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1.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi ; 54(10): 754-759, 2019 Oct 07.
Artigo em Chinês | MEDLINE | ID: mdl-31606988

RESUMO

Objective: To explore the correlation between sleep and laryngopharyngeal reflux disease by epidemiological approaches. Methods: From May 1, 2017 to April 30, 2018, data of age, gender, height, weight, smoking, alcohol consumption, constipation and high fat diet in patients in Otorhinolaryngology specialist clinic, the Eighth Medical Center, General Hospital of the Chinese PLA were retrospectively analyzed. Reflux Symptom Index (RSI), Pittsburgh Sleep Quality Index (PSQI) and Hospital Anxiety and Depression Scale (HADS)were filled. According to RSI scores, patients were divided into case group and control group. The differences of the above indicators between the two groups were compared by Stata 12.0 software, and the risk factors of LPRD were analyzed by multivariate Logistic regression. Results: A total of 908 patients were enrolled, including 166 in the case group and 742 in the control group. There was no significant difference in BMI, smoking, drinking, constipation and high fat diet between the two groups (all P>0.05). The PSQI, anxiety and depression score of the case group were higher than those of the control group. The anxiety and depression scores of the patients with sleep disorders in the case group were significantly higher than those of the normal sleepers (all P<0.05). RSI of the patients with sleep disorders was higher than that of the patients with normal sleep(9.5[4.0,16.0]vs. 5.0[1.0,10.0], Z=-6.07, P<0.001). Multivariate analysis showed that sleep disorder was the risk factors of LPRD (OR=2.59, 95%CI 1.75-3.84). Conclusions: Sleep disorder is related to the occurrence of LPRD. The association between LPRD and sleep disturbances is bidirectional. Sleep disorder may also be related to the anxiety and depression in LPRD patients. Handling sleep disorder timely may benefit LPRD patients.


Assuntos
Refluxo Laringofaríngeo/complicações , Transtornos do Sono-Vigília/etiologia , Adulto , Ansiedade/complicações , Ansiedade/epidemiologia , China/epidemiologia , Depressão/complicações , Depressão/epidemiologia , Humanos , Refluxo Laringofaríngeo/epidemiologia , Refluxo Laringofaríngeo/psicologia , Estudos Retrospectivos , Fatores de Risco , Transtornos do Sono-Vigília/epidemiologia , Transtornos do Sono-Vigília/psicologia
2.
Artigo em Chinês | MEDLINE | ID: mdl-31623035

RESUMO

Objective:To explore the effect of surgical treatment for OSA with laryngopharyngeal reflux(LPR). Method:A retrospective analysis was made in 42 patients diagnosed as moderate to severe OSA with LPR and treated with modified-coblation assisted Uvulopalatopharyngoplasty(M-CAUP). The results of PSG, reflux symptom index(RSI), reflux finding score(RFS) and 24-hour esophageal pH monitoring before and after operation were compared. Result:The AHI after operation was significantly lower than that before operation(P<0.05), and the average oxygen saturation and minimum blood pressure saturation were increased(P<0.05). The total scores of RSI and RFS after operation were lower than those before operation(P<0.05). The percentage of time of pH<4.0 in esophagus 24 hours after operation was lower than that before operation(P<0.05). Conclusion:For patients with moderate to severe OSA combined with LPR with oropharyngeal obstruction, surgical treatment can not only reduce airway stenosis and obstruction, but also improve the symptoms and signs of LPR.


Assuntos
Refluxo Laringofaríngeo/complicações , Apneia Obstrutiva do Sono/cirurgia , Monitoramento do pH Esofágico , Humanos , Faringe , Estudos Retrospectivos , Apneia Obstrutiva do Sono/complicações
3.
Int. arch. otorhinolaryngol. (Impr.) ; 23(3): 322-324, July-Sept. 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1040027

RESUMO

Abstract Introduction Laryngeal granulomas are benign, recurrent lesions of many causes (reflux, voice abuse, intubation, and idiopathic), which renders its treatment difficult. Objective To describe our experience in the treatment of laryngeal granulomas. Methods From 16 medical records of the patients with laryngeal granulomas seen between 2010 and 2017 in a university hospital, the following data were analyzed: age, gender, vocal and gastroesophageal symptoms, vocal overuse, intubation, treatments, videolaryngoscopy before and after the treatment. Results Gender: female, 10; male, 6. Age: between 20 and 60 years old (11%). Etiology of the granulomas: intubation (9), reflux (4), idiopathic (3). The initial treatments adopted in all cases were: inhaled beclomethasone dipropionate 100 μg 12/12 hours (1month), proton pump inhibitor, omeprazole 40 mg/day (2months), and dietary and voice education. After this period, 10 patients (7 postintubation, 3 idiopathic) were submitted to surgery, since no improvements in the symptoms or in the lesions were seen. Of these, two recurred, requiring a second surgery, one of which recurred six times and received botulinum toxin A. Only one patient with granulomas due to laryngopharyngeal reflux presented no improvement in the symptoms nor in the lesion after the pharmacological treatment and had been submitted to microsurgery. All of the other patients with reflux granulomas were successfully treated with the drug treatment, and the longest treatment time for complete remission of the symptoms and of the lesions was 9 months. Conclusions In laryngeal granulomas caused by reflux, treatment with inhaled steroids and proton pump inhibitors proved to be effective, although prolonged. In postintubation and idiopathic granulomas, surgery was the best treatment.


Assuntos
Humanos , Masculino , Feminino , Criança , Adulto , Pessoa de Meia-Idade , Granuloma Laríngeo/terapia , Granuloma Laríngeo/cirurgia , Granuloma Laríngeo/complicações , Granuloma Laríngeo/etiologia , Granuloma Laríngeo/tratamento farmacológico , Registros Médicos , Inibidores da Bomba de Prótons/uso terapêutico , Refluxo Laringofaríngeo/complicações , Intubação/efeitos adversos , Microcirurgia
4.
HNO ; 67(12): 940-947, 2019 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-31407018

RESUMO

The findings of functional endoscopy (upper esophageal sphincter insufficiency, cardia insufficiency, esophagitis, gastric heterotopia, axial sliding hernia, and visible aerosols) can be traced back to pharyngeal acid exposure by oropharyngeal pH measurement. Significantly increased pharyngeal acid loads are seen in gastric heterotopy and axial sliding hernia. For all measured statistics, the pharyngeal acid load is in the pathological or even very pathological range. The value of functional endoscopy in the context of laryngopharyngeal reflux diagnosis is clearly documented. The findings "heterotopic gastric mucosa" and "axial sliding hernia" may cause marked airway symptoms and a pathogenetic relationship with otorhinolaryngologic reflux-associated symptoms must be postulated for these entities.


Assuntos
Esofagite Péptica , Esofagoscopia , Refluxo Laringofaríngeo , Faringe/patologia , Esofagite Péptica/complicações , Esofagite Péptica/fisiopatologia , Humanos , Refluxo Laringofaríngeo/complicações , Refluxo Laringofaríngeo/fisiopatologia , Manometria
5.
Artigo em Chinês | MEDLINE | ID: mdl-31315368

RESUMO

Tinnitus is the most common symptom in otorhinolaryngology. In the past, tinnitus was often localized in the auditory system lesions, causing a great amount of idiopathic tinnitus patients inadequately treated. At present, it is believed that the pathogenesis of tinnitus not only originates from auditory system itself, but also participates in systemic disorders. In recent years, investigating in the effects of laryngopharyngeal reflux on tinnitus is undergoing rapid progress. This review highlights the current state of relationship between laryngopharyngeal reflux and tinnitus, which may provide a new systemic insight into diagnosis and treatment on tinnitus as well as laryngopharyngeal reflux.


Assuntos
Refluxo Laringofaríngeo/complicações , Zumbido/etiologia , Humanos , Refluxo Laringofaríngeo/diagnóstico , Zumbido/terapia
6.
Artigo em Inglês | MEDLINE | ID: mdl-31185704

RESUMO

BACKGROUND: To investigate the presence of laryngopharyngeal reflux in patients with obstructive sleep apnea (OSA) employing the salivary pepsin concentration method. To compare the results of pepsin concentration with the severity of the pathology. METHODS: Seventy-five OSA patients (44 males, 31 females) were enrolled in the study. For each patient, the AHI (apnea-hypopnea index) and the BMI (body mass index) were initially evaluated. All the patients enrolled were assessed using the reflux symptom index (RSI) and the reflux finding score (RFS) in order to perform a clinical diagnosis of laryngopharyngeal reflux. In all patients a salivary sample was taken to estimate the presence of pepsin and its concentration. RESULTS: The incidence of LPR (laryngopharyngeal reflux) in OSA patients, evaluated using the salivary pepsin concentration test (PEP-test), was found to be 32% of cases. Linear regression testing did not show any correlation between AHI and pepsin concentration in salivary samples (p = 0.1). CONCLUSION: A high number of patients with OSA seem to show positivity for salivary pepsin, correlated to an LPR. There does not appear to be a correlation between the severity of apnea and the grade of salivary pepsin reflux. On the other hand, direct correlation between BMI and the value of pepsin in salivary specimens was observed.


Assuntos
Refluxo Laringofaríngeo/diagnóstico , Pepsina A/análise , Saliva/química , Apneia Obstrutiva do Sono/complicações , Adulto , Índice de Massa Corporal , Emprego , Feminino , Humanos , Refluxo Laringofaríngeo/complicações , Modelos Lineares , Masculino , Pessoa de Meia-Idade
7.
Eur Arch Otorhinolaryngol ; 276(8): 2283-2287, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31177327

RESUMO

PURPOSE: To assess autonomic nerve function in patients with laryngopharyngeal reflux disease (LPRD) and determine the correlation between LPRD and autonomic nerve dysfunction. METHODS: Patients with suspected LPRD who visited our outpatient department were assessed using the reflux symptom index (RSI) and reflux finding score (RFS) scales. Eighty-one suspected LPRD patients with RSI > 13 and RFS > 7 were examined using 5-min short-range heart rate variability, and all were given proton pump inhibitor diagnostic treatment. RESULTS: The root mean square of successive R-R intervals, high-frequency (HF) power, standardized HF, and HF % were significantly lower in the case group than in the control group (p < 0.05); however, the low frequency (LF)/HF ratio was significantly higher in the case group (p < 0.05). There were no significant differences in the standard deviation of the average normal-to-normal interval, total power, LF power, and LF % between the two groups (p > 0.05). RSI, RFS, and disease duration were negatively correlated with HF power (r = - 0.89, -0.77, and -0.315, respectively; p < 0.05). The LF/HF ratio and disease duration were positively correlated (r = 0.315, p < 0.05). CONCLUSIONS: Autonomic nerve dysfunction was observed in our patients with LPRD. LPRD severity was significantly correlated with autonomic nerve dysfunction and negatively correlated with vagal nerve function.


Assuntos
Doenças do Sistema Nervoso Autônomo/diagnóstico , Doenças do Sistema Nervoso Autônomo/etiologia , Vias Autônomas/fisiopatologia , Refluxo Laringofaríngeo/complicações , Adulto , Idoso , Feminino , Frequência Cardíaca , Humanos , Refluxo Laringofaríngeo/diagnóstico , Refluxo Laringofaríngeo/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Inibidores da Bomba de Prótons/uso terapêutico
8.
Ear Nose Throat J ; 98(6): E44-E50, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30961379

RESUMO

Laryngopharyngeal reflux (LPR) is an inflammatory condition suspected to be associated with dysphonia. In this study, we investigated multidimensional perceptual, aerodynamic, and acoustic voice changes in patients with clinically diagnosed LPR compared to healthy participants. We prospectively included 80 outpatients with Reflux Finding Score (RFS) >7 and Reflux Symptom Index (RSI) >13 from September 2013 to April 2016 and we compared clinical and voice quality assessments of these patients with 80 healthy participants. Statistically significant differences were found between groups with regard to Voice Handicap Index, perceptual voice quality (grades of dysphonia, roughness, strain, breathiness, asthenia, and instability), phonatory quotient, percentage jitter, percentage shimmer, peak-to-peak amplitude variation, standard deviation of fundamental frequency, and noise to harmonic ratio. Granulation score of RFS was found to affect the highest number of acoustic parameters. We did not identify significant correlation between vocal fold edema and objective voice quality measurements. This study supports that patients with LPR have significant deterioration of both subjective and objective voice quality compared to healthy participants.


Assuntos
Laringite/fisiopatologia , Refluxo Laringofaríngeo/fisiopatologia , Distúrbios da Voz/fisiopatologia , Qualidade da Voz , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Disfonia/etiologia , Disfonia/fisiopatologia , Edema/etiologia , Edema/patologia , Edema/fisiopatologia , Feminino , Tecido de Granulação/patologia , Humanos , Laringite/etiologia , Laringite/patologia , Refluxo Laringofaríngeo/complicações , Refluxo Laringofaríngeo/patologia , Laringoscopia , Masculino , Pessoa de Meia-Idade , Espirometria , Estroboscopia , Prega Vocal , Distúrbios da Voz/etiologia , Adulto Jovem
10.
Laryngoscope ; 129(9): E329-E341, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-30892725

RESUMO

OBJECTIVES: To investigate the role of laryngopharyngeal reflux (LPR) in the development of benign lesions of the vocal folds (BLVF). METHODS: PubMed, Cochrane Library, and Scopus were searched by three independent investigators for articles published between January 1990 and November 2018 providing substantial information about the role of LPR in the development of nodules, polyps, cysts, Reinke's edema, and sulcus vocalis. Inclusion, exclusion, diagnostic criteria and clinical outcome evaluation of included studies were analyzed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. RESULTS: Of the 155 relevant publications, 42 studies were included. Thirty-five were clinical studies and seven were experimental research studying the impact of reflux on vocal fold tissue. Only seven clinical studies utilized objective LPR diagnoses (pH monitoring), suggesting an association between LPR and the development of nodules, polyps, and Reinke's edema. These studies were characterized by a substantial heterogeneity due to discrepancies in inclusion/exclusion criteria, diagnostic methods, and clinical outcome evaluation. The few basic science studies on this topic support that LPR creates an environment that may predispose to BLVF through changes in defense mechanisms of the vocal folds, cell-to-cell dehiscence, inflammatory reaction of the vocal folds, and reaction to phonotrauma. CONCLUSIONS: Caustic mucosal injury from LPR could cause increased susceptibility of the vocal fold mucosa to injury and subsequent formation of nodules, polyps, or Reinke's edema. However, the heterogeneity and the low number of high-quality studies limit the ability to draw definitive conclusions. Future clinical and experimental studies are needed to better identify the role of reflux in development of BLVF. Laryngoscope, 129:E329-E341, 2019.


Assuntos
Doenças da Laringe/etiologia , Edema Laríngeo/etiologia , Refluxo Laringofaríngeo/complicações , Pólipos/etiologia , Ensaios Clínicos como Assunto , Humanos , Refluxo Laringofaríngeo/patologia , Estudos Prospectivos , Estudos Retrospectivos , Prega Vocal/patologia
11.
Int J Pediatr Otorhinolaryngol ; 121: 188-196, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30925396

RESUMO

OBJECTIVES: The aim of this study was to assess the usefulness of 24-h pharyngeal pH monitoring in the diagnosis of laryngopharyngeal reflux (LPR) in children with voice disorders. METHODS: The study was conducted on 68 children aged 3-18 years old. In all cases, pH monitoring was successful; no child removed the probe from the nasal cavity or reported discomfort or other complaints. The following definitions were adopted: LPR in the upright position if Ryan Score upright >9.41; LPR in the supine position if there was at least one supine episode below pH 5.0 (equal to a Ryan Score supine >2.91). RESULTS: In 43 children (63%), vocal fold edema was strongly related to recorded reflux episodes, especially in the upright position. In 18 children (26%), vocal nodules were observed, but their occurrence did not significantly affect the Ryan Score, either upright or supine. The selected potential LPR markers were significantly correlated to all the pH monitoring variables and individual elements on the Reflux Symptoms Index and the Reflux Finding Score questionnaire. CONCLUSION: Our findings indicate that, together with vocal fold edema, laryngeal edema and posterior commissure mucosal hypertrophy are important determinants of paediatric LPR. In fact, if LPR is suspected in a child, 24-h pharyngeal pH monitoring appears to be a valuable and welltolerated diagnostic tool. Vocal fold edema observed in laryngeal endoscopy can be considered a probable sign of LPR. The Reflux Finding Score appears to be helpful in diagnosing LPR in children, especially if a cut-off value of 4/5 is adopted.


Assuntos
Edema/etiologia , Monitoramento do pH Esofágico , Refluxo Laringofaríngeo/complicações , Refluxo Laringofaríngeo/diagnóstico , Prega Vocal , Distúrbios da Voz/etiologia , Adolescente , Criança , Edema/diagnóstico por imagem , Feminino , Humanos , Concentração de Íons de Hidrogênio , Hipertrofia/diagnóstico por imagem , Mucosa Laríngea/patologia , Laringoscopia , Masculino , Faringe/fisiopatologia , Inquéritos e Questionários , Prega Vocal/diagnóstico por imagem
13.
Eur Arch Otorhinolaryngol ; 276(2): 467-471, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30607560

RESUMO

PURPOSE: Our aim is identify a new approach to vocal cord leukoplakia treatment and detect to efficiency of proton pump inhibitors. STUDY DESIGN: Prospective, nonrandomized experimental clinical trial. METHODS: A 'First Assessment Scale' was prepared. This scale included the lesion's and the patient's characteristics. Using this scale, 24 patients included to the study. 20 mg rabeprazole twice daily was applied to all patients. At the end of 3rd month, a 'Second Assessment Scale' was used and two groups created. In group 1, 19 patients were accepted to responsive for the therapy and received the same therapy. The group 2 was included five patients that accepted unresponsive to treatment and directed to surgery. All patients received the same treatment additionally 3 months. At the end of 6th month, the Reflux Symptom Index (RSI), the Reflux Finding Score (RFS) and the Red-Green-Blue (RGB) values evaluated and comparisons were made. RESULTS: The RSI and RFS values were significantly decreased in all patients. The Red values were significantly decreased with treatment in group 1, but the Green and Blue values were not. In group 2, the RGB values were not showed the significant differences. In conclusion, seven patients (29,2%) showed complete lesion regression, 12 patients (50%) showed partial lesion regression and five patients (20,8%) showed no response to treatment. CONCLUSIONS: The proton pump inhibitor treatment may be beneficial for the selected patients. The scales that we prepared were useful for lesion assesment.


Assuntos
Refluxo Laringofaríngeo/tratamento farmacológico , Leucoplasia/tratamento farmacológico , Leucoplasia/patologia , Inibidores da Bomba de Prótons/uso terapêutico , Rabeprazol/uso terapêutico , Prega Vocal/patologia , Adulto , Idoso , Feminino , Humanos , Refluxo Laringofaríngeo/complicações , Refluxo Laringofaríngeo/cirurgia , Laringoscopia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estroboscopia , Gravação em Vídeo
14.
Eur Arch Otorhinolaryngol ; 276(3): 767-774, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30600344

RESUMO

BACKGROUND: Recent studies have shown that laryngopharyngeal reflux is associated with chronic rhinosinusitis. Pepsin may be a key factor involved in the injury of nasal mucosal epithelial cells, but the pathogenesis remains unclear. We are to investigate whether a mitogen-activated protein kinase (MAPK) pathway regulates heat shock protein 70 (HSP70) expression in primary cultures of human nasal epithelial cells (HNEpCs) in response to pepsin stimulation. METHODS: HSP70 protein expression levels in HNEpCs were estimated by Western blot analysis after treatment with pepsin. MAPK pathway activity levels were also evaluated to elucidate the mechanism underlying the effects of pepsin on HSP70 in HNEpCs. Inhibitors of signaling pathways were used to determine the contribution of MAPKs in HSP70 response after pepsin stimulation. Cellular apoptosis and cell viability in HNEpCs after treatment with pepsin were measured. RESULTS: The expression of HSP70 increased after stimulation with pepsin and decreased after the removal of pepsin. Pepsin induced activation of p38, extracellular signal-regulated kinase 1/2, and c-Jun N-terminal kinase (JNK) 1/2. Inhibition of JNK1/2 reduced HSP70 expression in HNEpCs. The apoptosis in HNEpCs at 12 h after treatment with pepsin at pH 7.0 increased significantly when compared with the control and pH 7.0 groups. Cell viability decreased following exposure to pepsin at pH 7.0. CONCLUSION: Pepsin, even under neutral pH 7.0, increases the expression of HSP70 in HNEpCs by activating the JNK/MAPK signaling pathway. Increased HSP70 may be the protective mechanism when pepsin presents in the other parts of the body.


Assuntos
Células Epiteliais/efeitos dos fármacos , Proteínas de Choque Térmico HSP70/metabolismo , Proteínas Quinases JNK Ativadas por Mitógeno/metabolismo , Proteínas Quinases Ativadas por Mitógeno/metabolismo , Mucosa Nasal/citologia , Pepsina A/farmacologia , Apoptose , Western Blotting , Sobrevivência Celular , Células Cultivadas , Doença Crônica , Células Epiteliais/metabolismo , Humanos , Refluxo Laringofaríngeo/complicações , Pepsina A/antagonistas & inibidores , Transdução de Sinais , Sinusite/etiologia
15.
Laryngoscope ; 129(1): 198-202, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30098039

RESUMO

OBJECTIVE/HYPOTHESIS: Neurogenic chronic cough typically presents as a postviral chronic cough, often with paroxysms of coughing preceded by a tickle sensation with multiple triggers and often recalcitrant to multiple treatments for reflux disease, sinus disease, and asthma. Current treatment uses neuromodulating agents with moderate success. Post nasal drainage and laryngopharyngeal reflux can be triggers in the setting of laryngopharyngeal hypersensitivity. Treatment will focus on trigger reduction using nasal toilet and a dietary regimen for laryngopharyngeal reflux. STUDY DESIGN: Systematic review of retrospective cohort studies METHODS: One-year retrospective review of new patients with cough (R05.0) excluding asthma, proton pump inhibitor response, and sinus or pulmonary disease. Cough severity index (CSI) and reflux symptom index (RSI) were evaluated initially and 6 weeks after trigger-reduction treatment using nasal saline irrigation, nasal steroids, nasal antihistamines, and a plant-based diet with alkaline water. RESULTS: Of 119 patients, 29 met the criteria. Using the six-point reduction (improvement) in RSI as an accepted response, 20 of 29 patients (68.9%, P = .0014) experienced a clinical response. Using reduction in RSI and CSI as a continuous variable to assess response, patients experienced a 10 (95% confidence interval [CI]: 6.75-13.2) and 10.9 (95% CI: 7.4-14.3) mean point reduction, respectively. The mean percent reduction in RSI following 6 weeks of treatment was 54.7% (95% CI: 41.5-68.0; P = .0001). These patients experienced a 59.8% (95% CI: 43.4-76.2; P = .0001) reduction in CSI. CONCLUSIONS: A trigger-reduction approach using nasal toilet and a plant-based diet in patients with neurogenic chronic cough prior to the initiation of systemic neuromodulating medications should be considered. LEVEL OF EVIDENCE: 4 Laryngoscope, 129:198-202, 2019.


Assuntos
Tosse/terapia , Refluxo Laringofaríngeo/terapia , Neurotransmissores/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Tosse/tratamento farmacológico , Tosse/etiologia , Feminino , Antagonistas dos Receptores Histamínicos/uso terapêutico , Humanos , Refluxo Laringofaríngeo/complicações , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/complicações , Inibidores da Bomba de Prótons/uso terapêutico , Estudos Retrospectivos , Índice de Gravidade de Doença , Viroses/complicações
16.
Ann Otol Rhinol Laryngol ; 128(2): 121-127, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30403146

RESUMO

OBJECTIVES:: The aim of this study is to describe a clinical entity the authors term "Shar Pei larynx," characterized by redundant supraglottic and postcricoid mucosa that the authors hypothesize coexists in patients with obstructive sleep apnea, laryngopharyngeal reflux, and obesity. By exploring this hypothesis, the authors hope to set the foundation for future research with the goal of identifying whether Shar Pei larynx is a marker for untreated sleep apnea or other diseases. STUDY DESIGN:: Retrospective chart review. SETTING:: Two tertiary care academic institutions. METHODS:: Data were collected from a 5-year period by querying for patients described to have "Shar Pei larynx" or "posterior supraglottic and/or postcricoid mucosal redundancy" on laryngoscopic findings. Relevant demographic and clinical characteristics were analyzed, with a focus on associations with obesity, sleep apnea, and laryngopharyngeal reflux. RESULTS:: Thirty-two patients were identified with physical findings consistent with Shar Pei larynx. Twenty-six patients (81.3%) were obese; 16 (50%) were morbidly obese. Twenty-two patients (68.8%) either had an existing diagnosis of obstructive sleep apnea or were diagnosed on polysomnography performed after initial evaluation. Sixteen patients (50%) had type 2 diabetes mellitus, and 87.5% of these patients were obese. Twenty-eight patients (87.5%) noted histories of reflux, with a median reflux symptom index of 27 of 45. Five patients underwent procedures to reduce mucosal redundancy related to Shar Pei larynx. CONCLUSIONS:: This pilot study confirms that the majority of patients diagnosed with Shar Pei larynx also had diagnoses of obesity, obstructive sleep apnea, and reflux disease. The demonstrated association is strong enough to warrant further study.


Assuntos
Mucosa Laríngea/patologia , Refluxo Laringofaríngeo/patologia , Obesidade/patologia , Apneia Obstrutiva do Sono/patologia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/patologia , Feminino , Humanos , Refluxo Laringofaríngeo/complicações , Laringoscopia/métodos , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Projetos Piloto , Polissonografia , Estudos Retrospectivos , Apneia Obstrutiva do Sono/complicações , Tabagismo/complicações , Tabagismo/patologia
17.
Eur Arch Otorhinolaryngol ; 276(1): 175-183, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30535974

RESUMO

PURPOSE: To establish a novel and effective reflux model with a modified nasogastric aspiration tube and to investigate the association between different types of nasogastric aspiration tubes and reflux laryngitis, we conducted this study. METHODS: Thirty-eight healthy New Zealand albino rabbits (2.5-3.5 kg) were divided into three groups: control (CTR, n = 6)-non-intubated; normal nasogastric intubation (NNI, n = 16)-intubated with 4#, 6#, 8#, and 10# normal nasogastric aspiration tubes; and modified nasogastric intubation (MNI, n = 16)-intubated with 4#, 6#, 8#, and 10# modified nasogastric aspiration tubes. The laryngoscopy, body weight, and pH values at the esophageal entrance were recorded before and 1, 2, and 4 weeks after intubation. After the final laryngoscopy, the animals in groups with a pH below 4 were sacrificed to obtain histological and gene expression analysis results. RESULTS: The reflux finding score (RFS) after 4 weeks showed that there was a statistically significant difference in the 8# NNI group (7 ± 0.816, P < 0.001), the 8# MNI group (11.5 ± 2.517, P < 0.001) and the 10# MNI (12.75 ± 1.893, P < 0.001) group compared with the control group (1.83 ± 1.602). The pH values of these three groups were lower than 4. However, the weight loss of the rabbits in the 10# NNI and 10# MNI groups was more obvious. Submucous gland hyperplasia and inflammation were significantly increased in the 8# NNI group, 8# MNI group and the 10# MNI group, but in the level of some pro-inflammatory cytokines and COX-2, the MNI group was significantly higher than the NNI group (8# NNI × 8# MNI, P < 0.01; 8# MNI × 10# MNI, P < 0.01). CONCLUSION: This study showed that 8# modified nasogastric intubation (MNI) produces effective reflux laryngitis in the rabbits.


Assuntos
Modelos Animais de Doenças , Laringite/etiologia , Refluxo Laringofaríngeo/complicações , Coelhos , Animais , Intubação Gastrointestinal/efeitos adversos , Intubação Gastrointestinal/instrumentação , Laringite/diagnóstico por imagem , Laringite/patologia , Refluxo Laringofaríngeo/diagnóstico por imagem , Refluxo Laringofaríngeo/patologia , Laringoscopia , Masculino , Distribuição Aleatória
18.
Eur Ann Otorhinolaryngol Head Neck Dis ; 136(3S): S39-S43, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30166226

RESUMO

PURPOSE OF REVIEW: Laryngopharyngeal reflux (LPR) is an inflammatory disease associated with the development of voice disorder and vocal fold lesions. The occurrence of LPR in professional voice users as singers can have a dramatic impact of daily life. The aims of this paper is to review the current literature about the pathophysiological mechanisms underlying the development of voice disorder, especially in singers, and to propose a new patient-reported outcome instrument to assess complaints of these patients. RECENT FINDINGS: Many clinical and experimental studies reported that LPR leads to the development of significant macroscopic and microscopic histological changes in the mucosa of the vibratory margin of the vocal folds. Epithelial cell dehiscence, microtraumas, Reinke's space modifications, inflammatory infiltrates, mucosal drying, and epithelial thickening are associated with LPR. These histological changes may modify the biomechanical properties of the vocal fold tissue leading to hoarseness. In practice, singers with LPR may have normal or discretely pathological speaking voice but impaired singing voice (vocal fatigue, hoarseness, and loss of range). To date, the literature about the specific LPR signs and symptoms in singers is almost non-existent. However, singers are at high risk to present LPR because of necessary air support involving higher intra-abdominal pressure, increased stress due to career management and uncomfortable schedules, late meals just before sleep, bad nutrition habits like increased intake of citrus products, fats foods and spicy foods. PERSPECTIVES: The lack of clinical singer-reported outcome instrument may decrease the management of LPR in singers. In this context, the LPR Study Group of Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS) developed a new instrument to precisely assess symptoms related to LPR in singing voice. This instrument will be validated and could be used in clinical practice in voice centers.


Assuntos
Refluxo Laringofaríngeo/complicações , Doenças Profissionais/etiologia , Medidas de Resultados Relatados pelo Paciente , Canto , Distúrbios da Voz/etiologia , Fadiga/etiologia , Rouquidão/diagnóstico , Rouquidão/etiologia , Humanos , Doenças Profissionais/diagnóstico , Prega Vocal/patologia , Prega Vocal/fisiopatologia , Distúrbios da Voz/diagnóstico , Qualidade da Voz
20.
J Voice ; 33(2): 150-154, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29174850

RESUMO

OBJECTIVES: Our study was designed to further evaluate the relationships between the saliva pepsin level and the symptoms and quality of life of patients with laryngopharyngeal reflux (LPR). STUDY DESIGN: A prospective cohort study without controls. SETTING: Tertiary teaching hospital. SUBJECTS AND METHODS: We analyzed 50 patients diagnosed with LPR by 24-hour multichannel intraluminal impedance pH monitoring. All subjects were instructed to collect saliva samples upon waking in the morning. The saliva pepsin levels were analyzed using enzyme-linked immunosorbent assay. The Reflux Symptom Index, Reflux Finding Score, Laryngopharyngeal Reflux-Health-Related Quality of Life, and Short Form 36 survey were administered. RESULTS: The pepsin was detected in the saliva of 41 patients with LPR (17.15 ± 20.42 ng/mL). Nine patients did not have pepsin in the saliva. There were no significant associations between the pepsin level in the saliva and Reflux Symptom Index, Laryngopharyngeal Reflux-Health-Related Quality of Life, or Short Form 36 of patients with LPR. CONCLUSION: The saliva pepsin level is not significantly correlated with LPR symptoms or quality of life in LPR patients. It may be true that there is no association between pepsin levels and LPR symptoms, but this lack of association does not prove the lack of pathophysiological effect.


Assuntos
Refluxo Laringofaríngeo/enzimologia , Pepsina A/análise , Saliva/enzimologia , Adulto , Biomarcadores/análise , Ensaio de Imunoadsorção Enzimática , Monitoramento do pH Esofágico , Feminino , Humanos , Refluxo Laringofaríngeo/sangue , Refluxo Laringofaríngeo/complicações , Refluxo Laringofaríngeo/diagnóstico , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Qualidade de Vida , Inquéritos e Questionários
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