Using RSI and RFS scores to differentiate between reflux-related and other causes of chronic laryngitis.

OBJECTIVE: To establish if the Reflux Symptom Index (RFI) and the Reflux Finding Score (RFC) can help establish the differential diagnosis in patients with distinct causes of chronic laryngopharyngitis. METHODS: A group of 102 adult patients with chronic laryngopharyngitis (Group A - 37 patients with allergic rhinitis; Group B - 22 patients with Obstructive Sleep Apnea (OSA); Group C - 43 patients with Laryngopharyngeal Reflux (LPR)) were prospectively studied. Chronic laryngitis was diagnosed based on suggestive symptoms and videolaryngoscopic signs (RSI ≥ 13 and RFS ≥ 7). Allergies were confirmed by a positive serum RAST, OSA was diagnosed with a positive polysomnography, and LPR with a positive impedance-PH study. Discriminant function analysis was used to determine if the combination of RSI and RFS scores could differentiate between groups. RESULTS: Patients with respiratory allergies and those with LPR showed similar and significantly higher RSI scores when compared to that of patients with OSA (p < 0.001); Patients with OSA and those with LPR showed similar and significantly higher RFS scores when compared to that of patients with Respiratory Allergies (OSA vs. Allergies p < 0.001; LPR vs. Allergies p < 0.002). The combination of both scores held a higher probability of diagnosing OSA (72.73%) and Allergies (64.86%) than diagnosing LPR (51.16%). CONCLUSIONS: RSI and RFS are not specific for reflux laryngitis and are more likely to induce a false diagnosis if not used with diligence.

Using RSI and RFS scores to differentiate between reflux-related and other causes of chronic laryngitis

Abstract Objective: To establish if the Reflux Symptom Index (RFI) and the Reflux Finding Score (RFC) can help establish the differential diagnosis in patients with distinct causes of chronic laryngopharyngitis. Methods: A group of 102 adult patients with chronic laryngopharyngitis (Group A - 37 patients with allergic rhinitis; Group B - 22 patients with Obstructive Sleep Apnea (OSA); Group C -43 patients with Laryngopharyngeal Reflux (LPR)) were prospectively studied. Chronic laryngitis was diagnosed based on suggestive symptoms and videolaryngoscopic signs (RSI ≥ 13 and RFS ≥7). Allergies were confirmed by a positive serum RAST, OSA was diagnosed with a positive polysomnography, and LPR with a positive impedance-PH study. Discriminant function analysis was used to determine if the combination of RSI and RFS scores could differentiate between groups. Results: Patients with respiratory allergies and those with LPR showed similar and significantly higher RSI scores when compared to that of patients with OSA (p < 0.001); Patients with OSA and those with LPR showed similar and significantly higher RFS scores when compared to that of patients with Respiratory Allergies (OSA vs. Allergies p < 0.001; LPR vs. Allergies p < 0.002). The combination of both scores held a higher probability of diagnosing OSA (72.73%) and Allergies (64.86%) than diagnosing LPR (51.16%). Conclusions: RSI and RFS are not specific for reflux laryngitis and are more likely to induce a false diagnosis if not used with diligence.

Validation of the Brazilian Portuguese Version of the Reflux Finding Score.

INTRODUCTION: Laryngopharyngeal reflux (LPR) poses a diagnostic challenge. Clinical diagnosis, based on suggestive symptoms and laryngoscopic signs of inflammation, should be acceptable, as long as diligent differential diagnosis is sought. In order to minimize subjectivity, a number of diagnostic instruments have been proposed, being the most common the Reflux Symptom Index and the Reflux Finding Score (RFS). The latter has been translated into several languages including Portuguese, but it still has not been properly validated in this language. OBJECTIVE: To validate the Brazilian Portuguese version of the RFS. MATERIAL AND METHOD: For validity and internal consistency, 172 adults were studied (106 with LPR and 66 healthy controls). Flexible transnasal laryngoscopy images were randomly examined twice by each of the two experienced otolaryngologists with a 72-hour interval. Strict exclusion criteria were applied to avoid other possible known causes of chronic laryngitis. For assessment of reproducibility and temporal stability, a random sample of 108 subjects (53 patients and 55 controls) were tested and retested. RESULTS: A statistically significant difference was observed in the mean RFS between patients with LPR (10.26 ± 3.58) and controls (5.52 ± 1.34) (P < 0.001). The interclass correlation coefficient comparing test and retest for both raters was high (R1 = 0.956; R2 =  0.948). CONCLUSION: The Brazilian Portuguese version of the RFS proved to be a reliable and reproducible instrument for the diagnosis of LPR with a sensitivity of 82.08%, a specificity of 93.94%, a positive predictive value of 95.60%, and a negative predictive value was 76.54%.

Temporal Association Between Respiratory Events and Reflux in Patients With Obstructive Sleep Apnea and Laryngopharyngeal Reflux.

STUDY OBJECTIVES: The aim of the current study was to test the hypothesis that there is a temporal correlation between reflux episodes and respiratory events in patients with laryngopharyngeal reflux and obstructive sleep apnea. METHODS: Adults with clinically diagnosed laryngopharyngeal reflux confirmed by two validated instruments (reflux symptom index ≥ 13 and reflux finding score ≥ 7) and obstructive sleep apnea (OSA) underwent full polysomnography with concomitant and synchronized multichannel intraluminal impedance-pH esophageal monitoring. The apnea-hypopnea and arousal indexes that occurred 15, 30, and 45 minutes before and after each reflux episode were recorded and compared to full-night apnea and hypopnea and arousal index. RESULTS: We studied 27 patients (14 males, age 51.7 ± 9.1 years, body mass index 32.4 ± 4.2 kg/m²) with laryngopharyngeal reflux (reflux symptom index 16 ± 2 and reflux finding score 12 ± 3) and OSA (apnea-hypopnea index = 32.3 ± 28.4 events/h). We evaluated 102 reflux episodes. Almost half of the reflux episodes occurred while awake (43.1%) and only five reflux episodes (4.9%) occurred during an obstructive respiratory event. The apnea and hypopnea and arousal indexes 15, 30, and 45 minutes before and after reflux episodes were lower than full-night apnea and hypopnea and arousal indexes, respectively. CONCLUSIONS: Among patients with well-established laryngopharyngeal reflux and OSA, there is no temporal association between reflux and obstructive respiratory events. Even though the data comprised a small sample size, it seems that a more complex mechanism is involved with these two highly prevalent diseases.

Salivary transforming growth factor alpha in patients with Sjögren's syndrome and reflux laryngitis.

INTRODUCTION: Saliva plays a key role in the homeostasis of the digestive tract, through its inorganic components and its protein growth factors. Sjögren's syndrome patients have a higher prevalence of gastroesophageal reflux disease and laryngopharyngeal reflux. Decreased salivary transforming growth factor alpha levels were observed in dyspeptic patients, but there have been no studies in patients with Sjögren's syndrome and laryngopharyngeal reflux. OBJECTIVE: To compare the salivary transforming growth factor alpha levels of patients with Sjögren's syndrome and laryngopharyngeal reflux to those of healthy controls. METHODS: This is a prospective controlled study. Twelve patients with Sjögren's syndrome and laryngopharyngeal reflux and 11 controls were prospectively evaluated. Spontaneous and stimulated saliva samples were obtained to establish salivary transforming growth factor alpha concentrations. RESULTS: The salivary transforming growth factor alpha levels of patients were significantly higher than those of healthy controls. Five patients with laryngopharyngeal reflux also had erosive esophagitis; their salivary transforming growth factor alpha levels were comparable to controls. CONCLUSION: Salivary transforming growth factor alpha level was significantly higher in patients with Sjögren's syndrome and laryngopharyngeal reflux when compared to the control group.

Salivary transforming growth factor alpha in patients with Sjögren's syndrome and reflux laryngitis / Estudo da concentração salivar do fator transformador de crescimento alfa em indivíduos com Sindrome de Sjögren e refluxo laringofaríngeo

Introduction: Saliva plays a key role in the homeostasis of the digestive tract, through its inorganic components and its protein growth factors. Sjögren's syndrome patients have a higher prevalence of gastroesophageal reflux disease and laryngopharyngeal reflux. Decreased salivary transforming growth factor alpha levels were observed in dyspeptic patients, but there have been no studies in patients with Sjögren's syndrome and laryngopharyngeal reflux. Objective: To compare the salivary transforming growth factor alpha levels of patients with Sjögren's syndrome and laryngopharyngeal reflux to those of healthy controls. Methods: This is a prospective controlled study. Twelve patients with Sjögren's syndrome and laryngopharyngeal reflux and 11 controls were prospectively evaluated. Spontaneous and stimulated saliva samples were obtained to establish salivary transforming growth factor alpha concentrations. Results: The salivary transforming growth factor alpha levels of patients were significantly higher than those of healthy controls. Five patients with laryngopharyngeal reflux also had erosive esophagitis; their salivary transforming growth factor alpha levels were comparable to controls. Conclusion: Salivary transforming growth factor alpha level was significantly higher in patients with Sjögren's syndrome and laryngopharyngeal reflux when compared to the control group. .

Introdução: A saliva exerce influência primordial na homeostase do sistema digestório, pelos seus componentes inorgânicos e pelos fatores de crescimento. Indivíduos com sindrome de Sjögren (SS) apresentam maior incidência da doença do refluxo gastroesofágico (DRGE) e do refluxo laringofaríngeo (RLF). Concentrações salivares diminuídas do fator transformador de crescimento alfa (TGF-α) foram observadas em doentes dispépticos, porém não há estudos em populações com SS e RLF. Objetivo: Comparar concentrações salivares do TGF-α; de indivíduos com SS e RLF a de controles saudáveis. Método: Trata-se de um estudo prospectivo controlado. Doze pacientes com SS e RLF e 11 indivíduos controles saudáveis tiveram amostras salivares espontâneas e estimuladas coletadas para estabelecer concentração de TGF-α. Resultados: A concentração salivar de TGF-α; foi estatisticamente maior no grupo estudo para ambas amostras. Este aumento foi confirmado nos sete indivíduos do grupo estudo que não apresentavam esofagite erosiva quando comparados ao grupo controle, porém não houve diferença estatística da concentração de TGF-α; entre pacientes do grupo estudo que apresentava mesofagite erosiva em comparação ao grupo controle. Conclusão: A concentração salivar de TGF-α; foi estatisticamente maior no grupo de indivíduos com SS e RLF, sem esofagite erosiva. .

Prevalence of signs and symptoms of laryngopharyngeal reflux in snorers with suspected obstructive sleep apnea.

OBJECTIVE: To study the prevalence of signs and symptoms of reflux in snorers with suspected OSA. METHOD: This cross-sectional study enrolled 74 patients assessed positive for OSA with the Berlin questionnaire. The subjects were followed up at the sleep disorder ward of a university center. Studied variables included the BMI, the Epworth sleepiness scale, the reflux symptom index (RSI), the reflux finding score (RFS), and their subdomains related to increased inflammation. The correlations between sleep questionnaires, reflux scales, and their subdomains were deemed statistically significant when p < 0.05. RESULTS: Ninety-eight percent of the subjects had symptoms and signs suggestive of LPR; prevalence was significantly higher among obese individuals (p = 0.002). CONCLUSION: The significant difference seen in the prevalence of signs of inflammation suggestive of LPR when obese and non-obese subjects with suspected OSA were compared indicates that obesity may affect inflammatory findings of the pharynx and larynx. The high prevalence of symptoms and signs of reflux in patients with suspected OSA calls for more studies on the matter.

Prevalencia de sintomas e sinais de refluxo laringofaringeo em pacientes roncadores com suspeita de sindrome da apneia obstrutiva do sono / Prevalence of signs and symptoms of laryngopharyngeal reflux in snorers with suspected obstructive sleep apnea

Acredita-se que haja uma associação entre síndrome da apneia obstrutiva do sono (SAOS) e refluxo laringofaríngeo (RLF). OBJETIVO: Estudar a prevalência de sintomas/sinais de refluxo em pacientes roncadores com suspeita de SAOS. MÉTODO: Estudo clínico corte transversal de 74 adultos Berlim positivo acompanhados em ambulatório de distúrbios do sono de centro universitário. As variáveis estudadas foram IMC, Epworth, índice de sintomas de refluxo (RSI) e escala de achados endolaríngeos de refluxo (RFS), bem como seus subdomínios que podem traduzir maior inflamação. Correlações entre questionários de sono e escalas de refluxo, bem como seus subdomínios, foram feitas com significância estabelecida em p < 0,05. RESULTADOS: Noventa e oito porcento dos pacientes apresentaram sintomas e sinais sugestivos de RLF, sendo esta prevalência significativamente maior nos obesos (p = 0,002). CONCLUSÃO: A diferença significativa nos sinais inflamatórios sugestivos de RLF entre obesos e não obesos com suspeita de SAOS sugere que a obesidade pode interferir nos achados inflamatórios na faringe e laringe. A altíssima prevalência destes sintomas e sinais de refluxo nos pacientes com suspeita de SAOS demonstra a importância de aprofundar estudos nesta área. .

OBJECTIVE: To study the prevalence of signs and symptoms of reflux in snorers with suspected OSA. METHOD: This cross-sectional study enrolled 74 patients assessed positive for OSA with the Berlin questionnaire. The subjects were followed up at the sleep disorder ward of a university center. Studied variables included the BMI, the Epworth sleepiness scale, the reflux symptom index (RSI), the reflux finding score (RFS), and their subdomains related to increased inflammation. The correlations between sleep questionnaires, reflux scales, and their subdomains were deemed statistically significant when p < 0.05. RESULTS: Ninety-eight percent of the subjects had symptoms and signs suggestive of LPR; prevalence was significantly higher among obese individuals (p = 0.002). CONCLUSION: The significant difference seen in the prevalence of signs of inflammation suggestive of LPR when obese and non-obese subjects with suspected OSA were compared indicates that obesity may affect inflammatory findings of the pharynx and larynx. The high prevalence of symptoms and signs of reflux in patients with suspected OSA calls for more studies on the matter. .

Oropharyngeal dysphagia in patients with multiple sclerosis: do the disease classification scales reflect dysphagia severity?

UNLABELLED: Multiple sclerosis is a neurological disease that involves swallowing disorders. Many studies have shown an association between neurological and swallowing performance, but results have been conflicting. OBJECTIVE: To identify the frequency of dysphagia in patients with multiple sclerosis and neurological indicators that can represent the performance of swallowing. METHOD: In this study (cross-sectional) 120 Multiple Sclerosis patients underwent Functional Assessment of Swallowing by flexible nasal-pharyngo-laryngoscopy and the results were compared with the scores of the rating scales: (Clinical Evolving Forms of Disease, Functional Disability Scale for and Scale Systems Extended Functional Disability [Kurtzke Expanded Disability Status Scale]). RESULTS: Dysphagia was found in 90% of patients. Among the clinical forms of the disease, the progressive forms (primary progressive and secondary progressive) were more frequently associated with severe dysphagia, while the relapsing-remitting form presented more often mild and moderate dysphagia. Regarding the Disability Scale for Functional Systems, cerebellar function, brainstem function and mental health were associated with dysphagia, especially in the severe form. Regarding the Extended Functional Disability Scale, higher scores were associated with severe dysphagia. CONCLUSION: Dysphagia is common in MS patients, especially in those with greater impairment of neurological functions.

Disfagia orofaríngea em pacientes com esclerose múltipla: as escalas de classificação da doença refletem a gravidade da disfagia? / Oropharyngeal dysphagia in patients with multiple sclerosis: do the disease classification scales reflect dysphagia severity?

A esclerose múltipla é uma afecção neurológica que envolve distúrbios da deglutição. Muitos estudos têm mostrado associação entre o comprometimento neurológico e o desempenho da deglutição, porém, os resultados têm sido conflitantes. OBJETIVO: Identificar a frequência de disfagia nos pacientes com esclerose múltipla e os indicadores neurológicos que podem representar o desempenho da deglutição. MÉTODO: Neste estudo (estudo transversal), 120 pacientes com esclerose múltipla foram submetidos à avaliação funcional da deglutição por fibronasofaringolaringoscopia, cujos resultados foram comparados com a pontuação das escalas de classificação (Formas Clínicas Evolutivas da Doença, Escala de Incapacidade Funcional por Sistemas e Escala Ampliada de Incapacidade Funcional [Kurtzke Expanded Disability Status Scale]). RESULTADOS: A disfagia foi identificada em 90% dos pacientes. Dentre as formas clínicas, as formas progressivas (primária progressiva e secundária progressiva) apresentaram com maior frequência disfagia grave, enquanto a forma remitente-recorrente apresentou mais frequentemente disfagia leve e moderada. Em relação à Escala de Incapacidade Funcional por Sistemas, as funções cerebelares, do tronco encefálico e mental tiveram associação com a disfagia, especialmente na forma grave. Quanto à Escala Ampliada de Incapacidade Funcional, pontuações mais altas se associaram aos quadros graves de disfagia. CONCLUSÃO: A disfagia é frequente em pacientes com esclerose múltipla, especialmente naqueles com maior comprometimento das funções neurológicas.

Multiple sclerosis is a neurological disease that involves swallowing disorders. Many studies have shown an association between neurological and swallowing performance, but results have been conflicting. OBJECTIVE: To identify the frequency of dysphagia in patients with multiple sclerosis and neurological indicators that can represent the performance of swallowing. METHOD: In this study (cross-sectional) 120 Multiple Sclerosis patients underwent Functional Assessment of Swallowing by flexible nasal-pharyngo-laryngoscopy and the results were compared with the scores of the rating scales: (Clinical Evolving Forms of Disease, Functional Disability Scale for and Scale Systems Extended Functional Disability [Kurtzke Expanded Disability Status Scale]). RESULTS: Dysphagia was found in 90% of patients. Among the clinical forms of the disease, the progressive forms (primary progressive and secondary progressive) were more frequently associated with severe dysphagia, while the relapsing-remitting form presented more often mild and moderate dysphagia. Regarding the Disability Scale for Functional Systems, cerebellar function, brainstem function and mental health were associated with dysphagia, especially in the severe form. Regarding the Extended Functional Disability Scale, higher scores were associated with severe dysphagia. CONCLUSION: Dysphagia is common in MS patients, especially in those with greater impairment of neurological functions.

Translation and cultural adaptation of the Reflux Finding Score into Brazilian Portuguese.

UNLABELLED: The supraesophageal manifestations of Gastroesophageal Reflux Disease commonly known as Laryngopharyngeal Reflux (LPR) are highly prevalent. The diagnosis of LPR is challenging and mostly based on suggestive symptoms and signs of inflammation at the larynx and pharynx. In order to decrease the subjectivity of clinical assessment, a score based on endolaryngeal videolaryngoscopic findings, the Reflux Finding Score (RFS), was proposed by Belafasky et al. This score has proven to be highly sensitive and reproducible in the English language. OBJECTIVE: Translate and culturally adapt the RFS into Brazilian Portuguese and test its reliability. METHOD: Following international guidelines, translation and back translation of the RFS was made by 2 independent professional translators who were native English speakers. The translated version of the RFS was then applied to the videolaryngoscopic images of 24 patients by 3 examiners twice with a 24-hour minimum interval between scoring sessions, and tested for intraobserver reliability. RESULTS: The translation and cultural adaptation were carried out satisfactorily. Examiners applied the instrument, after brief technichal training, without difficulties. Intraobserver test re-test reliability and reproducibility were high. CONCLUSION: The Portuguese version of the RFS presents semantic similarity to the English version, and with reliability.

Tradução para o português brasileiro e adaptação cultural do Reflux Finding Score / Translation and cultural adaptation of the Reflux Finding Score into Brazilian portuguese

As manifestações supraesofágicas da Doença do Refluxo Gastroesofágico, conhecidas como Refluxo Laringofaríngeo (RLF) apresentam alta prevalência. Há dificuldade no diagnóstico, que é pautado em grande parte por sintomas sugestivos e sinais inflamatórios laringofaríngeos. Belafsky et al. propuseram um escore que pontua sinais inflamatórios laríngeos por meio de achados videolaringoscópicos, o Reflux Finding Score (RFS), de forma a diminuir a subjetividade do diagnóstico. Tal escore apresentou alta sensibilidade e reprodutibilidade na língua inglesa. OBJETIVO: Traduzimos para o português brasileiro, realizamos adaptações culturais e testamos a confiabilidade do RFS. MÉTODO: Seguindo diretrizes internacionais, foram realizadas as etapas de tradução e retrotradução por dois profissionais de forma independente e por tradutores nativos norte-americanos. O teste da versão final para avaliação da confiabilidade foi realizado a partir de 24 exames de videolaringoscopia em que os examinadores aplicaram a escala em português em cada exame por duas vezes, com intervalo mínimo de 24 horas, e avaliada a coerência intraexaminadores. RESULTADO: A tradução e adaptação cultural foi realizada de forma satisfatória. Houve facilidade de treinamento e aplicação do instrumento traduzido, além de boa reprodutibilidade e confiabilidade intraobservadores. CONCLUSÃO: Escala de Achados Endolaríngeos de Refluxo tem semelhança conceitual, semântica e de conteúdo com RFS, além de confiabilidade.

The supraesophageal manifestations of Gastroesophageal Reflux Disease commonly known as Laryngopharyngeal Reflux (LPR) are highly prevalent. The diagnosis of LPR is challenging and mostly based on suggestive symptoms and signs of inflammation at the larynx and pharynx. In order to decrease the subjectivity of clinical assessment, a score based on endolaryngeal videolaryngoscopic findings, the Reflux Finding Score (RFS), was proposed by Belafasky et al. This score has proven to be highly sensitive and reproducible in the English language. OBJECTIVE: Translate and culturally adapt the RFS into Brazilian Portuguese and test its reliability. METHOD: Following international guidelines, translation and back translation of the RFS was made by 2 independent professional translators who were native English speakers. The translated version of the RFS was then applied to the videolaryngoscopic images of 24 patients by 3 examiners twice with a 24-hour minimum interval between scoring sessions, and tested for intraobserver reliability. RESULTS: The translation and cultural adaptation were carried out satisfactorily. Examiners applied the instrument, after brief technichal training, without difficulties. Intraobserver test re-test reliability and reproducibility were high. CONCLUSION: The Portuguese version of the RFS presents semantic similarity to the English version, and with reliability.

pH salivary analysis of subjects suffering from Sjögren's syndrome and laryngopharyngeal reflux.

UNLABELLED: Saliva is one of the components for the digestive homeostasis. Recent studies have shown that patients with laryngopharyngeal reflux (LPR) present a drop in salivary pH. Patients with Sjögren's syndrome (SS) are a potential clinical research model for xerostomia and its laryngeal and pharyngeal consequences. The aim was to evaluate the characteristics of saliva of patients with SS and LPR. METHODS: 19 patients with SS plus LPR, and 12 healthy controls had their saliva studied prospectively for volume and pH. Two salivary samples were obtained from each participant: whole unstimulated saliva(WUS) and whole stimulated saliva(WSS) while chewing parafilm M®. All the participants were females. RESULTS: Mean age was 60 years (study group) and 44 years (control). LPR was diagnosed on all 19 subjects. The mean pH of WUS was 7.53 (SS) and 7.57 (controls), raising to 7.87 and 7.83 respectively after stimulation. The mean salivary volume of patients with SS was 1.27 mL (WUS) and 3.78 mL (WSS), whereas controls had a significantly higher salivary volume both before and after stimuli. CONCLUSION: A very high prevalence of LPR was found in patients with SS, which is probably caused by a uniform drop in salivary volume and all its contents, rather than a specific deficiency in its components, as shown previously in patients without SS.

Análise do pH salivar de indivíduos com Síndrome de Sjögren e refluxo laringofaríngeo / pH salivary analysis of subjects suffering from Sjögren's Syndrome and laryngopharyngeal reflux

A saliva é fundamental para a homeostase digestiva. Alterações no seu volume e composição são correlacionadas com o refluxo laringofaríngeo (RLF). Estudos recentes demonstraram que pacientes com RLF apresentam acidificação do pH salivar. A síndrome de Sjögren (SS) foi eleita como modelo de hiposalivação, com objetivo de analisar as repercussões da diminuição salivar na laringe e faringe. CASUÍSTICA E MÉTODO: Estudo clínico transversal de 19 sujeitos com SS e RLF comparados com 12 indivíduos saudáveis. Obtidas amostras de saliva total não estimulada (STNE) e saliva total estimulada por mastigação de parafilm M® (STE). RESULTADOS: Todos os indivíduos eram mulheres, média de idade de 60 anos (estudo) e 44 anos. A prevalência de RLF foi 100 por cento. O pH médio na STNE foi 7,53 (grupo estudo) e 7,57(controle), aumentando para 7,87 e 7,93, respectivamente, após estimulação mecânica. Não houve diferença significante de pH entre os grupos. O volume salivar médio dos pacientes com SS foi 1,27mL (STNE) e 3,78mL (STE), sendo o volume salivar do grupo controle significativamente maior (4,02mL na STNE e 11,96mL na STE). CONCLUSÕES: Todos os indivíduos estudados apresentaram RLF, fato provavelmente relacionado à queda uniforme observada no volume salivar e de todos seus componentes, não sendo observadas mudanças no pH salivar no grupo estudado. Isso sugere fisiopatogenias diferentes do RLF para indivíduos com SS.

Saliva is one of the components for the digestive homeostasis. Recent studies have shown that patients with laryngopharyngeal reflux (LPR) present a drop in salivary pH. Patients with Sjögren's syndrome (SS) are a potential clinical research model for xerostomia and its laryngeal and pharyngeal consequences. The aim was to evaluate the characteristics of saliva of patients with SS and LPR. METHODS: 19 patients with SS plus LPR, and 12 healthy controls had their saliva studied prospectively for volume and pH. Two salivary samples were obtained from each participant: whole unstimulated saliva(WUS) and whole stimulated saliva(WSS) while chewing parafilm M®. All the participants were females. RESULTS: Mean age was 60 years (study group) and 44 years (control). LPR was diagnosed on all 19 subjects. The mean pH of WUS was 7.53 (SS) and 7.57 (controls), raising to 7.87 and 7.83 respectively after stimulation. The mean salivary volume of patients with SS was 1.27 mL (WUS) and 3.78 mL (WSS), whereas controls had a significantly higher salivary volume both before and after stimuli. CONCLUSION: A very high prevalence of LPR was found in patients with SS, which is probably caused by a uniform drop in salivary volume and all its contents, rather than a specific deficiency in its components, as shown previously in patients without SS.

Unsuspected intraoperative finding of structural abnormalities associated with vocal fold polyps.

OBJECTIVES: To report the findings of unsuspected underlying concurrent abnormalities of the vocal fold (VF) associated with polyps. STUDY DESIGN AND SETTING: Retrospective chart review at tertiary teaching institution. SUBJECTS AND METHODS: Operative and clinical notes of 81 adults submitted to suspension laryngoscopy for vocal fold polyp (VFP) excision from 1998 to 2007, which had no previous report of associated structural abnormalities. RESULTS: Associated lesions were described in 54 patients (67%) (35 contralateral, 16 ipsilateral, and three bilateral): 18 reactive nodules, 21 sulcus vocalis, five cysts, two microwebs, and eight capillary ectasias. A positive correlation was found between the presence of polyps and associated structural abnormalities (r=0.0035; P<0.05). CONCLUSIONS: The high incidence of concurrent previously unsuspected VF lesions suggests that either these minor underlying anatomical deviations render the VF more vulnerable to vocal abuse, or that phonotrauma may cause a number of VF lesions that can lead to dysphonia.

[Incidence of structural vocal fold abnormalities associated with vocal fold polyps.

UNLABELLED: Phonotrauma is considered the main cause of vocal fold polyps (VFP). However, the authors believe that an underlying anatomical deviation could render the vocal folds more susceptible to such trauma. AIM: To prove this hypothesis a retrospective chart review was carried out to correlate the surgical findings of patients with VFP. MATERIAL AND METHODS: The charts of thirty-three patients who underwent surgery for excision of VFP were reviewed: 21 had right VFP, 10 had left VFP and 2 had bilateral lesions. RESULTS: Associated lesions were reported in 27 patients (14 lesions on the opposite VF and 13 on the ipsilateral VF): 10 opposite nodules, 12 sulcus vocalis, 3 cysts, and 2 capillary engorgement. DISCUSSION AND CONCLUSIONS: The high incidence of associated anatomical lesions to the VF (63%) suggests that patients with these minor underlying anatomical deviations are more vulnerable to vocal abuse, probably because they present abnormal glottic closure and an irregular vibratory margin.

Incidência de alterações estruturais das pregas vocais associadas ao pólipo de prega vocal / Incidence of structural vocal fold abnormalities associated with vocal fold polyps

A etiologia mais aceita para pólipos de pregas vocais é o fonotrauma. Imaginamos que possa existir alguma alteração anatômica prévia nas pregas vocais que predisponha indivíduos a apresentarem lesões fonotraumáticas. OBJETIVO: O presente estudo retrospectivo procura encontrar correlação entre os pólipos de prega vocal e alterações estruturais da prega vocais. MATERIAL E MÉTODO: Foi realizado trabalho retrospectivo a partir da descrição cirúrgica de 33 pacientes submetidos a exérese de pólipo de prega vocal no período de três anos em hospital universitário. RESULTADOS: Trinta e um pacientes apresentaram pólipos unilaterais e 2 bilaterais. Foram encontradas 27 lesões associadas: 10 lesões reacionais, 12 sulcos, 3 cistos e 2 ectasia capilars. Foram 14 lesões contralaterais e 13 ipsilaterais. DISCUSSÃO E CONCLUSÕES: Encontrou-se uma forte correlação entre a presença de uma lesão de base influindo como co-fator de fragilização da prega vocal ao fonotrauma, pois das 27 lesões encontradas 17 foram consideradas pré-existentes (63 por cento). As lesões poderiam interferir na coaptação das pregas vocais, gerando uma onda mucosa irregular durante a fonação, expondo o espaço de Reinke a uma agressão estrutural. Apesar do caráter preliminar do trabalho os achados sugerem íntima correlação entre o pólipo e lesões estruturais mínimas das pregas vocais.

Phonotrauma is considered the main cause of vocal fold polyps (VFP). However, the authors believe that an underlying anatomical deviation could render the vocal folds more susceptible to such trauma. AIM: To prove this hypothesis a retrospective chart review was carried out to correlate the surgical findings of patients with VFP. MATERIAL AND METHODS: The charts of thirty-three patients who underwent surgery for excision of VFP were reviewed: 21 had right VFP, 10 had left VFP and 2 had bilateral lesions. RESULTS: Associated lesions were reported in 27 patients (14 lesions on the opposite VF and 13 on the ipsilateral VF): 10 opposite nodules, 12 sulcus vocalis, 3 cysts, and 2 capillary engorgement. DISCUSSION AND CONCLUSIONS: The high incidence of associated anatomical lesions to the VF (63 percent) suggests that patients with these minor underlying anatomical deviations are more vulnerable to vocal abuse, probably because they present abnormal glottic closure and an irregular vibratory margin.

Auditory voice-perception analysis sensitivity and specificity in the screening of laryngeal disorders.

UNLABELLED: Despite the growing experience obtained from the National Pro-Voice Campaigns in screening individuals with laryngeal alterations, we still have not established which would be the best assessment method: speech and hearing screening alone, laryngoscopy alone, or a joint work with physicians and speech therapists doing the screening together. AIM: the goal of the present study was to assess the sensitivity, specificity, positive and negative predictive values of the auditory voice-perception analysis compared to videolaryngoscopy as a screening method for individuals with laryngo-pharyngeal disorders. MATERIALS AND METHODS: We compared the vocal aspects (GRBASI scale, pitch, loudness, CPF and resonance) and videolaryngoscopic from 567 individuals who participated in the National Pro-Voice Campaign 2005 in a tertiary university hospital. RESULTS: the most frequent laryngeal alteration was laryngo-pharyngeal reflux (LFR) (43.5%), followed by benign lesions (17%) and suspected malignant lesions (1%). The sensitivity of the auditory voice-perception assessment was of 91% for patients with benign lesions and 100% in those with suspected malignant lesions; however, it was only 76% in LFR. Of those tests considered normal, there were vocal alterations in 52%. The positive predictive value was of 71% and the negative was 61%. CONCLUSIONS: Despite its importance, the auditory voice-perception assessment should not be used as a single screening instrument in voice health campaigns.