The Laryngoscope
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Acute upper airway obstruction is a potentially life-threatening event. Hemophilia-A is a coagulopathy with high risk for spontaneous bleeding. Here we describe for the first time a spontaneous epiglottic internal hemorrhage leading to upper airway narrowing in a hemophilia-A patient. ⋯ In the first 48 hours there was rapid respiratory improvement. The epiglottic swelling resolved on the 5th day. In this patient no oral intubation or surgical management was needed.
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Comparative Study
Evaluation of the effectiveness of airway fluoroscopy in diagnosing patients with laryngomalacia.
To re-evaluate the usefulness of airway fluoroscopy (AF) in diagnosing laryngomalacia and to determine the effectiveness of AF in diagnosing laryngomalacia depending on the specific lesion. ⋯ AF is a commonly used modality in the diagnostic workup of a patient with stridor. The effectiveness of AF is limited when compared to endoscopy when used for the evaluation of laryngomalacia.
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The pathogenetic mechanisms underlying Bell's palsy remain obscure, despite the extensive relevant research. Magnetic resonance imaging (MRI) studies have strongly indicated that facial nerve edema cannot be regarded as the sole etiologic factor, because it might persist long after full clinical recovery, or might be demonstrated in the clinically unaffected side or healthy controls. The aim of this study was to investigate the hypothesis that a narrow facial canal might be implicated in the pathophysiology of Bell's palsy. ⋯ Bell's palsy seems to usually coincide with the narrower fallopian tube of the patient. This anatomical detail, supported by previous MRI studies, seems to indicate that an asymmetry between the right and left fallopian tube might be a necessary pathogenetic mechanism for the development of a facial nerve edema into Bell's palsy in the narrower fallopian canal. More studies on large healthy populations are needed before a notable facial canal asymmetry is linked to a higher risk for developing Bell's palsy.
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Botulinum toxin (Botox) injections into the thyroarytenoid muscles are the current standard of care for adductor spasmodic dysphonia (ADSD). Reported adverse effects include a period of breathiness, throat pain, and difficulty with swallowing liquids. Here we report multiple cases of bilateral abductor paralysis following Botox injections for ADSD, a complication previously unreported. ⋯ Bilateral abductor paralysis is a rare complication of Botox injections for ADSD, causing difficulty with breathing upon exertion. The likely mechanism of paralysis is diffusion of Botox around the muscular process of the arytenoid to the posterior cricoarytenoid muscles. The paralysis is temporary, and watchful waiting with restriction of activity is the recommended management.
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To identify the barriers faced by otolaryngology program directors as they implement competency-based education and assessment and to identify preferred approaches to meet these challenges as suggested by program directors. ⋯ Program directors in otolaryngology do not have sufficient financial support, protected time, and personnel to fulfill their administrative and educational responsibilities. They should be provided with additional institutional assistance to help them achieve the goals of the Accreditation Council for Graduate Medical Education outcome project.