Three-dimensional imaging of upper esophageal sphincter resting pressure

OBJECTIVE

High-resolution manometry (HRM) is used to analyze upper esophageal sphincter (UES) physiology. Conventional HRM can yield imprecise measurements of UES resting pressure given its unidirectional sensors and averaging of circumferential pressure. In contrast, three-dimensional (3D) measurements can yield precise UES resting pressure data over the entire length of the UES. This study conducted a detailed analysis of UES resting pressure as evaluated by 3D-HRM.

METHODS

Seventeen young, healthy adult participants (7 females and 10 males) were recruited. The 3D-HRM system used includes a pressure sensor catheter (outer diameter, 4 mm) and eight-channel transducers arranged circumferentially to acquire pressure data at 45° intervals. The catheter was inserted transnasally into the esophagus and automatically retracted at a speed of 1 mm/s. Participants performed the following tasks: maintain resting breathing, perform breath holding, and perform the Valsalva maneuver. Data were obtained and compared per millimeter over the longitudinal UES length.

RESULTS

Clear 3D waveforms were identified, with greater mean UES pressures in anterior-posterior directions than in lateral directions (P < .05). The anterior distribution was located superior to the posterior portion. Significant differences were observed in mean UES pressures and UES resting integrals between resting breathing and the Valsalva maneuver (P < 0.05). No differences in functional UES length were observed.

CONCLUSIONS

The normal UES resting pressure was not directionally uniform in the luminal structure. 3D-HRM imaging of UES resting pressure can help deepen our understanding of UES physiology.

LEVEL OF EVIDENCE

4.

Therapeutic efficacy of intralesional bleomycin injection for laryngopharyngeal haemangioma in adults

Background: Head and neck haemangiomas in the pharynx and larynx are rare, and the injection of bleomycin is currently one of the effective treatments. However, data on the therapeutic efficacy of this treatment are scarce.Objectives: To evaluate the clinical efficacy of bleomycin injection in the treatment of laryngopharyngeal haemangioma in adults and determine factors affecting efficacy.Materials and Methods: The clinical data of 42 adult patients with laryngopharyngeal haemangioma treated by intralesional bleomycin injection were retrospectively analysed to evaluate the clinical efficacy. Two groups (haemangioma reduction <50% and haemangioma reduction ≥50%) were compared to analyse factors affecting efficacy.Results: Seventy-five injections were administered to 42 patients: 34 (34/42 81%) patients with a haemangioma reduction ≥50% and 8 (8/42 19%) with a haemangioma reduction <50%. There was no difference in age, sex, haemangioma shape or number of operations between the two groups, but there was a significant difference in the base area of the haemangioma.Conclusions and Significance: Intralesional bleomycin injection is effective for the treatment of laryngopharyngeal haemangioma in adults. The base area of the haemangioma affects the therapeutic efficacy.

The effect of altered head and tongue posture on upper airway volume based on a validated upper airway analysis-An MRI pilot study

OBJECTIVE

To determine the influence of altered head or tongue posture on upper airway (UA) volumes using MRI imaging based on a new objective and validated UA evaluation protocol.

SETTING AND SAMPLE POPULATION

One supine CBCT and five sagittal MRI scans were obtained from ten subjects in different head and tongue positions: (a) supine neutral head position (NHP) with the tongue in a natural resting position with the tip of the tongue in contact with the lingual aspect of the lower incisors (TRP); (b) head extension with TRP; (c) head flexion with TRP; (d) NHP with the tip of the tongue in contact with the posterior edge of the hard palate (THP); and (e) NHP with the tip of the tongue in contact with the floor of the mouth in contact with the caruncula sublingualis.

MATERIAL AND METHODS

Based on a validated CBCT UA analysis, the retropalatal, oropharyngeal and the corresponding total volumes were measured from each MRI scan. Wilcoxon signed-rank test was applied to determine the statistically significant difference in mean volume between the baseline head and tongue posture (NHP with TRP) and the other postures.

RESULTS

Five females and five males with a mean age of 46.5 ± 13.7 years volunteered for this pilot study. UA volumes, particularly the oropharyngeal volume, increased significantly with head extension and NHP with THP and decreased significantly with head flexion.

CONCLUSION

Altered head and tongue posture proved to affect UA volumes, thus representing confounding variables during three-dimensional radiographic image acquisition.

Morphology of the Upper Esophageal Sphincter or Cricopharyngeus Muscle Revisited: A Study Using Adult and Fetal Specimens

Histological examination of specimens from 22 donated elderly cadavers and 15 human fetuses revealed that the cricopharyngeus muscle (CPM) provided (1) posterior circular muscle fibers adjacent to the external aspect of the uppermost esophageal circular muscle and (2) a thin anterior sling connecting to that same muscle. Another thick lateral bundle of longitudinal muscle originated independently from a fascia covering the posterior cricoarytenoideus muscle, extended laterally and posteriorly, and occupied a space after the CPM had disappeared at the anterolateral angle of the esophagus below the cricoid. The thick fascia contained abundant elastic fibers along the internal surface of the pharyngeal constrictors (posteromedial elastic lamina), but was interrupted or discontinued near the cricoid origin of the CPM. As no submucosal smooth muscles or elastic fibers were connected to it, the CPM did not accompany a specific elastic structure at the interface between the pharyngeal and esophageal muscles. In fetuses, the medial half of the CPM was inserted into the cricoid while the lateral half continued to the sternothyroideus muscle or ended at a fascia covering the cricothyroideus. These anterolateral ends provided a mechanical load for longitudinal growth of the pharyngeal constrictors. Consequently, the CPM was unlikely to develop and grow to form the upper esophageal sphincter, and the muscle bundle crossing the lateral aspect of the pharyngo-esophageal junction appeared to have a secondary passive role as a sphincter. This situation contrasts with that of another sphincter in the human body formed from striated muscle. Clin. Anat., 33:782-794, 2020. © 2019 Wiley Periodicals, Inc.

Lifespan Extension in C. elegans Caused by Bacterial Colonization of the Intestine and Subsequent Activation of an Innate Immune Response

Mechanisms that control aging are important yet poorly defined. To discover longevity control genes, we performed a forward genetic screen for delayed reproductive aging in C. elegans. Here, we show that am117 is a nonsense mutation in the phm-2 gene, which encodes a protein homologous to human scaffold attachment factor B. phm-2(lf) mutant worms have an abnormal pharynx grinder, which allows live bacteria to accumulate in the intestine. This defect shortens lifespan on highly pathogenic bacteria but extends lifespan and health span on the standard E. coli diet by activating innate immunity pathways that lead to bacterial avoidance behavior and dietary restriction. eat-2(lf) mutants displayed a similar phenotype, indicating accumulation of live bacteria also triggers extended longevity in this mutant. The analysis of phm-2 elucidates connections between pathogen response and aging by defining a mechanism of longevity extension in C. elegans-bacterial colonization, innate immune activation, and bacterial avoidance behavior.

The Differential Impact of SRC Expression on the Prognosis of Patients with Head and Neck Squamous Cell Carcinoma

Aberrant SRC expression and activation is frequently detected in multiple cancers, and hence, targeting SRC has emerged as a promising therapeutic strategy. Different SRC inhibitors have demonstrated potent anti-tumor activity in preclinical models, although they largely lack clinical efficacy as monotherapy in late-stage solid tumors, including head and neck squamous cell carcinomas (HNSCC). Adequate selection and stratification of patients who may respond to and benefit from anti-SRC therapies is therefore needed to guide clinical trials and treatment efficacy. This study investigates the prognostic significance of active SRC expression in a homogeneous cohort of 122 human papillomavirus (HPV)-negative, surgically treated HNSCC patients. Immunohistochemical evaluation of the active form of SRC by means of anti-SRC Clone 28 monoclonal antibody was specifically performed and subsequently correlated with clinical data. The expression of p-SRC (Tyr419), total SRC, and downstream SRC effectors was also analyzed. Our results uncovered striking differences in the prognostic relevance of SRC expression in HNSCC patients depending on the tumor site. Active SRC expression was found to significantly associate with advanced disease stages, presence of lymph node metastasis, and tumor recurrences in patients with laryngeal tumors, but not in the pharyngeal subgroup. Multivariate Cox analysis further revealed active SRC expression as an independent predictor of cancer-specific mortality in patients with laryngeal carcinomas. Concordantly, expression of p-SRC (Tyr419) and the SRC substrates focal adhesion kinase (FAK) and the Arf GTPase-activating protein ASAP1 also showed specific associations with poor prognosis in the larynx. These findings could have important implications in ongoing Src family kinase (SFK)-based clinical trials, as these new criteria could help to improve patient selection and develop biomarker-stratified trials.

[The role of the microbiome in otorhinolaryngology]

Our health is highly determined by the diverse microbial community living within our body and upon our skin. Balance among the members of the commensal microbiota is essential for the preservation of health. New generation sequencing is a rapid, sensitive method for determining the whole microbiome without prior hypothesis and also gives information on the resistance and virulence status. Application of this method can help to identify the pathogens contributing to different diseases, and also the protective bacteria inhibiting their growth. Detecting the changes of the microbiome helps to identify new therapeutic targets and establish targeted antibiotic therapy. Broad-spectrum antibiotics also act against the beneficial members of the microbial flora, which may lead to the development of recurrent or chronic disease. Ear, nose and throat infections are the most common infective diseases in humans and the leading cause for antibiotic prescription worldwide. In recent years, many studies using molecular biology methods were performed examining the microbiome of healthy humans and in otorhinolaryngologic diseases. In the present work, the authors review the changes of the microbiological communities in the healthy state and in various pathologic states in the anatomic regions of the ear, nose and throat. Orv Hetil. 2019; 160(39): 1533-1541.

Reliability and validity of two software systems used to measure the pharyngeal airway space in three-dimensional analysis

The aim of this study was to test the reliability and validity of two software systems used to measure the pharyngeal airway space three-dimensionally. A sample of 40 cone beam computed tomography images from adult patients was taken from a database. The cone beam computed tomography images were analysed by InVivoDental and Dolphin 3D software systems by two calibrated examiners. Three nasopharynx and oropharynx prototypes were used as a reference standard to validate the software systems. The volume, minimum area and minimum area localization were the measurements tested. Measurements were compared using a paired t-test; correlated using Pearson's correlation and linear regression. Bland-Altman analysis was also used. We found significant differences in the oropharynx volume (P=0.002) and nasopharynx minimum area localization (P=0.009). The Dolphin 3D software presented higher-volume values than the ones found in the prototype, while the InVivoDental software presented lower values. Strong (r>0.7; P>0.001) or very strong (r>0.9; P>0.001) correlations were observed between the software systems. Bland-Altman analysis found good agreement between prototypes and the software systems. The measurements obtained from the Dolphin 3D and InVivoDental software systems are both reliable, strongly correlated, but should not be assumed as equal. Dolphin 3D software overestimates the nasopharynx and oropharynx volumes, while the InVivoDental software underestimates them.

From fine-needle aspiration cytology to fluorescent in-situ hybridization in an unusual case of pharyngeal synovial sarcoma

Synovial sarcoma arising in the pharynx is a rare entity, with very few cases described in literature, mainly as surgical-oriented case reports. We report the case of a healthy 20-year old man who presented with a painless right neck mass, clinically suspicious for a thyroid nodule. Ultrasound scan and fine-needle aspiration cytology failed to provide a definitive result, although suggesting a mesenchymal proliferation, in accordance with magnetic resonance imaging findings. Therefore, the lesion was removed with a minimally invasive surgical intervention. Definitive histologic and immunohistochemical examination of the surgical specimen revealed a biphasic synovial sarcoma, further validated by the detection of SS18 gene rearrangement on fluorescent in-situ hybridization examination. Although rarely, synovial sarcoma may arise in the pharynx. Radiological, cytological, histological and molecular findings are needed along each step of the diagnostic process.

Extragenital Mycoplasma genitalium infections among men who have sex with men

OBJECTIVES

There are limited data on the prevalence of Mycoplasma genitalium (Mgen) coinfection with rectal chlamydia (Chlamydia trachomatis (CT)) and rectal gonorrhoea (Neisseria gonorrhoeae (NG)) infections and few studies examining the prevalence of pharyngeal Mgen in men who have sex with men (MSM). Using transcription-mediated amplification assay, this study aimed to determine the proportion of rectal CT and rectal NG infections in MSM who are coinfected with rectal Mgen, and the proportion of MSM with Mgen detected in the pharynx in order to inform clinical practice.

METHODS

This was a cross-sectional study conducted at Melbourne Sexual Health Centre in Australia. Consecutively collected rectal swabs from MSM that tested positive for CT (n=212) or NG (n=212), and consecutively collected pharyngeal samples (n=480) from MSM were tested for Mgen using the Aptima Mycoplasma genitalium Assay (Hologic, San Diego). Samples were linked to demographic data and symptom status.

RESULTS

Rectal Mgen was codetected in 27 of 212 rectal CT (13%, 95% CI 9 to 18) and in 29 of 212 rectal NG (14%, 95% CI 9 to 19) samples, with no difference in the proportion positive for Mgen. MSM with rectal CT/Mgen coinfection had more sexual partners than those with rectal CT monoinfection (mean 6 vs 11, p=0.06). MSM with rectal NG/Mgen coinfection were more likely to be HIV-positive than those with rectal NG monoinfection (OR=2.96, 95% CI 1.21 to 7.26, p=0.023). MSM with rectal CT/Mgen coinfection were more likely to be using pre-exposure prophylaxis than MSM with rectal NG/Mgen coinfection (OR 0.25, 95% CI 0.10 to 0.65, p=0.002). Pharyngeal Mgen was uncommon and detected in 8 of 464 samples (2%, 95% CI 1% to 3%). Pharyngeal Mgen was associated with having a rectal STI (OR=10.61, 95% CI 2.30 to 48.87, p=0.002), and there was a borderline association with being HIV-positive (p=0.079).

CONCLUSION

These data indicate one in seven MSM treated for rectal CT or rectal NG will have undiagnosed Mgen that is potentially exposed to azithromycin during treatment of these STIs. Rectal Mgen coinfection was associated with specific risk factors which may inform testing practices. Pharyngeal Mgen was uncommon.

Videofluoroscopic Evaluation of the Pharynx and Upper Esophageal Sphincter in the Dog: A Systematic Review of the Literature

Background: Diseases of the pharynx and upper esophageal sphincter can result in debilitating respiratory difficulty, dysphagia or a combination of both. An exact diagnosis is essential to properly prognosticate and guide therapy. Videofluoroscopic assessment of the pharynx and upper esophageal sphincter with or without orally administered contrast material is the diagnostic of choice for many diseases as both anatomic and functional information is gleaned. The purpose of this review is to assess for continuity in imaging protocols across institutions and to record quantitative and qualitative parameters used for analysis of videofluoroscopy of the pharynx and upper esophageal sphincter in dogs.

Methods: A systematic literature search was performed including articles published in peer-reviewed veterinary journals involving the topic of videofluoroscopy of the pharynx and upper esophageal sphincter through August 1, 2018. Specifics of study acquisition technique were recorded. Quantitative and qualitative videofluoroscopic parameters were recorded and compared across institutions where appropriate using one-way ANOVA with p ≤ 0.05 being considered significant.

Results: Videofluoroscopy of the pharynx and upper esophageal sphincter is performed either in right lateral or standing postures depending on the institution. Bolus size and consistency used during contrast videofluoroscopy of swallowing differs between institutions. Some institutions evaluate videofluoroscopic studies using qualitative criteria while others apply quantitative measures. Reported quantitative measures include inter-swallow interval, swallow rate, jaw cycles per swallow ratio, time to upper esophageal opening, maximal pharyngeal contraction, maximum laryngeal excursion, upper esophageal closure, epiglottic re-opening, and pharyngeal constriction ratio. Measurement outcomes are significantly different between institutions and when bolus size/consistency is variable when assessing healthy dogs.

Conclusions: The current peer-reviewed literature on fluoroscopic evaluation of the pharynx and UES in dogs shows a lack of standardization regarding imaging protocol. There is not a standard set of quantitative criteria applied amongst the institutions and there are significant differences in the outcomes obtained from videofluoroscopic assessment of swallowing suggesting significant inter-observer or inter-institutional variability. A consensus statement regarding imaging protocol and what parameters should be used to interpret airway and swallowing videofluoroscopic studies of the pharynx and UES in dogs is needed along with targeted analysis of observer variability.

Cross Talk with the GAR-3 Receptor Contributes to Feeding Defects in Caenorhabditis elegans eat-2 Mutants

Precise signaling at the neuromuscular junction (NMJ) is essential for proper muscle contraction. In the Caenorhabditis elegans pharynx, acetylcholine (ACh) released from the MC and M4 motor neurons stimulates two different types of contractions in adjacent muscle cells, termed pumping and isthmus peristalsis. MC stimulates rapid pumping through the nicotinic ACh receptor EAT-2, which is tightly localized at the MC NMJ, and eat-2 mutants exhibit a slow pump rate. Surprisingly, we found that eat-2 mutants also hyperstimulated peristaltic contractions, and that they were characterized by increased and prolonged Ca2+ transients in the isthmus muscles. This hyperstimulation depends on cross talk with the GAR-3 muscarinic ACh receptor as gar-3 mutation specifically suppressed the prolonged contraction and increased Ca2+ observed in eat-2 mutant peristalses. Similar GAR-3-dependent hyperstimulation was also observed in mutants lacking the ace-3 acetylcholinesterase, and we suggest that NMJ defects in eat-2 and ace-3 mutants result in ACh stimulation of extrasynaptic GAR-3 receptors in isthmus muscles. gar-3 mutation also suppressed slow larval growth and prolonged life span phenotypes that result from dietary restriction in eat-2 mutants, indicating that cross talk with the GAR-3 receptor has a long-term impact on feeding behavior and eat-2 mutant phenotypes.

Clinicopathological Features and Outcomes of Endoscopic Submucosal Dissection for Superficial Cancer of the Pharynx

The efficacy and safety of endoscopic submucosal dissection (ESD) for superficial cancer of the pharynx are still unclear. To identify clinicopathological features of superficial pharyngeal cancer, and the efficacy and safety of ESD, we retrospectively assessed 70 pharyngeal cancers in 59 patients who underwent ESD. Of these patients, 61.0% and 50.8% had a history of esophageal cancer and head and neck cancer, respectively. The median tumor size was 15 mm, and 75.7% of the lesions were located at the piriform sinus. The en bloc resection rate was 94.9%. Treatment-related adverse events occurred in 8 cases, but there was no treatment-related death. The lateral margin was positive for neoplasm in 3 lesions (4.3%) and inconclusive in 27 lesions (38.6%), but no local recurrence was observed. Cervical lymph node metastasis was observed in 6 patients, and was successfully treated by cervical lymph node dissection. The three-year overall survival rate was 91.5% (95%CI: 76.6-97.3%) and the cause-specific survival rate was 97.6% (95%CI: 84.9-99.7%). In conclusion, ESD for superficial pharyngeal cancer was safe and effective. "Resect and watch" is probably a feasible and rational strategy for treatment of patients with superficial pharyngeal cancer.

Bichir external gills arise via heterochronic shift that accelerates hyoid arch development

In most vertebrates, pharyngeal arches form in a stereotypic anterior-to-posterior progression. To gain insight into the mechanisms underlying evolutionary changes in pharyngeal arch development, here we investigate embryos and larvae of bichirs. Bichirs represent the earliest diverged living group of ray-finned fishes, and possess intriguing traits otherwise typical for lobe-finned fishes such as ventral paired lungs and larval external gills. In bichir embryos, we find that the anteroposterior way of formation of cranial segments is modified by the unique acceleration of the entire hyoid arch segment, with earlier and orchestrated development of the endodermal, mesodermal, and neural crest tissues. This major heterochronic shift in the anteroposterior developmental sequence enables early appearance of the external gills that represent key breathing organs of bichir free-living embryos and early larvae. Bichirs thus stay as unique models for understanding developmental mechanisms facilitating increased breathing capacity.

Antagonistic effects of Streptococcus and Lactobacillus probiotics in pharyngeal biofilms

Direct antagonism towards pathogens including Streptococcus pyogenes is a proposed mechanism of pharyngeal probiosis but off-target effects on the symbiotic microbiota of the throat are possible and may be beneficial, harmful or neutral. We have assessed the bacteriological effects of two candidate Lactobacillus probiotics and the established pharyngeal probiotic Streptococcus salivarius K12. Antagonism towards S. pyogenes and potential off-target effects were determined using sessile monospecies biofilms and pharyngeal microcosms, respectively. The candidate probiotics were antagonistic towards S. pyogenes (rank order of increasing potency, Lactobacillus acidophilus < Lactobacillus plantarum < Streptococcus salivarius) in the absence of significant acidification or cell-cell contact. Streptococcus salivarius and L. plantarum caused significant reductions in viable counts of streptococci in pharyngeal microbiotas, whilst S. salivarius also caused reductions in staphylococci. In contrast, changes in pharyngeal eubacterial DNA profiles were limited overall. In summary, the three candidate probiotics suppressed axenic Streptococcus pyogenes biofilms by mechanisms that did not depend on cell-cell contact or acidification and did not markedly destabilize complex pharyngeal microbiotas derived from healthy individuals. SIGNIFICANCE AND IMPACT OF THE STUDY: Candidate probiotic bacteria deployed to prevent or treat bacterial pharyngitis will interact with the target bacteria such as Streptococcus pyogenes as well as with the microbiota of the throat, where off-target effects are possible. Three candidate probiotics Lactobacillus acidophilus, Lactobacillus plantarum and Streptococcus salivarius reduced viability within extant S. pyogenes biofilms through the elaboration of diffusible factors other than fermentation acids but did not markedly disrupt ex situ pharyngeal microcosms. This work demonstrates the application of in vitro pharyngeal models in the preclinical testing of the safety and efficacy of candidate pharyngeal probiotics.

The Emerging Role of Robotic Surgery among Minimally Invasive Surgical Approaches in the Treatment of Hypopharyngeal Carcinoma: Systematic Review and Meta-Analysis

The aim of this systematic review with meta-analysis was to investigate the available literature on transoral approaches in the treatment of hypopharyngeal squamous cell carcinoma, with a special focus on transoral robotic surgery (TORS). A systematic review was conducted according to the PRISMA (preferred reporting items for systematic reviews and meta-analyses) check-list, and 15 studies were included. Five of the included studies evaluated TORS, while ten studies focused on transoral laser microsurgery (TLM) for the treatment of early or advanced stage hypopharyngeal cancer. Overall, survival rates of TLM and TORS studies, analyzed together in the cumulative meta-analysis, were 66.4% (95% confidence interval (CI) 54.3%–76.7%) at 36+ months of follow up. The TORS subgroup showed a higher cumulative survival rate (85.5%, 95% CI 55.8%–96.5%) compared to TLM (58.5%, 95% CI 46.6%–69.6%). Cumulative data showed that 29.3% (95% CI 24.0%–35.3%) of deaths were attributable to cancer. The results were similar between TLM and TORS studies. The larynx function preservation cumulative rate was 94.3% (95% CI 91.8%–96.1%). The results were similar among the two subgroups. The present review supports the use of transoral approaches in the treatment of hypopharyngeal cancer. TORS is oncologically sound and provides excellent functional results with low complication rates.

Pharyngeal hairy polyps: Case series and literature review

It was aimed to report 5 cases of pharyngeal hairy polyps, and to summarize the characteristics combined with literature review.Five cases with pathological diagnosis of pharyngeal hair polyps were diagnosed and treated in our department from June, 2006 to October, 2016, and retrospective analysis of their clinical data was performed. Among the 5 cases, there were 1 male and 4 female, with the age of 2 days to 26 months old. After birth, these patients were accompanied by stridor, difficulty breathing, snoring, feeding difficulties, and slow weight gain.Gray mass in the stem original from the pharynx was found in all 5 cases, with the surface hair-covering. The polyp resections were performed under general anesthesia, with the complete removal of polyp along the pars basilaris during surgery smoothly. The operation during was 5 to 20 minute, with an average of 12 minute, and there was little hemorrhage during operation. Symptoms disappeared completely after the surgery, and follow-up was performed for 1 year without recurrence shown.Pharyngeal hairy polyp is a rare non-malignant clinical disease, mainly caused by symptoms in respiratory tract obstruction. Complete removal of polyps along the pars basilaris is an effective treatment, with no recurrence case reported after surgery.

High-Level PM2.5/PM10 Exposure Is Associated With Alterations in the Human Pharyngeal Microbiota Composition

Previous studies showed that high concentration of particulate matter (PM) 2.5 and PM10 carried a large number of bacterial and archaeal species, including pathogens and opportunistic pathogens. In this study, pharyngeal swabs from 83 subjects working in an open air farmer's market were sampled before and after exposure to smog with PM2.5 and PM10 levels up to 200 and 300 μg/m3, respectively. Their microbiota were investigated using high-throughput sequencing targeting the V3-V4 regions of the 16S rRNA gene. The genus level phylotypes was increased from 649 to 767 in the post-smog pharyngeal microbiota, of which 142 were new and detected only in the post-smog microbiota. The 142 new genera were traced to sources such as soil, marine, feces, sewage sludge, freshwater, hot springs, and saline lakes. The abundance of the genera Streptococcus, Haemophilus, Moraxella, and Staphylococcus increased in the post-smog pharyngeal microbiota. All six alpha diversity indices and principal component analysis showed that the taxonomic composition of the post-smog pharyngeal microbiota was significantly different to that of the pre-smog pharyngeal microbiota. Redundancy analysis showed that the influences of PM2.5/PM10 exposure and smoking on the taxonomic composition of the pharyngeal microbiota were statistically significant (p < 0.001). Two days of exposure to high concentrations of PM2.5/PM10 changed the pharyngeal microbiota profiles, which may lead to an increase in respiratory diseases. Wearing masks could reduce the effect of high-level PM2.5/PM10 exposure on the pharyngeal microbiota.

Pharyngeal distensibility during expiration is an independent predictor of the severity of obstructive sleep apnoea

BACKGROUND AND OBJECTIVE

Pharyngeal distensibility and collapsibility reflect the passive properties of tissue in the airway, are an indicator of the ease with which an airway can be deformed and are related to the severity of obstructive sleep apnoea (OSA). During normal tidal respiration, the collapsibility of the pharynx during expiration is passive without confounding by neuromuscular activation that occurs during inspiration. We evaluated the distensibility and collapsibility of the upper airway in subjects with OSA during wakefulness using sophisticated dynamic computed tomography (CT) imaging. We hypothesized that the dynamic changes of the upper airway during expiration would be related to the severity of OSA.

METHODS

Twenty-three patients with OSA and eight normal subjects underwent simultaneous measurement of respiratory flow and airway calibre using ultrafast CT. The change in pharyngeal cross-sectional area divided by the change in concomitant flow (as distensibility or collapsibility) was measured and compared across different severities of OSA.

RESULTS

The slope of this relationship between delta area and delta flow during expiration was significantly higher in severe OSA when compared with normal controls and mild-moderate OSA. Differences in airway distensibility or collapsibility between severity groups were significant in expiration but not in inspiration. Distensibility or collapsibility contributed most to the apnoea-hypopnoea index in regression modelling. Age, gender, and body mass index (BMI) were not significant independent predictors.

CONCLUSION

Our study demonstrates that airway distensibility during the expiratory phase of awake respiration is correlated with the severity of OSA.

Validation of an analytical method to quantify the permeation and penetration of flurbiprofen into human pharynx tissue

The aim of this investigation was to develop receiver and extraction fluids, and subsequently validate an analytical method to quantify the permeation and penetration of flurbiprofen into human pharynx tissue using a Franz diffusion cell. The solubility and stability of flurbiprofen in a suitable receiver fluid, and a suitable extraction method and fluid to recover and quantitate flurbiprofen from human pharynx tissue, were investigated using high‐performance liquid chromatography (HPLC). The potential interference of human pharynx tissue in the receiver fluid was also investigated. The HPLC analytical method was successfully validated according to current guidelines. The final receiver fluid demonstrated sufficient solubility and stability, and the extraction method and fluid resulted in >95% recovery of flurbiprofen following exposure to human pharynx tissue. The lower limit of quantitation of flurbiprofen was 0.045 μg/mL in both the receiver and extraction fluids. There was no interference of the human pharynx tissue with the HPLC method. This investigation validated an analytical method for quantitating flurbiprofen, and determined a suitable receiver fluid and extraction method and fluid, which can be used to investigate the permeation and penetration of flurbiprofen through human pharynx tissue using the Franz diffusion cell method.

Pharyngeal Papilloma: a Rare Non-Pulmonary Cause of Hemoptysis

The most common benign neoplasm of the pharynx is papilloma. It is characterized by bulging brittle lesions, which are pedicled or sessile, whitish-grey or pinkish colour. Progressive hoarseness is the main clinical feature. When the papillomata spread throughout the tracheobronchial tree symptoms such as chronic cough, stridor, dyspnea or acute respiratory distress are mostly present. Hemoptysis as a presenting symptom is exceptionally rare in patients with pharyngeal papillomatosis. Herein, we report a case of pharyngeal papillomatosis in which hemoptysis was the primary clinical manifestation. The clinical and therapeutic aspects of the disease are briefly discussed.

Potential Anatomic Markers of Obstructive Sleep Apnea in Prepubertal Children

STUDY OBJECTIVES

Adenotonsillar hypertrophy is the major cause of obstructive sleep apnea (OSA) in prepubertal children, but children without enlarged lymphoid tissues may still suffer from OSA. This study aimed to identify other potential anatomic features associated with childhood OSA.

METHODS

This prospective study took place between January 2010 and April 2014. Prepubertal children suspected to have OSA, aged 6 to 11 years, were recruited. They underwent anthropometric measurements, nocturnal polysomnography, tonsil size evaluation, x-ray cephalometry, and sonographic measurement of lateral parapharyngeal wall (LPW) thickness. Linear regression analyses were used to test for the association between anatomic measurements and OSA severity. Logistic regression analyses were used to identify potential anatomic markers for different cutoffs (obstructive apneahypopnea index (OAHI) ≥ 1 and ≥ 5 events/h) for OSA.

RESULTS

Forty-seven children with OSA (20 with moderate to severe disease) and 43 children for the control group were recruited. Sonographic measurement of LPW thickness and position of hyoid bone taken from x-ray cephalometry were risk factors associated with OSA. Linear regression analyses found that these two phenotypes were associated with OAHI. Multivariate models adjusted for age, sex, body mass index, z score, and tonsil size revealed that lower position of hyoid bone was independently associated with higher risk for OSA, whereas both lower position of hyoid bone and greater LPW thickness were associated with higher OAHI and also a higher risk for moderate to severe OSA.

CONCLUSIONS

Position of hyoid bone and LPW thickness are anatomical markers of childhood OSA independent of obesity and tonsil size. Screening tools may include cephalometry and sonographic measurement of LPW to allow better delineation of OSA risk.

A Novel Non-invasive Approach for Measuring Upper Airway Collapsibility in Mice

Introduction: Invasive procedures were previously developed for measuring pharyngeal collapsibility in rodents during expiration, when declining neuromuscular activity makes the airway unstable. We developed a non-invasive approach for streamlining collapsibility measurements by characterizing responses in physiologic markers of dynamic expiratory airflow obstruction to negative nasal pressure challenges. Methods: Anesthetized mice were instrumented to monitor upper airway pressure-flow relationships with head-out plethysmography while nasal pressure was ramped down from ~ +5 to -20 cm H₂O over several breaths. Inspiratory and expiratory flow, volume, and timing characteristics were assessed breath-wise. Pcrit was estimated at transitions in expiratory amplitude and timing parameters, and compared to gold standard P_CRIT measurements when nasal and tracheal pressures diverged during expiration. Predictions equations were constructed in a development data set (n = 8) and applied prospectively to a validation data set (n = 16) to estimate gold standard P_CRIT. Results: The development data demonstrated that abrupt reversals in expiratory duration and tidal volume during nasal pressure ramps predicted gold standard P_CRIT measurements. After applying regression equations from the development to a validation dataset, we found that a combination of expiratory amplitude and timing parameters proved to be robust predictors of gold standard P_CRIT with minimal bias and narrow confidence intervals. Conclusions: Markers of expiratory airflow obstruction can be used to model upper airway collapsibility, and can provide sensitive measures of changes in airway collapsibility in rodents. This approach streamlines repeated non-invasive P_CRIT measurements, and facilitates studies examining the impact of genetic, environmental, and pharmacologic factors on upper airway control.

Systematic Review of Pharyngeal and Esophageal Manometry in Healthy or Dysphagic Older Persons (>60 years)

We undertook a systematic review of swallowing biomechanics, as assessed using pharyngeal and esophageal manometry in healthy or dysphagic older individuals aged over 60 years of age, comparing findings to studies of younger participants. PRISMA-P methodology was used to identify, select, and evaluate eligible studies. Across studies, older participants had lower upper esophageal sphincter (UES) resting pressures and evidence of decreased UES relaxation when compared to younger groups. Intrabolus pressures (IBP) above the UES were increased, demonstrating flow resistance at the UES. Pharyngeal contractility was increased and prolonged in some studies, which may be considered as an attempt to compensate for UES flow resistance. Esophageal studies show evidence of reduced contractile amplitudes in the distal esophagus, and an increased frequency of failed peristaltic events, in concert with reduced lower esophageal sphincter relaxation, in the oldest subjects. Major motility disorders occurred in similar proportions in older and young patients in most clinical studies, but some studies show increases in achalasia or spastic motility in older dysphagia and noncardiac chest pain patients. Overall, study qualities were moderate with a low likelihood of bias. There were few clinical studies specifically focused on swallowing outcomes in older patient groups and more such studies are needed.