Ortner’s Syndrome-A Rare Cause of Hoarseness: Its Importance to an Otorhinolaryngologist

Introduction: Cardiovocal hoarseness (Ortner’s syndrome) is hoarseness of voice due to recurrent laryngeal nerve involvement secondary to cardiovascular disease. Recurrent laryngeal nerve in its course (especially the left side) follows a path that brings it in close proximity to numerous structures. These structures interfere with its function by pressure or by disruption of the nerve caused by disease invading the nerve. However painless asymptomatic intramural hematoma of the aortic arch, causing hoarseness as the only symptom, is a rare presentation as in this case.  Case Report: We report a case of silent aortic intramural hematoma which manifested as hoarseness as the only presenting symptom. A detailed history and thorough clinical examination could not reveal the pathology of hoarseness. The cause of hoarseness was diagnosed as aortic intramural hematoma on contrast computed tomography. Thus the patient was diagnosed as case of cardiovocal hoarseness (Ortner’s syndrome) secondary to aortic intramural hematoma.   Conclusion:  A silent aortic intramural hematoma with hoarseness as the only presenting symptom is very rare. This particular case report holds lot of significance to an otolaryngologist as he should be aware of this entity and should always consider it in the differential diagnosis of hoarseness

Audiological Outcome of Classical Adenoidectomy versus Endoscopically-Assisted Adenoidectomy using a Microdebrider

Introduction: The aim of this study was to evaluate audiological outcomes following adenoidectomy by the classical method and by endoscopically-assisted adenoidectomy using a powered instrument (microdebrider).   Materials and Methods: This study was conducted in a tertiary care center. It included 40 patients divided into two equal groups of 20 each. Group-A patients underwent classical adenoidectomy, while Group-B patients were subjected to endoscopically-assisted adenoidectomy using a microdebrider. Hearing outcome was measured by post-operative pure-tone audiometry and tympanometry.   Results: The post-operative average air-bone gap (ABG) was reduced from 19.6 dB to 11.8 dB in Group A and from 17.6 dB to 8.7 dB in Group B (P=0.010). There was reversal of tympanometric curves from type-B and type-C to type-A in 55% of the patients in Group A, while type-A curve was seen in 90% cases in Group B in the post-operative period.   Conclusion:  Audiological outcomes of endoscopically-assisted adenoidectomy using a microdebrider were superior compared with classical adenoidectomy

Tuberculosis in larynx

Introduction: Laryngeal tuberculosis (TB) has shown increase in incidence in recent years and the increase in immunosuppressive conditions has altered the clinical profile of the disease. The aim of this study was to evaluate the changing trends of laryngeal TB and to highlight its site of involvement, type of lesion, and degree of involvement. Patients and Methods: This prospective study included 54 patients with a diagnosis of laryngeal TB. All patients were evaluated in terms of their age, chief complaints, lesions, and site of involvement on flexible fiber-optic bronchoscopy, and they also underwent a variety of laboratory investigations as indicated. Results: The study showed that true vocal cords + false cords + epiglottis were involved in 48.1% (n = 26), arytenoids + interarytenoid + posterior part of true cords in 24.1% (n = 13), true cords + false cords + arytenoids + interarytenoid in 18.5% (n = 10), true vocal cords alone in 5.5% (n = 3), interarytenoid in 1.8% (n = 1), and interarytenoid + arytenoid involvement was seen in 1.8% (n = 1) of patients. These lesions were categorized into four different appearances as follows: granulomatous lesions in 50% (n = 27), ulcerative lesions in 27.7% (n = 15), hyperemia and hypertrophic in 16.7% (n = 9), and papillomatous mass in 5.6% (n = 3) based on fiber-optic bronchoscopy. Conclusion: In this study, the disease was most rampant in the age group of 31–60 years, with a predilection seen in low socioeconomic groups, rural groups and in individuals addicted to smoling and alcoholism. Hoarseness and odynophagia are the major symptoms. Multiple subsites are involved, and the lesions show a predilection for the anterior part of the vocal cord