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Lechien JR, Akst LM, Saussez S, Crevier-Buchman L, Hans S, Barillari MR, Calvo-Henriquez C, Bock JM, Carroll TL. Involvement of Laryngopharyngeal Reflux in Select Nonfunctional Laryngeal Diseases: A Systematic Review. Otolaryngol Head Neck Surg 2020; 164:37-48. [DOI: 10.1177/0194599820933209] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Objectives To investigate the existing published evidence supporting the role of laryngopharyngeal reflux (LPR) in the development of the select nonfunctional laryngeal diseases of laryngotracheal stenosis, granuloma, leukoplakia, and laryngeal infections Data Sources PubMed, Cochrane Library, and Scopus. Review Methods A systematic review was performed by 3 independent investigators for studies providing information about the prevalence and role of LPR in the development of laryngotracheal stenosis, granuloma, leukoplakia, and laryngeal infections. Diagnostic criteria and clinical outcome evaluation of included studies were analyzed with PRISMA criteria. Results Of the 64 relevant publications, 27 clinical and 4 basic science studies were included. Ten studies used objective reliable examinations for LPR diagnosis (eg, dual- or triple-probe or oropharyngeal pH monitoring, multichannel intraluminal impedance–pH monitoring, or pepsin detection). According to the bias analysis and the results of studies, the association between LPR and laryngotracheal stenosis, leukoplakia, laryngeal papillomatosis, or vocal fold granuloma remains poorly demonstrated. There is a notable heterogeneity among included studies regarding their inclusion criteria, diagnostic methods, and clinical outcome evaluation. Although some experimental findings support the involvement of bile salts and other gastroduodenal proteins active in alkaline pH, no included clinical studies assessed the role of nonacid and mixed reflux through multichannel intraluminal impedance–pH monitoring. Conclusion The involvement of LPR in the development of leukoplakia, laryngotracheal stenosis, vocal fold granuloma, and laryngeal papillomatosis is currently not demonstrated. The potential relationship between LPR and these select nonfunctional laryngeal diseases must be confirmed through future clinical and experimental studies considering acid, nonacid, and mixed LPR.
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Affiliation(s)
- Jerome R. Lechien
- Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies, Paris, France
- Laboratory of Anatomy and Cell Biology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium
- Laboratory of Phonetics, Faculty of Psychology, Research Institute for Language Sciences and Technology, University of Mons, Mons, Belgium
- Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Lee M. Akst
- Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins Hospital, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Sven Saussez
- Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies, Paris, France
- Laboratory of Anatomy and Cell Biology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium
- Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Lise Crevier-Buchman
- Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies, Paris, France
- Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, Paris, France
| | - Stéphane Hans
- Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies, Paris, France
- Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, Paris, France
| | - Maria Rosaria Barillari
- Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies, Paris, France
- Division of Phoniatrics and Audiology, Department of Mental and Physical Health and Preventive Medicine, University of Naples SUN, Naples, Italy
| | - Christian Calvo-Henriquez
- Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies, Paris, France
- Department of Otorhinolaryngology and Head and Neck Surgery, Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain
| | - Jonathan M. Bock
- Division of Laryngology and the Professional Voice Department of Otolaryngology and Communication Science, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Thomas L. Carroll
- Department of Otolaryngology–Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
- Division of Otolaryngology, Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
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Dietary modification for laryngopharyngeal reflux: systematic review. The Journal of Laryngology & Otology 2019; 133:80-86. [PMID: 30646967 DOI: 10.1017/s0022215118002256] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE This study aimed to determine the relationship between laryngopharyngeal reflux and dietary modification. METHODS A systematic review was conducted. The data sources for the study were PubMed, Embase, Cochrane Library and Web of Science. Articles were independently extracted by two authors according to inclusion and exclusion criteria. The outcome focus was laryngopharyngeal reflux improvement through diet or dietary behaviour. RESULTS Of the 372 studies identified, 7 met our inclusion criteria. In these seven studies, laryngopharyngeal reflux symptoms improved following dietary modifications. However, the studies did not present the independent effect of each dietary factor on laryngopharyngeal reflux. Moreover, only one of the seven studies had a randomised controlled study design. CONCLUSION The reference studies of dietary modification for laryngopharyngeal reflux patients are not sufficient to provide recommendations.
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Hosoya M, Kobayashi R, Ishii T, Senarita M, Kuroda H, Misawa H, Tanaka F, Takiguchi T, Tashiro M, Masuda S, Hashimoto S, Goto F, Minami S, Yamamoto N, Nagai R, Sayama A, Wakabayashi T, Toshikuni K, Ueha R, Fujimaki Y, Takazawa M, Sekimoto S, Itoh K, Nito T, Kada A, Tsunoda K. Vocal Hygiene Education Program Reduces Surgical Interventions for Benign Vocal Fold Lesions: A Randomized Controlled Trial. Laryngoscope 2018; 128:2593-2599. [PMID: 30079962 PMCID: PMC6585860 DOI: 10.1002/lary.27415] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 04/22/2018] [Accepted: 06/05/2018] [Indexed: 11/29/2022]
Abstract
Objectives/Hypothesis Vocal fold polyps and nodules are common benign laryngeal lesions. Currently, the Japanese health insurance system covers surgical interventions. However, the establishment of more cost‐effective conservative methods is required, because healthcare costs are viewed as a major concern, and the government and taxpayers are demanding more economical, effective treatments. In this situation, more suitable vocal hygiene education may be important for the success of cost‐effective conservative treatment. In this study, we developed a novel reinforced vocal hygiene education program and compared the results of this program with those of previous methods of teaching vocal hygiene. Study Design Multicenter randomized controlled trial. Methods Patients who visited a National Hospital Organization (NHO) hospital for the surgical indication of hoarseness were included in the study. Before undergoing surgery, 200 patients with benign vocal fold lesions (vocal fold polyps/nodules) were enrolled and randomly allocated to the NHO‐style vocal hygiene educational program (intervention group) or control education program (control group). Two months after enrollment, the patients in both groups underwent laryngeal fiberscopic examinations to determine whether the benign lesions had resolved or whether surgery was indicated for the vocal fold polyps/nodules. Results After 2 months, in the intervention group, the proportion of lesion resolution (61.3%) was significantly greater than that in the control group (26.3%) (P < .001, Fisher exact test). Conclusions Our results clearly indicate that the quality and features of the education program could affect the outcome of the intervention. We found that a reinforced vocal hygiene education program increased the rate of the resolution of benign vocal fold polyps and nodules in a multicenter randomized clinical trial. Level of Evidence 1b Laryngoscope, 2593–2599, 2018
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Affiliation(s)
- Makoto Hosoya
- Department of Otolaryngology, National Hospital Organization, Tokyo Medical Center, Tokyo, Japan.,Clinical Research Center, National Hospital Organization, Nagoya Medical Center, Nagoya, Japan
| | - Rika Kobayashi
- Clinical Research Center, National Hospital Organization, Nagoya Medical Center, Nagoya, Japan.,Department of Artificial Organs and Medical Creation, National Institute of Sensory Organs, National Hospital Organization, Tokyo Medical Center, Tokyo, Japan
| | - Toyota Ishii
- Department of Otolaryngology, National Hospital Organization, Sagamihara Hospital Organization, Sagamihara, Japan
| | - Masamitsu Senarita
- Department of Otolaryngology, National Hospital Organization, Mito Medical Center, Mito, Japan
| | - Hiroyuki Kuroda
- Department of Otolaryngology, National Hospital Organization, Kobe Medical Center, Kobe, Japan
| | - Hayato Misawa
- Department of Otolaryngology, National Hospital Organization, Nagoya Medical Center, Nagoya, Japan
| | - Fujinobu Tanaka
- Department of Otolaryngology, National Hospital Organization, Nagasaki Medical Center, Nagasaki, Japan
| | - Tetsuya Takiguchi
- Department of Otolaryngology, National Hospital Organization, Kanazawa Medical Center, Kanazawa, Japan
| | - Masatsugu Tashiro
- Department of Otolaryngology, National Hospital Organization, Tochigi Medical Center, Tochigi, Japan
| | - Sawako Masuda
- Department of Otolaryngology, Mie National Hospital, Tsu, Japan
| | - Sho Hashimoto
- Department of Otolaryngology, National Hospital Organization, Sendai Medical Center, Sendai, Japan
| | - Fumiyuki Goto
- Department of Otolaryngology, National Hospital Organization, Tokyo Medical Center, Tokyo, Japan.,National Institute of Sensory Organs, National Hospital Organization, Tokyo Medical Center, Tokyo, Japan
| | - Shujiro Minami
- Department of Otolaryngology, National Hospital Organization, Tokyo Medical Center, Tokyo, Japan
| | - Nobuko Yamamoto
- Department of Otolaryngology, National Hospital Organization, Tokyo Medical Center, Tokyo, Japan
| | - Ryoto Nagai
- Department of Otolaryngology, National Hospital Organization, Tokyo Medical Center, Tokyo, Japan
| | - Akiko Sayama
- Department of Otolaryngology, National Hospital Organization, Tokyo Medical Center, Tokyo, Japan
| | - Takeshi Wakabayashi
- Department of Otolaryngology, National Hospital Organization, Tokyo Medical Center, Tokyo, Japan
| | - Keitaro Toshikuni
- Department of Otolaryngology, National Hospital Organization, Tokyo Medical Center, Tokyo, Japan
| | - Rumi Ueha
- Department of Otolaryngology, University of Tokyo Hospital, Tokyo, Japan
| | - Yoko Fujimaki
- Department of Otolaryngology, University of Tokyo Hospital, Tokyo, Japan
| | - Mihiro Takazawa
- Department of Artificial Organs and Medical Creation, National Institute of Sensory Organs, National Hospital Organization, Tokyo Medical Center, Tokyo, Japan
| | - Sotaro Sekimoto
- Department of Artificial Organs and Medical Creation, National Institute of Sensory Organs, National Hospital Organization, Tokyo Medical Center, Tokyo, Japan
| | - Kenji Itoh
- Department of Artificial Organs and Medical Creation, National Institute of Sensory Organs, National Hospital Organization, Tokyo Medical Center, Tokyo, Japan
| | - Takaharu Nito
- Department of Otolaryngology, University of Tokyo Hospital, Tokyo, Japan
| | - Akiko Kada
- Clinical Research Center, National Hospital Organization, Nagoya Medical Center, Nagoya, Japan
| | - Koichi Tsunoda
- Department of Otolaryngology, National Hospital Organization, Tokyo Medical Center, Tokyo, Japan.,Clinical Research Center, National Hospital Organization, Nagoya Medical Center, Nagoya, Japan.,Department of Artificial Organs and Medical Creation, National Institute of Sensory Organs, National Hospital Organization, Tokyo Medical Center, Tokyo, Japan.,Department of Otolaryngology, University of Tokyo Hospital, Tokyo, Japan
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Vaezi MF, Katzka D, Zerbib F. Extraesophageal Symptoms and Diseases Attributed to GERD: Where is the Pendulum Swinging Now? Clin Gastroenterol Hepatol 2018; 16:1018-1029. [PMID: 29427733 DOI: 10.1016/j.cgh.2018.02.001] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 01/31/2018] [Accepted: 02/02/2018] [Indexed: 02/07/2023]
Abstract
The purpose of this review is to outline the recent developments in the field of extraesophageal reflux disease and provide clinically relevant recommendations. The recommendations outlined in this review are based on expert opinion and on relevant publications from PubMed and EMbase. The Clinical Practice Updates Committee of the American Gastroenterological Association proposes the following recommendations: Best Practice Advice 1: The role of a gastroenterologist in patients referred for evaluation of suspected extra esophageal symptom is to assess for gastroesophageal etiologies that could contribute to the presenting symptoms. Best Practice Advice 2: Non-GI evaluations by ENT, pulmonary and/or allergy are essential and often should be performed initially in most patients as the cause of the extraesophageal symptom is commonly multifactorial or not esophageal in origin. Best Practice Advice 3: Empiric therapy with aggressive acid suppression for 6-8 weeks with special focus on response of the extraesophageal symptoms can help in assessing association between reflux and extraesophageal symptoms. Best Practice Advice 4: No single testing methodology exists to definitively identify reflux as the etiology for the suspected extra esophageal symptoms. Best Practice Advice 5: Constellation of patient presentation, diagnostic test results and response to therapy should be employed in the determination of reflux as a possible etiology in extra esophageal symptoms. Best Practice Advice 6: Testing may need to be off or on proton pump inhibitor (PPI) therapy depending on patients' presenting demographics and symptoms in assessing the likelihood of abnormal gastroesophageal reflux. A. On therapy testing may be considered in those with high probability of baseline reflux (those with previous esophagitis, Barrett's esophagus or abnormal pH). B. Off therapy testing may be considered in those with low probability of baseline reflux with the goal of identifying moderate to severe reflux at baseline. Best Practice Advice 7: Lack of response to aggressive acid suppressive therapy combined with normal pH testing off therapy or impedance-pH testing on therapy significantly reduces the likelihood that reflux is a contributing etiology in presenting extraesophageal symptoms. Best Practice Advice 8: Surgical fundoplication is discouraged in those with extra esophageal reflux symptoms unresponsive to aggressive PPI therapy. Best Practice Advice 9: Fundoplication should only be considered in those with a mechanical defect (e.g., hiatal hernia), moderate to severe reflux at baseline off PPI therapy who have continued reflux despite PPI therapy and have failed more conservative non-GI treatments.
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Affiliation(s)
- Michael F Vaezi
- Division of Gastroenterology, Hepatology, Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee.
| | - David Katzka
- Department of Gastroenterology, Mayo Clinic, Rochester, Minnesota
| | - Frank Zerbib
- CHU Bordeaux, Department of Gastroenterology, Hepatology and Digestive Oncology, University of Bordeaux, Bordeaux, France
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Wang J, Shi M, Xia Y, Luo S, Fu X, Xiao F, Li J, Deng Z, Long X. Three-dimensional conformal radiation therapy for refractory laryngeal granuloma. TUMORI JOURNAL 2018; 97:345-9. [DOI: 10.1177/030089161109700315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims and background The etiology of laryngeal granulomas is often multifactorial and the benefit of pharmacological therapy remains unclear. Anti-reflux treatment is only effective in granulomas definitely induced by gastroesophageal reflux. Steroid inhalation has shown favorable results but it is unclear whether it shortens the healing process. Surgical excision is associated with high recurrence rates. The aim of this study was to evaluate the role of 3-dimensional conformal radiation therapy (3DCRT) in the treatment of refractory laryngeal granuloma. Methods and study design The study was a retrospective review including all patients presenting to the Department of Radiation Oncology at Xijing Hospital from January 2004 to March 2007. We studied a total of 15 cases of refractory laryngeal granuloma that had recurred ≥2 times. Patients had previously been managed with voice rest, corticosteroids, antibiotics, antacids, surgery and botulinum toxin. All patients accepted surgical excision and immediate adjuvant 3DCRT at a total dose of 15 Gy over 5 days. Results All patients were successfully treated with surgery and 3DCRT. There has been no granuloma recurrence in 3 years of follow-up. Conclusions 3DCRT is a safe and effective therapy for refractory laryngeal granulomas, especially when other methods have failed.
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Affiliation(s)
- Jianhua Wang
- Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Mei Shi
- Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | | | - Shanquan Luo
- Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Xuehai Fu
- Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Feng Xiao
- Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Jianping Li
- Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Zhihong Deng
- Department of Otolaryngology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Xiaoli Long
- Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
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Kobayashi R, Tsunoda K, Ueha R, Fujimaki Y, Nito T, Yamasoba T. Role of lifestyle modifications for patients with laryngeal granuloma caused by gastro-esophageal reflux: comparison between conservative treatment and the surgical approach. Acta Otolaryngol 2017; 137:306-309. [PMID: 27758123 DOI: 10.1080/00016489.2016.1244858] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
CONCLUSIONS It is considered that a regimen combining pharmacologic management and lifestyle modifications is the most effective treatment for laryngeal granulomas caused by GER. OBJECTIVES This study compared the results of the combination therapy and surgery to determine the best treatment of laryngeal granuloma caused by gastro-esophageal reflux in 51 patients. METHODS Prospective study. RESULTS In the conservative treatment group, the CR rate was 89.7% and recurrence rate was 2.6%, while the lesions remained in patients (7.7%). This study compared the CR and recurrence rates between conservative treatment and surgery for granuloma. The results showed that the laryngeal granuloma recurrence rate was significantly lower with the conservative treatment regimen compared with surgery (p = .0016).
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Belafsky PC, Peake J, Smiley-Jewell SM, Verma SP, Dworkin-Valenti J, Pinkerton KE. Soot and house dust mite allergen cause eosinophilic laryngitis in an animal model. Laryngoscope 2015. [DOI: 10.1002/lary.25467] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
| | - Janice Peake
- Center for Health and the Environment, University of California Davis; Davis
| | - Suzette M. Smiley-Jewell
- Department of Otolaryngology; UC Davis Health System; Sacramento
- Center for Health and the Environment, University of California Davis; Davis
| | - Sunil P. Verma
- Department of Otolaryngology; University of California Irvine; Irvine California
| | | | - Kent E. Pinkerton
- Center for Health and the Environment, University of California Davis; Davis
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Krawczyk M, Scierski W, Ryszkiel I, Namysłowski G, Grzegorzek S, Misiołek M. Endoscopic evidence of reflux disease in the larynx. Acta Otolaryngol 2014; 134:831-7. [PMID: 24856451 DOI: 10.3109/00016489.2014.890738] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
CONCLUSION The severity of laryngeal mucosal lesions in patients with gastroesophageal reflux disease (GERD) is significantly greater than in controls. A higher degree of laryngeal mucosal injury is documented in patients in whom GERD is associated with more advanced esophageal lesions. OBJECTIVES (1) To confirm the presence of inflammatory lesions in the laryngopharynx of patients with GERD. (2) To analyze the relationship between the severity of laryngopharyngeal and esophageal lesions on the basis of the reflux finding score (RFS) and the Los Angeles (LA) scale of esophageal mucosal injury. METHODS The study included 92 subjects, among them 46 patients with GERD and 46 individuals without endoscopic evidence of esophageal lesions, qualified for routine endoscopy due to other indications. The endoscopic images of the inferior pharynx, larynx, and esophagus were analyzed during the video-endoscopic examination of the upper gastrointestinal tract. The laryngeal images were assessed according to RFS criteria and the numeric value of RFS was calculated. The degree of esophageal mucosal injury was described according to the LA scale. RESULTS Both global RFS score and the scores of all RFS parameters except the presence of granulomatous tissue were significantly higher in patients with GERD than in the controls. Patients in whom GERD was associated with more severe esophageal lesions (group B according to the LA scale) had significantly higher global RFS score and scores of all analyzed parameters of laryngeal injury except subglottic edema than individuals in whom the degree of esophageal involvement was classified as group A.
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Affiliation(s)
- Marek Krawczyk
- Department of Internal Diseases with a Gastroenterological Profile, Municipal Hospital , Tychy
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Abstract
OBJECTIVES To determine the incidence of black spots after resolution of laryngeal granuloma (LG), to compare the disease duration from the beginning of treatment to resolution between patients with and without black spots, and to assess the histologic findings of LG in resected or biopsied specimens. STUDY DESIGN Retrospective. METHODS Forty-six patients with LG on the cartilaginous portion of the vocal fold were included. Their clinical records were reviewed. Histologic specimens were re-examined. RESULTS Causes of LG were postintubation in 10 patients, unilateral vocal fold immobility in 1, Candida infection in 1, and were not specified in 34 (either hyperfunctional vocal abuse, laryngopharyngeal regurgitation, or both). Of the 10 patients with postintubation LG, 9 resolved; of the 33 patients with LG from other causes, 21 resolved. Of the 28 resolved patients, 12 developed a black spot at the previous lesion site. Of the 18 patients whose LG resolved without surgical intervention, 11 developed a black spot at the previous lesion site, and the remaining 7 patients did not develop any black spots. The treatment period until LG resolution was significantly longer among patients with a black spot than those without a spot (P = .0372). Histologic examination revealed the presence of hemosiderin accumulation accompanied by infiltration of lymphocytes and macrophages in 8 of the 16 patients who had their LGs resected or biopsied. CONCLUSIONS Accumulation of hemosiderin in the subepithelial layer, together with little blood flow and dense connective tissue in the cartilaginous portion of the vocal fold, are important factors contributing to the persistence of LG.
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Laryngopharyngeal reflux: diagnosis and treatment of a controversial disease. Curr Opin Allergy Clin Immunol 2008; 8:28-33. [PMID: 18188014 DOI: 10.1097/aci.0b013e3282f3f44f] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE OF REVIEW Laryngopharyngeal reflux is a well-recognized and widely used term in ear, nose and throat practice. However, the symptoms and signs attributed to laryngopharyngeal reflux are non-specific and treatment is usually empirical. This review discusses current knowledge on diagnosis and treatment of laryngopharyngeal reflux. RECENT FINDINGS Information is evolving regarding the implications of laryngopharyngeal reflux in the development of pathological conditions affecting the upper aerodigestive tract epithelium such as chronic laryngitis, otitis media with effusion and chronic sinusitis. However, there is still much to learn about the pathophysiologic mechanisms of laryngopharyngeal reflux and their role in its related disease conditions and there is still considerable controversy on diagnostic as well as therapeutic parameters for this condition. There is no consensus on the diagnosis and treatment of laryngopharyngeal reflux and the majority of clinicians depend mainly on clinical findings and empirical therapeutic tests rather than more specific investigations. SUMMARY The concept of laryngopharyngeal reflux is still controversial. The current practice of empirical treatment with proton-pump inhibitors is based on weak evidence. However, this practice seems to be widely accepted and will not change until further clinical and laboratory studies improve our understanding of this common and well-recognized condition.
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