The Diagnostic Usefullness of the Salivary Pepsin Test in Symptomatic Laryngopharyngeal Reflux.

OBJECTIVE: Laryngopharyngeal Reflux (LPR) is a disease characterized by the presence of symptoms, signs and tissue alterations in the aero-digestive upper tract as a consequence of the gastric contents retrograde movement. In most cases diagnosis is clinical and it is established by the presence of symptoms and endoscopic laryngeal signs. The aim of the study was to determine the sensitivity, specificity, positive and negative Likelihood Ratio (LR) of the salivary pepsin assay (PEP-test, RD Biomed, Hull, UK) as diagnostic tool of LPR. STUDY DESIGN: Diagnostic Accuracy Study. METHOD: 221 subjects aged between 26 and 68 years were recruited. All subjects completed the Reflux Symptom Index scale. PEP-test was carried out on fasting subjects, and a second test was performed one hour after the main meal, only on those subjects with a fasting negative result. RESULTS: Fasting PEP-test showed a 98% specificity, 40% sensitivity, positive LR of 16.4 and negative LR of 0.61. The use of both PEP-test showed a 95% specificity, 48% sensitivity, positive LR of 9.61 and negative LR of 0.55. CONCLUSIONS: The PEP-test is a simple, inexpensive, non-invasive and easily reproducible test that should be considered as an alternative diagnosis tool for LPR diagnosis. When there is a clinical suspicion of LPR disease, a positive result on the test could be considered diagnostic, but on subjects with negative results it should be complemented with more complex tests such as the 24-hour dual-channel pH-metry.

Valoración de la reacción emocional provocada por la prueba vestibular calórica mediante monitorización de variables fisiológicas / Emotional reaction evaluation provoked by the vestibular caloric test through physiological variables monitoring

INTRODUCCIÓN Y OBJETIVOS: La valoración emocional que provoca el vértigo se realiza mediante la historia clínica y diversos cuestionarios subjetivos. El objetivo del presente trabajo es valorar la respuesta emocional de forma objetiva, en sujetos normales, durante la crisis de vértigo inducida. MATERIAL Y MÉTODO: Se realizó la prueba vestibular calórica con agua fría en 30 sujetos sanos. Durante los 60 s previos a la estimulación y los 60 s posteriores a la misma se monitorizaron las siguientes variables fisiológicas: Conductabilidad cutánea, Volumen de pulso periférico, Temperatura corporal, Contracción muscular, Frecuencia cardiaca y Frecuencia respiratoria. Se valoró la velocidad angular máxima de la fase lenta del nistagmo provocado en cada estimulación. RESULTADOS: Durante las crisis de vértigo, la conductabilidad cutánea presentó un aumento estadísticamente significativo con relación al periodo previo a las mismas, mientras que el volumen de pulso periférico presentó una disminución estadísticamente significativa. No hubo relación entre la velocidad angular de la fase lenta del nistagmo provocado y los cambios de la conductabilidad y el volumen de pulso periférico. La disminución provocada en el volumen de pulso periférico fue significativamente mayor en la segunda crisis de vértigo. CONCLUSIONES: La conductabilidad cutánea y el volumen de pulso periférico cambiaron de forma significativa durante las crisis de vértigo. No Hubo relación entre la intensidad de la crisis vertiginosa provocada y los cambios producidos en estas variables. El estrés generado por la estimulación calórica es mayor en la segunda crisis, cuando el sujeto tiene experiencia del vértigo que provoca la estimulación

INTRODUCTION AND OBJECTIVES: The emotional evaluation of the causes of vertigo is made using the clinical records and several subjective questionnaires. The aim of the present study is to evaluate the emotional response objectively, in normal subjects, during an induced vertigo crisis. MATERIAL AND METHOD: A caloric vestibular test with cold water was performed on 30 healthy subjects. The following physiological parameters were monitored during the 60 seconds prior to and the 60 seconds after the stimulation: Skin Conductivity, Peripheral Pulse Volume, Body Temperature, Muscle Contraction, Heart Rate, and Respiratory Rate. The maximum angular speed of the nystagmus slow phase at each stimulation was assessed. RESULTS: Skin conductance presented a statistically significant increase during the vertigo crisis in relation to the prior period while the peripheral pulse volume presented a statistically significant decrease. There was no relationship between the slow phase of the provoked nystagmus angular speed and skin conductance and peripheral pulse volume changes. The decrease in peripheral pulse volume was significantly higher in the second vertigo crisis. CONCLUSIONS: Skin conductance and peripheral pulse volume changed significantly during a vertigo crisis. There was no relation between the provoked vertiginous crisis intensity and the changes produced in those variables. The stress generated by the caloric stimulation is higher in the second crisis, when the subject has experience of the vertigo caused by the stimulation

Test de pepsina en saliva: prueba útil y sencilla para el diagnóstico del reflujo faringo-laríngeo / Salivary Pepsin Test: Useful and simple tool for the laryngopharyngeal reflux diagnosis

Introducción y objetivos: El reflujo faringo-laríngeo (RFL) es una enfermedad caracterizada por la presencia de síntomas, signos y alteraciones tisulares, consecuencia del movimiento retrógrado del contenido gastrointestinal hacia el tracto aerodigestivo superior. Representa hasta el 10% de las consultas en otorrinolaringología. El objetivo de nuestro trabajo es describir los hallazgos obtenidos al aplicar el test de determinación de pepsina en saliva (PEP-test) en una muestra de pacientes con signos clínicos sugestivos de RFL. Material y métodos: En nuestro estudio clínico descriptivo se han incluido 142 sujetos con síntomas sugestivos de RFL que obtuvieron puntuaciones por encima de 13 en la escala RSI. A todos ellos se les realizó una endoscopia laríngea para descartar otras enfermedades que pudieran justificar los síntomas y el PEP-test. Ésta se realizó en ayunas a todos los sujetos, y en aquellos con resultados negativos se realizó una segunda determinación una hora después de comer. Resultados: Los resultados obtenidos en las pruebas realizadas en los 142 sujetos incluidos fueron los siguientes: 105 pacientes (73,94%) presentaron resultados positivos en alguna de las determinaciones de pepsina en saliva y en 37 sujetos (26,06%) los resultados de ambas determinaciones fueron negativos. Conclusión: El PEP-test es un método sencillo, económico, no invasivo y fácilmente repetible que podría minimizar el uso de tratamientos empíricos y pruebas invasivas para el diagnóstico del RFL, si bien son necesarias más investigaciones para la validación del mismo (AU)

Introduction and objectives: Laryngopharyngeal Reflux (LPR) is a disease characterized by the presence of symptoms, signs and tissue damage caused by retrograde flow of gastric contents to the upper aerodigestive tract. It represents up to 10% of otolaryngology consultations. The aim of the study is to describe the findings obtained by applying the salivary pepsin test (PEP-test) in a sample of patients with the clinical suspicion of LPR. Material and methods: Our descriptive clinical study included 142 subjects with symptoms suggestive of LPR and a score above 13 on the RSI scale. The subjects underwent laryngeal endoscopy to rule out other pathologies that could justify the symptoms and the salivary pepsin test (PEP-test). The latter was carried out on fasting subjects and a second test one hour after eating, only on those with negative results. Results: The results obtained in the tests performed on the 142 patients included in the study were: 105 (73.94%) presented positive results in some of the salivary pepsin tests and the results of both tests were negative in 37 subjects (26.06%). Conclusion: The salivary pepsin test is a simple, low-cost, non-invasive and easily repeatable tool which could minimize empirical treatments and invasive tests for LPR diagnosis, although further research is needed for its validation (AU)

Emotional reaction evaluation provoked by the vestibular caloric test through physiological variables monitoring. / Valoración de la reacción emocional provocada por la prueba vestibular calórica mediante monitorización de variables fisiológicas.

INTRODUCTION AND OBJECTIVES: The emotional evaluation of the causes of vertigo is made using the clinical records and several subjective questionnaires. The aim of the present study is to evaluate the emotional response objectively, in normal subjects, during an induced vertigo crisis. MATERIAL AND METHOD: A caloric vestibular test with cold water was performed on 30 healthy subjects. The following physiological parameters were monitored during the 60seconds prior to and the 60seconds after the stimulation: Skin Conductivity, Peripheral Pulse Volume, Body Temperature, Muscle Contraction, Heart Rate, and Respiratory Rate. The maximum angular speed of the nystagmus slow phase at each stimulation was assessed. RESULTS: Skin conductance presented a statistically significant increase during the vertigo crisis in relation to the prior period while the peripheral pulse volume presented a statistically significant decrease. There was no relationship between the slow phase of the provoked nystagmus angular speed and skin conductance and peripheral pulse volume changes. The decrease in peripheral pulse volume was significantly higher in the second vertigo crisis. CONCLUSIONS: Skin conductance and peripheral pulse volume changed significantly during a vertigo crisis. There was no relation between the provoked vertiginous crisis intensity and the changes produced in those variables. The stress generated by the caloric stimulation is higher in the second crisis, when the subject has experience of the vertigo caused by the stimulation.

Salivary Pepsin Test: Useful and simple tool for the laryngopharyngeal reflux diagnosis. / Test de pepsina en saliva: prueba útil y sencilla para el diagnóstico del reflujo faringo-laríngeo.

INTRODUCTION AND OBJECTIVES: Laryngopharyngeal Reflux (LPR) is a disease characterized by the presence of symptoms, signs and tissue damage caused by retrograde flow of gastric contents to the upper aerodigestive tract. It represents up to 10% of otolaryngology consultations. The aim of the study is to describe the findings obtained by applying the salivary pepsin test (PEP-test) in a sample of patients with the clinical suspicion of LPR. MATERIAL AND METHODS: Our descriptive clinical study included 142 subjects with symptoms suggestive of LPR and a score above 13 on the RSI scale. The subjects underwent laryngeal endoscopy to rule out other pathologies that could justify the symptoms and the salivary pepsin test (PEP-test). The latter was carried out on fasting subjects and a second test one hour after eating, only on those with negative results. RESULTS: The results obtained in the tests performed on the 142 patients included in the study were: 105 (73.94%) presented positive results in some of the salivary pepsin tests and the results of both tests were negative in 37 subjects (26.06%). CONCLUSION: The salivary pepsin test is a simple, low-cost, non-invasive and easily repeatable tool which could minimize empirical treatments and invasive tests for LPR diagnosis, although further research is needed for its validation.

¿Cómo analizar un Potencial evocado Miogénico Vestibular? Aplicación de un método no lineal / How to analyse a Vestibular Evoked Myogenic Potential? Applying a non-lineal method

Introducción: El propósito de este artículo es investigar la utilidad clínica de las redes neurales artificiales como alternativa a la interpretación del potencial evocado miogénico vestibular (VEMP). Métodos: Para ello se diseña una aplicación informática que implementa una red neural que reproduce e interpreta el potencial vestibular a estudio, ofreciendo un error estimado de su propia interpretación. Resultados: El grado de correlación obtenido en las distintas fases del trabajo entre la red neural y un observador experimentado se encontró siempre por encima del 95%. Conclusión: La red neural creada es válida para ofrecer una interpretación útil y fiable de los potenciales evocados miogénicos vestibulares según los criterios clínicos actuales (AU)

Introduction: This article presents the investigation of the clinical utility of artificial neural networks as an alternative in interpreting vestibular evoked myogenic potential (VEMP). Methods: We developed an application that incorporates a neural network. This software reproduces and analyses the vestibular potential under study. The software also gives an estimated error for this process. Results: The correlation obtained in this study between the neural network and an experienced human observer was always above 95%. Conclusion: The neural network created offers useful, reliable interpretations of vestibular evoked myogenic potential, in agreement with current clinical parameters (AU)

[How to analyse a vestibular evoked myogenic potential? Applying a non-linear [corrected] method]. / ¿Cómo analizar un Potencial evocado Miogénico Vestibular? Aplicación de un método no lineal.

INTRODUCTION: This article presents the investigation of the clinical utility of artificial neural networks as an alternative in interpreting vestibular evoked myogenic potential (VEMP). METHODS: We developed an application that incorporates a neural network. This software reproduces and analyses the vestibular potential under study. The software also gives an estimated error for this process. RESULTS: The correlation obtained in this study between the neural network and an experienced human observer was always above 95%. CONCLUSION: The neural network created offers useful, reliable interpretations of vestibular evoked myogenic potential, in agreement with current clinical parameters.

[Value of dynamic postural control tests on elderly people with vestibulopathy]. / Valor de las pruebas de control postural dinámico de la posturografía en ancianos con vestibulopatía.

INTRODUCTION AND OBJECTIVES: The stability limits and rhythmic weight shift tests study the functional capacity to achieve voluntary postural control of movement in the standing position. The objectives of this paper are to know the interest of these tests in the evaluation of elderly people with vestibular disorders and their relation with the number of falls suffered during the year prior to the study. MATERIAL AND METHODS: Sixty elderly people (65-80 years old) with vestibular disorders (patients) and 60 healthy subjects (control group) of similar age were selected. According to videonystagmographic and clinical criteria, the patients group was divided into compensated and decompensated. All the subjects in the sample performed the stability limits and rhythmic weight shift tests with the NedSVE/IBV system. The number of falls of each subject was determined by a meticulous anamnesis. RESULTS: Compensated patients, decompensated patients and the control group had similar scores in this instrumental functional evaluation, without any statistically significant differences. None of the parameters assessed in this study correlated statistically with the subjects' number of falls during the year prior to the study. CONCLUSIONS: The stability limits and rhythmic weight shift tests are of little utility in the functional evaluation of the elderly with vestibular disorders and in the detection of patients with greater risk of falls.

Valor de las pruebas de control postural dinámico de la posturografía en ancianos con vestibulopatía / Value of dynamic postural control tests on elderly people with vestibulopathy

Introducción y objetivos: Las pruebas de los límites de estabilidad y de control rítmico direccional estudian la capacidad funcional para el control postural voluntario del movimiento en bipedestación. En este trabajo se pretende conocer el interés de estas pruebas en la valoración de los ancianos con vestibulopatía y la relación con el número de caídas que sufrieron durante el año anterior al estudio. Material y métodos: Se seleccionó a 60 ancianos de 65-80 años con trastornos del sistema vestibular (pacientes) y 60 sujetos sanos (grupo control) de similar edad. El grupo de pacientes se dividió en compensados y descompensados, según criterios videonistagmográfi cos y clínicos. Todos los sujetos de la muestra realizaron las pruebas de los límites de estabilidad y de control rítmico y direccional mediante el sistema NedSVE /IBV. Se determinó el número de caídas de cada sujeto mediante una minuciosa anamnesis. Resultados: Las puntuaciones obtenidas en esta valoración funcional instrumental por los pacientes compensados y descompensados y los sujetos del grupo control fueron muy similares, sin diferencias estadísticamente significativas. Ninguno de los parámetros valorados en este estudio se correlacionó de forma significativa con el número de caídas de los sujetos durante el año anterior al estudio. Conclusiones: Las pruebas de los límites de estabilidad y de control rítmico-direccional tienen escasa utilidad en la valoración funcional de los ancianos con trastornos vestibulares y en la detección de pacientes con mayor riesgo de caídas (AU)

Introduction and objectives: The stability limits and rhythmic weight shift tests study the functional capacity to achieve voluntary postural control of movement in the standing position. The objectives of this paper are to know the interest of these tests in the evaluation of elderly people with vestibular disorders and their relation with the number of falls suffered during the year prior to the study. Material and methods: Sixty elderly people (65-80 years old) with vestibular disorders (patients) and 60 healthy subjects (control group) of similar age were selected. According to videonystagmographic and clinical criteria, the patients group was divided into compensated and decompensated. All the subjects in the sample performed the stability limits and rhythmic weight shift tests with the NedSVE/IBV system. The number of falls of each subject was determined by a meticulous anamnesis. Results: Compensated patients, decompensated patients and the control group had similar scores in this instrumental functional evaluation, without any statistically significant differences. None of the parameters assessed in this study correlated statistically with the subjects’ number of falls during the year prior to the study. Conclusions: The stability limits and rhythmic weight shift tests are of little utility in the functional evaluation of the elderly with vestibular disorders and in the detection of patients with greater risk of falls (AU)

[Static posturography versus clinical tests in elderly people with vestibular pathology]. / Posturografía estática frente a pruebas clínicas en ancianos con vestibulopatía.

INTRODUCTION AND OBJECTIVES: Balance can be quantified by clinical tests and through instrumental studies. The objective of this paper is to determine the correlation between static posturography and 4 clinical tests of balance in elderly people with vestibular disorders and to identify its capability to discriminate the groups studied. METHODS: 60 patients with vestibular disorders and 60 healthy subjects performed 4 clinical tests (one leg standing with opened eyes, Timed Up and Go, Tinetti and Berg tests) and a static posturography analysis (NedSVE/IBV system) under 4 conditions: Romberg Test, Eyes Open (REO), Romberg Test, Eyes Closed (REC), Romberg Test on Foam with Eyes Open (RFEO), and Romberg Test on Foam with Eyes Closed (RFEC). RESULTS: RFEO correlated best with the clinical tests and RFEC was the worst. RFEO distinguished between healthy individuals and decompensated patients. CONCLUSIONS: RFEO gave the best information about postural balance in the elderly. RFEC was not useful. Static posturography can be useful to distinguish vestibular compensation status.

Posturografía estática frente a pruebas clínicas en ancianos con vestibulopatía / Static posturography versus clinical tests in elderly people with vestibular pathology

Introducción y objetivos: El equilibrio postural puede cuantificarse mediante pruebas clínicas o estudio instrumental. El objetivo de este trabajo es determinar la correlación entre la posturografía estática y 4 pruebas clínicas de equilibrio en ancianos con trastornos vestibulares y conocer su capacidad de discriminación entre los grupos estudiados. Métodos: En total, 60 pacientes con enfermedades vestibulares y 60 sujetos sanos realizaron 4 pruebas clínicas (tiempos de apoyo monopodal con ojos abiertos, Timed-Up and Go, test de Tinetti y Berg) y una posturografía estática (sistema NedSVE/IBV) con 4 condiciones: Romberg con ojos abiertos (ROA), con ojos cerrados (ROC), sobre gomaespuma con ojos abiertos (RGA) y sobre gomaespuma con ojos cerrados (RGC). Resultados: La condición de RGA fue la que mejor se correlacionó con las pruebas clínicas y la de RGC la que peor lo hizo. La condición de RGA discriminó entre sanos y patológicos descompensados. Conclusiones: La condición de RGA es la que mejor informó del equilibrio postural en la población anciana. La condición de RGC no fue útil. La posturografía estática puede tener utilidad para distinguir el estado de compensación vestibular

Introduction and objectives: Balance can be quantified by clinical tests and through instrumental studies. The objective of this paper is to determine the correlation between static posturography and 4 clinical tests of balance in elderly people with vestibular disorders and to identify its capability to discriminate the groups studied. Methods: 60 patients with vestibular disorders and 60 healthy subjects performed 4 clinical tests (one leg standing with opened eyes, Timed Up and Go, Tinetti and Berg tests) and a static posturography analysis (NedSVE/IBV system) under 4 conditions: Romberg Test, Eyes Open (REO), Romberg Test, Eyes Closed (REC), Romberg Test on Foam with Eyes Open (RFEO), and Romberg Test on Foam with Eyes Closed (RFEC). Results: RFEO correlated best with the clinical tests and RFEC was the worst. RFEO distinguished between healthy individuals and decompensated patients. Conclusions: RFEO gave the best information about postural balance in the elderly. RFEC was not useful. Static posturography can be useful to distinguish vestibular compensation status

Vértigo paroxístico benigno infantil: categorización y comparación con el vértigo posicional paroxístico benigno del adulto / Benign paroxysmal vertigo of childhood: categorization and comparison with benign positional paroxysmal vertigo in adult

Introducción: Los síntomas vestibulares en la población pediátrica son una queja poco habitual. Esto, unido a la amplia variedad de cuadros clínicos y a las dificultades diagnósticas, hace que el manejo correcto sea más complejo de lo normal. Pacientes y método: Presentamos 23 casos de pacientes pediátricos consecutivos con síntomas de vértigo y/o desequilibrio. Del mismo modo, presentamos otro grupo de 15 pacientes adultos con vértigo posicional paroxístico benigno. Como grupo control se escogieron dos muestras de sujetos sanos, de los que se incluyó a 15 sujetos en edad pediátrica y 18 sujetos adultos. A todos los pacientes se les realizó una anamnesis completa y exploración otoneurológica en el momento de la consulta. Las exploraciones complementarias realizadas fueron audiometría, videonistagmografía y posturografía con estimulación optocinética. Resultados: La migraña, la actividad física previa al vértigo y el desencadenante posicional del vértigo fueron los elementos diferenciadores de las dos poblaciones. Las posturografía realizada en el grupo de adultos con vértigo difería significativamente de la realizada en su grupo control, a diferencia de la población pediátrica, en la que no hubo diferencias entre el estudio de las poblaciones control y patológicas. Conclusiones: El vértigo paroxístico de la infancia es la entidad clínica más frecuentemente hallada en la población pediátrica. La duración y sus desecadenantes son muy similares al vértigo paroxístico benigno. La inestabilidad posterior al vértigo fue menor en la población pediátrica, así como el cortejo vegetativo

Introduction: The differential diagnosis of vertigo in children is extensive. This implies an additional difficulty in diagnosing dizziness in paediatric population. Patients and method: Twenty-three children consecutively examined for paroxysmal attacks of dizziness and/or vertigo attacks entered our study, and were compared to a 15 adults group with benign positional paroxysmal vertigo. Fifteen healthy paediatric subjects and 18 adults were selected as control groups. The clinical characteristics of vertigo, presence of triggering factors, family history of migraine, presence of motion sickness, migraine, and other accompanying symptoms were considered. Neurological, vestibular, and auditory functions were assessed including the performance of a posturography in every group of patients. Results: The presence of migraine, physical activity prior to vertigo, and positional trigger of vertigo were the clinical elements which differentiated both populations of patients with vertigo. There were significant differences in adult posturography between vertigo and control groups. In paediatric population, there were no differences between vertigo and control group in the posturography study. Conclusions: The benign paroxysmal vertigo of childhood complex is the most frequent aetiology of paediatric dizziness. The duration and triggers of vertigo in children are quite similar to those found in VPPB adults. The instability posterior to vertigo, measured by posturography, were less intense in children than in adult population

[Benign paroxysmal vertigo of childhood: categorization and comparison with benign positional paroxysmal vertigo in adult]. / Vértigo paroxístico benigno infantil: categorización y comparación con el vértigo posicional paroxístico benigno del adulto.

INTRODUCTION: The differential diagnosis of vertigo in children is extensive. This implies an additional difficulty in diagnosing dizziness in paediatric population. PATIENTS AND METHOD: Twenty-three children consecutively examined for paroxysmal attacks of dizziness and/or vertigo attacks entered our study, and were compared to a 15 adults group with benign positional paroxysmal vertigo. Fifteen healthy paediatric subjects and 18 adults were selected as control groups. The clinical characteristics of vertigo, presence of triggering factors, family history of migraine, presence of motion sickness, migraine, and other accompanying symptoms were considered. Neurological, vestibular, and auditory functions were assessed including the performance of a posturography in every group of patients. RESULTS: The presence of migraine, physical activity prior to vertigo, and positional trigger of vertigo were the clinical elements which differentiated both populations of patients with vertigo. There were significant differences in adult posturography between vertigo and control groups. In paediatric population, there were no differences between vertigo and control group in the posturography study. CONCLUSIONS: The benign paroxysmal vertigo of childhood complex is the most frequent aetiology of paediatric dizziness. The duration and triggers of vertigo in children are quite similar to those found in VPPB adults. The instability posterior to vertigo, measured by posturography, were less intense in children than in adult population.