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Laryngeal tuberculosis with hoarseness: case report
Mohammad Ali Damghani , Mandana Saberi, Soheil Motamed,
Volume 78, Issue 9 (12-2020)
Abstract
Background: Laryngeal tuberculosis (TB) is one of the most common complications of pulmonary tuberculosis, which increased for various reasons such as more prevalence of immune system suppression diseases, increasing the survival of the elderly, immigrants from high-risk areas and the appearance of atypical or resistant organisms over the past two decades, and its clinical pattern changed compared to the past. In contrast to the past that patients complained about dyspnea, coughing and other symptoms, today, the main complaints of these patients are hoarseness and Odynophagia. In reality, the prevalence of laryngeal TB without pulmonary manifestation was increased these days. The purpose of this study was to evaluate these symptoms in laryngeal TB.
Case Presentation: In this case report study, we examined a 77-year-old man who was admitted to the otorhinolaryngology department of Shafa hospital of Kerman (an academic hospital of Kerman University of Medical Sciences), Iran in April 2019 due to hoarseness since 6 months before admission and the results of evaluation confirmed the presence of laryngeal tuberculosis in this patient. The patient treated with Anti-TB drugs (Isoniazid, Rifampicin, Pyrizinamide, and Ethambutol) according to standard protocol and responded appropriately to this medication regimen.
Conclusion: Although laryngeal tuberculosis is a rare disease, it still occurs. Therefore, by increasing the incidence of tuberculosis, changes in the clinical pattern and its spreading mechanism, physicians should always be aware of the unusual clinical features of laryngeal tuberculosis and the possibility of developing it for early diagnosis and treatment. It should be considered as a differential diagnosis in all laryngeal diseases to prevent the complications of the disease and decrease the risk of transferring it to other people.

Comparison of the complications and results of intubation with a cuffed tracheal tube filled with alkaline lidocaine gel and filled with air in patients admitted to Baqiyatallah Al-Azam Hospital
Pourya Mashategan, Mohammad Reza Ghane , Ali Bahramifar, Mahdi Raei ,
Volume 82, Issue 6 (9-2024)
Abstract
Background: Intubation is normally conducted in an emergency or prior to surgery. A cuffed tracheal tube is fitted, whose inflated cuff exerts pressure on the tracheal wall. Such pressure should, therefore, be monitored every day by use of pressure gauge devices. The general guideline in this regard is that the pressure of the cuff must lie between 20 and 30 cm of water. The exaggerated pressure may cause tissue ischemia, wound, and necrosis of the tracheal wall; if it is too low, this could result in air leakage and oropharyngeal secretions, increasing the risk of insufficient ventilation and aspiration pneumonia. This study aimed at comparing the cuff pressure of an endotracheal tube inflated with alkaline lidocaine versus air for any post-extubation complications and cuff pressure changes.
Methods: This prospective cohort study was conducted on patients who were admitted to the intensive care unit of Baqiyatullah Al-Azam Hospital in Tehran between May 2023 and February 2024, underwent intubation in this unit and met the inclusion criteria for the study. This prospective study included 62 patients, and tracheal tube cuff pressure was recorded at 30 minutes, 60 minutes, 120 minutes, 6 hours, and 24 hours after intubation with a pressure gauge. Patients were randomly divided into two groups-an 'air group', whose cuff was inflated to the pressure of 20 cmH2O by air, and a 'lidocaine group,' whose cuff was filled with 2% lidocaine to the same pressure. In this study, the post-extubation complications, such as sore throat, hoarseness, and cough, were assessed immediately and 24 hours after extubation. Similarly, the tracheal tube displacement during the intubation process was monitored in both groups.
Results: The results showed that the pressure of an endotracheal tube cuff inflated with lidocaine was drastically lower than the one inflated with air, with a p-value of 0.001. On the other hand, the sore throat, cough, and hoarseness after extubation and 24 hours later were significantly fewer in the lidocaine group compared with the air group at a p-value of 0.001.
Conclusion: Cuffs inflated with alkalinized lidocaine clearly avoided high cuff pressure at induction and reduced postextubation sore throat. Hence, alkalinized lidocine-filled endotracheal tube cuffs are comparatively safer and more beneficial than conventional air-filled cuffs.

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