Correlación diagnóstica entre fibrolaringoscopia y videoendoscopia digestiva alta en pacientes con reflujo gastroesofágico y reflujo laringofaríngeo / Diagnostic Correlation Between Fiberlaringoscopy and Upper Gastrointestinal Video Endoscopy in Patients with Gastroesophagic Reflux and Laryngopharyngeal Reflux

Introducción: el reflujo laringofaríngeo (RLF) se origina por el flujo retrógrado de contenido gástrico hacia la faringe, pero es una entidad diferente de la enfermedad por reflujo gastroesofágico (ERGE). El objetivo del estudio fue determinar la correlación entre los signos endoscópicos de la fibrolaringoscopia y la videoendoscopia digestiva alta (VEDA). Material y métodos: estudio observacional, retrospectivo y analítico. Se incluyeron pacientes que consultaron por sintomatología de RLF y ERGE. Los hallazgos visualizados por fibrolaringoscopia flexible, VEDA y biopsia de mucosa gástrica de cada paciente se compararon con la prueba de chi-cuadrado (χ²). Se consideró significativo un valor de p ≤ 0,05. Resultados: se incluyeron 318 pacientes entre 18 y 84 años. Se encontró que el 100 % de los pacientes con esofagitis tenía laringitis (p = 0,001); el 100 % de los pacientes con hernia hiatal tenían RLF (p = 0,001); el 97 % de los pacientes con Helicobacter pylori en la mucosa gástrica tenían RLF (p = 0.001). El 71 % de los pacientes con hernia hiatal tenían esofagitis (p = 0,001). Se encontró una asociación lineal entre la edad y la hernia hiatal con la edad y el RLF (p = 0,03). Conclusiones: en este estudio, los signos encontrados en la fibrolaringoscopia tuvieron una asociación estadística con la VEDA. Aproximadamente el 90 % de los pacientes con signos de laringitis tuvo una correlación con algún grado de esofagitis, esófago de Barrett, hernia hiatal y Helicobacter pylori. También se encontró que la laringitis por RLF y la hernia hiatal se relacionaron directamente con el incremento de la edad.

Introduction: Laryngopharyngeal reflux (LPR) is caused by the retrograde flow of gastric contents towards the pharynx, but it is a different entity from gastroesophageal reflux disease (GERD). The objective of the study was to determine the relationship between the endoscopic signs of fiber laryngoscopy and upper gastrointestinal video endoscopy. Material and methods: Observational, retrospective and analytical study. Patients who consulted for LPR and GERD symptoms were included. The findings visualized by flexible fiber laryngoscopy, upper gastrointestinal video endoscopy and gastric mucosal biopsy of each patient were compared with the Chi-square (χ²) test. A value of p ≤ 0.05 is estimated significantly. Results: 318 patients between 18 and 84 years old were included. A relationship was found in 100% of the patients with esophagitis had laryngitis (p = 0.001); 100% of the patients with hiatal hernia had LPR (p = 0.001); 97% of patients with Helicobacter pylori in the gastric mucosal have LPR (p= 0.001); 71% of patients with hiatal hernia had esophagitis (p = 0.001). A linear association was found between age and hiatal hernia with age and LPR. (p = 0.03). Conclusions: In this study, the signs found in fiber laryngoscopy had a statistical association with the upper gastrointestinal video endoscopy. Approximately 90% of patients with signs of laryngitis had correlation with some degree of esophagitis, Barrett's esophagus, hiatal hernia and Helicobacter pylori. It was also found that LPR and hiatal hernia were directly related to increasing age

Características do padrão de refluxo na posição ortostática versus posição supina em pacientes com refluxo laringofaríngeo

Resumo Introdução: Muitos problemas relacionados à laringe têm sido atribuídos ao refluxo laringofaríngeo, inclusive disfonia, pigarro frequente, tosse crônica e sensação de "globus" faríngeo. No entanto, ainda há controvérsias quanto ao diagnóstico e à apresentação clínica dessa condição clínica. Objetivo: Descrever as características do refluxo laringofaríngeo de diferentes posições, em pacientes diagnosticados por meio de pHmetria orofaríngea. Método: Foi feita uma revisão retrospectiva de prontuários de 161 pacientes com refluxo laringofaríngeo diagnosticado por pHmetria orofaríngea de 24 horas. Os indivíduos do estudo foram categorizados em grupos com refluxo laringofaríngeo na posição ortostática e refluxo laringofaríngeo na posição supina com base nos resultados do pH. Os dois grupos foram comparados quanto à apresentação clínica e às características do pH. Resultados: Foram encontradas taxas significativamente mais altas de refluxo laringofaríngeo na posição ortostática em comparação à posição supina (p < 0,0001). Os resultados do índice de sintomas de refluxo foram significativamente maiores no grupo com refluxo laringofaríngeo na posição ortostática em comparação com o grupo com refluxo laringofaríngeo na posição supina. O uso do escore de Ryan composto (composite Ryan score) para a pHmetria orofaríngea de 24 horas foi significantemente maior no grupo com refluxo laringofaríngeo ortostático em relação ao grupo supino (p < 0,0001). Nenhuma diferença significante foi encontrada entre os grupos refluxo laringofaríngeo na posição ortostática e posição supina em relação à frequência da apresentação clínica ou classificações do índice de desvantagem vocal. Conclusão: O refluxo laringofaríngeo foi mais prevalente na posição ortostática entre os grupos de estudo. As características relacionadas ao refluxo, inclusive parâmetros de pH, foram mais evidentes no refluxo laringofaríngeo na posição ortostática.

Sinais e sintomas de refluxo laringofaríngeo e sua relação com queixas e qualidade vocal / Signs and symptoms of laryngopharyngeal reflux and its relation to complaints and vocal quality

RESUMO Objetivo: Verificar a associação entre Refluxo laringofaríngeo (RLF) com idade, sexo, desvio vocal e queixas de voz. Método: Participaram do estudo pacientes entre 18 e 70 anos, encaminhados ao serviço de otorrinolaringologia por queixas de voz ou refluxo, de ambos os sexos. Os achados endolaríngeos foram classificados utilizando a escala Reflux Finding Score (RFS). A presença ou não de queixas vocais e de refluxo foi verificada e correlacionada com a classificação RFS. Na mesma data, os pacientes foram submetidos à gravação de voz de vogal sustentada e fala encadeada. A avaliação perceptivo-auditiva foi realizada por uma fonoaudióloga, classificando o grau geral do desvio vocal com base na escala GRBASI. Resultados: Foram avaliados 97 pacientes, com média de idade de 42,6 anos, sendo 62,3% do sexo feminino e média dos escores da escala RFS igual a 6,26 pontos. Do total de pacientes, 48 indivíduos apresentavam queixas vocais, sendo 34 mulheres com idade média de 44,9 anos e escore RFS médio de 6,94 pontos. Os outros 49 indivíduos não apresentavam queixas vocais, e desses 27 eram mulheres, com idade média de 41,2 anos e média de escore RFS igual a 5,5 pontos. As variáveis "queixa de refluxo", "queixa vocal" e idade foram as que mais se correlacionaram com os escores da escala RFS. Conclusão: Há relação entre queixas de refluxo, achados laríngeos e queixa vocal.

ABSTRACT Purpose: To verify the association between laryngopharyngeal reflux (LPR) with age, gender, vocal deviation and voice complaints. Methods: The study included patients between 18 and 70 years old, referred to the Otorhinolaryngology service for complaints of voice or reflux, of both sexes. Endolaryngeal findings were classified using the Reflux Finding Score (RFS) scale. The presence or absence of vocal and reflux complaints was verified and correlated with the RFS classification. On the same date, they were submitted to sustained vowel voice recording and chained speech. The auditory-perceptual assessment was performed by a speech therapist, classifying the general degree of vocal deviation based on the GRBASI scale. Results: Ninety-seven patients were evaluated, with a mean age of 42. 6 years, 62. 3% female, and mean RFS scores of 6. 26 points. Among the patients, 48 subjects had vocal complaints, 34 women with a mean age of 44. 9 years and an average RFS score of 6. 94 points. The other 49 individuals had no vocal complaints, and of these 27 were women, with a mean age of 41. 2 years and a mean RFS score of 5. 5 points. The variables "reflux complaint", "vocal complaint" and age were the ones that most correlated with the RFS scale scores. Conclusion: There is a relationship among reflux complaints, laryngeal findings and vocal complaint.

Duración del ayuno preoperatorio en pacientes con cirugía programada / Duration of preoperative fasting in patients with scheduled surgery

Antecedentes y objetivo: el ayuno preoperatorio disminuye el riesgo de aspiración del contenido gástrico y sus complicaciones. Sin embargo, si es excesivo, favorece la regurgitación y el riesgo de broncoaspiración tras la inducción anestésica, así como alteraciones metabólicas e hidroelectrolíticas. Analizamos su duración, en pacientes con cirugías programadas en un hospital público de agudos. Material y métodos: se encuestó a todos los pacientes mayores de 18 años con cirugías programadas. Se recolectaron datos sobre la prescripción médica de ayuno, la hora de inducción anestésica y personales. El ayuno prescripto se comparó con las recomendaciones de las guías de la AAARBA (Asociación de Anestesia, Analgesia y Reanimación de Buenos Aires). Resultados: se reclutaron 139 pacientes, con una mediana de edad de 48 años (30; 64), 53% femeninos. La mediana del ayuno prescripto fue de 12,5 horas tanto para sólidos como para líquidos. El ayuno para sólidos que realizaron los pacientes tuvo una mediana de 14 horas, la cual resultó significativamente mayor que la prescripción (p < 0,001). En cambio, el ayuno para líquidos tuvo una mediana de 12 horas, no hallándose una diferencia significativa (p = 0,452) con lo prescripto. En comparación con la guía de la AAARBA, el ayuno prescripto excedió la recomendación para sólidos (4,5 h) y para líquidos (10,5 h). El ayuno realizado por el paciente excedió lo prescripto para sólidos (1,5 h), mientras que para líquidos fue inferior (0,5 h). Conclusión: el ayuno preoperatorio prescripto no se adecuó a las recomendaciones actuales. Las horas de ayuno realizadas por el paciente resultaron excesivas. (AU)

Background and objective: preoperative fasting reduces the risk of aspiration of gastric contents and its complications. However, if fasting is excessive, it favours regurgitation and the risk of pulmonary aspiration in patients undergoing general anaesthetic, such as metabolic and electrolyte disorders. We analysed its duration in patients with elective surgeries in public acute care hospital. Material and methodologies: patients over 18 years old with elective surgeries were surveyed. Data about medical fasting indication, time of induction of anaesthesia and personal information was collected. The prescribed fast was compared with the recommendations of the AAARBA (Association of Anaesthesia, Analgesia and Reanimation of Buenos Aires) guidelines. Results: 139 patients were gathered with a median of 48 years old (30; 64), 53% of them were female. Fasting indication median was of 12.5 h for solids and liquids. The fasting made by the patient for solids had a median of 14 h which resulted to be significantly higher to the indication (p < 0.001). By contrast, the fasting for liquids had a median of 12 h which it did not show a significant difference (p = 0.452) with the indication. In comparison with the AAARBA guideline, the fasting indication exceeded the recommendation for solids (4.5 h) and for liquids (10.5 h). The fasting made by the patient exceeded to what was indicated for solids (1.5 h) while for liquids, it was inferior (0.5 h). Conclusion: the indicated preoperative fasting was not adequate to the current recommendations. The hours of fasting made by patient were excessive. (AU)

Treatment of Laryngeal Granulomas

Abstract Introduction Laryngeal granulomas are benign, recurrent lesions of many causes (reflux, voice abuse, intubation, and idiopathic), which renders its treatment difficult. Objective To describe our experience in the treatment of laryngeal granulomas. Methods From 16 medical records of the patients with laryngeal granulomas seen between 2010 and 2017 in a university hospital, the following data were analyzed: age, gender, vocal and gastroesophageal symptoms, vocal overuse, intubation, treatments, videolaryngoscopy before and after the treatment. Results Gender: female, 10; male, 6. Age: between 20 and 60 years old (11%). Etiology of the granulomas: intubation (9), reflux (4), idiopathic (3). The initial treatments adopted in all cases were: inhaled beclomethasone dipropionate 100 μg 12/12 hours (1month), proton pump inhibitor, omeprazole 40 mg/day (2months), and dietary and voice education. After this period, 10 patients (7 postintubation, 3 idiopathic) were submitted to surgery, since no improvements in the symptoms or in the lesions were seen. Of these, two recurred, requiring a second surgery, one of which recurred six times and received botulinum toxin A. Only one patient with granulomas due to laryngopharyngeal reflux presented no improvement in the symptoms nor in the lesion after the pharmacological treatment and had been submitted to microsurgery. All of the other patients with reflux granulomas were successfully treated with the drug treatment, and the longest treatment time for complete remission of the symptoms and of the lesions was 9 months. Conclusions In laryngeal granulomas caused by reflux, treatment with inhaled steroids and proton pump inhibitors proved to be effective, although prolonged. In postintubation and idiopathic granulomas, surgery was the best treatment.

Clinical and polysomnographic predictors of laryngopharyngeal reflux in obstructive sleep apnea syndrome / Avaliação do refluxo laringofaríngeo na síndrome da apneia obstrutiva do sono

Abstract Introduction Obstructive sleep apnea syndrome and laryngopharyngeal reflux are diseases with a high prevalence in the overall population; however, it remains unclear whether they are diseases with the same risk factors present in the same populations or if there is any association between them. Objectives To evaluate and determine the prevalence of laryngopharyngeal reflux in patients with moderate and severe obstructive apnea syndrome and also to determine its predictive factors. Methods Historical cohort, cross-sectional study of patients aged 18-70 years, referred to a tertiary service Otorhinolaryngology outpatient clinic with a polysomnographic diagnosis of moderate or severe obstructive sleep apnea syndrome. The reflux symptom index questionnaire and the reflux finding score at indirect videolaryngoscopy were applied to the assessed population, considering the inclusion and exclusion criteria. Results Fifty-six patients were evaluated, of which 64.3% had a positive laryngopharyngeal reflux (positive reflux symptom index and/or positive endolaryngeal reflux finding score). Body mass index was a predictor of reflux presence in this group of patients with moderate to severe obstructive sleep apnea syndrome. In patients with positive score for endoscopic findings and reflux symptom index (12.3%), there was a trend toward significance for a higher mean apnea-hypopnea index and a higher percentage of sleep time with oxyhemoglobin saturation below 90% (p = 0.05). Conclusion The prevalence of laryngopharyngeal reflux was higher in this group of patients with moderate to severe obstructive sleep apnea syndrome, and the body mass index was a predictor of laryngopharyngeal reflux in these patients. There was a trend toward greater oxyhemoglobin desaturation in patients with a positive score for reflux symptoms index (RSI) and reflux finding score (RFS).

Resumo Introdução A síndrome da apneia obstrutiva do sono e o refluxo laringofaríngeo são doenças com alta prevalência na população em geral. No entanto, ainda não está claro se são doenças com os mesmos fatores de risco presentes nas mesmas populações ou se há alguma relação entre elas. Objetivo Avaliar e determinar a prevalência de refluxo laringofaríngeo em pacientes com síndrome da apneia obstrutiva moderada e acentuada, bem como determinar os fatores preditivos de refluxo nesses pacientes. Método Estudo de coorte histórica com corte transversal de pacientes entre 18 e 70 anos, encaminhados a um ambulatório de Otorrinolaringologia em serviço terciário, com diagnóstico polissonográfico de síndrome da apneia obstrutiva do sono moderada ou acentuada. Foram aplicados o questionário Reflux Sympton Index e o escore de achados endolaríngeos por meio de videolaringoscopia indireta na população estudada, respeitando os critérios de inclusão e exclusão. Resultados Foram avaliados 56 pacientes, dos quais 64,3% apresentaram refluxo laringofaríngeo (Reflux Sympton Index positivo e/ou Reflux Finding Score positivo). O índice de massa corpórea foi fator preditor da presença de refluxo laringofaríngeo nesse grupo de pacientes com síndrome da apneia obstrutiva do sono moderada e acentuada. Nos pacientes cujos Reflux Sympton Index e o escore de achados endolaríngeos foram positivos (12,3%), houve uma tendência à significância para maior índice de apneia e hipopneia e maior porcentagem do tempo de sono com saturação de oxi-hemoglobina abaixo de 90% (p = 0,05). Conclusão A prevalência de refluxo laringofaríngeo foi alta nesse grupo de pacientes com síndrome da apneia obstrutiva do sono moderada e acentuada e o índice de massa corpórea foi fator preditor de refluxo nesses pacientes. Houve uma tendência a maior dessaturacão de oxi-hemoglobina em pacientes com "índice de sintomas de refluxo" e escore de achados endolaríngeos positivos.

Vocal cord dysfunction: analysis of 27 cases and updated review of pathophysiology & management

Introduction: Vocal cord dysfunction is characterized by unintentional paradoxical vocal cord movement resulting in abnormal inappropriate adduction, especially during inspiration; this predominantly manifests as unresponsive asthma or unexplained stridor. It is prudent to be well informed about the condition, since the primary presentation may mask other airway disorders. Objective: This descriptive study was intended to analyze presentations of vocal cord dysfunction in a tertiary care referral hospital. The current understanding regarding the pathophysiology and management of the condition were also explored. Methods: A total of 27 patients diagnosed with vocal cord dysfunction were analyzed based on demographic characteristics, presentations, associations and examination findings. The mechanism of causation, etiological factors implicated, diagnostic considerations and treatment options were evaluated by analysis of the current literature. Results: There was a strong female predilection noted among the study population ( n = 27), which had a mean age of 31. The most common presentations were stridor (44%) and refractory asthma (41%). Laryngopharyngeal reflux disease was the most common association in the majority (66%) of the patients, with a strong overlay of anxiety, demonstrable in 48% of the patients. Conclusion: Being aware of the condition is key to avoid misdiagnosis in vocal cord dysfunction. Fiberoptic laryngoscopy is the diagnostic gold standard to demonstrate paradoxical vocal cord adduction during an attack. A multidisciplinary approach should be adapted for the management, which should be specific and tailored for individual patients (AU)

Tos persistente y neuropatía laríngea / Persistent cough and laryngeal neuropathy

RESUMEN La tos persistente es un síntoma de consulta frecuente, de origen multifactorial, que involucra a diferentes especialidades como la neumología, la gastroenterología y la otorrinolaringología. Sus causas más frecuentes son la descarga nasal posterior, tos como variante del asma y reflujo gastroesofágico/faringolaríngeo. Una vez descartadas dichas causas, cobran importancia los trastornos sensoriales del nervio vago, una entidad relativamente nueva que también es conocida como neuropatía laríngea sensitiva. En la neuropatía laríngea, una injuria a nivel neuronal aferente del reflejo de la tos produce un estado de hipersensibilidad laríngea en la que estímulos normalmente ignorados (que no producen respuesta tusígena) comienzan a gatillar el reflejo. Las características clínicas de la tos y el descarte de las causas más frecuentes permite llegar a este diagnóstico. Su tratamiento tiene como objetivo la modulación de las vías neuronales alteradas basándose en 3 pilares: educación sobre la patología, recomendaciones conductuales (higiene vocal, estrategias de reducción de tos) y los fármacos entre los que se usan los inhibidores de bomba de protones, mucolíticos y neuromoduladores.

ABSTRACT Persistent cough is a common symptom for medical consultation, it is of multifactorial origin and involves different specialties such as pneumology gastroenterology and otorhinolaryngology. The most frequent causes are postnasal drip, cough variant asthma and gastroesophageal/pharyngolaryngeal reflux. Once these causes are discarded the vagus nerve sensory disorder becomes of importance, it is a relatively new entity also known as laryngeal sensitive neuropathy. In the laryngeal neuropathy, an injury in the afferent neuronal pathway of the cough reflex produces laryngeal hypersensitivity in which normally ignored stimulus (i.e. do not cause cough) start to trigger the reflex. The clinical features of the cough and the rule out of the most frequent causes allow the diagnosis. The objective of the treatment is to modulate the altered neuronal pathways based on 3 pillars: education regarding the pathology, behavioral recommendations (vocal hygiene, cough reduction strategies) and drugs among which proton pump inhibitors, mucolytics and neuromodulators are used.

Tos en otorrinolaringología: revisión actualizada del enfoque clínico / Cough in otolaryngology: an up to date of the diagnostic approach

La tos ocurre por la compleja acción del arco de la tos. En condiciones normales es esencial para proteger la vía aérea. Es un síntoma muy frecuente, con un gran número de etiologías posibles. El enfrentamiento diagnóstico de los pacientes con tos crónica, puede resultar un desafío diagnóstico. Deben considerarse las patologías más prevalentes, que incluyen el reflujo faringolaríngeo y la descarga posterior: ambas condiciones que son parte del área otorrinolaringológica. En el presente artículo de revisión se pretende entregar un enfoque actualizado de su enfrentamiento y manejo, con la finalidad de aportar información que resulte relevante para la práctica clínica diaria.

Cough occurs due to the complex action of the coughing arch. Under normal conditions it is essential to protect the airway. It is a very frequent symptom with a large of possible etiologies. The diagnosis process of patients with chronic cough can be a challenge. The most prevalent pathologies must be considered. Thus includes pharyngolaryngeal reflux and posterior discharge: both conditions that are part of the otorhinolaryngolocical area. In the present article review, we pretend to provide an updated approach and management to this condition, in order to asses relevant information to daily clinical practice.

Substernal goiter and laryngopharyngeal reflux

ABSTRACT Objective This study aims to compare the prevalence of laryngopharyngeal reflux signs between two groups of patients undergoing thyroidectomy for voluminous goiter: substernal goiters and voluminous cervical goiter without thoracic extension. Subjects and methods A retrospective case-control study was performed with data retrieved of the charts of the patients submitted to thyroidectomies occurred at a tertiary care center (Head and Neck Surgery Department, University of São Paulo Medical School) between 2010 and 2014. The selected thyroidectomies were allocated in two groups for study: patients with substernal goiters and patients with voluminous cervical goiter without thoracic extension. Cervical goiters were selected by ultrasonography mensuration. Clinical criterion was used to define substernal goiter. Results The average thyroid volume in patients with substernal goiter was significantly greater than the average volume in patients with only cervical goiter (p < 0.001). The prevalence of signs of reflux laryngitis at laryngoscopy was significantly greater in substernal goiter patients (p = 0.036). Moreover, substernal goiter was considered as the unique independent variable for high reflux laryngitis signs at laryngoscopy (OR = 2.75; CI95%: 1.05-7.20; p = 0.039) when compared to only cervical goiter patients. Conclusion This study shows a significant association between substernal goiters and signs of laryngopharyngeal reflux at preoperative laryngoscopy. Therefore, when compared with voluminous cervical goiters, the substernal goiters increase the chance of reflux laryngitis signs in patients.

Correlación diagnóstica entre fibronasolaringoscopía y videoendoscopía digestiva alta en pacientes con reflujo gastroesofágico y reflujo faringolaríngeo / Diagnostic correlation between fibronasolaringoscopy and upper gastrointestinal endoscopy video in patients with gastroesophagic reflux and faringolaryngeal reflux / Correlação do diagnóstico entre fibronasolaringoscopia eendoscopia digestiva alta em pacientes com refluxo gastroesofágico e refluxo faringolaríngeo

Introducción: el reflujo faringolaríngeo se origina por el flujo retrógrado de contenido gástrico hacia la faringe, pero existen factores capaces de perpetuarlo: disfunción del esfínter esofágico, tiempo de exposición y sensibilidad del tejido al material refluido, estos elementos permiten considerar al reflujo faringolaríngeo como una entidad diferente del reflujo gastroesofágico. Material y método: Estudio observacional, retrospectivo y analítico. Se incluyeron pacientes que consultaron al servicio de Otorrinolaringología y Gastroenterología de la Clínica Universitaria Reina Fabiola Córdoba Argentina, por sintomatología de reflujo faringolaríngeo y gastroesofágico. Entre mayo/2016 y mayo/2017. Los hallazgos de reflujo faringolaríngeo por fibrolaringoscopía flexible y de esofagitis por videoendoscopía digestiva alta de cada paciente se compararon con la prueba de Chi cuadrado. Se consideró significativo un valor de p ≤0,05. Resultados: Se incluyeron 49 pacientes entre 7 y 80 años; de éstos, el 45% son de género masculino, y 55% femenino. El 100% de los pacientes presentaron criterios fibrolaringoscópicos diagnósticos de reflujo faringolaríngeo; por el contrario, la videoendoscopía digestiva alta mostró que solo el 55% de los pacientes tenían signos de esofagitis (p= 0,24). Conclusiones: En este estudio no se observó una correlación diagnóstica entre los signos de la fibrolaringoscopía y videoendoscopía digestiva alta en relación al diagnóstico de reflujo faringolaríngeo y esofagitis. No se encontró una diferencia entre ambos géneros y los signos de reflujo faringolaríngeo y esofagitis. La frecuencia de las manifestaciones otorrinolaringológicas del reflujo faringolaríngeo se relaciona directamente con el incremento de la edad; sobre todo, la cuarta década de la vida.

Introduction: pharyngolaryngeal reflux. Its etiology, the retrograde flow of gastric contents towards the pharynx would be the origin, but there are factors, capable of perpetuating it: dysfunction of the esophageal sphincter, time of exposure and sensitivity of the tissue to the refluxed material, which allows pharyngolaryngeal reflux to be considered as a different entity from gastroesophageal reflux. Material and method: Observational, retrospective and analytical study of patients who have consulted the service of Otorhinolaryngology and Gastroenterology of the Reina Fabiola University Clinic, due to symptomatology of pharyngolaryngeal reflux and gastroesophageal reflux. Between May/2016 and May/2017. The findings of pharyngolaryngeal reflux by fiber-optic laryngoscopy and esophagitis by upper gastrointestinal endoscopy of each patient were compared with the Chi square test. A value of p ≤0.05 was considered significant. Results: We included 49 patients between 7 and 80 years old; 45% of them were male and 55% were female. 100% of the patients had fiber-optic laryngoscopy diagnostic criteria of pharyngolaryngeal reflux. In contrast, upper digestive endoscopy showed that only 55% of the patients had signs of esophagitis (p = 0.24). Conclusions: In this study, wasn´t observed a diagnostic correlation between the signs of fiber-optic laryngoscopy and upper gastrointestinal endoscopy in relation to the diagnosis of pharyngolaryngeal reflux and esophagitis. We did not find a difference between both genders and signs of esophageal pharyngolaryngeal reflux. The frequency of otorhinolaryngological manifestations of pharyngolaryngeal reflux is directly related to the increase in age.

Introdução: o refluxo faringolaríngeo. Sua etiologia é o fluxo retrógrado de conteúdo gástrico para a faringe, mas existem fatores capazes de perpetuá- lo: disfunção do esfíncter esofágico, tempo de exposição e sensibilidade do tecido ao material refluído, o que permite considerar o refluxo faringolaríngeo como uma entidade diferente do refluxo gastroesofágico. Material e métodos: Estudo observacional, retrospectivo e analítico de amostra de pacientes que consultaram o serviço de Otorrinolaringologia e Gastroenterologia da Clínica Universitária Reina Fabiola, devido à sintomatologia de refluxo faringolaríngeo e refluxo gastroesofágico, entre maio/2016 e maio/2017. Os achados do refluxo faringolaríngeo por fibrolaringoscopia flexível e esofagite por endoscopia digestiva alta de cada paciente foram comparados com o teste do chi-quadrado. Um valor de p ≤ 0,05 foi considerado significativo. Resultados: Foram estudados 49 pacientes entre 7 e 80 anos; destes, 45% do sexo masculino e 55% do sexo feminino. 100% os pacientes apresentavam critérios fibrolaringoscópicos para refluxo faringolaríngeo. Em contraste, a endoscopia digestiva alta mostrou que apenas 55% dos pacientes apresentavam sinais de esofagite (p = 0,24). Conclusões: Neste estudo, não foi observada correlação diagnóstica entre os sinais de fibrolaringoscopia e endoscopia digestiva alta em relação ao diagnóstico de refluxo faringolaríngeo e esofagite. Não foi encontrada diferença entre os sexos e os sinais de refluxo faringoaríngeo e esofagite. A freqüência das manifestações otorrinolaringoló- gicas do refluxo faringolaríngeo está diretamente relacionada ao aumento de idade.

Reflux finding score: análisis de la concordancia inter-observador / Reflux finding score: analysis of the interobserver concordance / Reflux finding score: análise de concordância interobservador

Introducción: el reflujo laringofaríngeo (RLF) es una manifestación extradigestiva del Reflujo Gastroesofágico (RGE). Actualmente, el algoritmo diagnóstico usado en la mayoría de los Servicios de Otorrinolaringologìa (ORL) consiste en identificar los síntomas sugestivos de reflujo laringofaríngeo y realizar una fibronasolaringoscopia flexible para determinar si existen cambios estructurales identificables en la laringe o en los tejidos vecinos. Se ha desarrollado una escala subjetiva para cuantificar la severidad de los cambios inflamatorios de la laringe, identificando los hallazgos laringoscópicos asociados con reflujo laringofaríngeo. Los mismos son clasificados por el índice de hallazgos de reflujo “Reflux Finding Score” (RFS), desarrollado por Belafky y cols. El puntaje máximo es de 26 y un puntaje de 7 o mayor a 7 es considerado altamente sospechoso de RLF. Objetivos: Determinar el índice Kappa de Resultados Interobservador usando el RFS en pacientes con RLF en el Servicio de Otorrinolaringología del Sanatorio Allende. Determinar las características de los pacientes con diagnóstico de RLF según: Sexo, edad, síntomas presentes y tratamiento indicado en pacientes que consultaron ambulatoriamente en el Servicio de ORL del Sanatorio Allende sucursal Nueva Córdoba. Material y método: Se determinó el índice Kappa de Resultados entre observadores usando el RFS en paciente con RLF entre 2 médicos del staff de Servicio de ORL del Sanatorio Allende, se analizó frecuencia de sexo, edad, síntomas, conducta médica. Conclusión: El índice Kappa del RFS para cada uno de los 8 ìtems del RFS es leve, medido como < 0,2.

Introduction: the Laryngopharyngeal Reflux (LPR) is recognized as an extra-digestive manifestation of gastroesophageal reflux (GERD). At present, the diagnostic algorithm used in most of the otorhinolaryngology (ORL) services involves identifying suggestive symptoms of laryngopharyngeal reflux and carrying out a flexible fibronasolaryngoscopy to determine if there are identifiable structural changes in the larynx or neighboring tissues. A subjective scale has been developed to quantify the severity of inflammatory changes in the larynx by identifying endoscopic findings related to laryngopharyngeal reflux. These subjective findings for patients with LPR are classified using the “Reflux Finding Score” (RFS) developed by Belafsky et al.The maximum score is 26 and a score of 7 or greater is considered to indicate that LPR is highly likely. Objetive: To determine the Kappa Coefficient of the interobserver agreement using the RFS in patients with LPR in the Otorhinolaryngology Service of the Allende Hospital. To determine the characteristics of patients with LPR diagnosis according to: Gender, age, manifested symptoms and treatment indicated in patients that were treated as an outpatient in the ORL Service of the Allende Hospital, Nueva Córdoba’s branch. Material and method: The Kappa Coefficient was determined by the interobserver agreement using the RFS in patients with LPR between two Staff doctors of the ORL Service of the Allende Hospital; it was investigated the sex frequency, age, symptoms and medical behavior. Conclusions: The Kappa Coefficient of LPR for each of the eight items of LPR is poor, valued as < 0.2.

Introdução: o refluxo laringofaríngeo (RFL) é uma manifestação extra-digestiva do refluxo gastroesofágico (RGE). Atualmente o algoritmo diagnóstico usado pela maioria dos Serviços de Otorrinolaringología (ORL) consistem em identificar os sintomas sugestivos do RFL e realizar uma fibronasolaringoscopia flexível para determinar se existem mudanças estruturais identificáveis na laringe ou nos tecidos vizinhos. Existe uma escala subjetiva para quantificar a severidade das alterações inflamatórias na laringe, identificando os achados laringoscópicos que têm relação com o RFL. Eles são classificados pelo índice de achados de refluxo “Reflux Finding Score” (RFS), desenvolvido por Belafky e cols. A pontuação maxima é de 26 e uma pontuação de 7 ou maior é considerado quase sugestivo de RFL. Objetivos: Determinar o índice Kappa dos resultados interobservador usando o RFS em pacientes com RFL no Serviço de Otorrinolaringologia do Sanatorio Allende. Determinar as características dos pacientes com diagnóstico de RFL Segundo: Sexo, idade, sintomas presentes e tratamento indicado em pacientes que fizeram consultas externas no Serviço de ORL do Sanatorio Allende em Nueva Córdoba. Material e método: Determinou-se o índice Kappa dos resultados entre observadores usando o RFS em pacientes com RFL entre 2 médicos do staff do Serviço de ORL do Sanatorio Allende. Analizou-se a frequência entre o sexo, a idade, os sintomas, as doenças associadas e a terapeútica médica. Conclusões: O índice Kappa do RFS para cada item do RFS é insuficiente, medida como < 0,2.

Comparison between the Reflux Finding Score and the Reflux Symptom Index in the Practice of Otorhinolaryngology

Abstract Introduction The Gastroesophageal Reflux Disease has a prevalence of 12% of the urban population in Brazil. Koufman proposed the term to designate Laryngeal Pharyngeal Reflux (LPR) symptoms, signs or tissue damage resulting from aggression of the gastrointestinal contents in the upper aerodigestive tract. Belafsky et al proposed a score that points to inflammatory laryngeal signs through videolaryngoscopic findings, the Reflux Finding Score (RFS). Moreover, in 2002, they published the Reflux Symptom Index (RSI). Objective The objective of this study is to provide a comparison between the Reflux Finding Score and the Reflux Symptom Index in the practice of Otorhinolaryngology. Methods Our study involved a total of 135 patients who visited the Ear, Nose, and Throat (ENT) clinic Núcleo de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço de São Paulo between April 2014 and May 2015 with suspected LPR.We excluded nine patients and the study group was 126 patients. All patients were ranked by their RSI and RFS scores. Results The study group consisted of 126 patients (88 women and 38 men). Their main complaints were cough (40.4%), globus (21.4%), dysphonia (19.8%), throat clearing (15.8%), postnasal drip (3.17%), snoring (1.5%), dysphagia (1.5%), cacosmia (0.7%), and regurgitation (1.5%). The RSI ranges from 13 to 42 with a mean of 20.7 (SD = 6.67). The RFS ranged from 3 to 19 with a mean of 9.53 (SD = 2.64). Conclusion The RSI and RFS can easily be included in ENT routines as objective parameters,with low cost and high practicality. Based on the clinical index, the specialist can evaluate the need for further tests.

Relação entre a presença de sinais videolaringoscópicos sugestivos de refluxo laringofaríngeo e distúrbio de voz em professoras / Relationship between the presence of videolaryngoscopic signs suggestive of laryngopharyngeal reflux and voice disorders in teachers

RESUMO Objetivo Analisar a relação entre a presença de sinais videolaringoscópicos sugestivos de refluxo laringofaríngeo (RLF) e distúrbio de voz (DV) em professoras. Métodos Pesquisa de natureza transversal, com amostra por conveniência que teve, como critérios de inclusão, ter mais de 18 anos, ser professor do sexo feminino, procurar atendimento com queixa de DV e/ou de RLF. Os fatores de exclusão foram: ser fumante e apresentar alterações respiratórias. Todos os sujeitos preencheram os seguintes instrumentos: Condição de Produção Vocal – Professor (CPV-P), inclusive o Índice de Triagem para Distúrbio de Voz (ITDV), e o Índice de Desvantagem Vocal (IDV). Fez-se coleta de amostra de fala para avaliação perceptivo-auditiva da voz e todas foram submetidas à avaliação otorrinolaringológica. Resultados Foram avaliadas 121 professoras, com média de idade de 43 anos e de 7,8 horas-aula por dia. Somente 24% das professoras não apresentaram lesões em pregas vocais e 42,1% apresentaram sinais videolaringoscópicos sugestivos de RLF. No grupo de professoras com presença de sinais de RLF, os sintomas do ITDV mais relatados foram garganta seca, rouquidão, pigarro, e a média do IDV foi de 17,9 pontos. Não houve associação entre distúrbio de voz e presença de sinais videolaringoscópicos sugestivos de RLF. Na análise de regressão logística binária múltipla, os fatores independentes para o RLF foram idade e escore (tercil: 13-20) do IDV. Conclusão Não houve associação entre o DV e o RLF e sim entre idade e escore IDV.

ABSTRACT Objective To analyze the relationship between the presence of videolaryngoscopic signs suggestive of laryngopharyngeal reflux (LPR) and voice disorder (VD) in teachers. Methods this is a cross-sectional study with convenience sample and inclusion criteria as subjects 18 years or older, be a teacher female, seek care with complaint of VD and/or LPR. The exclusion criteria included smoking and presence of respiratory changes. All subjects concluded the following instruments: Vocal Production Condition - Teacher (VPC-T), including the Screening Index for Voice Disorder (SIVD); and Voice Handicap Index (VHI). Speech samples were collected for voice perceptual assessment and all of them were submitted to otorhinolaryngology review. Results We evaluated 121 teachers, with a mean age of 43 years and 7.8 class hours per day. Only 24.0% of the teachers did not have vocal cord lesions and 42.1% had videolaryngoscopic signs suggestive of LPR. In the group of teachers with presence of Signs suggestive of LPR, the most common symptoms of SIVD were dry throat, hoarseness, throat clearing; the average VHI was 17.9 points. There was no association between voice disorder and presence of videolaryngoscopic signs suggestive of LPR. The independent factors for the LPR in the multiple binary logistic regression analysis were age and VHI score (tertile: 13-20). Conclusion There was no association between VD and LPR, but between age and VHI score.

Meta-analysis of the efficacy of proton pump inhibitors for the symptoms of laryngopharyngeal reflux

The objective of this study was to perform a systematic review and meta-analysis to assess the effectiveness of proton pump inhibitors (PPI) for reflux disease in adult patients with laryngopharyngeal symptoms. A comprehensive search of Cochrane Library, EMBASE, Ovid EBM Reviews, and PubMed was performed for English-language literature about laryngopharyngeal reflux (LPR), in September 2014. The papers were filtered using pre-defined inclusion and exclusion criteria. Eight papers were identified and included in this meta-analysis. The sample comprised a pooled total of 370 patients, of which 210 and 160 patients took PPIs and placebo, respectively. The difference between PPIs and placebo groups in overall improvement of symptoms in adult patients with LPR was not statistically significant (RR=1.22; 95%CI=0.93-1.58; P=0.149). The difference in cough improvement was also not significant between PPIs and placebo groups (RR=0.65; 95%CI=0.30-1.41; P=0.279).

A regurgitação como fator de risco para erosão dental em pacientes gastroplastizados / Regurgitation is a risk factor for dental erosion in bariatric patients

Este estudo teve como objetivo comparar pacientes submetidos a cirurgia bariátrica com e sem tratamento bucal. A metodologia utilizada foi de questionários com dados gerais do paciente (anamnese e exame clínico), questionário de autopercepção da saúde bucal dos pacientes (OHIP-14), questionário de hábitos alimentares, testes salivares, índice para erosão dentária (BEWE) e índices periodontais. O resultado mostrou que os grupos tratados pelo cirurgião-dentista apresentaram ganhos como: em autopercepção da saúde bucal (questionário OHIP-14), em melhora dos problemas periodontais e confirmaram uma diminuição de pH e aumento de frequência de vômitos em pacientes pós cirúrgicos. Assim, baseados nos achados desta pesquisa, conclui-se que a Doença do Refluxo Gástrico Esofágico (DRGE), é um fator de risco, também, nos bariátricos. Foi realizado estudo experimental, controlado, não randomizado, com um acompanhamento de até seis meses de pacientes submetidos à cirurgia bariátrica. O estudo foi composto por pacientes que estavam em tratamento no Centro Multidisciplinar de Tratamento da Obesidade (CMTO) Barra da Tijuca, Rio de Janeiro e Centro de Nova Iguaçu. Participaram da pesquisa 101 pacientes divididos em quatro Grupos. Grupo 1 com 40 pacientes obesos pré-cirúrgicos, Grupo 2, 29 (perda de 11) reavaliados póscirurgicamente seis meses depois. Grupo 3 com 20 pacientes, que se distingue do 1 e 2, por passarem por tratamento odontológico profilático e o mesmo grupo tratado, foi avaliado e chamado de grupo 4, com 17 pacientes (perda de 3) reavaliados, seis meses após. A análise de Dados, para realização dos testes, foi utilizado o teste K-S, os dados não são normalmente distribuídos (p < 0,05%). Foi então utilizada a distribuição t de Student para determinação dos intervalos de confiança para a média, o teste de Mann-whitney (significância p > 0,05) mostrou diferença significativa entre os grupos Gr3 e Gr4 no teste salivar. O programa analítico foi o Statistical Package for the Social Sciences (SPSS) versão 16.0 for Windows (NESC/UFRJ). Foram considerados significativos valores numéricos de P 0,05

This study aimed to compare patients who underwent bariatric surgery with and without oral treatment. The methodology used was questionnaires with general data of the patient (anamnesis and clinical examination), questionnaire of self-perception of patient's oral health (OHIP-14), eating habits questionnaire, salivary tests index for dental erosion (BEWE) and periodontal indexes. The results showed that the groups treated by a dentist showed gains as self-perception of oral health (OHIP-14 questionnaire), in improvement of the periodontal problems and confirmed a decrease in pH and an increase in vomiting frequency in post surgical patients. Thus, based on this research findings, it could be concluded that the inclusion of a dentist in the treatment team of patients undergoing bariatric surgery should be encouraged. Morbid obesity has become a public health problem, from the change in dietary habits of the 21st Century. An experimental controlled and non-randomized study, with a follow-up to six months in patients undergoing bariatric surgery was performed. The study consisted of patients who were being treated at the Multidisciplinary Center for Treatment of Obesity (CMTO). The participants were 101 patients divided into four groups. Group 1 with 40 pre-surgical obese patients; Group 2, 29 Patients (loss of 11) post-surgically re-evaluated after 6 months. Group 3 with 20 patients, which distinguishes the 1 and 2 by passing through oral treatment. Group 4 with 17 patients (loss of 3) evaluated six months after.

Reflux laryngitis: correlation between the symptoms findings and indirect laryngoscopy

Introduction The indirect laryngoscopy has an important role in the characterization of reflux laryngitis. Although many findings are nonspecific, some strongly suggest that the inflammation is the cause of reflux. Objective The aim of this study was to evaluate the correlation between reflux symptoms and the findings of indirect laryngoscopy. Methods We evaluated 27 patients with symptoms of pharyngolaryngeal reflux disease. Results Laryngoscopy demonstrated in all patients the presence of hypertrophy of the posterior commissure and laryngeal edema. The most frequent symptoms were the presence of dry cough and foreign body sensation. Conclusion There was a correlation between the findings at laryngoscopy and symptoms of reflux.