ABSTRACT
El reflujo gastroesofágico (RGE) ha sido asociado como causa de laringitis posterior, sin embargo, la evidencia sobre esto es controversial. El objetivo principal es establecer si los pacientes con síntomas y diagnóstico de laringitis posterior, se correlacionan con la existencia de RGE ácido patológico. Objetivo secundario es el estudio del valor predictivo de cada síntoma laríngeo para reflujo ácido patológico...
Gastroesophageal reflux (GER) is syndicated as a cause of posterior laryngitis. However the evidence for the association is weak. Aim: To determine if the presence of posterior laryngitis is associated with GER.
Subject(s)
Humans , Male , Female , Laryngitis/etiology , Gastroesophageal Reflux/complications , Gastroesophageal Reflux/diagnosis , Cross-Sectional Studies , Hydrogen-Ion Concentration , Manometry , Signs and SymptomsABSTRACT
Está demostrado que hay una fuerte asociación entre el reflujo gastroesofágico y el reflujo faringolaríngeo como causantes de enfermedad respiratoria, que puede manifestarse como disfonía, estridor, tos, laringitis recurrente, obstrucción bronquial, laringoespasmo y eventos de aparente amenaza para la vida (ALTE). Estas manifestaciones pueden ser leves o graves y potencialmente mortales. Se presentan los casos de dos pacientes con laringitis grave que requirieron intubación endotraqueal, a uno de los cuales se le realizó una traqueotomía. Se describen los métodos diagnósticos, sus limitaciones y la evolución presentada por los pacientes
There is a strong association between gastroesophageal reflux and pharyngolaryngeal reflux as factors leading to respiratory disease, manifested as dysphonia, wheezing, coughing, recurrent laryngitis, bronchial obstruction, laryngospasm and apparent life-threatening events (ALTEs). These manifestations can be mild or severe and may sometimes put the patients life at risk. We present two cases of patients with severe laryngitis who required endotracheal intubation, one of which underwent tracheostomy. The diagnostic methods and their limitations and the patients outcomes are described.
Subject(s)
Humans , Male , Female , Infant, Newborn , Gastroesophageal Reflux/complications , Laryngitis/etiology , Severity of Illness Index , AlgorithmsABSTRACT
Les laryngites chroniques correspondent a une inflammation de la muqueuse laryngee d'une duree superieure a quinze jours. Leur frequence est difficile a apprecier. Le risque de transformation maligne a implique un interet particulier a cette pathologie avec une prise en charge rigoureuse en detectant les facteurs de risque et assurant une surveillance reguliere a long terme des lesions precancereuses. Leur prise en charge; doit identifier precisement ces lesions a l'aide d'une videoscopie laryngee et/ou d'une videostroboscopie. L'appreciation endoscopique des lesions laryngees; en recourant selon les possibilites a l'autofluorescence; est un imperatif qui permet; outre de classer la pathologie; de proposer dans le meme temps un traitement adapte. a cet effet; l'avenement des techniques lasers a constitue une avancee therapeutique dans la prise en charge de ces lesions. Le but de notre travail est rappeler l'ethiopathogenie; exposer les moyens de diagnostic; de traitement des laryngites chroniques et d'etablir un protocole de surveillance adequat en se referant a la litterature
Subject(s)
Endoscopy , Laryngitis/diagnosis , Laryngitis/etiology , StroboscopyABSTRACT
We present the problem of viral croup or acute laryngotracheitis as an important respiratory issue in children that often prompts parents to seek physician consultation. Despite its frequency, there is still controversy among the medical team regarding its treatment. The problem will be defined and analyzed in-depth in terms of pathogenesis, to finally suggest a simple, clinically effective treatment than can be applied in any emergency service. We highlight the importance of epinephrine and corticosteroids in the acute treatment of these patients...
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Croup/epidemiology , Croup/prevention & control , Laryngitis/diagnosis , Laryngitis/epidemiology , Laryngitis/etiology , Laryngitis/prevention & control , Laryngitis/therapyABSTRACT
La laringitis aguda en niños es una patología frecuente, autolimitada, de breve duración: 2 a 7 días, causada por virus como influenza A y B, parainfluenza 1, 2 y 3, virus respiratorio sincitial (VRS) y adenovirus.Las infecciones prolongadas pueden involucrar otros patógenos; han sido reportados algunos casos de laringitis causadas por infecciones herpéticas, sobre todo por el virus herpes simple tipo 1 (VHS-1).Se sugiere la evaluación endoscópica de la vía aérea en casos de laringitis prolongadas para el diagnóstico e implementar medidas terapéuticas específicas para evitar complicaciones potencialmente graves. El uso de aciclovir ha demostrado ser efectivo en el tratamiento, siendo controvertido el uso de corticoides y antibióticos.Se presenta el caso de una niña de 7 meses con laringitis por Herpes virus, tratado con aciclovir...
Subject(s)
Humans , Female , Infant , Acyclovir/therapeutic use , Stomatitis, Herpetic/complications , Stomatitis, Herpetic/diagnosis , Stomatitis, Herpetic/therapy , Laryngitis/diagnosis , Laryngitis/etiology , Herpesvirus 1, HumanABSTRACT
BACKGROUND: Gastro-esophageal reflux (GERD) is highly prevalent in children and there is a tendency to disappear or decrease its frequency in the first year. However, in certain circumstances this reflux can have adverse consequences and these cases are known as gastro-esophageal reflux disease (GERD). The clinical manifestations of GERD include typical and atypical or extra digestive symptoms. The association between GERD and chronic laryngeal symptoms may present clinically as recurrent croup, stridor, chronic or intermittent hoarseness, globus sensation, excessive chronic cough and posterior rhinorrhea. Multi-channel intraluminal impedance-pH 24 hours (IIM-pH 24h) is the diagnostic method of choice for the study of this association. OBJECTIVE: To describe the behavior and characteristics of GERD in patients with recurrent laryngitis. MATERIAL AND METHODS: This is a retrospective study involving pediatric patients with recurrent laryngitis (2 or more episodes in 6 months) referred for study of possible GERD. RESULTS: We evaluated 28 children. Only 7 of them had normal studies. CONCLUSION: There is a significant percentage of patients with normal 24 hour Ph monitoring that had not been diagnosed with GERD without IIM. There was not a characteristic pattern.
Subject(s)
Electric Impedance , Laryngitis/etiology , Gastroesophageal Reflux/complications , Child , Retrospective Studies , Female , Humans , Male , Esophageal pH Monitoring , Child, Preschool , Recurrence , Gastroesophageal Reflux/diagnosisABSTRACT
É sabido que hábitos alimentares inadequados e diversos tipos de alimentos predispõem ao refluxo-gastroesofágico e consequentemente ao laringo-faríngeo. O presente trabalho justifica-se por não existirem dados locais a respeito do problema em questão e tem como objetivos: detectar as manifestações laríngeas do refluxo laringo-faríngeo com os hábitos alimentares da população manauense...
It is know that inadequate eating habits and diverse types of foods lead to gastroesophageal reflux and so to the pharyngolaryngeal. The present work is justified for the lack of local data regarding the problem and aims: to detecte the manifestations of laryngeal-pharynx: to determine eating habits of the manauenses (people from Manaus) which damage laryngeal-pharynx structure...
Subject(s)
Humans , Male , Female , Adult , Laryngeal Diseases/classification , Feeding Behavior , Gastroesophageal Reflux/classification , Brazil , Laryngitis/etiologyABSTRACT
Os mecanismos fisiopatológicos do refluxo laringofaríngeo (RLF) são pouco conhecidos. O Fator de Crescimento Epidérmico (EGF) é a proteína de produção salivar com maior ação na regeneração do epitélio da orofaringe e tubo digestivo alto, tendo sido demonstradas deficiências em sua concentração salivar em indivíduos com RLF. OBJETIVO: Comparar a concentração salivar de EGF em um mesmo indivíduo com RLF antes e após o tratamento. MATERIAL E MÉTODO: Neste estudo prospectivo doze indivíduos com DRGE e RLF de moderada intensidade tiveram sua saliva espontânea coletada antes e após o tratamento e controle da doença. A concentração salivar de EGF foi estabelecida através de exame de ELISA (Quantikine ®). RESULTADOS: Onze pacientes eram do sexo feminino e um do sexo masculino, com idade média de 49 anos. A concentração salivar de EGF pré-tratamento foi de 2.867,6pg/mL e a pós-tratamento foi 1.588,5pg/mL, sendo esta diferença estatisticamente significante (p=0,015). DISCUSSÃO E CONCLUSÕES: Apesar de a concentração salivar de EGF ser maior nos indivíduos antes do tratamento, esta não consegue alcançar àquela de uma população normal (estabelecida previamente), o que sugere uma deficiência primária deste importante fator de defesa em indivíduos com RLF.
The Laryngopharyngeal Reflux (LPR) physiopathology is still unknown. The Epidermal Growth Factor (EGF) is a biologically active salivary protein that aids in the rapid regeneration of the oropharyngeal and upper digestive tract mucosas. Salivary deficiency of this protein in patients with LPR has been demonstrated in previous studies. AIM: To compare salivary EGF concentration in patients with LPR before and after treatment. MATERIALS AND METHODS: In this prospective study twelve patients with GERD and moderate LPR were studied. Whole saliva samples were collected before and after treatment and salivary EGF concentration was determined using a commercially available ELISA kit (Quantikine ®). RESULTS: There were eleven females and one male among the patients, the mean age was 49 years. The mean pre-treatment salivary EGF concentration was 2,867.6 pg/mL and the mean post treatment EGF concentration was 1,588.5 pg/mL. This difference was statistically significant (p=0.015). DISCUSSION AND CONCLUSIONS: Although salivary EGF concentrations are higher before LPR treatment, the concentration is still much lower than the mean salivary EGF concentration in normal individuals without LPR, which suggests a primary disorder of this defense factor in individuals with LPR.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Epidermal Growth Factor/analysis , Gastroesophageal Reflux/complications , Laryngitis/metabolism , Saliva/chemistry , Chronic Disease , Enzyme-Linked Immunosorbent Assay , Gastroesophageal Reflux/drug therapy , Laryngitis/drug therapy , Laryngitis/etiology , Prospective Studies , Severity of Illness IndexABSTRACT
A doença do refluxo gastroesofágico freqüentemente se apresenta com pirose e regurgitação, os chamados sintomas típicos. Porém, um subgrupo de pacientes apresenta um conjunto de sinais e sintomas que não estão relacionados diretamente ao dano esofágico. A esse conjunto dá-se o nome de manifestações extra-esofágicas da doença do refluxo gastroesofágico. Compreendem, principalmente, broncoespasmo, tosse crônica e alterações inflamatórias na laringe (chamados manifestações atípicas). Apesar de essas manifestações formarem um grupo heterogêneo, algumas considerações gerais englobam todos os subgrupos: embora a associação entre a doença do refluxo gastroesofágico e as manifestações extra-esofágicas esteja bem estabelecida, uma relação entre causa e efeito definitiva ainda não está elucidada; em relação à patogênese das manifestações extra-esofágicas, os principais mecanismos propostos são a injúria direta do tecido extra-esofágico pelo conteúdo ácido gástrico refluído e o reflexo esôfago-brônquico mediado pelo nervo vago; a doença do refluxo gastroesofágico pode não ser incluída no diagnóstico diferencial do grupo de pacientes que apresenta somente os sintomas atípicos. Este artigo revisa as manifestações extra-esofágicas da doença do refluxo gastroesofágico encontradas na literatura, discutindo a epidemiologia, patogênese, diagnóstico e tratamento, com foco nas apresentações mais estudadas e estabelecidas.
Subject(s)
Humans , Gastroesophageal Reflux/complications , Lung Diseases/etiology , Otorhinolaryngologic Diseases/etiology , Asthma/diagnosis , Asthma/etiology , Asthma/therapy , Chronic Disease , Cough/diagnosis , Cough/etiology , Cough/therapy , Fundoplication , Gastroesophageal Reflux/therapy , Laparoscopy , Laryngitis/diagnosis , Laryngitis/etiology , Laryngitis/therapy , Lung Diseases/diagnosis , Lung Diseases/therapy , Otorhinolaryngologic Diseases/diagnosis , Otorhinolaryngologic Diseases/therapy , Pulmonary Fibrosis/diagnosis , Pulmonary Fibrosis/etiology , Pulmonary Fibrosis/therapyABSTRACT
INTRODUÇÃO: A Doença do Refluxo Gastroesofágico (DRGE) é a doença digestiva mais prevalente da atualidade e, recentemente, tem sido implicada em uma gama de alterações do seguimento laringofaríngeo (RLF). No entanto, pouco se sabe dos mecanismos fisiopatológicos destas manifestações supraesofágicas da DRGE. Os achados clínicos contraditórios e recentes pesquisas sugerem haver deficiências na capacidade de defesa deste seguimento. Uma das principais responsáveis pela homeostase da mucosa oral e do trato digestivo é a saliva com seu conteúdo orgânico e inorgânico. Tanto alterações do pH quanto do volume salivar já foram correlacionados com os sintomas e sinais sugestivos da DRGE e RLF. Estudo recente de nossa autoria demonstra diminuição estatisticamente significante do pH salivar de indivíduos com RLF quando comparado a controles sem a doença. Outro estudo constatou correlação entre a redução do volume X pH da saliva em indivíduos com DRGE, estando esta redução diretamente relacionada aos níveis de pH esofágico constatados durante pH-metria esofágica de 24 horas. OBJETIVOS: Avaliar como se comportam o pH e volume da saliva em um mesmo indivíduo com DRGE e RLF antes e após o tratamento clínico. MATERIAL E MÉTODO: Vinte e três pacientes com RLF tiveram o pH e volume da saliva total testados antes e após receberem tratamento com droga bloqueadora de bomba de prótons durante 12 semanas. RESULTADOS: Houve uma diferença estatisticamente significante (p<0,001) entre o pH da saliva antes e após o tratamento, estando este maior após o controle clínico da doença. O volume de saliva no paciente tratado foi significativamente maior do que no paciente pré-tratamento (p=0.009). DISCUSSÃO: Os achados sugerem que o pH salivar é influenciado pela presença de refluxo gastroduodenal à região laringofaríngea. Caso estudos futuros com populações maiores realmente comprovem esta correlação, poderemos cogitar a possibilidade de usar a mensuração do pH salivar, que é feita de forma rápida e não invasiva, como um meio de diagnosticar e avaliar o comportamento e controle do Refluxo Laringofaríngeo.
INTRODUCTION: Gastroesophageal Reflux Disease (GERD) is the most prevalent digestive disease of the modern society and has been associated with abnormalities in the larynx and pharynx (LPR). Nonetheless, little is known about the mechanisms involved in this atypical form of the disease. Contradictory clinical data suggest a defense deficit at this segment. Saliva with its organic and inorganic components is responsible for the homeostasis of the oral mucosa and the digestive tract. Salivary pH and volume abnormalities have been linked to laryngopharyngeal symptoms of GERD and LPR. In a recent study we demonstrated significant salivary pH reduction in patients with LPR. Another study found correlation between reduced salivary pH and volume directly related to esophageal pH-metry results. AIM: To evaluate salivary pH and volume before and after clinical treatment of LPR. MATERIAL AND METHOD: Twenty-three adults with LPR had total fasting saliva tested before and after a 12-week course of oral proton pump inhibitor. RESULTS: A statistically significant difference was found in salivary pH before and after treatment with increase of pH values after control of the disease (p<0.001). Salivary volumes of treated patients were also significantly higher than in pre-treated patients (p=0.009). DISCUSSION: These findings suggest that salivary pH and volume are influenced by the presence of gastroesophageal contents and that salivary pH monitoring can potentially become a cost-effective method for diagnosing and controlling LPR.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Proton Pumps/antagonists & inhibitors , Pharyngitis/diagnosis , Laryngitis/diagnosis , Omeprazole/therapeutic use , Saliva/chemistry , Proton Pumps/pharmacology , Chronic Disease , Hydrogen-Ion Concentration/drug effects , Pharyngitis/drug therapy , Pharyngitis/etiology , Laryngitis/drug therapy , Laryngitis/etiology , Manometry , Monitoring, Physiologic , Omeprazole/pharmacology , Gastroesophageal Reflux/complications , Gastroesophageal Reflux/drug therapy , Saliva/drug effects , SalivaABSTRACT
Objetivo. Determinar el flujograma para el diagnóstico oportuno de las inmunodeficiencias congénitas primarias, basado en las manifestaciones otorrinolaringológicas crónicas recurrentes de difícil control, con o sin enfermedades sistémicas asociadas. Material y método. Estudio retrospectivo, descriptivo y observacional que incluyó a pacientes con diagnóstico de inmunodeficiencia primaria conocida. Se revisaron los expedientes clínicos para conocer su evolución y tratamiento médico-quirúrgico. Resultados. Se encontraron 10 pacientes con diagnóstico de algunas inmunodeficiencias primarias; esto se hizo con base en los síntomas infecciosos otorrinolaringológicos crónicos recurrentes de díficil control; fueron seis hombres y cuatro mujeres entre los cuatro y 36 años de edad. Se encontraron las siguientes inmunodeficiencias: una de hiper IgM, tres por IgG, tres comunes variables, un déficit con C3 del complemento, dos de IgA más atopia. Conclusiones. La sinusitis crónica o recurrente y la otitis media crónica o recurrente pueden ser las únicas manifestaciones de un paciente con inmunodeficiencia primaria. La evaluación inmunológica debe incluir, por lo menos: biometría hemática completa con diferencial, niveles séricos de inmunoglobulinas, al igual que subclases de IgG, C4 y C3 del complemento, respuesta a inmunización con proteínas (difteria y tétanos), y antígenos polisacáridos (pneumovax)
Subject(s)
Humans , Male , Female , Child, Preschool , Adolescent , Adult , Bacterial Infections/immunology , Bacterial Infections/microbiology , Immunoglobulins , Immunoglobulins/blood , Laryngitis/etiology , Laryngitis/immunology , Otitis/etiology , Otitis/immunology , Immunologic Deficiency Syndromes/classification , Immunologic Deficiency Syndromes/complications , Immunologic Deficiency Syndromes/immunology , Sinusitis/etiology , Sinusitis/immunologyABSTRACT
Recently, increased incidence of outbreaks of infectious laryngotracheitis [ILT] was observed among chicken flocks in Egypt. These were associated with variable high mortalities. Investigation of 8 such outbreaks revealed that three nonvaccinated replacement layer pullets of 6-8 weeks of age were severely affected with mortality rates of 11-12% up to 40%, while in a 4[th] pullet flock of 24 weeks of age, which was comparatively milder and resulted in only 2% mortality. On the other hand, in four commercial broiler flocks of 5-7 weeks of age with no history of previous vaccination, the disease varied in severity and mortalities [7.6 - 18.0%]. Eight isolates were recovered from these outbreaks and were identified as those of ILTV. Pathogenicity tests for two representative isolates from pullets and broilers were carried out by inoculation of each intratracheally into susceptible chickens of the respective types [egg and meat-type], morbidity and mortality rates were used to calculate an intratracheal pathogenicity index used the same as that described for Newcastle disease virus, in addition to microscopic tracheal lesion scoring as criteria for judging their pathogenicity. Results indicated that both isolates were pathogenic like wild ILT field viruses. Reversed virulence of modified live vaccine viruses was speculated under prevailing conditions of suboptimal management practices, hygiene and biosecurity measures which help spread of infection between flocks, beside the role of latently infected carrier birds and other factors in the epizootiology of the disease, especially in nonvaccinated flocks, were discussed
Subject(s)
Animals, Laboratory , Tracheitis/veterinary , Chickens , Infections/veterinary , Disease Outbreaks , Laryngitis/etiology , Tracheitis/etiologySubject(s)
Humans , Animals , Cattle , Helminthiasis/complications , Laryngitis/parasitology , Laryngitis/etiologyABSTRACT
Relata-se o caso de um portador assintomático de Glicogenose tipo I com otites e laringites de repetiçäo, furunculose, broncopneumonia e derrame pleural, que evoluiu para septecemia e êxito letal. A maneira pela qual o caso se apresentou, constituindo, basicamente, um achado de necrópsia, despertou interresse da equipe no sentido de ficar mais atenta a quadros de infecçöes de repetiçäo em que a glicogenose é uma possibilidade diagnóstica