Scand J Rheumatol 20: 215, 1991
SUMMARY OF THESIS
Rheumatoid Arthritis in the Larynx AKE GETERUD
Scand J Rheumatol Downloaded from informahealthcare.com by University of Otago on 01/04/15 For personal use only.
L)e~ii,crrtrnetitsof OrorhiriolurytiKology, Clinical Physiology and Rheumatology, University of G8rrborg. Suhlgrenska sjukhuser, S-413 45 Goteborg, Sweden
Rheumatoid arthritis (RA) is a chronic inflammaroty disease of unknown etiology that predominantly affects joints. Beside joint involvement, systemic manifestations of the disease are known. Thc small cricoarytenoid joints in the larynx may be involved in the arthritic process. In order to assess the prevalence of laryngeal involvement in patients with RA and the occurrence of extrathoracic airway obstruction, 29 female patients with definite or classical RA and 30 controls were studied. Physical examination including direct fiberoptic laryngoscopy, respiratory function tests and low voltage radiography were used. The physical examination revealed laryngeal involvement in 17 RA patients (59%), extrahoracic airway obstruction was indicated by spirometry in 4 patients (14%) and radiography revealed obvious pathological findings in 3 patients (10%). In the control group n o subject had any finding indicating laryngeal involvement. The same group of RA patients were also studied regarding symptoms and sign of oral and swallowing disorders by means of a questionnaire, physical examination, stimulated saliva secretion and esophageal manometry. Subjective symptoms related to swallowing and dry mouth were reported four times more often by the RA patients than the controls. Xerostoniia was associated with decreased stimulated saliva secretion. The amplitude of the peristaltic pressure complex in the proximal part of the esophagus was significantly decreased in the RA group. In order to find a noninvasive method of assessing a laryngeal obstruction, the narrowest area of a short constriction of a plastic tube was calculated by means of computed tomography. The obtained area was compared with the airflow resistance, assessed by flowpressure measurements. The same methods were applied to 12 patients with laryngeal obstructions of varying origin. High correlations (model, r = 1.0; patients, r = 0.85) were found in both cases. Long-term results of a simple laterofixation procedure introduced in the late 1970s in Gsteborg were evaluated in 11 consecutive patients with bilateral vocal cord paralysis. The improvement of breathing obtained with the operation in most cases was shown to be longlasting. At the follow-up assessment, 9 patients were improved and 2 deteritorated compared to the preoperative situation. The voice quality did not change during the years after operation and most of the voices were judged socially acceptable by listening panels. N o aspiration problems were evoked by the operation. A modified laterofixation procedure, applied to RA patients with laryngeal ankylosis, was presented and documented. The procedure included mobilization of the arytenoid cartilages followed by laterofixation of one vocal cord. Five out of 6 operated patients were improved. Four of 5 patients with tracheostomas preoperatively were decannulated within 14 days postoperatively. The 5 patients without cannulas had acceptable voices postoperatively. N o patient developed aspiration problems.
SUMMARY OF THESIS
Rheumatoid Arthritis in the Larynx AKE GETERUD
Scand J Rheumatol Downloaded from informahealthcare.com by University of Otago on 01/04/15 For personal use only.
L)e~ii,crrtrnetitsof OrorhiriolurytiKology, Clinical Physiology and Rheumatology, University of G8rrborg. Suhlgrenska sjukhuser, S-413 45 Goteborg, Sweden
Rheumatoid arthritis (RA) is a chronic inflammaroty disease of unknown etiology that predominantly affects joints. Beside joint involvement, systemic manifestations of the disease are known. Thc small cricoarytenoid joints in the larynx may be involved in the arthritic process. In order to assess the prevalence of laryngeal involvement in patients with RA and the occurrence of extrathoracic airway obstruction, 29 female patients with definite or classical RA and 30 controls were studied. Physical examination including direct fiberoptic laryngoscopy, respiratory function tests and low voltage radiography were used. The physical examination revealed laryngeal involvement in 17 RA patients (59%), extrahoracic airway obstruction was indicated by spirometry in 4 patients (14%) and radiography revealed obvious pathological findings in 3 patients (10%). In the control group n o subject had any finding indicating laryngeal involvement. The same group of RA patients were also studied regarding symptoms and sign of oral and swallowing disorders by means of a questionnaire, physical examination, stimulated saliva secretion and esophageal manometry. Subjective symptoms related to swallowing and dry mouth were reported four times more often by the RA patients than the controls. Xerostoniia was associated with decreased stimulated saliva secretion. The amplitude of the peristaltic pressure complex in the proximal part of the esophagus was significantly decreased in the RA group. In order to find a noninvasive method of assessing a laryngeal obstruction, the narrowest area of a short constriction of a plastic tube was calculated by means of computed tomography. The obtained area was compared with the airflow resistance, assessed by flowpressure measurements. The same methods were applied to 12 patients with laryngeal obstructions of varying origin. High correlations (model, r = 1.0; patients, r = 0.85) were found in both cases. Long-term results of a simple laterofixation procedure introduced in the late 1970s in Gsteborg were evaluated in 11 consecutive patients with bilateral vocal cord paralysis. The improvement of breathing obtained with the operation in most cases was shown to be longlasting. At the follow-up assessment, 9 patients were improved and 2 deteritorated compared to the preoperative situation. The voice quality did not change during the years after operation and most of the voices were judged socially acceptable by listening panels. N o aspiration problems were evoked by the operation. A modified laterofixation procedure, applied to RA patients with laryngeal ankylosis, was presented and documented. The procedure included mobilization of the arytenoid cartilages followed by laterofixation of one vocal cord. Five out of 6 operated patients were improved. Four of 5 patients with tracheostomas preoperatively were decannulated within 14 days postoperatively. The 5 patients without cannulas had acceptable voices postoperatively. N o patient developed aspiration problems.
