Kulak Burun Boğaz Hastalıkları Kliniğinde Akut Dispne ile Yatan Hastaların Klinik Özellikleri, Tanı, Tedavi Yaklaşımları

Abstract

Objectives: In this study, we investigated the clinical features, examination and treatment approaches of patients with acute dyspnea who were hospitalized and treated at otorhinolaryngology department. Materials and Methods: The data of 66 (1.82%) patients with acute dyspnea were retrospectively studied between 2011 and 2017 at otorhinolaryngology department. Results: Vocal fold paralysis due to thyroid surgery is still the leading cause for majority of acute dyspnea patients presenting to otolaryngologydespite despite improved surgical techniques and neuromonitorisation. Infections and masses are other causes. Two patients (3.1%) were treated with medical treatment and observation and 64 patients (96.9%) were treated surgically. 11% of patients were treated with tracheotomy and direct laryngoscopy and/or bronchoscopy for diagnostic and therapeutic purposes. Seven patients (22.5%) were treated with tracheotomy, 24 patients (77.5%) were treated with posterior cordotomy and 1 patient (3.2%) was treated with posterior cordotomy and tracheotomy. Conclusions: It is important to follow the clinical situation in the diagnosis and treatment approach of the patients with acute dyspnea. These findings assess the options of treatment with least invasive methods of remission.

Keywords

• Acute Dyspnea
• Emergency
• Tracheotomy
• Upper Airway Obstruction
• Vocal Fold Paralysis

Kulak Burun Boğaz Hastalıkları Kliniğinde Akut Dispne ile Yatan Hastaların Klinik Özellikleri, Tanı, Tedavi Yaklaşımları

Abstract

Amaç: Kulak burun boğaz hastalıkları kliniğine, üst hava yolu problemine bağlı akut dispne ile yatırılarak tedavisi yapılan hastaların klinik özellikleri, tetkik ve tedavi yaklaşımlarımlarımızı araştırmayı amaçladık. Gereç ve Yöntem: Kulak burun boğaz hastalıkları kliniğinde, 2011-2017 yılları arasında akut dispne tanısı nedeniyle yatırılarak tetkik ve tedavi edilen 66 (%1,82) hastanın verileri retrospektif olarak incelendi. Bulgular: Akut dispne ile kulak burun boğaz hastalıkları kliniğinde takip edilen hastaların çoğunluğunu, gelişen cerrahi teknikler ve nöromonitorizasyona rağmen halen tiroid cerrahisine bağlı vokal fold paralizisi (VFP) oluşturmaktadır. Ardından enfeksiyöz ve kitlesel nedenler yer almaktadır. 2 hasta (%3,1) medikal tedavi ve gözlem ile takip edildi ve 64 hasta (%96,9) cerrahi yöntemle tedavi edildi. Hastaların %11 kadarına tanısal ve tedavi amaçlı direkt laringoskopi ve/veya bronkoskopi ile trakeotomi yapıldı. VFP ile takip edilen hastaların 7’si (%22,5) trakeotomi, 24’ü (%77,5) karbondioksit (CO2) lazer ile posterior kordotomi, 1’i (%3,2) posterior kordotomi + trakeotomi ile tedavi edildi. Sonuç: Akut dispne ile başvuran hastalara tanı ve tedavi yaklaşımında, hastanın klinik durum takibi önemlidir. Bu bulgular ışığında yapılan minimal invaziv yöntemlerle tedavi seçenekleri değerlendirilmelidir.

Keywords

• Acil
• Akut Dispne
• Trakeotomi
• Üst Hava Yolu Obstrüksiyonları
• Vokal Fold Paralizisi

References

1. 1. Manning HL, Schwartzstein RM. Pathophysiology of dyspnea. N Engl J Med. 1995;333:1547-1553.
2. 2. Parshall MB, Schwartzstein RM, Adams L, et al. Dyspnea. Mechanisms, assessment, and management: a consensus statement. American Thoracic Society. Am J Respir Crit Care Med. 1999;159:321-340.
3. 3. Lo CY, Kwok KF, Yuen PW. A prospective evaluation of recurrent laryngeal nerve paralysis during thyroidectomy. Arch Surg. 2000;135:204-207.
4. 4. Jatzko GR, Lisborg PH, Müller MG, Wette VM. Recurrent nerve palsy after thyroid operations--principal nerve identification and a literature review. Surgery. 1994;115:139-144.
5. 5. Godballe C, Madsen AR, Sørensen CH, et al. Risk factors for recurrent nerve palsy after thyroid surgery: a national study of patients treated at Danish departments of ENT Head and Neck Surgery. Eur Arch Otorhinolaryngol. 2014;271:2267-2276.
6. 6. Bergenfelz A, Salem AF, Jacobsson H, et al. Risk of recurrent laryngeal nerve palsy in patients undergoing thyroidectomy with and without intraoperative nerve monitoring. Br J Surg. 2016;103:1828-1838.
7. 7. Bergenfelz A, Jansson S, Kristoffersson A, et al. Complications to thyroid surgery: results as reported in a database from a multicenter audit comprising 3,660 patients. Langenbecks Arch Surg. 2008;393:667-673.
8. 8. Dursun G, Gökcan M. Aerodynamic, acoustic and functional results of posterior transverse laser cordotomy for bilateral abductor vocal fold paralysis. J Laryngol Otol. 2006;120:282-288.

9. 9. Lucking S, Maffei F, Tamburro R, et al. Upper Airway Obstruction. Pediatric Critical Care Study Guide. 2012;463-479.
10. 10. Çetin AÇ, Olgun Y, Özses A, et al. A New Trend in the Management of Pediatric Deep Neck Abscess: Achievement of the Medical Treatment Alone. Turk Arch Otorhinolaryngol. 2017;55:57-63.
11. 11. Stroud RH, Friedman NR. An update on inflammatory disorders of the pediatric airway: epiglottitis, croup, and tracheitis. Am J Otolaryngol. 2001;22:268-275.