Differences Between Patients With Chronic Epipharyngitis With and Without Previous COVID-19 Infection.

Objective Epipharyngeal abrasive therapy (EAT) is effective in patients with chronic epipharyngitis who previously had coronavirus disease 2019 (COVID-19). The study aimed to evaluate differences between patients with chronic epipharyngitis with (long COVID) or without a history of COVID-19 (non-long COVID). Methods This is a retrospective study based on the analysis of medical records of patients who visited the Mogitate ENT Clinic in Kawasaki, Japan, for six months from March 2022. Results Patients with long COVID were significantly younger (p=0.018). Fatigue and brain fog were prevalent in patients with long COVID, whereas throat discomfort, postnasal drip, and sputum were more common in those with non-long COVID. Epipharyngeal endoscopic findings in patients with long COVID showed significantly higher scores (p<0.001) compared with patients with non-long COVID. Conclusions The primary differences between patients with long COVID and non-long COVID were age, symptoms, and severity scores of endoscopic findings. The EAT should be aggressively implemented in patients with chronic epipharyngitis with or without COVID-19 infection, as there is no reason not to treat a patient with a condition caused by COVID-19 infection.

Exhaled nitric oxide levels are associated with the severity of chronic epipharyngitis and decreased via epipharyngeal abrasion.

OBJECTIVE: The author previously demonstrated that the levels of oral exhaled nitric oxide (NO) were reduced by repeated epipharyngeal abrasive therapy (EAT) for chronic epipharyngitis along with the patients' symptoms, suggesting that exhaled NO may be a useful outcome parameter of repeated EAT. This study aimed to investigate whether the levels of oral exhaled NO indicate the severity of epipharyngitis and whether an epipharyngeal abrasion immediately influences the amount of exhaled NO. METHODS: Participants visited the author's clinic for the diagnosis and treatment of chronic epipharyngitis from November 2020 to March 2021. NO levels were measured orally before EAT, after nasal anesthesia and EAT without zinc chloride (ZnCl2), and after EAT with ZnCl2. The correlation between the endoscopic finding scores in conventional light and black spots and the cobblestone appearance with granular changes in band-limited light as well as the exhaled NO levels were determined. RESULTS: The study included 102 patients (30 males, 72 females; median age, 45.7 years). NO levels were significantly lower (p < 0.01) in EAT without ZnCl2 (17.0 [11.0-25.3]) and even lower with ZnCl2 (12.0 [8.0-21.0]) than before EAT (21.5 [15.8-35.0]). NO was significantly higher (p <0.01) in chronic epipharyngitis with the cobblestone appearance with granular changes (23.5 [17.0-37.8]) than without it (19.0 [15.0-23.5]). The total number of endoscopic finding scores and the exhaled NO levels showed a positive correlation (r = 0.251; p = 0.015). Additionally, the cobblestone appearance with granular changes and exhaled NO levels showed a positive correlation (r = 0.256; p = 0.013). CONCLUSION: EAT decreased immediately exhaled NO levels with or without ZnCl2, suggesting that physical stimulation with a cotton swab without ZnCl2 is therapeutic, and ZnCl2 may increase this effect. The endoscopic scores were significantly associated with the exhaled NO levels, suggesting that the exhaled NO levels represent the severity of epipharyngitis. The cobblestone appearance with granular changes, which indicates that pathologic ciliated epithelium, was significantly correlated and increased exhaled NO levels, suggesting that NO may be exhaled from ciliated epithelia. These results indicated that exhaled NO levels may be useful as an objective parameter to express the severity of epipharyngitis as well as the outcomes of repeated EAT.

Effectiveness of Epipharyngeal Abrasive Therapy on Chronic Epipharyngitis and the Exhaled Nitric Oxide Levels.

Objective Considering the possibility that eosinophilic inflammation is involved in the pathogenesis of chronic epipharyngitis, this study determined whether or not the exhaled nitric oxide level of patients changed after epipharyngeal abrasive therapy (EAT). The diagnosis and follow-up of patients with chronic epipharyngitis were based on the endoscopic findings. If the exhaled nitric oxide level reflects the pathology of a patient with chronic epipharyngitis, the exhaled nitric oxide test can be performed for a follow-up examination as an objective test for chronic epipharyngitis. Methods The study period was 12 months, starting from February 2020. The age distribution and patients' median age and gender were retrospectively reviewed using medical records. Exhaled nitric oxide levels were measured before and after endoscopic EAT at the initial examination and before and after blind EAT at the follow-up examination. Patients Ninety-six new patients were included in this study. Results The study included 27 men and 69 women [median age (range), 45 (17-82) years old]. When patients with chronic epipharyngitis were treated using EAT, exhaled nitric oxide levels were significantly lower after EAT than before EAT at the initial visit. Six months after EAT, the exhaled nitric oxide level was significantly lower than that at the initial visit. Conclusion During the follow-up examination of patients with chronic epipharyngitis, the exhaled nitric oxide test may be an effective objective test, along with changes in endoscopic findings.

Epipharynegal Abrasive Therapy Downregulates the Number of Epipharyngeal Abrasive CD4 Cells With Symptomatic Recovery.

OBJECTIVE: In this study, the author focused on CD4 and CD8 profiles in epipharyngeal abrasive cells in patients with chronic epipharyngitis and investigated how the profiles differ from those in normal healthy subjects and how epipharyngeal abrasive therapy (EAT) influences these profiles. METHODS: This study included 18 patients (one male and 17 females, median age: 46 (30.0-56.5) years) who had been treated for chronic epipharyngitis between June 2021 and September 2021. Epipharyngeal abrasive cells were collected from patients with chronic epipharyngitis before EAT and three months after repeated EAT and were subjected to two-color flow cytometric analyses for CD4 and CD8 expression. The severity of participants' symptoms was monitored using the visual analog scale. RESULTS: Symptoms of chronic epipharyngitis were significantly abated after three months of repeated EAT (p <0.001). The number of epipharyngeal abrasive CD4(+) T cells in patients with chronic epipharyngitis before EAT, which was significantly higher than that in normal healthy subjects (p <0.01), significantly decreased by the third month of repeated EAT (p = 0.01), alongside symptomatic recovery. CONCLUSION: These results suggest that epipharyngeal CD4(+) T cells may have a critical role in treating the persistent inflammation of chronic epipharyngitis, and EAT may reduce the number of CD4 cells, which results in symptomatic recovery.

Outcome of an outpatient specialty clinic for chronic epipharyngitis.

OBJECTIVE: In Japan, chronic epipharyngitis became a subject of interest in the 1960s and is currently garnering renewed attention. Previous studies have focused only on the similarities between the immunological characteristics of the tonsil and epipharynx and reported the efficacy of epipharyngeal abrasive therapy (EAT) in patients with IgA nephropathy. However, endoscopic findings of chronic epipharyngitis have not yet been fully evaluated, and. this study aimed to elucidate those findings. METHODS: The study period was from November 2016 to October 2017. Two hundred and twelve new patients visited the specialty outpatient clinic for EAT. Age distribution and mean age of patients, sex, chief complaint, diagnosis at other departments and outcomes were retrospectively reviewed based on medical records. Band-limited light endoscopy was performed, and the findings were videotaped in 102 of the 212 new patients, who underwent endoscopic EAT for the first time. RESULTS: The study included 32 men and 70 women with a mean age of 46.0 years (range, 22-83 years). The most common complaint was postnasal drip (42 patients), followed by pharyngeal pain (12 patients), and throat discomfort (11 patients). The outcomes of 74 patients who continued treatment until the last session were; complete cure in 48.6% of cases, marked improvement in 21.6%, improvement in 16.2%, and no change in 13.5%. Band-limited light endoscopic findings included black spots (73%), granular changes (76%), vessel truncations (92%), crust/mucus adhesion (54%), adenoidal hypertrophy (31%) and tonsil cysts (7%). With regard to the appearance of the mucous membranes, 48% patients had an ivory-like-colored mucous membrane, 72% had a green vascular network, and 89% had a dark red to reddish-brown appearance. Six to nine months' EAT remarkably improved their symptoms with resolution of the endoscopic findings in 86% of the patients. CONCLUSION: Nasal endoscopy using band-limited light is useful for diagnosis and management of chronic epipharyngitis. We believe that this study not only provides information to help the diagnosis of chronic epipharyngitis but also contributes to treat sick patients suffering from chronic epipharyngitis.

[Relationship between globus sensation and esophageal clearance abnormalities in an elderly group].

Recent studies suggest that gastroesophageal reflux disease (GERD) may be a cause of globus sensation. However, it is difficult to examine the reflux of acidic gastric contents directly. We hypothesized that the esophageal clearance capacity against reflux acid may be responsible for the clinical symptoms of GERD. The purpose of this study was to investigate the bolus residue and reflux in the esophagus during swallowing in elderly patients and to discuss the relationship between globus sensation and esophageal clearance abnormalities. Videopharyngoesophageal examinations in the prone position were performed in 156 elderly patients with globus sensation (average age: 74.7 years old). Esophageal clearance in the prone position was classified into 4 subgroups according to the movement of a contrast bolus: Group 1, normal; group 2, retension in esophagus; group 3, reflux of contrast bolus within esophagus; group 4, reflux of contrast bolus into pharyngo-laryngeal regions. Group 1 contained 36 cases (23.1%), group 2 contained 8 cases (5.1%), group 3 contained 79 cases (50.6%), and group 4 contained 33 cases (21.2%). Overall, the reflux of a contrast bolus in the esophagus was observed in 112 cases (71.8%). We concluded that decreased esophageal clearance in elderly subjects affects the defense mechanism against acid exposure and may be a risk factor for the appearance of globus sensation. Videopharyngoesophageal examination in the prone position may be an easy and valuable method for evaluating the function of esophageal clearance.

The role of adjustment of expiratory effort in the control of vocal intensity: clinical assessment of phonatory function.

OBJECTIVE: To determine the role of the adjustment of expiratory effort in the control of vocal intensity. STUDY DESIGN: An intensity-loading test was performed by using the airway interruption method. Three groups of subjects were used: a control group thought to resemble normal vocal fold closure, a group of patients with Reinke's edema thought to represent increased mass at the level of the vocal folds, and a group with vocal fold paralysis that was thought to represent a group with lack of adequate vocal fold closure. RESULTS: In the control group, expiratory lung pressure and airway resistance slightly increased. In the patients with Reinke's edema, expiratory lung pressure, and airway resistance significantly increased. In this group, the voice intensity was controlled by laryngeal adjustment, but a greater expiratory effort was needed because of a greater increase in glottal resistance. In the patients with vocal cord paralysis, airway resistance did not increase even with a high-intensity voice. Vocal intensity was controlled by expiratory effort. CONCLUSIONS: If there is sufficient ability for laryngeal adjustment, vocal intensity is controlled primarily by laryngeal adjustment and by expiratory adjustment in response to increased glottal resistance. However, vocal intensity is controlled by expiratory effort when laryngeal adjustment ability is poor.

[Evaluation of pharyngeal swallowing elicited by fluid infusion using videoendoscopy in dysphagia patients].

The purpose of this study was to investigate the clinical value of assessing pharyngeal swallowing elicited by fluid infusion. Videoendoscopic examinations were performed in 126 patients with dysphagia, after injecting a fluid infusion into the pharyngeal cavity. Blue dye fluid was instilled into the unilateral vallecula through a catheter that was inserted into the biopsy channel of an endoscope. Pharyngeal swallowing elicited by the fluid infusion was classified according to 5 grades: grade 1, normal pharyngeal swallowing; grade IIa, laryngeal penetration before the triggering of pharyngeal swallowing; grade IIb, pharyngeal residue after swallowing; grade IIa + b; and grade III, no the pharyngeal swallowing. The recovery rates for oral intake using several approaches for dysphagia were 98% in grade I patients and 75% in grade IIb patients. However, the oral intake of food was more difficult in grade IIa, grade IIa + b and grade III patients. These results suggest that the classification of dysphagia based on the triggering and output situation of pharyngeal swallowing may be a useful guideline for demonstrating impaired oral food intake. We conclude that videoendoscopic examination using a fluid infusion is a valuable method for evaluating pharyngeal swallowing minus the influence of bolus transport from oral cavity to the pharynx.

[Changes in postural control mechanism after a long-time tilt].

In order to investigate the time-dependent dynamics of otolith organ-spinomotor function, we analyzed postural control biomechanically, in eight healthy adult volunteers, using a dynamic posturography (EquiTest System), before and after a four-hours lateral head and body tilt (90 degrees). After the tilt, a half of the subjects exhibited some changes. Their equilibrium scores decreased; i.e., the dependence on their vestibular inputs decreased, but in contrast, those on the visual and the somatosensory inputs increased. These changes were diminished by repeating the tests along the time course. The present findings confirmed [correction of comfirmed] the importance of vestibular gravity information for the maintenance of delicate postural stability.