Spasmodic Dysphonia

Spasmodic Dysphonia (SD)
Presentation by:Robin Bohot

Voice Disorders
Definition

* a central nervous system voice disorder caused by involuntary movements of one or more muscles of the larynx
* tight, strained or strangled voice quality

Causes of SD
* Damage to the Basal Ganglia
* Lack of any structural abnormality in the larynx
* Damage to the RLN?

Types of SD
* Adductor Spasmodic Dysphonia
* Mixed Spasmodic Dysphonia
* Variants-
http://www.youtube.com/watch?v=3m21wKQJwcU

Co-Occurring Disorders
* Blepharospasm (excessive eye blinking and involuntary forced eye closure)
* Tardive dyskinesia (involuntary and repetitious movement of muscles of the face, body, arms and legs)
* Oromandibular dystonia (involuntary movements of the jaw muscles, lips and tongue)
* Torticollis (involuntary movements of the neck muscles)
* Tremor (rhythmic, quivering muscle movements)

Treatments
Sources
* National Institute of Deafness and Other Communication Disorders
* http://www.dysphonia.org/
* http://www.asha.org/public/speech/disorders/SpasmodicDysphonia.htm

Spasmodic Dysphonia.ppt

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Management of Pediatric Neck masses

Evaluation and Management of Pediatric Neck masses
Presentation by:Steven T. Wright, M.D.
Ronald Deskin, M.D.

Pediatric Neck Masses
* Congenital masses
* Benign lesions
* Vascular and lymphatic malformations
* Infectious and inflammatory conditions
* Malignant lesions

Embryology and Anatomy
* Branchial System- 6 pairs of pharyngeal arches separated by endodermally lined pouches and ectodermally lined clefts.
* Each arch consists of a nerve, artery, and cartilaginous structures.
* The remaining neck musculature gains contributions from cervical somites.

Branchial system
* First Branchial arch
* Second Branchial Arch
* Third Branchial Arch

Branchial system
* Third Branchial Pouch
* Fourth and Sixth Branchial arches fuse to form the laryngeal cartilages.
* Fourth Arch
* Fourth Pouch- superior parathyroid glands and parafollicular thyroid cells
* Sixth Branchial Arch
* Epipericardial ridge
* Cervical Sinus of His

Thyroid Gland
First Branchial Cleft Cysts
* Type I
* Type II
Second Branchial Cleft Cysts
Fourth Branchial Cleft Cysts
Thyroglossal Duct Cyst
Cervical Thymic Cysts
Dermoid and Teratoid Cysts
Dermoid Cysts
Teratoid Cysts and Teratomas
Laryngoceles
Laryngoceles
Vascular Lesions
Lymphangiomas
Plunging Ranula
Sternomastoid Tumor of Infancy (Pseudotumor)
Infectious and Inflammatory Lesions
Bacterial Cervical Adenitis
Deep Space Neck Abscess
Tuberculous Mycobacteria
Nontuberculous Mycobacteria
Cat Scratch Disease
Viral Adenitis
Infectious Mononucleosis
Kawasaki Syndrome

Pediatric Neck masses.ppt

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Otitis Media

Otitis Media
Presentation by:Rick Newton, MD

Definition:inflammation of the middle ear

Why the Worry?
* Ear Pain
* Possible Complications
o Hearing Loss (esp. conductive)
+ Leading to speech, language, and cognitive abilities
o Ruptured TM
o Mastoiditis
o Meningitis
o Labyrinthitis
o Brain Abcess
o Lemierre’s Syndrome - anaerobic suppurative thrombophlebitis involving the internal jugular vein

Epidemiology
Risk Factors
Pathogenesis
* Typically follows URI or Allergy
* Congestion obstructs eustachian tube @ isthmus.
* Middle ear secretions accumulate
* Normal flora or new infections in upper respiratory tract to middle ear.

Bacteriology
3 bacteria remain most common isolates even in post-PCV7 & HIB vaccine era
Strep. pneumoniae
Haemophilus Influenzae
Moraxella catarrhalis


Symptoms/Signs
Otalgia
Otorrhea
Non-specific

o Fever
o Irritability
o HA
o Apathy
o Anorexia
o Vomiting
o diarrhea

Syndromes: Otitis-Conjunctivitis

* Symptom complex of otitis media and purulent conjunctivitis
* Classically nontypable H. influenzae (54% of all cases)
* inflammation of the TM in which bullae are present on the tympanic membrane
* occurs in ~ 5 percent of cases of AOM in children younger than 2 years
* Characterized by increased pain

Syndromes: Bullous Myringitis
Virology
* RSV
* Rhinoviruses
* Influenza

Other Microbes
* Mycoplasma pneumonniae
* Chlamydia trachomatis
* Tuberculous
* Ascaris lumbricoides
* Blastomyces dermatitidis
* Candida
* Aspergillus

Diagnosis

* Two diagnostic criteria for AOM
o Inflammation
o Fluid in middle ear
* Otoscopy
o TM erythematous, bulging, and immobile
* Techniques to Confirm Dx
o Pneumatic Otoscopy
o Culture

AAP Consensus Dx Criteria:
Nature of the Illness
Antibiotics & Otitis Media
The Controversy
Treatment Options
When to Consider Tympanostomy Tubes or Chemoprophylaxis
Tympanostomy Tubes
Complications of Tympanostomy Tubes
To Swim or Not to Swim
Management of Patients with Tympanostomy Tubes
* Otorrhea
* Tube Extrusion
* Cholesteatoma
* Persistent TM Perforation
* Tympanosclerosis

Otitis Media.ppt

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