Search results

1

Rhabdomyoma of the Parapharyngeal Space – A Case Report

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Sieniawska-Buccella O., Osuch-Wójcikiewicz E., Kazimierska K., Kukawska M., Rzepakowska A., Niemczyk K.

Polski Przegląd Otorynolaryngologiczny

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2020

|

vol. 9(2)

54-57

EN

Introduction: Rhabdomyomas (RM) are rare benign mesenchymal tumors. They are a much more uncommon entity than their malignant counterparts, rhabdomyosarcomas. Rhabdomyomas fall into two general categories: cardiac tumors and extracardiac tumors. Extracardiac myomas are among the rarest tumors in humans and can be classified as fetal and adult, depending on the degree of differentiation of individual tumors by light microscopy. Adult extracardiac myoma is most commonly characterized by the occurrence in the head and neck, and mainly in the laryngeal and pharyngeal area. Case report: This article presents a case of rhabdomyoma of the parapharyngeal space with a review of world literature.

2

Characteristics of swallowing disorders in patients with dysphonia

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Krasnodębska P., Szkiełkowska A., Jarzyńska-Bućko A., Włodarczyk E., Miaśkiewicz B.

Otolaryngologia Polska

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2020

|

vol. 74(2)

17-22

EN

Introduction: Coexistence of dysphagia with voice disorders is a topic rarely raised in the literature. Particular attention is paid to the aspect of dysfunction of laryngeal and pharyngeal muscles. Aim: The aim of the study was to analyse cases of patients with dysphonia in relation to coexistence of swallowing disorder. Material and method: The material of the study included 515 patients hospitalised due to dysphonia in 2018. Patients whose interview indicated swallowing difficulties were subjected to additional diagnosis for dysphagia (FEES, extended speech therapy test, SEMG). R esults: 11.8% of people requiring treatment for voice disorders reported coexistence of swallowing difficulties. Dysphagia was diagnosed in 9.3%. The percentage of respondents diagnosed with swallowing disorder differed depending on the type of underlying disease and was the highest in the group with neurological disorders. Analysis of the correlation between the severity of dysphagia (according to the assessed grade, DHI, EAT-10 results) and the severity of VHI showed a weak correlation between VHI and EAT-10 (p = 0.1), statistically significant correlations (p < 0,05) between the value of VHI and RSI in people with diagnosed neurological disease, between the value of VHI and DHI in people with hyperfunctional dysphonia and the value of VHI and BMI and EAT- 10 in people with chronic laryngitis. Moreover, statistically significant correlations were found between the severity of dysphagia and EAT-10 and DHI (p < 0.05). The speech therapy test indicated the co-existing problem of non-normative swallowing pattern. The electromyographic study showed the largest asymmetries in recording the average and maximum amplitude from masseters. C onclusions: Treatment of patients with voice disorders requires interdisciplinary care. A history of dysphagia in these patients should complement the medical history of voice disorders. The characteristics of swallowing disorders vary depending on the cause of the voice disorder and their co-occurrence affects on average 9.3% of patients. Coexistence of muscle tension dysphagia with voice disorder requires separate diagnostic protocol. Logopaedic procedure ought to be a key element in the interdisciplinary care of patients suffering from muscle tension dysphagia.

3

Dysphagia as an interdisciplinary problem. Difficulties in the diagnostic process of the vascular anomaly: a right-sided aortic arch with aberrant left subclavian artery (case report)

100%

Maciejewska B., Kania K., Kowal P., Wiskirska-Woźnica B.

Polski Przegląd Otorynolaryngologiczny

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2018

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vol. 7(1)

51-58

EN

Dysphagia is an underestimated health problem. At the same time, it is a potentially life-threatening condition. Dysphagia in young adults is rare and thus it is rarely discussed in the literature. Vascular anomalies are much less frequent causes of dysphagia than structural pathologies of the digestive system, iatrogenic lesions or neurological causes. This paper presents a case of a 21-year-old woman with escalating dysphagia in the course of a congenital vascular anomaly in the form of a right-sided aortic arch with retroesophageal left subclavian artery (left arteria lusoria) and compression. The paper highlights delayed symptomatology of the congenital defect, reasons behind the long-lasting diagnostic process, and the role of the laryngological – phoniatric examination in order to exclude oral and pharyngeal causes. The differential diagnostics and treatment options are discussed thereinafter.

4

Diagnosis in Muscle Tension Dysphagia

100%

Krasnodębska P., Jarzyńska-Bućko A., Szkiełkowska A., Miaśkiewicz B., Skarżyński H.

Otolaryngologia Polska

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2021

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vol. 75(1)

16-22

EN

Introduction: Patient-reported outcome measures have been used within the otorhinolaryngologic disorders’ field for many years to compare patient’s perception of the severity of symptoms and the effectiveness of a therapeutic approach. Questionnaires that evaluate dysphagia are relatively complex instruments aimed mostly at patients with neurological or malignant diseases. The ICD-10 classification specifies only one broad term – dysphagia (R13). Introduction of Muscle Tension Dysphagia (MTDg) in 2016 by Kang completed the spectrum of the nomenclature. This dysphagia type is defined as a type of laryngeal muscle tension disorder manifesting primarily as swallowing difficulty with or without any accompanying organic cause, laryngeal hyperresponsiveness and/or nonspecific laryngeal inflammation. Aim: Since there were no clear diagnostic and therapeutic perspectives on the group of patients with MTDg, the aim of this work was to analyse selected diagnostic tools used for the evaluation of swallowing disorders in the context of finding the most suitable tools for patients with Muscle Tension Dysphagia. Material and method: The material of the work included 61 patients. Each patient underwent otolaryngologic, phoniatric and speech therapist’s examination, Functional Endoscopic Evaluation of Swallowing (FEES) and filled out questionnaires concerning dysphonia and dysphagia symptoms. Results: The results of the work showed that patients with MTDg were characterised by correct results of FEES examination, prolonged swallowing, features of inappropriate mucous and oropharyngeal muscle function. Conclusions: The Swallowing Disorder Scale (SDS), developed by the authors, correlated best with the cause of dysphagia. The questionnaire corresponded well with the degree of severity. In the diagnostic process of MTDg one of the key tasks is the differentiation with patients with non-normative swallowing patterns. Apart from specialistic consultations with otolaryngologist and speech therapist, while diagnosing MTDg we recommend using objective (FEES, videofluroscopy, SEMG) and subjective (SDS, DHI, EAT-10 surveys) assessment tools. In our opinion, the inclusion of questionnaires to detect reflux syndromes is also important in the causal treatment of ailments.

5

Diagnosis in Muscle Tension Dysphagia

100%

Krasnodębska P., Jarzyńska-Bućko A., Szkiełkowska A., Miaśkiewicz B., Skarżyński H.

Polish Journal of Otolaryngology

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2021

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vol. 75

|

issue 1

16-22

EN

Introduction: Patient-reported outcome measures have been used within the otorhinolaryngologic disorders’ field for many years to compare patient’s perception of the severity of symptoms and the effectiveness of a therapeutic approach. Questionnaires that evaluate dysphagia are relatively complex instruments aimed mostly at patients with neurological or malignant diseases. The ICD-10 classification specifies only one broad term – dysphagia (R13). Introduction of Muscle Tension Dysphagia (MTDg) in 2016 by Kang completed the spectrum of the nomenclature. This dysphagia type is defined as a type of laryngeal muscle tension disorder manifesting primarily as swallowing difficulty with or without any accompanying organic cause, laryngeal hyperresponsiveness and/or nonspecific laryngeal inflammation. Aim: Since there were no clear diagnostic and therapeutic perspectives on the group of patients with MTDg, the aim of this work was to analyse selected diagnostic tools used for the evaluation of swallowing disorders in the context of finding the most suitable tools for patients with Muscle Tension Dysphagia. Material and method: The material of the work included 61 patients. Each patient underwent otolaryngologic, phoniatric and speech therapist’s examination, Functional Endoscopic Evaluation of Swallowing (FEES) and filled out questionnaires concerning dysphonia and dysphagia symptoms. Results: The results of the work showed that patients with MTDg were characterised by correct results of FEES examination, prolonged swallowing, features of inappropriate mucous and oropharyngeal muscle function. Conclusions: The Swallowing Disorder Scale (SDS), developed by the authors, correlated best with the cause of dysphagia. The questionnaire corresponded well with the degree of severity. In the diagnostic process of MTDg one of the key tasks is the differentiation with patients with non-normative swallowing patterns. Apart from specialistic consultations with otolaryngologist and speech therapist, while diagnosing MTDg we recommend using objective (FEES, videofluroscopy, SEMG) and subjective (SDS, DHI, EAT-10 surveys) assessment tools. In our opinion, the inclusion of questionnaires to detect reflux syndromes is also important in the causal treatment of ailments.

6

Characteristics of swallowing disorders in patients with dysphonia

100%

Krasnodębska P., Szkiełkowska A., Jarzyńska-Bućko A., Włodarczyk E., Miaśkiewicz B.

Polish Journal of Otolaryngology

|

2020

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vol. 74

|

issue 2

17-22

EN

Introduction: Coexistence of dysphagia with voice disorders is a topic rarely raised in the literature. Particular attention is paid to the aspect of dysfunction of laryngeal and pharyngeal muscles. Aim: The aim of the study was to analyse cases of patients with dysphonia in relation to coexistence of swallowing disorder. Material and method: The material of the study included 515 patients hospitalised due to dysphonia in 2018. Patients whose interview indicated swallowing difficulties were subjected to additional diagnosis for dysphagia (FEES, extended speech therapy test, SEMG). R esults: 11.8% of people requiring treatment for voice disorders reported coexistence of swallowing difficulties. Dysphagia was diagnosed in 9.3%. The percentage of respondents diagnosed with swallowing disorder differed depending on the type of underlying disease and was the highest in the group with neurological disorders. Analysis of the correlation between the severity of dysphagia (according to the assessed grade, DHI, EAT-10 results) and the severity of VHI showed a weak correlation between VHI and EAT-10 (p = 0.1), statistically significant correlations (p < 0,05) between the value of VHI and RSI in people with diagnosed neurological disease, between the value of VHI and DHI in people with hyperfunctional dysphonia and the value of VHI and BMI and EAT- 10 in people with chronic laryngitis. Moreover, statistically significant correlations were found between the severity of dysphagia and EAT-10 and DHI (p < 0.05). The speech therapy test indicated the co-existing problem of non-normative swallowing pattern. The electromyographic study showed the largest asymmetries in recording the average and maximum amplitude from masseters. C onclusions: Treatment of patients with voice disorders requires interdisciplinary care. A history of dysphagia in these patients should complement the medical history of voice disorders. The characteristics of swallowing disorders vary depending on the cause of the voice disorder and their co-occurrence affects on average 9.3% of patients. Coexistence of muscle tension dysphagia with voice disorder requires separate diagnostic protocol. Logopaedic procedure ought to be a key element in the interdisciplinary care of patients suffering from muscle tension dysphagia.

7

Functional Results after Larynx-Preserving Treatment of Laryngeal Cancer. Suggestions for follow-up

88%

Vlčková K., Tedla M.

Otolaryngologia Polska

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2019

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vol. 73(5)

31-36

EN

ntroduction: Laryngeal cancer and its treatment are associated with both short- and long-term side effects, affecting laryngeal functions and having an impact on the quality of life. Material and methods: Retrospective analysis of the medical records of patients receiving surgical or non-surgical, larynx- -preserving treatment for laryngeal cancer. R esults: After termination of the treatment, the highest proportion of patients with bad voice quality was in the glottic carcinoma group (both in early and late phase), with swallowing dysfunction in the transglottic carcinoma group. Compared to the situation before the treatment, the proportion of patients with impaired voice quality (bad voice quality and loss of voice) initially decreased among all groups (except for supraglottic carcinomas), and during the first post-treatment year either increased or did not change. The proportion of patients with no swallowing dysfunction increased in the supraglottic, subglottic and transglottic carcinoma groups. D iscussion: We consider necessary the implementation of a standard pre- and post-treatment monitoring of the voice and swallowing function in the management of patients with laryngeal cancer.

8

Functional Results after Larynx-Preserving Treatment of Laryngeal Cancer. Suggestions for follow-up

88%

Vlčková K., Tedla M.

Polish Journal of Otolaryngology

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2019

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vol. 73

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issue 5

31-36

EN

Introduction: Laryngeal cancer and its treatment are associated with both short- and long-term side effects, affecting laryngeal functions and having an impact on the quality of life. Material and methods: Retrospective analysis of the medical records of patients receiving surgical or non-surgical, larynx- -preserving treatment for laryngeal cancer. Results: After termination of the treatment, the highest proportion of patients with bad voice quality was in the glottic carcinoma group (both in early and late phase), with swallowing dysfunction in the transglottic carcinoma group. Compared to the situation before the treatment, the proportion of patients with impaired voice quality (bad voice quality and loss of voice) initially decreased among all groups (except for supraglottic carcinomas), and during the first post-treatment year either increased or did not change. The proportion of patients with no swallowing dysfunction increased in the supraglottic, subglottic and transglottic carcinoma groups. D iscussion: We consider necessary the implementation of a standard pre- and post-treatment monitoring of the voice and swallowing function in the management of patients with laryngeal cancer.

9

Adaptive therapy in the rehabilitation of swallowing disorders

88%

Jamróz B., Szałańska M., Chmielewska J., Milewska M., Przekop Z., Niemczyk K.

Polski Przegląd Otorynolaryngologiczny

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2017

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vol. 6(4)

25-28

EN

Dysphagia is an interdisciplinary problem. Doctors of different specialties (phoniatrician, ENT, gastrologist, neurologist), speech language therapists, physiotherapists and dieticians should be involved in the therapy of patients. The task of the first group is instrumental evaluation of swallowing, defining the safe consistency of fluids and foods, showing effective therapeutic maneuvers (restitutive and compensatory maneuvers), and finally - adapting the optimal diet to patient's eating ability (adaptive methods). The purpose of the study is to present a modification of the consistency of fluids and foods according to the recommendations of the International Dietary Standardization Initiative (IDDSI). The work shows the basic consistencies and tests that allow for them to be checked.

10

Application of Volume-Viscosity Screening Test as a screening tool in swallowing disorders diagnosis

88%

Milewska M., Jamróz B., Chmielewska J., Clave P.

Polski Przegląd Otorynolaryngologiczny

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2018

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vol. 7(2)

21-24

EN

It is commonly known that dysphagia is associated with primary (malnutrition, dehydration, aspiration pneumonia) as well as secondary consequences (longer hospital stay, increased treatment cost, higher risk of mortality). Therefore, screening tests in swallowing disorders, especially done in at-risk groups, are essential. The aim of screening is identification of patients at risk of dysphagia and referring patients to further instrumental methods. The test should be noninvasive, quick, easy to perform by medical staff, with highest sensitivity and specificity. An example is the Viscosity – Volume Screening Test (VVST) with 3 different consistencies at 3 volumes (5, 10 and 20 ml), with wider possibilities of this tool in safe consistency and volume indication.

11

The rare case of lipoma of posterior wall of the pharynx and parapharyngeal space

88%

Nowak K., Banaszewski J., Szyfter W.

Polski Przegląd Otorynolaryngologiczny

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2015

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vol. 4(3)

48-51

EN

The paper presents the rare case of lipoma of parapharyngeal space and oropharynx in 46-year-old man who came out suddenly while eating, giving the feeling of an obstacle in the throat. Preoperative diagnosis was based on a characteristic image of KT (low density, presence of capsule, lack of contrast gain and the use of fat suppression technique). The tumor was surgically removed in its entirety, from reaching the mouth. Emphasized the rarity of tumors of the weaving within the parapharyngeal space and throat, conditioned by a small amount of fat in this area, as well as the possibility of turbulent obstructive symptoms caused by the sudden disclosure of a tumor located deep in the tissues.

12

Instrumental evaluation of dysphagia after oropharyngeal cancer surgery with free flap reconstruction

88%

Jamróz B., Chmielewska J., Milewska M., Niemczyk K.

Polski Przegląd Otorynolaryngologiczny

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2016

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vol. 5(4)

22-28

EN

Introduction: Assessment of usefulness of instrumental method of evaluation of dysphagia in creating a therapeutic plan among patients after oropharyngeal cancer surgery with free flap reconstruction. Material and Method: Seven patients after oropharyngeal cancer surgery with free flap reconstruction hospitalized from January to September 2016 in the ENT Department of Warsaw Medical University were included in this study. All patients underwent few times after surgery: clinical swallowing examination, water swallowing screening test and fiberoptic endoscopic evaluation of swallowing and/or videofluoroscopy. Results: All patients were diagnosed with dysphagia and had unitentional weight loss (average 5,9% of initial weight during 3 months). In water swallowing test only three participant achieved negative score for 5 ml, and two for 10 ml, 20 ml and 90 ml of water. Fiberoptic endoscopic evaluation of swallowing was analyzed for swallowing patterns and laryngeal pathology. FEES showed following abnormalities: aspiration (saliva, liquid), penetration (puree, liquid), premature swallowing (liquid, puree) and multiswallowing (liquid, puree, solid food), retention (saliva, puree, liquid, solid food). Videofluroscopy showed on the first place problems with oral phase of swallowing: difficulty forming and propeling bolus, tongue pumping movements, oral cavity residue, premature spillage and delayed oral onset. During the pharyngeal phase we observed: residue in valleculae and piriform sinuses, reduced laryngeal elevation, penetration and aspiration, multiple swallows. Conclusion: Instrumental assessment of swallowing helps during diagnostic and therapeutic process of patients with dysphagia after oncological treatment. a.

13

Screening tests for dysphagia

88%

Jamróz B., Pabian M., Chmielewska J., Milewska M., Niemczyk K.

Polski Przegląd Otorynolaryngologiczny

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2017

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vol. 6(4)

10-13

EN

Many patients treated at hospital have difficulty with swallowing, which poses an interdisciplinary problem. We describe basic screening tests for dysphagia, which can be carried out by physicians, speech therapists, and nurses, and show how to use these tests.

14

Evaluation of dysphagia among patients with chronic cough

75%

Jamróz B., Pabian M., Walczak J., Milewska M., Grabczak E., Marta D., Niemczyk K.

Polski Przegląd Otorynolaryngologiczny

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2018

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vol. 7(2)

1-7

EN

Aim: The aim of the study was to determine the prevalence of dysphagia in patients with chronic cough. Material and methods: Thirty-four consecutive patients. All patients underwent physical examination, ENT assessment, functional phoniatric assessment at rest and speech, Water-Swallow Test (WST), and Fiberoptic Endoscopic Evaluation of Swallowing Disorders (FEES). Furthermore, Reflux Symptom Index (RSI) and Eating Assessment Tool 10 (EAT 10) questionnaires were performed. Results: Results of the RSI and EAT 10 questionnaires showed the risk of reflux and dysphagia in participating patients. WST positive results increase with water volume. Patients presented episodes of spillage, double swallows, penetration, aspiration and residue of food at the hypopharynx. Functional examination showed decrease of laryngeal elevation (33%) and hypertension of external laryngeal muscles. Conclusions: Results of the study showed prevalence of dysphagia in most patients with chronic chough. It seems that phoniatric assessment in those cases should be expanded and FEES examination should comprise an important part.

15

Fiberoendoscopic Evaluation of swallowing - FEES: procesure with an assesment questionare

75%

Jamróz B., Walczak J., Milewska M., Niemczyk K.

Polski Przegląd Otorynolaryngologiczny

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2018

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vol. 7(3)

1-8

EN

Endoscopic examination of swallowing FEES (fiberoptic endoscopic examination of swallowing) belongs to basic instrumental examinations used in diagnostics of oropharyngeal dysphagia. It consists of three parts: I. Evaluation of the anatomy and physiology of the throat and larynx; II. Assessment of drinking and eating liquids and foods with different consistencies; III. Evaluation of the effectiveness of therapeutic maneuvers. The work aims to present the test procedure and the form used to describe it.

16

Dystrofia mięśniowa oczno-gardzielowa – opis przypadku z pozytywnym wywiadem rodzinnym

63%

Kot M., Lewandowska M., Kruk-Jeromin J.

Aktualności Neurologiczne

|

2009

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vol. 9

|

issue 3

214-218

EN

Oculopharyngeal muscular dystrophy (OPMD) is an autosomal dominant muscle disorder. Occasional cases of autosomal recessive inheritance have been reported. The pathogenic mechanism of OPMD is unknown. The mutation of the gene encoding PABP1 protein has been detected in patient with OPMD. It consists in expansion of GCG triplet repeat sequence in this gene. Pathological alleles consist of expansions greater that 8 and up to 13 GCG repeats. Due to its prevalence of 1 to 2% in the Western world, the (GCG)7 allele per se is condidered a polymorphism. Clinically OPMD is characterized by slowly progressive blepharoptosis, dysphagia, limb weakness and dysarthria during the fifth or sixth decade of life. Cases of OPMD have been reported in 30 countries. In this report, we described 68-year-old patient with OPMD that has been verified by genetic testing. Dysphagia was occurred in the patient at the age of 28. The blepharoptosis, limb weakness and dysarthria occurred later than dysphagia. Additionally, patient’s mother, older patient’s sister and one brother of the patient’s mother similar symptoms are presented.

PL

Dystrofia oczno-gardzielowa (OPMD) jest autosomalnie dominującą chorobą mięśni. Opisano również nieliczne przypadki z typem dziedziczenia autosomalnym recesywnym. Mechanizm patogenetyczny choroby nie jest znany. U chorych z OPMD wykrywana jest mutacja w genie kodującym białko PABP1. Polega ona na wydłużeniu ciągu powtórzeń trinukleotydowych CAG w obrębie tego genu. Patologiczny allel zawiera od 8 do 13 powtórzeń tripletów GCG. W przypadku 7 powtórzeń stwierdza się istnienie zmienności polimorficznej w oparciu o wynoszącą 1-2% częstość występowania allelu [GCG]7 w krajach zachodnich. Klinicznie OPMD cechuje się wolno postępującym opadnięciem powiek górnych, dysfagią, osłabieniem kończyn i dyzartrią, które pojawiają się w 5. lub 6. dekadzie życia. Przypadki OPMD zostały opisane w 30 krajach. W pracy przedstawiono przypadek dystrofii oczno-gardzielowej u 68-letniej pacjentki, zweryfikowany badaniem genetycznym. W wieku 28 lat pojawiły się u chorej zaburzenia połykania. Opadnięcie powiek górnych, osłabienie kończyn i dyzartria wystąpiły później niż dysfagia. Ponadto matka oraz starsza siostra pacjentki, a także brat matki prezentowali podobne objawy.

17

Acute dyspnea as a manifestation of Forestier's disease. A case report

63%

Kuryłowicz J., Stodulski D., Garsta E., Mikaszewski B.

Polski Przegląd Otorynolaryngologiczny

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2021

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vol. 10(1)

49-52

EN

Introduction: Diffuse idiopathic skeletal hyperostosis (DISH), also known as Forestier’s disease, is a noninflammatory disease and is characterized by ossification of the anterolateral aspect of vertebral bodies, mostly in thoracic part of the spine. Although, usually, DISH is asymptomatic, in rare cases osteophytes located in the cervical part of the spine can cause otolaryngological manifestations, such as dysphagia (most common), hoarseness and stridor Case report: In differential diagnosis of upper respiratory tract symptoms, we should consider DISH. We present case of 82-years old male patient with acute dyspnea, who was diagnosed with osteophytes of C4–C7 vertebral bodies. In this case conservative therapy was not efficient, therefore successful surgical treatment was performed. BMI – Body Mass IndexCRP – C Reactive Protein CT – computed tomography DISH – diffuse idiopathic skeletal hyperostosis GERD – gastro-esophageal reflux disease MRI – magnetic resonance imaging NSAIDs – nonsteroidal anti-inflammatory drugs ORL PPI – proton pump inhibitors Diffuse idiopathic skeletal hypMRerostosis (DISH), also known as Forestier’s disease, was first described under the name “senile ankylosing hyperostisis of the spine” by Jacques Forestier in 1950 [1]. It is a noninflammatory disease, characterized by ossification of the anterolateral aspect of vertebral bodies, mostly in thoracic part of the spine. It may also involve enthesopathy of the extremities. Forestier’s disease is a rather common condition, which affects approximately 40% of older (>65 years old) male patients. Prevalence of DISH increases with age (56% for age >80 years old), BMI and blood pressure [2] and is associated with diabetes mellitus, elevated insulin-like growth factor and hyperuricemia [3].Although usually DISH is asymptomatic, in rare cases osteophytes located in the cervical part of the spine can cause otolaryngological manifestations, such as dysphagia (most common), hoarseness and stridor [4–10]. null null null null An 82-years old man was admitted to the Department of Otolaryngology due to acute dyspnea with stridor at rest. Respiratory disorder was progressing for 2 months. Moreover, patient complained of dysphagia and hoarseness, which were present for a year. The patient was diagnosed with GERD and treatment was administrated. Medical history was significant of duodenal ulcer with perforation and prostate cancer treated with hormonal therapy for 13 months. Flexible nasopharyngoscopy revealed large mass protruding from the posterior wall of hypopharynx and oedema, which concealed interarytenoid notch and partly rima glottis (Fig. 1.). No other abnormalities in ORL examination were present. Increased CRP level and impaired fasting glucose were found in laboratory tests during hospitalization. CT (Fig. 2.) and MRI (Fig. 3.) revealed massive osteophytes on the anterior part of vertebral bodies C4–C7 without intervertebral disc space narrowing, thickened vestibular folds and peri-arytenoid region. X-ray revealed no changes in sacro-iliac joints. Hypopharyngoscopy and microlaryngoscopy were performed in due to rule out neoplastic changes. Antibiotis, steroids and high doses of PPI (proton pump inhibitors) were administered, resulting in oedema decrease and resolution of the symptoms. After 7 months patient was hospitalized again, due to acute dyspnea and stridor. Increased CRP level was found in laboratory tests. Despite conservative therapy (corticosteroids, antibiotics and PPI) no significant respiratory improvement was achieved, therefore decision on surgical treatment was made. Patient was referred to the Department of Neurosurgery where, after elective tracheotomy, cervical osteophytes (C2–C5) were removed, using an anterolateral transcervical approach, without any complications (Fig. 4.). Because of postoperative laryngeal and hypopharyngeal oedema, steroid therapy was maintained. Decannulation was performed on 7th postoperative day, although patient complained of more severe dysphagia with aspiration while swallowing. Nasogastric feeding tube was inserted for 3 weeks. At the 6-month follow up dyspnea and dysphagia are absent, patient successfully swallows solid food and liquids. Endoscopic examination revealed only small protrusion and minor oedema on posterior wall of hypopharynx on the level of arytenoids (Fig. 5., 6.). null null Forestier’s disease otolaryngological manifestations are extremely rare. The most common symptom is dysphagia, aside from it aspiration [11], dyspnea (with or without stridor) and hoarseness [4].Our patient’s main complaint and reason of hospitalization was dyspnea, while dysphagia was secondary problem. Foregoing symptoms can occur not only due to osteophytes compression on larynx and esophagus, but also because of chronic inflammation and chronic or recurrent edema caused by mechanic irritation. Other symptoms, such as aspiration while swallowing, can be caused by impaired movability of epiglottis or vocal chords [8, 11].In presented case symptoms (especially dyspnoe) were increasing during upper respiratory tract infections and due to exacerbation of GERD.In literature authors described similar cases, where inflammation led to oedema, chronic or remitting during infection, which worsened patient’s condition [12, 13] and caused respiratory decompensation, necessitating even urgent tracheotomy [10].During diagnosis of DISH with otolaryngologic manifestations, mirror laryngoscopy and fiberoscopy should be performed. It can reveal fine, firm protrusion on the posterior wall of pharynx, accompanied by oedema and impaired movability of larynx [8].In differential diagnosis of protrusion on the posterior wall of pharynx we should consider retropharyngeal pathologies, such as malignant tumors (including lymphoma), benign tumors, metastases, congenital defects (e.g. vascular malformations), lymphadenopathy, retropharyngeal abscess or massive oedema. Imaging (CT, MRI) can rule out these diseases [14].Forestier’s disease should also be distinguished from other pathologies, which involve vertebral bodies, including ankylosing spondylitis, osteophytes in osteoarthritis or osteomas [3]. Differential diagnosis can be based on Resnick’s radiological classification criteria of DISH [15]: presence of flowing calcification and ossification along with the anterolateral aspects of at least four contiguous vertebral bodies, relative preservation of intervertebral disc height in the involved vertebral segments and absence of apophyseal joint bony ankylosis and sacro-iliac joint erosion, sclerosis or bony fusion.In cases with dysphagia being the main patient’s complaint, esophagogram with barium swallowing should be performed [5, 9, 11]. Elective panendoscopy with biopsy should always be considered to rule out neoplasm [5, 16].If DISH is diagnosed accidently in imaging, we can assume an expectant attitude. Conservative treatment with NSAIDs, steroids and dietary measures can be introduced in cases without weight loss and with minor respiratory symptoms. Gastroesophageal reflux can be symptom-worsening factor, therefore PPI treatment should be considered. If conservative treatment is not effective, osteophytes’ surgical removal is recommended, preferably using anterolateral approach [16].In our case, conservative therapy was not sufficient. Massive hypopharyngeal oedema and stridor were present in spite of high doses of corticosteroids. Due to the pre-operative oedema we decided to perform an elective tracheotomy before neurosurgical intervention, to avoid possible complications [13].It is remarkable, that after surgery dyspnea resolved after few days, whilst dysphagia and aspiration worsened in post-operative time and nasogastric tube insertion was necessary.Authors present this case in aim to draw attention to Forestier’s disease as possible reason for respiratory and gastrointestinal symptoms among elderly people.

18

Dysphagia among patients after total laryngectomy: diagnostic and therapeutic procedures

63%

Jamróz B., Chmielewska-Walczak J., Milewska M.

Polski Przegląd Otorynolaryngologiczny

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2020

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vol. 9(4)

23-28

EN

Dysphagia concerns 10–89% patients after total laryngectomy; to a greater extent it regards patients receiving complementary radiotherapy. The disease mechanism is associated with anatomical changes after surgery (typeof surgery) or complications of adjuvant therapy (xerostomia, neuropathy, swelling of tissue, etc.). The above changes lead to: decreased mobility of the lateral walls of the pharynx and tongue retraction, the occurrence of tounge pumping movements, decreased swallowing reflex, weakening of the upper esophageal sphincter opening, contraction of the cricopharyngeal muscle, tissue fibrosis, formation of pharyngeal pseudodiverticulum, etc. As a result: regurgitation of food through the nose and oral cavity, food sticking in middle and lower pharynx, prolongation of bolus transit time. Upon the formation of tracheoesophageal fistula, there may be aspiration of gastric contents. The above changes considerably reduce patients’ quality of life after surgery. The diagnostic protocol includes: medical interview (questionnaires such as EAT 10, SSQ, MDADI, DHI can be helpful), clinical swallowing assessment and instrumental examinations: primarily videofluoroscopy but also endoscopic evaluation of swallowing. Selected cases also require high frequency manometry. The treatment options include: surgical methods (e.g. balloon dilatation of the upper esophageal sphincter, cricopharyngeal myotomy, pharyngeal plexus neurectomy, removal of the pharyngeal pseudodiverticulum), pharmacological treatment or conservative methods (e.g. botulinum toxin injection of the upper esophageal sphincter, speech therapy, nutritional treatment) and supportive methods such as consultation with a psychologist, physiotherapist, clinical dietitian). The selection of a specific treatment method should be preceded by a diagnostic process in which the mechanism of functional disorders related to voice formation and swallowing will be established.

19

Przezskórna endoskopowa gastrostomia u dzieci – szansa na lepsze życie czy zło konieczne?

63%

Jabłoński J., Czajka P., Białas A. J., Lewandowska M.

Pediatria i Medycyna Rodzinna

|

2010

|

vol. 6

|

issue 3

204-210

EN

Introduction: Percutaneous endoscopic gastrostomy (PEG) is a surgical procedure for placing a gastrostomy tube into the stomach using a gastroscope in order to administer food directly to the stomach. The main group of paediatric patients qualified for PEG procedure are those with neurological conditions associated with dysphagia. Objectives: The aim of the study was to evaluate long-term results after PEG insertion and parents satisfaction from use of PEG. Material and methods: The study group consisted patients treated in University Maria Konopnicka Hospital in Lodz who had PEG performed, in the period from 2002 to 2007. Indications of PEG performed, time from insertion to feeding start, complications, frequency and cause replace tube by another were retrospectively reviewed. Nutritional status was assessed according to BMI values referred to Polish BMI standards charts. The main source of data on parents satisfaction were original questionnaires. Results: Medical records of 27 patients were analyzed. The main indications for PEF was diseases of central nervous system. Feeding was started during of 3 day after PEG insertion in 70.4% patients. Post-procedure complication were seen in 10 patients (37%) and all were minor problems. Blockage of the tube seen in 16 patients (59.3%). The gastrostomy tube was removed after PEG placement in 11 children (40.7%). Duration of feeding was shorter after PEG insertion. Improving the nutritional status was observed in 23 patients (85%). Majority of parents highly evaluated the use of PEG and would have recommended this method of feeding to the other parents with similar problems. Only one parent negatively evaluated training about use of PEG. Conclusions: The PEG procedure is a well tolerated, effective, highly evaluated by parents way to tube feeding with relatively low complications rate.

PL

Wprowadzenie: Przezskórna endoskopowa gastrostomia (PEG) to zabieg polegający na wytworzeniu przetoki żołądkowo-skórnej za pomocą gastroskopu w celu bezpośredniego podawania pokarmu do żołądka. Główną grupą pacjentów pediatrycznych kwalifikującą się do PEG są chorzy z chorobami neurologicznymi, u których wystąpiły zaburzenia połykania. Cel pracy: Celem pracy była analiza wyników odległych u dzieci po założeniu PEG oraz ocena satysfakcji rodziców z użytkowania PEG. Materiał i metody: Badaniem objęto pacjentów Uniwersyteckiego Szpitala Klinicznego nr 4 im. Marii Konopnickiej, u których w latach 2002-2007 założono przezskórną endoskopową gastrostomię. Analizie retrospektywnej poddano: przyczyny założenia PEG, powikłania, czas od założenia PEG do rozpoczęcia żywienia, częstość i przyczynę wymiany zestawu do gastrostomii. Stan odżywienia określono na podstawie siatek centylowych dla BMI. Podstawowym źródłem danych o satysfakcji rodziców była odpowiedź pisemna udzielona na pytania zawarte w oryginalnych kwestionariuszach. Wyniki: Analizie poddano historie chorób 27 pacjentów. Głównym wskazaniem do założenia PEG były choroby centralnego układu nerwowego. Rozpoczęcie żywienia u 70,4% pacjentów nastąpiło do 3. doby po założeniu PEG. U 10 pacjentów (37%) wystąpiły niegroźne powikłania. Zatykanie rurki obserwowano u 16 pacjentów (59,3%). Wymiany rurki dokonano u 11 dzieci (40,7%). Czas karmienia po założeniu PEG uległ skróceniu. Stwierdzono poprawę stanu odżywienia u 23 dzieci (85%). Wszyscy rodzice wysoko ocenili wyniki użytkowania PEG i poleciliby ten sposób żywienia dzieci innym rodzicom w podobnej sytuacji. Tylko jeden rodzic negatywnie ocenił szkolenie na temat użytkowania PEG. Wnioski: PEG jest metodą leczenia żywieniowego dobrze tolerowaną, efektywną, obciążoną niewielkimi powikłaniami oraz wysoko ocenianą przez rodziców chorych dzieci.

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Przezskórna endoskopowa gastrostomia u dzieci – szansa na lepsze życie czy zło konieczne?