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Podzimek J, Jecker P, Koscielny S, Guntinas-Lichius O. [Reliability and validity of the German version of the Glasgow Edinburgh Throat Scale]. Laryngorhinootologie 2024. [PMID: 39102848 DOI: 10.1055/a-2362-0465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/07/2024]
Abstract
BACKGROUND Many patients who consult the ENT doctor suffer from globus sensation, as a term for a multifactorial symptom description. It is particularly important during initial consultation to take the often-sensitive patients seriously and to offer a structured diagnostic clarification. Today, there is a lack of a screening tool in everyday clinical practice that can be used to differentiate the globus sensations more closely and assess their severity OBJECTIVES: The reliability and validity of the German version of the Glasgow Edinburgh Throat Scale (GETS) were examined. MATERIALS UND METHODS The original GETS questionnaire was translated into German (GETS-G) and completed by 60 patients with globus sensation (>3 months) in a prospective observational study. All patients received a clinical examination a sonography of the neck. In patients without an identifiable organic cause, a pH monitoring was carried out. RESULTS A local organic cause for the globus sensation was found in 30 patients (50%). In addition, reflux was detected in 24 patients (40%) using pH monitoring. No cause could be determined in only 6 patients (10%). According to the overall score (Q1-Q12), there was no significant difference between these three groups. The Cronbach's alpha for assessing reliability was 0.88 in the 12-item analysis. Principal component analysis yielded a globus scale, dysphagia scale and a chronic pharyngeal irritation scale. CONCLUSIONS The GETS-G showed high reliability and validity, which justifies its use in patients with globus sensation in German-speaking countries and may lead to a better assessment of the severity of this symptom.
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Affiliation(s)
- Jiri Podzimek
- Klinik für HNO und Plastische Kopf-Hals-Chirurgie, Klinikum Bad Salzungen GmbH, Bad Salzungen, Germany
| | - Peter Jecker
- Klinik für HNO und Plastische Kopf-Hals-Chirurgie, Klinikum Bad Salzungen GmbH, Bad Salzungen, Germany
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Goyal S, Jitender, Garg M, Bala R. Etiological and clinical profiles of patients with dysphagia: A teaching institution experience. J Family Med Prim Care 2024; 13:1881-1886. [PMID: 38948572 PMCID: PMC11213375 DOI: 10.4103/jfmpc.jfmpc_1226_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 12/11/2023] [Accepted: 12/16/2023] [Indexed: 07/02/2024] Open
Abstract
Background Dysphagia can involve any structure from the mouth to the lower esophageal sphincter. The etiologies vary from benign causes to malignant lesions. There is dearth of data regarding dysphagia in our population. Methods A total of 208 patients with complaints of dysphagia were screened for the study. After ruling out neurological/local oropharyngeal causes of dysphagia, 200 patients with suspected esophageal dysphagia (ED) were recruited in the study. Dysphagia was graded as per the dysphagia scoring system. All patients underwent upper gastro-intestinal endoscopy and were evaluated for the presence of mechanical and non-mechanical causes of ED. Results The mean age of patients with dysphagia was 53.8 ± 15.4 years. with males and females being 82 and 118, respectively. The mean duration of the symptom was 7.2 ± 10.6 months (median 3 months). Ninety-eight patients (49%) having dysphagia were in the age group of 56-65 years. The dysphagia score was 0 among 58, and 4 among 26 subjects. Foreign body sensation was the most frequent chief complaint in 90 (45%) patients. Ninety-six (48%) and 104 (52%) patients had mechanical and non-mechanical causes of dysphagia, respectively. Among mechanical causes of dysphagia, 68 patients (70.8%) had esophageal growth and 28 (29.2%) had esophageal stricture. Sixty-seven patients had squamous cell carcinoma. Among non-mechanical causes, 50 (48.1%) had globus sensation, 24 (23.1%) had hiatus hernia, and 16 (15.4%) functional dysphagia. Conclusion Dysphagia is a common problem with varied etiologies. The esophageal growth and globus sensation are among the predominant causes of ED. We stress that all patients of dysphagia must be meticulously investigated.
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Affiliation(s)
- Sandeep Goyal
- Department of Medicine, Pt. B. D. Sharma PGIMS, Rohtak, Haryana, India
| | - Jitender
- Department of Medicine, Pt. B. D. Sharma PGIMS, Rohtak, Haryana, India
| | - Manjri Garg
- Department of Medicine, Pt. B. D. Sharma PGIMS, Rohtak, Haryana, India
| | - Renu Bala
- Department of Medicine, Pt. B. D. Sharma PGIMS, Rohtak, Haryana, India
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Ayres L, Perring S, Nouraei SAR. A multidisciplinary approach to identifying and managing heterotopic gastric inlet patches. Neurogastroenterol Motil 2024; 36:e14768. [PMID: 38487993 DOI: 10.1111/nmo.14768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 12/23/2023] [Accepted: 12/26/2023] [Indexed: 03/26/2024]
Abstract
INTRODUCTION Gastric inlet patches are often incidental, but can also be a treatable cause of laryngo-esophageal symptoms. METHODS We retrospectively reviewed all patients whose gastric inlet patches were diagnosed following assessment for laryngopharyngeal and swallowing symptoms. Improvement following Argon Plasma Coagulation (APC) was assessed using Minimum Clinically-Important Difference methodology combining voice, throat, and swallowing domains. Correlations between APC response and measures of reflux and mucosal barrier integrity, measured during 24-h pH-impedance manometry, were obtained. Proximal and Distal Mean Nocturnal Baseline Impedance (MNBI) values were separately calculated and the novel variable of Mucosal Impedance Gradient was derived as [((Distal MNBI-Proximal MNBI)/((Distal MNBI + Proximal MMBI)/2)) x 100]. KEY RESULTS Inlet patches were detected in 57 of 651 patients who had Transnasal Panendoscopy (8.7 ± 2.2%). There were 34 males. Mean age was 58 years. Mean duration of symptoms was 2 years. The commonest symptoms were hoarseness (n = 33), throat symptoms (n = 24), and dysphagia (n = 21), respectively. APC was used to ablate patches in 34 patients. Treatment response was 71% at a mean followup of 5.5 months. MIG > - 25% predicted response to APC, with area under the receiver operating characteristic curve of 0.875 (Sensitivity = 81%; Specificity = 100%; p < 0.0001). CONCLUSIONS Gastric inlet patches are common and under-recognized. They can cause protracted pharyngo-esophageal symptoms. Patch ablation is an effective treatment for carefully selected patients. Optimal patient selection requires multidisciplinary teamwork. Mucosal Impedance Gradient could further refine patient selection.
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Affiliation(s)
- L Ayres
- Department of Gastroenterology, University Hospitals of Dorset NHS Foundation Trust, Poole, UK
| | - S Perring
- Department of Medical Physics, University Hospitals of Dorset NHS Foundation Trust, Poole, UK
| | - S A R Nouraei
- The Clinical Informatics Research Unit, University of Southampton, Southampton, UK
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Thomson S, Ainsworth G, Selvanathan S, Brown S, Croft J, Kelly R, Mujica-Mota R, Rousseau N, Higham R, Stocken D. Clinical and cost-effectiveness of PCF versus ACD in the treatment of cervical brachialgia (FORVAD trial). Br J Neurosurg 2024; 38:141-148. [PMID: 37807634 DOI: 10.1080/02688697.2023.2267119] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 10/01/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Cervical radiculopathy occurs when a nerve root is compressed in the spine, if symptoms fail to resolve after 6 weeks surgery may be indicated. Anterior Cervical Discectomy (ACD) is the commonest procedure, Posterior Cervical Foraminotomy (PCF) is an alternative that avoids the risk of damage to anterior neck structures. This prospective, Phase III, UK multicentre, open, individually randomised controlled trial was performed to determine whether PCF is superior to ACD in terms of improving clinical outcome as measured by the Neck Disability Index (NDI) 52 weeks post-surgery. METHOD Following consent to participate and collection of baseline data, subjects with cervical brachialgia were randomised to ACD or PCF in a 1:1 ratio on the day of surgery. Clinical outcomes were assessed on day 1 and patient reported outcomes on day 1 and weeks 6, 12, 26, 39 and 52 post-operation. A total of 252 participants were planned to be randomised. Statistical analysis was limited to descriptive statistics. Health economic outcomes were also described. RESULTS The trial was closed early (n = 23). Compared to baseline, the median (interquartile range (IQR)) NDI score at 52 weeks reduced from 44.0 (36.0, 62.0) to 25.3 (20.0, 42.0) in the PCF group and increased from 35.6 (34.0, 44.0) to 45.0 (20.0, 57.0) in the ACD group. ACD may be associated with more swallowing, voice and other complications and was more expensive; neck and arm pain scores were similar. CONCLUSIONS The trial was closed early, therefore no definitive conclusions on clinical or cost-effectiveness could be made.
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Affiliation(s)
- Simon Thomson
- Department of Neurosurgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Senthil Selvanathan
- Academic Unit of Health Economics, Institute of Health Sciences, University of Leeds, UK
| | - Sarah Brown
- Clinical Trials Research Unit, University of Leeds, UK
| | - Julie Croft
- Clinical Trials Research Unit, University of Leeds, UK
| | - Rachel Kelly
- Clinical Trials Research Unit, University of Leeds, UK
| | | | | | - Ruchi Higham
- Clinical Trials Research Unit, University of Leeds, UK
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Parker SM, Smith JA, Birring SS, Chamberlain-Mitchell S, Gruffydd-Jones K, Haines J, Hennessey S, McGarvey LP, Marsden P, Martin MJ, Morice A, O'Hara J, Thomas M. British Thoracic Society Clinical Statement on chronic cough in adults. Thorax 2023; 78:s3-s19. [PMID: 38088193 DOI: 10.1136/thorax-2023-220592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Affiliation(s)
- Sean M Parker
- Department of Respiratory Medicine, North Tyneside General Hospital, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Jaclyn Ann Smith
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
| | - Surinder S Birring
- Department of Respiratory Medicine, Kings College Hospital, London, UK
- Centre for Human and Applied Physiological Sciences, School of Basic and Medical Biosciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | | | | | - Jemma Haines
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
- North West Lung Centre, Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
| | | | | | - Paul Marsden
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
- North West Lung Centre, Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
| | | | - Alyn Morice
- Castle Hill Hospital, Cottingham, UK
- University of Hull, Hull, UK
| | - James O'Hara
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
- Population Health Sciences Institute, Newcastle University, Newcastle, UK
| | - Mike Thomas
- Academic Unit of Primary Care and Population Science, University of Southampton, Southampton, UK
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Thomson S, Ainsworth G, Selvanathan S, Kelly R, Collier H, Mujica-Mota R, Talbot R, Brown ST, Croft J, Rousseau N, Higham R, Al-Tamimi Y, Buxton N, Carleton-Bland N, Gledhill M, Halstead V, Hutchinson P, Meacock J, Mukerji N, Pal D, Vargas-Palacios A, Prasad A, Wilby M, Stocken D. Posterior cervical foraminotomy versus anterior cervical discectomy for Cervical Brachialgia: the FORVAD RCT. Health Technol Assess 2023; 27:1-228. [PMID: 37929307 PMCID: PMC10641711 DOI: 10.3310/otoh7720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023] Open
Abstract
Background Posterior cervical foraminotomy and anterior cervical discectomy are routinely used operations to treat cervical brachialgia, although definitive evidence supporting superiority of either is lacking. Objective The primary objective was to investigate whether or not posterior cervical foraminotomy is superior to anterior cervical discectomy in improving clinical outcome. Design This was a Phase III, unblinded, prospective, United Kingdom multicentre, parallel-group, individually randomised controlled superiority trial comparing posterior cervical foraminotomy with anterior cervical discectomy. A rapid qualitative study was conducted during the close-down phase, involving remote semistructured interviews with trial participants and health-care professionals. Setting National Health Service trusts. Participants Patients with symptomatic unilateral cervical brachialgia for at least 6 weeks. Interventions Participants were randomised to receive posterior cervical foraminotomy or anterior cervical discectomy. Allocation was not blinded to participants, medical staff or trial staff. Health-care use from providing the initial surgical intervention to hospital discharge was measured and valued using national cost data. Main outcome measures The primary outcome measure was clinical outcome, as measured by patient-reported Neck Disability Index score 52 weeks post operation. Secondary outcome measures included complications, reoperations and restricted American Spinal Injury Association score over 6 weeks post operation, and patient-reported Eating Assessment Tool-10 items, Glasgow-Edinburgh Throat Scale, Voice Handicap Index-10 items, PainDETECT and Numerical Rating Scales for neck and upper-limb pain over 52 weeks post operation. Results The target recruitment was 252 participants. Owing to slow accrual, the trial closed after randomising 23 participants from 11 hospitals. The qualitative substudy found that there was support and enthusiasm for the posterior cervical FORaminotomy Versus Anterior cervical Discectomy in the treatment of cervical brachialgia trial and randomised clinical trials in this area. However, clinical equipoise appears to have been an issue for sites and individual surgeons. Randomisation on the day of surgery and processes for screening and approaching participants were also crucial factors in some centres. The median Neck Disability Index scores at baseline (pre surgery) and at 52 weeks was 44.0 (interquartile range 36.0-62.0 weeks) and 25.3 weeks (interquartile range 20.0-42.0 weeks), respectively, in the posterior cervical foraminotomy group (n = 14), and 35.6 weeks (interquartile range 34.0-44.0 weeks) and 45.0 weeks (interquartile range 20.0-57.0 weeks), respectively, in the anterior cervical discectomy group (n = 9). Scores appeared to reduce (i.e. improve) in the posterior cervical foraminotomy group, but not in the anterior cervical discectomy group. The median Eating Assessment Tool-10 items score for swallowing was higher (worse) after anterior cervical discectomy (13.5) than after posterior cervical foraminotomy (0) on day 1, but not at other time points, whereas the median Glasgow-Edinburgh Throat Scale score for globus was higher (worse) after anterior cervical discectomy (15, 7, 6, 6, 2, 2.5) than after posterior cervical foraminotomy (3, 0, 0, 0.5, 0, 0) at all postoperative time points. Five postoperative complications occurred within 6 weeks of surgery, all after anterior cervical discectomy. Neck pain was more severe on day 1 following posterior cervical foraminotomy (Numerical Rating Scale - Neck Pain score 8.5) than at the same time point after anterior cervical discectomy (Numerical Rating Scale - Neck Pain score 7.0). The median health-care costs of providing initial surgical intervention were £2610 for posterior cervical foraminotomy and £4411 for anterior cervical discectomy. Conclusions The data suggest that posterior cervical foraminotomy is associated with better outcomes, fewer complications and lower costs, but the trial recruited slowly and closed early. Consequently, the trial is underpowered and definitive conclusions cannot be drawn. Recruitment was impaired by lack of individual equipoise and by concern about randomising on the day of surgery. A large prospective multicentre trial comparing anterior cervical discectomy and posterior cervical foraminotomy in the treatment of cervical brachialgia is still required. Trial registration This trial is registered as ISRCTN10133661. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 27, No. 21. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Simon Thomson
- Department of Neurosurgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Gemma Ainsworth
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | | | - Rachel Kelly
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Howard Collier
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | | | - Rebecca Talbot
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Sarah Tess Brown
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Julie Croft
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Nikki Rousseau
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Ruchi Higham
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Yahia Al-Tamimi
- Department of Neurosurgery, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Neil Buxton
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | | | - Martin Gledhill
- Department of Speech and Language Therapy, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Peter Hutchinson
- Department of Clinical Neurosciences, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - James Meacock
- Department of Neurosurgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Nitin Mukerji
- Department of Neurosurgery, The James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Debasish Pal
- Department of Neurosurgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Anantharaju Prasad
- Department of Neurosurgery, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Martin Wilby
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Deborah Stocken
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
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Imperiale MN, Lieb R, Meinlschmidt G. Treatment-associated network dynamics in patients with globus sensations: a proof-of-concept study. Sci Rep 2023; 13:15615. [PMID: 37730963 PMCID: PMC10511470 DOI: 10.1038/s41598-023-42186-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 09/06/2023] [Indexed: 09/22/2023] Open
Abstract
In this proof-of-concept study, we used a systems perspective to conceptualize and investigate treatment-related dynamics (temporal and cross-sectional associations) of symptoms and elements related to the manifestation of a common functional somatic syndrome (FSS), Globus Sensations (GS). We analyzed data from 100 patients (M = 47.1 years, SD = 14.4 years; 64% female) with GS who received eight sessions of group psychotherapy in the context of a randomized controlled trial (RCT). Symptoms and elements were assessed after each treatment session. We applied a multilevel graphical vector-autoregression (ml GVAR) model approach resulting in three separate, complementary networks (temporal, contemporaneous, and between-subject) for an affective, cognitive, and behavioral dimension, respectively. GS were not temporally associated with any affective, cognitive, and behavioral elements. Temporally, catastrophizing cognitions predicted bodily weakness (r = 0.14, p < 0.01, 95% confidence interval (CI) [0.04-0.23]) and GS predicted somatic distress (r = 0.18, p < 0.05, 95% CI [0.04-0.33]). Potential causal pathways between catastrophizing cognitions and bodily weakness as well as GS and somatic distress may reflect treatment-related temporal change processes in patients with GS. Our study illustrates how dynamic NA can be used in the context of outcome research.
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Affiliation(s)
- Marina N Imperiale
- Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Missionsstrasse 62a, 4055, Basel, Switzerland
| | - Roselind Lieb
- Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Missionsstrasse 62a, 4055, Basel, Switzerland
| | - Gunther Meinlschmidt
- Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Missionsstrasse 62a, 4055, Basel, Switzerland.
- Department of Clinical Psychology and Cognitive Behavioral Therapy, International Psychoanalytic University (IPU) Berlin, Stromstrasse 1, 10555, Berlin, Germany.
- Department of Digital and Blended Psychosomatics and Psychotherapy, Psychosomatic Medicine, University Hospital Basel and University of Basel, Hebelstrasse 2, 4031, Basel, Switzerland.
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Akbaş Y, Atalik G, Yilmaz M, Bozdayi G. Determination of the Relationship between Globus-Type Complaints and COVID-19 Anxiety in Adult Cases with COVID-19. Folia Phoniatr Logop 2023; 76:183-191. [PMID: 37573781 PMCID: PMC10997256 DOI: 10.1159/000533564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 06/26/2023] [Indexed: 08/15/2023] Open
Abstract
INTRODUCTION Besides generalized symptoms, patients with COVID-19 also show otolaryngological (ENT) symptoms. Globus is one of these symptoms. Anxiety problems may accompany the disease, as well. This study investigated the relationship between globus symptoms and COVID-19 anxiety in patients diagnosed with COVID-19. METHODS The Turkish version of Glasgow-Edinburgh Throat Scale (GETS-T) and Coronavirus Anxiety Scale (CAS) was used to investigation of the relationship between globus symptoms and COVID-19 anxiety in patients diagnosed with COVID-19. They responded to the GETS-T for the evaluation of throat symptoms and determination of their severity. Additionally, it examined the level of dysfunctional anxiety associated with the coronavirus in COVID-19 patients by using the CAS. Data were collected through telephone interviews. There were 220 participants in a prospective cross-sectional study (110 COVID-19 patients and 110 non-COVID-19). RESULTS Results show the GETS-T total score to be significantly higher in the COVID-19 group than in the non-COVID-19 group (p < 0.001). As the GETS-T total score increased, CAS total score also increased significantly in the COVID-19 group. Total scores of GETS-T and CAS were found to be lower in the post-acute period than in the acute period in the COVID-19 group (p < 0.001). CONCLUSION This study confirms that globus-type symptoms may be present in the clinical appearance of COVID-19 infection. In addition, the results support the opinion held in the academic literature that there are positive correlations between globus sensation and psychosomatic etiology. Furthermore, the study concludes that the symptoms generalized as globus-type symptoms, which include sore throat, the feeling that something is stuck in the throat, and the inability to clear the throat, decrease and almost disappear after the first month of the disease.
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Affiliation(s)
- Yasemin Akbaş
- Department of Otolaryngology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Güzide Atalik
- Department of Speech and Language Therapy, Gazi University, Ankara, Turkey
| | - Metin Yilmaz
- Department of Otolaryngology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Gülendam Bozdayi
- Department of Medical Microbiology, Faculty of Medicine, Gazi University, Ankara, Turkey
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Alkhowaiter SS, Alshahrani AH, Almarzouqi HF, Alonazi GK, Alhawassi TM, AlRasheed MM. Feasibility, and barriers to use escitalopram in functional gastrointestinal disorders. Front Pharmacol 2023; 14:1131354. [PMID: 37284319 PMCID: PMC10240913 DOI: 10.3389/fphar.2023.1131354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 04/28/2023] [Indexed: 06/08/2023] Open
Abstract
Background and study aims: The feasibility and barriars of escitalopram use in patients with functional gastrointestinal disorders (FGIDs) are still debated. We aimed to evaluate the feasibility, safety and efficacy and barriars of escitalopram use in managing FGIDs in the Saudi population. Patients and Methods: We included 51 patients who received escitalopram for irritable bowel syndrome (n = 26), functional heartburn (n = 10), globus sensation (n = 10) or combined disorders (n = 5). We used an irritable bowel syndrome-severity scoring system IBS-SSS), GerdQ questionnaire and Glasgow Edinburg Throat Scale (GETS) to assess disease severity change before and after treatment. Results: The median age was 33 years (25th- 75th percentiles: 29-47), and 26 (50.98%) were males. Forty-one patients experienced side effects (80.39%), but most side effects were mild. The most common side effects were drowsiness/fatigue/dizziness (54.9%), xerostomia (23.53%), nausea/vomiting (21.57%) and weight gain (17.65%). IBS-SSS was 375 (255-430) and 90 (58-205) before and after treatment, respectively (p < 0.001). GerdQ score was 12 (10-13) before treatment and 7 (6-10) after treatment (p = 0.001). GETS score before treatment was 32.5 (21-46) and after treatment became 22 (13-31) (p = 0.002). Thirty-five patients refused to take the medications, and seven patients discontinued the medication. Possible causes of the poor compliance were fear of the medications and not being convinced of taking psychiatric medications for functional disorders (n = 15). Conclusion: Escitalopram could be a safe and effective treatment for functional gastrointestinal disorders. Targeting and managing factors leading to poor compliance could further improve the treatment outcome.
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Affiliation(s)
- Saad S. Alkhowaiter
- Department of Medicine- Gastroenterology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Amani H. Alshahrani
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Hala F. Almarzouqi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Gadah K. Alonazi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Tariq M. Alhawassi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Maha M. AlRasheed
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
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Poovipirom N, Ratta-Apha W, Maneerattanaporn M, Geeratragool T, Chuenprapai P, Leelakusolvong S. Treatment outcomes in patients with globus: A randomized control trial of psychoeducation, neuromodulators, and proton pump inhibitors. Neurogastroenterol Motil 2023; 35:e14500. [PMID: 36443929 DOI: 10.1111/nmo.14500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 11/03/2022] [Accepted: 11/09/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Globus is a persistent or intermittent nonpainful sensation of a lump or foreign body, which markedly affect patient's quality of life. Treatment options for globus are limited and unsatisfying. This study aims to compare the effects of cognitive-behavioral-theory-based psychoeducation (CBT), neuromodulators (NMD), and proton pump inhibitor (PPI) on treatment outcomes in patients with globus. METHODS Eligible patients were randomly received CBT, 0.5 mg flupenthixol and 10 mg melitracen; NMD, or omeprazole 20 mg; PPI, for 4 weeks. The primary endpoint was the reduction in symptom scores; Glasgow Edinburgh Throat Scale (GETS). The secondary endpoints included treatment efficacy on Reflux Symptom Index (RSI), Hospital Anxiety Depression Scale (HADS), and quality of life (QoL) based on a 36-item short-form health survey (SF-36). Treatment compliance and adverse effects were recorded. KEY RESULTS Forty patients were completed study. Baseline characteristics between the groups were comparable. By the end of treatment, both CBT and NMD provided greater reduction in GETS than PPI (CBT vs PPI; 6.46 ± 8.56 vs 0.21 ± 5.42; p = 0.031, NMD vs PPI; 6.92 ± 9.85 vs 0.21 ± 5.42; p = 0.036). The improvement of RSI, HADS, and SF-36 among the groups was similar. Neuromodulators caused more adverse events. CONCLUSIONS & INFERENCES Both CBT and NMD provided equally effective treatment and better than PPI in patients with globus determined by the reduction in GETS. The improvement in RSI, HADS, and QoL of the three groups was not different. Given less of adverse effect than NMD, CBT should be considered as a substantial treatment.
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Affiliation(s)
- Natthanan Poovipirom
- Division of Gastroenterology, Department of Internal Medicine Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Woraphat Ratta-Apha
- Department of Psychiatry, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Monthira Maneerattanaporn
- Division of Gastroenterology, Department of Internal Medicine Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Tanawat Geeratragool
- Division of Gastroenterology, Department of Internal Medicine Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pritsana Chuenprapai
- Division of Gastroenterology, Department of Internal Medicine Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Somchai Leelakusolvong
- Division of Gastroenterology, Department of Internal Medicine Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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11
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Xuelai L, Xueyan L, Wen X. Exploring the Use of the Current Perception Threshold in Pharyngeal Paresthesia Patients. Dysphagia 2022; 37:1431-1439. [PMID: 34978622 DOI: 10.1007/s00455-021-10401-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 12/13/2021] [Indexed: 12/16/2022]
Abstract
To explore pharyngeal sensory function by current perception threshold (CPT) measurement in paresthetic pharynx. In total, 58 healthy participants and 66 patients with pharyngeal paresthetic symptoms underwent CPT evaluation. Pharyngeal paresthesia (n = 66) was classified into three categories based on aetiologies: six cases with pain in pharynx; 34 neuropathic patients with glossopharyngeal nerve and/or vagus nerve or recurrent laryngeal nerve injury; and 26 patients with globus pharyngeus. CPT measurements were obtained from bilateral palatoglossal arch and tongue base at 2000, 250 and 5 Hz stimulation frequencies. Ranked from high to low, the CPT values for the bilateral palatoglossal arches and tongue bases were: lower cranial neuropathic patients, globus pharyngeus, healthy participants and patients with pain. The CPT values for neuropathic patients on the injured side were significantly higher than those on the healthy side (P < 0.05). The CPT values for patients with pain in pharynx were significantly lower than those of healthy participants (P < 0.05) when the bilateral tongue bases were stimulated. The CPT measurement is a reliable method for quantitatively assessing pharyngeal sensory function and able to differentiate pharyngeal paresthesia between lower cranial neuropathic and subjective discomfort. Pharyngeal sensory function is more sensitive in patients with pain in pharynx. Pharyngeal sensory function is significantly reduced in lower cranial neuropathic patients, especially on the injured side. Patients with globus pharyngeus have pharyngeal hyposensitivity.
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Affiliation(s)
- Liu Xuelai
- Department of Otorhinolaryngology-Head Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education, 1 Dongjiaominxiang, Beijing, 100730, China
- Department of Otolaryngology Head and Neck Surgery, Chongqing General Hospital, Chongqing, China
| | - Li Xueyan
- Department of Otorhinolaryngology-Head Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education, 1 Dongjiaominxiang, Beijing, 100730, China
| | - Xu Wen
- Department of Otorhinolaryngology-Head Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education, 1 Dongjiaominxiang, Beijing, 100730, China.
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12
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Kohansal A, Khoddami SM, Ansari NN, Lechien JR, Aghazadeh K. Validity and Reliability of the Persian Version of Reflux Symptom Score-12 in Patients with Laryngopharyngeal Reflux Disease. J Voice 2022:S0892-1997(22)00224-7. [PMID: 36030157 DOI: 10.1016/j.jvoice.2022.07.022] [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: 05/28/2022] [Revised: 07/24/2022] [Accepted: 07/25/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Cross cultural adaptation of the reflux symptom score-12 (RSS-12) into Persian language and to evaluate its validity and reliability in the assessment of patients with laryngopharyngeal reflux disease (LPRD). STUDY DESIGN A cross-sectional and prospective cohort design. METHODS A standard forward and backward translation was followed to cross-culturally adapt the RSS-12 into Persian language. To study discriminative validity, the RSS-12p was administrated to 63 patients with LPRD (40 men and 23 women; mean age: 39.26 ± 9.79 years) and 50 healthy volunteers (31 men and 19 women; mean age: 37.24 ± 10.28 years). The patients completed the reflux symptom index (RSI) to assess construct validity. The test-retest reliability was investigated in 31 patients (time interval = 7 days). RESULTS There were no missing responses and floor or ceiling effects. The assessing of discriminative validity showed that the questionnaire was able to discriminate between patients with LPRD and healthy participants (P<0.001). Construct validity was confirmed by the Pearson correlation between the RSS-12p and the RSI (rp= 0.87; P<0.00). The internal consistency was confirmed with Cronbach α 0.85 and 0.72 for the RSS-12p and quality of life (QoL), respectively. Test-retest reliability was excellent (ICCagreement = 0.98 for the RSS-12p and 0.94 for QoL). CONCLUSIONS The Persian version of RSS-12 is a valid and reliable self-administered questionnaire for assessing LPRD in Persian-speaking patients.
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Affiliation(s)
- Azin Kohansal
- Department of Speech Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyyedeh Maryam Khoddami
- Department of Speech Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran.
| | - Noureddin Nakhostin Ansari
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran; Research Center for War-affected People, Tehran University of Medical Sciences, Tehran, Iran
| | - Jerome R Lechien
- Department of Otolaryngology-Head and Neck Surgery, Polyclinique de Poitiers, Elsan, Poitiers, France
| | - Kayvan Aghazadeh
- Otolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran
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13
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Shires CB, Dewan K. Is there Really a Lump in My Throat? The Incidence and Implication of Vocal fold Abnormalities in Patients Presenting with Globus. J Voice 2022:S0892-1997(22)00141-2. [PMID: 35794058 DOI: 10.1016/j.jvoice.2022.05.008] [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: 03/07/2022] [Revised: 05/11/2022] [Accepted: 05/12/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To identify the prevalence of vocal fold abnormalities in patients with a primary complaint of globus sensation. Secondly, to determine the relationship between globus, vocal fold abnormality, and patient-reported quality of life questionnaire score. STUDY DESIGN Retrospective chart review. METHODS A retrospective chart review was performed to identify all new patients evaluated at a tertiary academic care laryngology practice between January 2018 and December 2018 presenting with a chief complaint of globus. Variables of interest include age, gender, laryngeal symptoms, self-reported quality-of-life questionnaire results, and laryngostroboscopy findings. Questionnaires selected for this investigation include the reflux symptom index (RSI), eating assessment tool-10 (EAT-10), and voice handicap index-10 (VHI-10). RESULTS Two hundred twenty-eight subjects with an average age of 54 ±17 years, were categorized based on one of three laryngostroboscopic findings: absence of vocal fold abnormality, vocal fold paresis/paralysis (motion abnormality), or a vocal fold mass lesion. Fifty percent of patients reporting globus had a normal laryngeal exam, and 50% had a mass lesion or motion abnormality. Twenty five percent had vocal fold motion abnormality (paresis, paralysis, or supraglottic squeeze); 19% had a mass lesion; and 3% had both a lesion and motion abnormality. The average self-reported survey scores were compared among the three groups. Patients with dysphonia had a significantly higher VHI-10 (P = 0.00), and a significantly higher RSI (P = 0.00) than those without dysphonia. Those patients with dysphagia had significantly higher EAT-10 (P = 0.00) and RSI (P = 0.02) scores than those who did not have dysphagia. Patients with vocal fold motion abnormality had significantly higher VHI-10 than those with normal vocal fold mobility (P = 0.02) CONCLUSIONS: Identifying the etiology of globus presents a significant challenge to laryngologists. Data presented here suggest that vocal fold abnormalities may contribute to the sensation of globus and should therefore be considered in the differential when managing these patients.
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Affiliation(s)
| | - Karuna Dewan
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University, Shreveport, Louisiana.
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14
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O'Hara J, Fisher H, Hayes L, Wilson J. 'Persistent throat symptoms' versus 'laryngopharyngeal reflux': a cross-sectional study refining the clinical condition. BMJ Open Gastroenterol 2022; 9:bmjgast-2021-000850. [PMID: 35338049 PMCID: PMC8961157 DOI: 10.1136/bmjgast-2021-000850] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 02/11/2022] [Indexed: 11/10/2022] Open
Abstract
Objective Many patients are assessed for chronic symptoms including: dysphonia, ‘globus’, throat clearing, postnasal secretions and cough; commonly grouped together and attributed to ‘laryngopharyngeal reflux’. This study aimed to explore a clinical trial’s baseline dataset for patterns of presenting symptoms, which might provide a more rational basis for treatment. Design Baseline data were analysed for participants entering the Trial Of Proton-Pump Inhibitors in Throat Symptoms: age, body mass index, Reflux Symptom Index, Comprehensive Reflux Symptom Score, Laryngopharyngeal Reflux-Health-related Quality of Life questionnaire and Reflux Finding Score (RFS-endoscopic examination). The relationships between the questionnaires and demographic factors were assessed. Exploratory factor analysis (EFA) was conducted on individual symptom items in the combined questionnaires. The EFA factors were applied to a Cluster Analysis of participants, to explore the presence of identifiable patient. Results Throat clearing and globus were the highest ranked scores in the 344 participants. Increasing age was inversely associated with symptom severity (p<0.01). There was no relationship between the RFS and any of the three questionnaires. EFA resulted in a seven-factor model with clinically meaningful labels: voice, cough, gastrointestinal symptoms, airway symptoms and dysphagia, throat clearing, lump in throat, and life events. Cluster analysis failed to demonstrate any clinically meaningful clusters of patients. Conclusion This study offers a framework for future research and demonstrates that individual symptoms cannot be used to group patients. The analysis supports the use of a broad ‘umbrella’ term such as persistent throat symptoms. Trial registration number ISRCTN38578686.
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Affiliation(s)
- James O'Hara
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK james.o'.,Department of Otolaryngology - Head and Neck Surgery, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Holly Fisher
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Louise Hayes
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Janet Wilson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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15
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Khanna R, Meena RN, Kumar R, Khanna S. Audit of Neurological Complications After Thyroid Surgery. Indian J Surg 2021. [DOI: 10.1007/s12262-021-02756-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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16
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Hernandez BO, Russell GB, Wright SC, Madden LL. Normative Value for the Laryngopharyngeal Measure of Perceived Sensation. Laryngoscope 2021; 132:398-400. [PMID: 34272881 DOI: 10.1002/lary.29764] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 06/18/2021] [Accepted: 07/02/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS The Laryngopharyngeal Measure of Perceived Sensation (LUMP) is a recently validated patient-reported outcome measure (PROM) aimed at evaluating the symptom severity of patients with globus pharyngeus (GP). The objective of this study was to define the normative values for the LUMP questionnaire. STUDY DESIGN Prospectively collected, descriptive research/scale development. METHODS The LUMP questionnaire was completed by 88 subjects. Individuals without throat-related symptoms such as dysphagia, dysphonia, or cough were provided LUMP. The results of the eight-item questionnaire were analyzed for standard error of the mean (SEM), mean, and standard deviation (SD). RESULTS Review of the 88 LUMP questionnaires elucidated a mean of 0.42 (SEM = 0.10, SD = 0.96) in the normative population. By gender, the female (n = 50) mean was 0.24, SD = 0.66, SEM = 0.09; for males (n = 38), the mean was 0.66, SD = 1.21, SEM = 0.20. CONCLUSIONS This study provides normative data for the LUMP, a recently established PROM useful in patients with GP. A LUMP score greater than or equal to 3 should be considered abnormal and warrants additional attention. LEVEL OF EVIDENCE 3 Laryngoscope, 2021.
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Affiliation(s)
- Brian O Hernandez
- Department of Otolaryngology - Head and Neck Surgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, U.S.A
| | - Gregory B Russell
- Department of Biostatistics and Data Science, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, U.S.A
| | - Stephen Carter Wright
- Department of Otolaryngology - Head and Neck Surgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, U.S.A
| | - Lyndsay L Madden
- Department of Otolaryngology - Head and Neck Surgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, U.S.A
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17
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Strohl MP, Chang JL, Dwyer CD, Young VN, Rosen CA, Cheung SW. Laryngeal Adductor Reflex Movement Latency Following Tactile Stimulation. Otolaryngol Head Neck Surg 2021; 166:720-726. [PMID: 34253075 DOI: 10.1177/01945998211025517] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To measure the latency of laryngeal adductor reflex (LAR) motion onset at 2 laryngopharyngeal subsites using calibrated aesthesiometers. STUDY DESIGN Cross-sectional. SETTING Academic institution. METHODS Twenty-one asymptomatic, healthy subjects (11 male, 10 female) underwent laryngopharyngeal sensory testing with tactile stimuli delivered to the aryepiglottic fold and medial pyriform sinus using 30-mm Cheung-Bearelly monofilaments (4-0 and 5-0 nylon sutures) via channeled flexible laryngoscope. The LAR onset latency, defined as the first visual detection of ipsilateral vocal fold adduction following tactile stimulation, was measured with frame-by-frame analysis of video recordings. RESULTS The overall mean LAR latency across both subsites and stimulation forces was 176.6 (95% CI, 170.3-183.0) ms, without significant difference between subsites or forces. The critical value for LAR response latency prolongation at the .01 significance level was 244 ms. At 30 frames/s video capture resolution, LAR response latency ≥8 frame intervals would indicate abnormal prolongation. CONCLUSION Aesthesiometer-triggered LAR latency appears to be invariant over an 8.7-dB force range and between the aryepiglottic fold and medial pyriform sinus subsites in controls. Laryngeal adductor reflex latency incongruences between stimulation forces or laryngopharyngeal subsites may serve as pathophysiological features to dissect mechanisms of upper aerodigestive tract disorders. LEVEL OF EVIDENCE Level 3B.
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Affiliation(s)
- Madeleine P Strohl
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Jolie L Chang
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Christopher D Dwyer
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, USA
| | - VyVy N Young
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Clark A Rosen
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Steven W Cheung
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, USA
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18
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Abstract
Globus is the sensation of a foreign body in the throat. Investigation and management of patients with globus is widely variable. Most investigations yield negative results yet incur varying patient morbidity and healthcare costs, while malignancy is vanishingly rare in the absence of red flag symptoms and ear, nose and throat examination findings. History taking is key and can help to identify possible causative pathology, directing further investigations and management if necessary. Treatment of globus mainly centres on patient reassurance and counselling, and may include reflux management, neuromodulation, or speech therapy in selected cases, and treatment of any identified cause.
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Affiliation(s)
- Richard Siau
- Ear, Nose and Throat Department, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Andrew Kinshuck
- Ear, Nose and Throat Department, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Lisa Houghton
- Speech and Language Therapy Department, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
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19
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An Y, Gao F, Su X, Zhou C, Huang J, Chen S, Liu T, Lu Z. Characteristics of pharyngeal paraesthesia symptoms in patients with obstructive sleep apnoea. Sleep Breath 2021; 25:2163-2169. [PMID: 33604802 DOI: 10.1007/s11325-021-02325-z] [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: 10/19/2020] [Revised: 02/05/2021] [Accepted: 02/12/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE This study aimed to investigate pharyngeal paraesthesia symptoms in patients with obstructive sleep apnoea (OSA). MATERIAL AND METHODS Patients with snoring and suspected OSA as well as age-matched controls were recruited. All participants underwent nocturnal polysomnography (PSG) and pharyngeal paraesthesia assessment using the Glasgow-Edinburgh throat scale (GETS). The incidence and severity of pharyngeal paraesthesia symptoms were compared between the groups. RESULTS A total of 280 patients who snored or were suspected of having OSA and 35 healthy, age-matched controls were recruited. The total pharyngeal paraesthesia symptom score was significantly higher in the OSA group than in the healthy group (12 [5, 23] vs. 3 [0, 9]; p < 0.001). The most frequent pharyngeal paraesthesia symptoms in the snore patients were Q7 (catarrh down the throat) and Q3 (discomfort/irritation in the throat), which are related to the irritability of the throat. The incidence of Q7 (OSA, 58% vs. controls, 14%; χ2 = 23.66; p < 0.001), Q3 (OSA, 46% vs. controls, 3%; χ2 = 23.07; p < 0.001), Q1 (feeling of something stuck in the throat; OSA, 33% vs. controls, 6%; χ2 = 11.00; p = 0.001), Q6 (swelling in the throat; OSA, 31% vs. controls, 0%; χ2 = 14.53; p < 0.001), Q9 (want to swallow all the time; OSA, 20% vs. controls, 6%; χ2 = 6.28; p = 0.012), Q5 (throat closing off; OSA, 24% vs. controls, 6%; χ2 = 6.16; p = 0.013), and Q2 (pain in the throat; OSA, 23% vs. controls, 6%; χ2 = 5.32; p = 0.021) was significantly higher in the OSA group than in the controls CONCLUSIONS: Patients with obstructive sleep apnoea have higher pharyngeal paraesthesia symptoms scores and tend to have irritated throats compared to healthy controls. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03506178.
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Affiliation(s)
- Yunsong An
- Department of Otolaryngology-Head and Neck Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No.106 Zhongshanerlu Street, Yuexiu District, Guangzhou, China.
| | - Fei Gao
- Department of Otolaryngology-Head and Neck Surgery, Gansu Provincial Hospital, Lanzhou, China.,Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China.,Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education, Capital Medical University, Beijing, China
| | - Xiaomei Su
- Department of Otolaryngology-Head and Neck Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No.106 Zhongshanerlu Street, Yuexiu District, Guangzhou, China
| | - Chuan Zhou
- Department of Otolaryngology-Head and Neck Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No.106 Zhongshanerlu Street, Yuexiu District, Guangzhou, China
| | - Jiayu Huang
- Department of Otolaryngology-Head and Neck Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No.106 Zhongshanerlu Street, Yuexiu District, Guangzhou, China
| | - Shaohua Chen
- Department of Otolaryngology-Head and Neck Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No.106 Zhongshanerlu Street, Yuexiu District, Guangzhou, China
| | - Tao Liu
- Department of Otolaryngology-Head and Neck Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No.106 Zhongshanerlu Street, Yuexiu District, Guangzhou, China
| | - Zhongming Lu
- Department of Otolaryngology-Head and Neck Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No.106 Zhongshanerlu Street, Yuexiu District, Guangzhou, China.
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20
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Takahashi N, Ikeda K, Iwai G, Shinbori K, Baba H, Sasaki T, Takahashi K, Morita Y, Horii A. Prediction of effectiveness of potassium-competitive acid blocker and serotonin noradrenaline reuptake inhibitor on abnormal sensation in the throat: use of patient-reported outcome measures (PROMs). Eur Arch Otorhinolaryngol 2021; 278:1483-1489. [PMID: 33388987 PMCID: PMC8057989 DOI: 10.1007/s00405-020-06544-0] [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: 09/30/2020] [Accepted: 12/01/2020] [Indexed: 11/22/2022]
Abstract
Purpose To determine patients with abnormal sensation in the throat (AST) who would respond to potassium-competitive acid blocker (P-CAB) or serotonin noradrenaline reuptake inhibitor (SNRI) treatment. Methods AST patients were randomly divided into two groups. Thirty-one and 21 patients received P-CAB and SNRI treatment, respectively. GETS-J, the Japanese version of Glasgow Edinburgh Throat Scales (GETS), consisted of three subscales of throat symptoms (globus sensation, pain/swelling of the throat, and dysphagia) and somatic distress due to the disease, Frequency Scale for the Symptoms of Gastro-esophageal reflux disease (FSSG), and Hospital Anxiety and Depression Scale (HADS) were used before and after treatments. Responders to treatments were defined as those who showed 50% or more decrease in symptom scores or somatic distress. Results Pre-treatment GETS-J pain/swelling scores and FSSG acid reflux scores were higher in P-CAB responders and decreased after treatment. Receiver operating characteristic curve for pain/swelling subscale had an area under the curve (AUC) of 0.792 to predict P-CAB responders and a score of 11 provided the best combination of sensitivity (62.5%) and specificity (80%). Somatic distress and HADS anxiety scores, but no other GETS-J symptom scores, decreased after SNRI treatment. Pre-treatment globus scores were lower in SNRI responders. AUC value for globus subscale to predict SNRI responders was 0.741 and a score of 6.5 provided the best combination of sensitivity (70%) and specificity (73%). Conclusions Pain/swelling is a characteristic symptom in AST patients who respond to P-CAB treatment. SNRI treatment would be effective for somatic distress in cases with mild symptoms.
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Affiliation(s)
- Nao Takahashi
- Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chuo-ku, Niigata City, 951-8510, Japan.
| | - Kaori Ikeda
- Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chuo-ku, Niigata City, 951-8510, Japan
| | - Genki Iwai
- Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chuo-ku, Niigata City, 951-8510, Japan
| | - Kaori Shinbori
- Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chuo-ku, Niigata City, 951-8510, Japan
| | - Hironori Baba
- Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chuo-ku, Niigata City, 951-8510, Japan
| | - Takanobu Sasaki
- Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chuo-ku, Niigata City, 951-8510, Japan
| | - Kuniyuki Takahashi
- Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chuo-ku, Niigata City, 951-8510, Japan
| | - Yuka Morita
- Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chuo-ku, Niigata City, 951-8510, Japan
| | - Arata Horii
- Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chuo-ku, Niigata City, 951-8510, Japan
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21
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Wilson JA, Stocken DD, Watson GC, Fouweather T, McGlashan J, MacKenzie K, Carding P, Karagama Y, Harries M, Ball S, Khwaja S, Costello D, Wood R, Lecouturier J, O'Hara J. Lansoprazole for persistent throat symptoms in secondary care: the TOPPITS RCT. Health Technol Assess 2021; 25:1-118. [PMID: 33492208 PMCID: PMC7869007 DOI: 10.3310/hta25030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Persistent throat symptoms are commonly attributed to 'laryngopharyngeal reflux'. Despite a limited evidence base, these symptoms are increasingly being treated in primary care with proton pump inhibitors. OBJECTIVE To assess the value of proton pump inhibitor therapy in patients with persistent throat symptoms. DESIGN This was a double-blind, placebo-controlled, randomised Phase III trial. SETTING This was a multicentre UK trial in eight UK ear, nose and throat departments. PARTICIPANTS A total of 346 participants aged ≥ 18 years with persistent throat symptoms and a Reflux Symptom Index score of ≥ 10, exclusive of the dyspepsia item, were recruited. INTERVENTION Random allocation (1 : 1 ratio) to either 30 mg of lansoprazole twice daily or matched placebo for 16 weeks. MAIN OUTCOME MEASURE Symptomatic response (i.e. total Reflux Symptom Index score after 16 weeks of therapy). RESULTS A total of 1427 patients were screened and 346 were randomised. The mean age was 52 years (standard deviation 13.7 years, range 20-84 years); 150 (43%) participants were male and 196 (57%) were female; 184 (53%) participants had a mild Reflux Symptom Index minus the heartburn/dyspepsia item and 162 (47%) had a severe Reflux Symptom Index minus the heartburn/dyspepsia item. A total of 172 patients were randomised to lansoprazole and 174 were randomised to placebo. MAIN OUTCOMES A total of 267 participants completed the primary end-point visit (lansoprazole, n = 127; placebo, n = 140), of whom 220 did so between 14 and 20 weeks post randomisation ('compliant' group); 102 received lansoprazole and 118 received placebo. The mean Reflux Symptom Index scores at baseline were similar [lansoprazole 22.0 (standard deviation 8.0), placebo 21.7 (standard deviation 7.1), overall 21.9 (standard deviation 7.5)]. The mean Reflux Symptom Index scores at 16 weeks reduced from baseline in both groups [overall 17.4 (standard deviation 9.9), lansoprazole 17.4 (standard deviation 9.9), placebo 15.6 (standard deviation 9.8)]. Lansoprazole participants had estimated Reflux Symptom Index scores at 16 weeks that were 1.9 points higher (worse) than those of placebo participants (95% confidence interval -0.3 to 4.2; padj = 0.096), adjusted for site and baseline severity. SECONDARY OUTCOMES Ninety-five (43%) participants achieved a Reflux Symptom Index score in the normal range (< 12) at 16 weeks: 42 (41%) in the lansoprazole group and 53 (45%) in the placebo group. A total of 226 participants completed the end-of-trial follow-up visit (lansoprazole, n = 109; placebo, n = 117), of whom 181 were 'compliant'. The mean Reflux Symptom Index scores at 12 months reduced from baseline in both groups [lansoprazole 16.0 (standard deviation 10.8), placebo 13.6 (standard deviation 9.6), overall 14.7 (standard deviation 10.2)]. A total of 87 (48%) participants achieved a Reflux Symptom Index score in the normal range at 12 months: 33 (40%) in the lansoprazole group and 54 (55%) in the placebo group. Likewise, the Comprehensive Reflux Symptom Score and Laryngopharyngeal Reflux - Health Related Quality of Life total scores and subscales all showed very similar changes in the lansoprazole and placebo cohorts at both 16 weeks and 12 months. LIMITATIONS Drop-out rate and compliance are issues in pragmatic clinical trials. The Trial Of Proton Pump Inhibitors in Throat Symptoms (TOPPITS) aimed to detect clinically relevant difference with 90% power. The 346 randomised participants reduced to 283 at the primary end point; 267 completed the primary outcome measure, 220 within the protocol time scale. Despite this, the powers to detect the clinically relevant difference in Reflux Symptom Index score at 16 weeks were 82% (compliant comparison) and 89% (pragmatic comparison). The lack of difference between lansoprazole and placebo is generalisable across NHS clinics. CONCLUSIONS Participants on lansoprazole did not report significantly better outcomes than participants on placebo on any of the three patient-reported outcome tools (Reflux Symptom Index, Comprehensive Reflux Symptom Score and Laryngopharyngeal Reflux - Health Related Quality of Life). This multicentre, pragmatic, powered, definitive Phase III trial found no evidence of benefit for patients by treating persistent throat symptoms with lansoprazole. TRIAL REGISTRATION Current Controlled Trials ISRCTN38578686 and EudraCT number 2013-004249-17. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 3. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Janet A Wilson
- Ear, Nose and Throat Department, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Deborah D Stocken
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Gillian C Watson
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Tony Fouweather
- Biostatistics Research Group, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Julian McGlashan
- Ear, Nose and Throat Department, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Kenneth MacKenzie
- Ear, Nose and Throat Department, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Paul Carding
- Oxford Institute of Nursing, Midwifery and Allied Health Research, Oxford Brookes University, Oxford, UK
| | - Yakubu Karagama
- Ear, Nose and Throat Department, Manchester University NHS Foundation Trust, Manchester, UK
| | - Meredydd Harries
- Ear, Nose and Throat Department, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Stephen Ball
- Ear, Nose and Throat Department, City Hospitals Sunderland NHS Foundation Trust, Sunderland, UK
| | - Sadie Khwaja
- Ear, Nose and Throat Department, Stockport NHS Foundation Trust, Stockport, UK
| | - Declan Costello
- Ear, Nose and Throat Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ruth Wood
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Jan Lecouturier
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - James O'Hara
- Ear, Nose and Throat Department, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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22
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Zerbib F, Rommel N, Pandolfino J, Gyawali CP. ESNM/ANMS Review. Diagnosis and management of globus sensation: A clinical challenge. Neurogastroenterol Motil 2020; 32:e13850. [PMID: 32329203 DOI: 10.1111/nmo.13850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 02/17/2020] [Accepted: 03/18/2020] [Indexed: 12/20/2022]
Abstract
Globus is a non-painful sensation of a tightness or a lump/foreign body in the throat that is not associated with dysphagia and may actually improve during meals. While several otorhinolaryngologic, thyroid, and esophageal disorders have been linked to globus, cause-and-effect relationships are difficult to establish. Consequently, though part of the evaluation, objective otorhinolaryngologic and esophageal testing is often negative. The presence of alarm symptoms, particularly pain, weight loss, dysphagia, or odynophagia is indications for objective testing. A diagnosis of idiopathic globus requires exclusion of pharyngeal, laryngeal, and esophageal disorders with laryngoscopy, endoscopy, high-resolution manometry, barium radiography, and/or ambulatory reflux monitoring. A trial of acid-suppressive therapy may be reasonable in the absence of alarm symptoms, especially if concurrent reflux symptoms are identified. Ablation of heterotopic gastric mucosa in the proximal esophagus has been reported to improve globus symptoms. Beyond these specific approaches, further management of idiopathic globus consists of reassurance, neuromodulators, and complementary approaches. Globus has a benign course with no long-term consequences, and the overall prognosis is good as the magnitude of symptoms may decline over time.
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Affiliation(s)
- Frank Zerbib
- Department of Gastroenterology, Bordeaux University Hospital, Université de Bordeaux, Bordeaux, France
| | - Nathalie Rommel
- Department of Gastroenterology, Neurogastroenterology & Motility, Catholic University of Leuven, Leuven, Belgium
| | - John Pandolfino
- Division of Gastroenterology, Department of Medicine, Northwestern University, Chicago, IL, USA
| | - C Prakash Gyawali
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO, USA
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23
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Đanić Hadžibegović A, Hergešić F, Babić E, Slipac J, Prstačić R. Thyroidectomy-related Swallowing Difficulties: Review of the Literature. Acta Clin Croat 2020; 59:38-49. [PMID: 34219883 PMCID: PMC8212616 DOI: 10.20471/acc.2020.59.s1.05] [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] [Indexed: 11/24/2022] Open
Abstract
This study aims to provide insight into the etiology and frequency of swallowing complications that arise after thyroidectomy and to outline the available diagnostic procedures by revising the existing literature on this topic. We conducted a bibliographic search using the electronic database MEDLINE/PubMed to identify all relevant articles and 44 studies were included in the review out of a total of 218 published articles. Dysphagia after thyroid surgery is a common postoperative complication which, in the short- or long-term, significantly affects patient life quality. There is no standard diagnostic protocol for thyroidectomy-related swallowing impairment. Among the reviewed studies, 8 questionnaires and 12 instrumental diagnostic tools were used to identify swallowing difficulties related to thyroid surgery. The Swallowing Impairment Index (SIS-6) was the most-used questionnaire. Fiberoptic endoscopy is a standard diagnostic tool performed prior and after thyroid surgery, primarily to identify changes in vocal fold mobility. Although instrumental findings usually reveal non-specific alterations of swallowing; swallowing videofluoroscopy and esophageal manometry can be the most helpful tools in further management of thyroidectomy dysphagia. In patients with thyroidectomy-related swallowing difficulties and suspected laryngopharyngeal reflux, 24-hour MII-pH metry should be performed.
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Affiliation(s)
| | - Filip Hergešić
- 1Clinical Department for ENT and Head and Neck Surgery, Zagreb University Hospital Centre, 2Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Croatia, 3School of Medicine, Zagreb University, Croatia, 4Faculty of Education and Rehabilitation Sciences University of Zagreb, Croatia
| | - Ema Babić
- 1Clinical Department for ENT and Head and Neck Surgery, Zagreb University Hospital Centre, 2Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Croatia, 3School of Medicine, Zagreb University, Croatia, 4Faculty of Education and Rehabilitation Sciences University of Zagreb, Croatia
| | - Juraj Slipac
- 1Clinical Department for ENT and Head and Neck Surgery, Zagreb University Hospital Centre, 2Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Croatia, 3School of Medicine, Zagreb University, Croatia, 4Faculty of Education and Rehabilitation Sciences University of Zagreb, Croatia
| | - Ratko Prstačić
- 1Clinical Department for ENT and Head and Neck Surgery, Zagreb University Hospital Centre, 2Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Croatia, 3School of Medicine, Zagreb University, Croatia, 4Faculty of Education and Rehabilitation Sciences University of Zagreb, Croatia
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24
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Zhou W, Deng Q, Jia L, Zhao H, Yang M, Dou G, He Z, Guo W. Acute Effect of Transcutaneous Electroacupuncture on Globus Pharyngeus: A Randomized, Single-Blind, Crossover Trial. Front Med (Lausanne) 2020; 7:179. [PMID: 32528966 PMCID: PMC7247858 DOI: 10.3389/fmed.2020.00179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Accepted: 04/16/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Wencong Zhou
- Department of Gastroenterology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Qi Deng
- Department of Gastroenterology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Lin Jia
- Department of Gastroenterology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, China
- *Correspondence: Lin Jia
| | - Hanbing Zhao
- Department of Gastroenterology, the Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Meng Yang
- Department of Gastroenterology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Guoyuan Dou
- Department of Gastroenterology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Zijian He
- Department of Gastroenterology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Wanwei Guo
- Department of Gastroenterology, Guangdong Second Provincial General Hospital, Guangzhou, China
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25
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Korkmaz MÖ, Tüzüner A, Bahçecitapar M, Karacaer C. Reliability and Validity of the Turkish Version of the Glasgow-Edinburgh Throat Scale: Use for a Symptom Scale of Globus Sensation in Turkish Population. Turk Arch Otorhinolaryngol 2020; 58:41-47. [PMID: 32313894 DOI: 10.5152/tao.2020.4686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2019] [Indexed: 11/22/2022] Open
Abstract
Objective In this study, we aimed to translate the Glasgow-Edinburgh Throat Scale (GETS) into Turkish and test its reliability and validity. Methods A total of 69 patients with globus sensation and no signs of otolaryngologic or gastroenterological disease in etiology were included in the study. The patients were asked to complete the translated Turkish version (GETS-T) of GETS and the Hospital Anxiety and Depression Scale (HADS). Results The Cronbach's alpha coefficient of the patients in the study group was calculated based on the 12 questions in the GETS-T scale and found as 0.868. The correlation between the GETS-T total score and the total HADS score in the study group was found to be very low and statistically insignificant. As a result of factor analysis, it was found that the first 10 problems in GETS-T were divided into two sub-groups, unlike GETS. Conclusion Translation of GETS into Turkish (GETS-T) showed high reliability and validity, suggesting that translation and cross-cultural adaptation was appropriate. The GETS-T can be used in studies about globus pharyngeus in future.
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Affiliation(s)
- Müge Özçelik Korkmaz
- Department of Otorhinolaryngology, Sakarya University School of Medicine Korucuk Training and Research Hospital, Sakarya, Turkey
| | - Arzu Tüzüner
- Department of Otorhinolaryngology, Başkent University School of Medicine, Ankara, Turkey
| | - Melike Bahçecitapar
- Department of Statistics, Hacettepe University School of Sciences, Ankara, Turkey
| | - Cengiz Karacaer
- Department of Gastroenterology, Sakarya University School of Medicine Training and Research Hospital, Sakarya, Turkey
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26
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Chang W, Xu W, Hu R, An Y. Current Perception Threshold Testing in Pharyngeal Paresthesia Patients with Depression or Anxiety. Neuropsychiatr Dis Treat 2020; 16:1023-1029. [PMID: 32368064 PMCID: PMC7182447 DOI: 10.2147/ndt.s248236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 04/08/2020] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Satisfactory quantitative diagnostic approaches to pharyngeal paresthesia patients with depression or anxiety remain to be explored. This study investigated the plausibility of current perception threshold (CPT) testing in diagnosing pharyngeal paresthesia in patients with depression or anxiety. PATIENTS AND METHODS A total of 41 patients with pharyngeal paresthesia with depression or anxiety were recruited as the study group. Additionally, 60 healthy volunteers constituted the control group. The CPT values associated with 5-, 250-, and 2000-Hz electrical stimulation frequencies were measured at the palatal lingual arch and posterior third of the lingual body (two sensory nerve distribution sites in the pharynx). The normal range of CPT values of the above three frequencies was analyzed. The differences in the CPT values for sensory nerves were compared. RESULTS There were no significant differences in age and sex between the study and control groups. The CPT values of the pharynx at the two tested sites were not significantly correlated with age and gender. The CPT value of the study group was significantly lower than that of the control group in the palatal lingual arch and posterior third of the lingual body at an electrical stimulation of 5 Hz (p<0.05). No significant differences in the CPT values at other frequencies were found between the two groups. CONCLUSION CPT testing is effective in determining pharyngeal paresthesia in patients with depression and anxiety. Paresthesia of the pharyngeal sensory nerve region is caused by damaged C fibers.
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Affiliation(s)
- Wei Chang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, People's Republic of China
| | - Wen Xu
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, People's Republic of China
| | - Rong Hu
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, People's Republic of China
| | - Yunsong An
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, People's Republic of China
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27
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Melancon CC, Russell GB, Ruckart K, Persia S, Peterson M, Carter Wright S, Madden LL. The development and validation of the laryngopharyngeal measure of perceived sensation. Laryngoscope 2019; 130:2767-2772. [PMID: 31643076 DOI: 10.1002/lary.28348] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 09/17/2019] [Accepted: 09/19/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Globus pharyngeus (GP) is described as the subjective sensation of having a "lump" in the throat in the absence of correlating physical findings or dysphagia. Historically, despite the frequency of patient complaints, GP has been difficult to quantify with current outcome measures. This is in large part due to lack of a user-friendly, modernized, objective patient-reported outcome measure (PROM) of symptom severity. The aim of this study is to develop a modernized, practical, validated PROM for evaluating GP symptom severity. METHODS The Laryngopharyngeal Measure of Perceived Sensation (LUMP questionnaire) was created in three phases: 1) item generation by an expert panel involving two laryngologists and two speech language pathologists developed from common patient-reported GP symptoms, with patient confirmation; 2) line-item reduction based on internal consistency and reliability; 3) and instrument validity, which was assessed by administering the questionnaire to patients complaining of GP as well as patients without GP. RESULTS A 19-item questionnaire was developed from an expert panel, which was then administered to 110 patients, 100 of whom met inclusion criteria. After statistical analysis, less internally consistent or relevant questions were removed, leaving eight items with an internal consistency (Cronbach alpha) of 0.892. When administered to 54 patients with GP versus 31 normal patients, the mean score was found to be higher in those with GP versus normal patients (P value <0.0001). CONCLUSION Preliminary results suggest the eight-item LUMP questionnaire is a valuable PROM for evaluating GP symptom severity. LEVEL OF EVIDENCE NA Laryngoscope, 2019.
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Affiliation(s)
- C Claire Melancon
- Department of Otolaryngology-Head and Neck Surgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, U.S.A
| | - Gregory B Russell
- Department of Biostatistics and Data Sciences, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, U.S.A
| | - Kathryn Ruckart
- Department of Otolaryngology-Head and Neck Surgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, U.S.A
| | - Sarah Persia
- Department of Otolaryngology-Head and Neck Surgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, U.S.A
| | - Margarita Peterson
- Department of Otolaryngology-Head and Neck Surgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, U.S.A
| | - S Carter Wright
- Department of Otolaryngology-Head and Neck Surgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, U.S.A
| | - Lyndsay L Madden
- Department of Otolaryngology-Head and Neck Surgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, U.S.A
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28
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Alizadeh F, Dehqan A, Shahin MA, Ghaemi H, Zainaee S, Sobhani-Rad D. Persian Translation, Validation and Reliability of the Voice Handicap Index-Throat (VHI-T). J Voice 2019; 35:160.e1-160.e6. [PMID: 31395302 DOI: 10.1016/j.jvoice.2019.07.016] [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: 05/06/2019] [Revised: 07/19/2019] [Accepted: 07/19/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The aim of the present study is to validate, and assess the reliability of the Persian version of Voice Handicap Index-Throat (VHI-Tp) as a self-reported questionnaire for patients with throat problems that could make the patients' estimation of the throat discomforts possible. It is a subscale to be used independently. STUDY DESIGN This is a cross-sectional study. MATERIALS AND METHOD During this study, the VHI-Tp was administered to120 patients with throat problems related to laryngeal discomfort (51 male and 69 female, age range: 30-60 years).The diagnosis of Voice disorder was performed by an ENT physician based on video-laryngoscopy evidences and medical examination. To assess the content validity, the questions were first given to 15 experts to comment on content applicability and relevance through a Likert scale. Eighty patients rated its importance to detect face validity. To evaluate the concurrent validity, the same 80 patients completed both the VHI-Tp as well as the Persian version of Voice Symptom Scale. The VHI-Tp total scores of the patients with diagnosed throat problem related to laryngeal discomfort and of the 40 healthy participants were compared to test the clinical validity (discriminant validity). Also, internal consistency reliability was assessed using Cronbach α coefficient. The relative reliability was calculated by asking 40 of all patients out of the 80 participants, to complete the VHI-Tp twice, with a week of interval between the first and the second times. To detect the absolute reliability, Standard Error of Measurement and Smallest Detected Change were calculated. RESULTS Discriminative validity differed significantly between patients and healthy participants. There was a significant correlation between the VHI-Tp and Voice Symptom Scale total scores (r = 0.6, P < 0.05). The internal consistency was confirmed (Cronbach α = 0.78). The test-retest reliability was excellent (intraclass correlation coefficient = 0.95).The Standard Error of Measurement and Smallest Detected Changes were acceptable (0.39 and 1.08), respectively. CONCLUSION The Persian version of the VHI-T was demonstrated to be a valid and reliable self-rated questionnaire for use in Persian patients with throat problem related to laryngeal discomfort.
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Affiliation(s)
- Farhad Alizadeh
- Department of Speech Pathology, Paramedical Sciences Faculty, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Dehqan
- Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Mohammad-Ali Shahin
- Department of Speech Pathology, Paramedical Sciences Faculty, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hamide Ghaemi
- Department of Speech Pathology, Paramedical Sciences Faculty, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Shahryar Zainaee
- Department of Speech Pathology, Paramedical Sciences Faculty, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Davood Sobhani-Rad
- Department of Speech Pathology, Paramedical Sciences Faculty, Mashhad University of Medical Sciences, Mashhad, Iran
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29
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Lechien JR, Akst LM, Hamdan AL, Schindler A, Karkos PD, Barillari MR, Calvo-Henriquez C, Crevier-Buchman L, Finck C, Eun YG, Saussez S, Vaezi MF. Evaluation and Management of Laryngopharyngeal Reflux Disease: State of the Art Review. Otolaryngol Head Neck Surg 2019; 160:762-782. [PMID: 30744489 DOI: 10.1177/0194599819827488] [Citation(s) in RCA: 210] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To review the current literature about the epidemiology, clinical presentation, diagnosis, and treatment of laryngopharyngeal reflux (LPR). DATA SOURCES PubMed, Cochrane Library, and Scopus. METHODS A comprehensive review of the literature on LPR epidemiology, clinical presentation, diagnosis, and treatment was conducted. Using the PRISMA statement, 3 authors selected relevant publications to provide a critical analysis of the literature. CONCLUSIONS The important heterogeneity across studies in LPR diagnosis continues to make it difficult to summarize a single body of thought. Controversies persist concerning epidemiology, clinical presentation, diagnosis, and treatment. No recent epidemiologic study exists regarding prevalence and incidence with the use of objective diagnostic tools. There is no survey that evaluates the prevalence of symptoms and signs on a large number of patients with confirmed LPR. Regarding diagnosis, an increasing number of authors used multichannel intraluminal impedance-pH monitoring, although there is no consensus regarding standardization of the diagnostic criteria. The efficiency of proton pump inhibitor (PPI) therapy remains poorly demonstrated and misevaluated by incomplete clinical tools that do not take into consideration many symptoms and extralaryngeal findings. Despite the recent advances in knowledge about nonacid LPR, treatment protocols based on PPIs do not seem to have evolved. IMPLICATIONS FOR PRACTICE The development of multichannel intraluminal impedance-pH monitoring and pepsin and bile salt detection should be considered for the establishment of a multiparameter diagnostic approach. LPR treatment should evolve to a more personalized regimen, including diet, PPIs, alginate, and magaldrate according to individual patient characteristics. Multicenter international studies with a standardized protocol could improve scientific knowledge about LPR.
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Affiliation(s)
- Jerome R Lechien
- 1 Laryngopharyngeal Reflux Study Group of Young Otolaryngologists, International Federation of Oto-rhino-laryngological Societies, Paris, France.,2 Department of Anatomy and Experimental Oncology, Mons School of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium.,3 Laboratory of Phonetics, Faculty of Psychology, Research Institute for Language Sciences and Technology, University of Mons, Mons, Belgium.,4 Department of Otorhinolaryngology and Head and Neck Surgery, CHU Saint-Pierre, Faculty of Medicine, University Libre de Bruxelles, Brussels, Belgium
| | - Lee M Akst
- 5 Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Abdul Latif Hamdan
- 1 Laryngopharyngeal Reflux Study Group of Young Otolaryngologists, International Federation of Oto-rhino-laryngological Societies, Paris, France.,6 Department of Otorhinolaryngology and Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Antonio Schindler
- 1 Laryngopharyngeal Reflux Study Group of Young Otolaryngologists, International Federation of Oto-rhino-laryngological Societies, Paris, France.,7 Department of Biomedical and Clinical Sciences, Phoniatric Unit, L. Sacco Hospital, University of Milan, Milan, Italy
| | - Petros D Karkos
- 1 Laryngopharyngeal Reflux Study Group of Young Otolaryngologists, International Federation of Oto-rhino-laryngological Societies, Paris, France.,8 Department of Otorhinolaryngology and Head and Neck Surgery, Thessaloniki Medical School, Thessaloniki, Greece
| | - Maria Rosaria Barillari
- 1 Laryngopharyngeal Reflux Study Group of Young Otolaryngologists, International Federation of Oto-rhino-laryngological Societies, Paris, France.,9 Division of Phoniatrics and Audiology, Department of Mental and Physical Health and Preventive Medicine, University of Naples SUN, Naples, Italy
| | - Christian Calvo-Henriquez
- 1 Laryngopharyngeal Reflux Study Group of Young Otolaryngologists, International Federation of Oto-rhino-laryngological Societies, Paris, France.,10 Department of Otorhinolaryngology and Head and Neck Surgery, Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain
| | - Lise Crevier-Buchman
- 1 Laryngopharyngeal Reflux Study Group of Young Otolaryngologists, International Federation of Oto-rhino-laryngological Societies, Paris, France.,11 Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, Paris, France
| | - Camille Finck
- 1 Laryngopharyngeal Reflux Study Group of Young Otolaryngologists, International Federation of Oto-rhino-laryngological Societies, Paris, France.,2 Department of Anatomy and Experimental Oncology, Mons School of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium.,12 Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Liège, Faculty of Medicine, University of Liège, Liège, Belgium
| | - Young-Gyu Eun
- 1 Laryngopharyngeal Reflux Study Group of Young Otolaryngologists, International Federation of Oto-rhino-laryngological Societies, Paris, France.,13 Department of Otorhinolaryngology and Head and Neck Surgery, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Sven Saussez
- 1 Laryngopharyngeal Reflux Study Group of Young Otolaryngologists, International Federation of Oto-rhino-laryngological Societies, Paris, France.,2 Department of Anatomy and Experimental Oncology, Mons School of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium.,4 Department of Otorhinolaryngology and Head and Neck Surgery, CHU Saint-Pierre, Faculty of Medicine, University Libre de Bruxelles, Brussels, Belgium
| | - Michael F Vaezi
- 14 Division of Gastroenterology, Hepatology, Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Laryngopharyngeal reflux disease: clinical presentation, diagnosis and therapeutic challenges in 2018. Curr Opin Otolaryngol Head Neck Surg 2018; 26:392-402. [DOI: 10.1097/moo.0000000000000486] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Tang B, Wang X, Chen C, Deng X, Ouyang X, Jia L, Gong J. The differences in epidemiological and psychological features of globus symptoms between urban and rural Guangzhou, China: A cross-sectional study. Medicine (Baltimore) 2018; 97:e12986. [PMID: 30412130 PMCID: PMC6221633 DOI: 10.1097/md.0000000000012986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
To compare the epidemiological and psychological features of globus symptoms between individuals from urban and rural areas in Guangzhou.In total, 3360 individuals aged 18 years and over were selected to participate in our questionnaire investigation using random cluster sampling under the stratification of a urban area and a rural area. The questionnaire comprised questions on personal characteristics and globus symptomatology and psychological characteristic and sleep quality scales.Lifetime prevalence and Glasgow-Edinburgh throat scale scores of globus symptoms were greater in the urban area than in the rural area, but no significant differences in sex ratio or onset age between individuals with globus were found. The incidences and severity of anxiety, depression, and sleep disorders were significantly higher among patients who presented with globus in the urban area than among those in the rural area.The lifetime prevalence of globus symptoms and the psychological features of globus patients differ between urban and rural inhabitants. We should pay more attention to these differences.
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Affiliation(s)
- Bei Tang
- Department of Gastroenterology, Shunde Second People's Hospital, Foshan
| | - Xiaogu Wang
- Department of Gastroenterology, Shunde Second People's Hospital, Foshan
| | - Chaoda Chen
- Department of Gastroenterology, Shunde Second People's Hospital, Foshan
| | - Xuqun Deng
- Department of Gastroenterology, Shunde Second People's Hospital, Foshan
| | - Xinqiang Ouyang
- Department of Gastroenterology, Shunde Second People's Hospital, Foshan
| | - Lin Jia
- Department of Gastroenterology, Guangzhou Nansha Central Hospital, Guangzhou, Guangdong Province, China
| | - Jianan Gong
- Department of Gastroenterology, Shunde Second People's Hospital, Foshan
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Takahashi N, Mori K, Baba H, Sasaki T, Ohno M, Ikarashi F, Aizawa N, Sato K, Tsuchiya A, Hanazawa H, Tomita M, Kubota Y, Morita Y, Takahashi K, Horii A. Reliability and validity of the Japanese version of the Glasgow Edinburgh Throat Scale (GETS-J): Use for a symptom scale of globus sensation. Auris Nasus Larynx 2018. [DOI: 10.1016/j.anl.2018.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Harvey PR, Theron BT, Trudgill NJ. Managing a patient with globus pharyngeus. Frontline Gastroenterol 2018; 9:208-212. [PMID: 30046425 PMCID: PMC6056082 DOI: 10.1136/flgastro-2017-100844] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 05/26/2017] [Accepted: 07/03/2017] [Indexed: 02/04/2023] Open
Abstract
A woman aged 47 years reported the feeling of a lump in her throat for the past year. The sensation was present intermittently and usually improved when she ate. She noted it was worse with dry swallows when she felt like a tablet was stuck in her throat. The sensation had become more persistent in recent weeks leading her to worry that she had cancer. She had no cough, sore throat or hoarseness. There were no precipitating factors and no symptoms of weight loss, dysphagia, odynophagia or change in her voice. She had smoked previously and rarely had heartburn. She had no other anxieties and was not under any unusual stress. She was initially assessed by an ear, nose and throat surgeon, who found no abnormalities on examination of her neck, throat and oral cavity. Nasolaryngoscopy was normal. An upper gastrointestinal endoscopy was organised and reported a hiatus hernia, but a 3-month trial of a proton pump inhibitor did not have any impact on her symptoms. The benign nature of her symptoms was discussed at her gastroenterology follow-up appointment. She was discharged back to primary care with a final diagnosis of 'globus'. A trial of speech therapy, cognitive behavioural therapy or amitriptyline would be recommended if her symptoms became more troublesome in future.
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Affiliation(s)
- Philip R Harvey
- Department of Gastroenterology, Sandwell General Hospital, West Bromwich, Birmingham, UK
| | - Byron T Theron
- Department of Gastroenterology, Sandwell General Hospital, West Bromwich, Birmingham, UK
| | - Nigel J Trudgill
- Department of Gastroenterology, Sandwell General Hospital, West Bromwich, Birmingham, UK
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The palatal septal cartilage implantation for snoring and obstructive sleep apnea. Auris Nasus Larynx 2018; 45:1199-1205. [PMID: 29706415 DOI: 10.1016/j.anl.2018.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 03/15/2018] [Accepted: 04/09/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Patients with snoring and obstructive sleep apnea frequently have nasal and palatal obstruction. The objective of this study was to investigate the safety and feasibility of a palatal septal cartilage implant (SCI) for snoring and obstructive sleep apnea. METHODS This was a preliminary study of 10 consecutive patients who were enrolled retrospectively from electronic charts. The patients had undergone a single-stage operation including septoturbinoplasty and palatal SCI at a tertiary referral hospital. After nasal surgery, the harvested cartilage was prepared and trimmed into strips for palatal implantation. Key procedures of palatal SCI include vertical tunneling of the midline and paramedian soft palate, insertion of the septal cartilage strips, and fixation suture of the implants. The primary outcome measures were adverse events, including implant extrusion, infection, bleeding, velopharyngeal insufficiency and globus symptoms, assessed by the Glasgow-Edinburgh Throat Scale (GETS) questionnaire (10-item, 8-grade [0-7] Likert scale). Secondary outcomes were subjective snoring loudness (visual analogue scale, VAS), excessive daytime sleepiness (Epworth sleepiness scale, ESS) and objective apnea-hypopnea index. All patients were followed up for at least 1 year. RESULTS None of the aforementioned adverse events were noted during the one-year follow-up. Among the ten items of the GETS, the median score of nine items was 0, and the median score of the total GETS was 2.0, which was classified as "asymptomatic". The snoring loudness improved significantly from 8.0 points (IQR 8.0-9.0) preoperation to 4.0 points (IQR 2.5-6.0) at 3 months postoperation and 4.5 points (IQR 3.3-6.0) at 1 year postoperation (P=0.002 and P=0.002, respectively). The ESS score improved significantly from 11.5 points (IQR 8.3-18.5) preoperation to 8.0 points (IQR 6.3-10.8) at 3 months postoperation and 8.5 points (IQR 6.3-10.8) at 1 year postoperation (P=0.004 and P=0.004, respectively). The apnea-hypopnea index significantly decreased from 54.7 (IQR 23.4-62.8) to 20.5 (IQR 14.7-45.6) (P=0.047) in patients with a lower tongue position (modified Mallampati class≤II; n=7). CONCLUSION Palatal SCI is a safe and feasible procedure. The advantages include providing implants of tailor-made length, biocompatible autologous cartilage and no need for extra-payment for the implant material. By using the SCI procedure, both nasal obstruction and sleep-disordered breathing can be managed in a single-stage operation. The long-term effectiveness of SCI deserves further research.
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Penović S, Roje Ž, Brdar D, Gračan S, Bubić A, Vela J, Punda A. Globus Pharyngeus: A Symptom of Increased Thyroid or Laryngopharyngeal Reflux? Acta Clin Croat 2018; 57:110-115. [PMID: 30256018 PMCID: PMC6400352 DOI: 10.20471/acc.2018.57.01.13] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
SUMMARY – The aim of this study was to investigate the relationship between globus pharyngeus and laryngopharyngeal reflux, as well as between globus and thyroid volume. A two-year prospective study included 56 patients aged 18-75 with globus symptom. Anthropometric, clinical and laboratory data were collected. All patients filled-out the Glasgow Edinburgh Throat Scale (GETS) and then underwent thyroid ultrasound. Morphological changes of the larynx were detected by direct laryngoscopy and classified by the Reflux Finding Score (RFS). If RFS >7, the diagnosis of laryngopharyngeal reflux was made and therapy with proton pump inhibitors initiated. According to GETS, there was significant difference between patients with normal volume and those with large thyroid volume. There was no statistically significant difference between patients with RFS <7 and RFS >7. In conclusion, the incidence and severity of globus pharyngeus do not definitely indicate laryngopharyngeal reflux. It is more common in patients with normal thyroid volume.
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Affiliation(s)
| | - Željka Roje
- Private Practice of Otorhinolaryngology, Split, Croatia
| | - Dubravka Brdar
- Department of Nuclear Medicine, Split University Hospital Centre, Split, Croatia
| | - Sanda Gračan
- Department of Nuclear Medicine, Split University Hospital Centre, Split, Croatia
| | - Ana Bubić
- Institute of Emergency Medicine of Split-Dalmatia County, Split, Croatia
| | - Jadranka Vela
- University Department of ENT, Head and Neck Surgery, Split University Hospital Centre, Split, Croatia
| | - Ante Punda
- Department of Nuclear Medicine, Split University Hospital Centre, Split, Croatia
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Liu Y, Jia L, Jiang SM, Chen DY, Song JS, Xu J. Serotonin Transporter Gene (SLC6A4) Polymorphism May Be Associated with Chinese Globus Pharyngeus and Its Antidepressant Effects. Digestion 2018; 97:146-153. [PMID: 29310115 DOI: 10.1159/000484202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 10/12/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND Although globus pharyngeus is not rare in clinical practice, little is known about its associated gene polymorphism. We investigated the association between the SLC6A4 polymorphism and globus pharyngeus and its response to treatment with antidepressants. METHODS A total of 84 patients were diagnosed with globus pharyngeus according to Rome III, and 160 healthy controls were genotyped for the SLC6A4 polymorphism using polymerase chain reaction amplification and agarose gel electrophoresis. All patients with globus were studied using high-resolution manometry pre-therapy. Globus patients were randomized into paroxetine or amitriptyline groups for a 6-week treatment and asked to complete the following pre- and post-therapy questionnaires: the Glasgow Edinburgh Throat Scale (GETS), the Pittsburgh Sleep Quality Index, and the Hamilton Rating Scale Anxiety/Depression. Treatment response was defined as a >50% reduction in the GETS scores. RESULTS A significant difference was observed in the globus S/S genotype with anxiety compared to that without anxiety (χ2 = 14.579, p = 0.006). The L/S genotype showed a significant difference between high upper esophageal sphincter pressure (>104 mm Hg) and non-high upper esophageal sphincter pressure patients (χ2 = 14.433, p = 0.006). A significant association between the S/S genotype and the response to antidepressant treatment was also observed, while patients with sleep disorders or depression showed no association. CONCLUSION A significant association was observed between the S/S genotype of the SLC6A4 polymorphism and globus pharyngeus, suggesting that SLC6A4 is a potential candidate gene involved in the pathogenesis of globus pharyngeus.
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Affiliation(s)
- Yao Liu
- Department of Gastroenterology, The Second Affiliated Hospital, South China University of Technology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Lin Jia
- Department of Gastroenterology, The Second Affiliated Hospital, South China University of Technology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Shu-Man Jiang
- Department of Gastroenterology, The Second Affiliated Hospital, South China University of Technology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Dong-Yun Chen
- Department of Gastroenterology, The Second Affiliated Hospital, South China University of Technology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Jiang-Shun Song
- Department of Otorhinolaryngology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Jian Xu
- Department of Psychology, The Second Affiliated Hospital, South China University of Technology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, China
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The effects of paroxetine and amitriptyline on the upper esophageal sphincter (UES) pressure and its natural history in globus pharyngeus. Dig Liver Dis 2017; 49:757-763. [PMID: 28258931 DOI: 10.1016/j.dld.2017.02.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 02/02/2017] [Accepted: 02/02/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Antidepressant agents have been shown to be an effective and safe treatment method for patients with globus. However, there are few clinical trials dedicated to studying the effects of antidepressant agents on the natural history and upper oesophageal sphincter (UES) pressure of treated globus patients. AIMS To evaluate the effect of paroxetine and amitriptyline to prevent relapses in patients with globus, the simultaneous relationship between changes in UES pressure and improvement of globus symptoms were measured. METHODS Globus patients were randomised into amitriptyline, paroxetine and lansoprazole groups for a 6-week treatment period, and follow-up was extended to 12 additional months. Efficacy was evaluated in terms of the Glasgow-Edinburgh Throat Scale (GETS), and UES pressure was measured by standard oesophageal manometry. RESULTS Paroxetine therapy resulted in a higher withdrawal rate due to symptom relapse (15.9% vs 44.1%, P=0.01; 15.9% vs 64.7, P=0.001) than amitriptyline and lansoprazole. Furthermore, globus symptoms were alleviated with the decrease of UES pressure after paroxetine and amitriptyline treatment (r=0.620, P=0.02; r=0.575, P=0.03) CONCLUSIONS: This follow-up study indicates that paroxetine may alter the natural history of globus and can effectively be used for the long-term management of patients with the disease. Apart from the clinical benefits, paroxetine and amitriptyline can potentially decrease UES pressure.
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Mohammed H, Coates M, Masterson L, Chan W, Hassan Y, Nassif R. Role of transnasal flexible laryngo-oesophagoscopy (TNFLO) in investigating patients with globus symptoms. Clin Otolaryngol 2017; 42:1311-1318. [DOI: 10.1111/coa.12872] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2017] [Indexed: 12/11/2022]
Affiliation(s)
- H. Mohammed
- Department of Otolaryngology-Head and Neck Surgery; Norfolk and Norwich University Hospital; Norwich UK
| | - M. Coates
- Department of Otolaryngology-Head and Neck Surgery; Norfolk and Norwich University Hospital; Norwich UK
| | - L. Masterson
- Department of Otolaryngology-Head and Neck Surgery; Norfolk and Norwich University Hospital; Norwich UK
| | - W.Y. Chan
- Department of Otolaryngology-Head and Neck Surgery; Norfolk and Norwich University Hospital; Norwich UK
| | - Y. Hassan
- Department of Otolaryngology-Head and Neck Surgery; Norfolk and Norwich University Hospital; Norwich UK
| | - R. Nassif
- Department of Otolaryngology-Head and Neck Surgery; Norfolk and Norwich University Hospital; Norwich UK
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Francis DO, Patel DA, Sharda R, Hovis K, Sathe N, Penson DF, Feurer ID, McPheeters ML, Vaezi MF. Patient-Reported Outcome Measures Related to Laryngopharyngeal Reflux: A Systematic Review of Instrument Development and Validation. Otolaryngol Head Neck Surg 2016; 155:923-935. [PMID: 27554511 PMCID: PMC5639324 DOI: 10.1177/0194599816664330] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 06/22/2016] [Accepted: 07/25/2016] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Patient-reported outcome (PRO) measures are often used to diagnose laryngopharyngeal reflux (LPR) and monitor treatment outcomes in clinical and research settings. The present systematic review was designed to identify currently available LPR-related PRO measures and to evaluate each measure's instrument development, validation, and applicability. DATA SOURCES MEDLINE via PubMed interface, CINAHL, and Health and Psychosocial Instrument databases were searched with relevant vocabulary and key terms related to PRO measures and LPR. REVIEW METHODS Three investigators independently performed abstract review and full text review, applying a previously developed checklist to critically assess measurement properties of each study meeting inclusion criteria. RESULTS Of 4947 studies reviewed, 7 LPR-related PRO measures (publication years, 1991-2010) met criteria for extraction and analysis. Two focused on globus and throat symptoms. Remaining measures were designed to assess LPR symptoms and monitor treatment outcomes in patients. None met all checklist criteria. Only 2 of 7 used patient input to devise item content, and 2 of 7 assessed responsiveness to change. Thematic deficiencies in current LPR-related measures are inadequately demonstrated: content validity, construct validity, plan for interpretation, and literacy level assessment. CONCLUSION Laryngopharyngeal reflux is often diagnosed according to symptoms. Currently available LPR-related PRO measures used to symptomatically identify suspected LPR patients have disparate developmental rigor and important methodological deficiencies. Care should be exercised to understand the measurement characteristics and contextual relevance before applying these PRO measures for clinical, research, or quality initiatives.
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Affiliation(s)
- David O Francis
- Department of Otolaryngology, Bill Wilkerson Center, Nashville, Tennessee, USA
- Center for Surgical Quality and Outcomes Research, Nashville, Tennessee, USA
- Vanderbilt Evidence-Based Practice Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Dhyanesh A Patel
- Division of Gastroenterology and Hepatology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Rohit Sharda
- Division of Gastroenterology and Hepatology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kristen Hovis
- Department of Otolaryngology, Bill Wilkerson Center, Nashville, Tennessee, USA
| | - Nila Sathe
- Vanderbilt Evidence-Based Practice Center, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - David F Penson
- Center for Surgical Quality and Outcomes Research, Nashville, Tennessee, USA
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Geriatric Research and Education Coordination Center, Veteran's Administration Tennessee Valley Health System, Nashville, Tennessee, USA
| | - Irene D Feurer
- Center for Surgical Quality and Outcomes Research, Nashville, Tennessee, USA
- Departments of Surgery and Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Melissa L McPheeters
- Vanderbilt Evidence-Based Practice Center, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Center for Population Health Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Michael F Vaezi
- Division of Gastroenterology and Hepatology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Anticholinergic medication use is associated with globus pharyngeus. The Journal of Laryngology & Otology 2016; 130:1125-1129. [DOI: 10.1017/s002221511600918x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AbstractBackground:Globus pharyngeus has been linked to salivary hypofunction. We hypothesise that a considerable portion of the globus experienced by patients is due to a drying effect secondary to anticholinergic medication use; this study aimed to determine their association.Methods:A cross-sectional study was conducted of 270 patients who presented to a laryngology practice over 6 months. Participants rated globus sensation on a 5-point severity scale, with those scoring 0 considered as controls (non-globus). Participants were excluded if they had a likely cause of globus. Scores were compared with participants’ medication lists, co-morbidities, age and gender, and evaluated using multivariate analysis, with significance set at p < 0.05.Results:Any participant taking at least 2 anticholinergic medications had a 3.52 increased odds (p = 0.02) of experiencing globus. A previous diagnosis of gastroesophageal reflux disease was also significantly associated with globus (p = 0.004), with an odds ratio of 3.75.Conclusion:A substantial portion of idiopathic globus may be due to anticholinergic use or reflux. The findings implicate medication use as a risk factor for globus. An awareness of these associations is invaluable for identifying cause and treating globus.
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Esophageal Sensorimotor Function and Psychological Factors Each Contribute to Symptom Severity in Globus Patients. Am J Gastroenterol 2016; 111:1382-1388. [PMID: 27481312 DOI: 10.1038/ajg.2016.302] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 06/02/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Altered upper esophageal sphincter (UES) and esophageal body (EB) sensorimotor function and psychosocial factors may both be involved in symptom generation in globus, but their common impact is not yet assessed. The aim of the study is (1) to compare UES and EB sensitivity and compliance of globus patients with healthy controls (HC); (2) to study the association of globus symptom severity (GSS) with UES and EB sensitivity and compliance, UES motor function and psychosocial factors. METHODS In 58 globus patients, GSS, somatization, and anxiety disorders were determined using validated questionnaires. In 26 HC and 42/58 patients, UES and EB sensitivity and compliance were assessed twice using barostat measurements. UES function of 27 globus patients was evaluated using high-resolution manometry. Bivariate correlations and a general linear model tested the association of these factors with GSS. RESULTS UES and EB compliance did not differ between globus patients and HC. Upon repeated distension, UES habituation was seen in both groups, whereas EB sensitization (23.3±1.3 vs. 19.5±1.5 mm Hg, P<0.0001) only occurred in globus patients, (P=0.038). UES compliance (ρ=0.37, P=0.04), change in EB compliance upon repeated distension (ρ=0.45, P=0.007), somatization (ρ=0.43, P=0.003), panic disorder (t=3.04, P=0.004), and post-traumatic stress severity (ρ=0.40, P=0.005) were associated with GSS. UES compliance and somatization were independently associated with GSS. A trend (P=0.061) was found for the association of GSS with change in EB compliance. CONCLUSIONS UES compliance, change in EB compliance, and somatization explain 40% of the variance in GSS. This indicates that globus is a complex disorder of the brain-gut axis rather than a "psychosomatic" disorder or a peripheral esophageal disorder.
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Chen DY, Jia L, Gu X, Jiang SM, Xie HL, Xu J. Comparison of paroxetine and amitriptyline in the treatment of refractory globus pharyngeus. Dig Liver Dis 2016; 48:1012-7. [PMID: 27378704 DOI: 10.1016/j.dld.2016.05.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 05/22/2016] [Accepted: 05/30/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Clinical trials of antidepressants for treatment of globus are generally rare, let alone for refractory globus pharyngeus. AIMS To illustrate the efficacy and side-effects of antidepressants between paroxetine and amitriptyline for refractory globus patients. METHODS Refractory globus patients were randomized into paroxetine group; amitriptyline group and lansoprazole group for 6-week treatment. All the subjects were asked to complete the following questionnaires pre- and post-therapy: Glasgow Edinburgh Throat Scale (GETS), Pittsburgh Sleep Quality Index, Hamilton Rating Scale Anxiety/Depression and Medical outcome short-form 36. Treatment response was defined as a >50% reduction in the GETS score. RESULTS One hundred and forty-eight patients completed the study. After 6 week treatment, 71.7% of paroxetine group (33/46) were calculated as treatment response, significantly higher than that in amitriptyline group (46.2%, 24/52) and lansoprazole group (14.0%, 7/50). Compared with lansoprazole group or amitriptyline group, a more distinct improvement of emotional well-being, quality of life and quality of sleep were observed in paroxetine group after 6-week treatment. CONCLUSION Paroxetine therapy is more efficacious than empirical high-dose antisecretory treatment, or even the low-dose amitriptyline therapy in alleviating globus symptoms, and producing global improvements for refractory globus patients.
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Affiliation(s)
- Dong-Yun Chen
- Department of Gastroenterology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Lin Jia
- Department of Gastroenterology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong Province, China; Department of Gastroenterology, Guangzhou Nansha Central Hospital Affiliated to Guangzhou First People's Hospital, Guangzhou, Guangdong Province, China.
| | - Xi Gu
- Department of Gastroenterology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Shu-Man Jiang
- Department of Gastroenterology, Guangzhou Nansha Central Hospital Affiliated to Guangzhou First People's Hospital, Guangzhou, Guangdong Province, China
| | - Hai-Li Xie
- Department of Epidemiology, Guangzhou Nansha Central Hospital, Guangzhou, Guangdong Province, China
| | - Jian Xu
- Department of Psychology, Guangzhou Nansha Central Hospital, Guangzhou, Guangdong Province, China
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Abstract
This clinical case describes the assessment and treatment of Roger, a 31-year-old veteran who served in Operation Iraqi Freedom. In addition to combat-related post-traumatic stress disorder (PTSD), Roger presented with a conversion disorder (globus pharyngeus) and avoidance of consuming solid food without also consuming alcohol. A multicomponent treatment program for PTSD, trauma management therapy (TMT), was provided 5 times per week over a 3-week period. TMT included daily-exposure therapy (EXP) as well as daily social and emotion regulation (SER) group therapy to target anger, social withdrawal, and depression. In addition to TMT, exposure to food consumption in the absence of alcohol was provided in the final week. PTSD symptoms were assessed via semi-structured interview and self-report measures, while food intake was assessed via behavioral observation. PTSD symptoms as measured by the Clinician-Administered PTSD Scale (CAPS) decreased from 63 at pre-treatment to 17 at post-treatment, indicating that Roger no longer met criteria for PTSD. Exposure to food intake was equally successful with Roger consuming full meals (e.g., hamburger and french fries) without consuming alcohol. This case study exemplifies the successful use of intensive exposure therapy to target comorbid anxiety-based disorders in a short period.
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Tang B, Cai HD, Xie HL, Chen DY, Jiang SM, Jia L. Epidemiology of globus symptoms and associated psychological factors in China. J Dig Dis 2016; 17:319-24. [PMID: 27125332 DOI: 10.1111/1751-2980.12354] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 03/29/2016] [Accepted: 04/25/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To investigate the lifetime prevalence, epidemiological characteristics and psychological factors of globus symptoms in Guangzhou (Guangzhou Province, China). METHODS A total of 3 360 individuals were randomly selected and participated in the study. Respondents completed questionnaires about their physical and psychological characteristics, globus symptomatology and the Glasgow-Edinburgh throat scale questionnaires and quality of sleep and life. Those who had experienced a globus sensation with no history of gastroesophageal reflux disease, dysphagia, odynophagia or alerting symptoms such as weight loss and hoarseness were diagnosed as having globus. RESULTS A total of 3 006 respondents completed the questionnaires, giving a response rate of 89.5%. The overall lifetime prevalence of globus was 21.5%, with a peak age at disease onset of 35-54 years. The prevalence of globus was higher in participants from the urban region than those from the rural areas (26.5% vs 16.4%, P = 0.001). No sex-related difference was observed (P = 0.082). Anxiety (39.8% vs 22.3%, P = 0.001), depression (31.2% vs 18.0%, P = 0.001) and sleep disorders (23.7% vs 13.6%, P = 0.001) were significantly more common in respondents with globus than in those without. Scores on all dimensions of the 36-item short-form health survey, except physical function, were lower in respondents with globus than in those without (all P < 0.05). CONCLUSIONS Globus symptoms are common and often accompanied by psychological and sleep disorders. The medical community should pay more attention to globus in clinical setting.
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Affiliation(s)
- Bei Tang
- Department of Gastroenterology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangdong Province, China
| | - Hou Da Cai
- Department of Gastroenterology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangdong Province, China
| | - Hai Li Xie
- Department of Epidemiology, Guangzhou Nansha Central Hospital, Guangzhou First People's Hospital, Guangzhou, Guangdong Province, China
| | - Dong Yun Chen
- Department of Gastroenterology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangdong Province, China
| | - Shu Man Jiang
- Department of Gastroenterology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangdong Province, China.,Department of Gastroenterology, Guangzhou Nansha Central Hospital, Guangzhou First People's Hospital, Guangzhou, Guangdong Province, China
| | - Lin Jia
- Department of Gastroenterology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangdong Province, China.,Department of Gastroenterology, Guangzhou Nansha Central Hospital, Guangzhou First People's Hospital, Guangzhou, Guangdong Province, China
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Tang B, Jia L, Liu J, Gu X, Ye HX, Song JS, Su F, Ji XB, Xie JH, Zhang XH. Clinical-psychological characteristics of refractory globus patients in China. Dig Liver Dis 2016; 48:381-4. [PMID: 26687029 DOI: 10.1016/j.dld.2015.11.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 11/18/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Refractory globus is not rare in clinical practice, but little research about it. AIMS To investigate the clinical-psychological characteristics of patients with refractory globus. METHODS Six hundred and nineteen globus patients were divided into the refractory globus group (n=149) and the non-refractory globus group (n=470). All subjects completed the following questionnaires: demographic characteristics, medical information, Hamilton Rating Scale of Anxiety/Depression, Pittsburgh Sleep Quality Index, Glasgow Edinburgh Throat Scale, and 36-item Short Form Health Survey. RESULTS No significantly differences were found in demographic characteristics between the two groups, but the refractory globus group had longer disease duration and more serious symptoms. Sought healthcare more frequently but still had poorer quality of life than did the non-refractory globus group. Compared with the non-refractory globus group, the refractory globus group also had higher percentages of anxiety, depression, and sleep disorders. Positive correlations were observed between the severity of globus symptoms and HAMA, HAMD, and PSQI scores. CONCLUSIONS Refractory globus is not rare in clinical practice and should receive more attention from patients and doctors because of its severe symptoms, long disease duration, poor quality of life, and accompanied by psychological disorders and sleep disorders.
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Affiliation(s)
- Bei Tang
- Department of Gastroenterology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Lin Jia
- Department of Gastroenterology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong Province, China; Department of Gastroenterology, Guangzhou Nansha Central Hospital affiliated with Guangzhou First People's Hospital, Guangzhou, Guangdong Province, China.
| | - Jing Liu
- Department of Gastroenterology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong Province, China; Department of Gastroenterology, Guangzhou Nansha Central Hospital affiliated with Guangzhou First People's Hospital, Guangzhou, Guangdong Province, China
| | - Xi Gu
- Department of Gastroenterology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Hai-Xia Ye
- Department of Psychology, Guangzhou Nansha Central Hospital affiliated with Guangzhou First People's Hospital, Guangzhou, Guangdong Province, China
| | - Jiang-Shun Song
- Department of Otorhinolaryngology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Fang Su
- Department of Otorhinolaryngology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Xiao-Bing Ji
- Department of Otorhinolaryngology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Jin-Hua Xie
- Department of Otorhinolaryngology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Xue-Hui Zhang
- Department of Otorhinolaryngology, Guangdong No. 2 Provincial People's Hospital, Guangzhou, Guangdong Province, China
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Consorti F, Mancuso R, Mingarelli V, Pretore E, Antonaci A. Frequency and severity of globus pharyngeus symptoms in patients undergoing thyroidectomy: a pre-post short term cross-sectional study. BMC Surg 2015; 15:53. [PMID: 25928173 PMCID: PMC4419479 DOI: 10.1186/s12893-015-0037-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Accepted: 04/20/2015] [Indexed: 01/28/2023] Open
Abstract
Background Globus pharyngeus is a sensation of a lump or foreign body in the throat, sometimes associated with thyroid diseases and surgery. Previous studies investigated this condition with contradictory results, mainly because not standardized instruments of measure were used. The aim of this study was to evaluate the prevalence and severity of globus pattern symptoms in a population of patients three months after a thyroidectomy, and the reduction or increase of pre-existing symptoms or the onset of new symptoms. Methods Ninety-five patients (65 women, 30 men, mean age 56.03 ± 12.45) were assessed for globus pattern symptoms before and three months after thyroid surgery (72 patients: benign goiter, 23 patients: papillary cancer). The Glasgow-Edinburgh Throat Scale (GETS) was translated into Italian and used as a validated instrument of measure of the severity of globus pattern symptoms. Results The Italian version of the GETS was reliable (Cronbach alpha = 0.85) and valid. Normative data were used to classify patients into 4 groups of severity. A significant decrease of the mean GETS score was observed at the postoperative assessment (13.02 ± 11.84 vs 8.00 ± 11.26; p < 0.01), but beside symptomatic patients who improved we could observe also two other significant groups of patients: asymptomatic patients who developed symptoms and symptomatic patients who remained symptomatic. Conclusions The significant decrease of the mean GETS postoperative score was mainly due to the improvement of strongly symptomatic patients. Two other significant outcomes exist and further studies are needed to understand their pathophysiological mechanism.
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Affiliation(s)
- Fabrizio Consorti
- Department of Surgical Sciences, University "Sapienza" of Rome, Viale del Policlinico, 00161, Roma, Italy.
| | - Rosaria Mancuso
- Department of Surgical Sciences, University "Sapienza" of Rome, Viale del Policlinico, 00161, Roma, Italy
| | - Valentina Mingarelli
- Department of Surgical Sciences, University "Sapienza" of Rome, Viale del Policlinico, 00161, Roma, Italy
| | - Eugenio Pretore
- Department of Surgical Sciences, University "Sapienza" of Rome, Viale del Policlinico, 00161, Roma, Italy
| | - Alfredo Antonaci
- Department of Surgical Sciences, University "Sapienza" of Rome, Viale del Policlinico, 00161, Roma, Italy
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Peng L, Patel A, Kushnir V, Gyawali CP. Assessment of upper esophageal sphincter function on high-resolution manometry: identification of predictors of globus symptoms. J Clin Gastroenterol 2015; 49:95-100. [PMID: 24492407 PMCID: PMC4117818 DOI: 10.1097/mcg.0000000000000078] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Globus is commonly encountered in clinical practice, but high-resolution manometry (HRM) characteristics are incompletely characterized. We evaluated HRM metrics in globus subjects, compared with age-matched and sex-matched dysphagia subjects and healthy controls. STUDY Twenty-four subjects with globus (53.3 ± 2.3 y, 58% female) were compared with 24 age-matched and sex-matched subjects with nonobstructive dysphagia (52.5 ± 2.5 y, 58% female), and 21 healthy controls (27.6 ± 0.6 y, 52% female). Sphincter and segment anatomy, and pressure volume metrics assessed skeletal (proximal contractile integral) and smooth muscle contraction (distal contractile integral). Parameters significantly different across groups on univariate analysis were subjected to multivariate logistic regression and receiver-operating characteristic analysis to identify HRM predictors of globus. RESULTS Upper esophageal sphincter (UES) postswallow residual pressures were highest in globus (2.6 ± 0.5 vs. 2.3 ± 0.5 mm Hg in dysphagia and 0.6 ± 0.6 mm Hg in controls, P = 0.03); 66.7% had recordable UES residual pressure, in contrast to 9.5% of controls, and 37.5% of dysphagia patients (P = 0.0002). Although different from controls, UES length and basal pressure, and segment 1 parameters did not differ from dysphagia controls. In a multivariate model, measurable UES residual pressure (odds ratio, 6.33; 95% confidence interval, 1.79-25.96) independently predicted globus. Receiver-operating characteristic analysis identified a threshold of 0.4 mm Hg UES residual pressure in segregating globus (sensitivity 66.7%, specificity 71.5%, positive predictive value 55.2%, and negative predictive value 80.0%). CONCLUSION HRM with measurement of UES residual pressure allows objective assessment of patients with globus sensation, and has potential to complement current diagnostic strategies.
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Affiliation(s)
- Lihua Peng
- Chinese PLA General Hospital, Beijing, China,Department of Medicine, Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO
| | - Amit Patel
- Department of Medicine, Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO
| | - Vladimir Kushnir
- Department of Medicine, Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO
| | - C. Prakash Gyawali
- Department of Medicine, Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO
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Ogawa H, Fujimura M, Ohkura N, Makimura K. It is time to call attention to the clinical significance of fungal colonization in chronic cough. Allergol Int 2014; 63:611-2. [PMID: 25150447 DOI: 10.2332/allergolint.14-le-0691] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- Haruhiko Ogawa
- Division of Pulmonary Medicine, Ishikawa-ken Saiseikai Kanazawa Hospital, Japan
| | - Masaki Fujimura
- Respiratory Medicine, National Hospital Organization Nanao Hospital, Japan
| | - Noriyuki Ohkura
- Respiratory Medicine, Ishikawa Prefectural Central Hospital, Ishikawa, Japan
| | - Koichi Makimura
- Laboratory of Space and Environmental Medicine, Teikyo University, Tokyo, Japan
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Ogawa H, Fujimura M, Ohkura N, Makimura K. Atopic cough and fungal allergy. J Thorac Dis 2014; 6:S689-98. [PMID: 25383202 PMCID: PMC4222924 DOI: 10.3978/j.issn.2072-1439.2014.09.25] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Accepted: 08/24/2014] [Indexed: 11/14/2022]
Abstract
We have shown that some patients presenting with chronic bronchodilator-resistant non-productive cough have a global atopic tendency and cough hypersensitivity without nonspecific bronchial hyperresponsiveness, abbreviated as atopic cough (AC). The cough can be treated successfully with histamine H1 antagonists and/or glucocorticoids. Eosinophilic tracheobronchitis and cough hypersensitivity are pathological and physiological characteristics of AC. Fungus-associated chronic cough (FACC) is defined as chronic cough associated with basidiomycetous (BM) fungi found in induced sputum, and recognition of FACC has provided the possibility of using antifungal drugs as new treatment strategies. Bjerkandera adusta is a wood decay BM fungus, which has attracted attention because of its potential role in enhancing the severity of cough symptoms in FACC patients by sensitization to this fungus. Before making a diagnosis of "idiopathic cough" in cases of chronic refractory cough, remaining intractable cough-related laryngeal sensations, such as "a sensation of mucus in the throat (SMIT)," which is correlated with fungal colonization, should be evaluated and treated appropriately in each patient. The new findings, i.e., the detection of environmental mushroom spores that should not be present in the human airways in addition to the good clinical response of patients to antifungal drugs, may lead to the development of novel strategies for treatment of chronic cough.
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Ogawa H, Fujimura M, Ohkura N, Makimura K. Chronic cough management: dealing with a sensation of irritation in the throat. Respirology 2014; 18:1278-9. [PMID: 23937276 DOI: 10.1111/resp.12166] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Revised: 07/24/2013] [Accepted: 07/30/2013] [Indexed: 11/28/2022]
Abstract
Among the various types of laryngeal paraesthesia suffered by chronic cough patients, we often encounter 'a sensation of irritation in the throat (SIT)'. Our study indicated that capsaicin cough threshold was significantly (P < 0.05) lower in the SIT-positive group (13.9 μmol/L) than in the SIT-negative group (49.6 μmol/L). The establishment of treatment strategies for SIT would be advantageous for treating chronic cough patients suffering from this laryngeal sensation.
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Affiliation(s)
- Haruhiko Ogawa
- The Division of Pulmonary Medicine, Ishikawa-ken Saiseikai Kanazawa Hospital, Kanazawa, Japan
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