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1.
ORL J Otorhinolaryngol Relat Spec ; 83(3): 159-166, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33756454

RESUMO

INTRODUCTION: Vocal fold leukoplakia (VFL) has a risk of malignant transformation, and the underlying mechanisms are currently unrecognized. Some clinical evidence has indicated that laryngopharyngeal reflux (LPR) probably plays a critical role. OBJECTIVE: To explore the risk factors associated with the occurrence of VFL and to investigate the importance of LPR in VFL and its different pathological types using 24-h multichannel intraluminal impedance-pH monitoring. MATERIALS AND METHODS: Eighty-one patients with VFL and 27 healthy volunteers were recruited. General information and LPR parameters were analyzed. RESULTS: The monitoring showed that 35.8% (29/81) of patients had acidic LPR and that 43.2% (35/81) had weakly acidic LPR. Heavy drinking (odds ratio = 4.004, p = 0.037) and acidic LPR (odds ratio = 4.471, p = 0.029) were independent risk factors for the occurrence of VFL. Acidic LPR showed a strong correlation with the Reflux Finding Score (p < 0.05) in patients suspected of having LPR based on the scale score. Meanwhile, weakly acidic LPR parameters increased with the severity of pathological degrees which were higher in high-grade dysplasia (p < 0.05). CONCLUSION: Our study confirms the importance of LPR in VFL. Heavy drinking patients with VFL, particularly those with acidic LPR, should undergo intensive treatment. Meanwhile, weakly acidic LPR may play a critical role in the pathological changes in VFL.


Assuntos
Doenças da Laringe , Refluxo Laringofaríngeo , Humanos , Refluxo Laringofaríngeo/complicações , Refluxo Laringofaríngeo/diagnóstico , Refluxo Laringofaríngeo/epidemiologia , Leucoplasia , Fatores de Risco , Prega Vocal
2.
Codas ; 32(5): e20180052, 2020.
Artigo em Português, Inglês | MEDLINE | ID: mdl-33174981

RESUMO

PURPOSE: To verify the association between laryngopharyngeal reflux (LPR) with age, gender, vocal deviation and voice complaints. METHODS: The study included patients between 18 and 70 years old, referred to the Otorhinolaryngology service for complaints of voice or reflux, of both sexes. Endolaryngeal findings were classified using the Reflux Finding Score (RFS) scale. The presence or absence of vocal and reflux complaints was verified and correlated with the RFS classification. On the same date, they were submitted to sustained vowel voice recording and chained speech. The auditory-perceptual assessment was performed by a speech therapist, classifying the general degree of vocal deviation based on the GRBASI scale. RESULTS: Ninety-seven patients were evaluated, with a mean age of 42. 6 years, 62. 3% female, and mean RFS scores of 6. 26 points. Among the patients, 48 subjects had vocal complaints, 34 women with a mean age of 44. 9 years and an average RFS score of 6. 94 points. The other 49 individuals had no vocal complaints, and of these 27 were women, with a mean age of 41. 2 years and a mean RFS score of 5. 5 points. The variables "reflux complaint", "vocal complaint" and age were the ones that most correlated with the RFS scale scores. CONCLUSION: There is a relationship among reflux complaints, laryngeal findings and vocal complaint.


Assuntos
Refluxo Laringofaríngeo , Voz , Adolescente , Adulto , Idoso , Feminino , Humanos , Refluxo Laringofaríngeo/complicações , Refluxo Laringofaríngeo/diagnóstico , Masculino , Pessoa de Meia-Idade , Qualidade da Voz , Adulto Jovem
4.
Artigo em Chinês | MEDLINE | ID: mdl-32791777

RESUMO

Objective: To investigate whether laryngopharyngeal reflux(LPR) is an independent risk factor for vocal fold polyps and to analyze the potential mechanism. Methods: Case control survey was designed. Subjects who came to the Department of Otorhinolaryngology Head and Neck Surgery of the First Affiliated Hospital of Chongqing Medical University from September 2018 to December 2019, including 152 cases with vocal fold polyps and 176 cases with normal vocal folds, were selected. All the subjects filled in a questionnaire and were assessed by the reflux symptom index (RSI) and the reflux finding score (RFS) scale. RSI>13 and(or) RFS>7 were classified as LPR. Chi-square test, univariate and multivariate unconditional logistic regression models were used for statistical analysis. Results: The incidence of LPR and throat clearing in vocal fold polyps group (47.37%, 73.68%) was significantly higher than that in control group (27.27%, 59.09%), with statistically significant difference (P<0.001, P=0.005, respectively). The incidence of troublesome cough, indigestion or stomach acid coming up was no difference between the two groups(P=0.672, P=0.099). Multivariate unconditional logistic regression analysis showed that LPR (OR=1.815, 95%CI:1.061-3.103), occupational exposure(OR=2.655, 95%CI:1.397-5.042), spicy food(OR=1.958, 95%CI:1.142-3.355) were risk factors for vocal fold polyps. Conclusion: LPR, occupational exposure, spicy food are independent risk factors for vocal fold polyps. Frequent throat clearing caused by LPR may be the main cause of vocal ford polyps. In order to prevent vocal fold polyps, we need to take action to treat laryngopharyngeal reflux disease actively.


Assuntos
Doenças da Laringe , Refluxo Laringofaríngeo , Pólipos , Prega Vocal/patologia , Estudos de Casos e Controles , Humanos , Doenças da Laringe/etiologia , Doenças da Laringe/patologia , Refluxo Laringofaríngeo/complicações , Pólipos/patologia , Fatores de Risco , Inquéritos e Questionários
5.
Ann Otol Rhinol Laryngol ; 129(9): 886-893, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32390460

RESUMO

OBJECTIVE: This study explored the impact of laryngopharyngeal reflux (LPR) on quality-of-life outcomes captured by Sino-Nasal Outcome Test (SNOT-22) and Reflux Symptom Index (RSI) in patients with chronic rhinosinusitis (CRS) and patients with symptoms of LPR. METHODS: In a retrospective chart review, SNOT-22 and RSI scores were analyzed in patients seen at a tertiary care center with CRS, LPR, or both CRS and LPR. SNOT-22 items were grouped into sleep, nasal, otologic, and emotional symptom subdomains. RESULTS: A total of 138 patients (36 with CRS alone, 60 with LPR alone, and 42 with both CRS and LPR) were included. Compared to patients with CRS alone, those with CRS and LPR (CRS+LPR) had higher SNOT-22 total (50.54 ± 19.53 vs 35.31 ± 20.20, P < .001), sleep (19.61 ± 9.31 vs 14.42 ± 10.34, P < .022), nasal (17.38 ± 7.49 vs 11.11 ± 8.52, P < .001), otologic subdomains (9.17 ± 5.07 vs 5.53 ± 5.14, P < .002), and RSI (22.06 ± 9.42 vs 10.75 ± 8.43, P < .003). Patients with LPR alone had higher RSI compared to those with CRS (18.48 ± 9.77 vs 10.75 ± 8.43, P < .037). RSI and SNOT-22 scores were positively correlated irrespective of patient group (R = 0.289, P = .003). CONCLUSION: Compared to patients with CRS or LPR alone, those with CRS+LPR demonstrated higher RSI and total and subdomain SNOT-22 scores. Patients with LPR alone had elevated SNOT-22 despite absent endoscopic evidence of sinusitis.


Assuntos
Refluxo Laringofaríngeo/complicações , Medidas de Resultados Relatados pelo Paciente , Qualidade de Vida , Rinite/complicações , Sinusite/complicações , Doença Crônica , Humanos , Estudos Retrospectivos
6.
Ann Otol Rhinol Laryngol ; 129(10): 1020-1029, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32468832

RESUMO

OBJECTIVES: To investigate the psychometric properties of the reflux symptom index (RSI) as short screening approach for the diagnostic of laryngopharyngeal reflux (LPR) in patients with confirmed diagnosed regarding the 24-hour multichannel intraluminal impedance-pH monitoring (MII-pH). METHODS: From January 2017 to December 2018, 56 patients with LPR symptoms and 71 healthy individuals (control group) were prospectively enrolled. The LPR diagnosis was confirmed through MII-pH results. All subjects (n = 127) fulfilled RSI and the Reflux Finding Score (RFS) was performed through flexible fiberoptic endoscopy. The sensitivity and the specificity of RSI was assessed by ROC (Receiver Operating Characteristic) analysis. RESULTS: A total of 15 LPR patients (26.8%) of the clinical group met MII-pH diagnostic criteria. Among subjects classified as positive for MII- pH diagnoses, RSI and RFS mean scores were respectively 20 (SD ± 10.5) and 7.1 (SD ± 2.5), values not significantly different compared to the negative MII-pH group. The metric analysis of the items led to the realization of a binary recoding of the score. Both versions had similar psychometric properties, α was 0.840 for RSI original version and 0.836 for RSI binary version. High and comparable area under curve (AUC) values indicate a good ability of both scales to discriminate between individuals with and without LPR pathology diagnosis. Based on balanced sensitivity and specificity, the optimal cut-off scores for LPR pathology were ≥ 5 for RSI binary version and ≥ 15 for RSI original version. Both version overestimated LPR prevalence. The original version had more sensitivity and the RSI Binary version had more specificity. CONCLUSIONS: It would be necessary to think about modifying the original RSI in order to improve its sensitivity and specificity (RSI binary version, adding or changing some items), or to introduce new scores in order to better frame the probably affected of LPR patient.


Assuntos
Monitoramento do pH Esofágico , Esôfago/fisiopatologia , Refluxo Laringofaríngeo/diagnóstico , Manometria , Adulto , Estudos de Casos e Controles , Tosse/etiologia , Tosse/fisiopatologia , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/fisiopatologia , Feminino , Sensação de Globus/etiologia , Sensação de Globus/fisiopatologia , Azia/etiologia , Azia/fisiopatologia , Rouquidão/etiologia , Rouquidão/fisiopatologia , Humanos , Refluxo Laringofaríngeo/complicações , Refluxo Laringofaríngeo/fisiopatologia , Masculino , Pessoa de Meia-Idade , Análise de Componente Principal , Psicometria , Reprodutibilidade dos Testes , Inquéritos e Questionários
7.
Int J Pediatr Otorhinolaryngol ; 133: 109974, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32197186

RESUMO

OBJECTIVES: Describe acoustic and laryngeal findings in pediatric patients with subjective dysphonia attributed to laryngopharyngeal reflux (LPR). Determine the impact of LPR on perceived voice quality using the pediatric Voice Handicap Index (pVHI). Compare these findings with age-matched normative values as well as data on pediatric patients with dysphonia due to other etiologies. METHODS: Retrospective case series of pediatric patients (age 2-17 years) evaluated at a specialty pediatric voice clinic at a tertiary care children's hospital from January 1 2007 to December 31 2017 in whom LPR in whom LPR was deemed to be the most significant contributing factor for dysphonia based on physical examination and history. Patients with structural laryngeal abnormalities unrelated to LPR, such as raised lesions, stenosis, papillomatosis, or vocal fold immobility were excluded. RESULTS: 163 out of 1195 evaluable patients met inclusion criteria. Of these, 87% had pVHI and 83% had acoustic data available from their first appointment for analysis. Mean total pVHI score was 24 (range: 0-81). Perturbation measures were elevated in both females (jitter 1.38%, shimmer 4.16%) and males (jitter 2.01%, shimmer 5.62%). Laryngologic assessment revealed: vocal fold changes including erythema and/or pre-nodules in 72% of patients. Cobblestoning of any portion of the pharynx was present in 67% with hypopharyngeal cobblestoning the most common, present in 64% of patients. CONCLUSION: Pediatric patients with clinically diagnosed LPR have pVHI, jitter, and shimmer scores that are comparable to previously reported patients with raised lesions, scar and immobility, and values that are significantly higher than published normative data. Dysphonic children should be assessed for LPR and treated when indicated. LEVEL OF EVIDENCE: 4.


Assuntos
Disfonia/diagnóstico , Disfonia/etiologia , Refluxo Laringofaríngeo/complicações , Refluxo Laringofaríngeo/diagnóstico , Qualidade da Voz , Adolescente , Fatores Etários , Criança , Pré-Escolar , Feminino , Humanos , Refluxo Laringofaríngeo/fisiopatologia , Masculino , Estudos Retrospectivos , Autoimagem , Prega Vocal/patologia , Prega Vocal/fisiopatologia
9.
J Voice ; 34(1): 112-120, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30220528

RESUMO

PURPOSE: To study the usefulness of voice quality as therapeutic outcome in laryngopharyngeal reflux disease. MATERIAL AND METHODS: A total of 80 patients with reflux finding score (RFS) > 7 and reflux symptom index (RSI) > 13 were treated with pantoprazole, diet, and lifestyle recommendations for 3 months. The therapeutic effectiveness was assessed with RSI; RFS; Voice Handicap Index; blinded Grade, Roughness, Breathiness, Asthenia, Strain, and Instability (GRBASI); aerodynamic and a panel of acoustic measurements before and after treatment. A correlation analysis between symptoms, videolaryngostroboscopic signs, and acoustic measurements was conducted. RESULTS: Compared to baseline, means of RSI, RFS, Voice Handicap Index, perceptual dysphonia, and roughness significantly decreased. Significant improvements of phonatory quotient, percent jitter, percent shimmer, Relative Average Perturbation, Pitch Perturbation Quotient, Phonatory F0 Range, Amplitude Perturbation Quotient, smooth Amplitude Perturbation Quotient, and Peak-to-Peak Amplitude Variation were found at the end of treatment. Studies of correlation did not identify relevant correlation between videolaryngostroboscopic signs, especially vocal folds edema, and objective voice quality evaluations. CONCLUSION: Voice quality assessments can help to better understand voice disorders and can be used as indicators of the treatment effectiveness in patients with laryngopharyngeal reflux-related symptoms.


Assuntos
Dieta Saudável , Refluxo Laringofaríngeo/terapia , Pantoprazol/uso terapêutico , Inibidores da Bomba de Prótons/uso terapêutico , Comportamento de Redução do Risco , Acústica da Fala , Distúrbios da Voz/terapia , Qualidade da Voz , Acústica , Feminino , Humanos , Refluxo Laringofaríngeo/complicações , Refluxo Laringofaríngeo/diagnóstico , Refluxo Laringofaríngeo/fisiopatologia , Masculino , Pessoa de Meia-Idade , Fonação , Estudos Prospectivos , Qualidade de Vida , Recuperação de Função Fisiológica , Medida da Produção da Fala , Fatores de Tempo , Resultado do Tratamento , Distúrbios da Voz/diagnóstico , Distúrbios da Voz/etiologia , Distúrbios da Voz/fisiopatologia
10.
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
11.
J Clin Sleep Med ; 15(10): 1397-1402, 2019 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-31596203

RESUMO

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.


Assuntos
Esôfago/fisiopatologia , Refluxo Laringofaríngeo/complicações , Refluxo Laringofaríngeo/fisiopatologia , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polissonografia , Tempo
12.
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
13.
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
14.
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
15.
Braz. j. otorhinolaryngol. (Impr.) ; 85(4): 408-415, July-Aug. 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1019588

RESUMO

Abstract Introduction Obstructive sleep apnea syndrome and laryngopharyngeal reflux are diseases with a high prevalence in the overall population; however, it remains unclear whether they are diseases with the same risk factors present in the same populations or if there is any association between them. Objectives To evaluate and determine the prevalence of laryngopharyngeal reflux in patients with moderate and severe obstructive apnea syndrome and also to determine its predictive factors. Methods Historical cohort, cross-sectional study of patients aged 18-70 years, referred to a tertiary service Otorhinolaryngology outpatient clinic with a polysomnographic diagnosis of moderate or severe obstructive sleep apnea syndrome. The reflux symptom index questionnaire and the reflux finding score at indirect videolaryngoscopy were applied to the assessed population, considering the inclusion and exclusion criteria. Results Fifty-six patients were evaluated, of which 64.3% had a positive laryngopharyngeal reflux (positive reflux symptom index and/or positive endolaryngeal reflux finding score). Body mass index was a predictor of reflux presence in this group of patients with moderate to severe obstructive sleep apnea syndrome. In patients with positive score for endoscopic findings and reflux symptom index (12.3%), there was a trend toward significance for a higher mean apnea-hypopnea index and a higher percentage of sleep time with oxyhemoglobin saturation below 90% (p = 0.05). Conclusion The prevalence of laryngopharyngeal reflux was higher in this group of patients with moderate to severe obstructive sleep apnea syndrome, and the body mass index was a predictor of laryngopharyngeal reflux in these patients. There was a trend toward greater oxyhemoglobin desaturation in patients with a positive score for reflux symptoms index (RSI) and reflux finding score (RFS).


Resumo Introdução A síndrome da apneia obstrutiva do sono e o refluxo laringofaríngeo são doenças com alta prevalência na população em geral. No entanto, ainda não está claro se são doenças com os mesmos fatores de risco presentes nas mesmas populações ou se há alguma relação entre elas. Objetivo Avaliar e determinar a prevalência de refluxo laringofaríngeo em pacientes com síndrome da apneia obstrutiva moderada e acentuada, bem como determinar os fatores preditivos de refluxo nesses pacientes. Método Estudo de coorte histórica com corte transversal de pacientes entre 18 e 70 anos, encaminhados a um ambulatório de Otorrinolaringologia em serviço terciário, com diagnóstico polissonográfico de síndrome da apneia obstrutiva do sono moderada ou acentuada. Foram aplicados o questionário Reflux Sympton Index e o escore de achados endolaríngeos por meio de videolaringoscopia indireta na população estudada, respeitando os critérios de inclusão e exclusão. Resultados Foram avaliados 56 pacientes, dos quais 64,3% apresentaram refluxo laringofaríngeo (Reflux Sympton Index positivo e/ou Reflux Finding Score positivo). O índice de massa corpórea foi fator preditor da presença de refluxo laringofaríngeo nesse grupo de pacientes com síndrome da apneia obstrutiva do sono moderada e acentuada. Nos pacientes cujos Reflux Sympton Index e o escore de achados endolaríngeos foram positivos (12,3%), houve uma tendência à significância para maior índice de apneia e hipopneia e maior porcentagem do tempo de sono com saturação de oxi-hemoglobina abaixo de 90% (p = 0,05). Conclusão A prevalência de refluxo laringofaríngeo foi alta nesse grupo de pacientes com síndrome da apneia obstrutiva do sono moderada e acentuada e o índice de massa corpórea foi fator preditor de refluxo nesses pacientes. Houve uma tendência a maior dessaturacão de oxi-hemoglobina em pacientes com "índice de sintomas de refluxo" e escore de achados endolaríngeos positivos.


Assuntos
Humanos , Masculino , Feminino , Adulto , Idoso , Apneia Obstrutiva do Sono/complicações , Refluxo Laringofaríngeo/complicações , Índice de Gravidade de Doença , Brasil , Índice de Massa Corporal , Estudos Transversais , Inquéritos e Questionários , Polissonografia , Apneia Obstrutiva do Sono/diagnóstico , Refluxo Laringofaríngeo/diagnóstico
16.
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
17.
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
18.
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
19.
JAMA Otolaryngol Head Neck Surg ; 145(7): 655-666, 2019 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-31046069

RESUMO

Importance: Laryngopharyngeal reflux (LPR) is a prevalent disease that is usually treated with diet, lifestyle modifications, and proton pump inhibitor therapy. However, nearly 10% to 30% of patients do not achieve adequate acid suppression even with high doses of proton pump inhibitors. For these patients with resistant disease, fundoplication may be recommended but the success rate of fundoplication surgery on laryngopharyngeal symptoms and findings remains uncertain. Objective: To determine whether fundoplication is associated with control of signs and symptoms in patients with LPR. Evidence Review: A literature search was conducted on PubMed, Cochrane Library, and Scopus according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guideline to identify studies published between 1990 and 2018 about the efficacy of fundoplication on clinical outcomes of LPR. Three investigators screened publications for eligibility and exclusion based on predetermined criteria. Study design, patient characteristics, diagnostic method, exclusion criteria, treatment characteristics, follow-up, and quality of the outcome assessment were evaluated. Findings: Of the 266 studies identified, 34 met the inclusion criteria, accounting for 2190 patients with LPR (1270 women and 920 men; mean [SD] age at the time of surgery, 49.3 [6.3] years). A weighted mean of 83.0% of patients (95% CI, 79.7%-86.3%) experienced improvement and a weighted mean of 67.0% of patients (95% CI, 64.1%-69.9%) experienced a disappearance of symptoms, but there is a high level of methodological heterogeneity among studies according to diagnostic method, exclusion criteria, and outcomes used to assess the efficacy of fundoplication. A pH study without impedance study was used in most studies but with various inclusion criteria. According to results of an a priori assessment, the clinical outcomes used were overall poor, excluding many symptoms and findings associated with LPR. Conclusion and Relevance: The reported studies of fundoplication in LPR disease have important heterogeneity in method of diagnosis, exclusion criteria, symptoms, and signs assessed as therapeutic outcomes; therefore, this systematic review was nonconclusive regarding whether surgery for LPR disease is associated with effective control of sight and symptoms. Otolaryngologists, gastroenterologists, and surgeons must establish a diagnostic criterion standard, clear indications for surgery, and future clinical outcomes to precisely assess the effectiveness of treatment.


Assuntos
Fundoplicatura/métodos , Refluxo Laringofaríngeo/cirurgia , Otopatias/complicações , Feminino , Humanos , Refluxo Laringofaríngeo/complicações , Refluxo Laringofaríngeo/diagnóstico , Laringoscopia/métodos , Masculino , Pessoa de Meia-Idade , Doenças Nasais/complicações , Doenças Faríngeas/complicações , Resultado do Tratamento
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