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JAMA Otolaryngology-- Head & Neck... Jul 2019Laryngopharyngeal reflux (LPR) is a prevalent disease that is usually treated with diet, lifestyle modifications, and proton pump inhibitor therapy. However, nearly 10%... (Meta-Analysis)
Meta-Analysis
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.
Topics: Ear Diseases; Female; Fundoplication; Humans; Laryngopharyngeal Reflux; Laryngoscopy; Male; Middle Aged; Nose Diseases; Pharyngeal Diseases; Treatment Outcome
PubMed: 31046069
DOI: 10.1001/jamaoto.2019.0315 -
The Laryngoscope Aug 2014Pharyngocutaneous fistulae (PCF) are known to occur in nearly one-third of patients after salvage total laryngectomy (STL). PCF has severe impact on duration of... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES/HYPOTHESIS
Pharyngocutaneous fistulae (PCF) are known to occur in nearly one-third of patients after salvage total laryngectomy (STL). PCF has severe impact on duration of admission and costs and quality of life and can even cause severe complications such as bleeding, infection and death. Many patients need further surgical procedures. The implications for functional outcome and survival are less clear. Several studies have shown that using vascularized tissue from outside the radiation field reduces the risk of PCFs following STL. This review and meta-analysis aims to identify the evidence base to support this hypothesis.
DATA SOURCES
English language literature from 2004 to 2013 REVIEW METHODS: We searched the English language literature for articles published on the subject from 2004 to 2013.
RESULTS
Adequate data was available to identify pooled incidence rates from seven articles. The pooled relative risk derived from 591 patients was 0.63 (95% CI: 0.47 to 0.85), indicating that patients who have flap reconstruction/reinforcement reduced their risk of PCF by one-third.
CONCLUSION
This pooled analysis suggests that there is a clear advantage in using vascularized tissue from outside the radiation field in the laryngectomy defect. While some studies show a clear reduction in PCF rates, others suggest that the fistulae that occur are smaller and rarely need repair.
Topics: Cutaneous Fistula; Fistula; Humans; Laryngectomy; Pharyngeal Diseases; Salvage Therapy; Surgical Flaps
PubMed: 24474684
DOI: 10.1002/lary.24619 -
Advanced Emergency Nursing JournalSpontaneous retropharyngeal emphysema (SRE) is a rare condition, occurring in the absence of trauma. Symptoms usually include acute-onset odynophagia and dyspnea. This...
Spontaneous retropharyngeal emphysema (SRE) is a rare condition, occurring in the absence of trauma. Symptoms usually include acute-onset odynophagia and dyspnea. This is an interesting case of a young, healthy woman who presented to an emergency department with benign upper respiratory symptoms but took a drastic turn while in the waiting room after being triaged. The features and implications of SRE are discussed in this case, including emergent thoracic surgery consultation and additional testing.
Topics: Conservative Treatment; Diagnosis, Differential; Emergency Service, Hospital; Emphysema; Female; Humans; Pharyngeal Diseases; Triage; Young Adult
PubMed: 33915559
DOI: 10.1097/TME.0000000000000345 -
Journal of Clinical Pharmacy and... Aug 2014Dantrolene can be combined with baclofen to better treat spasticity, but may cause muscular weakness and dysphagia. We instead describe a pharyngeal spasm due to...
WHAT IS KNOWN AND OBJECTIVE
Dantrolene can be combined with baclofen to better treat spasticity, but may cause muscular weakness and dysphagia. We instead describe a pharyngeal spasm due to dantrolene.
CASE SUMMARY
A 12-year-old male received dantrolene 3 mg/kg/day in adjunct to baclofen 2 mg/kg/day, to improve spasticity. After 5 days of full-dose dantrolene, his dysphagia worsened and he developed pharyngeal spasm. Dantrolene was suspected for an adverse reaction and removed. The patient subsequently improved.
WHAT IS NEW AND CONCLUSION
Causality analysis determined a probable relationship between dantrolene and pharyngeal spasm. This may be due to direct muscle contraction by dantrolene, an effect seen previously in vitro.
Topics: Baclofen; Child; Dantrolene; Deglutition Disorders; Drug Therapy, Combination; Humans; Male; Muscle Contraction; Muscle Relaxants, Central; Muscle Spasticity; Pharyngeal Diseases
PubMed: 24725261
DOI: 10.1111/jcpt.12161 -
International Journal of Pediatric... Dec 2019To compare the frequency and type of diagnoses associated with pharyngeal dysfunction (PD) in children presenting with early versus late onset sleep disordered breathing...
OBJECTIVE
To compare the frequency and type of diagnoses associated with pharyngeal dysfunction (PD) in children presenting with early versus late onset sleep disordered breathing (SDB).
METHODS
This was a retrospective, cross-sectional study. A consecutive series of children ≤3 years old who underwent management for SDB were retrospectively identified from a prospectively kept surgical database. The early onset group was compared with two separate late onset (≥4years old) groups. Diagnoses associated with PD included gastroesophageal reflux disease (GERD), swallowing dysfunction, prematurity, asthma, and obesity. Distribution of PD diagnoses, airway lesions, syndromic conditions, pulse oximetry scores, and endoscopic pattern of airway obstruction were compared.
RESULTS
73 patients with early onset SDB were identified (51 boys, mean age 2.25 ± 0.64 years, range 1.75-3 years) and compared with two groups of later onset SDB consisting of 75 and 72 patients with mean ages of 7.58 ± 2.40 years and 8.04 ± 3.34 years respectively (range 4-16 years). The early onset SDB group had a higher prevalence of PD diagnoses compared to the later onset group with 35 of 73 patients being diagnosed compared to 41 of 147 children (p = 0.01). Early onset SDB patients were more likely to have GERD or swallowing dysfunction (p < 0.01) while later onset patients more commonly presented with associated asthma or obesity (p < 0.01). There was no statistically significant difference in airway lesions between groups.
CONCLUSION
Early-onset SDB is associated with conditions causing PD more often than later-onset SDB. Identifying these conditions and optimizing their management may impact outcomes in treating pediatric SDB.
Topics: Adolescent; Age of Onset; Airway Obstruction; Asthma; Child; Child, Preschool; Cross-Sectional Studies; Deglutition Disorders; Endoscopy; Female; Gastroesophageal Reflux; Humans; Infant; Male; Obesity; Oximetry; Pharyngeal Diseases; Pharynx; Premature Birth; Retrospective Studies; Sleep Apnea Syndromes
PubMed: 31499263
DOI: 10.1016/j.ijporl.2019.109667 -
Clinical Infectious Diseases : An... Feb 2018Anal sex is a common sexual behavior among women that increases their risk of acquiring rectal infection with Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC).
BACKGROUND
Anal sex is a common sexual behavior among women that increases their risk of acquiring rectal infection with Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC).
METHODS
We estimated the frequency and positivity of rectal CT and GC tests for women aged 15-60 years performed by a large US commercial laboratory between November 2012 and September 2015. We also estimated the frequency and positivity of pharyngeal and genital specimens also performed on the same date. Among women with a positive CT or GC result, we estimated the frequency and positivity of recommended repeat testing within 12 months.
RESULTS
Of 5499 women who had rectal CT and GC tests, positivity was 10.8%. On the same date, approximately 80% also had genital CT tests, genital GC tests, and pharyngeal GC tests, while 40% had pharyngeal CT tests. Rectal CT or GC infection was associated with genital CT or GC infection, but 46.5% of rectal CT and GC infections would not have been identified with genital testing alone. Among women with a rectal CT or GC infection, only 20.0% had a recommended repeat rectal test. Of those who had a repeat test, 17.7% were positive.
CONCLUSIONS
Testing women for rectal CT and GC was infrequent, but positive tests were often found in women with negative genital tests. Most women with positive rectal tests were not retested. Interventions are needed to increase extragenital CT and GC testing of at-risk women.
Topics: Adolescent; Adult; Chlamydia Infections; Chlamydia trachomatis; Clinical Laboratory Techniques; Female; Gonorrhea; Humans; Middle Aged; Neisseria gonorrhoeae; Nucleic Acid Amplification Techniques; Pharyngeal Diseases; Pharynx; Rectal Diseases; Rectum; Sexual Behavior; United States; Young Adult
PubMed: 29028971
DOI: 10.1093/cid/cix857 -
The Journal of Laryngology and Otology Mar 2020Total laryngectomy is often utilised to manage squamous cell carcinoma of the larynx or hypopharynx. This study reports on surgical trends and outcomes over a 10-year...
BACKGROUND
Total laryngectomy is often utilised to manage squamous cell carcinoma of the larynx or hypopharynx. This study reports on surgical trends and outcomes over a 10-year period.
METHOD
A retrospective review of patients undergoing total laryngectomy for squamous cell carcinoma was performed (n = 173), dividing patients into primary and salvage total laryngectomy cohorts.
RESULTS
A shift towards organ-sparing management was observed. Primary total laryngectomy was performed for locoregionally advanced disease and utilised reconstruction less than salvage total laryngectomy. Overall, 11 per cent of patients developed pharyngocutaneous fistulae (primary: 6 per cent; salvage: 20 per cent) and 11 per cent neopharyngeal stenosis (primary: 9 per cent; salvage: 15 per cent). Pharyngocutaneous fistulae rates were higher in the reconstructed primary total laryngectomy group (24 per cent; 4 of 17), compared with primary closure (3 per cent; 3 of 90) (p = 0.02). Patients were significantly more likely to develop neopharyngeal stenosis following pharyngocutaneous fistulae in salvage total laryngectomy (p = 0.01) and reconstruction in primary total laryngectomy (p = 0.02). Pre-operative haemoglobin level and adjuvant treatment failed to predict pharyngocutaneous fistulae development.
CONCLUSION
Complications remain hard to predict and there are continuing causes of morbidity. Additionally, prior treatment continues to affect surgical outcomes.
Topics: Adult; Aged; Carcinoma, Squamous Cell; Causality; Cutaneous Fistula; Female; Humans; Hypopharyngeal Neoplasms; Laryngeal Neoplasms; Laryngectomy; Laryngostenosis; Male; Middle Aged; Pharyngeal Diseases; Postoperative Complications; Retrospective Studies; United Kingdom
PubMed: 32079554
DOI: 10.1017/S0022215120000341 -
The Laryngoscope Mar 2020In patients with head and neck carcinoma of unknown primary (HNCUP;pT0) following TORS-assisted workup, we have adopted a pharyngeal-sparing radiation therapy (PSRT)...
OBJECTIVE
In patients with head and neck carcinoma of unknown primary (HNCUP;pT0) following TORS-assisted workup, we have adopted a pharyngeal-sparing radiation therapy (PSRT) approach targeting only the at-risk neck and omitting treatment of the pharynx. We report outcomes following PSRT, and compare to institutional historical control subjects who received pharyngeal-targeted RT (PRT).
METHODS
Between 2009 and 2018, 172 patients underwent TORS-assisted endoscopy as part of their workup for HNCUP. Following TORS, 54 patients had pT0 disease, of which 45 received RT. Forty-nine percent received PSRT and 51% received PRT.
RESULTS
No statistically significant differences existed between the PSRT and PRT groups with respect to overall nodal distribution, p16 positivity (55% vs. 43%, P = .12), neck dissection rates (77% vs. 65%, P = .51), and administration of chemotherapy (55% vs. 65%, P = .55). Median follow-up for PSRT and PRT groups were 24 and 28 months, respectively (P = .04). Two-year RFS was 86% and 74% for PSRT and PRT patients, respectively (log-rank P = .30). Three and six patients recurred after PSRT and PRT, respectively. Two-year OS for PSRT and PRT patients was 91% and 74%, respectively (log-rank P = .31). Compared to PRT, PSRT was associated with statistically significantly less: grade 2+ mucositis (18% vs. 91%, P < .01), new opioid requirement (27% vs. 91%, P < .01), mean weight loss during RT (6.2 lbs vs. 17.4 lbs, P < .01), feeding tube placement during RT (5% vs. 43%, P < .01), and treatment-related unplanned hospitalizations (9% vs. 39%, P = .04).
CONCLUSION
Following TORS-assisted management of patients with pT0 HNCUP, we observed reduced toxicity following PSRT compared to PRT without apparent compromise of disease cure.
LEVEL OF EVIDENCE
Level 3 evidence, retrospective review comparing cases and controls Laryngoscope, 130:691-697, 2020.
Topics: Carcinoma; Case-Control Studies; Female; Head and Neck Neoplasms; Humans; Male; Middle Aged; Neck; Neoplasms, Unknown Primary; Organ Sparing Treatments; Organs at Risk; Pharyngeal Diseases; Pharynx; Postoperative Period; Radiation Injuries; Retrospective Studies; Robotic Surgical Procedures; Treatment Outcome
PubMed: 31411747
DOI: 10.1002/lary.28200 -
European Annals of Otorhinolaryngology,... Apr 2019
Topics: Adult; Female; Glossopharyngeal Nerve Diseases; Herpes Zoster; Humans; Laryngeal Diseases; Mouth Diseases; Pharyngeal Diseases; Vagus Nerve Diseases
PubMed: 30553733
DOI: 10.1016/j.anorl.2018.11.004 -
Journal of Voice : Official Journal of... Mar 2018The aim of this study was to describe the presentation of pharyngeal dystonia (PD), which can occur as a focal or segmental dystonia with a primarily pharyngeal...
OBJECTIVE
The aim of this study was to describe the presentation of pharyngeal dystonia (PD), which can occur as a focal or segmental dystonia with a primarily pharyngeal involvement for the discussion of treatment methods for controlling consequent symptoms. PD is specific to speech-related tasks.
METHODS
A retrospective medical record review of four patients with PD was performed.
RESULTS
All patients were initially misdiagnosed with adductor spasmodic dysphonia and failed standard treatment with botulinum toxin type A (BTX). On laryngoscopy, the patients were discovered to have segmental or focal dystonia primarily affecting the pharyngeal musculature contributing to their vocal manifestations. A novel treatment regimen was designed, which involved directing BTX injections into the muscles involved in spasmodic valving at the oropharyngeal level. After titrating to an optimal dose, all patients showed improvement in their voice and speech with only mild dysphagia. These patients have maintained favorable results with repeat injections at 6- to 12-week intervals.
CONCLUSIONS
PD, or dystonia with predominant pharyngeal involvement, is a rare entity with vocal manifestations that are not well described. It can be easily mistaken for spasmodic dysphonia. PD is specific to speech-related tasks. A novel method of BTX injections into the involved muscles results in a significant improvement in voice without significant dysphagia.
Topics: Acetylcholine Release Inhibitors; Aged; Botulinum Toxins, Type A; Diagnosis, Differential; Diagnostic Errors; Dysphonia; Female; Humans; Injections, Intramuscular; Laryngoscopy; Male; Medical Records; Middle Aged; Pharyngeal Diseases; Pharyngeal Muscles; Predictive Value of Tests; Recovery of Function; Retrospective Studies; Speech Acoustics; Treatment Outcome; Voice Quality
PubMed: 28651822
DOI: 10.1016/j.jvoice.2017.05.004