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Cruz J, Vargas D, Goecke A, Molina ML. An unusual extranodal natural killer/T-cell lymphoma presenting as chronic laryngitis: A case report. Medicine (Baltimore) 2021; 100:e26314. [PMID: 34160395 PMCID: PMC8238288 DOI: 10.1097/md.0000000000026314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 05/25/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Nasal-type, extranodal natural killer (NK)/T-cell lymphoma is a rare lymphoma. The tumor usually shows ulcerative and necrotic lesions in the nasal cavities and sinuses. Tissue involvement outside the nasal cavity is uncommon. PATIENT CONCERN We describe a 30-year-old man with a 2-month history of hoarseness, weight loss, and dyspnea. DIAGNOSIS Magnetic resonance image (MRI) showed edema of the larynx with obliteration of the airway. Laryngoscopic examination described necrotic tissue in the glottis and larynx. The biopsy showed chronic, necrotizing laryngitis, with no granulomas, vasculitis, or atypical cells. The immunologic and microbiologic study was negative. Later, after immunosuppressive therapy, the patient presented erythema and diffuse enlargement of the right arm. MRI showed myositis of the biceps and brachial muscles. Infection was rule out, and direct microscopy showed an extensive muscle infiltration by mononuclear cells and abundant mitosis. Immunohistochemistry was positive for CD3, CD8, Ki 67 (90%), and CD56 compatible with extranodal NK/T cell lymphoma. INTERVENTIONS The patient initially received immunosuppression treatments (corticoids, cyclofosfamide, and Rituximab) with relapsing episodes. When lymphoma was diagnosed, chemotherapy was started. OUTCOMES The patient died during chemotherapy. LESSONS Nasal-type, extranodal NK/T-cell lymphoma should be suspected even when there are no classical findings of neoplasms on histology. Immunohistochemistry is mandatory to rule it out.
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Abstract
OBJECTIVES The aim of this study was to investigate the association between chronic laryngitis (CL) and insulin resistance (IR) in South Korea using data from the 2010 Korea National Health and Nutrition Examination Surveys (KNHANES). DESIGN, SETTING AND PARTICIPANTS Cross-sectional data of 4,261 adults who completed KNHANES were analyzed. CL was considered when participants experienced a voice change and demonstrated flexible laryngoscopic findings of diffuse laryngeal inflammation. All participants were assessed for IR using the homeostasis model assessment of insulin resistance (HOMA-IR). RESULTS Among the Korean population older than 19 years, the prevalence of chronic laryngitis was 3.8±0.7%. Univariate analysis demonstrated that CL was significantly associated with smoking and systolic and diastolic blood pressure in men and with age, diastolic blood pressure, HDL cholesterol, insulin, and HOMA-IR in women. Multiple regression analysis demonstrated that the mean value of HOMA-IR was significantly associated with CL in women only. In addition, CL was more prevalent in the highest compared with the lowest HOMA-IR quartile (OR [95% CI]: 2.268 [1.053-4.884] after adjusting for age, OR [95% CI]: 2.235 [1.040-6.181] after adjusting for confounding factors of age, body mass index, smoking status, alcohol intake, regular exercise, education, and income). CONCLUSIONS These findings indicate that IR characterized by HOMA-IR is significantly associated with CL in Korean women only. Our results suggest that HOMA-IR could be an early predictive factor of increased risk of CL in Korean women.
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Affiliation(s)
- J-H Cho
- Young-Hoon Joo, MD, Department of Otolaryngology, Head and Neck Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 2 Sosa-dong, Wonmi-gu, Bucheon, Kyounggi-do 420-717, Republic of Korea, Tel: +82 32 340 7090, Fax: +82 32 340 2674, E-mail:
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Affiliation(s)
- W J Issing
- Department of Otolaryngology, Freeman Hospital, Newcastle upon Tyne NE7 7DN, UK
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Abstract
BACKGROUND This research aims to assess the response to acid suppression therapy in gastroesophageal reflux disease (GERD)-related chronic laryngitis (CL). METHODS Data were extracted from Web of Knowledge, Embase, and PubMed for English language article published up to March 2016. Pooled overall response rate (ORR) rates were evaluated to determine acid suppression treatment efficacy. Random effects model was used with standard approaches to sensitivity analysis, quality assessment, heterogeneity, and exploration of publication bias. RESULTS Pooled data from 21 reports (N = 2864, antireflux medicine: 2741; antireflux surgery: 123, study duration 4-108 week) were analyzed. With the random-effect model, the ORR was 66% (95% confidence interval [CI] 54%-78%). The ORRs were 80% for antireflux surgery (95% CI 67%-93%, 3 studies, 123 patients), whereas 64% for antireflux medicine (95% CI 50%-77%, 18 studies, 2741 patients), and the ORR was 70% (95% CI 55%-85%, 15 reports, 2731 patients) for >8 weeks' therapy duration, whereas 57% (95% CI 48%-65%, 6 reports, 133 patients) for ≤8 weeks' duration of therapy. CONCLUSIONS Acid suppression seems to be an effective therapy for GERD-related CL. There was an increase in effect among patients with surgery therapeutic method and longer therapy duration.
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Affiliation(s)
- Yue Yang
- Department of Otolaryngology, Eye Ear Nose & Throat Hospital, Fudan University, 83 Fenyang Road
- Shanghai Key Clinical Disciplines of otorhinolaryngology, Shanghai, China
| | - Haitao Wu
- Department of Otolaryngology, Eye Ear Nose & Throat Hospital, Fudan University, 83 Fenyang Road
- Shanghai Key Clinical Disciplines of otorhinolaryngology, Shanghai, China
| | - Jian Zhou
- Department of Otolaryngology, Eye Ear Nose & Throat Hospital, Fudan University, 83 Fenyang Road
- Shanghai Key Clinical Disciplines of otorhinolaryngology, Shanghai, China
- Correspondence: Jian Zhou, Department of Otolaryngology, Eye Ear Nose & Throat Hospital, Fudan University, 83 Fenyang Road, Shanghai 200031, China (e-mail: )
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Tanabe T, Oridate N. [Chronic pharyngitis and laryngitis caused by gastroesophageal reflux]. Nihon Rinsho 2016; 74:1367-1371. [PMID: 30562444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
A certain percentage of patients with gastroesophageal reflux disease (GERD) have laryn- gopharyngeal symptoms such as hoarseness, cough, and lump sensation in the throat. An updated meta-analysis showed that proton pump inhibitors (PPIs) reduced laryngopharyngeal symptoms significantly compared with placebo in patients suspected to have these symptoms caused by gastroesophageal reflux(GER). Although PPIs are often used to confirm the diagnosis of GERD (so-called "PPI test"), it is still not clear whether the -test can be applied to patients with laryngopharyngeal symptoms. We therefore have to conclude that no solid diagnostic tool is available to determine whether GER is an actual cause of chronic pharyngitis and laryngitis.
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Ling ZQ, Mukaisho KI, Hidaka M, Chen KH, Yamamoto G, Hattori T. Duodenal Contents Reflux-Induced Laryngitis in Rats: Possible Mechanism of Enhancement of the Causative Factors in Laryngeal Carcinogenesis. Ann Otol Rhinol Laryngol 2016; 116:471-8. [PMID: 17672251 DOI: 10.1177/000348940711600613] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Objectives: The main factors considered responsible for the onset of laryngeal cancer are tobacco smoking and alcohol abuse. Recently, gastroesophageal reflux has also been implicated as a causative factor in several laryngeal disorders, including laryngeal cancer. However, the significance of gastroesophageal reflux in laryngeal cancer is controversial. Methods: We investigated the histologic features of the esophagus and larynx in a rat model of reflux of the duodenal contents. Cell proliferation was also evaluated in laryngeal samples by detection of Ki67 antigen. Results: In this reflux model, laryngitis with infiltration of inflammatory cells and proliferation of small mucous glands was evident from 10 weeks after operation, and basal cell hyperplasia around the epiglottis and hyperplastic changes in the larynx were detected at 30 weeks. No dysplastic or malignant lesions were detected in the laryngeal samples within the duration of the experiment, in spite of detection of malignancy in 31.3% of lesions in esophageal samples at 30 weeks. The Ki67 index at each week was significantly higher than that of the control animals. Conclusions: Previous studies have shown smoking and alcohol abuse to have refluxogenic effects. Reflux of duodenal contents causes laryngitis. Reflux does not appear to be an independent risk factor for laryngeal carcinogenesis, but it may enhance the acknowledged etiologic risk factors, namely, smoking and alcohol abuse, by promoting cell proliferation.
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Affiliation(s)
- Zhi-Qiang Ling
- Department of Pathology, Shiga University of Medical Science, Seta-tsukinowa-cho, Ohtsu, Shiga 520-2192, Japan
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Abstract
Most agree that bile reflux occurs with regularity in an otherwise healthy population and that biliary and acid reflux may play a synergistic role in damaging esophageal mucosa. But to what extent is laryngeal mucosa at risk? We constructed a saline-controlled rat model (n = 40) in which active component solutions of bile — taurocholic acid and chenodeoxycholic acid — were applied to intact laryngeal mucosa at various pH levels. Histologic sampling of the laryngeal mucosa allowed inflammation scores to be generated by a pathologist blinded to the solutions used. Both taurocholic acid at acid pH and chenodeoxycholic acid at basic pH preferentially induced statistically greater inflammation scores than did the saline control, approaching or exceeding inflammation scores attributed to hydrochloric acid at pH 1.2. These observations may clarify reasons for failure to uniformly control laryngeal injury by adequate suppression of gastric acid alone and may further justify alternative methods of laryngeal protection in patients refractory to adequate acid control.
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Affiliation(s)
- Clarence T Sasaki
- Section of Otolaryngology, Department of Pathology, Yale School of Medicine, New Haven, Connecticut 06520-8041, USA
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Payne RJ, Kost KM, Frenkiel S, Zeitouni AG, Sejean G, Sweet RC, Naor N, Hernandez L, Kimoff RJ. Laryngeal Inflammation Assessed using the Reflux Finding Score in Obstructive Sleep Apnea. Otolaryngol Head Neck Surg 2016; 134:836-42. [PMID: 16647544 DOI: 10.1016/j.otohns.2006.01.012] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2004] [Accepted: 01/19/2006] [Indexed: 11/22/2022]
Abstract
OBJECTIVES: To evaluate the relationships between laryngeal inflammation assessed using the Reflux Finding Score (RFS), laryngeal sensory function, and apnea severity in patients with obstructive sleep apnea (OSA). METHODS: Endoscopic sensory testing (EST) was performed with subsequent blinded scoring from video of RFS. An RFS > 7 was indicative of increased inflammatory change. RESULTS: Of 34 patients evaluated, 29 had OSA (apneahypopnea index [AHI] ≥ 15 events/h) at polysomnography. Increased inflammation was present in 26/29 (90%), with changes suggestive of laryngopharyngeal reflux. There were significant correlations between: inflammation and OSA severity (eg, RFS vs AHI, r = 0.57, P < 0.001); inflammation and laryngeal sensory impairment (EST detection threshold and pressure required to elicit the laryngeal adductor reflex, LAR); and the degree of sensory impairment and OSA severity. CONCLUSIONS: Laryngeal inflammation is prevalent among OSA patients and correlates with laryngeal sensory dysfunction, attenuation of the LAR, and apnea severity. EBM rating: C-4
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Affiliation(s)
- Richard J Payne
- Department of Otolaryngology-Head and Neck Surgery, Jewish General Hospital, McGill University, Montreal, Canada.
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Bărboi OB, Prelipcean CC, Mihai C, Floria M, Chirilă I, Darie AM, Drug VL, Bălan G. EXTRADIGESTIVE MANIFESTATIONS OF GASTROESOPHAGEAL REFLUX DISEASE: DEMOGRAPHIC, CLINICAL, BIOLOGICAL AND ENDOSCOPIC FEATURES. Rev Med Chir Soc Med Nat Iasi 2016; 120:282-287. [PMID: 27483705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
UNLABELLED Gastroesophageal reflux disease (GERD) with extradigestive manifestations is a disorder increasingly recognized both by gastroenterologists, pneumologists, otolaryngologists and cardiologists. AIM To evaluate the demographical, clinical, biological and endoscopic features of the patients with gastroesophageal reflux disease and extradigestive manifestations (chronic laryngitis, asthma, pseudoangina). MATERIAL AND METHODS Prospective case-control study, including 137 patients selected from patients referred to the Iasi Institute of Gastroenterology and Hepatology between July 2014-September 2015. In the presence of typical GERD symptoms (heartburn or regurgitation), the patients were assessed by upper digestive endoscopy for the detection or exclusion of esophagitis. Despite the absence of esophageal lesions, the patients were further assessed by impedance-pHmetry. RESULTS Depending on the dominant extradigestive manifestation, the patients were assigned into 3 groups: 94 chronic laryngitis patients, 24 asthma patients and 19 pseudoangina patients. Females were more frequent among pseudoangina patients (68.4%). Mean age of the male patients with dysphonia or asthma was lower (p=0.002), the majority (78.1%) living in urban areas. Obesity was predominant in pseudoangina group (52.6%), as compared to dysphonia group (16%) the differences being statistically significant (p=0.002). A share of 57.9% of pseudoangina patients were dyslipidemic, in contrast to dysphonia (24.5%) or asthma group (37.5%) (p=0.013). Esophagitis was also more frequent at pseudoangina group (84.2%), but with no significant statistical difference between the study groups (79.8% and 75%, respectively) (p=0.115). It seems that Helicobacterpylori infection tends to be protective in patients with GERD and pseudoangina (RR=0.61), but it can not be extrapolated to the general population (p=0.459). CONCLUSION GERD with extradigestive manifestations is a prevalent and heterogeneous disease. There are demographic, clinical, biological and endoscopic differences between patiens with extradigestive GERD.
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[In laryngitis an allergy test is worthwhile]. MMW Fortschr Med 2015; 157 Spec No 2:9. [PMID: 26953447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Fries S, Pasche P, Brunel C, Schweizer V. [Laryngeal amyloidosis: a clinical case and review of literature]. Rev Med Suisse 2015; 11:1796-1802. [PMID: 26619702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Amyloidosis consists of different forms of systemic or isolated organ lesions characterised by fibrillary protein deposits in extra-cellular tissue. The isolated involvement of the larynx is the most frequent form in the ENT sphere. We present a clinical case of a 67 year-old woman addressed for a sub-acute laryngitis resistant to conservative treatment, and finally diagnosed with laryngeal amyloidosis. We reviewed its physiopathology, the scientific literature as well as the different possibilities of management. Laryngeal amyloidosis is rare. A thorough additional work-up for the research of multifocal or systemic forms is highly recommended. The treatment aims at a minimal invasive endoscopic surgery with functional organ preservation.
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Tamagawa S, Hotomi M, Yuasa J, Tuchihashi S, Yamauchi K, Togawa A, Yamanaka N. Primary laryngeal cryptococcosis resembling laryngeal carcinoma. Auris Nasus Larynx 2015; 42:337-40. [PMID: 25701260 DOI: 10.1016/j.anl.2015.01.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 12/26/2014] [Accepted: 01/14/2015] [Indexed: 12/15/2022]
Abstract
A case of an 82-year-old female with primary laryngeal cryptococcosis who had undergone long-term corticosteroid therapy for chronic obstructive pulmonary disease and rheumatoid arthritis is reported. She complained hoarseness with swallowing pain and irritability of the larynx for over a month. Endoscopic examination revealed a white, exudative irregular region on right arytenoid that mimicked a laryngeal carcinoma. Histological examination showed pseudoepitheliomatous hyperplasia and severe submucosal inflammation with ovoid budding yeasts by Grocott's stain. A serological study indicated a high titer of cryptococcal antigen. After treating with oral fluconazole for 3 months, her primary lesion of larynx turned to be clear. We implicate a long-term use of steroids as the significant risk factor in developing cryptococcosis of the larynx.
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Affiliation(s)
- Shunji Tamagawa
- Department of Otolaryngology-Head and Neck Surgery, Wakayama Medical University, Wakayama, Japan
| | - Muneki Hotomi
- Department of Otolaryngology-Head and Neck Surgery, Wakayama Medical University, Wakayama, Japan.
| | - Jun Yuasa
- Department of Otolaryngology-Head and Neck Surgery, Wakayama Medical University, Wakayama, Japan
| | - Shigeki Tuchihashi
- Department of Otolaryngology-Head and Neck Surgery, Wakayama Medical University, Wakayama, Japan
| | - Kazuma Yamauchi
- Department of Otolaryngology-Head and Neck Surgery, Wakayama Medical University, Wakayama, Japan
| | - Akihisa Togawa
- Department of Otolaryngology-Head and Neck Surgery, Wakayama Medical University, Wakayama, Japan
| | - Noboru Yamanaka
- Department of Otolaryngology-Head and Neck Surgery, Wakayama Medical University, Wakayama, Japan
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Affiliation(s)
- John M Wood
- Otolaryngology Head Neck Surgery, Princess Margaret Hospital, Subiaco, WA, Australia
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Witt DR, Chen H, Mielens JD, McAvoy KE, Zhang F, Hoffman MR, Jiang JJ. Detection of chronic laryngitis due to laryngopharyngeal reflux using color and texture analysis of laryngoscopic images. J Voice 2013; 28:98-105. [PMID: 24314831 DOI: 10.1016/j.jvoice.2013.08.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2013] [Accepted: 08/26/2013] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine if pattern recognition of hue and textural parameters can be used to identify laryngopharyngeal reflux (LPR). METHODS Laryngoscopic images from 20 subjects with LPR and 42 control subjects without LPR were obtained. LPR status was determined using the reflux finding score. Color and texture features were quantified using hue calculation and two-dimensional Gabor filtering. Five regions were analyzed: true vocal folds, false vocal folds, epiglottis, interarytenoid space, and arytenoid mucosae. A multilayer perceptron artificial neural network with varying numbers of hidden nodes was used to classify images according to pattern recognition. Receiver operating characteristic (ROC) analysis was used to evaluate diagnostic utility, and intraclass correlation coefficient analysis was performed to determine interrater reliability. RESULTS Classification accuracy when including all parameters was 80.5% ± 1.2% with an area under the ROC curve of 0.887. Classification accuracy decreased when including only hue (73.1% ± 3.5%; area under the curve = 0.834) or texture (74.9% ± 3.6%; area under the curve = 0.852) parameters. Interrater reliability was 0.97 ± 0.03 for hue parameters and 0.85 ± 0.11 for texture parameters. CONCLUSIONS This preliminary study suggests that a combination of hue and texture features can be used to detect chronic laryngitis due to LPR. A simple, minimally invasive assessment would be a valuable addition to the currently invasive and somewhat unreliable methods currently used for diagnosis. Including more data will likely improve classification accuracy. Additional investigations will be performed to determine if results are in accordance with those provided by pH probe monitoring.
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Affiliation(s)
- Daniel R Witt
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Huijun Chen
- Department of Otolaryngology-Head and Neck Surgery, Shanghai EENT Hospital, Fudan University, Shanghai, People's Republic of China
| | - Jason D Mielens
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Kieran E McAvoy
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Fan Zhang
- Department of Otolaryngology-Head and Neck Surgery, Shanghai EENT Hospital, Fudan University, Shanghai, People's Republic of China
| | - Matthew R Hoffman
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Jack J Jiang
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; Department of Otolaryngology-Head and Neck Surgery, Shanghai EENT Hospital, Fudan University, Shanghai, People's Republic of China.
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Hueston WJ, Kaur D. Section four: laryngitis and dysphonia. FP Essent 2013; 415:27-36. [PMID: 24328951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Acute laryngitis is most often caused by viral illnesses through direct inflammation of the vocal cords or from irritation due to postnasal drainage. Bacterial infections, such as acute epiglottitis, also can cause dysphonia but typically have other systemic symptoms as well as respiratory distress. Chronic laryngitis is characterized by symptoms lasting more than 3 weeks. Chronic vocal cord issues can be related to overuse or stress on the vocal cords resulting in nodules or polyps. Individuals in certain occupations, such as singers, school teachers, and chemical workers, are at greater risk of chronic laryngitis. The diagnostic approach to chronic laryngitis should include visualization of the vocal cords to rule out potential malignant lesions. For acute and chronic overuse symptoms, the best treatment is vocal rest. The use of antibiotics or decongestants should be discouraged.
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Affiliation(s)
- William J Hueston
- Medical University of South Carolina, 5 Charleston Center Drive MSC 192, Charleston, SC 29425,
| | - Dipinpreet Kaur
- Medical University of South Carolina, 5 Charleston Center Drive MSC 192, Charleston, SC 29425,
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O'Niel MB, Chun RH, Conley SF. Ulcerative lesions as a rare cause of laryngotracheitis in the pediatric population. Am J Otolaryngol 2013; 34:541-4. [PMID: 23535210 DOI: 10.1016/j.amjoto.2013.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2013] [Accepted: 02/15/2013] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The goal of this study is to describe a unique finding of ulcerative lesions of the larynx in two pediatric patients presenting with prolonged acute laryngotracheitis and compare to previously described reports to determine the typical clinical picture, need for intervention, and management model. METHODS We present two cases of ulcerative lesions of the larynx in immunocompetent children, one with PCR positive HSV, which presented as severe croup requiring intensive care unit admission. Literature review was completed to assess for current knowledge of this entity. Our cases are discussed in the context of previously reported cases of HSV laryngotracheitis. Descriptive analysis was completed focusing on presentation, physical exam findings, treatment, length of therapy, and outcomes. RESULTS Literature review uncovered six case reports including 10 individual cases of prolonged croup with findings of HSV laryngitis and one retrospective review describing 15 cases of prolonged croup found to be caused by ulcerative laryngitis. All patients underwent direct laryngoscopy and bronchoscopy for evaluation. Analysis was completed comparing the studies to our patients with significant findings including high intubation rate of 77%, ulcerative stomatitis in 63%, and treatment with antiviral medication directed at HSV in 85% with improvement in symptoms. CONCLUSION It is important to consider HSV as a possible pathogen in cases of prolonged or atypical croup. Laryngoscopy should be used for diagnostic intervention and identification of ulcerative lesions. Stomatitis may be an indication for earlier direct inspection. Treatment with anti-viral therapy and with discontinuation or taper of steroid is suggested.
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Affiliation(s)
- Mallory B O'Niel
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, and Children's Hospital of Wisconsin, Milwaukee, WI, USA.
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Olleta L, Sabban JC, Orsi M. [Recurrent laryngitis in child: evaluation with multichannel intraluminal impedance]. Acta Gastroenterol Latinoam 2013; 43:9-11. [PMID: 23650827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Gastro-esophageal reflux (GERD) is highly prevalent in children and there is a tendency to disappear or decrease its frequency in the first year. However, in certain circumstances this reflux can have adverse consequences and these cases are known as gastro-esophageal reflux disease (GERD). The clinical manifestations of GERD include typical and atypical or extra digestive symptoms. The association between GERD and chronic laryngeal symptoms may present clinically as recurrent croup, stridor, chronic or intermittent hoarseness, globus sensation, excessive chronic cough and posterior rhinorrhea. Multi-channel intraluminal impedance-pH 24 hours (IIM-pH 24h) is the diagnostic method of choice for the study of this association. OBJECTIVE To describe the behavior and characteristics of GERD in patients with recurrent laryngitis. MATERIAL AND METHODS This is a retrospective study involving pediatric patients with recurrent laryngitis (2 or more episodes in 6 months) referred for study of possible GERD. RESULTS We evaluated 28 children. Only 7 of them had normal studies. CONCLUSION There is a significant percentage of patients with normal 24 hour Ph monitoring that had not been diagnosed with GERD without IIM. There was not a characteristic pattern.
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Affiliation(s)
- Laureana Olleta
- Servicio de Gastroenterología, Hepatología y Trasplante Hepático e Intestinal Infantil; Hospital Italiano de Buenos Aires, Argentina.
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Gilifanov EA, Nevzorova VA. [The functional state of the upper respiratory tract and ears in the patients presenting with chronic obstructive pulmonary disease]. Vestn Otorinolaringol 2013:9-12. [PMID: 24429847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The objective of the present work was to study the functional state of the ENT organ system in 50 patients during exacerbation of chronic obstructive pulmonary disease. The most pronounced clinical manifestations of the disease included chronic catarrhal rhinitis, chronic catarrhal pharyngitis, and hyperplastic laryngitis. No clinically significant pathological changes were documented in the organs of hearing.
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Cobzeanu MD, Voineag M, Drug VL, Ciubotaru A, Cobzeanu BM, Palade OD. Laryngeal morphological changes due to gastroesophageal reflux disease. Rev Med Chir Soc Med Nat Iasi 2012; 116:1011-1015. [PMID: 23700880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
UNLABELLED Chronic laryngitis may have life impact on professional voice users. Besides smoking and excessive alcohol intake, GERD is a determiniing factor in the etiology of dysphonia. AIM To evaluate the laryngeal alteration due to GERD in professional voice users. MATERIAL AND METHODS The study included 96 vocal professionals (teachers, actors, singers and priests), 58 males and 38 females, with a mean age of 38.3 +/- 7.5 years, presented for chronic laryngeal symptoms. The patients filled out a standardized questionnaire and were examined laryngoscopically. RESULTS Laryngeal changes were scaled 0 (absence) to 7 (maximum) - arytenoid edema (5.07 +/- 1.08), interarytenoid edema (6.18 +/- 1.12), vocal folds edema (5.67 +/- 1.04), ventricular bands edema (4.96 +/- 0.97), laryngeal edema 4.12 +/- 0.83). CONCLUSIONS Laryngoscopic changes may suggest the concomitance of GERD in professional voice users with dysphonia.
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Affiliation(s)
- M D Cobzeanu
- University of Medicine and Pharmacy Grigore T Popa Iasi, Faculty of Medicine
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Zhang T, Jiang MZ. [Advances in research on extra-oesophageal symptoms of pediatric gastroesophageal reflux]. Zhongguo Dang Dai Er Ke Za Zhi 2012; 14:391-395. [PMID: 22613116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The manifestations of pediatric gastroesohageal reflux (GER) are varied and complex. Extra-oesophageal symptoms, including GER-related respiratory diseases, ear, nose and throat diseases, oral diseases and neuropsychiatric symptoms, are thought to be major manifestations of pediatric GER, but the causal relationship between GER and these extra-oesophageal symptoms is still unclear. Therefore, we describe the progress of research on the relationship between GER and asthma, chronic cough, laryngitis, pharyngitis, laryngeal papilloma, sinusitis, otitis media, dental erosion, apparent life-threatening event, and the crying baby syndrome in this review. It provides new strategies for the diagnosis and treatment of GER-related diseases in children.
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Affiliation(s)
- Ting Zhang
- Department of Gastroenterology, Zhejiang University School of Medicine, Hangzhou, China
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21
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Mureşan I, Picos A, Grad S, Dumitrascu DL. Respiratory involvement in the gastroesophageal reflux disesease. Rev Med Chir Soc Med Nat Iasi 2011; 115:662-671. [PMID: 22046769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The pathological gastroesophageal reflux disease may lead to the gastroesophageal reflux disease (GERD), manifested as a spectrum of conditions including erosive esophagitis, Barrett esophagus and has been linked to the development of adenocarcinoma of the esophagus. The gastroesophageal reflux has been incriminated in the occurence of a number of pulmonary symptoms and diseases, otolaryngologic symptoms, and other extraesophageal manifestations. Clinicians must be aware of the possibility of some extraesophageal reflux-related manifestations, even in the absence of heartburn and acid reflux, classic esophageal symptoms of GERD. Although the correlation between gastroesophageal reflux disease and the extraesophageal manifestations has been established, a cause-and-effect relationship has not been proved yet. In this article, we present the respiratory manifestations of gastroesophageal reflux disease, referring to epidemiology, pathogenesis, diagnosis and treatment.
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Affiliation(s)
- Iulia Mureşan
- University of Medicine and Pharmacy Iuliu Hatieganu Cluj-Napoca, Romania, 2nd Medical Dept
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22
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Voineag M, Drug V, Indrei LL, Cobzeanu MD. [Diagnostic and treatment algorithm for pharyngolaryngeal reflux]. Rev Med Chir Soc Med Nat Iasi 2011; 115:405-411. [PMID: 21870732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Pharyngolaryngeal reflux (PLR) refers to backflow of stomach contents into the throat and larynx. Its diagnosis is difficult because of a variety of atypical symptoms, low sensitivity of traditional tests of gastrointestinal tract, and no consensus on the diagnostic algorithm. The aim of this study was to provide an algorithm for the diagnosis and treatment of PLR. There were no pathognomonic symptoms or findings, but the characteristic symptoms validate the Reflux Symptom Index and Reflux Findings Score as tools in the initial diagnosis. The first approach is empirical medical treatment for 3 month, based on endoscopic findings at laryngofiberscopy; then objective demonstration of reflux events using multichannel intraluminal impedance and pH monitoring. Proton pump inhibitors represent the mainstay of therapy for the patients with PLR, but they require a more aggressive and prolonged treatment than the patients with gastroesophageal symptoms.
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Affiliation(s)
- Monica Voineag
- Universităţii de Medicină şi Farmacie Gr. T. Popa Iaşi Centrul de Diagnostic şi Tratament Dr. Victor Babeş Bucureşti Universitatea de Medicină şi Farmacie Gr. T. Popa Iaşi
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23
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Morozov SV, Gibadullina LV, Isakova VA, Svistushkin VM. [Optimal diagnostic criteria of ENT manifestations of GERD]. Eksp Klin Gastroenterol 2011:8-18. [PMID: 22629749 DOI: pmid/22629749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND GERD has a number of extraesophageal manifestations (EEM) such as ENT, pulmonary etc. 24-hours pH monitoring in distal esophagus is widely used to confirm the diagnosis but its cut-off values for the diagnosing of extraesophageal manifestations of GERD (for example ENT) are unknown. AIM To evaluate the optimal cut-off values for mean pH, time pH < 4 a day in the proximal esophagus and number of high gastroesophageal refluxes (HGR) in regard to presence of extraesophageal manifestations of GERD. METHODS Ninety one GERD patients (50 men, 41 women, 42.33 +/- 16.1 y.o.) were examined using dual-probe 24-hours pH monitoring. The proximal probe was placed in the upper 1/3 part of esophagus over the upper esophageal sphincter. To confirm the presence of ENT manifestations of GERD all the patients were examined by qualified ENT-specialist; special ENT tests (laryngoscopy, pharyngoscopy with cytology and bacteriology) were performed. Toxic, allergic and infectious etiology of ENT were exclusion criteria. ROC curve analysis was used to evaluate optimal cut-off values of pH-studies. The cut-off values were chosen by the optimal diagnostic sensitivity (DSp)/specificity (DSp) ratio. RESULTS ENT diseases were found in 59 of all the examined patients (chronic pharyngitis in 79.66% of them). HGR was found in 76.27% of patients in ENT group and in 43.75% of controls (consisted of GERD patients without signs of ENT pathology, n = 32), p = 0.0026. Mean number of HGRs was higher in ENT group compared to controls: (M +/- s) 12.51 +/- 18.56 vs 2.84 +/- 7.11 respectively, p (Mann-Whitney U-test) = 0.0003. Mean pH levels in the proximal esophagus were lower in the ENT group: (M +/- m) 6.32 +/- 0.52 vs 6.58 +/- 0.42, p = 0.011. Mean time pH <4 in the proximal esophagus differed significantly between ENT and GERD patients without ENT: 3.19 +/- 6.76 min in ENT group compared to 2.42 +/- 10.02 min in controls, p = 0.003. The calculated cut-off values for the number of high GER were 2 (DSn 71.19%, DSp 68.75%) or 3 (DSn = 61.02%, DSp = 71.88%); for mean pH in the proximal esophagus--6.3 (DSn = 75%, DSp = 51.47) or 6.4 (DSn = 68.75%, DSp = 58.82%); for time pH < 4--optimal value was 25 sec (DSn = 72.88%, DSp = 68.75%). CONCLUSIONS Proximal pH monitoring may be useful in diagnosing extraesophageal manifestation of GERD. Optimal cut-off values of number of high GER are 2 to 3, mean pH 6.3-6.4 and time pH < 4 - 25 sec.
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24
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[The state of the larynx in children following repeated and recurrent croup]. Vestn Otorinolaringol 2011;:31-3. [PMID: 22433683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The obstructive forms of laryngitis and/or laryngotracheitis are the emergency conditions in the pediatric practice that frequently necessitate hospitalization of the affected patients. According to R.J. Rosychuk and co-workers, such patients make up to 6% of the total number of children admitted to stationary clinics. The authors discuss the problem of recurrent catarrhal croup in the children and its differential diagnosis from other diseases. The results of endoscopic and virological examination of the children with repeated or recurring croup are discussed. The children of this group most frequently present with infections by respiratory syncytial and parainfluenza viruses. The endoscopic examination has revealed various forms of chronic laryngitis in 21 (42%) children, subacute (including reactive) laryngitis in 8 (16%), and the developing nodules in the vocal cords of 15 (30%) patients. Six (12%) patients experienced a change of the quality of voice in the absence of structural alterations in the larynx (functional dysphonia). It is concluded that the results of endoscopic and virological examination do not correlate with one another.
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Bansal A, Kahrilas PJ. Treatment of GERD complications (Barrett's, peptic stricture) and extra-oesophageal syndromes. Best Pract Res Clin Gastroenterol 2010; 24:961-8. [PMID: 21126707 PMCID: PMC3006235 DOI: 10.1016/j.bpg.2010.09.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2010] [Accepted: 09/23/2010] [Indexed: 01/31/2023]
Abstract
Apart from typical reflux symptoms and oesophagitis, the clinical presentation of GERD can be dominated by mucosal complications of reflux (Barrett's oesophagus, oesophageal adenocarcinoma, Peptic structure) or by extra-oesophageal syndromes, most notably asthma, laryngitis, or chronic cough. Managing these entities is much less straightforward than with oesophagitis. With respect to adenocarcinoma, metaplasia and dysplasia are recognised precursors, but the potential of these lesions to evolve to cancer has not been shown to lessen as a result of treatment, medical or surgical. Consequently, management focuses on strategies to identify and eliminate high-grade dysplasia and intramucosal cancer, lesions that are potentially curable by endoscopic ablation or surgical resection. With respect to the extra-oesophageal GERD syndromes, these are increasingly recognised as multifactorial conditions with reflux as an exacerbating factor. Treatment trials have been generally disappointing and the clinical challenge remains in accurately identifying afflicted patients who might benefit from more intensive medical or surgical reflux treatment.
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Affiliation(s)
- Ajay Bansal
- Department of Medicine, Veterans Affairs Medical Center and University of Kansas, Kansas City, MO
| | - Peter J. Kahrilas
- Department of Medicine, The Feinberg School of Medicine, Northwestern University, Chicago, IL
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26
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Beer AM. [Sinobronchial syndrome. What can conventional medicine and what can naturopathy accomplish?]. MMW Fortschr Med 2010; 152:18. [PMID: 21171463 DOI: 10.1007/bf03367278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Andre-Michael Beer
- Klinik Blankenstein Abt. Naturheilkunde, Im Vogelsang 5-11, D-45527 Hattingen
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27
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Niki Y. [Questionnaire study to measure patient satisfaction for the treatment with sustained-release formulation of 2 g azithromycin]. Jpn J Antibiot 2010; 63:291-298. [PMID: 21298862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Dimache M, Turcan E, Nătase M. [Noncardiac chest pain and gastroesophageal reflux disease]. Rev Med Chir Soc Med Nat Iasi 2010; 114:342-348. [PMID: 20700964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Gastroesophageal reflux disease (GERD) may manifest typically with heartburn and regurgitation or may have atypical manifestations as laryngitis, asthma, chronic cough or noncardiac chest pain (NCCP). While typical GERD is easy to be recognized, the atypical extraesophageal symptoms of the disease make the diagnosis difficult because most patients do not have heartburn or regurgitation. Most common atypical manifestations include ear, nose and throat (ENT), pulmonary or cardiac symptoms. GERD should be included in the differential diagnosis of patients with atypical symptoms, especially when alternative diagnoses are excluded. NCCP is defined as recurring angina-like substernal chest pain of noncardiac origin. We present the most recent epidemiologic data, pathophysiology, diagnosis and treatment of NCCP. The major causes of NCCP are GERD and esophageal dysmotility. By far, GERD has been demonstrated to be the most frequent source of NCCP. After a complete cardiac evaluation, the patient with NCCP will be referred to a gastroenterologist. All recent studies suggest the use of PPI test as the first diagnostic tool in patients with NCCP. The invasive diagnostic tests (especially, the 24-hour pH monitoring and esophageal manometry) are used only in those cases who do not respond to PPI therapy. Patients with GERD-related NCCP require long-term treatment with a PPI.
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Affiliation(s)
- Mihaela Dimache
- Universitatea de Medicină şi Farmacie Gr.T. Popa Iaşi Facultatea de Medicină, Institutul de Gastroenterologie şi Hepatologie Iaşi
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29
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Madani A, Wong E, Sowerby L, Fung K, Gregor JC. Detecting the other reflux disease. J Fam Pract 2010; 59:102-107. [PMID: 20141724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Amin Madani
- Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
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30
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Kirasirova EA, Gorban DG, Lafutkina NV, Tarasenkova NN, Miroshnichenko NA, Piminidi OK. [Treatment of patients with complicated tonsillogenic infection]. Vestn Otorinolaringol 2010:58-59. [PMID: 20517283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The number of patients with pyo-inflammatory complications associated with chronic tonsillitis has increased in the recent years. The objective of this paper was to analyse the frequency of stenotic conditions caused by purulent complications of tonsillogenic infection. An algorithm is proposed for diagnostic examination and treatment of patients with descending tonsillogenic infection suffering obstruction of the upper respiratory tract.
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31
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Onuchina EV, Brikova SI, Tsukanov VV. [Using gaviscon preparation for relief of esophageal, extraesophageal syndromes and functional dyspepsia in elderly patients with GERD]. Eksp Klin Gastroenterol 2010:80-86. [PMID: 21434379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To compare the clinical efficacy of alginate drug Geviskon and aluminum-magnesium antacids to relieve symptoms of esophageal, extraesophageal syndrome and functional dyspepsia at 3 and 7 days of study in patients with GERD elderly. MATERIALS AND METHODS An open, longitudinal, randomized, parallel-group. The study included 60 patients with "A" degree of ERD, consistently received in-patient treatment in the Municipal KGVV, mean age 79.0 +/- 6.8 years. During the first 12 hours of hospital stay by "sealed envelopes" them randomly divided into equal groups of comparison, given 3 times a day: alginate product--Geviskon forte dose of 10 ml and aluminum-magnesium antacid drug at a dose of 1 sachet. Assess the frequency and severity of esophageal symptoms, extraesophageal syndrome, functional dyspepsia at 3 and 7 days of study on 5-point scale Likert. The degree of esophageal mucosal injury was determined during endoscopy before the study. RESULTS The technique of alginate compared with antacids provided significantly more complete and earlier effect on the relief of heartburn, regurgitation, chronic cough, sore throat, and EBS. Only Geviskon influenced the symptoms of PPD in patients with GERD. CONCLUSION The clinical features Geviskon the frequency and timing of relief of symptoms of esophageal, extraesophageal syndrome, functional dyspepsia with GERD in the older age groups is higher than that of antacids. Suspension Geviskon may be recommended in patients with middle and old age as an effective and safe symptomatic funds in the first days of exchange rate earlier generations of PPI therapy, as well as monotherapy--to maintain remission.
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32
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Feierabend RH, Shahram MN. Hoarseness in adults. Am Fam Physician 2009; 80:363-370. [PMID: 19678604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Numerous conditions can cause hoarseness, ranging from simple inflammatory processes to more serious systemic, neurologic, or cancerous conditions involving the larynx. Evaluation of a patient with hoarseness includes a careful history, physical examination, and in many cases, laryngoscopy. Any patient with hoarseness lasting longer than two weeks in the absence of an apparent benign cause requires a thorough evaluation of the larynx by direct or indirect laryngoscopy. The management of hoarseness includes identification and treatment of any underlying conditions, vocal hygiene, voice therapy, and specific treatment of vocal cord lesions. Vocal hygiene education is an integral aspect of the treatment of hoarseness in most cases. Referral to a speech-language pathologist for voice therapy may be particularly helpful for patients whose occupation depends on singing or talking loudly or for prolonged periods. Voice therapy is an effective method for improving voice quality and vocal performance in patients with nonorganic dysphonia and for treating many benign pathologic vocal cord lesions. Referral for surgical or other targeted interventions is indicated when conservative management of vocal cord pathology is unsuccessful, when dysplasia or carcinoma is suspected, or when significant airway obstruction is present.
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Affiliation(s)
- Raymond H Feierabend
- Department of Family Medicine, East Tennessee State University, Bristol, Tennessee 37620, USA.
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Abstract
Laryngopharyngeal reflux of liquid and gaseous gastric contents should be considered in every patient with unexplained hoarseness. Pathophysiology and treatment of reflux-associated laryngitis are different from those of reflux esophagitis and therefore remain an unsolved puzzle. The laryngeal mucosa is considerably more sensitive to acid and pepsin than the mucosa of the esophagogastric junction. Therefore definitions of acid and nonacid reflux used for gastroesophageal reflux disease may not be helpful for explaining pathophysiologic mechanisms in the larynx or pharynx. A reflux symptom index and reflux finding score may be useful in helping to select the minority of patients who may benefit from acid-suppressive therapy; however, further research is needed. Further research is also needed to identify those patients who may require higher doses or prolonged duration of proton pump inhibitors or alternative treatments like prokinetics or alginate, or those patients who may benefit from surgical treatment of gastroesophageal reflux. Since symptoms of laryngopharyngeal reflux may predict esophageal adenocarcinoma, every patient with laryngopharyngeal reflux should have an upper gastrointestinal endoscopy, even if no classical symptoms of gastroesophageal reflux disease are present.
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Affiliation(s)
- Heinz F Hammer
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Graz, Graz, Austria.
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34
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Heidelbaugh JJ, Gill AS, Van Harrison R, Nostrant TT. Atypical presentations of gastroesophageal reflux disease. Am Fam Physician 2008; 78:483-488. [PMID: 18756656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Gastroesophageal reflux disease typically manifests as heartburn and regurgitation, but it may also present with atypical or extraesophageal symptoms, including asthma, chronic cough, laryngitis, hoarseness, chronic sore throat, dental erosions, and noncardiac chest pain. Diagnosing atypical manifestations of gastroesophageal reflux disease is often a challenge because heartburn and regurgitation may be absent, making it difficult to prove a cause-and-effect relationship. Upper endoscopy and 24-hour pH monitoring are insensitive and not useful for many patients as initial diagnostic modalities for evaluation of atypical symptoms. In patients with gastroesophageal reflux disease who have atypical or extraesophageal symptoms, aggressive acid suppression using proton pump inhibitors twice daily before meals for three to four months is the standard treatment, although some studies have failed to show a significant benefit in symptomatic improvement. If these symptoms improve or resolve, patients may step down to a minimal dose of antisecretory therapy over the following three to six months. Surgical intervention via Nissen fundoplication is an option for patients who are unresponsive to aggressive antisecretory therapy. However, long-term studies have shown that some patients still require antisecretory therapy and are more likely to develop dysphagia, rectal flatulence, and the inability to belch or vomit.
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Affiliation(s)
- Joel J Heidelbaugh
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.
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35
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Kim GH. [Extraesophageal manifestations of gastroesophageal reflux disease]. Korean J Gastroenterol 2008; 52:69-79. [PMID: 19077497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Gastroesophageal reflux disease (GERD) often presents as typical symptoms such as heartburn or acid regurgitation. However, a subgroup of patients presents a collection of symptoms and signs that are not directly related to esophageal damage. These are known collectively as the extraesophageal manifestations of GERD, such as non-cardiac chest pain, laryngitis, chronic cough, hoarseness, asthma or dental erosion. They have a common pathophysiology, involving microaspiration of acid into the larynx and pharynx, and vagally mediated bronchospasm and laryngospasm. The role of extraesophageal reflux in such disorders is underestimated due to often silent symptoms and difficult confirmation of diagnosis. Endoscopy and pH monitoring are insensitive and therefore not useful in many patients as diagnostic modalities. Thus, anti-secretory therapy by proton pump inhibitor is used as both a diagnostic trial and as a therapy in the majority. Attention to optimizing therapy and judicious use of endoscopy and reflux monitoring are needed to maximize treatment success.
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Affiliation(s)
- Gwang Ha Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea.
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36
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Amernik K. [Glottis morphology and perceptive--acoustic characteristics of voice and speech in patients with rheumatoid arthritis]. Otolaryngol Pol 2008; 62:105-7. [PMID: 18637431 DOI: 10.1016/s0030-6657(08)70218-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Katarzyna Amernik
- Katedra i Klinika Otolaryngologii i Onkologii Laryngologicznej Pomorskiej AM, Szczecin.
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McGlashan JA, Johnstone LM, Sykes J, Strugala V, Dettmar PW. The value of a liquid alginate suspension (Gaviscon Advance) in the management of laryngopharyngeal reflux. Eur Arch Otorhinolaryngol 2008; 266:243-51. [PMID: 18506466 DOI: 10.1007/s00405-008-0708-7] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2008] [Accepted: 04/30/2008] [Indexed: 01/06/2023]
Abstract
Laryngopharyngeal reflux (LPR) refers to the backflow of stomach contents into the laryngopharynx. Increasing evidence has demonstrated that LPR is a contributing factor in some cases of hoarseness, vocal fatigue, voice breaks, cough and globus and chronic throat clearing. However, several randomised placebo-controlled trials of proton pump inhibitors in the treatment of LPR have been reported with the majority showing no significant benefit in patient symptom scores over placebo. The aim of this pilot clinical study was to investigate whether any improvement in LPR-related symptoms, using the Reflux Symptom Index (RSI), and clinical findings, using the Reflux Finding Score (RFS), could be achieved with treatment with a liquid alginate suspension compared to control (no treatment). Patients presenting with the symptoms of LPR to the Otorhinolaryngology Outpatient Department at the Queen's Medical Centre, Nottingham, UK were considered eligible if they had an RSI of greater than 10 and an RFS greater than 5 based on a fibreoptic examination of the larynx. A total of 49 patients were randomised into the open, parallel group study; 24 patients were randomised to receive 10 ml liquid alginate suspension (Gaviscon Advance) four times daily after meals and at bedtime, and 25 patients into the control group (no treatment). Patients were assessed pre-treatment and at 2, 4 and 6 months post treatment. Mean (SD) RSI and RFS pre-treatment scores were 23.9 (7.0) and 10.4 (3.6) for the treatment group and 24.6 (7.4) and 10.3 (3.3) for the control group, respectively. Significant differences between treatment and control were observed for RSI at the 2-month (11.2 (7.0) vs. 16.8 (6.4), P=0.005) and 6-month (11.2 (8.1) vs. 18.3 (9.4), P=0.008) assessments and for RFS at the 6-month (7.1 (2.8) vs. 9.5 (3.4), P=0.005) assessment. Significant improvement in symptom scores and clinical findings were achieved with liquid alginate suspension (Gaviscon Advance) compared to control and further evaluation for the management of patients presenting with LPR is warranted.
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Affiliation(s)
- Julian A McGlashan
- Department of Otorhinolaryngology Head and Neck Surgery, Queen's Medical Centre, Nottingham University Hospital, Nottingham NG7 2UH, UK
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Eckley CA, Rios LDS, Rizzo LV. Salivary egf concentration in adults with reflux chronic laryngitis before and after treatment: preliminary results. Braz J Otorhinolaryngol 2008; 73:156-60. [PMID: 17589721 PMCID: PMC9450656 DOI: 10.1016/s1808-8694(15)31060-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2007] [Accepted: 02/15/2007] [Indexed: 01/20/2023] Open
Abstract
UNLABELLED The Laryngopharyngeal Reflux (LPR) physiopathology is still unknown. The Epidermal Growth Factor (EGF) is a biologically active salivary protein that aids in the rapid regeneration of the oropharyngeal and upper digestive tract mucosas. Salivary deficiency of this protein in patients with LPR has been demonstrated in previous studies. AIM To compare salivary EGF concentration in patients with LPR before and after treatment. MATERIALS AND METHODS In this prospective study twelve patients with GERD and moderate LPR were studied. Whole saliva samples were collected before and after treatment and salivary EGF concentration was determined using a commercially available ELISA kit (Quantikine). RESULTS There were eleven females and one male among the patients, the mean age was 49 years. The mean pre-treatment salivary EGF concentration was 2,867.6 pg/mL and the mean post treatment EGF concentration was 1,588.5 pg/mL. This difference was statistically significant (p=0.015). DISCUSSION AND CONCLUSIONS Although salivary EGF concentrations are higher before LPR treatment, the concentration is still much lower than the mean salivary EGF concentration in normal individuals without LPR, which suggests a primary disorder of this defense factor in individuals with LPR.
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Thibeault SL, Smith ME, Peterson K, Ylitalo-Moller R. Gene expression changes of inflammatory mediators in posterior laryngitis due to laryngopharyngeal reflux and evolution with PPI treatment: a preliminary study. Laryngoscope 2008; 117:2050-6. [PMID: 17721405 DOI: 10.1097/mlg.0b013e318124a992] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
HYPOTHESIS Standard of care in laryngopharyngeal reflux (LPR) is acid suppression therapy. Its treatment efficacy and mechanism of action are not well documented. No objective study investigating the molecular patterns of inflammation in LPR or in response to proton pump inhibitor (PPI) treatment has been accomplished. We hypothesized that gene expression levels of mediators of inflammation -- interleukin 6 (IL6), interleukin 8 (IL8), interleukin 1a (IL1a), interleukin 1b (IL1b), transforming growth factor beta 1 (TGFbeta1), vascular endothelial growth factor (VEGF), fibroblast growth factor-2 (FGF2), and tumor necrosis factor alpha (TNFalpha) -- in posterior larynx tissue would be increased in those with diagnosed LPR and would be then reduced with PPI treatment. STUDY DESIGN Prospective uncontrolled trial. METHODS Biopsies from the posterior larynx were taken from 25 participants with LPR before and after a 10-week period with rabeprazole (40 mg). RNA isolation and real-time PCR was used to measure gene expression levels. RESULTS No significant differences were measured for any of the cytokines, either for the entire participant group (n = 25) or for the subset of participants who did not have a previous history of PPI usage (n = 15). In those participants who had a history of PPI usage (n = 10), a significant increase in gene expression levels post medication was measured for TGFbeta1 (P = .0396), VEGF (P = .0216), IL8 (P = .0297), after adjusting for compliance, subjective improvement, and reflux severity. CONCLUSIONS Our findings are provocative and speak to the unresolved understanding of the pathophysiology of LPR, its diagnosis, and its differences from gastroesophageal reflux disease.
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Affiliation(s)
- Susan L Thibeault
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin-Madison, Madison, WI 53792-7375, USA.
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Pribuisiene R, Uloza V, Kupcinskas L. Diagnostic sensitivity and specificity of laryngoscopic signs of reflux laryngitis. Medicina (Kaunas) 2008; 44:280-287. [PMID: 18469504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To assess the diagnostic sensitivity and specificity of the laryngoscopic signs of reflux laryngitis. MATERIAL AND METHODS Using original quantitative evaluation system, the laryngoscopic signs of 108 patients with reflux laryngitis and 90 healthy people were subjected to comparative analysis in this study. Summing up all evaluations of laryngeal changes, laryngoscopic reflux index was proposed. RESULTS Mucosal lesions and edema of vocal cords along with mucosal lesions of the interarytenoid notch were found to be most significant for diagnostics of reflux laryngitis. Presence of mucosal lesions of the interarytenoid notch (roughness, hypertrophy, keratosis, granuloma) increases the odds ratio to attribute the patient to the reflux laryngitis patient group 21 times (OR=21.32, 95% CI 4.38-103.93; P<0.001). Mucosal lesions (hypertrophy, keratosis, granuloma) and edema of vocal cords were determined as the most sensitive and rather specific laryngoscopic signs. Roughness and grade II hypertrophy of interarytenoid notch were found to be the most specific (98%) and sensitive (56%) laryngoscopic signs of reflux laryngitis. Abnormal values of laryngoscopic reflux index (higher than 5 points) reflect a diagnostic sensitivity of 96% and specificity of 97% differentiating patients with reflux laryngitis from healthy persons. CONCLUSIONS Mucosal lesions and edema of vocal cords along with mucosal lesions of the interarytenoid notch are found to be the most significant laryngoscopic signs for diagnostics of reflux laryngitis. Laryngoscopic reflux index was found to be the most sensitive and specific diagnostic criterion for reflux laryngitis.
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Affiliation(s)
- Rūta Pribuisiene
- Department of Otorhinolaryngology, Kaunas University of Medicine, Eiveniu 2, 50009 Kaunas, Lithuania.
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Abstract
Parvovirus-B19 has been reported a rare cause of acute laryngitis. Here, we described an 11-month-old girl who had prolonged acute laryngitis and neutropenia associated with parvovirus-B19 infection. Intravenous immunoglobulin therapy resulted in resolution of her symptoms, except neutropenia. We concluded that parvovirus-B19 can cause prolonged laryngitis and intravenous immunoglobulin treatment should be considered.
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Affiliation(s)
- Ozlem Yilmaz Ozbek
- Department of Pediatrics, Baskent University Faculty of Medicine, Ankara, Turkey.
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Abstract
Gastroesophageal reflux disease (GERD) is a common medical condition affecting approximately 35-40% of the adult population in the western world. The role of GERD in causing extra-esophageal symptoms including laryngitis, asthma, cough, chest pain, and dental erosions is increasingly recognized with renewed interest among gastroenterologists and other specialists. Direct injury by mucosal contact, and vagally mediated reflex from distal esophageal acid exposure are the two possible mechanisms by which reflux-related extra-esophageal tissue injuries may occur. Several investigational techniques may be used to diagnose gastroesophageal reflux; however, because of the poor sensitivity of endoscopy and pH monitoring, and the poor specificity of laryngoscopy, empiric therapy with proton-pump inhibitors (PPI) is now considered the initial diagnostic step in patients suspected of having GERD-related symptoms. In those who improve with such therapy, it is likely that GERD may be the cause of the extra-esophageal presentation. In those who are unresponsive to such therapy, other diagnostic testing such as impedance/pH monitoring may be reasonable in order to exclude continued acid or weakly acid reflux. However, PPI-unresponsive patients usually have causes other than GERD for the extra-esophageal symptoms and signs.
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Affiliation(s)
- F Farrokhi
- Division of Gastroenterology and Hepatology, Center for Swallowing and Esophageal Disorders, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Gurski RR, da Rosa ARP, do Valle E, de Borba MA, Valiati AA. Extraesophageal manifestations of gastroesophageal reflux disease. J Bras Pneumol 2007; 32:150-60. [PMID: 17273585 DOI: 10.1590/s1806-37132006000200011] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2005] [Accepted: 07/07/2005] [Indexed: 02/07/2023] Open
Abstract
Gastroesophageal reflux disease often presents as heartburn and acid reflux, the so-called "typical" symptoms. However, a subgroup of patients presents a collection of signs and symptoms that are not directly related to esophageal damage. These are known collectively as the extraesophageal manifestations of gastroesophageal reflux disease. Principal among such manifestations are bronchospasm, chronic cough and laryngitis, which are classified as atypical symptoms. These manifestations comprise a heterogeneous group. However, some generalizations can be made regarding all of the subgroups. First, although the correlation between gastroesophageal reflux disease and the extraesophageal manifestations has been well established, a cause-and-effect relationship has yet to be definitively elucidated. In addition, the main proposed pathogenic mechanisms of extraesophageal reflux are direct injury of the extraesophageal tissue (caused by contact with gastric acid) and the esophagobronchial reflex, which is mediated by the vagus nerve. Furthermore, gastroesophageal reflux disease might not be considered in the differential diagnosis of patients presenting only the atypical symptoms. In this article, we review the extraesophageal manifestations of gastroesophageal reflux disease, discussing its epidemiology, pathogenesis, diagnosis and treatment. We focus on the most extensively studied and well-established presentations.
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Abstract
UNLABELLED Rheumatoid arthritis (RA) is an inflammatory disease of the connective tissue, which can affect larynx and cricoarytenoid (CA) joints, as well. The AIM of this study was assessment of 1) glottis morphology and frequency of laryngeal structures involvement in RA of peripheral joints and 2) evaluation of rheumatoid patients' complaints which can indicate the laryngeal involvement. MATERIAL 77 patients were examined (71 women and 16 men) in the age from 19 to 77 (mean 56,69). RA duration was from 1 month to 29 years (mean 9,38). RA was active in 61% of patients. METHOD Anamnesis, physical examination, videolaryngoscopy, computer tomography, electromyography. RESULTS The most frequent complaints were: foreign body sensation in the throat (51%), hoarseness (47%) with accompanying weakness of voice and dysphagia. In videolaryngoscopic examination swelling and/or redness of mucosal tissue in CA area was observed in 45% of patients. In 3 women impairment of vocal folds was stated, in 1 it was limitation of right vocal fold mobility and in 2 bilateral vocal folds immobility and tracheotomy was necessary. In patients with active RA and with foreign body sensation in the throat significantly more often inflammatory changes in larynx were visible. CONCLUSIONS 1. Rheumatoid inflammation in the larynx is demonstrated by swelling and/or redness of mucosal tissue in CA area and in some individuals by its immobilization. 2. In the periods of RA intensification complains of foreign body sensation in the throat and hoarseness may indicate on laryngeal involvement. Our study results justify a suggestion of continuation of the morphological and functional changes estimation in patients with peripheral RA.
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Affiliation(s)
- Katarzyna Amernik
- Katedra i Klinika Otolaryngologii i Onkologii Laryngologicznej PAM w Szczecinie
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Abstract
Gastroesophageal reflux disease (GERD) is a common disorder. A significant percentage of patients with GERD may experience extra-esophageal manifestations, such as asthma, cough, and laryngitis. Epidemiologic studies consistently demonstrate strong associations between GERD and potential extra-esophageal manifestations. However, randomized controlled studies evaluating the use of proton-pump inhibitors for treatment of extra-esophageal GERD have inconsistent results. In asthma, few randomized controlled studies have shown improvement in objective measures, such as forced expiratory volume or peak flow. For chronic cough, studies are all small and have not demonstrated consistent improvement with acid suppression. Even a recent well-designed large randomized controlled study in laryngitis demonstrated no difference in resolution of symptoms with acid suppression. Given the examples from the literature, the current treatment of extra-esophageal symptoms with acid suppression is controversial. Although improvement in symptoms has been shown in case series, it has not been consistent in randomized controlled studies. We offer potential explanations for the discrepancy between the epidemiologic associations and the lack of response to therapy in clinical trials.
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Affiliation(s)
- Millie D Long
- Center for Esophageal Diseases and Swallowing, University of North Carolina-Chapel Hill, Campus Box 7080, Chapel Hill, NC 27599-7080, USA
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Hellmig S, Fölsch UR. [Gastroesophageal reflux: diagnostics and therapy of a widespread disease]. Med Klin (Munich) 2007; 102:373-80; quiz 381-2. [PMID: 17497088 DOI: 10.1007/s00063-007-1046-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Affiliation(s)
- Stephan Hellmig
- Klinik für Allgemeine Innere Medizin, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Schittenhelmstrasse 12, 24105, Kiel, Germany.
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Eckley CA, Costa HO. Comparative study of salivary pH and volume in adults with chronic laryngopharyngitis by gastroesophageal reflux disease before and after treatment. Braz J Otorhinolaryngol 2007; 72:55-60. [PMID: 16917554 PMCID: PMC9445775 DOI: 10.1016/s1808-8694(15)30035-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2005] [Accepted: 09/13/2005] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION Gastroesophageal Reflux Disease (GERD) is the most prevalent digestive disease of the modern society and has been associated with abnormalities in the larynx and pharynx (LPR). Nonetheless, little is known about the mechanisms involved in this atypical form of the disease. Contradictory clinical data suggest a defense deficit at this segment. Saliva with its organic and inorganic components is responsible for the homeostasis of the oral mucosa and the digestive tract. Salivary pH and volume abnormalities have been linked to laryngopharyngeal symptoms of GERD and LPR. In a recent study we demonstrated significant salivary pH reduction in patients with LPR. Another study found correlation between reduced salivary pH and volume directly related to esophageal pH-metry results. AIM To evaluate salivary pH and volume before and after clinical treatment of LPR. MATERIAL AND METHOD Twenty-three adults with LPR had total fasting saliva tested before and after a 12-week course of oral proton pump inhibitor. RESULTS A statistically significant difference was found in salivary pH before and after treatment with increase of pH values after control of the disease (p<0.001). Salivary volumes of treated patients were also significantly higher than in pre-treated patients (p=0.009). DISCUSSION These findings suggest that salivary pH and volume are influenced by the presence of gastroesophageal contents and that salivary pH monitoring can potentially become a cost-effective method for diagnosing and controlling LPR.
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Abstract
BACKGROUND Gastro-oesophageal reflux is thought to cause chronic laryngitis through laryngopharyngeal reflux. Response of laryngitis to treatment with acid-suppressive therapy supports this causal link. AIM To determine the prevalence of gastro-oesophageal reflux disease in patients with chronic laryngitis and response to proton-pump inhibitor therapy. METHODS Patients with chronic laryngitis were recruited. The frequency and severity of reflux and laryngeal symptoms were scored and laryngitis graded by laryngoscopy. All patients underwent esophagogastroduodenoscopy and 24-h ambulatory pH monitoring before receiving lansoprazole 30 mg b.d. for 8 weeks. RESULTS The prevalence of gastro-oesophageal reflux disease was 65.6% (21 of 32). Based on positive pH test, the prevalence was 25% (eight of 32). The change in laryngeal symptom score and laryngitis grade was significantly higher in GERD compared with non-GERD patients (P = 0.010 for both). The proportion of patients with marked/moderate improvement in laryngeal symptoms were significantly higher in patients with reflux (14 of 21, 67%) compared to those without reflux (two of 11, 18%; P = 0.026). CONCLUSIONS The prevalence of gastro-oesophageal reflux disease amongst our patients with chronic laryngitis was high. The response to treatment with proton-pump inhibitors in patients with reflux disease compared to those without underlined the critical role of acid reflux in a subset of patients with chronic laryngitis.
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Affiliation(s)
- C S Qua
- Division of Gastroenterology, Facultu of Medicine, University of Malaysia, Kuala Lumpur, Malaysia
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Dore MP, Pedroni A, Pes GM, Maragkoudakis E, Tadeu V, Pirina P, Realdi G, Delitala G, Malaty HM. Effect of antisecretory therapy on atypical symptoms in gastroesophageal reflux disease. Dig Dis Sci 2007; 52:463-8. [PMID: 17211695 DOI: 10.1007/s10620-006-9573-7] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2006] [Accepted: 08/15/2006] [Indexed: 02/07/2023]
Abstract
The effect of proton pump inhibitor (PPI) therapy on extraesophageal or atypical manifestations of gastroesophageal reflux disease (GERD) remains unclear. This study aimed to evaluate the prevalence of atypical manifestations in patients with acid reflux disease and the effect of PPI treatment. Patients with symptoms and signs suggestive of reflux were enrolled. Erosive esophagitis was stratified using the Los Angeles classification. Demographic data and symptoms were assessed using a questionnaire and included typical symptoms (heartburn, regurgitation, dysphagia, odynophagia), and atypical symptoms (e.g., chest pain, sialorrhea, hoarseness, globus sensation, chronic coughing, episodic bronchospasm, hiccup, eructations, laryngitis, and pharyngitis). Symptoms were reassessed after a 3-month course of b.i.d. PPI therapy. A total of 266 patients with a first diagnosis of GERD (erosive, 166; non-erosive, 100) were entered in the study. Presentation with atypical symptoms was approximately equal in those with erosive GERD and with non-erosive GERD, 72% vs 79% (P = 0.18). None of the study variables showed a significant association with the body mass index. PPI therapy resulted in complete symptom resolution in 69% (162/237) of the participants, 12% (28) had improved symptoms, and 20% (47) had minimal or no improvement. We conclude that atypical symptoms are frequent in patients with GERD. A trial of PPI therapy should be considered prior to referring these patients to specialists.
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Affiliation(s)
- Maria Pina Dore
- Istituto di Clinica Medica, Università di Sassari, Viale San Pietro 8, Sassari, Italy.
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Siupsinskiene N, Uloza V, Pribuisiene R, Butkus E, Kupcinskas L. [Modern attitude towards management of laryngopharyngeal form of gastroesophageal reflux disease. Lithuanian clinical practice guidelines for adults]. Medicina (Kaunas) 2007; 43:832-839. [PMID: 17998802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The aim of this article is to introduce Lithuanian clinical practice guidelines for the management of laryngopharyngeal form of gastroesophageal reflux disease for standardization of the diagnosis and treatment of the disease and prevention of its complications. Composed guidelines provide recommendations for primary care physicians as well as otorhinolaryngologists and gastroenterologists for the management of adults with uncomplicated laryngopharyngeal form of gastroesophageal reflux disease. Committee composed of experts from Lithuanian Otorhinolaryngological and Gastroenterological Societies developed guidelines based on a comprehensive review of the evidence-based literature related to laryngopharyngeal form of gastroesophageal reflux disease and guidelines of other countries. The guidelines provide description of each medicine groups with emphasis on proton pump inhibitors as the most effective drugs for the treatment of laryngopharyngeal form of gastroesophageal reflux disease. Indications for empirical treatment with proton pump inhibitors are described, as well as duration of treatment, doses, optimal regimen of use, and assessment of treatment efficacy. The therapy should begin with the application of proton pump inhibitors twice daily, before meal for three months. Combined therapy for nonresponders is described. Algorithm for stopping the medication is recommended. These recommendations may provide an efficient and economical approach to the management of this problem.
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Affiliation(s)
- Nora Siupsinskiene
- Department of Otorhinolaryngology, Kaunas University of Medicine, Kaunas, Lithuania.
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