Correlação do pH e volume salivares com sintomas laringofaríngeos

Sialometry: aspects of clinical interest

Whole saliva is a multiglandular secretion complex consisting of gingival fluid, desquamated epithelial cells, microorganisms, products of bacterial metabolism, food debris, leukocytes mucus from the nasal cavity and the pharynx. Saliva has many functions, including tissue repair, tamponage, protection, digestion, taste, antimicrobial action, maintaining tooth integrity and antioxidant defense system. A decrease in salivary flow (hyposalivation) is a common disorder and it is estimated that approximately 20% of the general population have this alteration. Hyposalivation may be due to diabetes mellitus, hypothyroidism, dehydration, impaired glandular parenchyma by infectious processes, granulomatous diseases or autoimmune and inflammatory conditions (such as Sjogren's syndrome and rheumatoid arthritis), radiotherapy of head and/or neck region, or it may be associated with mood disorders, adverse effects caused by the use of some medications or even be idiopathic. Conventional therapies for the treatment of reduced saliva flow with the use of chemical and gustatory secretagogues are still limited. However, new alternatives have shown great perspective in the treatment of this disorder. To diagnose a patient as having chronic hyposalivation is a challenge in clinical practice and methods of salivary flow assessment are little known by rheumatologists. The serial evaluation of salivary flow is important for the diagnosis and prognosis of certain oral and systemic conditions. This review addresses some aspects related to the role of saliva, the consequences of hyposalivation and methods of salivary flow rate measurement, useful concepts in the daily practice of rheumatology.

Influence of smoking isolated and associated to multifactorial aspects in vocal acoustic parameters

INTRODUCTION

Smoking affect voice quality in a long period of time, but other factors may compromise it, such as professional using of voice, habits, alcohol dependence and GERD. The aim was associate the influence of these factors on vocal parameters.

STUDY DESIGN

Contemporary cohort study with cross-sectional.

MATERIALS AND METHODS

Eighty adults of 35 to 60 years old had participated in this study, they had been divided into two groups, smokers (GF) and control (GC). There was application of questionnaire and voices were recorded. Praat software has been used for voice assessment and Man-Whitney, chi-square and logistic regression has been used for statistical analysis.

RESULTS

The GF had a higher incidence of alcohol dependence, coughing, throat clearing and professional voice using. Respecting to the acoustic parameters: noise-to-harmonic ratio (NHR), jitter and shimmer, the GF presented higher values. Relating these data to the questionnaire, it's noticed that female gender have influence over all acoustic parameters, GERD have influence over jitter and smoking can affect fundamental frequency, jitter, shimmer and NHR.

CONCLUSION

Smoking interferes in acoustics parameters isolated and associated with alcohol dependence, GERD, cough, throat clearing, gender and professional using of voice.

pH salivary analysis of subjects suffering from Sjögren's Syndrome and laryngopharyngeal reflux

Saliva is one of the components for the digestive homeostasis. Recent studies have shown that patients with laryngopharyngeal reflux (LPR) present a drop in salivary pH. Patients with Sjögren´s syndrome (SS) are a potential clinical research model for xerostomia and its laryngeal and pharyngeal consequences. The aim was to evaluate the characteristics of saliva of patients with SS and LPR.

Methods

19 patients with SS plus LPR, and 12 healthy controls had their saliva studied prospectively for volume and pH. Two salivary samples were obtained from each participant: whole unstimulated saliva(WUS) and whole stimulated saliva(WSS) while chewing parafilm M^®. All the participants were females.

Results

Mean age was 60 years (study group) and 44 years (control). LPR was diagnosed on all 19 subjects. The mean pH of WUS was 7.53 (SS) and 7.57 (controls), raising to 7.87 and 7.83 respectively after stimulation. The mean salivary volume of patients with SS was 1.27 mL (WUS) and 3.78 mL (WSS), whereas controls had a significantly higher salivary volume both before and after stimuli.

Conclusion

A very high prevalence of LPR was found in patients with SS, which is probably caused by a uniform drop in salivary volume and all its contents, rather than a specific deficiency in its components, as shown previously in patients without SS.

Diagnosis and management of laryngopharyngeal reflux disease

PURPOSE OF REVIEW

Laryngopharyngeal reflux has shown high prevalence and it is an interesting issue for otorhinolaryngologists, head and neck surgeons, and gastroenterologists. The present paper presents the most recent findings in diagnosis and management of laryngopharyngeal reflux.

RECENT FINDINGS

Clinical presentation of laryngopharyngeal reflux is widely varied and it may be manifested by a wide range of signs and symptoms. Other diseases that affect the larynx may also show the same signs and symptoms, such as, for example, vocal abuse, allergy, asthma, sinusitis, and smoking. Overvaluation of signs and symptoms related to reflux may be responsible for overdiagnosis of laryngopharyngeal reflux disease. The 24-hour dual-probe pH monitoring is considered the gold standard for the diagnosis of laryngopharyngeal reflux disease, and is essential in cases of pharyngolaryngeal complaints. The management of laryngopharyngeal reflux cases should be based on severity of symptoms, laryngoscopic findings, and frequency of reflux episodes. Proton-pump inhibitors are the preferred drugs for managing patients with laryngopharyngeal reflux and the best control can be achieved by prescribing high doses, twice a day. Patients that do not respond satisfactorily to clinical management are candidates for surgical fundoplication.

SUMMARY

Laryngopharyngeal reflux is characterized by a set of signs and symptoms resulting from extraesophageal manifestations of gastroesophageal reflux disease; however, this set of signs and symptoms may be related to other causes and the results of management, based on clinical presentation, vary widely and have low cure index.