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A 31-year-old woman presented with a nasal voice, dysarthria, and upper limb weakness during her first pregnancy. Soon after delivery of her first baby, her symptoms disappeared. At the age of 34 years, during her second pregnancy, her nasal voice re-appeared. After delivery of the second baby, her nasal voice worsened, and bilateral eyelid ptosis and easy fatigability were also evident. She was referred to our hospital. Because of her myasthenic symptoms and anti-muscle-specific tyrosine kinase (MuSK) antibody (Ab)-positive status, she was diagnosed as having myasthenia gravis (MG). Her symptoms were worse than those in her first pregnancy. She was treated with oral steroid and double filtration plasmapheresis. After initiation of treatment, her myasthenic symptoms improved completely. In addition, her baby developed transient neonatal MG (TNMG) on the fourth day after birth and then gradually recovered over 30 days. It should be noted that symptoms of patients with anti-MuSK Ab-positive MG (MuSK-MG) can deteriorate during pregnancy, and the babies delivered of patients with MuSK-MG have a high probability of developing TNMG.

Background: Cleft palate leads to oroantral communication and also malformations of the palate and agenese of teeth adjacent to the defect. Abnormal defect closure was done by replacing the hard, soft tissues and missing teeth using an intraoral maxillofacial prosthesis called obturator. Purpose: Assess the use of prosthetic rehabilitation using frame obturator combination with acrylic resin on patient’s palatum defect to restore esthetic, speech, swallowing, mastication functions. Case: 23 years old male patient with chief complaint palatum defect that cause nasal voice. Intraoral examination revealed a large palate defect in the right of palatum durum segment, also defect on left labial gingiva, and missing teeth in 13, 15, 16, 21, 22, 23, 24, 25, 26, 35, 36, 45, 46. Case Management: Obturator was made to cover defect of palate and replace missing teeth. Impression was taken with hydrocoloid irreversible and gauze that cover the defect to avoid alginate entering nasal cavity. Insertion of obturator showed cleft palate was covered well by frame combination with acrylic resin base. The retention, stabilization and occlusion were good, nasal voice was reduced, defect on left labial gingiva were covered by labial wing. Discussion: Patient was satisfed because nasal voice was reduced, estethic, mastication and swallowing function were restored, also. Patient can clean and use obturator easily. Conclusion: Frame obturator in patient’s palate defect can reduce nasal voice, restore esthetic, swallowing and mastication functions.

A 12-year-old girl presented with headache, nasal voice, and anosmia. Magnetic resonance imaging demonstrated a 11 × 9 × 8-cm tumor extending from the nasal cavity to the frontal lobes. Histological analysis was consistent with transitional meningioma WHO grade I. As far as we know, this is the first reported case of a giant olfactory groove meningioma invading the nasal cavity through the anterior cranial base. Complete surgical removal was accomplished with excellent result via a staged endoscopic and transcranial approach. A microvascularized vastus laterallis flap was used for reconstruction. Surgical options and technical details in the management of this lesion are reviewed.

A 6-year-old girl with acute pharyngitis presented with complaints of hypernasal speech and double vision. Examination revealed a bilateral abduction deficit associated with soft palate palsy causing rhinolalia aperta. Cerebrospinal fluid analysis showed albuminocytologic dissociation. Her sister also suffered from the same disorder, albeit milder, 1 month before. After treatment with intravenous immunoglobulin and steroids, the patient made a full recovery. After the case report, a brief discussion of Miller Fisher syndrome, Guillan–Barré syndrome, and their variants is made. This case highlights that bilateral sixth nerve palsy and rhinolalia aperta in the absence of ataxia should still raise suspicion for these autoimmune conditions that may rarely and atypically present in siblings.

OBJECTIVES This study aims to investigate the possible impact of hormonal changes on nasal resonance during pregnancy. PATIENTS AND METHODS Between January 2013 and June 2013, a total of 101 pregnant women (mean age 27.1±5.8 years; range 18 to 41 years) visiting obstetric clinics for routine antenatal checkups were included in the study. The control group was consisted of 99 patients (mean age 29.2±6.6 years; range 18 to 42 years) without any nasal complaints. Nasal symptoms were assessed using the Nasal Obstruction Symptom Evaluation (NOSE) Scale. Nasalance scores were calculated by nasometry. The results were compared between study and control groups. RESULTS The mean nasalance score in pregnant women (40.4±7.8) were statistically significantly lower than the control group (44.7±6.4) (p

Background Changes in nasalance caused by resonance change after endonasal surgeries have been reported in prior studies. In clinical practice, although patients often complain of a nasal voice just after surgery, their voices recover over time. The objective of this study was to evaluate the long-term nasalance changes before and after endonasal surgery. Methods Patients who underwent sinonasal surgery at Yeouido St. Mary's Hospital between March 2009 and July 2011 were included in this study. We classified the subjects into three groups according to the surgeries they underwent: group 1, the septoturbinoplasty group; group 2, the endoscopic sinus surgery group; and group 3, the septoturbinoplasty and endoscopic sinus surgery group. We checked acoustic profiles, Grade, Roughness, Breathiness, Asthenia, Strain (GRBAS) scores, and nasalance using a nasometer before and after the sinonasal surgery. Results When considering multidimensional voice program results, no observed parameters showed statistically meaningful changes before or after the operation in all three groups. GRBAS scales in all patients changed less than two scales postoperatively. Nasalance increased at 1 month after the operation in all groups. However, it returned to original levels with time: 3 months in group 2 and 6 months in groups 1 and 3. Conclusion Sinonasal surgery can change the acoustic characteristics of the vocal tract and produce a significant increase in nasality in the early phase. However, after proper healing of the nasal cavity, nasality was observed to become similar to the preoperative level. Therefore, patients, especially voice professionals, do not need to be wary of voice changes after sinonasal surgery.

We present a woman and her daughter with an apparently new short stature syndrome associated with facial and skeletal anomalies and hypernasality. Manifestations included hypertelorism with broad and high nasal bridge, epicanthal folds, narrow and high arched palate, mild mesomelic brachymelia, short broad hands, prominent finger pads, hyperextensibility of hand joints, small feet, nasal voice, and normal intelligence. The mother had short stubby thumbs and the daughter had posteriorly angulated ears and delayed bone age. The morphology of the nose and the hypernasality are reminiscent to those in the velo-cardio-facial syndrome. High resolution banding and fluorescent in situ hybridization studies showed no evidence of 22q11 deletions. Differentiation from Aarskog syndrome and Robinow syndrome is discussed.

Tek taraflı izole yumuşak damak felci nadir bir klinik durumdur. Tipik klinik özellikleri ani olarak başlaması, rinolali ve tek taraflı burun deliğinden nazal sıvı kaçağı olmasıdır. Bu hastalıkta viral bir etiyoloji düşünülmekte olup sıklıkla 2-3 yaşları arasında erkek çocuklar etkilenmekte ve kendiliğinden düzelmektedir. Biz akut disfaji, nazal konuşma ve buruna sıvı regürjitasyonu olan yedi yaşında bir erkek olguyu sunuyoruz. Olgunun magnetik rezonans ve viral serolojik testler gibi tamamlayıcı çalışmalarının tümü normaldi. Olguya herhangi bir tedavi verilmedi ve semptomları kendiliğinden iyileşti. Sonuç olarak, bizim olgumuz gibi akut disfaji, nazal konuşma ve buruna sıvı kaçağı olan olgularda yumuşak damak felci akılda tutulmalıdır., Unilateral isolated paralysis of the soft palate is a rare clinical entity. Typical clinical features are sudden onset, rhinolalia, and nasal escape of fluids from the ipsilateral nostril. This disorder suggests a viral etiology, affects mainly male children at the ages of 2 to 3 years, and resolves spontaneously. We describe the case of a 7-year-old boy who presented with acute dysphagia, nasal voice and liquid regurgitation to the nose. All the complementary studies, including magnetic resonance and viral serology tests, were normal. No treatment was administered, and his symptoms improved spontaneously. In conclusion, paralysis of the soft palate should be considered in patients with acute dysphagia, rhinolalia and liquid regurgitation to the nose

The near-ubiquity of falls in elderly people1 should not deter doctors from seeking the cause. The annual incidence of myasthenia gravis in the UK is estimated at 1-2 in 100 000, but may be five times as high in elderly people in whom the disorder is thought to be substantially underdiagnosed. The mean time taken to diagnose myasthenia gravis in people over 60 years of age, after they develop symptoms, was estimated in 1996 as 4.5 months--almost twice the time taken to diagnose the disorder in younger people. Language: en

We present an unusual cause of rhinolalia clausa secondary to an oropharyngeal mass. A 69-year-old male presented to the otorhinolaryngology clinic with a one year history of a ‘plummy’ voice. He had a longstanding history of severe ankylosing spondylitis. Examination revealed an obvious hyponasal voice and a smooth hard mass in the midline of the posterior nasopharyngeal and oropharyngeal walls. Subsequent computed tomography scans and lateral plain neck X-ray showed a fracture dislocation of the odontoid peg, secondary to ankylosing spondylitis, which had eroded through the body of the C1 vertebra to lie anteriorly, resulting in the aforementioned impression into the pharyngeal mucosa. The radiological images, the role of the nasal airways in phonation and the causes of hyponasal speech are discussed.

A conservative surgical technique is proposed as an alternative to the classical uvulopalatopharyngoplasty (UPPP) for the treatment of obstructive sleep apnea and snoring. The resection is strictly intrapalatine, and careful suturing in three planes seems to lead to complete disappearance of the often unbearable postoperative pain. The soft palate is shortened but nonetheless still resembles a normal soft palate. Uvulopalatopharyngoplasty (UPPP) was described by Ikematsu in 1952. This method has taken on a new lease of life in recent years. Its efficacy is generally accepted, and its use, especially in cases of obstructive sleep apnea syndrome, is the only treatment of the palatal velum at present practiced. In addition to aesthetic problems, this method generally gives rise to complications in the shape of temporary--but sometimes considerable--pain, nasal regurgitation, and a nasal voice. In a small percentage of patients, some of these disorders may prove irreversible. In my series of eight patients, five were obese and presented with hypertension. Three of them also were suffering from obstructive sleep apnea syndrome. The three others were ordinary snorers who caused considerable inconvenience to sleeping partners.

An Italian male aged 50 years with oculopharyngeal muscular dystrophy is reported. Eleven of his relatives, over a period of three generations, had ptosis, dysphagia, nasal voice and difficulty in walking. The distribution of muscle weakness in the propositus and in one of his sisters was proximal in the upper, but distal in the lower limbs, confirming the existence of a relationship between oculopharyngeal dystrophy and distal myopathy. The first muscle biopsy appeared normal except for some round-cell collections, whereas the second one, 5 years later, showed marked dystrophic changes. Some patients with oculopharyngeal dystrophy may apparently pass through a secondary muscular inflammatory stage.

In 1976, we reported a peculiar facial appearance [1] specifically related to conotruncal anomalies of the heart that was thus named “conotruncal anomaly face” (CTAF) and was characterized by lateral displacement of inner canthi, narrow palpebral fissures, flat nasal bridge, bloated eyelids, small mouth, hypoplastic mandibula, deformed earlobe, and nasal voice with velopharyngeal insufficiency [1–3].

The following brief clinical studies of multiple neuritis embrace only those cases in which were found motor and sensory paralysis of symmetric development, but do not include that form of neuritis which affects only the muscles of the palate or of the nose, as shown by regurgitations of fluids, with nasal voice or those cases affecting only the ocular muscles. Diphtheria is undoubtedly by far the greatest cause of multiple neuritis. Comparatively few cases are caused by the other infectious diseases. Smallpox is not infrequently a cause of the disease, but I have seen no mention made of chicken-pox giving rise to the disease. I, unfortunately, have one case to report of the production of the disease by arsenic given during the course of treatment of chorea. I have twelve cases to report, the causes of which were: arsenic administered for chorea, 1 child; diphtheria, 9 cases; varicella, 1 case