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Williams HR, Wood G, Hakim AJ, Birchall M, Hirani SP. Self-reported throat symptoms in Ehlers-Danlos syndromes and hypermobility spectrum disorders: A cross-sectional survey study. Laryngoscope Investig Otolaryngol 2023; 8:1259-1264. [PMID: 37899864 PMCID: PMC10601551 DOI: 10.1002/lio2.1120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 06/15/2023] [Accepted: 06/22/2023] [Indexed: 10/31/2023] Open
Abstract
Objectives This study identified the frequency and severity of dysphagia, dysphonia, and laryngopharyngeal reflux symptoms in people with Ehlers-Danlos syndromes (EDS) or hypermobility spectrum disorders (HSD) and explored differences between diagnostic groups. Methods Participants were recruited via non-probability convenience sampling. Information was gathered via online survey, including the Reflux Symptom Index (RSI; Belafsky et al., J Voice. 2002;16:274-277), the Eating and Drinking Assessment Tool (EAT-10; Belafsky et al., Ann Otol Rhinol Laryngol. 2008;117:919-924), and the Voice Handicap Index (VHI; Jacobson et al., Am J Speech Lang Pathol. 1997;6(3):66-70). These were analyzed using ANOVAs. Results There were 1620 participants (96.6% female, 2.8% male) that met the inclusion criteria. The mean age was 38.09 (SD 12.22). 75.51% had hypermobile EDS (hEDS), 17.83% had HSD and 3.33% had classic EDS (cED). The cohort's mean scores were RSI = 22.95 (SD 9.01), EAT-10 = 11.91 (SD 9.66), and VHI score = 31.99 (SD 24.36). The hEDS group had significantly higher mean scores than the HSD group on RSI score and on some RSI items, on EAT-10 score and on all EAT-10 items, and on one VHI item. Conclusion People with EDS/HSD experience symptoms of acid reflux, dysphagia, and dysphonia to varying degrees with significant differences between hEDS than HSD. Awareness of the impact of EDS/HSD on throat symptoms will enable health care professionals to anticipate throat symptoms more readily in this population, providing individualized and effective management plans. Level of Evidence IV.
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Affiliation(s)
- Hannah R. Williams
- School of Health and Psychological SciencesCity, University of LondonLondonUK
- Surrey and Sussex Healthcare NHS TrustLondonUK
| | - Gary Wood
- University College London HospitalsLondonUK
- UCL Ear InstituteUniversity College London, University of LondonLondonUK
| | - Alan J. Hakim
- University College London HospitalsLondonUK
- The Wellington Hospital, HCA HealthcareUKLondonUK
| | - Martin Birchall
- University College London HospitalsLondonUK
- UCL Ear InstituteUniversity College London, University of LondonLondonUK
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Wang G, Wang L, Sun Z, Li L, Guo Y, Wu J, Wang Q, Fang J, Lv Q, Li G, Han H, Zhong C, Qu C, Li B, Sui X, Zhou Y, Liu H, Sataloff RT, Wu W. A Comparison Between W Score and RYAN Score in Diagnosing Laryngopharyngeal Reflux Disease. J Voice 2023:S0892-1997(23)00174-1. [PMID: 37429810 DOI: 10.1016/j.jvoice.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 06/05/2023] [Accepted: 06/06/2023] [Indexed: 07/12/2023]
Abstract
OBJECTIVE To assess the diagnostic value of the W score in differentiating laryngopharyngeal reflux disease (LPRD) patients from the normal population by pharyngeal pH (Dx-pH) monitoring, compared with the RYAN score. METHODS One hundred and eight patients with suspected LPRD and complete follow-up results after more than 8 weeks of anti-reflux therapy were enrolled from the Department of Otolaryngology-Head and Neck Surgery, Gastroenterology and Respiratory Medicine of seven hospitals. Their Dx-pH monitoring data before treatment were reanalyzed to obtain the W score in addition to the RYAN score and then the diagnostic sensitivity and specificity were compared and evaluated with reference to the result of anti-reflux therapy. RESULTS In eighty-seven (80.6%) cases, anti-reflux therapy was effective, and in 21 patients (19.4%), therapy was ineffective. Twenty-seven patients (25.0%) had a positive RYAN score. The W score was positive in 79 (73.1%) patients. There were 52 patients who had a negative RYAN score, but a positive W score. The diagnostic sensitivity, specificity, positive predictive value, and negative predictive value of the RYAN score were 28.7%, 90.5%, 92.6%, and 23.5%, respectively (kappa = 0.092, P = 0.068), whereas those of the W score for LPRD was 83.9%, 71.4%, 92.4%, and 51.7%, respectively (kappa = 0.484, P < 0.001). CONCLUSIONS W score is much more sensitive for the diagnosis of LPRD. Prospective studies with larger patient populations are necessary to validate and improve diagnostic efficacy. TRIAL REGISTRATION Chinese Clinical Trial Registry: ChiCTR1800014931.
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Affiliation(s)
- Gang Wang
- Department of Otorhinolaryngology-Head and Neck Surgery, PLA Strategic Support Force Characteristic Medical Center, Beijing, China
| | - Lei Wang
- Department of Otorhinolaryngology-Head and Neck Surgery, PLA Strategic Support Force Characteristic Medical Center, Beijing, China
| | - Zhezhe Sun
- Department of Otorhinolaryngology-Head and Neck Surgery, PLA Strategic Support Force Characteristic Medical Center, Beijing, China
| | - Lianyong Li
- Department of Gastroenterology, PLA Strategic Support Force Characteristic Medical Center, Beijing, China
| | - Yuzhu Guo
- Department of Automation Science and Electrical Engineering, Beihang University, Beijing, China
| | - Jimin Wu
- Department of Gastroesophageal Surgery, PLA Rocket Force Characteristic Medical Center, Beijing, China
| | - Qi Wang
- Department of Otorhinolaryngology-Head and Neck Surgery, Beijing Tongren Hospital of the Capital Medical University, Beijing, China
| | - Jugao Fang
- Department of Otorhinolaryngology-Head and Neck Surgery, Beijing Anzhen Hospital of the Capital Medical University, Beijing, China
| | - Qiuping Lv
- Department of Otorhinolaryngology-Head and Neck Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Gelin Li
- Department of Otorhinolaryngology-Head and Neck Surgery, Beijing Friendship Hospital of the Capital Medical University, Beijing, China
| | - Haolun Han
- Department of Otorhinolaryngology-Head and Neck Surgery, PLA Strategic Support Force Characteristic Medical Center, Beijing, China
| | - Changqing Zhong
- Department of Gastroenterology, PLA Strategic Support Force Characteristic Medical Center, Beijing, China
| | - Changmin Qu
- Department of Gastroenterology, PLA Strategic Support Force Characteristic Medical Center, Beijing, China
| | - Baowei Li
- Department of Otorhinolaryngology-Head and Neck Surgery, PLA Strategic Support Force Characteristic Medical Center, Beijing, China
| | - Xinke Sui
- Department of Gastroenterology, PLA Strategic Support Force Characteristic Medical Center, Beijing, China
| | - Ying Zhou
- Department of Otorhinolaryngology-Head and Neck Surgery, PLA Strategic Support Force Characteristic Medical Center, Beijing, China
| | - Hongdan Liu
- Department of Otorhinolaryngology-Head and Neck Surgery, PLA Strategic Support Force Characteristic Medical Center, Beijing, China
| | - Robert T Sataloff
- Department of Otorhinolaryngology-Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Wei Wu
- Department of Otorhinolaryngology-Head and Neck Surgery, PLA Strategic Support Force Characteristic Medical Center, Beijing, China.
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Role of Laryngopharyngeal Reflux Changes in Children with Adenoid Hypertrophy: A Randomized Controlled Prospective Study. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2023; 2023:5628551. [PMID: 36793763 PMCID: PMC9925235 DOI: 10.1155/2023/5628551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/07/2022] [Accepted: 10/12/2022] [Indexed: 02/09/2023]
Abstract
Objectives This prospective randomized controlled analysis aimed to assess the changes in laryngopharyngeal reflux (LPR) in children with adenoid hypertrophy (AH). Study design: a prospective, randomized, and controlled analysis. Methods The reflux symptom index (RSI) and the reflux finding score (RFS) scores were used to evaluate the laryngopharyngeal reflux changes in children diagnosed with adenoid hypertrophy. The pepsin concentration in salivary samples was examined, and the positive pepsin was used to assess the sensitivity and specificity of RSI, RFS, and RSI combined with RFS in forecasting LPR. Results In 43 children with AH, the sensitivity of the RSI and RFS scale (used alone or in combination) in diagnosing pharyngeal reflux in children with adenoid hypertrophy was lower. Pepsin expression was identified in 43 items of salivary samples, with a total positive rate of 69.77%, most of which were optimistic. The expression level of pepsin was positively correlated with the grade of adenoid hypertrophy (r = 0.576, P < 0.01). Based on the positive rate of pepsin, we found that the sensitivity and specificity of RSI and RFS were 5.77%, 35.03%, and 91.74%, 55.89%. Moreover, there was a noticeable distinction in the number of acid reflux episodes between the LPR-positive and LPR-negative groups. Conclusion There is a special connection between LPR change and children's AH. LPR exerts a crucial role in the progression of children's AH. Because of the low sensitivity of RSI and RFS, it is not suitable for LPR children to choose AH.
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Voice Disorders in Lower Primary School Teachers: An Observational Study. J Voice 2023; 37:141.e1-141.e8. [PMID: 33349479 DOI: 10.1016/j.jvoice.2020.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 12/03/2020] [Accepted: 12/03/2020] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Voice problems are very common among teachers, and etiology-based methods are used in the diagnosis and treatment process. Our study aims to reveal the changes in subjective voice analysis during the diagnosis and treatment process of dysphonia in lower primary school teachers. METHODS The nature of the study is a prospective observational one designed for lower primary school teachers in Kahramanmaraş conducted between the year 2015 and 2019 and evaluations for parameters including sociodemographic characteristics, laryngeal lesions and pre- and post-treatment scales such as Voice Handicap Index-10 (VHI-10), Reflux Symptom Index (RSI) and Hospital-Anxiety Depression Scale (HADS) for treatment subgroups were made. Statistical analysis was analyzed using SPSS. RESULTS Three hundred and fifty-one lower primary school teachers were included in the study. A statistically significant difference was found for the development of dysphonia in terms of sociodemographic features such as smoking, professional experience and crowdedness of classroom. Changes in RSI, VHI-10 and HADS values after treatment were clinically significant in all treatment groups. While there was a significant post-treatment improvement in terms of RSI in patients with granuloma and laryngopharyngeal reflux disorders, the VHI-10, and HADS assessments revealed a significant difference in clinical recovery compared to laryngeal lesions. CONCLUSION The RSI, VHI-10 and HADS values for various laryngeal pathologies were found to be high in dysphonic teachers. An improvement was observed in the scale scores upon the application of treatment modalities. This situation emphasizes the importance of questionnaire survey in the diagnosis, treatment, and follow-up process of dysphonia.
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Fujiki RB, Thibeault SL. Pediatric Voice Therapy: How Many Sessions to Discharge? AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:2663-2674. [PMID: 36198045 PMCID: PMC9911102 DOI: 10.1044/2022_ajslp-22-00111] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
PURPOSE Voice therapy is the primary treatment for children presenting with benign morphological vocal fold changes. This study examined the number of voice therapy sessions required to meet treatment goals and identified factors that predicted treatment length for pediatric voice patients. METHOD An observational cohort design was employed. Data were extracted from the University of Wisconsin-Madison Voice and Swallow Outcome Database. This study examined 62 children who completed a course of voice therapy with a speech-language pathologist (SLP) addressing dysphonia caused by benign vocal fold lesions. Extracted data included patient demographics, auditory-perceptual assessments, acoustic and aerodynamic voice measures, videostroboscopy ratings, and medical comorbidities. Linear regression was used to identify predictors of number of therapy sessions. RESULTS Patients received an average of 7.5 sessions of voice therapy prior to discharge. Baseline auditory-perceptual assessment of dysphonia (p = .032), phonation threshold pressure (PTP, p = .005), Glottal Function Index (GFI) score (p = .006), and glottic closure pattern (p = .023) were significant predictors of number of voice therapy sessions. These measures, as well as hourglass glottic closure, predicted longer intervention duration. The regression model had an overall r 2 of .62. CONCLUSIONS Pediatric voice therapy addressing benign vocal fold lesions and/or laryngeal edema required an average of 7.54 sessions before voice outcomes were sufficiently improved for discharge. More severe overall SLP ratings of dysphonia, GFI scores, PTP, or hourglass glottic closure pattern significantly predicted increased number of therapy sessions prior to discharge. Future work should determine what other factors affect treatment duration and how the efficiency of pediatric voice therapy can be maximized.
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Mahmud Mohayuddin N, Azman M, Wan Hamizan AK, Zahedi FD, Carroll TL, Mat Baki M. Reflux Finding Score Using HD Video Chromoendoscopy: A Diagnostic Adjunct in Suspected Laryngopharyngeal Reflux? J Voice 2022:S0892-1997(22)00164-3. [PMID: 35896429 DOI: 10.1016/j.jvoice.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 06/04/2022] [Accepted: 06/08/2022] [Indexed: 10/16/2022]
Abstract
OBJECTIVE To explore the use of real-time virtual chromoendoscopy (i-scan) in characterizing the mucosal changes present in subjects with suspected laryngopharyngeal reflux (LPR) and to compare the inter-rater and intra-rater agreement of Reflux Finding Scores (RFS) from both laryngologists and general otolaryngologists (ORL) observing exams using both white light endoscopy (WLE) and i-scan. METHODS This is a cross-sectional study that included 66 subjects: 46 symptomatic and 20 asymptomatic of suspected LPR based on the reflux symptom index (RSI). Subjects underwent flexible video laryngoscopic evaluation of the larynx utilising both WLE and i-scan during one continuous exam. Subjects also underwent 24-hour oropharyngeal pH-monitoring (Dx-pH). Two laryngologists and two general otolaryngologists evaluated the anonymized videos independently using RFS. Dx-pH results were interpreted using the pH graph, report and RYAN score. Subjects were then designated into one of three groups: no reflux, acid reflux and alkaline reflux. RESULTS For the symptomatic group, no mucosal irregularities or early mucosal lesions were observed except in one subject who had granulation tissue. The mean RFS using WLE and i-scan were, respectively: 11.8 (SD 6.1) and 11.3 (SD 5.6) in symptomatic and 7.3 (SD 5.7) and 7.3 (SD 5.2) in asymptomatic group. The inter-rater agreement of RFS using WLE and i-scan for both groups were good with intraclass correlation, ICC of 0.84 and 0.88 (laryngologists); and 0.85 and 0.81 (ORL). The intra-rater agreement among all four raters were good to excellent and similar for both WLE and i-scan (ICC of 0.80 to 0.99). 47 of 66 subjects had evidence of LPR on Dx-pH results which more specifically showed 39 subjects had "acid reflux" and 8 had "alkaline reflux". Sixteen subjects demonstrated a positive RYAN score but showed none were significantly correlated with their RFS. CONCLUSIONS This study reports the first utilization of real-time video chromoendoscopy with i-scan technology through high-definition flexible endoscopes to attempt to characterize laryngopharyngeal findings in patients suspected of having LPR. Both general otolaryngologists and laryngologists were equally capable of reliably calculating the RFS using both WLE and i-scan, however no significant improvement in agreement or change in RFS was found when i-scan technology was employed. LEVEL OF EVIDENCE Level 2.
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Affiliation(s)
- Nurhamizah Mahmud Mohayuddin
- Universiti Kebangsaan Malaysia Medical Centre, Hospital Canselor Tuanku Muhriz, Department of Otorhinolaryngology, Head and Neck Surgery, Kuala Lumpur, Malaysia
| | - Mawaddah Azman
- Universiti Kebangsaan Malaysia Medical Centre, Hospital Canselor Tuanku Muhriz, Department of Otorhinolaryngology, Head and Neck Surgery, Kuala Lumpur, Malaysia
| | - Aneeza Khairiyah Wan Hamizan
- Universiti Kebangsaan Malaysia Medical Centre, Hospital Canselor Tuanku Muhriz, Department of Otorhinolaryngology, Head and Neck Surgery, Kuala Lumpur, Malaysia
| | - Farah Dayana Zahedi
- Universiti Kebangsaan Malaysia Medical Centre, Hospital Canselor Tuanku Muhriz, Department of Otorhinolaryngology, Head and Neck Surgery, Kuala Lumpur, Malaysia
| | - Thomas Leigh Carroll
- Brigham and Women's Hospital, Division of Otolaryngology-Head and Neck Surgery and Harvard Medical School, Department of Otolaryngology-Head and Neck Surgery, Boston Massachusetts
| | - Marina Mat Baki
- Universiti Kebangsaan Malaysia Medical Centre, Hospital Canselor Tuanku Muhriz, Department of Otorhinolaryngology, Head and Neck Surgery, Kuala Lumpur, Malaysia.
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Pan Z, Ma T, Gao B, Ma EPM, Yu L, Qiu Z, Lu D. Survey of Referral Patterns in Southwestern Mainland China: How Do Pediatricians Manage Children with Dysphonia. J Voice 2022:S0892-1997(22)00128-X. [PMID: 35623982 DOI: 10.1016/j.jvoice.2022.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 04/22/2022] [Accepted: 04/22/2022] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Voice disorders are common in children and have a negative impact on their quality of life. However, presently, voice assessment and therapy are inaccessible in most pediatric departments of Mainland China. Thus, referring pediatric patients with voice disorders to otolaryngology is warranted for prompt and appropriate treatment. The purpose of this study is to investigate referral patterns and their influencing factors for pediatricians' managing children with dysphonia in Southwestern Mainland China. STUDY DESIGN Observational study. METHODS A 28-item questionnaire was designed by multidisciplinary experts, and an anonymous survey was performed online via Wenjuanxing between September 8, 2021 and October 8, 2021. The statistical analyses were performed using the independent sample median test, the linear/logistic regression model, the Kruskal-Wallis test, and Spearman's correlation test to determine any statistically significant relationships between the variables of interest. RESULTS Predominantly recruited from institutions in Southwestern China, 368 pediatricians were surveyed. (1) The majority of the pediatricians reported that ≤10% of children sought medical help for voice disorders; (2) only 22.1% of the pediatricians' hospitals had equipment for evaluating voice disorders; (3) 74.6% of the pediatricians would refer children with dysphonia to otolaryngology, and the older pediatricians were more likely to refer their patients than were the younger pediatricians (P = 0.022); (4) in the group that would make a referral (n = 250), the pediatricians who had worked longer (P = 0.037) and practised in the Grade-A tertiary hospitals (P = 0.044) were more likely to trust their experience as a reason for making a referral. For each year worked the probability of referring children with dysphonia depending on the pediatrician's experience increased by 3.4%. CONCLUSION Although the pediatricians encountered some barriers to diagnosing voice disorders, their attitude towards making referrals was positive. The age and work duration of the pediatricians and the hospital grade were the influencing factors in the referral patterns. Further publicity of vocal hygiene, ongoing education among Chinese pediatricians and the improvement of referral systems may be most useful for better managing children with dysphonia.
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Affiliation(s)
- Zhongjing Pan
- Department of Otorhinolaryngology, Head & Neck Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Tianpei Ma
- Laboratory for Aging and Cancer Research, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Bo Gao
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Estella P-M Ma
- Voice Research Laboratory, Faculty of Education, The University of Hong Kong, Pokfulam, Hong Kong
| | - Lingyu Yu
- Department of Otorhinolaryngology, Head & Neck Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zijun Qiu
- West China Clinical Medical School, Sichuan University, Chengdu Sichuan,China
| | - Dan Lu
- Department of Otorhinolaryngology, Head & Neck Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Perrine BL, Monzón K, Weber LM, Funderburk LK. The Impact of Fish Oil Supplementation on Self-Perception of the Voice in Vocal Performers: A Randomized, Single-Blind, Placebo-Controlled Study. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:4784-4790. [PMID: 34705542 DOI: 10.1044/2021_jslhr-21-00295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE Physically active adults have experienced training benefits from fish oil-derived omega-3 fatty acid (FO n3), which may also be of benefit to singers. The purpose of this research study was to determine if self-reported vocal adaptations and body composition changes occur in singers following FO n3 supplementation in conjunction with a singer's normal training regimen. METHOD Twenty college students, currently enrolled in vocal lessons at a university, were randomized to receive either 3.0 g of FO n3 or placebo, which they took during a 10-week study period. Participants were blinded to group assignment. Participants completed the Reflux Symptom Index (RSI), Singing Voice Handicap Index-10 (SVHI-10), and the Evaluation of Ability to Sing Easily (EASE) and submitted to body composition measures (weight, skeletal mass, and body fat mass) before and after the study period. RESULTS Sixteen participants completed all parts of the study protocol. Mean compliance for the placebo group (83.9%) and the supplement group (75.2%) was similar. There were no significant differences in body composition measures, RSI scores, and EASE scores between groups. Scores on the SVHI-10 decreased significantly over time for all participants. CONCLUSIONS Improvements seen in the SVHI-10 were not meaningfully different between the supplement and placebo group, pointing to the benefit of weekly lessons. The lack of changes in the questionnaire scores in the supplement group are partially attributed to the low compliance rate and low sample size, which is supported by the lack of change in the body composition measures.
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Affiliation(s)
- Brittany L Perrine
- Department of Communication Sciences and Disorders, Baylor University, Waco, TX
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Snow G, Dhar SI, Akst LM. How to Understand and Treat Laryngopharyngeal Reflux. Gastroenterol Clin North Am 2021; 50:871-884. [PMID: 34717876 DOI: 10.1016/j.gtc.2021.08.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Laryngopharyngeal reflux (LPR) is frustrating, as symptoms are nonspecific and diagnosis is often unclear. Two main approaches to diagnosis are empiric treatment trials and objective reflux testing. Initial empiric trial of Proton pump inhibitors (PPI) twice daily for 2-3 months is convenient, but risks overtreatment and delayed diagnosis if patient complaints are not from LPR. Dietary modifications, H2-antagonists, alginates, and fundoplication are other possible LPR treatments. If objective diagnosis is desired or patients' symptoms are refractory to empiric treatment, pH testing with/without impedance should be considered. Additionally, evaluation for non-reflux etiologies of complaints should be performed, including laryngoscopy or videostroboscopy.
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Affiliation(s)
- Grace Snow
- Division of Laryngology, Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins University School of Medicine, 601 North Caroline Street, 6th Floor, Baltimore, MD 21287, USA
| | - Shumon I Dhar
- Division of Laryngology, Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins University School of Medicine, 601 North Caroline Street, 6th Floor, Baltimore, MD 21287, USA
| | - Lee M Akst
- Division of Laryngology, Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins University School of Medicine, 601 North Caroline Street, 6th Floor, Baltimore, MD 21287, USA.
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Benign Vocal Fold Lesions in Children. CURRENT OTORHINOLARYNGOLOGY REPORTS 2021. [DOI: 10.1007/s40136-020-00318-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kakaje A, Alhalabi MM, Alyousbashi A, Hamid A, Mahmoud Y. Laryngopharyngeal reflux in war-torn Syria and its association with smoking and other risks: an online cross-sectional population study. BMJ Open 2020; 10:e041183. [PMID: 33243809 PMCID: PMC7692828 DOI: 10.1136/bmjopen-2020-041183] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 10/17/2020] [Accepted: 11/05/2020] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES To demonstrate the burden of laryngopharyngeal reflux (LPR) in Syria and its associated variables. DESIGN This is a cross-sectional study that used online questionnaires that included demographics, smoking, war-related questions and reflux symptom index (RSI). SETTING This research was conducted online across Syria and included the general population. PARTICIPANTS Participants who lived in Syria, agreed to participate, and responded to all the RSI questions were included. This research comprised 734 participants, with 94.6% response rate, 75.5% being females, and a mean age of 24 years. RESULTS Overall, 31.9% of subjects had symptoms suggestive of LPR. Participants who were 30 years and younger had fewer symptoms suggestive of LPR compared with the older group p=0.012 (OR 0.534; 95% CI 0.325 to 0.877). While having an epigastric burning sensation, chest pain and indigestion were the most common symptoms, having a sore throat was the least common. Being distressed from war noises was associated with more symptoms p=0.009 (OR 1.562; 95% CI 1.117 to 2.183). However, losing someone or changing place of living due to war were not significantly associated with these symptoms p>0.05. RSI scores were associated with cigarette and/or shisha smoking p<0.05. Finally, asthma, allergic disorders and having a job were associated with having LPR symptoms p<0.05. No significant findings were observed in consanguinity, marital status, educational level and socioeconomic status. CONCLUSIONS War, smoking, asthma, allergies, respiratory conditions and having a job were associated with LPR symptoms. However, they may be associated with these symptoms independently from LPR; for instance, similar symptoms can be caused by the mental disorders from war, the unique environment and irritant substances of the laryngeal mucosa.
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Affiliation(s)
- Ameer Kakaje
- Damascus University Faculty of Medicine, Damascus, Syrian Arab Republic
| | | | - Ayham Alyousbashi
- Damascus University Faculty of Medicine, Damascus, Syrian Arab Republic
| | - Aya Hamid
- Damascus University Faculty of Medicine, Damascus, Syrian Arab Republic
| | - Yousef Mahmoud
- Damascus University Faculty of Medicine, Damascus, Syrian Arab Republic
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Dabirmoghaddam P, Rahmaty B, Erfanian R, Taherkhani S, Hosseinifar S, Satariyan A. Voice Component Relationships with High Reflux Symptom Index Scores in Muscle Tension Dysphonia. Laryngoscope 2020; 131:E1573-E1579. [PMID: 33135806 DOI: 10.1002/lary.29220] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 09/22/2020] [Accepted: 10/16/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To analyze the Reflux Symptom Index (RSI) and the Voice-Related Quality of Life (V-RQOL) scores based on the perceptual and analytical parameters in primary MTD patients with no reflux. STUDY DESIGN Cross-sectional study. METHODS One hundred and eighteen participants, that is, sixty patients with normal voices and fifty-eight patients with primary MTD were recruited in this study. The diagnosis of primary MTD was made by perceptual voice analysis, neck palpation, video-laryngoscopic examination, and exclusion of other etiologies. Acoustic analysis and the GRBAS (Grade, Roughness, Breathiness, Asthenia, and Strain) scale were evaluated for all participants. The V-RQOL and RSI questionnaires were then given to all participants. RESULTS This study included 118 participants of 29 males (48.3%) and 31 females (51.7%) in the normal group. MTD group also included 27 males (46.6%) and 31 (53.4%) female patients. Mean (SD) RSI and V-RQOL scores were 12.35 (3.84) and 11.09 (2.20) for the normal group, and 22.87 (6.97) and 22.89 (7.94) for the MTD group (P = .000). In the MTD group, V-RQOL had a positive correlation with jitter for /i/ and /u/, Noise to Harmonic Ratio (NHR) for /i/, /a/, and /u/, and Grade, Roughness, and Strain of GRBAS scale (P < .05). In addition, RSI had a positive correlation with Strain in the MTD group (P < .05). CONCLUSION MTD patients in the absence of laryngopharyngeal reflux findings may have high RSI scores. Hence, patients with high RSI scores and disproportionate acoustic and perceptual analysis would require a thorough evaluation of MTD. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E1573-E1579, 2021.
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Affiliation(s)
- Payman Dabirmoghaddam
- Associate Professor of Otorhinolaryngology-Head and Neck Surgery, Otorhinolaryngology Research Center, Amir Alam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Benyamin Rahmaty
- Resident of Otorhinolaryngology-Head and Neck Surgery, Otorhinolaryngology Research Center, Amir Alam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Erfanian
- Assistant Professor of Otorhinolaryngology-Head and Neck Surgery, Otorhinolaryngology Research Center, Amir Alam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Safa Taherkhani
- Department of Biomedical Engineering (Center of Excellence), Amirkabir University of Technology, Tehran, Iran
| | - Shamim Hosseinifar
- Otorhinolaryngology Research Center, Amir Alam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Adnan Satariyan
- College of Arts, Law, and Education, University of Tasmania (UTAS), Launceston, Tasmania, Australia
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Zhang M, Chia C, Stanley C, Phyland DJ, Paddle PM. Diagnostic Utility of Salivary Pepsin as Compared With 24-Hour Dual pH/Impedance Probe in Laryngopharyngeal Reflux. Otolaryngol Head Neck Surg 2020; 164:375-380. [DOI: 10.1177/0194599820951183] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Objective Laryngopharyngeal reflux (LPR) is defined as the retropulsion of gastric contents into the larynx, oropharynx, and/or nasopharynx. The 24-hour combined hypopharyngeal-esophageal multichannel intraluminal impedance with dual pH probe (24h-HEMII-pH) is currently the gold standard in LPR diagnosis; however, it is invasive, user dependent, and not always tolerated. This study assesses the diagnostic utility of salivary pepsin (Peptest) at different thresholds and during symptomatic periods as compared with the 24h-HEMII-pH probe in diagnosing LPR. Study Design Prospective cohort study. Setting Private laryngology clinic in Melbourne, Australia. Subjects and Methods Thirty-five patients with a clinical history and endoscopic findings of LPR were recruited and simultaneously evaluated for LPR via 24h-HEMII-pH probe and salivary pepsin analysis at 5 key time points over the same 24-hour period. Results Salivary pepsin was 76.9% sensitive and had a positive predictive value (PPV) of 87.0% at a threshold of 16 ng/mL when compared with the 24h-HEMII-pH probe. If the pathologic pepsin threshold was raised to 75 ng/mL, salivary pepsin had a sensitivity of 57.7%, a specificity of 75.0%, and a PPV of 93.8%. Symptomatic testing conferred a superior specificity at 16 ng/mL (66.7%) and 75 ng/mL (100.0%) and a superior PPV at 16 ng/mL (92.3%) and 75 ng/mL (100.0%). Conclusion Salivary pepsin detection is a simpler, more cost-effective, and less traumatic universal first-line alternative to 24h-HEMII-pH probe in diagnosing LPR. Superior specificities conferring greater diagnostic value may be achieved with higher thresholds and symptomatic testing. If clinical suspicion remains high following negative salivary pepsin analysis, a 24h-HEMII-pH study could provide further diagnostic information.
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Affiliation(s)
- Michael Zhang
- Department of Otolaryngology–Head and Neck Surgery, Monash Health, Melbourne, Australia
| | - Clemente Chia
- Department of Otolaryngology–Head and Neck Surgery, Monash Health, Melbourne, Australia
| | - Claire Stanley
- Department of Otolaryngology–Head and Neck Surgery, Monash Health, Melbourne, Australia
| | - Debra J. Phyland
- Department of Otolaryngology–Head and Neck Surgery, Monash Health, Melbourne, Australia
- Department of Surgery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
- Melbourne Swallow Analysis Centre, Melbourne, Australia
| | - Paul M. Paddle
- Department of Otolaryngology–Head and Neck Surgery, Monash Health, Melbourne, Australia
- Department of Surgery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
- Melbourne Swallow Analysis Centre, Melbourne, Australia
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14
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Jiang G, Cai Y, Yi X, Li Y, Lin Y, Li Q, Xu J, Ke M, Xue K. The impact of laryngopharyngeal reflux disease on 95 hospitalized patients with COVID-19 in Wuhan, China: A retrospective study. J Med Virol 2020; 92:2124-2129. [PMID: 32396239 PMCID: PMC7272861 DOI: 10.1002/jmv.25998] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 05/02/2020] [Accepted: 05/07/2020] [Indexed: 01/08/2023]
Abstract
Studies have demonstrated that comorbidities, especially cardiovascular and endocrine diseases, correlated with poorer clinical outcomes. However, the impact of digestive system diseases has not been issued. The aim of this study is to determine the impact of laryngopharyngeal reflux disease (LPRD) on hospitalized patients with coronavirus disease 2019 (COVID‐19). We extracted clinical data regarding 95 patients in Wuhan Jinyintan Hospital, Wuhan, China, between 26 January and 21 February 2020. The Reflux Symptom Index (RSI) was used to assess the presence and severity of LPRD. An RSI greater than 13 is considered to be abnormal. A total of 95 patients with COVID‐19 were enrolled, with 61.1% (58/95), 32.6% (31/95), and 6.3% (6/95) being moderately ill, severely ill, and critically ill, respectively. In this study, 38.9% (37/95) of the patient had an RSI score over 13, which was indicative of LPRD. In univariable analysis, the age and RSI scores of severely or critically ill patients were statistically significantly higher than patients with moderate disease (P = .026 and P = .005, respectively). After controlling for age difference in a multivariable model, the RSI greater than 13, compared to RSI equal to 0, was associated with significantly higher risk of severe infection (P < .001; odds ratio [OR] = 11.411; 95% confidence interval [CI], 2.95‐42.09) and critical infection (P = .028; OR= 19.61; 95% CI, 1.38‐277.99). Among hospitalized patients with COVID‐19, RSI scores greater than 13, indicative of LPRD, correlated with poorer clinical outcomes. The prevalence of LPRD may be higher than the general population, which indicated that COVID‐19 can impair the upper esophageal sphincter and aggravate reflux. The imapct of laryngopharyngeal reflux disease (LPRD) has been analyzed. The prevalence of LPRD in patients with COVID‐19 may be higher than the general population. The RSI score greater than 13, indicative of LPRD, correlated with poorer clinical outcomes.
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Affiliation(s)
- Guiyuan Jiang
- Respiratory Hospital of the Second Affiliated Hospital of Xiamen Medical College, Xiamen, Fujian, China.,Institute of Respiratory Diseases, Xiamen Medical College, Xiamen, China
| | - Yanping Cai
- Infection Division, Wuhan Jinyintan Hospital, Wuhan, China
| | - Xue Yi
- Institute of Respiratory Diseases, Xiamen Medical College, Xiamen, China.,Key Laboratory of Functional and Clinical Translational Medicine, Fujian Province University, Fuzhou, China
| | - Yanping Li
- Institute of Respiratory Diseases, Xiamen Medical College, Xiamen, China.,Key Laboratory of Functional and Clinical Translational Medicine, Fujian Province University, Fuzhou, China
| | - Yong Lin
- Department of Respiratory Medicine, Xiamen Haicang Hospital, Xiamen, Fujian, China
| | - Qing Li
- Department of Intensive Care Unit, The Second People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Jingqing Xu
- Third Department of Intensive Care Unit, Fujian Provincial Hospital, Fuzhou, China
| | - Mingyao Ke
- Respiratory Hospital of the Second Affiliated Hospital of Xiamen Medical College, Xiamen, Fujian, China.,Institute of Respiratory Diseases, Xiamen Medical College, Xiamen, China
| | - Keying Xue
- Respiratory Hospital of the Second Affiliated Hospital of Xiamen Medical College, Xiamen, Fujian, China.,Institute of Respiratory Diseases, Xiamen Medical College, Xiamen, China
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