Allergic laryngitis: unraveling the myths

Prevalence of Laryngopharyngeal Reflux Related Symptoms in Patients With Allergy

OBJECTIVE

To describe the prevalence of laryngopharyngeal reflux (LPR)-related symptoms in allergy patient using the Reflux Symptom Index (RSI) by Belafsky et al and the Reflux Symptom Score (RSS) by Lechien et al. SUBJECTS AND METHODS: A total of 84 patients were enrolled in this study. Fifty-two consecutive patients were asked to fill RSI. Similarly, 32 patients were asked to fill RSS. Demographic data included age, gender, history of smoking, family history for eczema, atopy, asthma, food and drug allergy.

RESULTS

Fifty-seven of the 84 patients were positive for at least one allergen and hence were diagnosed with allergy. Of the 52 patients who received the RSI, 36 patients were allergic to at least one allergen (36/52). Of the 32 patients who filled the RSS, 21 tested positive for at least one allergen (21/32). There was no significant difference in the number of positive RSI scores (>13) between patients with allergy to at least one allergen in comparison to patients with no allergy (P = 0.329). There was a significant difference in the number of positive RSS scores (>13) between patients with allergy to at least one allergen in comparison to patients with no allergy (P-value 0.0345). The odds of having RSS >13 in an allergic patient was significant (OR = 5.6, CI 95% = 1.15-27.37).

CONCLUSION

The results of this study provide evidence that patients with allergy have increased incidence of LPR related symptoms using the RSS. The cross-cutting in the clinical picture of patients with allergy and LPR stresses the need for objective testing such as double probe Ph-metry and impedance to diagnose this latter. Future studies are needed to explore further the cause-effect relationship between allergy and LPR.

Practical multidisciplinary framework for the assessment and management of patients with unexplained chronic aerodigestive symptoms

OBJECTIVE

Patients experiencing unexplained chronic throat symptoms (UCTS) are frequently referred to gastroenterology and otolaryngology outpatient departments for investigation. Often despite extensive investigations, an identifiable structural abnormality to account for the symptoms is not found. The objective of this article is to provide a concise appraisal of the evidence-base for current approaches to the assessment and management of UCTS, their clinical outcomes, and related healthcare utilisation.

DESIGN

This multidisciplinary review critically examines the current understanding of aetiological theories and pathophysiological drivers in UCTS and summarises the evidence base underpinning various diagnostic and management approaches.

RESULTS

The evidence gathered from the review suggests that single-specialty approaches to UCTS inadequately capture the substantial heterogeneity and pervasive overlaps among clinical features and biopsychosocial factors and suggests a more unified approach is needed.

CONCLUSION

Drawing on contemporary insights from the gastrointestinal literature for disorders of gut-brain interaction, this article proposes a refreshed interdisciplinary approach characterised by a positive diagnosis framework and patient-centred therapeutic model. The overarching aim of this approach is to improve patient outcomes and foster collaborative research efforts.

Using RSI and RFS scores to differentiate between reflux-related and other causes of chronic laryngitis

OBJECTIVE

To establish if the Reflux Symptom Index (RFI) and the Reflux Finding Score (RFC) can help establish the differential diagnosis in patients with distinct causes of chronic laryngopharyngitis.

METHODS

A group of 102 adult patients with chronic laryngopharyngitis (Group A - 37 patients with allergic rhinitis; Group B - 22 patients with Obstructive Sleep Apnea (OSA); Group C - 43 patients with Laryngopharyngeal Reflux (LPR)) were prospectively studied. Chronic laryngitis was diagnosed based on suggestive symptoms and videolaryngoscopic signs (RSI ≥ 13 and RFS ≥ 7). Allergies were confirmed by a positive serum RAST, OSA was diagnosed with a positive polysomnography, and LPR with a positive impedance-PH study. Discriminant function analysis was used to determine if the combination of RSI and RFS scores could differentiate between groups.

RESULTS

Patients with respiratory allergies and those with LPR showed similar and significantly higher RSI scores when compared to that of patients with OSA (p < 0.001); Patients with OSA and those with LPR showed similar and significantly higher RFS scores when compared to that of patients with Respiratory Allergies (OSA vs. Allergies p < 0.001; LPR vs. Allergies p < 0.002). The combination of both scores held a higher probability of diagnosing OSA (72.73%) and Allergies (64.86%) than diagnosing LPR (51.16%).

CONCLUSIONS

RSI and RFS are not specific for reflux laryngitis and are more likely to induce a false diagnosis if not used with diligence.

The bumpy road to achieve reliability of clinical profile characteristics in psychosis and related disorders

OBJECTIVES

Profile characteristics are factors that are relevant for diagnosis, prognosis or treatment. The present study aims to develop a set of clinically relevant profile characteristics. Moreover, our goal is to determine the inter-rater reliability (IRR) of the selected profile characteristics.

METHODS

Potential profile characteristics were determined by literature review. Assessment of IRR was done by comparing scores on profile characteristics determined by two researchers. We conducted three subsequent studies: (1) assessment of pre-training IRR, (2) IRR following implementation of an instruction manual, (3) IRR after optimizing scoring methods. IRR was measured with the Intraclass Correlation Coefficient (ICC).

RESULTS

IRR scores of profile characteristic Illegal activities were high across the three studies (ICC ≥ 0.75). Following training procedures in study 2 and 3, reliability estimates remained low to moderate (ICC < 0.75) for the profile characteristics Support of relatives, Aggression recent and lifetime, substance use and insight recent. IRR scores of the other eight profile characteristics varied from low, moderate to high across studies.

CONCLUSION

IRR scores of profile characteristics were highly variable, and mostly inadequate in all three studies. Consequently, further research should focus on specification of severity scores of profile characteristics, optimizing scoring methods and re-evaluation of IRR.

Allergic Rhinitis and Laryngeal Pathology: Real-World Evidence

Allergic rhinitis (AR) is correlated with diseases including allergic laryngitis, chronic obstructive pulmonary disease (COPD), asthma, and chronic rhinosinusitis (CRS). The unified airway model suggests that inflammation can spread in both lower and upper respiratory tracts. Moreover, some voice problems-laryngeal edema, dysphonia, and vocal nodules-have been associated with AR. We examined the association between AR and laryngeal pathology. We investigated 51,618 patients with AR between 1 January 1997 and 31 December 2013, along with 206,472 patients without AR matched based on age, gender, urbanization level, and socioeconomic status at a 1:4 ratio. We followed patients up to the end of 2013 or their death. The occurrence of laryngeal pathology was the primary outcome. Individuals with AR had a 2.43 times higher risk of laryngeal pathology than the comparison cohort group (adjusted HR: 2.43, 95% CI: 2.36-2.50, p < 0.001). Patients diagnosed as having AR exhibited higher comorbidity rates, including of asthma, COPD, CRS, gastroesophageal reflux disease, and nasal septum deviation, than those of the comparison cohort. Our results strongly indicate that AR is an independent risk factor for laryngeal pathology. Therefore, when treating AR and voice problems, physicians should be attuned to possible laryngeal pathology.

Predictive fiberoptic endoscopic findings of upper airway in children with allergic rhinitis

OBJECTIVE

To determine predictive fiberoptic findings of upper airway in children with allergic rhinitis.

METHOD

129 children had fiberoptic evaluation of nasal cavity, pharynx and larynx. They were divided into allergic rhinitis group and normal group based on skin prick test results. All video recordings were randomly reviewed by three independent national board-certified otolaryngologists who were blinded to the clinical details and outcomes of the participants' allergy testing. Each physician assessed and documented 10-item questionnaire. Intra-rater, inter-rater reliability and correlation between items and allergic status was calculated.

RESULTS

Intra-rater reliability was moderate to perfect for all physicians on all items (kappa = 0.578-0.962). Inferior turbinate hypertrophy (κ = 0.714, p = 0.02), middle turbinate hypertrophy (κ = 0.728, p = 0.01), discoloration of inferior turbinate (κ = 0.685, p = 0.01), adenoid hypertrophy (κ = 0.662, p = 0.02) had good inter-rater reliability and these findings were predictive of allergic rhinitis. Adenoid hypertrophy was less encountered in allergic rhinitis. All other endoscopic findings beyond the nasal cavity were not predictive for allergic rhinitis in children.

CONCLUSION

Nasal cavity findings including inferior turbinate hypertrophy, middle turbinate hypertrophy, discoloration of inferior turbinate and adenoid tissue assessment rather than pharyngolaryngeal findings are predictive of allergic rhinitis in children.

Identification and Management of Chronic Laryngitis

Chronic laryngitis is an inflammatory process of at least 3 weeks duration and affects phonation, breathing, and swallowing. This article describes the infectious, inflammatory, and autoimmune causes of chronic laryngitis. Symptoms of chronic laryngitis are nonspecific and may range from mild to airway compromise requiring emergent tracheostomy.