Idiopathic Subglottic Laryngeal Stenosis

Idiopathic s ubglottic stenosis (ISS) is a rare, slowly progressive inflammatory disease of unknown aetiology involving mainly the region of cricoid cartilage and the first tracheal ring. The pathogenesis of the disease remains hypothetical. ISS has recently been associated with various possible causes, such as gastro-oesopha-geal reflux, autoimmune diseases and previous infections of the respiratory tract [30, 174, 369]. Maronian and co-workers suggested that the term ISS should even be replaced by reflux-induced subglottic stenosis, if there is no other clear cause of the disease [229]. ISS has a strong female predilection [73, 132, 369]. The age of females when the symptoms start to appear ranges from 15 to 75 years (average 43.5 years) [73].

The diagnosis of disease is a matter of exclusion, and all other possible causes of a subglottic stenosis must first be ruled out. Aetiologically, subglottic stenoses are most commonly linked to endolaryngeal trauma, especially after prolonged intubation. Other diseases, including infections, laryngotracheal localisation of systemic diseases such as Wegener's granulomatosis and other collagen vascular diseases, amyloidosis and sar-coidosis, are rarely associated with laryngeal stenosis. Various benign and malignant tumours may also resemble ISS [132, 281]. ISS usually presents as dyspnoea, a cough and dysphonia [30, 73, 369].

Histological examination characteristically shows a spreading of dense fibrous tissue, extending up to the surface of the epithelium. Fibrosis is usually poorly cellular, with prominent augmentation of thick col-

lagenous fibres. Some inconspicuous chronic inflammatory infiltrate may be present around blood vessels, without evidence of vasculitis. The covering epithelium, squamous or respiratory, may be reactively hyperplastic. ISS is a chronic lifetime disease that requires multiple surgical dilatations for palliation [73]. Evaluation for laryngopharyngeal reflux disease should be performed with pharyngeal pH testing in all patients, in an attempt to clarify the aetiology of ISS [229]. More severe cases are managed with laryngotracheal resection and reconstruction [369].

Angioneurotic oedema (ANO) is a rapidly appearing, recurrent, non-pitting oedema of the subcutaneous and/or submucosal tissues causing a life-threatening condition, affecting the larynx, hypo-and oropharynx and oral cavity [144]. ANO can occur as a result of hereditary and acquired deficiencies in the immune and non-immune responses [81]. Several forms of ANO are recognised:

1. IgE-dependent, caused by pollens, foods, drugs, fungi, cold, sun and exercise;

2. Complement-mediated, hereditary and acquired with deficiency of the C1 esterase inhibitor of the complement cascade;

3. Non-immunologic, direct mast cell-releasing agents caused by different drugs and aspirin, and other non-steroidal anti-inflammatory drugs that alter the ara-chidonic acid metabolism;

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Cure Tennis Elbow Without Surgery

Cure Tennis Elbow Without Surgery

Everything you wanted to know about. How To Cure Tennis Elbow. Are you an athlete who suffers from tennis elbow? Contrary to popular opinion, most people who suffer from tennis elbow do not even play tennis. They get this condition, which is a torn tendon in the elbow, from the strain of using the same motions with the arm, repeatedly. If you have tennis elbow, you understand how the pain can disrupt your day.

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