The acoustic cough monitoring and manometric profile of cough and throat clearing.

Cough and throat clearing might be difficult to differentiate when trying to detect them acoustically or manometrically. The aim of this study was to assess the accuracy of acoustic monitoring for detecting cough and throat clearing, and to also determine whether these two symptoms present with different manometric profiles on esophageal pressure topography. Ten asymptomatic volunteers (seven females, mean age 31.1) were trained to simulate cough and throat clearing in a randomized order every 6 minutes during simultaneous acoustic monitoring and high-resolution manometry. The accuracy of automated acoustic analysis and two blinded reviewers were compared. The pattern of the events and the duration of the pressure changes were assessed using the 30 mmHg isobaric contour. There were 50 cough and 50 throat-clearing events according to the protocol. The sensitivity and specificity of automated acoustic analysis was 84% and 50% for cough, while the blinded analysis using sound revealed a sensitivity and specificity of 94% and 92%. The manometric profile of both cough and throat clearing was similar in terms of qualitative findings; however, cough was associated with a greater number of repetitive pressurizations and a more vigorous upper esophageal sphincter contraction compared with throat clearing. The acoustic analysis software has a moderate sensitivity and poor specificity to detect cough. The profile of cough and throat clearing in pressure topography revealed a similar qualitative pattern of pressurization with more vigorous pressure changes and a greater rate of repetitive pressurizations in cough.

Exploring the Action Mechanism and Validation of the Key Pathways of Dendrobium officinale Throat-clearing Formula for the Treatment of Chronic Pharyngitis Based on Network Pharmacology.

This study investigated the molecular action mechanism of a compound herb, also known as the Dendrobium officinale throat-clearing formula (QYF), by using network pharmacology and animal experimental validation methods to treat chronic pharyngitis (CP). The active ingredients and disease targets of QYF were determined by searching the Batman-TCM and GeneCards databases. Subsequently, the drug-active ingredient-target and protein-protein interaction networks were constructed, and the core targets were obtained through network topology. The Metascape database was screened, and the core targets were enriched with Gene Ontology and the Kyoto Encyclopedia of Genes and Genomes. In total, 1403 and 241 potential targets for drugs and diseases, respectively, and 81 intersecting targets were yielded. The core targets included TNF, IL-6, and IL-1ß, and the core pathways included PI3K-Akt. The QYF treatment group exhibited effectively improved general signs, enhanced anti-inflammatory ability in vitro, reduced serum and tissue expressions of TNF-α, IL-6, and IL-1ß inflammatory factors, and decreased blood LPS levels and Myd88, TLR4, PI3K, Akt, and NF-κB p65 protein expression in the tissues. QYF could inhibit LPS production, which regulated the expression of the TLR4/PI3K/Akt/NF-κB signaling pathway to suppress the expression of the related inflammatory factors (i.e., TNF-α, IL-6, and IL-1ß), thereby alleviating the CP process.

Effectiveness of Thymepearls After Vocal Loading in Professional Voice Users: A Randomized Placebo-Controlled Double-Blind Clinical Trial.

OBJECTIVES: Professional voice users depend on their voice for optimal performance of their profession. The aim of this study was to find out to what extent sucking a placebo and thyme represent an improvement of the voice in professional voice users after vocal loading. METHODS: A randomized placebo-controlled clinical double-blind study was conducted with four measurement moments: a premeasurement, immediately after the vocal loading, after the subsequent ingestion of the "thymepearl" (TP) in the experimental group and in the control group the placebo, and after a half-hour break. Finally, 18 subjects were considered, 9 participants in each group. RESULTS: No significant differences in the objective measurements of both groups could be observed. However, significant improvements in subjective measures (perceptions of dry mouth and feeling of hoarseness) could be observed after vocal loading by sucking the thymepearls in direct comparison to the placebo. CONCLUSIONS: Sucking the TP can improve subjective sensation after vocal loading compared with placebo, but no differences are seen on objective vocal measures.

A Detailed Motion Analysis of the Angular Velocity Between the Vocal Folds During Throat Clearing Using High-speed Digital Imaging.

OBJECTIVES: To assess the angular velocity between the vocal folds just before the compression phase of throat clearing (TC) using high-speed digital imaging (HSDI) of the larynx. METHODS: Twenty normal healthy adults (13 males and seven females) were enrolled in the study. Each participant underwent transnasal laryngo-fiberscopy, and was asked to perform weak/strong TC followed by a comfortable, sustained vowel phonation while recording an HSDI movie (4000 frames/s) of the larynx. Using a motion analysis, the changes in the vocal fold angle and angular velocity during vocal fold adduction were assessed. Subsequently, we calculated the average angular velocities in the ranges of 100-80%, 80-20%, and 20-0% from all of the angular changes. RESULTS: The motion analysis demonstrated that the changes in the angular velocity resulted in polynomial-like and sigmoid curves during TC and vowel phonation, respectively. The angular velocities during weak TC were significantly higher in the 20-0%, 80-20%, and 100-80% regions (in order); the 80-20% angular velocity in vocal fold adduction during phonation was highest. The 20-0% angular velocity during strong TC was more than twofold higher than 20-0% angular velocity during phonation. CONCLUSIONS: The present results confirmed that the closing motions of the vocal folds accelerate throughout the precompression closing phase of a TC episode, and decelerate just before the impact between the vocal folds at the onset of phonation, suggesting that the vocal fold velocity generated by TC is sufficient to damage the laryngeal tissues.

Importance of esophageal manometry and pH monitoring for the evaluation of otorhinolaryngologic (ENT) manifestations of GERD. A multicenter study.

BACKGROUND/AIMS: Patients with otorhinolaryngologic (ear, nose, and throat-ENT) symptoms attributed to gastroesophageal reflux disease (GERD) are usually treated with medication based on the findings of nasal endoscopy and laryngoscopy only. This study aims to determine sensitivity and specificity of symptoms, nasal endoscopy, and laryngoscopy for the diagnosis of GERD as compared to pH monitoring. METHODS: We studied 79 patients (mean age 53 years, 38 % males) in whom ENT symptoms were assumed to be secondary to GERD. All patients underwent a transnasal laryngoscopy by the ENT team and upper endoscopy and esophageal function tests by the surgical team. GERD was defined by a pathological pH monitoring. RESULTS: Pathologic reflux by pH monitoring was documented in 36 of the 79 patients (46 %), with a mean DeMeester score of 44. In 25 of the 36 patients (69 %), distal and proximal reflux was present. Among patients with negative pH monitoring, one patient was diagnosed with achalasia. ENT symptom sensitivity for globus, hoarseness and throat clearing was respectively 11, 58, and 33 %; specificity was respectively 77, 42, and 58 %. Positive predictive value for nasal endoscopy and laryngoscopy was 46 %. Among patients with positive pH monitoring, 13 (36 %) had a hypotensive lower esophageal sphincter (p < 0.01) and 27 (34 %) had abnormal peristalsis (p < 0.01). CONCLUSIONS: In conclusion, the results of this study showed that (a) ENT symptoms were unreliable for the diagnosis of GERD and (b) laryngoscopy had a low positive predictive value for the diagnosis of GERD. These data confirm the importance of esophageal manometry and pH monitoring in any patient with suspected ENT manifestations of GERD before starting empiric therapy with acid-reducing medications since pathologic reflux by pH monitoring was confirmed in less than half of the patients with suspected GERD.

Supraesophageal Reflux: Correlation of Position and Occurrence of Acid Reflux-Effect of Head-of-Bed Elevation on Supine Reflux.

BACKGROUND: Supraesophageal reflux of gastric contents can contribute to perennial nasopharyngitis, cough, and asthma. However, effective treatment strategies for supraesophageal reflux disease (SERD) remain inadequately defined. OBJECTIVE: The purpose of this study is to assess the prevalence and timing of SERD and to investigate the efficacy of head-of-bed elevation in its treatment. METHODS: A retrospective chart review of patients seen at Scripps Clinic Division of Allergy, Asthma and Immunology was performed who had undergone overnight nasopharyngeal pH monitoring with a commercially available nasopharyngeal pH-monitoring device, Dx-pH Measurement System from Restech, San Diego, Calif. Subjects with reflux were classified based on the position of reflux as either supine only, upright only, or both supine and upright. In a subset of subjects with supine-only reflux, pH monitoring was compared before and after elevating the head of bed 6 inches. RESULTS: Adequate nasopharyngeal pH-monitoring data were obtained for 235 patients. Reflux was detected in 113 (48%) patients. The pattern of reflux observed was 62 (55%) supine only, 4 (4%) upright only, and 47 (42%) upright and supine. Sequential overnight nasopharyngeal pH monitoring before and after head-of-bed elevation was obtained in 13 individuals with supine-only reflux. Ten subjects demonstrated significant improvement, 8 of whom demonstrated complete resolution of supine reflux with 6 inches of head-of-bed elevation. CONCLUSION: This study provides new evidence that SERD frequently occurs in the supine position and that 6 inches of head-of-bed elevation is effective in reducing supine SERD.