RESUMEN
The aim of the article was to study if there is any relationship between globus sensation in the jugular fossa (GJ), intermittent esophageal dysphagia (IED), and the presence of a hiatus hernia, and if GJ can be relieved after hiatus hernia repair. 167 patients with a hiatus hernia (Group A) and 61 other patients with hiatus hernia and gastroesophageal reflux disease who were surgically treated with Nissen fundoplication (Group B), filled in a symptom questionnaire on GJ and IED. GJ was found in 66% and IED in 68% of patients in group A. In group B, 49% had GJ and 64% IED before surgery. At surgical follow-up 16% (P < 0.005) and 43% (P < 0.05) had GJ and IED, respectively. The combination of GJ and IED was found in 28% of IED patients before operation and in 31% at surgical follow-up. The high frequency of GJ in patients with hiatus hernia and the significant relief of GJ after hiatus hernia repair imply that GJ most likely is a referred sensation from the esophagus. IED and GJ are two parallel phenomena in patients with hiatus hernia, but do not seem to have any causal relationship.
Asunto(s)
Trastornos de Conversión/etiología , Trastornos de Deglución/etiología , Deglución/fisiología , Hernia Hiatal/complicaciones , Faringe/fisiopatología , Adulto , Anciano , Trastornos de Conversión/fisiopatología , Trastornos de Deglución/fisiopatología , Diagnóstico Diferencial , Monitorización del pH Esofágico , Esófago/fisiopatología , Femenino , Estudios de Seguimiento , Fundoplicación/métodos , Hernia Hiatal/diagnóstico , Hernia Hiatal/cirugía , Humanos , Laparoscopía , Masculino , Manometría , Persona de Mediana Edad , Faringe/inervación , Presión , Pronóstico , Estudios Prospectivos , Encuestas y Cuestionarios , Factores de TiempoRESUMEN
52 patients with laryngeal carcinoma were studied before and after laryngectomy with regard to what factors might influence the development of oesophageal speech. The investigations consisted of oesophageal manometry, a follow-up interview and a review of surgical approaches and radiotherapy. 43% of the patients achieved socially acceptable oesophageal speech, 22% were able to speak single words, and 35% had no oesophageal speech at all. 61% had post-operative dysphagia. Age was the only factor which significantly correlated to intelligible speech. The intraoesophageal pressure during oesophageal phonation exceeded in all cases the low PO-HPZ pressure after operation. The extension of surgery and radiation field, severity of dysphagia, alcohol and smoking habits, and mental condition did not differ between the 3 groups of oesophageal speech. It was concluded that the rather complicated process of acquiring oesophageal speech is much more dependent on learning ability which decreases with age than on various kinds of motor dysfunction after laryngectomy.