Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0011168 (dysphagia)
 15,644 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

All clinicians responsible for diagnosing and treating diseases of the head and neck should be familiar with the possible clinical manifestations of a mineralized stylohyoid or stylomandibular ligament. Many patients with Eagle's syndrome have been misdiagnosed as having neuralgias, TMJ problems, psychosomatic disorders, or other vague, ill-defined diseases of the head and neck. Unfortunately , patients have been treated for these conditions with negative results. Extraction of teeth, especially third molars, has been performed unnecessarily in an attempt to alleviate the symptoms caused by a mineralized stylohyoid or stylomandibular ligament. Patients complaining of vague facial pain (especially when swallowing, turning the head or opening the mouth), dysphagia, otalgia, and headache with dizziness and with radiographic evidence of mineralization in the stylohyoid-stylomandibular ligament complex may have Eagle's syndrome. If digital palpation of the tonsillar fossa on the affected side causes the typical pain that the patient has been experiencing and if the mineralized abnormality can be felt in the fossa, the patient is considered to have the syndrome, and surgical resection of the abnormality should be considered.
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PMID:Eagle's syndrome diagnosed after history of headache, dysphagia, otalgia, and limited neck movement. 695 Sep 78

Cervical masses in adult patients should be regarded as metastatic until proven otherwise. Work-up must therefore begin with a thorough search for a possible primary cancer. 90% of all head and neck primaries that present with a cervical mass are located in the oral cavity, pharynx or larynx. Pain [particularly otalgia], dysphagia, nasal obstruction, unilateral hearing loss, and hoarseness are the most common key symptoms of these tumors. Cancer cannot always be ruled out, even with regression of symptoms following antibiotic treatment or normal laboratory findings. If no primary lesion is found, then fine-needle aspiration biopsy of the neck mass is indicated. Only if fine-needle aspiration biopsy fails to come up with a diagnosis, should open [whenever possible excisional] biopsy be performed.
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PMID:[Diagnostic procedures in obscure cervical nodes in adults]. 750 54

In 511 patients with T3N0-3M0 laryngeal carcinoma, 24 possible prognostic factors were analysed retrospectively. The factors were age, sex, mode of treatment, duration of several clinical symptoms, the presence of sore throat, otalgia, dyspnoea, and dysphagia, previous tracheotomy, tumour extension, lymph node status (five items), histologic grading, smoking habits, and alcohol intake. For 300 patients in whom surgery was part of the primary treatment, pathologic staging of the primary tumour and of lymph nodes in neck dissection specimens, cartilage invasion, radicality of the operation, differentiation grade, and subglottic extension were also evaluated. Univariate analysis revealed prognostic significance on survival for tumour extension (limited to the glottic region), lymph node status (clinically palpable lymph nodes, cytologically confirmed positive lymph nodes), level of lymph node metastasis (high and midjugular site), histologic grading (poor differentiation grade), and treatment modality (planned combined therapy). In the group that underwent surgery, all factors derived from specimens of the larynx and neck dissections had prognostic significance. Multivariate analysis revealed that the glottic site of the tumour, the presence of cyto- and histopathologically proven metastatic lymph nodes, pretreatment tracheotomy, positive resection margins, and planned combined treatment had a significant influence on corrected actuarial survival.
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PMID:[Uni- and multivariate analysis of prognostic factors in T3 laryngeal cancers]. 830 23

Infection by neurotropic viruses, as exemplified by the herpes family, is universally accepted as a cause of palsies of the cochleo-vestibular and facial nerve. Palsies of the vagus nerve with a possible viral etiology have been described, although viruses have been identified in only a few selected cases. We report a 52-year-old man with unilateral otalgia, hoarseness and dysphagia. Examination revealed unilateral (left-sided) pharyngeal dysfunction, and paralysis of the left vocal cord fixed in the paramedian position. A barium swallow documented dysfunction of the left pharyngeal constrictor muscles. These findings suggested the lesion to be located either at the inferior ganglion of the vagus nerve or cranially. At direct laryngoscopy a smear was obtained from a 4-mm mucosal ulcer at the region of the left arytenoid cartilage. This smear demonstrated antibodies to herpes simplex virus (HSV) type I by immunofluorescence. On follow-up 19 months after the initial infection there was complete remission of the paralysis of the left vocal cord and normal pharyngeal function. The demonstration of HSV type 1 antibodies from a mucosal lesion in the distribution of the superior laryngeal nerve suggests that reactivation of HSV type I was the most likely explanation for the temporary nerve palsy seen.
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PMID:Herpes simplex virus type I reactivation as a cause of a unilateral temporary paralysis of the vagus nerve. 873 89

Granular cell tumour (GCT) is a benign tumour with abundant eosinophilic cytoplasm filled with granules of varying sizes. These granules are the defining characteristic of the GCT and are believed to represent lysosomes in varying stages of fragmentation. The commonly used term granular cell myoblastoma, found in the older literature, is a misnomer because the tumour is clearly not of muscle origin. Among the major theories of origin, some support the tumour's derivation from neuronal tissue, histiocytes, fibroblast or Schwann cells. In the larynx, pseudoepitheliomatous hyperplasia may predispose to confuse the GCT with squamous cell carcinoma. The most common region of GCT is in the head and neck, accounting for approximately 30 to 50 per cent of all lesions. The larynx is relatively an uncommon location for these tumours, accounting for approximately three to 10 per cent of the reported cases. Affected patients typically present with persistent hoarseness, stridor, haemoptysis, dysphagia, and otalgia, but the tumour may be asymptomatic and be discovered only incidentally during a routine examination. Complete excision with an attempt to maintain normal structures generally results in cure. We present the case of a patient with typical features of a GCT of the larynx. The gross appearance, histopathology and brief discussion of the current literature are also presented.
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PMID:Granular cell tumour of the larynx. 965 2

The TNM staging system for head and neck cancer is based on the morphologic description of the tumor and disregards the clinical condition of the patient. Cancer symptoms were evaluated as a biologic index of disease to improve survival estimates. The medical records of 1010 patients receiving initial cancer treatment between 1980 and 1991 were retrospectively reviewed. The mean survival duration was 62 months for the entire population. By use of SAS statistical software (SAS Institute, Cary, NC), 48 symptom variables were screened by univariate analysis, and 23 of these variables were selected for entry into a Cox proportional hazards model on the basis of survival duration. Dysphagia, otalgia, neck lump, and weight loss were identified as independent predictors of survival duration (P < 0.01). A composite symptom-severity staging system was created on the basis of the 4 symptoms. Mean survival duration (95% CI) by symptom-severity stage was as follows: none, 74 months (70 to 79 months); mild, 56 months (51 to 61 months); moderate, 40 months (33 to 47 months); and severe, 31 months (22 to 41 months) (chi 2 = 30.8, P = 0.0001). Survival duration by TNM stage was as follows: I, 89 months (82 to 95 months); II, 71 months (65 to 78 months); III, 53 months (47 to 59 months); and IV, 42 months (37 to 47 months) (chi 2 = 56.2, P = 0.0001). When symptom-severity stage was entered in a proportional-hazards model along with TNM stage, comorbidity, age, and alcohol use, all 5 variables were independently predictive of survival duration (risk ratio: symptom severity 1.28, TNM 1.33, comorbidity 1.80, age 1.47, alcohol use 1.09). Appropriately defined symptom variables contain important prognostic information, which is independent of the TNM system. Therefore symptoms provide an index of biologic behavior in head and neck cancer.
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PMID:Symptoms as an index of biologic behavior in head and neck cancer. 1006 42

A 30-year-old woman with a 10-year history of recurrent bloody diarrhea and documented colitis of the descending colon, consistent with Crohn's disease, presented with an exacerbation of her gastrointestinal disease and an 18-month history of recurrent facial and genital swelling. Her course evolved to include severe ear pain, dysphagia and colonic dysmotility. She was diagnosed with Melkersson-Rosenthal syndrome and treated with multiple agents. The neurological aspects of her presentation are highlighted, and the Melkersson-Rosenthal syndrome is reviewed.
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PMID:Crohn's disease and the Melkersson-Rosenthal syndrome. 1020 35

The REPOSE system is a new, mini-invasive technique with which the base of the tongue is suspended to treat sleep breathing disorders (SBD) induced by hypertrophy of the base of the tongue. The surgical technique calls for the intra-oral insertion of a small titanium screw in the anterior portion of the mandible. Two polypropylene threads are attached to the screw and these are passed through the base of the tongue and then tied at the point where it is inserted in the floor of the mouth, thus effectively suspending the base of the tongue. 10 patients with SBD due to hypertrophy of the base of the tongue underwent this procedure. Only one major complication was found: an infection requiring sectioning of the suspension thread. For an average 7 to 30 days all patients showed signs of odinophagia, bilateral otalgia, dysphagia and dislalia. In all patients snoring either disappeared altogether or was significantly reduced. Statistical analysis of the pre- and post-operative polysonnograph data showed a significant reduction in the apnea index (AI), the respiratory distress index (RDI) (p = 0.009) as well as a significant improvement in the degree of oxygen saturation (SaO2) (p = 0.008). The results were independent from the body mass since the patients did not lose weight during the follow-up period.
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PMID:[A new mini-invasive technique for the treatment of sleep breathing disorders: preliminary results of a clinical experience]. 1041 88

Historically, the lingual tonsils are the most neglected members of Waldeyer's ring. They are often overlooked even in a thorough head and neck exam because of their anatomic location and the ambiguous constellation of symptoms which they produce when they are diseased or enlarged. The lingual tonsils have been reported to be associated with a variety of upper aerodigestive tract symptoms including odynophagia, dysphagia, otalgia, globus, halitosis, chronic cough, and dyspnea. Many patients with lingual tonsillar pathology may undergo extensive work-up for some of these non-specific upper airway complaints by their primary physician before referral to an otolaryngologist. Consequently, the diagnosis of lingual tonsillar disease requires a high index of suspicion and a thorough physical exam including evaluation of the tongue base and hypophaynx with indirect mirror or fiberoptic exam. In order to draw attention to this frequently unrecognized entity, we present a case report of a child with chronic cough resulting from lingual tonsillar hypertrophy.
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PMID:Lingual tonsillectomy for refractory paroxysmal cough. 1086 27

Vagus nerve palsy caused by herpes simplex virus (HSV) infection is rare. Here, we present a 29-year-old man with acute onset of right side otalgia and sore throat, followed by dysphonia, dysphagia and some vesicles seen on the deep soft palate. Laryngoscopy revealed right vocal cord palsy. Neck to chest CT did not reveal local lesion. Three months later, his serum HSV IgG antibody titer was eight times elevation and a throat swab culture for virus isolation yielded HSV type I. T2-weighted images of neck MRI showed abnormally high signal intensity on the right sub-glottis region with Gadolinium enhancement that was compatible with local infection. Thereafter, one course of acyclovir; was given. Three months after finishing the acyclovir, his symptoms were almost gone and neck MRI did not show the aforementioned lesions. HSV infection should be considered as a differential diagnosis for patients with idiopathic dysphonia and dysphagia.
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PMID:Isolated vagus nerve palsy probably associated with herpes simplex virus infection. 1155 Dec 39


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