Comparison of transnasal esophagoscopy and sedated esophagogastroduodenoscopy in the assessment of laryngopharyngeal reflux.

OBJECTIVE: Transnasal esophagoscopy (TNE) in the awake patient and esophagogastroduodenoscopy (EGD) in sedation are both used in the assessment of laryngopharyngeal reflux (LPR). The objective of this study was to compare these two endoscopic methods in contributing to the diagnosis of LPR. METHODS: This study included 54 patients presenting with signs and symptoms suspicious for LPR, which were examined both by TNE and EGD. The contribution of each method to the diagnosis of LPR was evaluated separately and then compared with each other. RESULTS: In detecting LPR, TNE showed a significant higher sensitivity (94% vs. 60%) and accuracy (93% vs. 59%) than EGD, but their specificity was equal (50% each). The most common pathologic findings in both methods were a hiatal hernia (70% vs. 48%) and gaping cardia (69% vs. 24%), followed by peptic esophagitis (41% vs. 24%). CONCLUSION: The value of EGD is limited in the workup of LPR, as sedation tends to mask the subtle findings in this kind of reflux disease.

Long-term assessment of auditory changes resulting from a single noise exposure associated with non-occupational activities.

We examined the long-term sequelae in both ears of 42 patients who reported the occurrence of auditory changes resulting from a single exposure to intense sound levels during non-occupational activities. We divided these patients into two groups, based upon noise exposures of either continuous duration or single high-energy impulse. Audiometric data were available for each of these subjects shortly after their noise-exposure events and follow-up examinations took place more than one year after the noise occurrence (range: 1-16 years). The initial median hearing loss for the continuous-type noise exposure group at 3-8 kHz was found to be 9 dB, relative to the age-appropriate norms, in the more affected ears, and hearing function was found to have returned to normal levels at follow-up. The same initial hearing loss was measured for the impulse-type noise group, but a residual hearing loss of 4 dB was measured at follow-up. Furthermore, the majority of the subjects from both groups reported tinnitus and hypersensitivity to sound at follow-up, but with minimal impact on their lives.