1
|
Doruk C, Mocchetti V, Rives H, Christos P, Rameau A. Correlations Between Anxiety and/or Depression Diagnoses and Dysphagia Severity. Laryngoscope 2024; 134:2115-2120. [PMID: 37942834 PMCID: PMC11006580 DOI: 10.1002/lary.31164] [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: 08/11/2023] [Revised: 09/29/2023] [Accepted: 10/23/2023] [Indexed: 11/10/2023]
Abstract
OBJECTIVE An increased prevalence of mood and anxiety disorders in patients with dysphagia has been noted previously, but whether dysphagia severity may be exacerbated by anxiety and depression has never been studied before. The purpose of this study is to identify the effect of pre-existing diagnosis of anxiety and/or depression (anxiety/depression) on the Eating Assessment Tool (EAT-10), a validated patient-reported outcome measure for dysphagia. We hypothesized that patients with dysphagia and normal instrumental evaluation have higher EAT-10 score in the presence of pre-existing anxiety and depression. METHODS A retrospective chart review was conducted of patients seen at the multi-disciplinary dysphagia clinic of an urban academic institution. EAT-10 scores and pre-existing diagnoses of anxiety/depression were collected at the first visit with laryngologists. The two-sample t-test was used to compare mean EAT-10 scores between the anxiety/depression and no anxiety/depression groups, stratified by swallowing dysfunction etiology. RESULTS The study included 290 consecutive patients seen starting in January 2018. In this cohort, 60 (21%) had pre-existing anxiety, 49 (17%) depression, and 36 (12%) both. Overall, 59 patients had normal swallowing based on instrumental swallowing testing (flexible endoscopic evaluation of swallowing, videofluoroscopic swallow study, esophagram, or esophagoscopy). Among those, mean EAT-10 score was significantly higher in patients with anxiety and/or depression (n = 30) (14.63, SD = 11.42) compared to those with no anxiety and/or depression (n = 29) (8.93, SD = 6.59) (p = 0.023). CONCLUSION While anxiety/depression may aggravate dysphagia in patients with normal swallowing function, this correlation may not hold in those with objective swallowing dysfunction. LEVEL OF EVIDENCE 4 Laryngoscope, 134:2115-2120, 2024.
Collapse
Affiliation(s)
- Can Doruk
- Weill Cornell Medicine, Department of Otolaryngology-Head & Neck Surgery, Sean Parker Institute for the Voice, New York, NY
| | - Valentina Mocchetti
- Weill Cornell Medicine, Department of Otolaryngology-Head & Neck Surgery, Sean Parker Institute for the Voice, New York, NY
| | - Hal Rives
- Weill Cornell Medicine, Department of Otolaryngology-Head & Neck Surgery, Sean Parker Institute for the Voice, New York, NY
| | - Paul Christos
- Weill Cornell Medicine, Department of Population Health Sciences, New York, NY
| | - Anaïs Rameau
- Weill Cornell Medicine, Department of Otolaryngology-Head & Neck Surgery, Sean Parker Institute for the Voice, New York, NY
| |
Collapse
|
2
|
Gascon L, Bryson PC, Benninger M, Brodsky MB. Assessing Dysphagia in the Adult. Otolaryngol Clin North Am 2024:S0030-6665(24)00044-6. [PMID: 38632000 DOI: 10.1016/j.otc.2024.03.003] [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: 04/19/2024]
Abstract
This article explores the landscape of dysphagia assessment in adults. Dysphagia, a complex condition affecting the lifespan and many health conditions, significantly compromises individuals' quality of life. Dysphagia is often underdiagnosed, emphasizing the need for comprehensive assessment methods to ensure timely and accurate intervention. It encompasses clinical history, physical examination, clinical and instrumental swallow evaluations. Procedures within each of these modalities are reviewed, highlighting strengths, limitations, and contribution toward a complete understanding of dysphagia, ultimately guiding effective intervention strategies for improved patient outcomes.
Collapse
Affiliation(s)
- Laurence Gascon
- Head and Neck Institute, Cleveland Clinic, Cleveland, OH, USA; Cleveland Clinic Voice Center.
| | - Paul C Bryson
- Head and Neck Institute, Cleveland Clinic, Cleveland, OH, USA; Cleveland Clinic Voice Center
| | - Michael Benninger
- Head and Neck Institute, Cleveland Clinic, Cleveland, OH, USA; Cleveland Clinic Voice Center
| | - Martin B Brodsky
- Head and Neck Institute, Cleveland Clinic, Cleveland, OH, USA; Cleveland Clinic Voice Center; Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, USA; Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
| |
Collapse
|
3
|
Podzimek J, Jecker P, Koscielny S, Guntinas-Lichius O. [Use of flexible transnasal esophagogastroscopy in patients with unclear globus sensation]. HNO 2024:10.1007/s00106-024-01462-7. [PMID: 38592479 DOI: 10.1007/s00106-024-01462-7] [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: 02/20/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND Globus pharyngeus is a common symptom with considerable suffering. Globus sensation can be caused by reflux. In many places, endoscopy of the esophagus is recommended for clarification, especially when there is a question about the presence of a hiatal hernia as the cause of reflux. Transnasal esophagogastroscopy (TNE) represents an alternative to conventional gastroesophagoscopy. It enables a quick low-complication examination of the upper aerodigestive tract in the sitting, non-sedated patient. OBJECTIVE The aim of this work was to assess the feasibility of outpatient TNE in patients with globus sensation. Furthermore, the results of dual-probe pH monitoring were compared with the results of TNE in order to assess the value of TNE in the clarification of globus sensation and reflux. MATERIALS AND METHODS In 30 patients with globus symptoms, 24-hour dual-probe pH monitoring and TNE were performed. In pH monitoring, reflux number, fraction time, reflux surface area index, and DeMeester score were evaluated as indicators of laryngopharyngeal reflux (LPR) and gastroesophageal reflux (GERD). Abnormalities of the esophageal mucosa and the gastroesophageal junction were recorded in TNE. The results were compared. RESULTS The TNE could be performed without any complications. Mean examination time was 5.34 ± 0.12 min. Reflux was measured in 80% of the patients (24/30) with pH monitoring. In almost half of these patients (46%), abnormalities were detected in TNE as indirect evidence of reflux. In addition to an axial hiatal hernia, these included mucosal changes such as erosive esophagitis and Barrett's metaplasia. Patients with a hiatal hernia also suffered significantly more often from LPR than patients without a hernia (9:1). CONCLUSION TNE is a quick and safe examination method for diagnosing patients with an unclear globus sensation. Detection of a hiatal hernia can be seen as an indication of reflux disease. Lack of evidence of a hernia does not rule out reflux. Thus, TNE is a useful addition to pH monitoring in patients with globus sensation, because reflux-related changes in the mucosa can be recognized early and adequately treated.
Collapse
Affiliation(s)
- J Podzimek
- Klinik für Hals-Nasen-Ohrenheilkunde und plastische Kopf-Hals-Chirurgie, Klinikum Bad Salzungen, Lindigallee 3, 36433, Bad Salzungen, Deutschland.
| | - P Jecker
- Klinik für Hals-Nasen-Ohrenheilkunde und plastische Kopf-Hals-Chirurgie, Klinikum Bad Salzungen, Lindigallee 3, 36433, Bad Salzungen, Deutschland
| | - S Koscielny
- Klinik für Hals, Nasen- und Ohrenheilkunde, Universitätsklinikum Jena, Jena, Deutschland
| | - O Guntinas-Lichius
- Klinik für Hals, Nasen- und Ohrenheilkunde, Universitätsklinikum Jena, Jena, Deutschland
| |
Collapse
|
4
|
Hernandez BO, Nagatsuka M, Wright SC, Marcellino AJ, Lovin BD, Walker FO, Madden LL. Hemodynamic Changes Associated With Transcervical Laryngeal Injection of Botulinum Toxin. J Voice 2023; 37:452-455. [PMID: 33541763 PMCID: PMC8325702 DOI: 10.1016/j.jvoice.2021.01.003] [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: 08/31/2020] [Revised: 01/01/2021] [Accepted: 01/18/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Laryngeal dystonia is a chronic neurologic disorder characterized by intention-induced spasms of the vocal folds driven by aberrant central motor processing. The use of in-office transcervical botulinum toxin injection for the treatment of laryngeal disorders, such as laryngeal dystonia, has been deemed safe and efficacious. There is, however, no available data outlining the hemodynamic changes experienced by patients undergoing this frequently performed procedure. METHODS One hundred and one patients diagnosed with laryngeal dystonia were enrolled in this prospective study. These patients underwent transcervical laryngeal botulinum toxin injection to address their dysphonia. Vital signs where acquired prior to, and at the time of injection. Alterations in these parameters were then evaluated for statistical significance. RESULTS Statistically significant increases in mean heart rate (5.8 ± 10.8 bpm, P < 0.0001), systolic blood pressure and diastolic blood pressure (7.0 ± 9.5 mm Hg, P < 0.0001; 8.7 ± 14.7 mm Hg, P < 0.0001) were discovered. No statistically significant difference in oxygen saturation was noted and no patients in the study faced major adverse outcomes. CONCLUSIONS Though these findings may not have related to clinically significant complication, our study demonstrates the importance of understanding potential stressors in a procedure routinely performed by laryngologists. This may result in more careful patient selection, alterations in procedure, and improved safety by acting in a timely fashion if alarming changes in hemodynamic parameters are noted.
Collapse
Affiliation(s)
- Brian O Hernandez
- Department of Otolaryngology Head and Neck Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Moeko Nagatsuka
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Stephen Carter Wright
- Department of Otolaryngology Head and Neck Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Amanda J Marcellino
- Department of Otolaryngology Head and Neck Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Benjamin D Lovin
- Department of Otolaryngology Head and Neck Surgery, Baylor College of Medicine, Houston, Texas
| | - Francis O Walker
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Lyndsay L Madden
- Department of Otolaryngology Head and Neck Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina.
| |
Collapse
|
5
|
Hamdan AL, Jabbour C, Khalifee E, Ghanem A, Hage AE. Tolerance of Patients Using Different Approaches in Laryngeal Office-Based Procedures. J Voice 2023; 37:263-267. [PMID: 33589373 DOI: 10.1016/j.jvoice.2020.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/07/2020] [Accepted: 12/09/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To evaluate the tolerance, overall experience, procedure discomfort, and patient anxiety using different routes in office-based laryngeal procedures. SUBJECTS AND METHODS We performed a retrospective analysis of patients undergoing office-based laryngeal procedures for the treatment or diagnosis of laryngeal lesions via transnasal, transoral, or percutaneous routes. Tolerability, overall experience, procedure discomfort, and patient's anxiety were evaluated and reported on a custom scale over 5. RESULTS A total 178 procedures performed on 154 patients were reviewed. The video-recordings and data on 15 procedures were missing. A total of 163 procedures were included in this study. These were stratified as follows; 128 procedures via the transnasal fiberoptic approach, 16 procedures via the transoral fiberoptic approach, and 19 procedures via the percutaneous approach. There was no significant difference in the mean score of overall experience across the three different approaches (P= 0.926). The mean overall experience score for the transnasal approach was 1.85, vs 1.93 and 1.94 for the transoral and percutaneous approach, respectively. Similarly, there was no significant difference in the mean score of tolerability across the three different approaches. The mean tolerability score was 1.68 using the transnasal approach, compared to 1.6 using the transoral approach, and 1.84 using the percutaneous approach (P= 0.77). Anxiety scores, and procedure discomfort scores did not differ either among the three groups (P= 0.138 and P= 0.656, respectively). CONCLUSIONS There was no significant difference in tolerability, anxiety, procedure discomfort, and overall experience regarding the different approaches employed.
Collapse
Affiliation(s)
- Abdul-Latif Hamdan
- Department of Otolaryngology and Head & Neck Surgery, American University of Beirut-Medical Center, Beirut, Lebanon.
| | - Christopher Jabbour
- Department of Otolaryngology and Head & Neck Surgery, American University of Beirut-Medical Center, Beirut, Lebanon
| | - Elie Khalifee
- Department of Otolaryngology and Head & Neck Surgery, American University of Beirut-Medical Center, Beirut, Lebanon.
| | - Anthony Ghanem
- Department of Otolaryngology and Head & Neck Surgery, American University of Beirut-Medical Center, Beirut, Lebanon
| | - Aya El Hage
- Department of Otolaryngology and Head & Neck Surgery, American University of Beirut-Medical Center, Beirut, Lebanon
| |
Collapse
|
6
|
Office-Based Evaluation and Management of Dysphagia in Otolaryngology. CURRENT OTORHINOLARYNGOLOGY REPORTS 2023. [DOI: 10.1007/s40136-023-00439-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
|
7
|
Shoowit P, Wanichakorntrakul P, Wongwattana P. The Efficacy of Transnasal Esophagoscopy in Laryngopharyngeal Reflux Patients at HRH Princess Maha Chakri Sirindhorn Medical Center (MSMC), Thailand. Indian J Otolaryngol Head Neck Surg 2022; 74:4906-4910. [PMID: 36742942 PMCID: PMC9895211 DOI: 10.1007/s12070-021-02425-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 01/25/2021] [Indexed: 02/07/2023] Open
Abstract
To evaluate the positive pathological findings, patient satisfaction, pain, and complications of transnasal esophagoscopy (TNE) in laryngopharyngeal reflux (LPR) patients at HRH Princess Maha Chakri Sirindhorn Medical Center (MSMC), Thailand. A descriptive cross-sectional study. Forty adult LPR patients who had failed 3-months proton-pump inhibitor therapy were recruited to undergo TNE at Otolaryngology department, MSMC from January 1, 2019 to December 31, 2019. Data including demographics, Reflux Finding Score, Reflux Symptom Index, Eating Assessment Tool (EAT-10) scores, and endoscopic findings were recorded and compared between patients who had positive pathological findings and those who had negative findings. Sixteen patients (40%) had positive findings, which led to the changes in management of their conditions. Most positive findings included multiple esophageal and gastric ulcers (4/16), gastric ulcer (3/16), esophagitis (2/16), and esophageal candidiasis (2/16). There was no statistically significant difference in the baseline data between patients in the TNE positive and the TNE negative groups. The average patient satisfaction on VAS was 8.60 ± 1.43. Most patients were in the mild pain score group (18/40). Complications were not encountered. TNE is an efficient tool for evaluating LPR in Thai patients. The procedure was proven to be safe, well tolerated, and highly satisfied.
Collapse
Affiliation(s)
- Parkkapus Shoowit
- Department of Otolaryngology, Faculty of Medicine, Srinakharinwirot University, Sukhumvit 23, Watana, Bangkok, 10110 Thailand
| | - Pisit Wanichakorntrakul
- Department of Otolaryngology, Faculty of Medicine, Srinakharinwirot University, Sukhumvit 23, Watana, Bangkok, 10110 Thailand
| | - Panuwat Wongwattana
- Department of Otolaryngology, Faculty of Medicine, Srinakharinwirot University, Sukhumvit 23, Watana, Bangkok, 10110 Thailand
| |
Collapse
|
8
|
Lakshminarasimman P, Pai PS, Mehta S, Patil P. Is Direct Laryngoscopy Obsolete? "Trans Nasal Oesophagoscopy" the Complete Endoscopic Solution in Head Neck Practice. Indian J Otolaryngol Head Neck Surg 2021; 73:310-314. [PMID: 34471618 DOI: 10.1007/s12070-021-02368-4] [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: 12/17/2020] [Accepted: 01/04/2021] [Indexed: 10/22/2022] Open
Abstract
Direct laryngoscopy (DL) is the standard of care for the evaluation of suspicious lesions in the larynx and hypo pharynx but requires general anaesthesia and a dedicated operation theatre. While DL offers us the ability to map the lesion adequately and take a biopsy, it requires workup for anaesthesia well as rigid oesophagoscopy for assessing the oesophagus with its associated complications. Sixty-nine patients underwent TNE under topical anaesthesia. The lesions were mapped and biopsies taken. Those patients who had an inadequate evaluation on TNE or negative biopsy underwent direct laryngoscopy. Completeness of evaluation, adequacy of biopsy, presence of synchronous oesophageal lesions and the modified Gloucester Comfort Score for patient comfort was documented. Amongst 69 cases enrolled for TNE evaluation, 97% of cases had an adequate mapping of disease extent, and 100% adequacy of biopsy material. General anaesthesia could be avoided in 92.75% of patients. TNE took a median time of 8 min. Synchronous oesophageal tumours were seen in 5.8% of patients. There were no complications and 74% patients did not experience any discomfort. TNE appears to be simple, safe, efficient office based diagnostic procedure. TNE has the potential to be the new standard of care making DL obsolete.
Collapse
Affiliation(s)
- P Lakshminarasimman
- Department of Head and Neck Surgery (Surgical Oncology), Sri Ramachandra Medical College and Research Institute, No. 1, Ramachandra Nagar, Porur, Chennai, 600116 India
| | - Prathamesh S Pai
- Department of Head and Neck Surgical Oncology, Tata Memorial Hospital, Dr. E. Borges Road, Parel, Mumbai, 400012 India
| | - Shaesta Mehta
- Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Hospital, Dr. E. Borges Road, Parel, Mumbai, 400012 India
| | - Prachi Patil
- Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Hospital, Dr. E. Borges Road, Parel, Mumbai, 400012 India
| |
Collapse
|
9
|
Abstract
Dysphagia, defined as impairment of the swallowing process, is a common symptom and can be a significant source of morbidity and mortality in the general population. This article summarizes the causes of the condition, its prevalence, and the consequences and costs of untreated dysphagia. The aim of this article is to provide a framework for the general internist in assessing, diagnosing, and managing dysphagia in an adult patient. Basic diagnostic screening procedures and techniques for management are emphasized. A basic treatment pathway based on cause is provided for reference.
Collapse
Affiliation(s)
- E Berryhill McCarty
- Department of Otolaryngology, University of Pittsburgh, 203 Lothrop Street #500, Pittsburgh, PA 15213, USA
| | - Tiffany N Chao
- Department of Otolaryngology-Head and Neck Surgery, Hospital of the University of Pennsylvania, 3737 Market Street, 3rd Floor, Philadelphia, PA 19104, USA.
| |
Collapse
|
10
|
Horvath L, Fostiropoulos K, Burri E, Kraft M. Value of Transnasal Esophagoscopy in the Workup of Laryngo-Pharyngeal Reflux. J Clin Med 2021; 10:jcm10143188. [PMID: 34300353 PMCID: PMC8305729 DOI: 10.3390/jcm10143188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/18/2021] [Accepted: 07/19/2021] [Indexed: 01/06/2023] Open
Abstract
Background: Laryngopharyngeal reflux (LPR) can display a variety of symptoms, and upper endoscopy is occasionally used for its investigation. The aim of the present study was to determine the value of transnasal esophagoscopy (TNE) in the workup of LPR. Methods: In 200 consecutive patients with suspected LPR, reflux symptom index (RSI), reflux finding score (RFS), oropharyngeal pH-monitoring (PHM) and transnasal esophagoscopy (TNE) were carried out and rated according to the Horvath Score. Results: In the investigation of LPR, TNE showed a sensitivity, specificity and accuracy of 96%, 85% and 95%, respectively. The most common pathologic TNE findings in LPR patients were an insufficient cardia, hiatal hernia, lymphoid follicles and visible reflux. Conclusions: TNE is a supportive method in the workup of LPR, which can display the underlying pathology and directly affect therapeutic decisions.
Collapse
Affiliation(s)
- Lukas Horvath
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Basel, 4031 Basel, Switzerland
- Correspondence: ; Tel.: +41-61-265-2525
| | | | - Emanuel Burri
- Department of Gastroenterology and Hepatology, University Medical Clinic, Kantonsspital Baselland, 4410 Liestal, Switzerland;
| | - Marcel Kraft
- HNO-Zentrum Beider Basel, 4142 Münchenstein, Switzerland; (K.F.); (M.K.)
| |
Collapse
|
11
|
Shukla RN, Schoeman MN, Thompson SK. How to insert a naso-enteric tube using an ultrathin scope. ANZ J Surg 2021; 91:1613-1614. [PMID: 33978297 DOI: 10.1111/ans.16932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 04/23/2021] [Accepted: 04/25/2021] [Indexed: 11/28/2022]
Abstract
Although not a technically challenging procedure, the correct insertion of a naso-enteric feeding tube is an important skill for the surgeon. The described technique has been refined over two decades, and is well tolerated, reliable and reproducible.
Collapse
Affiliation(s)
- Rippan N Shukla
- Discipline of Surgery, College of Medicine & Public Health, Flinders Medical Centre, Flinders University, Bedford Park, South Australia, Australia
| | - Mark N Schoeman
- Department of Gastroenterology & Hepatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Sarah K Thompson
- Discipline of Surgery, College of Medicine & Public Health, Flinders Medical Centre, Flinders University, Bedford Park, South Australia, Australia
| |
Collapse
|
12
|
Whited CW, Lubin J, Marka N, Koszewski IJ, Hoffman MR, Schoeff S, Dailey SH. Pain Experience and Tolerance of Awake In-Office Upper Airway Procedures: Influencing Factors. Laryngoscope 2020; 131:E1580-E1588. [PMID: 33196115 DOI: 10.1002/lary.29238] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 09/21/2020] [Accepted: 10/22/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS Awake, unsedated in-office upper airway procedures are performed frequently and have high completion rates, yet less is known about the patients' pain experience and potentially influencing factors. It is also unclear if patients' pain experiences become worse with repeated procedures. We identified procedure- and patient-related factors that might influence procedural completion and pain scores. STUDY DESIGN Retrospective chart review. METHODS Pre-, intra-, and post-procedure pain scores were collected prospectively for awake unsedated upper airway procedures performed at a single institution over a 5-year period. Patient factors reviewed were demographics, body mass index, psychiatric and/or pain diagnosis, and related medications. Procedure factors reviewed were procedure type, route, side, and performance of the same procedure multiple times. Patients reported their pain level before, during, and after the procedure using a standard 0 to 10 scale. Maximum pain score change (PΔmax), or the difference between highest and lowest reported pain levels, was calculated. Descriptive and multivariate analyses were performed. RESULTS Procedure completion was 98.7% for 609 first time patients and 99.0% in 60 patients undergoing 292 repeat procedures. PΔmax did not covary with age, gender, or BMI. PΔmax covaried with pain and psychiatric conditions and associated medications. PΔmax was highest for injection medialization and lowest for tracheoscopy. PΔmax decreased over time for those undergoing multiple identical procedures. CONCLUSIONS Procedures were performed with a very high completion rate and low pain scores. Age, sex, and BMI did not affect pain experience. A combination of pain and psychiatric conditions did. Injection medialization had the highest PΔmax and tracheoscopy the lowest. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E1580-E1588, 2021.
Collapse
Affiliation(s)
- Chad W Whited
- Austin Voice Center, Austin Ear, Nose, and Throat Clinic, Austin, Texas, U.S.A
| | - Jonathan Lubin
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A
| | - Nicholas Marka
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A
| | - Ian J Koszewski
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A
| | - Matthew R Hoffman
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A
| | - Stephen Schoeff
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A
| | - Seth H Dailey
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A
| |
Collapse
|
13
|
Extended role of transnasal oesophagoscopy: a review of the literature. The Journal of Laryngology & Otology 2020; 134:481-486. [PMID: 32616097 DOI: 10.1017/s002221512000105x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Advances in endoscopic technology have allowed transnasal oesophagoscopy to be used for a variety of diagnostic and therapeutic procedures. METHOD A review of the literature was carried out to look into the extended role of transnasal oesophagoscopy within otolaryngology, using the Embase, Cinahl and Medline databases. RESULTS There were 16 studies showing that transnasal oesophagoscopy is safe and cost effective and can be used for removal of foreign bodies, tracheoesophageal puncture, laser laryngeal surgery and balloon dilatation. CONCLUSION This study presents a summary of the literature showing that transnasal oesophagoscopy can be used as a safe and cost-effective alternative or adjunct to traditional rigid endoscopes for therapeutic procedures.
Collapse
|
14
|
Slack IF, Schwartz JT, Mukkada VA, Hottinger S, Abonia JP. Eosinophilic Esophagitis: Existing and Upcoming Therapies in an Age of Emerging Molecular and Personalized Medicine. Curr Allergy Asthma Rep 2020; 20:30. [PMID: 32506181 DOI: 10.1007/s11882-020-00928-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW Recent research efforts have spurred great progress in the diagnosis and management of eosinophilic esophagitis (EoE). Nonetheless, challenges remain in addressing disease burden and impairment in the growing EoE population. We highlight work from the Cincinnati Center for Eosinophilic Disorders, the Consortium of Eosinophilic Gastrointestinal Disease Researchers, and others that address these ongoing challenges. RECENT FINDINGS New tools for characterizing EoE disease activity include the EoE Histology Scoring System (EoEHSS), endoscopic alternatives, validated patient-reported outcome (PRO) questionnaires, and investigational biomarkers. These diagnostic and monitoring strategies have been complemented by advances in EoE therapy. Treatment modalities have refined the traditional approaches of dietary elimination, swallowed steroids, and proton pump inhibitors (PPI), and biologics offer promise for future treatment. This review summarizes EoE advances in disease management and newly defined EoE endotypes that may serve as the foundation for EoE-personalized medicine.
Collapse
Affiliation(s)
- Ian F Slack
- Division of Allergy and Immunology, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 7028, Cincinnati, OH, 45229, USA
| | - Justin T Schwartz
- Division of Allergy and Immunology, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 7028, Cincinnati, OH, 45229, USA
| | - Vincent A Mukkada
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Shawna Hottinger
- Division of Allergy and Immunology, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 7028, Cincinnati, OH, 45229, USA
| | - J Pablo Abonia
- Division of Allergy and Immunology, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 7028, Cincinnati, OH, 45229, USA.
| |
Collapse
|
15
|
Marinone Lares SG, Allen JE. Safety of in-office laryngology procedures. Curr Opin Otolaryngol Head Neck Surg 2020; 27:433-438. [PMID: 31567495 DOI: 10.1097/moo.0000000000000585] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE OF REVIEW A wide range of diagnostic and therapeutic laryngology procedures are currently performed in an office setting. In-office laryngology procedures (IOLP) are increasingly seen as standard-of-care, and while generally considered safe, high-quality evidence supporting the latter statement is lacking. This review aims to summarize recent literature regarding the safety of IOLP. RECENT FINDINGS There is a paucity of guidelines and standardized protocols for IOLP. To date, there is one available safety protocol specific to in-office laser procedures. Haemodynamic changes during IOLP have been documented and the significance of these changes continues to be unclear. Therefore, monitoring of vital signs is recommended. Continuing antithrombotic therapy during IOLP also appears safe, and this decision may be left to surgeon discretion. A protocol for management of antithrombotic therapy prior to in-office laser procedures is available. Actual serum lidocaine levels following topical application of mixed lidocaine preparations falls well below reported toxic levels but persists for longer than previously reported. SUMMARY IOLP are safer that suspension laryngoscopy under general anaesthetic. Although complication rates of IOLP are low, patient characteristics and potential complications of both the procedure and of topical anaesthetic use must be considered. One must be prepared and equipped to deal with these potential complications.
Collapse
Affiliation(s)
| | - Jacqueline E Allen
- Department of Surgery, University of Auckland.,Department of Otolaryngology, North Shore Hospital, Auckland, New Zealand
| |
Collapse
|
16
|
Abstract
PURPOSE OF REVIEW The purpose of this review is to assess recent literature on the clinical relevance of the gastric inlet patch with particular focus on endoscopic diagnosis and treatment, the relationship of the inlet patch to laryngopharyngeal reflux disease and the association of proximal esophageal adenocarcinoma with inlet patch. RECENT FINDINGS Recent studies suggest endoscopic diagnosis of inlet patch increases with endoscopist awareness (up to 10-fold) and when using enhanced imaging techniques such as narrow band imaging (up to three-fold). The literature remains mixed on the association of inlet patch with laryngopharyngeal symptoms or globus sensation. Studies of endoscopic ablation, using argon plasma coagulation or radiofrequency ablation have shown improved laryngopharyngeal reflux symptom scores posttreatment. Proximal esophageal adenocarcinomas are rare but often associated with inlet patch when they occur. Case studies have described endoscopic resection of malignant lesions related to inlet patch, using endoscopic mucosal resection or submucosal dissection. SUMMARY Prospective, multicenter studies of symptom association with inlet patch using validated symptom questionnaires and blinded sham-controlled treatments are needed to further clarify the role of such treatments, which to date are limited to a small numbers of centers with a special interest.
Collapse
|
17
|
Office-Based 532-Nanometer Pulsed Potassium-Titanyl-Phosphate Laser Procedures in Laryngology. Otolaryngol Clin North Am 2019; 52:537-557. [PMID: 30922560 DOI: 10.1016/j.otc.2019.02.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
With fiber-based lasers that may be passed via the working channel of a flexible laryngoscope, in-office laser laryngeal surgery has become possible. The potassium-titanyl-phosphate laser has several features that make it ideal for laryngeal surgery, and it is now the laser of choice for in-office management of a variety of laryngeal lesions. Its applications have expanded significantly since its introduction, with reports of new indications continuing to appear in the literature. This article provides a comprehensive review of the indications and technical details of in-office potassium-titanyl-phosphate laser laryngeal surgery, and a summary of the existing literature regarding outcomes of these procedures.
Collapse
|
18
|
Wellenstein DJ, Honings J, Schutte HW, Herruer JM, van den Hoogen FJA, Marres HAM, Takes RP, van den Broek GB. Cost analysis of office-based transnasal esophagoscopy. Eur Arch Otorhinolaryngol 2019; 276:1457-1463. [PMID: 30806806 PMCID: PMC6458968 DOI: 10.1007/s00405-019-05357-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 02/20/2019] [Indexed: 12/23/2022]
Abstract
Purpose Although office-based transnasal esophagoscopy has been investigated extensively, a cost analysis is still lacking. We performed a cost analysis combined with feasibility study for two diagnostic processes: patients with globus pharyngeus and/or dysphagia, and hypopharyngeal carcinoma. Methods Prospective cohort study. Results Forty-one procedures were performed, of which 35 were fully completed. The procedure was well tolerated with mild complaints such as nasal or pharyngeal pain and burping. Four complications occurred: two minor epistaxis and two vasovagal reactions. In patients with globus pharyngeus and/or dysphagia, transnasal esophagoscopy resulted in a cost saving of €94.43 (p 0.026) per procedure, compared to our regular diagnostic process. In patients with suspicion of hypopharyngeal carcinoma, cost savings were €831.41 (p 0.000) per case. Conclusions Cost analysis showed that office-based transnasal esophagoscopy can provide significant cost savings for the current standard of care. Furthermore, this procedure resulted in good patient acceptability and few complications.
Collapse
Affiliation(s)
- David J Wellenstein
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Philips van Leydenlaan 15, 6500 HB, Nijmegen, The Netherlands.
| | - Jimmie Honings
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Philips van Leydenlaan 15, 6500 HB, Nijmegen, The Netherlands
| | - Henrieke W Schutte
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Philips van Leydenlaan 15, 6500 HB, Nijmegen, The Netherlands
| | - Jasmijn M Herruer
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Philips van Leydenlaan 15, 6500 HB, Nijmegen, The Netherlands
| | - Frank J A van den Hoogen
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Philips van Leydenlaan 15, 6500 HB, Nijmegen, The Netherlands
| | - Henri A M Marres
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Philips van Leydenlaan 15, 6500 HB, Nijmegen, The Netherlands
| | - Robert P Takes
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Philips van Leydenlaan 15, 6500 HB, Nijmegen, The Netherlands
| | - Guido B van den Broek
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Philips van Leydenlaan 15, 6500 HB, Nijmegen, The Netherlands
| |
Collapse
|
19
|
Mohammed H, Del Pero M, Coates M, Masterson L, Tassone P, Burrows S, Nassif R. Office-based transnasal esophagoscopy biopsies for histological diagnosis of head and neck patients. Laryngoscope 2018; 129:2721-2726. [PMID: 30548865 DOI: 10.1002/lary.27714] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 10/12/2018] [Accepted: 11/01/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS To present yield of transnasal esophagoscopy (TNE) biopsies of upper aerodigestive tract (UADT) lesions and define the role of TNE as a safe alternative to rigid endoscopy. STUDY DESIGN Retrospective case series. METHODS All patients who underwent TNE-guided biopsies attempted over a 2-year period were included. Patients were identified using coding records and outpatient diaries. Demographic data were recorded as well as the histological diagnosis and additional histological diagnostic procedures. RESULTS During the observation period, 134 TNE-guided procedures were attempted. The procedure could not be completed in 19 patients. There were 102/115 (89%) patients who did not require further interventions for histological diagnosis of the tumor. The most common biopsied area was the larynx (53), followed by the tongue base (29). The most common malignancy was invasive squamous cell carcinoma in 42/115 (36.5%). CONCLUSIONS The work presented in this article strongly suggests that TNE-guided biopsy is a valuable diagnostic tool for patients suspected of having carcinoma of the UADT. LEVEL OF EVIDENCE 4 Laryngoscope, 129:2721-2726, 2019.
Collapse
Affiliation(s)
- Hassan Mohammed
- Department of Otolaryngology-Head and Neck Surgery, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Marcus Del Pero
- Department of Otolaryngology-Head and Neck Surgery, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Matthew Coates
- Department of Otolaryngology-Head and Neck Surgery, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Liam Masterson
- Department of Otolaryngology-Head and Neck Surgery, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Peter Tassone
- Department of Otolaryngology-Head and Neck Surgery, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Stuart Burrows
- Department of Otolaryngology-Head and Neck Surgery, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Ramez Nassif
- Department of Otolaryngology-Head and Neck Surgery, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| |
Collapse
|
20
|
Best AR, Halum SL, Parker NP. Current Indications for Transnasal Esophagoscopy: An American Broncho-Esophagological Association Survey. Ann Otol Rhinol Laryngol 2018; 127:926-930. [PMID: 30235935 DOI: 10.1177/0003489418800840] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION: The aim of this study was to evaluate the current indications for and clinical factors influencing the use of transnasal esophagoscopy (TNE). METHODS: An online survey was sent to American Broncho-Esophagological Association members, including questions on demographics, indications, and factors influencing the use of TNE. RESULTS: Sixty of 251 members (24%) completed the survey. Ninety-three percent of respondents reported academic practices, while 98% practice in medium to large urban settings. Thirty-five (58%) completed laryngology fellowships. Mean monthly TNE procedure count was 7.15 (range, <1-35). The most common indications were dysphagia (82%), biopsy (50%), and laryngopharyngeal reflux (47%). Chronic cough, head and neck cancer screening, gastroesophageal reflux (GER), and tracheoesophageal puncture were also commonly reported indications (44% each). For laryngopharyngeal reflux and GER, most respondents perform TNE for recalcitrant disease following a medical trial of at least 3 months. Long-standing GER symptoms, documentation of GER on pH and impedance testing, and abnormal findings on previous esophagoscopy lead to greater TNE use. Specific dysphagia indications included abnormal esophagographic findings (70%), history or examination localizing to the esophagus (60%), solid dysphagia only (53%), and solid and/or liquid dysphagia (40%). The primary sites most likely to prompt TNE use for head and neck cancer surveillance were the esophagus (92.3%) and hypopharynx (84.6%). Balloon dilation was the most common indication for which respondents do not currently perform TNE but would like to (n = 8). CONCLUSIONS: TNE indications have not been well established. According to respondents from the American Broncho-Esophagological Association, TNE is most commonly used for dysphagia and laryngopharyngeal reflux and slightly less so for GER and head and neck cancer screening and surveillance. Several clinical indicators were identified that influence the decision to perform TNE.
Collapse
Affiliation(s)
- Amy R Best
- 1 Department of Otolaryngology-Head and Neck Surgery, Indiana University, Indianapolis, IN, USA
| | - Stacey L Halum
- 2 Department of Speech, Language, and Hearing Sciences, Purdue University, Lafayette, IN, USA.,4 The Voice Clinic of Indiana, Carmel, IN, USA
| | - Noah P Parker
- 3 Department of Speech and Hearing Sciences, Indiana University, Bloomington, IN, USA.,4 The Voice Clinic of Indiana, Carmel, IN, USA
| |
Collapse
|
21
|
Rusu R, Ishaq S, Wong T, Dunn JM. Cervical inlet patch: new insights into diagnosis and endoscopic therapy. Frontline Gastroenterol 2018; 9:214-220. [PMID: 30046427 PMCID: PMC6056090 DOI: 10.1136/flgastro-2017-100855] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 09/25/2017] [Accepted: 10/18/2017] [Indexed: 02/04/2023] Open
Abstract
The cervical inlet patch is an island of heterotopic gastric mucosa, most commonly found in the proximal oesophagus. Its importance as a cause of throat symptoms has been recognised, particularly chronic globus sensation. This has led to a change in the Rome IV criteria for globus management, with emphasis on ruling out the condition. Proton pump inhibitors are often ineffective in resolving symptoms. Endoscopic studies on the use of ablative techniques, most recently radiofrequency ablation (RFA), have shown promise in reversing the CIP to mormal squamous mucosa, with subsequent symtpomatic resolution. The aim of this review is to update on the investigation and management of the CIP.
Collapse
Affiliation(s)
- Radu Rusu
- Department of Gastroenterology, Guy's & St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Sauid Ishaq
- Department of Gastroenterology, Russells Hall Hospital, Birmingham City University, Birmingham, UK
| | - Terry Wong
- Department of Gastroenterology, Guy's & St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Jason M Dunn
- Department of Gastroenterology, Guy's & St Thomas' Hospitals NHS Foundation Trust, London, UK
| |
Collapse
|
22
|
Globus pharyngeus: a review of etiology, diagnostics, and treatment. Eur Arch Otorhinolaryngol 2018; 275:1945-1953. [DOI: 10.1007/s00405-018-5041-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 06/14/2018] [Indexed: 12/13/2022]
|
23
|
Howell RJ, Schopper MA, Giliberto JP, Collar RM, Khosla SM. Office-based esophageal dilation in head and neck cancer: Safety, feasibility, and cost analysis. Laryngoscope 2018; 128:2261-2267. [DOI: 10.1002/lary.27121] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 12/24/2017] [Accepted: 01/10/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Rebecca J. Howell
- Department of Otolaryngology-Head and Neck Surgery; University of Cincinnati College of Medicine; Cincinnati Ohio U.S.A
| | - Melissa A. Schopper
- Department of Otolaryngology-Head and Neck Surgery; University of Cincinnati College of Medicine; Cincinnati Ohio U.S.A
| | - John Paul Giliberto
- Department of Otolaryngology-Head and Neck Surgery; University of Cincinnati College of Medicine; Cincinnati Ohio U.S.A
| | - Ryan M. Collar
- Department of Otolaryngology-Head and Neck Surgery; University of Cincinnati College of Medicine; Cincinnati Ohio U.S.A
| | - Sid M. Khosla
- Department of Otolaryngology-Head and Neck Surgery; University of Cincinnati College of Medicine; Cincinnati Ohio U.S.A
| |
Collapse
|
24
|
Hu CT, Lei WY, Lin JS, Hung JS. Endoscopic meatus scoring scale versus sniff test to predict insertability before transnasal endoscopy: A prospective, randomized study. J Gastroenterol Hepatol 2017; 32:1914-1921. [PMID: 28444800 DOI: 10.1111/jgh.13810] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 04/17/2017] [Accepted: 04/19/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND AIM Sniff test is a common method before unsedated transnasal esophago-gastro-duodenoscopy (UT-EGD) to select a nostril insertion site. Yet there is no objective method to select a more specific meatus insertion tract for anesthesia and insertion. We devised an endoscopic meatus scoring scale by anterior meatuscopy to select the most optimal meatus insertion tract. We hypothesized that meatuscopy instead of sniff test might improve tolerance and reduce adverse events during nasal anesthesia and UT-EGD. METHODS A prospective randomized controlled trial to compare patient tolerance and adverse events. RESULTS A total of 359 patients were assessed and finally 310 patients were analyzed. There were no statistical differences in patient characteristics and insertion failure rates. Pain scores during nasal anesthesia, nasal insertion/exsertion, UT-EGD, and overall tolerance were significantly lower in the meatuscopy group than sniff test group. Compared with the sniff tested patients, the meatuscopied patients had significantly lower epistaxis rates during insertion/exsertion, better visual capacity after decongestive anesthesia, and shorter total procedure time. A significantly higher proportion of the meatuscopied than sniff tested patients would like to receive the same procedure next time. Nasal discharge, nasal pain, epistaxis, and blowing out blood clots occurred significantly less frequent in the meatuscopy group than sniff test group. More sniff tested than meatuscopied patients had headache, delayed epistaxis, and sinusitis although they were not statistically significant. CONCLUSION Selection of an optimal meatus insertion tract by an anterior meatuscopy causes lesser nasal pain, epistaxis, and post-procedural side effects in nasal anesthesia and UT-EGD than the conventional sniff test.
Collapse
Affiliation(s)
- Chi-Tan Hu
- Division of Gastroenterology, Department of Internal Medicine, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan.,Graduate Institute of Clinical Medicine, School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Wei-Yi Lei
- Division of Gastroenterology, Department of Internal Medicine, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
| | - Jen-Shung Lin
- Division of Gastroenterology, Department of Internal Medicine, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
| | - Jui-Sheng Hung
- Division of Gastroenterology, Department of Internal Medicine, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
| |
Collapse
|
25
|
Wellenstein DJ, Schutte HW, Marres HAM, Honings J, Belafsky PC, Postma GN, Takes RP, van den Broek GB. Office-based procedures for diagnosis and treatment of esophageal pathology. Head Neck 2017; 39:1910-1919. [DOI: 10.1002/hed.24819] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- David J. Wellenstein
- Department of Otorhinolaryngology and Head and Neck Surgery; Radboud University Medical Center; Nijmegen The Netherlands
| | - Henrieke W. Schutte
- Department of Otorhinolaryngology and Head and Neck Surgery; Radboud University Medical Center; Nijmegen The Netherlands
| | - Henri A. M. Marres
- Department of Otorhinolaryngology and Head and Neck Surgery; Radboud University Medical Center; Nijmegen The Netherlands
| | - Jimmie Honings
- Department of Otorhinolaryngology and Head and Neck Surgery; Radboud University Medical Center; Nijmegen The Netherlands
| | - Peter C. Belafsky
- Center for Voice and Swallowing; Department of Otolaryngology and Head and Neck Surgery, University of California, Davis School of Medicine; Sacramento California
| | - Gregory N. Postma
- Department of Otolaryngology; Medical College of Georgia at Augusta University; Augusta Georgia
| | - Robert P. Takes
- Department of Otorhinolaryngology and Head and Neck Surgery; Radboud University Medical Center; Nijmegen The Netherlands
| | - Guido B. van den Broek
- Department of Otorhinolaryngology and Head and Neck Surgery; Radboud University Medical Center; Nijmegen The Netherlands
| |
Collapse
|
26
|
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
| |
Collapse
|
27
|
Postma G. In reference to Is esophagoscopy necessary during panendoscopy? Laryngoscope 2017; 127:E415. [DOI: 10.1002/lary.26596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 01/23/2017] [Indexed: 11/10/2022]
Affiliation(s)
- Gregory Postma
- Department of Otolaryngology-Head and Neck Surgery; Medical College of Georgia at Augusta University; Augusta Georgia U.S.A
| |
Collapse
|
28
|
Allen J, Belafsky PC. Gastroesophageal Reflux Disease, Globus, and Dysphagia. Dysphagia 2017. [DOI: 10.1007/174_2017_139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
29
|
Howell RJ, Pate MB, Ishman SL, Isseroff TF, Rubin AD, Soliman AM, Postma GN, Pitman MJ. Prospective multi-institutional transnasal esophagoscopy: Predictors of a change in management. Laryngoscope 2016; 126:2667-2671. [DOI: 10.1002/lary.26171] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 06/07/2016] [Indexed: 12/20/2022]
Affiliation(s)
- Rebecca J. Howell
- Department of Otolaryngology-Head and Neck Surgery; University of Cincinnati College of Medicine; Cincinnati Ohio U.S.A
| | - Mariah B. Pate
- Department of Otolaryngology-Head and Neck Surgery and Center for Voice Airway and Swallowing; Georgia Regents University; Augusta Georgia U.S.A
| | - Stacey L. Ishman
- Department of Otolaryngology-Head and Neck Surgery; University of Cincinnati College of Medicine, and Divisions of Otolaryngology-Head and Neck Surgery and Pulmonary Medicine, Cincinnati Children's Hospital Medical Center; Cincinnati Ohio U.S.A
| | - Tova F. Isseroff
- New York Eye and Ear Infirmary of Mount Sinai; New York New York U.S.A
| | - Adam D. Rubin
- Lakeshore Professional Voice; St. Clair Shores Michigan U.S.A
| | - Ahmed M. Soliman
- Department of Otolaryngology-Head and Neck Surgery; Lewis Katz School of Medicine at Temple University; Philadelphia Pennsylvania U.S.A
| | - Gregory N. Postma
- Department of Otolaryngology-Head and Neck Surgery and Center for Voice Airway and Swallowing; Georgia Regents University; Augusta Georgia U.S.A
| | - Michael J. Pitman
- Voice and Swallowing Institute, Department of Otolaryngology-Head and Neck Surgery, Columbia University Medical Center; New York New York U.S.A
| |
Collapse
|
30
|
Sanyaolu LN, Jemah A, Stew B, Ingrams DR. The role of transnasal oesophagoscopy in the management of globus pharyngeus and non-progressive dysphagia. Ann R Coll Surg Engl 2016; 98:49-52. [PMID: 26688400 DOI: 10.1308/rcsann.2015.0052] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Introduction Transnasal oesophagoscopy is a relatively new method of examining the upper aerodigestive tract via the nasal passage as an outpatient procedure without the need for sedation. It has been shown to be a well tolerated, safe and accurate technique, that can therefore be used in the investigation of patients thought to have globus pharyngeus and other non sinister causes of dysphagia. Methods A total of 150 consecutive patients undergoing transnasal oesophagoscopy were analysed retrospectively. Results The main indications for this procedure were non-progressive dysphagia (n=68, 45%) and globus pharyngeus (n=60, 40%). Transnasal oesophagoscopy was normal in 65% of patients and 42% of patients were discharged from clinic at the same appointment with no further investigation. The most common positive findings were laryngeal erythema (13%) and oesophagitis (10%). Conclusions Transnasal oesophagoscopy is a useful adjunct to the management of patients with the symptoms of globus pharyngeus and non-progressive dysphagia.
Collapse
Affiliation(s)
| | - A Jemah
- Aneurin Bevan University Health Board , UK
| | - B Stew
- Aneurin Bevan University Health Board , UK
| | | |
Collapse
|
31
|
Hemodynamic Parameters during Laryngoscopic Procedures in the Office and in the Operating Room. Otolaryngol Head Neck Surg 2016; 155:466-72. [DOI: 10.1177/0194599816645809] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Accepted: 04/01/2016] [Indexed: 11/15/2022]
Abstract
Objective Previous research has shown that office-based laryngoscopic procedures can induce hemodynamic changes, including tachycardia and severe hypertension, calling into question the safety of these procedures. However, comparison between office and operating room (OR) procedures has not been carried out. Therefore, we prospectively measured hemodynamic variables in both settings to compare hemodynamic changes between office and OR procedures. Study Design Prospective cohort study. Setting Single academic center. Subjects and Methods Subjects undergoing office and OR laryngoscopic procedures were prospectively identified, and 92 OR and 70 office subjects were included. Heart rate and blood pressure were measured at established time points before, during, and after the procedures. Descriptive and comparative statistical analyses were conducted. Results Severe hemodynamic events, either tachycardia or severe hypertension (blood pressure >180 mm Hg systolic or >110 mm Hg diastolic), occurred significantly more frequently in OR than office procedures (41% vs 20%; P = .006). OR severe hemodynamic events occurred more commonly than previously reported rates in the office (41% vs 28%; P = .012). Regression analyses showed that the odds of having a severe hemodynamic event were 3.66 times higher in OR versus office procedures. Conclusion Severe hemodynamic events are more likely to occur in the OR than in the office during laryngologic procedures. While larger studies will be required to establish rates of dangerous cardiovascular events in laryngoscopic procedures, hemodynamic parameters indicate that office-based procedures have a safety benefit for procedures that can be conducted in either setting.
Collapse
|
32
|
Polat B, Karahatay S, Birkent H, Gerek M. The Practicability of Transnasal Esophagoscopy and the Evaluation of Patient's Perception: A Prospective Study. Clin Exp Otorhinolaryngol 2016; 9:366-369. [PMID: 27334507 PMCID: PMC5115155 DOI: 10.21053/ceo.2015.01935] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 01/17/2016] [Accepted: 01/19/2016] [Indexed: 12/29/2022] Open
Abstract
Objectives Transnasal esophagoscopy (TNE) is a relatively new diagnostic procedure in the evaluation of patients with globus sensation and dysphagia. Enabling doctors to examine all of the upper aerodigestive system without the need for sedation, this technique is becoming more popular among otolaryngology specialists. The aim of this study is to evaluate the practicability of TNE and tolerability of patients to the test. Methods The study group consisted of 314 patients who were admitted to the swallowing center of a tertiary medical institution with the symptoms of dysphagia and globus sensation. In addition to other diagnostic procedures, patients were informed of the TNE and the necessary consents were obtained. Before the examination, patients were asked to foresee the level of discomfort they would presumably feel, according to the information they had. After the TNE, patients were asked to score the real level of discomfort they experienced during the test. A visual analog scale was used to note the levels. The duration of the tests and any complications were also noted. Results We could not perform TNE in 12 of the 314 patients due to nasal obstruction, intractable retching and vasovagal syncope (7, 4, and 1 patients, respectively). The average discomfort score foreseen before the test was 4.7±1.4 (mean±standard deviation). The post-procedure discomfort score was 1.6±1.1, and the difference was statistically significant (P<0.001). The average time to perform the TNE was 5 minutes (range, 3 to 13 minutes). Except for minor epistaxis in 7 patients (2%), no complications occurred. Conclusion According to our results, TNE is an easy and well-tolerated procedure, it may be logical to tell the patient that the procedure will be less annoying and irritating than they assume. It is also a time saving procedure with low complication rates.
Collapse
Affiliation(s)
- Bahtiyar Polat
- Department of Otorhinolaryngology, Head and Neck Surgery, Gelibolu Military Hospital, Gelibolu, Turkey
| | - Serdar Karahatay
- Department of Otorhinolaryngology, Head and Neck Surgery, Gulhane Military Medical Academy, Ankara, Turkey
| | - Hakan Birkent
- Department of Otorhinolaryngology, Head and Neck Surgery, Gulhane Military Medical Academy, Ankara, Turkey
| | - Mustafa Gerek
- Department of Otorhinolaryngology, Head and Neck Surgery, Gulhane Military Medical Academy, Ankara, Turkey
| |
Collapse
|
33
|
Rees CJ, Halum SL, Wijewickrama RC, Koufman JA, Postma GN. Patient Tolerance of In-Office Pulsed Dye Laser Treatments to the Upper Aerodigestive Tract. Otolaryngol Head Neck Surg 2016; 134:1023-7. [PMID: 16730550 DOI: 10.1016/j.otohns.2006.01.019] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2005] [Accepted: 01/30/2006] [Indexed: 11/22/2022]
Abstract
INTRODUCTION: Recent advances in technology have facilitated a movement toward unsedated in-office treatment of laryngeal, tracheal, and esophageal lesions. The objective of this study was to determine patient tolerance of inoffice pulsed-dye laser (PDL) treatment of upper aerodigestive tract pathoses via the transnasal esophagoscope. METHODS: Three hundred twenty-eight unsedated in-office PDL cases were performed at a university-based tertiary referral center in 131 patients. These procedures were performed for various upper aerodigestive pathoses, including recurrent respiratory papillomatosis, chronic granulomas, and recurrent leukoplakia. Eighty-nine subjects completed a phone survey concerning their discomfort level after the PDL procedure. They were also asked specific questions about recovery time, pain medication, and preference of operating room versus inoffice procedures. RESULTS: The average comfort score was 7.4 (10 being minimal discomfort). Eighty-four percent did not use any pain medication; 87% stated that, if possible, they would prefer to undergo unsedated inoffice procedures rather than surgeries under general anesthesia for further treatment of their upper aerodigestive tract pathosis. CONCLUSIONS: Unsedated transnasal treatment of upper aerodigestive tract pathoses is readily accepted and well-tolerated by otolaryngology patients. Patients overwhelmingly prefer the inoffice PDL over surgeries under general anesthesia.
Collapse
Affiliation(s)
- Catherine J Rees
- Center for Voice and Swallowing Disorders, Department of Otolaryngology, Medical College of Georgia, Augusta, GA 30912-4060, USA
| | | | | | | | | |
Collapse
|
34
|
Kenny M, Cercone M, Rawlinson JJ, Ducharme NG, Bookbinder L, Thompson M, Cheetham J. Transoesophageal ultrasound and computer tomographic assessment of the equine cricoarytenoid dorsalis muscle: Relationship between muscle geometry and exercising laryngeal function. Equine Vet J 2016; 49:395-400. [PMID: 26709115 DOI: 10.1111/evj.12561] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 12/13/2015] [Indexed: 11/27/2022]
Abstract
REASONS FOR PERFORMING STUDY Early detection of recurrent laryngeal neuropathy (RLN) is of considerable interest to the equine industry. OBJECTIVES To describe two imaging modalities, transoesophageal ultrasound (TEU) and computed tomography (CT) with multiplanar reconstruction to assess laryngeal muscle geometry, and determine the relationship between cricoarytenoid dorsalis (CAD) geometry and function. STUDY DESIGN Two-phase study evaluating CAD geometry in experimental horses and horses with naturally occurring RLN. METHODS Equine CAD muscle volume was determined from CT scan sets using volumetric reconstruction with LiveWire. The midbody and caudal dorsal-ventral thickness of the CAD muscle was determined using a TEU in the same horses; and in horses with a range of severity of RLN (n = 112). RESULTS Transoesophageal ultrasound was able to readily image the CAD muscles and lower left:right CAD thickness ratios were observed with increasing disease severity. Computed tomography based muscle volume correlated very closely with ex vivo muscle volume (R2 = 0.77). CONCLUSIONS Computed tomography reconstruction can accurately determine intrinsic laryngeal muscle geometry. A relationship between TEU measurements of CAD geometry and laryngeal function was established. These imaging techniques could be used to track the response of the CAD muscle to restorative surgical treatments such as nerve muscle pedicle graft, nerve anastomosis and functional electrical stimulation.
Collapse
Affiliation(s)
- M Kenny
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | - M Cercone
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | | | - N G Ducharme
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | - L Bookbinder
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | - M Thompson
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | - J Cheetham
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
| |
Collapse
|
35
|
Abstract
PURPOSE OF REVIEW The role of transnasal esophagoscopy (TNE) in the evaluation and management of the head and neck cancer patient is evolving. This study reviews the most recent advances in the use of this technology in the head and neck patient population. RECENT FINDINGS It appears that in-office, unsedated TNE is a useful alternative to conventional endoscopy in the evaluation and management of the head and neck patient. The current literature defines the feasibility and limitations of this technology for screening for the development of synchronous and metachronous primaries, diagnosing esophageal and upper gastrointestinal disorders, as well as performing certain office-based procedures. Perhaps most importantly, TNE is better able to navigate the anatomical and functional limitations common to the head and neck patient, which can prevent use of conventional transoral endoscopy. SUMMARY TNE has a significant role in the evaluation and management of the head and neck cancer patient and it enables the otolaryngologist to provide improved quality of care.
Collapse
|
36
|
Lin PH, Wang CP, Lou PJ, Ko JY, Hsiao TY, Chen TC. Evaluation of swallowing disorders by use of transnasal esophagoscopy in patients treated for head and neck cancer. Head Neck 2015; 38 Suppl 1:E1137-43. [DOI: 10.1002/hed.24174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2015] [Indexed: 11/08/2022] Open
Affiliation(s)
- Pei-Hsuan Lin
- Department of Otolaryngology; National Taiwan University Hospital and National Taiwan University College of Medicine; Taipei Taiwan
- Department of Otolaryngology; National Taiwan University Hospital Yun-Lin Branch; Yun-Lin Taiwan
| | - Cheng-Ping Wang
- Department of Otolaryngology; National Taiwan University Hospital and National Taiwan University College of Medicine; Taipei Taiwan
- Graduate Institute of Pathology, College of Medicine; National Taiwan University; Taipei Taiwan
| | - Pei-Jen Lou
- Department of Otolaryngology; National Taiwan University Hospital and National Taiwan University College of Medicine; Taipei Taiwan
| | - Jeng-Yuh Ko
- Department of Otolaryngology; National Taiwan University Hospital and National Taiwan University College of Medicine; Taipei Taiwan
| | - Tzu-Yu Hsiao
- Department of Otolaryngology; National Taiwan University Hospital and National Taiwan University College of Medicine; Taipei Taiwan
| | - Tseng-Cheng Chen
- Department of Otolaryngology; National Taiwan University Hospital and National Taiwan University College of Medicine; Taipei Taiwan
- Department of Otolaryngology; National Taiwan University Hospital Yun-Lin Branch; Yun-Lin Taiwan
- Graduate Institute of Pathology, College of Medicine; National Taiwan University; Taipei Taiwan
| |
Collapse
|
37
|
Tsikoudas A, Vijendren A, Haloob N, Mochloulis G. Impact of Otolaryngology in the diagnosis of early oesophageal malignancy. Surgeon 2015; 14:22-5. [PMID: 25595730 DOI: 10.1016/j.surge.2014.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 09/02/2014] [Accepted: 10/07/2014] [Indexed: 12/13/2022]
Abstract
INTRODUCTION A large number of patients present in Otolaryngology clinics with vague upper gastro intestinal symptoms, some potentially originating from the oesophagus. In the United Kingdom there is no consensus for investigation protocols. The concern is that diagnosis of early oesophageal malignancy can be delayed with detrimental effects to the prognosis of the patient. The aim of this paper is to attempt to establish the impact of Ear Nose and Throat (ENT) work up in the diagnostic pathway of these patients. METHODS Retrospective analysis of case notes of newly diagnosed oesophageal carcinoma over a 15 month period. RESULTS Sixty five patients with a new diagnosis of oesophageal carcinoma were identified from the upper GI cancer network. A cohort of 7 patients was initially referred to ENT with related symptoms. Delays occurred at different stages during the course of their diagnostic pathways. Only 2 patients were diagnosed from ENT prior to referral to upper GI. CONCLUSION We support the creation of one stop clinics incorporating the use of transnasal oesophagoscopy. The current literature is discussed.
Collapse
Affiliation(s)
- A Tsikoudas
- Lister Hospital, Department of ORL, Stevenage, UK.
| | - A Vijendren
- Lister Hospital, Department of ORL, Stevenage, UK
| | - N Haloob
- Lister Hospital, Department of ORL, Stevenage, UK
| | - G Mochloulis
- Lister Hospital, Department of ORL, Stevenage, UK
| |
Collapse
|
38
|
Abou-Nader L, Wilson JA, Paleri V. Transnasal oesophagoscopy: diagnostic and management outcomes in a prospective cohort of 257 consecutive cases and practice implications. Clin Otolaryngol 2015; 39:108-13. [PMID: 24713033 DOI: 10.1111/coa.12241] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2014] [Indexed: 01/29/2023]
Abstract
OBJECTIVES To determine the success rate, patient tolerability and impact of introducing transnasal oesophagoscopy on clinical practices. DESIGN Prospective cohort with review of electronic patient records for outcomes. SETTING UK tertiary centre Otolaryngology Department. PARTICIPANTS The cohort comprised of two hundred and fifty-seven patients, 128 females (50%) and 129 males (50%) with an age range of 20-91 years; mean age 59 years (sd 13.6). MAIN OUTCOME MEASURES Success rates, indications, findings and outcomes of patients undergoing transnasal oesophagoscopy and impact on rigid examinations of the pharynx and oesophagus were also considered. RESULTS Transnasal oesophagoscopy has a high success rate of 97%; it is well tolerated by patients, and poor views are uncommon. Pathology was detected in 44% of patients. The most common indications for transnasal oesophagoscopy were unexplained throat symptoms (50%) and dysphagia (25%). Common positive findings were hiatus hernia (7%), Barrett's oesophagus (5%), dysmotility (5%) and oesophageal candidiasis (5%). Following transnasal oesophagoscopy, 59% of patients were discharged to their referring clinician, 17% continued to undergo otolaryngology follow-up, and 13% were referred to our gastrointestinal colleagues. Following the introduction of transnasal oesophagoscopy, there was a reduction in the number of rigid examinations of the pharynx and oesophagus in the subsequent years, despite an increase in total referrals. CONCLUSIONS Transnasal oesophagoscopy is a well-tolerated procedure that allows otolaryngologists to make management decisions on common referrals swiftly in the clinic setting avoiding unnecessary investigations, follow-up and referral.
Collapse
Affiliation(s)
- L Abou-Nader
- Department of Otolaryngology-Head and Neck Surgery, Freeman Hospital, Newcastle upon Tyne, UK
| | | | | |
Collapse
|
39
|
Office-based tracheoesophageal puncture: updates in techniques and outcomes. Am J Otolaryngol 2014; 35:549-53. [PMID: 24880759 DOI: 10.1016/j.amjoto.2014.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 04/09/2014] [Accepted: 04/22/2014] [Indexed: 11/20/2022]
Abstract
PURPOSE Tracheoesophageal puncture (TEP) is an effective rehabilitation method for postlaryngectomy speech and has already been described as a procedure that is safely performed in the office. We review our long-term experience with office-based TEP over the past 7 years in the largest cohort published to date. MATERIALS AND METHODS A retrospective chart review was performed of all patients who underwent TEP by a single surgeon from 2005 through 2012, including office-based and operating room procedures. Indications for the chosen technique (office versus operating room) and surgical outcomes were evaluated. RESULTS Fifty-nine patients underwent 72 TEP procedures, with 55 performed in the outpatient setting and 17 performed in the operating room, all without complication. The indications for performing TEPs in the operating room included 2 primary TEPs, 14 due to concomitant procedures requiring general anesthesia, and 1 due to failed attempt at office-based TEP. Nineteen patients with prior rotational or free flap reconstruction successfully underwent office-based TEP. CONCLUSIONS TEP in an office-based setting with immediate voice prosthesis placement continues to be a safe method of voice rehabilitation for postlaryngectomy patients, including those who have previously undergone free flap or rotational flap reconstruction. Office-based TEP is now our primary approach for postlaryngectomy voice rehabilitation.
Collapse
|
40
|
Yılmaz T, Bajin MD, Günaydın R&O, Özer S, Sözen T. Laryngopharyngeal reflux and Helicobacter pylori. World J Gastroenterol 2014; 20:8964-8970. [PMID: 25083069 PMCID: PMC4112879 DOI: 10.3748/wjg.v20.i27.8964] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Revised: 01/17/2014] [Accepted: 04/03/2014] [Indexed: 02/06/2023] Open
Abstract
Laryngopharyngeal reflux (LPR) occurs when gastric contents pass the upper esophageal sphincter, causing symptoms such as hoarseness, sore throat, coughing, excess throat mucus, and globus. The pattern of reflux is different in LPR and gastroesophageal reflux. LPR usually occurs during the daytime in the upright position whereas gastroesophageal reflux disease more often occurs in the supine position at night-time or during sleep. Ambulatory 24-h double pH-probe monitoring is the gold standard diagnostic tool for LPR. Acid suppression with proton pump inhibitor on a long-term basis is the mainstay of treatment. Helicobacter pylori (H. pylori) is found in many sites including laryngeal mucosa and interarytenoid region. In this paper, we aim to present the relationship between LPR and H. pylori and review the current literature.
Collapse
|
41
|
The Role of Transnasal Esophagoscopy in ENT Office: A Prospective, Multicenter Study in Korea. Clin Exp Otorhinolaryngol 2014; 7:123-5. [PMID: 24917909 PMCID: PMC4050084 DOI: 10.3342/ceo.2014.7.2.123] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Revised: 10/23/2012] [Accepted: 11/15/2012] [Indexed: 11/27/2022] Open
Abstract
Objectives The purpose of study was to report the current role of transnasal esophagoscopy (TNE) in Korea. Methods One hundred thirty-seven patients who underwent TNE at Soonchunhyang University Bucheon Hospital (n=69) and Korea University Anam Hospital (n=68) from July 2007 to February 2009 were prospectively analyzed. Laryngopharyngeal reflux disease (LPRD) patients without any response to proton-pump inhibitor (n=102), and patients with complaints that require esophagoscopy as part of their evaluation (n=35) were included in this study; investigation of metachronous lesions or routine follow-up screening of head and neck cancer patients, n=17; dysphagia, n=9; blood tinged saliva, n=4; to determine the cause of vocal fold paralysis as screening tool, n=4; suspicious esophageal foreign body, n=1. Results Fifty-three patients (38.7%) had positive findings on TNE. Positive finding ratio was highest in group of dysphagia (7 among 9 patients, 78%). Forty-two patients (41.1%) were found to have pathology (esophagitis, n=41; esophageal diverticulum, n=1) during the screening examination for LPRD. There were no significant complications in any of the patients. Conclusion TNE is a high-yield diagnostic and therapeutic modality available to otolaryngologists for use on awake patients in the office setting.
Collapse
|
42
|
Comparative study of flexible nasoendoscopic and rigid endoscopic examination for patients with upper aerodigestive tract symptoms. The Journal of Laryngology & Otology 2013; 127:1012-6. [DOI: 10.1017/s002221511300203x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractIntroduction:The objective of the current study was to compare the outcomes of rigid endoscopic procedures with those of pre-operative flexible nasoendoscopy.Methods:A total of 253 patients who had undergone rigid endoscopic examination under anaesthesia between 6 January 2010 and 31 August 2011 were identified. Their clinical, surgical and histological records were evaluated.Results:A total of 213 patients had a flexible nasoendoscopic procedure performed and recorded pre-operatively, and 82 in this cohort had a specific lesion or area of concern identified. There were 21 confirmed malignant biopsy results, the majority of which were squamous cell carcinoma. No patient with a negative pre-operative endoscopy had a malignant lesion discovered on endoscopic biopsy. The sensitivity and specificity of pre-operative nasoendoscopy were 100 per cent and 66.3 per cent, respectively.Conclusion:Diagnostic rigid endoscopic examination of the upper aerodigestive tract remains an important tool for excluding malignancy in high-risk patients, but is an unnecessary procedure in those low-risk patients with normal pre-operative findings.
Collapse
|
43
|
Dolan RW, Anderson TD. Practical Applications of In-Office Fiberoptic Transnasal Esophagoscopy in the Initial Evaluation of Patients with Squamous Cell Cancer of the Head and Neck. EAR, NOSE & THROAT JOURNAL 2013. [DOI: 10.1177/014556131309200910] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We conducted a study to analyze the effectiveness of trans-nasal esophagoscopy (TNE) as an alternative to operative endoscopy (OE) for the evaluation of primary head and neck cancers and for the surveillance of synchronous esophageal cancers. Our study population was made up of 96 consecutively presenting patients—75 men and 21 women, aged 45 to 88 years (mean: 64)—who were treated at our institution for squamous cell cancer of the head and neck. Of this group, 42 patients had been evaluated with TNE and 54 with OE. More OEs were performed inpatients with an unknown primary (26 vs. 3). Incidental findings on TNE included 3 cases of gastritis, 2 cases each of hiatal hernia and esophagitis, 1 case of Barrett esophagus, and 1 inlet patch. No incidental findings were reported during OE. Primary cancers were biopsied by TNE through a port on the endoscope in 4 patients; 2 of these cancers were in the tongue base, 1 in the hypopharynx, and 1 in the aryepiglottic fold. After the initial visit, patients in the TNE group waited significantly fewer days for their endoscopy than did those in the OE group (median: 6.5 vs. 16; p < 0.05). Conversely, patients in the OE group waited significantly fewer days for treatment following endoscopy (median: 12 vs. 20; p < 0.05). However, there was no significant difference between the TNE patients and the OE patients in the total number of days comprising the their entire course of management, from the initial visit to definite treatment (median: 27.5 and 33 days, respectively; p = 0.7). We conclude that TNE is a reasonable alternative to OE for the initial screening for synchronous esophageal cancers inpatients with squamous cancers of the head and neck. OE is preferred for the initial workup of unknown primary cancers and for large tongue base cancers. The rate of detection of clinically relevant incidental findings is higher with TNE. Biopsy is possible during TNE for all subsites within the upper aerodigestive tract.
Collapse
Affiliation(s)
- Robert W. Dolan
- From the Department of Otolaryngology-Head and Neck Surgery, Lahey Clinic, Burlington, Mass
| | - Timothy D. Anderson
- From the Department of Otolaryngology-Head and Neck Surgery, Lahey Clinic, Burlington, Mass
| |
Collapse
|
44
|
Abstract
Globus pharyngeus is a common ENT condition. This paper reviews the current evidence on globus and gives a rational guide to the management of patients with globus. The aetiology of globus is still unclear though most ENT surgeons believe that reflux whether acidic or not plays a significant role. Though proton pump inhibitors are used extensively in practice, there is little evidence to support their efficacy. Most patients with globus can be discharged after simple office investigations. The role of pepsin-induced laryngeal injury is an exciting concept that needs further study. Given the benign nature of globus pharyngeus, in most cases, reassurance rather than treatment or extensive investigation with rigid oesophagoscopy or contrast swallows is all that is needed. We need more research into the aetiology of globus.
Collapse
|
45
|
Changing trends in oesophageal endoscopy: a systematic review of transnasal oesophagoscopy. ISRN OTOLARYNGOLOGY 2013; 2013:586973. [PMID: 23984101 PMCID: PMC3747410 DOI: 10.1155/2013/586973] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2013] [Accepted: 07/07/2013] [Indexed: 12/15/2022]
Abstract
The safety, efficacy, and economic implications of using transnasal oesophagoscopy (TNE) are compared with conventional rigid or flexible oesophagoscopy for oesophageal disorders in otorhinolaryngology (ORL) clinics in this systematic review. Eleven electronic databases were searched for articles on transnasal oesophagoscopy. A total of 67 relevant titles were identified and 39 abstracts were screened of which 17 full- text articles were included in this report. There was fair level of evidence to suggest that TNE was effective for screening examination in patients with dysphagia, globus pharyngeus, and reflux symptoms and for detection of metachronous oesophageal carcinoma. TNE can also be used to biopsy suspicious lesions in the upper aerodigestive tract, placement of wireless pH capsule, transnasal balloon dilation of the oesophagus, secondary tracheoesophageal puncture, and management of foreign bodies. TNE was well tolerated and can be safely performed in an office setting with topical anaesthesia. Complications associated with TNE were mild and uncommon. There was evidence to suggest potential cost savings by performing TNE in the office setting compared with conventional investigation and examination for dysphagia. TNE may lead to a change in practice from investigation and treatment in the operating theatre or day care center to an office-based practice.
Collapse
|
46
|
Abstract
Since the mid 1900s, esophagoscopy has been performed under sedation or general anesthesia. With transnasal esophagoscopy (TNE), there has been a return to awake, in-office esophagoscopy. Technologic advances have allowed the advent of a ultrathin, flexible esophagoscope that is introduced transnasally, allowing esophagoscopy to be performed in unsedated patients. TNE correlates with conventional esophagoscopy (sedated, flexible esophagoscopy) in diagnostic capacity. Over time, as the benefits of TNE have become elucidated, the procedure has gained wider acceptance and continues to have its role in patient care defined.
Collapse
Affiliation(s)
- Carrie M Bush
- Department of Otolaryngology, Georgia Health Sciences University, Augusta, GA 30912, USA.
| | | |
Collapse
|
47
|
Tsikoudas A, Mochloulis G. Role of transnasal oesophagoscopy in diagnosis of early malignancy in the area of the oesophagus and hypopharynx. A review of the literature. Eur Arch Otorhinolaryngol 2013; 271:203-4. [PMID: 23665747 DOI: 10.1007/s00405-013-2560-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Accepted: 05/06/2013] [Indexed: 10/26/2022]
Affiliation(s)
- A Tsikoudas
- Department of ORL, Lister Hospital, Corey's Mill Lane, Stevenage, Hertfordshire, UK,
| | | |
Collapse
|
48
|
|
49
|
|
50
|
Morrison MP, O'Rourke A, Dion GR, Eller RL, Weinberger P, Postma GN. Hemodynamic Changes during Otolaryngological Office-Based Flexible Endoscopic Procedures. Ann Otol Rhinol Laryngol 2012. [DOI: 10.1177/000348941212101103] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: A preponderance of literature supports the safety of office-based flexible endoscopic procedures of the upper aerodigestive tract; however, until recently there were no data regarding hemodynamic stability during these procedures. A recent study showed intraprocedure changes in patients' hemodynamic parameters, raising the concern that perhaps patients should be monitored during these procedures. The aim of our study was to determine whether physiologically significant alterations in vital signs occur during office-based flexible endoscopic procedures. Methods: We performed a retrospective review of 100 consecutive patients who underwent office-based flexible endoscopic procedures of the upper aerodigestive tract from July 2010 to October 2011. Baseline values and the maximal changes in systolic blood pressure, diastolic blood pressure, heart rate, and oxygen saturation were recorded and compared. Results: One hundred consecutive patients were included in the study. Twenty-one patients (21%) had severe hypertension and 40 patients (40%) had tachycardia during the procedure. The mean change overall in systolic blood pressure was 26.2 mm Hg (p < 0.001), the mean change in diastolic blood pressure was 13.9 mm Hg (p < 0.001), the mean change in heart rate was 16.6 beats per minute (p < 0.001), and the mean change in oxygen saturation was 1.6% (p < 0.001). These changes were significant. On further breakdown into groups, patients over 50 years of age and patients who were undergoing esophageal or laser procedures had significant elevations in heart rate (p = 0.01 and p = 0.04, respectively). An elevation in diastolic blood pressure was also significant in patients who were undergoing esophageal or laser procedures (p = 0.04 for both). Conclusions: These data concur with those of the previous report that found potentially significant hemodynamic changes during office-based procedures. Although preliminary, our findings suggest that it may be wise to monitor vital signs in patients over 50 years of age and patients who are undergoing an esophageal or laser procedure who are at risk for complications that could arise from tachycardia and hypertension.
Collapse
|