[Laryngotracheitis, recurrent laryngotracheitis and asthma in children: features of ontogenesis and feeding in the first months of life].

UNLABELLED: Objective of research was to study features of ontogenesis and feeding in the first months of life in children with laryngotracheitis (LT), recurrent laryngotracheitis (RLT) and asthma. METHODS: Questionnaire-based survey was performed to collect data on anamnesis of 1004 children aged 6-14 years (575 children with a history of LT, 60 children with asthma, and 369 children of control group) pertaining to preeclampsia in mothers, history of birth asphyxia, preterm birth and feeding during the first months of life in children. Children with LT were divided into two groups: 458 children with 1-3 episodes of LT and 117 children with RLT (4 or more episodes of LT). RESULTS: The frequency of preeclampsia among mothers of children with RLT exceeded the corresponding frequency among mothers of children with 1-3 episodes of LT and children of control group in 2.1 and 2.8 times, respectively. The frequency of birth asphyxia or preterm birth among children with RLT exceeded the corresponding frequency among children with 1-3 episodes of LT and children of control group by a factor of 2. The frequency of breastfeeding initiation after 24 hours of birth among children with asthma or RLT exceeded the corresponding frequency among children with 1-3 episodes of LT (in 1.4 and 1.5 times, respectively) and among children of control group (in 2.4 and 2.6 times, respectively). CONCLUSION: The frequency of preeclampsia in mothers, birth asphyxia, preterm birth and late initiation of breastfeeding among children with RLT exceeded the corresponding frequency among children with 1-3 episodes of LT and children of control group. There was no significant difference between the frequency of preeclampsia in mothers, birth asphyxia, initiation of breastfeeding among children with RLT and children with asthma. Formula feeding in the first months of life was equally often observed among children with LT, RLT and asthma and significantly exceeded the corresponding percentage among children in control group.

[The frequency and clinical aspects of extraesophageal syndromes in elderly patients with gastroesophageal reflux disease].

AIM: To investigate the frequency of extraesophageal syndromes in elderly patients with gastroesophageal reflux disease (GERD). MATERIALS AND METHODS: This cross-sectional study was conducted to compare the clinical manifestations of GERD in 1100 patients aged 60 to 75 years and in 453 patients aged 36 to 60 years. A control group consisted of 154 elderly patients without GERD and 178 mature-aged patients without this condition. GERD was diagnosed via analysis of its symptoms, esophagogastroduodenoscopy, and 24-hour pH monitoring on the basis of the Montreal consensus guidelines. Extraesophageal syndromes were detected actively using the current methods accepted to treat lung, heart, and ENT diseases and a simultaneous gastroesophageal examination. RESULTS: Chronic cough, asthma, chronic laryngitis, cardialgias and cardiac arrhythmias were much more common in elderly patients with GERD than in those without this condition and prevalent in patients with erosive esophagitis and Barrett's esophagus as compared with those with non-erosive reflux disease. The mature-aged patients were recorded to have similar but less pronounced trends. The authors proposed an algorithm for the management of patients with extraesophageal manifestations of GERD, the important aspect of which was two-month acid-suppressive therapy used as both diagnostic testing and empirical treatment for this pathology. CONCLUSION: The extraesophageal manifestations of GERD in elderly patients are a serious clinical problem calling for considerable attention.

[The potential of prophylaxis and optimization of the treatment of rhinosinusitis in the children presenting with stenosing laryngotracheitis].

The objective of the present work was to estimate the clinical, prophylactic, and microbiological effectiveness of fusafungine applied for the treatment of acute rhinosinusitis (ARS) in the children that develops as a consequence of acute stenosing laryngotracheitis. The study included 61 children presenting with ARS and concomitant acute stenosing laryngotracheitis (ASLT) that were treated with fusafungine (Bioparox). Both tolerance and safety of this preparation were evaluated. Fusaferine was prescribed after reduction of pharyngeal stenosis. The children were divided into two groups. Group 1 was comprised of the patients with the respiratory symptoms and rhinosinusitis (n = 36), group 2 consisted of the children with the respiratory symptoms in the absence of rhinosinusitis (n = 25). Subgroups of the children treated with fusafungine and without it were distinguished to estimate the clinical, prophylactic, and microbiological effectiveness of fusafungide. Within the first days after hospitalization, 59% of the children with diagnosis ASLT developed bilateral rhinosinusitis, in all probability of viral etiology. Fusafungine produced the clinically apparent effect in the patients with ASLT regardless of the presence of ARS. Specifically, this preparation decreased the degree of hypertrophy of pharyngeal tonsils three times faster than standard therapy; moreover, it reduced the requirement for systemic antibiotics by 1.9 times. The treatment with fusaferine prevented the development of acute bilateral rhinosinusitis in the children with ASLT and promoted compete decontamination of the nasopharynx from M. catarrhalis, Str. pneumonia, Str. pyogenes, H. influenza, Cor. s the nasopharynx pecies, E. faecalis, and C. albicans. The frequency of adverse reactions of organoleptic character was estimated at 16.6%.

[Laryngopharyngeal reflux and larynx-related symptoms]. / Laryngopharyngealer Reflux und kehlkopfassoziierte Beschwerden.

BACKGROUND: Chronic hoarseness, globus sensation or mucous obstruction are among a wide range of symptoms possibly related to laryngopharyngeal reflux (LPR). METHOD AND RESULTS: A selective literature research was carried out using PubMed, in which original articles and reviews in German and English were included. Altogether, 2541 articles were found. Despite the large number of publications, there are still open questions regarding aspects of LPR. DISCUSSION: It can be assumed that refluxate reaching the larynx can damage it. Due to the fact that the symptoms possibly related to LPR can, however, be linked to other causes, a careful consideration of the patient's medical history is of the utmost importance, followed by mandatory laryngoscopy. Diagnostic procedures, such as the trial administration of proton pump inhibitors (PPI) or long-term pH measurement should be used selectively. Depending on the individual symptoms, breathing or voice therapy and/or PPI therapy might be useful. Lifestyle changes including dietary measures should also be contemplated.

Connections between voice ergonomic risk factors in classrooms and teachers' voice production.

OBJECTIVE: The aim of the study was to investigate if voice ergonomic risk factors in classrooms correlated with acoustic parameters of teachers' voice production. METHODS: The voice ergonomic risk factors in the fields of working culture, working postures and indoor air quality were assessed in 40 classrooms using the Voice Ergonomic Assessment in Work Environment - Handbook and Checklist. Teachers (32 females, 8 males) from the above-mentioned classrooms recorded text readings before and after a working day. Fundamental frequency, sound pressure level (SPL) and the slope of the spectrum (alpha ratio) were analyzed. RESULTS: The higher the number of the risk factors in the classrooms, the higher SPL the teachers used and the more strained the males' voices (increased alpha ratio) were. The SPL was already higher before the working day in the teachers with higher risk than in those with lower risk. CONCLUSION: In the working environment with many voice ergonomic risk factors, speakers increase voice loudness and use more strained voice quality (males). A practical implication of the results is that voice ergonomic assessments are needed in schools.

Laryngeal Mucosa Alterations in Mice Model of Gastroesophageal Reflux: Effects of Topical Protection.

OBJECTIVES/HYPOTHESIS: The objectives of this study were to evaluate laryngeal inflammation and mucosal integrity in a murine model of reflux disease and to assess the protective effects of topical agents including alginate, hyaluronic acid, and cashew gum. STUDY DESIGN: Animal study. METHODS: A surgical murine model of reflux disease was evaluated at 3 or 7 days postsurgery, and laryngeal samples were collected to measure inflammation (wet weight and myeloperoxidase [MPO]) and mucosal integrity (transepithelial resistance [TER] and mucosal permeability to fluorescein). Additional groups of animals were administered one of several topical agents (alginate, hyaluronic acid, or cashew gum) daily, and laryngeal inflammation and mucosal integrity were evaluated at 3 days postsurgery. RESULTS: At 3 days, and not 7 days postsurgery, we observed increased laryngeal wet weight and MPO, decreased laryngeal TER, and increased laryngeal mucosa permeability. Alginate partially decreased laryngeal inflammation (wet weight and not MPO) and dramatically improved laryngeal mucosal integrity. Conversely, hyaluronic acid eliminated the inflammation; however, it had no effect on laryngeal mucosal integrity impairment. Cashew gum eliminated laryngeal inflammation as well as the impairment in laryngeal mucosal integrity. CONCLUSIONS: This study shows that a surgical model of reflux disease induced laryngeal inflammation and impairment in laryngeal barrier function. These observed alterations were partially attenuated by alginate and hyaluronic acid and completely reversed by cashew gum. LEVEL OF EVIDENCE: NA Laryngoscope, 2020.

Postbiotics for Preventing and Treating Common Infectious Diseases in Children: A Systematic Review.

Postbiotics have recently been tentatively defined as bioactive compounds produced during a fermentation process (including microbial cells, cell constituents and metabolites) that supports health and/or wellbeing. Postbiotics are currently available in some infant formulas and fermented foods. We systematically reviewed evidence on postbiotics for preventing and treating common infectious diseases among children younger than 5 years. The PubMed, Embase, SpringerLink, and ScienceDirect databases were searched up to March 2019 for randomized controlled trials (RCTs) comparing postbiotics with placebo or no intervention. Seven RCTs involving 1740 children met the inclusion criteria. For therapeutic trials, supplementation with heat-killed Lactobacillus acidophilus LB reduced the duration of diarrhea (4 RCTs, n = 224, mean difference, MD, -20.31 h, 95% CI -27.06 to -13.57). For preventive trials, the pooled results from two RCTs (n = 537) showed that heat-inactivated L. paracasei CBA L74 versus placebo reduced the risk of diarrhea (relative risk, RR, 0.51, 95% CI 0.37-0.71), pharyngitis (RR 0.31, 95% CI 0.12-0.83) and laryngitis (RR 0.44, 95% CI 0.29-0.67). There is limited evidence to recommend the use of specific postbiotics for treating pediatric diarrhea and preventing common infectious diseases among children. Further studies are necessary to determine the effects of different postbiotics.

Enhanced infection of avian influenza virus H9N2 with infectious laryngeotracheitis vaccination in chickens.

Avian influenza and infectious laryngeotracheitis viruses are common causes of respiratory diseases in chickens with economical importance worldwide. In this study, we investigated the effect of experimental co-infection of avian influenza virus-H9N2 (AIV-H9N2) with infectious laryngeotracheitis virus (ILTV) live-attenuated vaccine (LAR-VAC®) on chickens. Four experimental groups were included in this study: negative control group, AIV-H9N2 group, AIV-H9N2+LAR-VAC® group, and LAR-VAC® group. AIV-H9N2 was inoculated intranasally to challenged groups at 35 days of age. On the same day, LAR-VAC® was ocularly administered to vaccinated groups. Chickens were observed for clinical signs, changes in body weight and mortality rates. Tissue samples, sera, tracheal and cloacal swabs, and blood were also collected at 3, 6, 9 and 12 days post-infection (PI). A significant increase in clinical signs and mortality rates were observed in the AIV-H9N2 + LAR-VAC® group. Moreover, chickens coinfected with AIV-H9N2 and LAR-VAC® showed a significant decrease in body weight and lymphoid organs indices. The tracheal gross and histopathological lesions and the shedding titer and period of AIV-H9N2 were significantly higher in AIV-H9N2 + LAR-VAC® group when compared to other groups. Furthermore, AIV-H9N2 infection leads to humoral and cellular immunosuppression as shown by a significant decrease in the CD4+/CD8+ ratio and antibody responses to ILTV and a significant increase in H/L ratio. In conclusion, this is the first report of co-infection of AIV-H9N2 and ILTV vaccine in chickens, which leads to increased pathogenicity, pathological lesions, and AIV-H9N2 shedding titer and period, which can lead to severe economic losses due to poor weight gain and mortality.

Surgical therapy for supraesophageal reflux complications of gastroesophageal reflux disease.

Supraesophageal complications of gastroesophageal reflux can be successfully treated by antireflux surgery. Careful preoperative testing, including 24-hour esophageal pH, manometry, and endoscopy, will help to identify appropriate patients who will benefit from surgery. The best results are achieved in patients with nocturnal asthma, the onset of reflux before pulmonary symptoms, laryngeal inflammation, and a good response to medical therapy. Cough is more responsive to surgical therapy than is asthma. The benefits of minimally-invasive surgery are evident in patients with pulmonary disease, who have a faster recovery with fewer complications than after open surgery.

Dexamethasone treatment does not ameliorate subglottic ischemic injury in rabbits.

BACKGROUND: Following tracheal intubation, a small proportion of patients develop laryngeal inflammation or tissue necrosis severe enough to result in clinical symptoms. Although corticosteroids are frequently advocated to prevent such injury, human studies have been inconclusive because of the low incidence of the problem. This study developed a rabbit model of endotracheal tube-induced laryngeal injury to test the hypothesis that a corticosteroid, dexamethasone, could ameliorate the inflammation and necrosis. METHODS: Subglottic injury was induced in 21 anesthetized rabbits by inflating the cuff of an endotracheal tube to 100 mm Hg with the cuff just below the vocal cords. Every 30 min for 2 h, the cuff was deflated, the tube turned 90 degrees, and the cuff then reinflated. After 2 h, the rabbits' tracheas were extubated. Rabbits were divided into two groups: the treatment group received dexamethasone (1 mg/kg) i.v. 1 h prior to extubation with the dose repeated 6 h following extubation; the untreated group received a saline solution placebo. Four additional rabbits were anesthetized for the same period but did not have a tracheal tube inserted. All rabbits were killed 24 h later and the larynxes were harvested. Sections through the larynx at the level of the cricoid cartilage were randomized and submitted blindly to a veterinary pathologist. Larynxes were scored and ranked according to the severity of mucosal inflammation and necrosis, and submucosal hemorrhage, edema, inflammation, and necrosis. Specimens were also evaluated for focal vs diffuse disease. RESULTS: Injured rabbits demonstrated focal to diffuse mucosal and submucosal inflammation and necrosis. Inflammatory exudates were present in sections from most of the injured rabbits and large sections of the larynxes were denuded of epithelium. There were no differences in injury scores between the treated and untreated rabbits. The four uninjured control rabbits had normal larynxes. CONCLUSIONS: Two hours of endotracheal tube cuff inflation to 100 mm Hg causes an inflammatory laryngeal injury. The histologic features of the injury are unaltered by treatment with 2 mg/kg dexamethasone.

Changing patterns in pediatric supraglottitis: a multi-institutional review, 1980 to 1992.

Supraglottitis is a rapidly progressive, life-threatening airway emergency in pediatric patients typically caused by Haemophilus influenzae type B (HIB). With distribution of the first efficacious vaccine for HIB in April 1985, changing disease patterns have begun to emerge; however, certain characteristics have remarkably persisted. The authors reviewed 252 pediatric patients with acute supraglottitis spanning the prevaccination and postvaccination years 1980 to 1992 at three major regional pediatric hospitals in Massachusetts, Ohio, and California, as well as at two community hospitals in Massachusetts. Findings include a decline in disease prevalence in all geographic areas with demographic, etiologic, and management evolution all seen. Children who had been immunized yet developed supraglottitis have been examined as predictive of future trends.

Effect of route of vaccination on the prevention of infectious laryngotracheitis in commercial egg-laying chickens.

Commercial egg-laying chickens were vaccinated for infectious laryngotracheitis (ILT) with one of five commercially available vaccines (designated A, B, C, D, and E) on five separate farms by either eyedrop (e), spray (s), or double dose in the water (w) method. Groups were identified by the vaccine designation and the method of vaccination. Birds from the test groups were transferred to an isolation facility and challenged intratracheally 3 wk after vaccination. The remaining birds were given a second vaccination with the original chicken embryo origin vaccine by spray or a chicken embryo origin vaccine if the first vaccine was of tissue culture origin. After challenge, birds were monitored for clinical signs. Those surviving were euthanatized on day 6 postchallenge, and tissues and blood were collected for histopathology, virus isolation, and serology. On the basis of histopathology and enzyme-linked immunosorbent assay (ELISA) results, after one vaccination, all chickens given vaccines by eyedrop were provided better protection than nonvaccinated controls (CTLs). Birds in groups Bs and Ds had lower microscopic lesion scores whereas only birds given Bs had higher ELISA titers than CTLs. Birds in groups As and Cs and groups Bw birds taken from the rear of the barn (r) had microscopic lesion scores that were no different from those of CTLs. These same birds in addition to vaccine Ds had ELISA titers no different from those of CTLs. Of all vaccines, only A given by eyedrop or spray produced higher virus isolation titers than those of CTLs. The remainder of the vaccines produced virus isolation titers that were no different from those of CTLs. After two vaccinations, all groups had lower microscopic lesion scores than CTLs. Only Bw birds from the middle of the barn Bs, EeDs, and AsAs had virus isolation results that were higher than those of CTLs. Only groups BwrBs, CsCs, and DsDs had ELISA titers no different from those of controls. These results suggest that a priming vaccination followed by a booster dose offers better protection against ILT than a single vaccination alone. Vaccine application by eyedrop provides more uniform protection if only one vaccination is given, whereas spray vaccination may serve as an alternative method of vaccination for birds receiving two doses of vaccine.

Hemophilus influenzae epiglottitis occurring concurrently in two siblings.

Epiglottis (more properly supraglottitis) is a potentially life-threatening infection of the supraglottic larynx that is most often caused by Hemophilus influenzae type B (HITB). Intrafamily spread of HITB disease has been described often for meningitis, but is rarely reported in epiglottis. We describe two siblings seen concurrently with HITB epiglottitis and discuss prophylaxis of family members and close contacts.

[Infectious laryngotracheitis (ILT) in Switzerland: recent situation and thoughts about future possibilities for control]. / Die Infektiöse Laryngotracheitis (ILT) in der Schweiz: Aktueller Stand und Gedanken zu zukünftigen Bekämpfungsmöglichkeiten.

This short review highlights the characteristics of infectious laryngotracheitis, the diagnostic methods and the actual disease situation in Switzerland and other European countries. Recommendations for a future control policy are outlined.

Role of steroids in acute phonotrauma: A basic science investigation.

OBJECTIVES/HYPOTHESIS: Steroids are used for the treatment of laryngitis in vocal performers and other individuals despite the absence of evidence demonstrating their impact on vocal fold inflammation. Our objective was to examine laryngeal secretion cytokine inflammatory profile changes associated with corticosteroid treatment in a human phonotrauma model. STUDY DESIGN: Prospective, individual, randomized, double-blinded, controlled trial. METHODS: Participants included 10 healthy females who were randomized to either treatment with oral hydrocortisone or placebo, each given in three doses over 20 hours after the experimental induction of acute phonotrauma. Cytokines associated with inflammation and healing (interleukin [IL]-1ß, IL-6, IL-10) were measured in laryngeal secretions before and after vocal loading and at 4 and 20 hours after treatment. RESULTS: Proinflammatory mediators IL-1ß and IL-6 were doubled in the controls versus the steroid treatment group at 21 hours following induction of acute vocal fold inflammation. Anti-inflammatory cytokine IL-10 showed a 6.3-fold increase in the steroid treatment group versus the controls, indicating anti-inflammatory modulation by steroid treatment. CONCLUSIONS: This study provides biologic evidence supporting the use of steroids for acute vocal fold inflammation associated with phonotrauma. LEVEL OF EVIDENCE: 1b.

Suppressive therapy using azithromycin in 2 rare cases of recurrent staphylococcal infections.

Recurrent staphylococcal skin and soft tissue infections may recur despite decontamination and multiple courses of antibiotic therapy and may dramatically impair the patient's quality of life. We report successful use of long-term azithromycin prophylaxis in a recurrent laryngitis and a scalp folliculitis due to methicillin-susceptible Staphylococcus aureus.

Should antiviral medications be considered preoperatively for microlaryngoscopy in patients with a history of recurrent herpes stomatitis?

Infectious complications following phonomicrosurgery are rare. Reports of herpetic laryngitis are in the literature but none following microlaryngoscopy. We present a case of a 55-year-old female who underwent microsurgical excision of a left vocal fold (VF) lesion and KTP ablation of bilateral vascular ectasias. Postoperative stroboscopy demonstrated severe bilateral VF edema, erythema, and ulcerations of the VFs, encompassing an area greater than the original surgical field. Initial management included voice rest, antibiotics, steroids, and aggressive reflux treatment. The patient experienced prolonged VF edema and poor voice outcome, which ultimately resolved over 6 months. Clinical diagnosis of herpetic laryngitis was presumptively made after the patient revealed a history of relapsing oral herpes incited by stress with a recent episode before microlaryngoscopy. This case highlights the importance of thorough review of a patient's medical history. A protocol for preoperative (prophylactic) antiviral therapy and appropriate timing of surgery is presented for patients with history of herpes infection.

Section four: laryngitis and dysphonia.

Acute laryngitis is most often caused by viral illnesses through direct inflammation of the vocal cords or from irritation due to postnasal drainage. Bacterial infections, such as acute epiglottitis, also can cause dysphonia but typically have other systemic symptoms as well as respiratory distress. Chronic laryngitis is characterized by symptoms lasting more than 3 weeks. Chronic vocal cord issues can be related to overuse or stress on the vocal cords resulting in nodules or polyps. Individuals in certain occupations, such as singers, school teachers, and chemical workers, are at greater risk of chronic laryngitis. The diagnostic approach to chronic laryngitis should include visualization of the vocal cords to rule out potential malignant lesions. For acute and chronic overuse symptoms, the best treatment is vocal rest. The use of antibiotics or decongestants should be discouraged.

Aquaporin changes in compound 48/80 induced inflammatory sublaryngeal edema in rat.

OBJECTIVES/HYPOTHESIS: Laryngeal edema is a common clinical condition. However, the underlying molecular mechanisms remain elusive. Aquaporins (AQPs) are small integral plasma membrane proteins that transport water across the plasma membrane. In this study, we explore the relationship between inflammatory laryngeal edema induced by compound 48/80 and the expression of AQPs. STUDY DESIGN: Prospective, controlled, experimental animal study. METHODS: Healthy adult male SD rats were injected with either sterile water, compound 48/80 (2 mg/kg), or compound 48/80 plus dexamethasone (3 mg/kg) via the tail vein. The larynxes were harvested 10, 30 minutes, and 1 hour after the injection for the measurement of sublaryngeal water content and histological and molecular evaluations. RESULTS: Ten and 30 minutes after the compound 48/80 injection compared with the sterile water injection control groups, the water content in subglottic larynx increased significantly and the tissues were markedly swollen accompanied with inflammatory cell infiltration. AQP1 and AQP5 mRNA decreased significantly. One hour after the compound 48/80 injection, the edema was diminished, but the inflammatory cell infiltration remained. AQP1 was elevated but AQP5 was still lower than controls. Dexamethasone did not significantly reduce laryngeal edema, but significantly reduced inflammatory cells infiltration induced by compound 48/80 injection. Dexamethasone increased the AQP5 level but not AQP1. CONCLUSIONS: AQP1 and AQP5 might play key roles in inflammatory subglottic edema caused by compound 48/80 in rats. AQP1 and AQP5 might be useful molecular targets of clinical treatment of inflammatory laryngeal edema.