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.

Evaluation of Oropharyngeal pH-Monitoring in the Assessment of Laryngopharyngeal Reflux.

BACKGROUND: Laryngopharyngeal reflux (LPR) is a prevalent disorder. The aim of the present retrospective cohort study was to evaluate oropharyngeal pH-monitoring using a novel scoring system for LPR. METHODS: In a total of 180 consecutive patients with possible LPR, reflux symptom index (RSI), reflux finding score (RFS), oropharyngeal pH-monitoring and transnasal esophagoscopy were carried out for further investigation. RESULTS: In our series, 99 (55%) patients had severe LPR, 29 (16%) cases presented with moderate and 23 (13%) with mild severity, 9 (5%) subjects revealed neutral values, and 7 (4%) individuals were alkaline, while 13 (7%) patients had no LPR. In detecting LPR, the sensitivity, specificity and accuracy of oropharyngeal pH-monitoring was 95%, 93% and 94%, respectively. CONCLUSION: Oropharyngeal pH-monitoring is a reliable tool in the assessment of LPR, but the pH graphs have to be precisely analyzed and interpreted in context with other validated diagnostic tests.

Smell and taste loss in COVID-19 patients: assessment outcomes in a Victorian population.

Background: It has been noted that olfactory and gustatory disturbances may precede or accompany the typical features of COVID-19, such as fever and cough. Hence, a high index of suspicion is required when patients report sudden loss of smell or taste, in order to facilitate timely diagnosis and isolation.Aims/objectives: The aim of this study was to assess the frequency of olfactory and gustatory disturbances in COVID-19 positive patients from a cohort representative of Melbourne, Australia.Methods: A retrospective descriptive study was conducted on patients who tested positive for COVID-19. Standardised phone consultations and online follow-up questionnaires were performed to assess clinical features of COVID-19, with a focus on smell and taste disorders.Results: The most frequent symptoms experienced were taste and smell disturbances with 74% experiencing either smell or taste disturbance or both. Post-recovery, 34% of patients continued to experience ongoing hyposmia and 2% anosmia, whereas 28% continued to suffer from hypogeusia or ageusia.Conclusion and significance: This study presents the high rates of improvement of both olfactory and gustatory disturbance in a short-lived period. It also highlights the importance of these symptoms in prompting appropriate testing, quarantine precautions, initiate early olfactory retraining and the potential for continued sensory disturbance.

Evaluation of ultrasound and fine-needle aspiration in the assessment of head and neck lesions.

PURPOSE: Neck masses of uncertain character need further investigation through imaging and tissue sampling. This is the most extensive study in the literature of clinician-operated ultrasound and fine-needle aspiration (US + FNA) of the head and neck with histological verification, itemized into organ system. The purpose of the present study was to comprehensively evaluate the combination of US + FNA in the assessment of various kinds of head and neck lesions in the hand of the clinician in one single study. METHODS: A total of 408 histologically verified head and neck lesions in 376 consecutive patients undergoing all three diagnostic steps (US, FNA, US + FNA) were included. Excisional biopsy or core-needle biopsy served as a gold standard. US and FNA were evaluated alone and in combination to distinguish between malignant and benign lesions as well as to establish an approximate and specific diagnosis. Each calculation was itemized by organ system. RESULTS: In detecting malignancy, US + FNA showed a significantly higher accuracy (97% vs 86% and 92%) than US and FNA alone. An approximate diagnosis was established in 93%, and a specific diagnosis in 88%, which was significantly better than that of US and FNA alone. CONCLUSION: US + FNA is suited for an efficient evaluation of head and neck masses. This combined method should be the first line of investigation in such lesions before any other imaging and/or sampling methods. While discrepancies in diagnostic findings potentially occur, the key is the interpretation of the package (US and cytologic findings, clinical information) made in one consultation by one clinician to proceed in proper decision making regarding an adequate treatment plan. Consequently US + FNA belong to the standard armamentarium of the otolaryngologist.