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Sales TMAL, Sidou FMNO, da Costa Filho HB, de Melo Nogueira K, Dias Júnior GJ, de Sousa Lima MA, da Silva LMG, Nicolau LAD, Soares PMG, Nobre E Souza MÂ, Sifrim D, de Souza MHLP. Pepsin Inhibitors Prevent Inflammation and Loss of Laryngeal Barrier Function in Mice with Gastroesophageal Reflux. Laryngoscope 2024; 134:3080-3085. [PMID: 38214310 DOI: 10.1002/lary.31239] [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: 10/08/2023] [Revised: 11/12/2023] [Accepted: 12/04/2023] [Indexed: 01/13/2024]
Abstract
OBJECTIVE This study aimed to evaluate the role of pepsin inhibitors in the inflammatory response and their effects on laryngeal mucosal integrity during gastroesophageal reflux (GERD) under in vivo conditions. METHODS A surgical model of GERD was used, in which mice were treated with pepstatin (0.3 mg/kg) or darunavir (8.6 mg/kg) for 3 days. On the third day after the experimental protocol, the laryngeal samples were collected to assess the severity of inflammation (wet weight and myeloperoxidase activity) and mucosal integrity (transepithelial electrical resistance and paracellular epithelial permeability to fluorescein). RESULTS The surgical GERD model was reproduced. It showed features of inflammation and loss of barrier function in the laryngeal mucosa. Pepstatin and darunavir administration suppressed laryngeal inflammation and preserved laryngeal mucosal integrity. CONCLUSION Pepsin inhibition by the administration of pepstatin and darunavir improved inflammation and protected the laryngeal mucosa in a mouse experimental model of GERD. LEVEL OF EVIDENCE NA Laryngoscope, 134:3080-3085, 2024.
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Järvenpää P, Kinnari T, Pietarinen P, Ilmarinen T. Efficient management of benign laryngeal symptoms in an endoscopy outpatient clinic. Laryngoscope Investig Otolaryngol 2024; 9:e1223. [PMID: 38525117 PMCID: PMC10960242 DOI: 10.1002/lio2.1223] [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: 01/11/2024] [Accepted: 01/25/2024] [Indexed: 03/26/2024] Open
Abstract
Objectives A globus and thick mucus in the throat are common reasons for referral to an ear, nose, and throat (ENT) specialist. ENT outpatient appointments focus on nasolaryngoscopy examinations, patient education, and reassurance. An endoscopic outpatient clinic (EOC) was established to efficiently manage patients with benign laryngeal symptoms. Methods Patients referred between February 2022 and June 2023 due to a globus and/or thick mucus in the throat were immediately contacted via post. The contact letter included patient education about the potential underlying reasons for their symptoms and self-care instructions. A 15-min outpatient visit was scheduled for an ENT examination and nasolaryngoscopy. Patients completed a questionnaire about their current symptoms and whether they had followed the self-care instructions just before visiting the EOC and 1-month following their appointment. Results In total, 203 patients examined in the EOC were included in the study. Before the EOC visit, most patients (89.2%) considered the information letter useful, it relieved concerns in 44.2% of patients, and 73.2% patients had already followed the self-care instructions. After the 1-month follow-up period, symptoms diminished significantly (p < .001). Conclusions Instructions for self-care and encouragement relieved concerns among patients with benign laryngeal symptoms. Moreover, symptoms improved significantly after a 1-month follow-up period. Level of evidence 4.
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Affiliation(s)
- Pia Järvenpää
- Department of Otorhinolaryngology – Head and Neck SurgeryUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
| | - Teemu Kinnari
- Department of Otorhinolaryngology – Head and Neck SurgeryUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
| | - Petra Pietarinen
- Department of Otorhinolaryngology – Head and Neck SurgeryUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
| | - Taru Ilmarinen
- Department of Otorhinolaryngology – Head and Neck SurgeryUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
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Ren QW, Lei G, Zhao YL, Zhou L, Luo XL, Peng SL. Laryngopharyngeal Reflux and Benign Vocal Fold Lesions: A Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg 2024; 170:309-319. [PMID: 37727944 DOI: 10.1002/ohn.529] [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: 06/07/2023] [Revised: 08/04/2023] [Accepted: 08/26/2023] [Indexed: 09/21/2023]
Abstract
OBJECTIVE There is a link between laryngopharyngeal reflux (LPR) and the formation of benign vocal fold lesions (BVFLs). However, previous studies have mainly focused on LPR suggested by symptoms and signs, rather than objectively diagnosed LPR via pharyngeal pH monitoring. We, therefore, conducted a Meta-analysis to evaluate the association between pharyngeal pH monitoring diagnosed LPR and the odds of BVFLs. DATA SOURCES Relevant observational studies were identified by searching PubMed, Embase, Cochrane Library, and Web of Science. REVIEW METHODS We evaluated between-study heterogeneity using the Cochrane Q test and estimated the I2 statistic. Random-effects models were used when significant heterogeneity was observed; otherwise, fixed-effects models were used. RESULTS Thirteen datasets from 9 studies were included. Among them, 493 were diagnosed with LPR and 344 had BVFLs. LPR was related to a higher odds of BVFLs (odds ratio: 3.26, 95% confidence interval: 1.84-5.76, P < .001) with moderate heterogeneity (P for Cochrane Q test = .006, I2 = 57%). Subgroup analyses showed that the association was similar in studies with only pharyngeal pH monitoring (Restech), with double-probe or 3-site pH monitoring, and with 24-hour multichannel intraluminal impedance-pH monitoring (P for subgroup difference = .15). In addition, subgroup analysis showed consistent results in studies from Asia and Europe (P for subgroup analysis = .12), and the association seemed to be consistent for vocal Reinke's edema, nodules, and polyps (P for subgroup difference = .09). CONCLUSION Pharyngeal pH monitoring diagnosed LPR is associated with the formation of BVFLs.
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Affiliation(s)
- Quan-Wei Ren
- Department of Otorhinolaryngology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Department of Otolaryngology, Chongqing Traditional Chinese Medicine Hospital, Chongqing, China
| | - Gang Lei
- Department of Otolaryngology, Chongqing Traditional Chinese Medicine Hospital, Chongqing, China
| | - Yan-Li Zhao
- Department of Otolaryngology, Chongqing Traditional Chinese Medicine Hospital, Chongqing, China
| | - Li Zhou
- Department of Otorhinolaryngology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xiao-Li Luo
- Department of Otolaryngology, Chongqing Traditional Chinese Medicine Hospital, Chongqing, China
| | - Shun-Lin Peng
- Department of Otorhinolaryngology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
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Lukaschyk J, Abel J, Brockmann-Bauser M, Clausen JF, Reiter R, Wessel J, Rohlfs AK. The Relation Between Endoscopic and Subjective Laryngopharyngeal Reflux Signs, Vocal Tract Discomfort, Voice Handicap, and Voice Disorder Type: Same Yet Different? J Voice 2024:S0892-1997(23)00381-8. [PMID: 38182496 DOI: 10.1016/j.jvoice.2023.11.021] [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: 08/30/2023] [Revised: 11/19/2023] [Accepted: 11/20/2023] [Indexed: 01/07/2024]
Abstract
OBJECTIVES This study aimed to investigate the relation between subjective voice-related symptoms and endoscopic findings in patients with different etiology of voice disorder and vocally healthy subjects with and without laryngopharyngeal reflux (LPR). STUDY DESIGN Retrospective cross-sectional study. METHODS The study involved 149 participants (106 female, 43 male) including 125 with various voice disorders (functional, structural, and neurogenic) and 24 vocally healthy individuals. For self-rating the German versions of the Voice Handicap Index (VHI), Vocal Tract Discomfort (VTD) Scale, and Reflux Symptom Index (RSI) were applied, while endoscopic evaluations utilized the Reflux Finding Score (RFS) and Reflux Sign Assessment (RSA). Statistical analyses incorporated ANOVA with Bonferroni posthoc tests to identify group variations. Correlations between VTD Scale, VHI, RSI, RFS, and RSA were evaluated using Pearson's correlation coefficient. To examine test sensitivity and specificity for the VTD Scale and RSA, we performed a receiver operating characteristics analysis. Youden's-Index was applied to determine the cut-off-value with best discriminatory abilities. The diagnosis of LPR was assumed when the criteria of RFS > 7 AND RSI > 13 was met. RESULTS Significant differences for all voice diagnosis groups and vocally healthy individuals for RFS and all three self-rating questionnaires were found. Moreover, there was significant correlation between VTD Scale and VHI and RSI as well as RSI and RFS, which was moderate, negative in the group of persons with LPR. However, there was no significant difference for RSA results between the vocally healthy or any diagnosis group. CONCLUSION Thus, the RFS may be more suitable to predict reflux and voice-related symptoms. The VTD Scale is a useful instrument in screening voice disorders but also LPR and can therefore be used as a tool for decision-making when transferring to a specialist.
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Affiliation(s)
- Julia Lukaschyk
- ENT, Phoniatrics and Pedaudiology - Klosterstern, Hamburg, Germany.
| | - Jakob Abel
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Meike Brockmann-Bauser
- Department of Phoniatrics and Speech Pathology, Clinic for Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jacob Friedrich Clausen
- Department of Otorhinolaryngology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Rudolf Reiter
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Hospital, Ulm, Germany
| | - Julian Wessel
- ENT, Phoniatrics and Pedaudiology - Klosterstern, Hamburg, Germany
| | - Anna-Katharina Rohlfs
- ENT, Phoniatrics and Pedaudiology - Klosterstern, Hamburg, Germany; Department of Otorhinolaryngology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Javorská Z, Zeleník K, Lukáčová K, Taimrová R, Vrtková A, Hránková V, Lubojacký J, Formánek M, Tedla M. Mulberry Posterior Inferior Nasal Turbinate Is Associated with a Lower Pharyngeal pH Environment. Laryngoscope 2024; 134:62-68. [PMID: 37246719 DOI: 10.1002/lary.30766] [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: 02/06/2023] [Revised: 04/24/2023] [Accepted: 05/13/2023] [Indexed: 05/30/2023]
Abstract
OBJECTIVES Mulberry-like changes of the posterior inferior nasal turbinate (MPINT) can lead to nasal obstruction. Extraesophageal reflux (EER) characterized by lower pH causes mucosal inflammation and therefore can contribute to sinonasal pathologies. No prior studies have objectively examined the possible association between acidic pH and MPINT formation. Therefore, this study is aimed to investigate the 24-h pharyngeal pH value in patients with MPINT. STUDY DESIGN Prospective case-control multi-center study. METHODS Fifty-five patients with chronic EER symptoms were included in the study. They filled in questionnaires aimed at reflux and sinonasal symptoms (RSI®, SNOT-22) and underwent video endoscopy evaluating the laryngeal findings (RFS®) and the presence or absence of the MPINT. And, 24-h oropharyngeal pH monitoring was used to detect the acidic pH environment in the pharynx. RESULTS Out of the 55 analyzed patients, 38 had the MPINT (group 1), and in 17 patients, the MPINT was absent (group 2). Based on the pathological RYAN Score, in 29 (52.7%) patients, severe acidic pH drops were detected. In group 1, the acidic pH drops were diagnosed significantly more often (68.4%) compared with those in group 2 (p = 0.001). Moreover, in group 1, a significantly higher median total percentage of time spent below pH 5.5 (p = 0.005), as well as a higher median number of events lasting more than 5 min (p = 0.006), and higher median total number of events with pH drops (p = 0.017) were observed. CONCLUSION In this study, the MPINT was significantly more often present in patients with acidic pH events detected by 24-h oropharyngeal pH monitoring. Acidic pH in the pharynx might lead to MPINT formation. LEVEL OF EVIDENCE 3 Laryngoscope, 134:62-68, 2024.
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Affiliation(s)
- Zuzana Javorská
- Department of Otolaryngology, Head and Neck Surgery, Comenius University, University Hospital, Bratislava, Slovakia
| | - Karol Zeleník
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, Ostrava, Czech Republic
- Department of Craniofacial Surgery, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Kristína Lukáčová
- Department of Otolaryngology, Head and Neck Surgery, Comenius University, University Hospital, Bratislava, Slovakia
| | | | - Adéla Vrtková
- Department of Applied Mathematics, Faculty of Electrical Engineering and Computer Science, VSB-Technical University of Ostrava, Ostrava, Czech Republic
- Department of Deputy Director for Science, Research and Education, University Hospital Ostrava, Ostrava, Czech Republic
| | - Viktória Hránková
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, Ostrava, Czech Republic
- Department of Craniofacial Surgery, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Jakub Lubojacký
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, Ostrava, Czech Republic
- Department of Craniofacial Surgery, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Martin Formánek
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, Ostrava, Czech Republic
- Department of Craniofacial Surgery, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Miroslav Tedla
- Department of Otolaryngology, Head and Neck Surgery, Comenius University, University Hospital, Bratislava, Slovakia
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Zhang J, Fan X. Analysis on the pharyngeal microbiota in patients with laryngopharyngeal reflux disease. Braz J Otorhinolaryngol 2023; 89:101331. [PMID: 37782990 PMCID: PMC10562751 DOI: 10.1016/j.bjorl.2023.101331] [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: 05/22/2023] [Revised: 08/21/2023] [Accepted: 09/02/2023] [Indexed: 10/04/2023] Open
Abstract
OBJECTIVE(S) In this study, the laryngopharynx microbiome alterations were characterized after proton pump inhibitor treatment in patients with Laryngopharyngeal Reflux Disease (LPRD) and healthy people. The potential outcome-predictive biomarker was explored. METHODS Patients with LPRD and healthy controls were enrolled. The composition of their laryngopharynx microbiota was analyzed both by traditional plate count of the main bacterial groups and PCR amplification followed by denaturing gradient gel electrophoresis. Shannon-Wiener index and evenness index based on Dice index were used to assess the bacterial diversity. Droplet digital PCR was used to determine the total bacterial RNA and relative abundance of Klebsiella oxytoca. Receiver operating characteristic curve was plotted to explore the potential of Klebsiella oxytoca as an outcome-predictive biomarker. RESULTS A total of 29 LPRD cases and 28 healthy subjects were enrolled. The composition of the laryngopharynx microbiota was almost similar, except Klebsiella oxytoca. The cluster analysis showed that the similarity between healthy and treatment-effective groups, as well as pretreatment and treatment-invalid groups, was close. Statistical analysis showed that there were differences in the diversity index and richness among the healthy, treatment-effective, pretreatment and treatment-invalid groups. The abundance of Klebsiella oxytoca in the treatment-effective LPRD group was lower than that of the treatment-invalid LPRD group. The abundance of Klebsiella oxytoca can distinguish treatment-effective and -invalid groups (AUC=0.859) with a sensitivity of 77.78% and specificity of 90.91%. CONCLUSION There were differences in the diversity of cecal contents microbial community between treatment-invalid and treatment-effective LPRD groups. Klebsiella oxytoca has potential to distinguish treatment outcomes. LEVEL OF EVIDENCE How common is the problem? Level 1. Is this diagnostic or monitoring test accurate? (Diagnosis) Level 4. What will happen if we do not add a therapy? (Prognosis) Level 5. Does this intervention help? (Treatment Benefits) Level 4. What are the COMMON harms? (Treatment Harms) Level 4. What are the RARE harms? (Treatment Harms) Level 4. Is this (early detection) test worthwhile?(Screening) Level 4.
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Affiliation(s)
- Jintang Zhang
- The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Department of Otolaryngology, Yiwu, China
| | - Xiaofan Fan
- The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Department of Otolaryngology, Yiwu, China.
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Rameau A, Lee M, Andreadis K, Sulica L. Perception of Proton Pump Inhibitor Side Effects Among Members of the American Broncho-Esophagological Association. J Voice 2023; 37:757-763. [PMID: 34154915 DOI: 10.1016/j.jvoice.2021.05.006] [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: 03/25/2021] [Revised: 04/27/2021] [Accepted: 05/04/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To investigate awareness of proton pump inhibitor (PPI) side effects and the resulting changes in reflux mana management among members of the American Broncho-Esophagological Association (ABEA) caring for adult patients in light of increasing concern for PPIs long-term adverse effects. STUDY DESIGN Cross-sectional survey study METHODS: Online surveys were electronically distributed to ABEA members assessing awareness of PPI side effects and current practice in reflux management. RESULTS 374 ABEA members were contacted, of whom, 43 (11.5%) completed the survey. The majority of respondents (94.1%) selected laryngology as their principal focus. The entire cohort warned their patients about PPI side effects, with highest concern for osteoporotic risk. Most respondents (88.2%) had changed their PPI prescription frequency in light of recent studies on PPI side effects, with 55.9% avoiding PPI prescription and 94.1% limiting the duration of PPI courses. Instead of PPIs, 73.5% of responders prescribe H2-receptor blockers. The primary reasons for starting patients on PPIs were typical gastroesophageal reflux symptoms (47.1%), followed by laryngopharyngeal reflux symptoms (41.2%), and endoscopic findings suspicious for reflux (11.8%). Finally, the majority of respondents (82.4%) had referred at least one patient for surgical management of gastroesophageal reflux in the past year. CONCLUSIONS The majority of surveyed ABEA members were concerned about reports of PPI adverse effects and had modified their prescription patterns as a result. Avoidance of PPI recommendation was common, along with the preference for H2 blockers in the management of GERD and LPR. PPI side effects of greatest concern to broncho-esophagologists treating adult patients were osteoporosis, renal dysfunction and dementia. LEVEL OF EVIDENCE: 5
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Affiliation(s)
- Anaïs Rameau
- Sean Parker Institute for the Voice, Department of Otolaryngology, Head & Neck Surgery, Weill Cornell Medical College, New York, NY.
| | - Mark Lee
- Sean Parker Institute for the Voice, Department of Otolaryngology, Head & Neck Surgery, Weill Cornell Medical College, New York, NY
| | - Katerina Andreadis
- Sean Parker Institute for the Voice, Department of Otolaryngology, Head & Neck Surgery, Weill Cornell Medical College, New York, NY
| | - Lucian Sulica
- Sean Parker Institute for the Voice, Department of Otolaryngology, Head & Neck Surgery, Weill Cornell Medical College, New York, NY
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8
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Lin Y, Peng S. Current Treatment of Laryngopharyngeal Reflux. EAR, NOSE & THROAT JOURNAL 2023:1455613231180031. [PMID: 37296536 DOI: 10.1177/01455613231180031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023] Open
Abstract
Objectives: Laryngopharyngeal reflux (LPR) is a complex syndrome characterized by the reflux of gastroduodenal contents into the pharynx or larynx, resulting in a range of symptoms, including chronic cough, throat clearing, pain, dysphagia, hoarseness, and dysphonia. Despite the lack of a gold standard for diagnosis or treatment, various strategies have been proposed to manage LPR. However, the effectiveness of these treatments is compromised by the lack of a uniform treatment protocol, which places a burden on patients, physicians, and the healthcare system. This study aims to systematically review the treatments of LPR and provide updated and useful clinical information to clinical physicians. Methods: The literature with an emphasis on LPR and related keywords is searched and reviewed in PubMed. Results: Treatment of LPR includes health education, lifestyle modification, dietary changes, medications, and surgery, as well as the emergence of a novel treatment method involving external upper esophageal sphincter compression devices. Conclusions: Currently, medication is the main treatment, supplemented with lifestyle and dietary changes, but there is still a lack of effective means for patients with drug-resistant or intolerant LPR. More high-quality and rigorous trials must continue to be conducted to determine the best treatment options and find novel treatments. Taking into account the complexity of LPR, this study proposes a simple algorithm to help clinicians with the initial management of this disease.
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Affiliation(s)
- Yang Lin
- School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, People's Republic of China
| | - Shunlin Peng
- School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, People's Republic of China
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Xie M, Zhang QQ, Liu XH, Guo RX, Chen YJ, Ma SJ, Liu HQ, Ren XY, Luo HN. Submucosal Clustered Brownish Microvessels Based on NBI Endoscopy: A Characteristic of LPR. Otolaryngol Head Neck Surg 2023; 168:790-797. [PMID: 35787712 DOI: 10.1177/01945998221109220] [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: 03/12/2022] [Accepted: 06/03/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This study aimed to analyze the characteristics of laryngopharyngeal reflux (LPR) by using narrow band imaging (NBI) endoscopy. STUDY DESIGN A prospective study. SETTING A large-volume practice with tertiary care providers. METHODS A total of 67 patients with suspected LPR who underwent 24-hour multichannel intraluminal impedance-pH monitoring were included from June 2020 to March 2022. Manifestations of NBI endoscopy included submucosal clustered brownish microvessels (CBMs), spotted brownish microvessels, and no special microvessels; the latter 2 formed the non-CBM group. The manifestations of all patients and their changes were observed after 8 weeks of proton pump inhibitor and symptomatic treatment for patients with LPR, and symptomatic treatment for patients without LPR. RESULTS According to the results of 24-hour multichannel intraluminal impedance-pH monitoring, the incidence of submucosal CBMs was significantly higher in patients with LPR (30 cases) than in those without LPR (37 cases, P < .001), particularly in the posterior cricoid area (P < .001). Besides Reflux Finding Score, the incidence of signs such as subglottic edema and vocal fold edema was significantly higher in the CBM group than the non-CBM group (P < .05). Finally, 22 patients with LPR (91.7%) and only 2 patients without LPR (28.6%) underwent a transformation from CBMs to spotted brownish microvessels after continuous medication for 8 weeks in the CBM group (χ2 = 15.916, P < .001), while no significant change was observed in patients with or without LPR in the non-CBM group (P > .05). CONCLUSION Submucosal CBMs in the posterior cricoid area under NBI endoscopy may be a characteristic of LPR. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Meng Xie
- Department of Otolaryngology-Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Qing-Qing Zhang
- Department of Otolaryngology-Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xiao-Hong Liu
- Department of Otolaryngology-Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Rui-Xin Guo
- Department of Otolaryngology-Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yang-Juan Chen
- Department of Otolaryngology-Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Si-Jing Ma
- Department of Otolaryngology-Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Hai-Qin Liu
- Department of Otolaryngology-Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xiao-Yong Ren
- Department of Otolaryngology-Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Hua-Nan Luo
- Department of Otolaryngology-Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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Alrayah M, Alzahrani R, Alghamdi MA, Alghamdi KM, Almutairi FF, Alghamdi AA, Alzahrani RA, Bajaber TA, Alanazi TF, Alnafisah HA. Assessment of the Current Knowledge and Practice of General Practitioners Towards Laryngopharyngeal Reflux in Saudi Arabia. Cureus 2023; 15:e38043. [PMID: 37228524 PMCID: PMC10208014 DOI: 10.7759/cureus.38043] [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] [Accepted: 04/24/2023] [Indexed: 05/27/2023] Open
Abstract
Background General practitioners (GPs) have a significant role in the diagnosis of patients with laryngopharyngeal reflux (LPR). Some published data revealed a lack of knowledge among GPs about the disease, consequently, this lack of knowledge impacted their performance. This survey aims to assess the current knowledge and practice of general practitioners regarding laryngopharyngeal reflux in Saudi Arabia. Methodology This survey study was conducted to assess the current knowledge and practice of general practitioners regarding laryngopharyngeal reflux in Saudi Arabia using an online questionnaire. The questionnaire was distributed and collected from the five regions in Saudi Arabia, which are The Central Region (Riyadh, Qassim), Eastern Region (Dammam, Al-Kharj, Al-Ahasa), Western Region (Makkah, Madinah, Jeddah), Southern Region (Asir, Najran, Jizan), and Northern Region (Tabuk, Jouf, Hail). Results In the current study, we collected data from 387 general practitioners, 61.8% of whom were aged between 21-30 years old, and 57.4% of the participants were males. Moreover, 40.6% of the participants thought that both LPR and gastroesophageal reflux disease (GERD) share pathophysiology, however, they are two different diseases considering their clinical presentation. Moreover, it was found that heartburn was the most known symptom of LPR among the participants (Mean score 2.14 (SD=1.31), where a lower score indicated more relation). Considering the treatment of LPR, 40.6% and 40.3% of the participants reported using proton pump inhibitors once or twice daily respectively. In contrast, antihistamine/H2 blockers, alginate, and magaldrate were used to a lesser extent as reported by 27.1%, 21.7%, and 12.1%. Conclusion The current study showed limited knowledge among general practitioners considering LPR with a higher rate of referring patients to other departments depending on symptoms which may increase the pressure on other departments of mild cases.
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Affiliation(s)
- Mujtaba Alrayah
- Unit of Otolaryngology, Department of Surgery, Faculty of Medicine, Al-Baha University, Al-Baha, SAU
| | - Rajab Alzahrani
- Unit of Otolaryngology, Department of Surgery, Faculty of Medicine, Al-Baha University, Al-Baha, SAU
| | - Mohammed A Alghamdi
- Unit of Otolaryngology, Department of Surgery, Faculty of Medicine, Al-Baha University, Al-Baha, SAU
| | - Kholoud M Alghamdi
- Department of Medicine, Faculty of Medicine, Al-Baha University, Al-Baha, SAU
| | - Faisal F Almutairi
- Department of Medicine, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, SAU
| | - Anwar A Alghamdi
- Department of Medicine, Faculty of Medicine, Al-Baha University, Al-Baha, SAU
| | - Raghad A Alzahrani
- Department of Medicine, Faculty of Medicine, Al-Baha University, Al-Baha, SAU
| | - Taif A Bajaber
- Department of Medicine, Faculty of Medicine, Fakeeh College of Medical Sciences, Jeddah, SAU
| | - Tahani F Alanazi
- Department of Medicine, Faculty of Medicine, University of Tabuk, Tabuk, SAU
| | - Haya A Alnafisah
- Department of Medicine, Faculty of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, SAU
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11
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O’Shea R, Gaffney M, Kaare M, Fenton JE. Laryngopharyngeal reflux induced sleep-related laryngospasm. Ir J Med Sci 2023; 192:335-340. [PMID: 35099721 PMCID: PMC9892074 DOI: 10.1007/s11845-022-02934-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 01/19/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND Sleep-related laryngospasm (SRL) has been defined as the sustained closure of the vocal cords during sleep. Studies have suggested that it is a rare manifestation of laryngopharyngeal reflux (LPR). Difficulties in diagnosing SRL and LPR have led to the condition being under-recognised in the clinical setting. AIMS The aim of this study was to determine if LPR was the cause of the SRL symptoms seen in our patients. METHODS A retrospective chart assessment of patients with SRL. Patients with risk factors for LPR were identified. These included smoking status, alcohol intake, a history of dyspepsia or history of gastroesophageal reflux disease, a history of late-night eating and a history of eating spicy or fatty foods before bed. A clinical diagnosis based on the history and response to management was made for the diagnosis of LPR. All were advised to refrain from late meals and those with signs of nasopharyngitis were commenced on proton pump inhibitor therapy. RESULTS Nineteen patients (mean age ± SD: 57.21 ± 15.18) were included in the study. All had at least one risk factor for LPR. Ten (52.6%) had signs of nasopharyngitis on nasendoscopy. Following treatment, 17 (89.5%) reported no further SRL symptoms at 1-year follow-up. CONCLUSION SRL is a largely unknown and under-diagnosed condition. We believe this study provides supportive evidence for the causal relationship between LPR and SRL.
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Affiliation(s)
- Ross O’Shea
- grid.10049.3c0000 0004 1936 9692Faculty of Education and Health Sciences, University of Limerick Medical School, Garraun, Castletroy Limerick, Ireland
| | - Máire Gaffney
- grid.10049.3c0000 0004 1936 9692Faculty of Education and Health Sciences, University of Limerick Medical School, Garraun, Castletroy Limerick, Ireland
| | - Majura Kaare
- grid.10049.3c0000 0004 1936 9692Department of Otorhinolaryngology Head and Neck Surgery, University Limerick Medical School, Limerick, Ireland
| | - John Eugene Fenton
- grid.10049.3c0000 0004 1936 9692Department of Otorhinolaryngology Head and Neck Surgery, University Limerick Medical School, Limerick, Ireland
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12
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Xiao S, Li J, Zheng H, Li X, Yang H, Zhang J, Peng X, Zhou S, Zhao C, Chen D, Xiao X, Shi L, Huangfu H, Tao Z, Chen X, Liu Y, Qu S, Wang G, Chen T, Cui X, Tian L, Zhou W, Fang H, Huang Y, Yu G, Lin Z, Tang L, He J, Ma R, Yu Z. Awareness about laryngopharyngeal reflux disease among Chinese otolaryngologists: a nationwide survey. BMJ Open 2022; 12:e058852. [PMID: 35732392 PMCID: PMC9226935 DOI: 10.1136/bmjopen-2021-058852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES This study aimed to investigate the status of the current knowledge about laryngopharyngeal reflux disease (LPRD) among Chinese otolaryngologists. DESIGN Multi-centre cross-sectional survey. SETTING 220 medical centres in different regions of China. PARTICIPANTS A total of 2254 otolaryngologists from 220 medical centres in China who were successfully on-site surveyed between November 2019 and December 2020. MAIN OUTCOME MEASURES Awareness about LPRD included knowledge about risk factors, symptoms, laryngoscope signs, related diseases, current diagnostic methods and treatments. RESULTS The percentage of participants who had heard of LPRD was 96.4%, with academic conferences as the most common source of information (73.3%). The most commonly known risk factor, symptom, laryngoscope sign, related disease, diagnostic method and treatment were alcohol consumption (44.0%), pharyngeal foreign body sensation (66.9%), hyperaemia (52.4%), pharyngolaryngitis (54.8%), pH monitoring (47.6%) and medication (82.1%), respectively. Only 28.3% of all participants knew that 24 h pH or multichannel intraluminal impedance pH monitoring was the most accurate diagnostic test. As many as 73.1% of all participants knew that proton pump inhibitors were the first-line treatment drugs. An analysis of the overall status of awareness using a scoring system suggested that otolaryngologists were better aware owing to more access, working at 3A hospitals, and postgraduate or above educational background (all p<0.05). CONCLUSION Although the majority of Chinese otolaryngologists had heard of LPRD, their overall awareness about the disease was not encouraging. More efforts are needed to increase the knowledge about LPRD among this group of physicians. TRIAL REGISTRATION NUMBER ChiCTR1900025581.
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Affiliation(s)
- Shuifang Xiao
- Department of Otolaryngology, Head and Neck Surgery, Peking University First Hospital, Beijing, China
| | - Jinrang Li
- Department of Otolaryngology, Head and Neck Surgery, The Sixth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Hongliang Zheng
- Department of Otolaryngology, Head and Neck Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Xiangping Li
- Department of Otolaryngology, Head and Neck Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Hui Yang
- Department of Otolaryngology, Head and Neck Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Junbo Zhang
- Department of Otolaryngology, Head and Neck Surgery, Peking University First Hospital, Beijing, China
| | - Xiaoxia Peng
- Clinical Epidemiology and Evidence-based Medicine Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Shuihong Zhou
- Department of Otolaryngology, Head and Neck Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Chen Zhao
- Department of Otolaryngology, Head and Neck Surgery, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Donghui Chen
- Department of Otolaryngology, Head and Neck Surgery, Jiangsu Province Hospital, Nanjing, Jiangsu, China
| | - Xuping Xiao
- Department of Otolaryngology, Head and Neck Surgery, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan, China
| | - Li Shi
- Department of Otolaryngology, Head and Neck Surgery, Xijing Hospital, Air Force Military Medical University, Xi'an, Shaanxi, China
| | - Hui Huangfu
- Department of Otolaryngology, Head and Neck Surgery, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Zhenfeng Tao
- Department of Otolaryngology, Head and Neck Surgery, Bethune International Peace Hospital, Shijiazhuang, Hebei, China
| | - Xiong Chen
- Department of Otolaryngology, Head and Neck Surgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Yehai Liu
- Department of Otolaryngology, Head and Neck Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Shenhong Qu
- Department of Otolaryngology, Head and Neck Surgery, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Guangke Wang
- Department of Otolaryngology, Head and Neck Surgery, Henan Provincial People's Hospital, Zhengzhou, Henan, China
| | - Ting Chen
- Department of Otolaryngology, Head and Neck Surgery, Fujian Provincial Hospital, Fuzhou, Fujian, China
| | - Xiaobo Cui
- Department of Otolaryngology, Head and Neck Surgery, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia, China
| | - Linli Tian
- Department of Otolaryngology, Head and Neck Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Wensheng Zhou
- Department of Otolaryngology, Head and Neck Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Hongyan Fang
- Department of Otolaryngology, Head and Neck Surgery, Chongqing General Hospital, Chongqing, China
| | - Yongwang Huang
- Department of Otolaryngology, Head and Neck Surgery, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Guodong Yu
- Department of Otolaryngology, Head and Neck Surgery, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Zhenqun Lin
- Department of Otolaryngology, Head and Neck Surgery, Hainan Provincial People's Hospital, Haikou, Hainan, China
| | - Liang Tang
- Department of Otolaryngology, Head and Neck Surgery, The People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, China
| | - Jian He
- Department of Otolaryngology, Head and Neck Surgery, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Ruixia Ma
- Department of Otolaryngology, Head and Neck Surgery, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Zhaoyan Yu
- Department of Otolaryngology, Head and Neck Surgery, Shandong Provincial ENT Hospital, Shandong Provincial ENT Hospital Affiliated to Shandong University, Jinan, Shandong, China
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13
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Casciaro S, Gelardi M, Giancaspro R, Quaranta VN, Porro G, Sterlicchio B, Abbinante A, Corsalini M. Dental Disorders and Salivary Changes in Patients with Laryngopharyngeal Reflux. Diagnostics (Basel) 2022; 12:diagnostics12010153. [PMID: 35054320 PMCID: PMC8775268 DOI: 10.3390/diagnostics12010153] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 01/03/2022] [Accepted: 01/07/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Laryngopharyngeal reflux (LPR) is a common inflammatory condition of the upper aerodigestive tract tissues related to the effects of gastroduodenal content reflux, characterized by a wide variety of clinical manifestations. The aim of our study was to evaluate the possible association between dental disorders and LRP, focusing on the role of salivary changes. Methods: Patient’s dental status was evaluated according to Schiff Index Sensitivity Scale (SISS), Basic Erosive Wear Examination (BEWE) and Decayed, Missing, and Filled Teeth (DMFT) scores. Reflux-associated symptoms were assessed according to Reflux symptom index (RSI). A qualitative and quantitative examination of saliva was performed. Results: Patients suffering from LPR had a higher incidence of dental disorders, regardless the presence of salivary pepsin, and thus, statistically significant higher scores of RSI (p = 0.0001), SISS (p = 0.001), BEWE (p < 0.001) and VAS (p < 0.001). Moreover, they had lower salivary flow compared with healthy patients. Conclusions: The finding of demineralization and dental caries on intraoral evaluation must raise the suspicion of LRP. Reflux treatments should also be aimed at correcting salivary alterations, in order to preserve the buffering capacity and salivary pH, thus preventing mucosal and dental damage.
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Affiliation(s)
| | - Matteo Gelardi
- Unit of Otolaryngology, Department of Clinical and Experimental Medicine, University of Foggia, 71121 Foggia, Italy;
| | - Rossana Giancaspro
- Unit of Otolaryngology, Department of Clinical and Experimental Medicine, University of Foggia, 71121 Foggia, Italy;
- Correspondence: ; Tel.: +39-3293-389-107
| | - Vitaliano Nicola Quaranta
- Department of Basic Medical Sciences, Neurosciences and Sense Organs—Section of Respiratory Disease, University of Bari Aldo Moro, 70124 Bari, Italy;
| | - Giuseppe Porro
- Unit of Otolaryngology, Hospital of Lecce, 73100 Lecce, Italy;
| | | | - Antonia Abbinante
- Dental Hygienic Studies Course, University of Bari, 70125 Bari, Italy;
| | - Massimo Corsalini
- Department of Interdisciplinary Medicine, University of Bari, 70124 Bari, Italy;
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14
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Bonini S, Labetoulle M, Messmer E, Aragona P, Benitez Castillo JM, Ciprandi G, Damiani V, Irkec M, Baudouin C, Rolando M. Association of Dry Eye with Laryngopharyngeal Reflux in Clinical Practice. Reply to Lechien et al. Curr Eye Res 2021; 47:327-328. [PMID: 34842017 DOI: 10.1080/02713683.2021.2012807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- S Bonini
- Ophthalmology Department, Campus Bio-Medico University, Rome, Italy
| | - M Labetoulle
- Ophthalmology Départment, Hôpitaux Universitaires Paris-Sud, APHP, Université Paris-Saclay, IDMIT Infrastructure, CEA, Inserm U1184, Fontenay-aux-Roses Cedex, France
| | - E Messmer
- Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany
| | - P Aragona
- Department of Biomedical Sciences, Ophthalmology Clinic, University of Messina, Messina, Italy
| | - J M Benitez Castillo
- Departamento de Oftalmología, Hospital Clínico San Carlos; Clínica Rementeria; Instituto Investigaciones Oftalmologicas Ramon Castroviejo, Universidad Complutense, Madrid, Spain
| | - G Ciprandi
- Allergy Clinic, Casa di Cura Villa Montallegro, Genoa, Italy
| | - V Damiani
- Medical Department, DMG Italia, Rome, Italy
| | - M Irkec
- Department of Ophthalmology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - C Baudouin
- Quinze-Vingts National Eye Hospital, Ihu ForeSight, Paris Saclay University, Paris, France
| | - M Rolando
- Ocular Surface Centre, ISPRE Ophthalmics, Genoa, Italy
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