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Query: UMLS:C0011168 (dysphagia)
 15,644 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Arytenoid subluxation (AS), ie, malpositioning of the arytenoid cartilage with abnormal but existent contact between the joint surfaces, is an uncommon entity, and fewer than 70 cases have been reported, 26 of which were in a recently published series. Usually, AS is the result of upper airway instrumentation, and only a few cases were reported to occur with external trauma to the neck. Some predisposing factors and possible mechanisms have been suggested, but the reason for its occurrence remains obscure. Hoarseness and, to a lesser degree, dysphagia, odynophagia, cough, and sore throat may be indicative of AS. Diagnosis is established by the clinical course, laryngoscopy, and computed tomography. Electromyography and strobovideolaryngoscopy are additional diagnostic measures described. We report 7 cases of postintubation AS of long standing. Three of these patients had prior unilateral vocal cord paralysis, formerly undescribed as a possible contributing factor for AS. The pertinent literature is reviewed and treatment options are discussed.
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PMID:Postintubation arytenoid subluxation. 865 33

Pneumomediastinum is an entity with diverse underlying etiologies and variable clinical presentations. We present a case of pneumomediastinum that on initial presentation appeared to be an upper airway emergency most consistent with adult epiglottitis. The pathophysiology of pneumomediastinum involves extravasation of air through perivascular interstitial tissues. Once air has gained access into the soft tissues, it may dissect upward into the neck and distend upper airway structures. This may cause patients with pneumomediastinum to have symptoms such as a sore throat or dysphagia. The patient we describe had such dramatic upper airway symptomatology that adult epiglottitis was the initial suspected diagnosis, and acute airway intervention was required. The various etiologies, presentations, and pathophysiology of pneumomediastinum are discussed.
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PMID:Pneumomediastinum presenting as acute airway obstruction. 874 Jul 45

The case of an 18-yr-old otherwise healthy adult with retropharyngeal abscess (RPA) presenting with sore throat and syncope is reported. The case illustrates that sore throat with symptoms out of proportion to oropharyngeal findings should prompt a search for pathology other than simple pharyngitis. A literature search for case reports of RPA in adults was done to derive characterizations about this disease. Adult RPA patients present with sore throat, dysphagia, neck pain and, less commonly, stridor. Adult RPA occurs as a complication of procedures or blunt trauma to the neck, or spread of infection from an adjacent focus. The incidence of underlying disease causing immunosuppression is high. RPA in adults without history of preceding trauma or coexistent illness is unusual.
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PMID:Adult retropharyngeal abscess: a case report and review of the literature. 874 Jul 44

Eagle's syndrome occurs when an elongated styloid process or calcified stylohyoid ligament causes recurrent throat pain or foreign body sensation, dysphagia, or facial pain. Additional symptoms may include neck or throat pain with radiation to the ipsilateral ear. In adults, the styloid process is approximately 2.5 cm long, and its tip is located between the external and internal carotid arteries, just lateral to the tonsillar fossa. It may develop inflammatory changes or impinge on the adjacent arteries or sensory nerve endings, leading to the symptoms described. Diagnosis can usually be made on physical examination by digital palpation of the styloid process in the tonsillar fossa, which exacerbates the pain. In addition, relief of symptoms with injection of an anesthetic solution into the tonsillar fossa is highly suggestive of this diagnosis. Radiographic workup should include anterior-posterior and lateral skull films. The treatment of Eagle's syndrome is primarily surgical. The styloid process can be shortened through an intraoral or external approach. We present two cases and review the literature.
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PMID:Eagle's syndrome (elongated styloid process) 943 2

A 45-year-old woman presented to the emergency department (ED) with a 3-day history of fever, progressive sore throat, dysphagia, and difficulty speaking. She was diagnosed with acute lingual tonsillitis. The ED physician must consider this rarely discussed disorder when presented with the previously mentioned signs and symptoms. This will allow for prompt diagnosis and treatment of acute lingual tonsillitis and may help to avoid potential airway compromise.
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PMID:Acute lingual tonsillitis. 914 94

The clinical efficacy of procaine penicillin and sulbactam-ampicillin was compared in patients with peritonsillar abscesses after peroral abscess drainage. Forty-two patients were randomly assigned to receive either procaine penicillin or sulbactam-ampicillin intramuscularly on an outpatient basis. The mean time required for clinical symptoms (throat pain, dysphagia and fever) to resolve was compared. No statistically significant difference was found between the clinical recoveries of patients using either antibiotic (P > 0.05). The authors conclude that intramuscular procaine penicillin can be safely prescribed on an outpatient basis to most patients with peritonsillar abscess after incision and drainage. In contrast, a broader spectrum and more expensive antibiotic, such as sulbactam-ampicillin, should be reserved for non-responders.
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PMID:A comparison of procaine penicillin with sulbactam-ampicillin in the treatment of peritonsillar abscesses. 956 66

A 25-year-old Hispanic woman presented with painful oral ulcers, a sore throat, and dysphagia of two weeks' duration. She was treated empirically with acyclovir for presumed herpes simplex stomatitis and esophagitis and sent home. A week later, she returned with complaints of worsening sore throat, fever (as high as 38.9 degrees C), and cough producing yellow-green sputum. She had not had chills, shortness of breath, burning on urination, or a change in bowel habits.
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PMID:An uncommon cause of oral ulcers. 971 74

GABHS is the most common bacterial cause of tonsillopharyngitis, but this organism also produces acute otitis media; pneumonia; skin and soft-tissue infections; cardiovascular, musculoskeletal, and lymphatic infections; bacteremia; and meningitis. Most children and adolescents who develop a sore throat do not have GABHS as the cause; their infection is viral in etiology. Other bacterial pathogens produce sore throat infrequently (e.g., Chlamydia pneumoniae and Mycoplasma pneumoniae), and when they do, other concomitant clinical illness is present. Classic streptococcal tonsillopharyngitis has an acute onset; produces concurrent headache, stomach ache, and dysphagia; and upon examination is characterized by intense tonsillopharyngeal erythema, yellow exudate, and tender/enlarged anterior cervical glands. Unfortunately only about 20% to 30% of patients present with classic disease. Physicians overdiagnose streptococcal tonsillopharyngitis by a wide margin, which almost always leads to unnecessary treatment with antibiotics. Accordingly, use of throat cultures and/or rapid GABHS detection tests in the office is strongly advocated. Their use has been shown to be cost-effective and to reduce antibiotic overprescribing substantially. Penicillin currently is recommended by the American Academy of Pediatrics and American Heart Association as first-line therapy for GABHS infections; erythromycin is recommended for those allergic to penicillin. Virtually all patients improve clinically with penicillin and other antibiotics. However, penicillin treatment failures do occur, especially in tonsillopharyngitis in which 5% to 35% of patients do not experience bacteriologic eradication. Penicillin treatment failures are more common among patients who have been treated recently with the drug. Cephalosporins or azithromycin are preferred following penicillin treatment failures in selected patients as first-line therapy, based on a history of penicillin failures or lack of compliance and for impetigo. GABHS remain exquisitely sensitive to penicillin in vitro. There are several explanations for penicillin treatment failures, but the possibility of copathogen co-colonization in vivo has received the most attention. Treatment duration with penicillin should be 10 days to optimize cure in GABHS infections. A 5-day regimen is possible and approved by the United States Food and Drug Administration for cefpodoxime (a cephalosporin) and azithromycin (a macrolide). Prevention of rheumatic fever is the primary objective for antibiotic therapy of GABHS infections, but a reduction in contagion and faster clinical improvement also can be achieved. Development of streptococcal toxic shock syndrome and necrotizing fasciitis ("flesh-eating bacteria") are rising concerns. The portal of entry for these invasive GABHS strains is far more often skin and soft tissue than the tonsillopharynx.
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PMID:Group A beta-hemolytic streptococcal infections. 974 11

In order to evaluate complications due to cervical spine surgery using the anterior cervical approach a prospective study was conducted on 125 patients. ENT examination with the fibroscope was employed for all the patients before the procedure. The patients were operated on under general anesthesia and were intubated with an armoured tube, and then were placed in an intensive care unit for 24 hours. Assessment of deglutition and an ENT examination were performed the day after surgery. Before surgery, two cases of vocal cord paralysis were noted. 111 patients (88.8%) presented with subjective disorders: problems such as sore throat, odynophagia, dysphagia, dysphagia with overspill and hoarseness were respectively noted in 55 (44%), 34 (27.2%), 32 (25.6%), 11 (8.8%) and 13 (10.4%) cases. Dyspnoea was found in 2 cases (1.6%). 117 patients (93.6%) presented postoperative anomalies which were found on the posterolateral pharyngeal wall, on the arytenoids and on posterior third of the vocal cords. Inflammatory and/or swollen lesions were slight, moderate, significant or very significant in respectively 22.4%, 22.4%, 15.2% and 1.6% of cases. Very significant circumferential swelling of the pharyngeal wall and of the arytenoids was responsible for two cases of respiratory distress, and the patients required reintubation and return to theatre. Severe pharyngeal lesion correlated with duration of surgery (r = 0.20; p < 0.05), with the number levels of fusion (r = 0.02; p < 0.02) and with the age of the patient (p < 0.02). Six patients presented problems of mobility of the vocal cords: 3 had a right vocal cord paresis which was temporary and 3 had paralysis, also on the right but which persisted. There were no other complications. It is concluded that (i) ENT complications are frequently found in postoperative cervical spine surgery using the anterior cervical approach, some of them being severe. An ENT examination must be performed before the procedure for legal reasons. It is also recommended in the postoperative period in the case of discomfort; (ii) patients need to be placed in an intensive care unit during for the first 24 hours (iii). This study needs to be attended over more patients (iv) comparison with a control group of patients having non cervical surgery and intubated in the same way is needed to differentiate lesions related to surgery or intubation.
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PMID:[A prospective study of ENT complication following surgery of the cervical spine by the anterior approach (preliminary results)]. 977 50

A 42-year-old man presented as an emergency to the ENT department with sore throat and complete dysphagia, having undergone an umbilical hernia repair under general anaesthesia with tracheal intubation 3 weeks previously at another institution. One course of antibiotics from his general practitioner improved the symptoms but, on discontinuation of the antibiotics, symptoms flared up leading to complete dysphagia. Indirect laryngoscopy showed a bulging of the retropharyngeal wall, which was confirmed as a widening of the retropharyngeal space on a lateral soft-tissue X-ray film of the neck. Surgical exploration confirmed a retropharyngeal abscess, which probably occurred as a complication of the original tracheal intubation.
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PMID:Retropharyngeal abscess: an unusual complication of tracheal intubation. 1010 31


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