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American Family Physician Jan 2021Dysphagia is common but may be underreported. Specific symptoms, rather than their perceived location, should guide the initial evaluation and imaging. Obstructive... (Review)
Review
Dysphagia is common but may be underreported. Specific symptoms, rather than their perceived location, should guide the initial evaluation and imaging. Obstructive symptoms that seem to originate in the throat or neck may actually be caused by distal esophageal lesions. Oropharyngeal dysphagia manifests as difficulty initiating swallowing, coughing, choking, or aspiration, and it is most commonly caused by chronic neurologic conditions such as stroke, Parkinson disease, or dementia. Symptoms should be thoroughly evaluated because of the risk of aspiration. Patients with esophageal dysphagia may report a sensation of food getting stuck after swallowing. This condition is most commonly caused by gastroesophageal reflux disease and functional esophageal disorders. Eosinophilic esophagitis is triggered by food allergens and is increasingly prevalent; esophageal biopsies should be performed to make the diagnosis. Esophageal motility disorders such as achalasia are relatively rare and may be overdiagnosed. Opioid-induced esophageal dysfunction is becoming more common. Esophagogastroduodenoscopy is recommended for the initial evaluation of esophageal dysphagia, with barium esophagography as an adjunct. Esophageal cancer and other serious conditions have a low prevalence, and testing in low-risk patients may be deferred while a four-week trial of acid-suppressing therapy is undertaken. Many frail older adults with progressive neurologic disease have significant but unrecognized dysphagia, which significantly increases their risk of aspiration pneumonia and malnourishment. In these patients, the diagnosis of dysphagia should prompt a discussion about goals of care before potentially harmful interventions are considered. Speech-language pathologists and other specialists, in collaboration with family physicians, can provide structured assessments and make appropriate recommendations for safe swallowing, palliative care, or rehabilitation.
Topics: Deglutition; Deglutition Disorders; Esophagus; Family Practice; Female; Humans; Male; Pharynx; Physical Examination
PubMed: 33448766
DOI: No ID Found -
Clinical Microbiology and Infection :... Apr 2012The European Society for Clinical Microbiology and Infectious Diseases established the Sore Throat Guideline Group to write an updated guideline to diagnose and treat...
The European Society for Clinical Microbiology and Infectious Diseases established the Sore Throat Guideline Group to write an updated guideline to diagnose and treat patients with acute sore throat. In diagnosis, Centor clinical scoring system or rapid antigen test can be helpful in targeting antibiotic use. The Centor scoring system can help to identify those patients who have higher likelihood of group A streptococcal infection. In patients with high likelihood of streptococcal infections (e.g. 3-4 Centor criteria) physicians can consider the use of rapid antigen test (RAT). If RAT is performed, throat culture is not necessary after a negative RAT for the diagnosis of group A streptococci. To treat sore throat, either ibuprofen or paracetamol are recommended for relief of acute sore throat symptoms. Zinc gluconate is not recommended to be used in sore throat. There is inconsistent evidence of herbal treatments and acupuncture as treatments for sore throat. Antibiotics should not be used in patients with less severe presentation of sore throat, e.g. 0-2 Centor criteria to relieve symptoms. Modest benefits of antibiotics, which have been observed in patients with 3-4 Centor criteria, have to be weighed against side effects, the effect of antibiotics on microbiota, increased antibacterial resistance, medicalisation and costs. The prevention of suppurative complications is not a specific indication for antibiotic therapy in sore throat. If antibiotics are indicated, penicillin V, twice or three times daily for 10 days is recommended. At the present, there is no evidence enough that indicates shorter treatment length.
Topics: Acetaminophen; Anti-Bacterial Agents; Chlamydophila Infections; Chlamydophila pneumoniae; Disease Management; Humans; Ibuprofen; Mycoplasma pneumoniae; Nasopharynx; Palatine Tonsil; Penicillin V; Pharyngitis; Pharynx; Streptococcal Infections; Streptococcus pyogenes
PubMed: 22432746
DOI: 10.1111/j.1469-0691.2012.03766.x -
The British Journal of Radiology Sep 2023The pharynx plays a significant role in swallowing and speech, and this is reflected in both its complex anatomy and degree of physiological motility. Patients who... (Review)
Review
The pharynx plays a significant role in swallowing and speech, and this is reflected in both its complex anatomy and degree of physiological motility. Patients who present with pharynx-related symptoms such as sore throat, globus, dysphagia or dysphonia will usually undergo visual and nasal endoscopic examination in the first instance. Imaging is frequently required to supplement clinical assessment and this typically involves MRI and CT. However, fluoroscopy, ultrasound and radionuclide imaging are valuable in certain clinical situations. The aforementioned complexity of the pharynx and the myriad of pathologies which may arise within it often make radiological evaluation challenging. In this pictorial review, we aim to provide a brief overview of cross-sectional pharyngeal anatomy and present the radiological features of a variety of pharyngeal pathologies, both benign and malignant.
Topics: Humans; Pharynx; Cross-Sectional Studies; Deglutition Disorders; Deglutition; Fluoroscopy
PubMed: 37334795
DOI: 10.1259/bjr.20230046 -
European Annals of Otorhinolaryngology,... Apr 2019Based on a review of the medical literature, the authors document the key technical points, variants, technical errors to avoid and main functional results of lateral...
Based on a review of the medical literature, the authors document the key technical points, variants, technical errors to avoid and main functional results of lateral pharyngotomy for resection of cancers originating from the lateral oro and/or hypopharynx.
Topics: Anatomic Landmarks; Humans; Medical Illustration; Pharyngeal Neoplasms; Pharynx
PubMed: 30482706
DOI: 10.1016/j.anorl.2018.10.011 -
Cell Host & Microbe Apr 2017Landscape ecology examines the relationships between the spatial arrangement of different landforms and the processes that give rise to spatial and temporal patterns in... (Review)
Review
Landscape ecology examines the relationships between the spatial arrangement of different landforms and the processes that give rise to spatial and temporal patterns in local community structure. The spatial ecology of the microbial communities that inhabit the human body-in particular, those of the nose, mouth, and throat-deserves greater attention. Important questions include what defines the size of a population (i.e., "patch") in a given body site, what defines the boundaries of distinct patches within a single body site, and where and over what spatial scales within a body site are gradients detected. This Review looks at the landscape ecology of the upper respiratory tract and mouth and seeks greater clarity about the physiological factors-whether immunological, chemical, or physical-that govern microbial community composition and function and the ecological traits that underlie health and disease.
Topics: Ecosystem; Humans; Microbiota; Mouth; Nose; Pharynx
PubMed: 28407480
DOI: 10.1016/j.chom.2017.03.011 -
European Archives of... Jun 2024To discuss the different swallowing improvement surgeries that address one or more dysfunctional pharyngolaryngeal structures causing dysphagia. These surgeries reduce... (Review)
Review
PURPOSE
To discuss the different swallowing improvement surgeries that address one or more dysfunctional pharyngolaryngeal structures causing dysphagia. These surgeries reduce the risk of aspiration without sacrificing vocal function.
METHODS
We searched the PubMed database and used Google Scholar search engine to find studies discussing the different swallowing improvement surgeries. A manual search of references in selected articles and reviews was done as well. No chronologic limitation was set for the studies; however, only articles written in English and Japanese were considered. Due to the nature of this article, no particular inclusion or exclusion criteria were set when searching for studies to be used as references; however, all relevant studies were reviewed and agreed upon by the authors for inclusion in this review article.
RESULTS/DISCUSSION
Surgeries to improve swallowing function can be categorized into those that reinforce nasopharyngeal closure or pharyngeal contraction, improve laryngeal elevation or pharyngoesophageal segment opening, and those that improve vocal fold closure to protect the airway during swallowing. They are an effective alternative treatment that may significantly improve these patients' quality of life. Swallowing rehabilitation with the altered pharyngolaryngeal structures is required post-operatively to significantly improve patients' dysphagia.
CONCLUSIONS
Surgeries to improve swallowing function address specific dysfunctional sites involved in the swallowing mechanism. Choosing the most appropriate surgery for each patient requires knowledge of the pathophysiology for their dysphagia and detailed pre-operative work-up.
Topics: Humans; Deglutition; Deglutition Disorders; Larynx; Otorhinolaryngologic Surgical Procedures; Pharynx
PubMed: 38265461
DOI: 10.1007/s00405-024-08452-z -
European Annals of Otorhinolaryngology,... Sep 2021This article reviews the development of practical and theoretical teaching of surgical management of throat cancer, from the dialectic of the Middle Ages to computer... (Review)
Review
This article reviews the development of practical and theoretical teaching of surgical management of throat cancer, from the dialectic of the Middle Ages to computer simulation of the 21st century. This work is essentially based on original historical publications, analysed from secondary references relevant to the interpretation of the original texts. The literature search was essentially conducted in the "bibliothèque universitaire de médecine de Tours", the "bibliothèque inter-universitaire de médecine de Paris", the "Assistance publique-Hôpitaux de Paris archives" and the "bibliothèque nationale de France". PubMed was used for the most recent references. The search terms focused on surgical training, the history of otorhinolaryngology and throat cancer. Up until the 19th century, throat cancer surgery training was provided by general surgeons. The otorhinolaryngology specialty was created at the turn of the 20th century: throat cancer surgery became a subspecialty, but certain university obstacles prevented the creation of formal throat cancer surgery training. In the 20th and 21st century, throat cancer surgery training was enhanced by technical innovations as well as ethical imperatives. The principle of mentoring, essential in surgical training, has remained a constant feature throughout the ages, regardless of the scientific progress described in this historical review.
Topics: Computer Simulation; France; History, 19th Century; History, 20th Century; Humans; Neoplasms; Otorhinolaryngologic Surgical Procedures; Pharynx
PubMed: 33184014
DOI: 10.1016/j.anorl.2020.09.008 -
Australian Journal of General Practice Oct 2018Patients with foreign bodies in their ear, nose or throat typically present to general practitioners. The safe and timely removal of foreign bodies ensures good patient... (Review)
Review
BACKGROUND
Patients with foreign bodies in their ear, nose or throat typically present to general practitioners. The safe and timely removal of foreign bodies ensures good patient outcomes and limits complications.
OBJECTIVES
The aim of this paper is to outline common foreign objects and review the associated anatomy that may make removal difficult. A description of instruments and indications for use is provided, along with circumstances where specialist referral is warranted.
DISCUSSION
The use of appropriate techniques for removal of foreign bodies reduces the complications of removal and associated distress, and limits the number of cases that require surgical input.
Topics: Ear; Foreign Bodies; Humans; Nose; Otorhinolaryngologic Diseases; Pharynx; Referral and Consultation; Therapeutic Irrigation
PubMed: 31195771
DOI: 10.31128/AJGP-02-18-4503 -
BMJ Case Reports Feb 2021
Topics: Humans; Neck; Nose; Otolaryngology; Pharynx
PubMed: 33563681
DOI: 10.1136/bcr-2020-241172 -
ELife Feb 2020MRI experiments have revealed how throat singers from Tuva produce their characteristic sound.
MRI experiments have revealed how throat singers from Tuva produce their characteristic sound.
Topics: Pharynx; Singing; Sound; Speech Acoustics
PubMed: 32048994
DOI: 10.7554/eLife.55749