologia caracterizada por vasculite sistêmica e inflamação granulomatosa necrotizante que compromete o trato respiratório alto, pulmões e rins, cujas manifestações iniciais, na maioria das vezes, ocorre em maiores de 20 anos de idade. As queixas clínicas otorrinolaringológicas estão, com freqüência, presentes nas fases iniciais da doença, sendo rinite, sinusopatia de repetição e epistaxe as mais comuns. A estenose subglógica parece estar correlacionada com a Granulomatose de Wegener em adolescentes. Relatamos o caso de uma paciente portadora de Granulomatose de Wegener cujo início dos sintomas foi na infância, tendo evoluído com estenose laríngea durante o curso da doença.Hospital do Servidor Público do Estado de São Paulo Serviço de Otorrinolaringologia/Cabeça e PescoçoFaculdade de Medicina de São Paulo Divisão de Clínica OtorrinolaringológicaUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaUNIFESP, EPMSciEL

MRI Anatomical and Morphological Differences in the Vocal Tract Between Dysphonic and Normal Adult Women

Objective. To analyze the vocal tract morphometry of women with vocal nodules (VN) compared with normal subjects by means of magnetic resonance imaging (MRI) at rest position.Study Design. Prospective study.Methods. the present research included 20 young adult women, aged 18-40 years: 10 dysphonic patients with VN and 10 normal subjects. All participants were tested using MRI; 12 measurements of the vocal tract were performed: nine in median sagittal section and three in axial section.Results. the 12 measurements were smaller in the dysphonic group; statistical significance was obtained for three parameters: in the sagittal plane, the laryngeal vestibule area was significantly smaller in the dysphonic group, with P = 0.012* (* = statistical significance); in the axial section, the distance between the right and left vocal processes of the arytenoids' cartilages and the distance between the anterior commissure of the glottis and the laryngeal posterior wall were also significantly lower in the dysphonic group, with P = 0.036* and 0.010*, respectively. Significant differences in the vocal tract morphometry of individuals with VN were observed compared with normal subjects, at rest position.Conclusions. Results obtained from this study suggest that patients with VN may present a constantly increased tension of the laryngeal muscles, even at rest; moreover, reduced anterior-posterior dimension of the larynx may be a morphological characteristic of patients with VN.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Fed Univ São Paulo UNIFESP, Dept Diagnost Imaging, São Paulo, BrazilFed Univ São Paulo UNIFESP, Dept Speech Language Pathol & Audiol, São Paulo, BrazilCEV, BR-04044905 São Paulo, BrazilFed Univ São Paulo UNIFESP, Larynx & Voice Sect, São Paulo, BrazilFed Univ São Paulo UNIFESP, Dept Diagnost Imaging, São Paulo, BrazilFed Univ São Paulo UNIFESP, Dept Speech Language Pathol & Audiol, São Paulo, BrazilFed Univ São Paulo UNIFESP, Larynx & Voice Sect, São Paulo, BrazilWeb of Scienc

Morphometric aspects of the human hypoglossal nerve in adults and the elderly

OBJETIVO: Realizar análise morfométrica das fibras mielínicas do nervo hipoglosso direito, em dois grupos etários, com a finalidade de verificar modificações quantitativas decorrentes do processo de envelhecimento. FORMA DE ESTUDO: anatômico. MATERIAL E MÉTODO: Foi coletado fragmento de 1cm do nervo hipoglosso direito de 12 cadáveres do sexo masculino, sem antecedentes para doenças como diabetes, alcoolismo e neoplasia maligna. A amostra foi dividida em dois grupos: grupo adulto (idade inferior a 60 anos), composto por seis cadáveres; grupo idoso (idade igual ou superior a 60 anos), composto por seis cadáveres. O material foi fixado em solução contendo 2,5% de glutaraldeído e 2% de paraformaldeído; pós-fixado em tetróxido de ósmio 2%; desidratado em concentrações crescentes de etanol e incluído em resina epóxi. Cortes semifinos de 0,3¼m de espessura foram obtidos, corados com azul de toluidina a 1% e avaliados em microscópio de luz acoplado a sistema analisador de imagens. Os seguintes dados morfométricos foram quantificados: área de secção transversal intraperineural, número e o diâmetro das fibras mielínicas. RESULTADOS: A área intraperineural do nervo hipoglosso foi semelhante nos dois grupos etários (p=0,8691). A média da área no grupo adulto foi de 1,697 mm2, e no grupo idoso foi de 1,649 mm2. O número total de fibras mielínicas do nervo hipoglosso foi semelhante nos dois grupos etários (p=0,9018). O grupo adulto apresentou média de 10.286 ± 2308 fibras mielínicas e o grupo idoso apresentou média de 10.141 ± 1590 fibras mielínicas. Foi observada distribuição bimodal das fibras mielínicas, com pico acentuado nas fibras de 9¼m e outro menor nas fibras de 2¼m. CONCLUSÃO: A área intraperineural e o número total de fibras mielínicas do nervo hipoglosso direito é semelhante nos dois grupos etários.AIM: Perform a morphometric analysis of the myelinic fibers of the right hypoglossal nerve, in two age groups; to verify quantitative changes as a result of the aging process. STUDY DESIGN: anatomic. MATERIAL AND METHOD: A 1cm fragment of the right hypoglossal nerve was collected from 12 male corpses without any medical history of diseases such as: diabetes, alcoholism, and malignant neoplasia. The sample was divided in two groups: group with six corpses under sixty years old (adult), and another group with six corpses sixty years old or above (elderly). The material was fixed at 2.5% glutaldehyde and 2% paraformaldehyde solution; post-fixed at 2% osmium tetroxide; dehydrated with increasing ethanol concentrations, and included in epoxy resin. Semi-thin sections of 0.3µm were obtaining, colored in 1% toluidine blue, and evaluated with light microscope combined with image analyzing system. The following morphometric data were quantified: intraperineural transversal section area, number, and diameter of the myelinic fibers. RESULTS: The intraperineural area of the hypoglossal nerve was similar in both age groups (p=0.8691). The average area in the adult group was 1.697mm² and in the elderly group it was 1.649mm². The total number of myelinic fibers of the hypoglossal nerve was similar in both age groups (p=0.9018). The adult group presented an average of 10,286 ± 2,308 myelinic fibers, and the elderly group presented an average of 10,141 ± 1,590 myelinic fibers. A bimodal distribution of the myelinic fibers was observed, with a significant peak on the 9µm fibers, and another smaller peak on the 2µm fibers. CONCLUSION: The intraperineural area and the total number of myelinic fibers of the right hypoglossal nerve are similar in both age groups

Vestibular folds configuration in vocal nodule

Vocal nodules are among the most common laryngopathies that cause vocal functional disorders. The voice production mechanism is complex and demand interaction of different systems of the human body. The physiological role of the vocal folds as the glottic sound source is evident, however, there is no consensus regarding the vestibular folds' participation/influence in phonation. AIM: To verify if there is difference in the bidimensional configuration of the vestibular folds between two distinct groups of women, one with the diagnosis of vocal nodules and the other without vocal complaints and vocal fold lesions. STUDY DESIGN: clinical with transversal cohort. MATERIAL AND METHOD: Ninety-six laryngeal images were evaluated, 48 from individuals without vocal complaints and 48 from patients with the diagnosis of vocal nodules. Angles were obtained and bilaterally measured in single frames of the vestibular folds during sustained phonation and those structures were morphologically classified as concave, linear or convex. RESULTS: Among the 96 vestibular folds evaluated in each group, there was predominance of the concave form, followed by the linear and the convex ones. In the control group, there was a single convex vestibular fold, 27 were linear and 68 were concave folds. In the group of vocal nodules, 8 were convex, 15 were linear and 73 were concave folds. However, the differences among groups were not statistically significant as well as those among the angles, whose average measures were proven quite similar. CONCLUSION: In the female gender, the vestibular folds presented similar behavior regarding the morphology in both patients with vocal nodules and women without vocal complaints.O nódulo vocal está entre as laringopatias mais comuns que resultam em alterações na função vocal. O mecanismo da produção da fala é complexo e exige interação de diversos sistemas do organismo humano. A importância das pregas vocais na fisiologia e na formação da fonte sonora glótica é evidente; contudo, quanto à participação das pregas vestibulares neste processo, ainda não existe consenso entre os estudiosos da área. OBJETIVO: Verificar se existe diferença na conformação das pregas vestibulares entre dois grupos de indivíduos do sexo feminino, sendo um composto por pacientes com diagnóstico de nódulo vocal e outro por pacientes sem alteração da voz e sem lesão em pregas vocais. FORMA DE ESTUDO: clínico com coorte transversal MATERIAL E MÉTODO: Foram analisadas 96 imagens de laringes, de indivíduos do sexo feminino, sendo 48 sem queixa vocal e 48 com diagnóstico de nódulo vocal. Foram medidos os ângulos formados nas pregas vestibulares durante a fonação, dos lados direito e esquerdo, bem como feita classificação das mesmas quanto à forma (côncava, linear ou convexa). RESULTADOS: Das 96 pregas vestibulares analisadas em cada grupo, a forma côncava foi predominante, seguida da linear e da convexa. No grupo controle, apenas uma das pregas estudadas tinha a conformação convexa, 27 conformação linear e 68 eram côncavas, enquanto no grupo nódulo vocal os resultados foram 8 convexas, 15 lineares e 73 côncavas. Estas diferenças não apresentaram significância, bem como as diferenças nos ângulos, cujas médias foram bastante semelhantes. CONCLUSÃO: As pregas vestibulares no sexo feminino se comportam da mesma maneira tanto nas pacientes com nódulo vocal quanto nas mulheres sem queixa vocal

Laryngeal sarcoidosis: Literature review

Introduction: Laryngeal sarcoidosis is a granulomatous disease representing a challenge as regards diagnosis and treatment. Method: In this review, all aspects of the disease are involved, including etiology, clinical manifestations in adults and children, diagnosis, and treatment, by searching through Medline, Lilacs and Scielo databases, as well as English and Portuguese articles published from 1973 to 2008. Final Comments: Despite the breakthroughs in its diagnosis and treatment, sarcoidosis is a disease that remains without a clear etiology and physiopathology, becoming an exclusion diagnosis due to both the lack of precise exams and its likely multifactor background. Laryngeal impairment, however infrequent, is a suspicion mainly when there is a precedent history of systemic sarcoidosis, and the research for differentiated diagnosis must be wide-ranging so as to prevent severe diseases like malign neoplasia from being unnoticed