scholarly journals Neck complaints before and after uncomplicated thyroidectomy: prevalence, postoperative outcome and relationships with thyroid weight and reflux like symptoms

Endocrine ◽  
2021 ◽  
Author(s):  
Maria Raffaella Marchese ◽  
Jacopo Galli ◽  
Lucia D’Alatri ◽  
Annamaria D’Amore ◽  
Francesco Sionne ◽  
...  
Keyword(s):  
Thyroid Disease ◽  
Subjective Evaluation ◽  
Postoperative Outcome ◽  
Reflux Symptom Index ◽  
Symptom Index ◽  
Gland Weight ◽  
Reflux Symptoms ◽  
Airway Symptoms ◽  
Before And After ◽  
Score Gain

Abstract Purpose The surgical thyroid disease includes upper aerodigestive complaints with not homogenous prevalence and specific features. The purpose was to analyze before and after total thyroidectomy (TT) the prevalence and severity of voice, swallowing, respiratory, and reflux airway symptoms in relation with thyroid weight. Methods A total of 98 consenting patients undergoing TT were enrolled. Preoperatively, 1 and 3 months after TT, patients underwent videolaryngoscopy, subjective evaluation of voice (VIS), swallowing (SIS and EAT-10), respiratory (mMRC), and reflux symptoms (RSI, Gerd-Q). The scores were analyzed based on thyroid weight (<25 gr, 26–50 gr, 51–75 gr, >75 gr) and post-operative score gain was calculated from the score before TT and the follow-up examination. Results In total, 40/98 selected cases of uncomplicated TT completed the postoperative evaluation. Endoscopic signs suggestive of reflux disease were observed in 1/40 (2.5%) and 0/19 cases before and after TT respectively. The prevalence of cases with abnormal reflux symptom index decreased significantly after surgery (8/40 vs 1/40) (p < 0.05), similarly occurred for the Gerd-Q (4/40 vs 1/40) (p < 0.05). Three months after TT the voice, swallowing and respiratory scores were significantly lower than the preoperative ones (p < 0.05). The SIS correlated positively with EAT-10 and RSI. After 3 months the postoperative score gain of voice, swallowing, respiratory, and reflux symptoms (Gerd-Q) was statistically higher (p < 0.05) in the cases with heaviest gland. Conclusions The surgical thyroid disease is associated to mild aerodigestive preoperative compressive symptoms, that include respiratory abnormalities and reflux like symptoms, regardless of the gland weight. In absence of endoscopic signs of airway reflux the presence of reflux symptoms suggests an overlapping with thyroid neck complaints. The patients undergoing uncomplicated TT had improvement in compressive symptoms and the greatest improvement is seen in larger goiters.

scholarly journals Usefulness of The Reflux Symptom Index in the Management of Laryngopharyngeal Reflux

2021 ◽  
Vol 28 (3) ◽  
pp. 234-240
Author(s):  
Saai Ram Thejas ◽  
Ganganamoni Rajamohan ◽  
Sindu Mohan ◽  
Kowsalya Swarna
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Laryngopharyngeal Reflux ◽  
Lower Oesophageal Sphincter ◽  
Reflux Symptom ◽  
Reflux Symptom Index ◽  
Symptom Index ◽  
Before And After ◽  
Treatment Data ◽  
Transient Relaxation

Introduction Laryngopharyngeal Reflux (LPR) is highly prevalent in the general population and its impact on health systems is growing dramatically by the day. The contents of the stomach flowing back into the oesophagus, pharynx and larynx because of a transient relaxation of the lower oesophageal sphincter leads to a spectrum of symptoms diagnosed as LPR and Gastroesophageal Reflux Disease (GERD). The aim was to study in detail the symptoms of LPR and to ascertain if and how they hamper the routine of an individual by using the Reflux Symptom Index (RSI).  Materials and Methods The Reflux Symptom Index (RSI) is a self-administered nine-item outcomes instrument for LPR.  Ninety-one patients with clinically diagnosed LPR were taken up for this study and were issued the RSI (translated into the local language for better results) before and after treatment.  Data was assessed at the end of 3 months and 6 months.  Results The tabulated data showed significant improvement in the symptomatic index after treatment.   Conclusion It can thus be concluded that RSI is still highly valid in the follow-up for patients with LPR because it can be easily administered and gives accurate results with excellent validation.

scholarly journals Aggravation of Reflux Finding Score (RFS) after thyroidectomy

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0254235
Author(s):  
Hyung-Joon Yoon ◽  
Hee Ryung Kim ◽  
Chang Myeon Song ◽  
Ji Young Lee ◽  
You Hern Ahn ◽  
...  
Keyword(s):  
Esophageal Manometry ◽  
Laryngopharyngeal Reflux ◽  
Ph Monitoring ◽  
Central Neck Dissection ◽  
Reflux Finding Score ◽  
Reflux Symptom Index ◽  
Preoperative Level ◽  
Symptom Index ◽  
Before And After ◽  
Possible Cause

Laryngopharyngeal reflux (LPR) has been suggested as a possible cause of post-thyroidectomy syndrome. However, the pathophysiology and relationship between thyroidectomy and LPR have not been well investigated. We aimed to evaluate the correlation between thyroidectomy and LPR by assessing changes in LPR-related symptoms and laryngoscopic findings before and after thyroidectomy. Ninety-five patients who underwent thyroidectomy with or without central neck dissection were included. The reflux finding score (RFS) and reflux symptom index (RSI) were investigated one day before surgery and two, four, six, and twelve months after surgery. The RFS scores increased significantly after thyroidectomy and decreased to the preoperative level 12 months after surgery. The RSI scores increased after surgery and decreased gradually by 12 months postoperatively, although it was not statistically significant. The RSI and RFS scores improved with the administration of proton pump inhibitors. In conclusion, LPR-related laryngoscopic findings were exacerbated after uncomplicated thyroidectomy. Further studies using pH-monitoring and esophageal manometry are required to investigate the possible deterioration of LPR itself and the UES pressure after thyroidectomy.

scholarly journals PS01.057: THYROIDECTOMY AND LARYNGO-PHARYNGEAL REFLUX: WHAT’S NEW

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 66-66
Author(s):  
Ina Macaione ◽  
Alessia Cusimano ◽  
Calogero Cipolla ◽  
Giuseppa Graceffa ◽  
Gianni Pantuso ◽  
...  
Keyword(s):  
Clinical Picture ◽  
Conflicts Of Interest ◽  
Pathological Condition ◽  
Control Group ◽  
Reflux Symptom Index ◽  
Symptom Index ◽  
Before And After ◽  
Group A ◽  
Group B ◽  
Pharyngeal Reflux

Abstract Background ‘Local neck symptoms’ may be related to goiter; a persistence of those symptoms after an uncomplicated total thyroidectomy (TT) might be referred to the laryngo-pharyngeal reflux (LPR). Our previous study found a correlation between goiter and LPR in selected patients with local neck symptoms; the purpose of our current study is to investigate the presence of a laringopharyngitis in patients with goiter, before and after TT, even in the absence of local neck symptoms, assessing whether the presence of LPR may play a role at the outset of the symptomatology. Methods Two groups of patients were considered and they differred for the presence or absence of local neck symptoms: group A (25 patients) and group B (40 patients). The clinical evaluation was standardized using the reflux symptom index. The patients were subjected to videolaringoscopy (VLS) and to esophageal videoflurography (VFGE) before and three months after surgery. Results Before surgery all the patients in group A showed a normal vocal chord motility and laryngitis findings at the VLS. The VFGE was positive to abnormal swallowing in 86% of patients. The laryngitis findings at VLS, were found in 38% of cases in group B. At VFGE 96% of the patients were positive to the test. The symptoms reported in the pre-operative were unchanged after surgery in group A. In group B 63% of patients remained positive; at VFGE 73% had a clear pathological condition. Conclusion In 2010 ‘Amelita’ study concluded that LPR should be taken into account as a possible movens of post-thyroidectomy clinical picture, both in the diagnosis and in the therapeutic management of those patients who complained about local neck symptoms, since the only TT hadn’t been effective. The collected data of the current study are consistent with those of the previous study: symptoms persisted or increased in laryngopharingeal reflux-positive patients, while in the control group the symptoms were absent or the new appearance symptomatic pictures were moderate. It is a shared view that we shouldn’t wait for the overt clinical picture, but prevent it. It is essential to identify, through a careful pre-operative evaluation, patients positive to LPR. Disclosure All authors have declared no conflicts of interest.

The association between the reflux symptoms index and nasal symptoms among patients with non-allergic rhinitis

2021 ◽  
pp. 1-5
Author(s):  
A W Hamizan ◽  
Y Y Choo ◽  
P V Loh ◽  
N F Abd Talib ◽  
M F Mohd Ramli ◽  
...  
Keyword(s):  
Allergic Rhinitis ◽  
Laryngopharyngeal Reflux ◽  
Nasal Symptom ◽  
Reflux Symptom ◽  
Reflux Symptom Index ◽  
Symptom Index ◽  
Cross Sectional ◽  
Nasal Symptoms ◽  
Reflux Symptoms ◽  
Non Allergic Rhinitis

Abstract Background Laryngopharyngeal reflux symptoms assessed with the reflux symptom index can overlap with non-allergic rhinitis symptoms. This study aims to explore the association between the reflux symptom index and nasal symptoms in non-allergic rhinitis patients. Methods A cross-sectional study was conducted on consecutive adults with non-allergic rhinitis. The reflux symptom index (score of more than 13 = laryngopharyngeal reflux) and nasal symptoms (categorised as mild (total score of 0–3), moderate (4–7) or severe (8–12)) were assessed. Results The study included 227 participants (aged 58.64 ± 12.39 years, 59.5 per cent female). The reflux symptom index scores increased with total nasal symptom scores (mild vs moderate vs severe, 8.61 ± 6.27 vs 12.94 ± 7.4 vs 16.40 ± 8.10; p < 0.01). Logistic regression indicated that laryngopharyngeal reflux is more likely in patients with severe nose block (odds ratio 5.47 (95 per cent confidence interval = 2.16–13.87); p < 0.01). Conclusion Laryngopharyngeal reflux symptoms are associated with nasal symptom severity, and nasal symptoms should be primarily treated. Those with predominant nose block and laryngopharyngeal reflux symptoms are more likely to have laryngopharyngeal reflux.

scholarly journals Smoking Cessation Improves the Symptoms and the Findings of Laryngeal Irritation

2019 ◽  
Vol 99 (2) ◽  
pp. 124-127
Author(s):  
A. Secil Kayalı Dinc ◽  
Melih Cayonu ◽  
Tijen Sengezer ◽  
M. Melih Sahin
Keyword(s):  
Smoking Cessation ◽  
Vocal Fold ◽  
Laryngopharyngeal Reflux ◽  
Endoscopic Examination ◽  
Reflux Finding Score ◽  
Reflux Symptom Index ◽  
Posterior Commissure ◽  
Symptom Index ◽  
Before And After ◽  
Cigarette Cessation

Smoking is known to increase laryngeal inflammation and laryngopharyngeal reflux (LPR), which cause laryngeal irritation. Thus, the aim of this study is to evaluate the changes in the symptoms and the findings of laryngeal irritation in smokers after a smoking cessation period. The reflux symptom index (RSI) and the reflux finding score (RFS) were used for evaluating the symptoms and findings of laryngeal irritation in smokers. Endoscopic examination of the laryngeal structures for RFS and symptom inquiry for RSI were performed at the beginning of the study and after a 2 months of cigarette cessation period. This study was carried out in 24 volunteers (14 female and 10 male), between the ages of 24 and 62 years. When we compared the results of RSI and RFS that were performed before and after the cigarette cession period, we found that there was a significant improvement both in RSI and in RFS ( P < .001 and P < .001, respectively). Also, there was significant correlation between the cigarette smoking period and RFS score that was determined at the beginning of the study ( P = .006, r = .54). A significant improvement was found both in RSI and in RFS after smoking cessation period, which might be the evidence of improvement in laryngeal irritation possibly caused by inflammation due to smoking and LPR. A significant positive correlation was found between smoking period and RFS, especially with vocal fold edema and posterior commissure hypertrophy.

Voice Therapy With Seniors: Attendance, Outcomes, and Associated Patient Characteristics

2019 ◽  
Vol 4 (5) ◽  
pp. 814-824 ◽  
Author(s):  
Bonnie E. Smith ◽  
Ruth Huntley Bahr ◽  
Hector N. Hernandez
Keyword(s):  
Outcome Data ◽  
Voice Therapy ◽  
Similar Data ◽  
Success Rates ◽  
Reflux Symptom Index ◽  
Voice Change ◽  
Related Factors ◽  
Symptom Index ◽  
Younger Patients ◽  
Unsuccessful Treatment

Purpose The purpose of this study was to determine the attendance and success rates for seniors in voice therapy, identify any contributing patient-related factors, and compare results to existing findings for younger patients. Method This retrospective study included information from the voice records of 50 seniors seen by the same speech-language pathologist in a private practice. Analysis of attendance and outcome data divided participants into 6 groups. Outcomes for Groups 1–3 (64% of patients) were considered successful (positive voice change), while outcomes for Groups 4–6 (36% of patients) were considered unsuccessful. These data were compared to similar data collected for younger adults in a previous study. Results The attendance and success rates for seniors in this study were higher than those previously reported for younger patients. Further consideration of patient factors revealed that reports of increased stress, Reflux Symptom Index scores > 13, and higher Voice Handicap Index functional subscale scores were significant in distinguishing between patients in the successful and unsuccessful treatment outcome groups. Conclusions The relatively high attendance and success rates among this sample of seniors suggest the desire to achieve voice improvement does not diminish with age, and chances for success in voice therapy among nonfrail seniors may be greater than for younger patients.

Assessment and Diagnostic Accuracy Evaluation of the Reflux Symptom Index (RSI) Scale: Psychometric Properties using Optimal Scaling Techniques

2020 ◽  
Vol 129 (10) ◽  
pp. 1020-1029
Author(s):  
Andrea Nacci ◽  
Luca Bastiani ◽  
Maria Rosaria Barillari ◽  
Jerome R. Lechien ◽  
Massimo Martinelli ◽  
...  
Keyword(s):  
Psychometric Properties ◽  
Sensitivity And Specificity ◽  
Reflux Symptom ◽  
Original Version ◽  
Control Group ◽  
Clinical Group ◽  
Accuracy Evaluation ◽  
Reflux Symptom Index ◽  
Characteristic Analysis ◽  
Symptom Index

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.

scholarly journals Allergic rhinitis, asthma and laryngopharyngeal reflux disease: a cross-sectional study on their reciprocal relations

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ameer Kakaje ◽  
Mohammad Marwan Alhalabi ◽  
Ayham Alyousbashi ◽  
Ayham Ghareeb
Keyword(s):  
Allergic Rhinitis ◽  
Reflux Disease ◽  
Medical Condition ◽  
Laryngopharyngeal Reflux ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Reflux Symptom Index ◽  
Symptom Index ◽  
Cross Sectional ◽  
Wide Range

AbstractAllergic rhinitis (AR) is a common medical condition worldwide. It is an inflammation in the nasal mucosa due to allergen exposure throughout the year. Laryngopharyngeal reflux (LPR) is another medical condition that can overlap with AR. LPR can be considered an extra oesophageal manifestation of gastro-oesophageal reflux disease (GORD) or a different entity. Its diagnosis imposes a real challenge as it has a wide range of unspecific symptoms. Although AR and LPR are not life-threatening, they can severely affect the quality of life for years and cause substantial distress. Moreover, having AR is associated with having asthma which is also in turn associated with GORD. This is a cross-sectional study which used surveys distributed online on Social Media and targeted people across Syria. All participants who responded to the key questions were included. Reflux symptom index (RSI) was used for LPR, and score for allergic rhinitis (SFAR) was used for AR. Demographic questions and whether the participant had asthma were also included in the survey. We found that there was an association between the symptoms of LPR and AR p < 0.0001 (OR, 2.592; 95% CI 1.846–3.639), and their scores were significantly correlated (r = 0.334). Having asthma was associated with LPR symptoms p = 0.0002 (OR 3.096; 95% CI 1.665–5.759) and AR p < 0.0001 (OR 6.772; 95% CI 2.823–16.248). We concluded that there was a significant association between having LPR, AR, and asthma. We need more studies to distinguish between their common symptoms and aetiologies.

scholarly journals Laparoscopic hand-sewn cardioplasty: an alternative procedure for end-stage achalasia

2021 ◽  
Author(s):  
Fátima Senra ◽  
Lalin Navaratne ◽  
Asunción Acosta-Mérida ◽  
Stuart Gould ◽  
Alberto Martínez-Isla
Keyword(s):  
Assessment Tool ◽  
Case Series ◽  
Invasive Procedure ◽  
Lower Oesophageal Sphincter ◽  
Poor Quality ◽  
Motor Disorder ◽  
Reflux Symptom Index ◽  
Symptom Index ◽  
End Stage ◽  
Rescue Procedure

Abstract Background Primary achalasia is a rare oesophageal motor disorder characterized by the absence of swallow-induced relaxation of the lower oesophageal sphincter and diminished or absent oesophageal body peristalsis. Around 5% of these patients will develop end-stage achalasia, where oesophagectomy may be advocated. We present the laparoscopic hand-sewn cardioplasty as an alternative ‘oesophagus-preserving’ procedure in patients with end-stage achalasia. Methods We present a retrospective review of four patients who underwent laparoscopic hand-sewn cardioplasty. Data collected included pre-operative demographic information and investigations; and post-operative outcomes. Patients were scored pre- and post-operatively using Reflux Symptom Index, Eating Assessment Tool-10 and Voice Handicap Index-10 questionnaires. Results Four patients underwent laparoscopic hand-sewn cardioplasty during the study period. In one patient, it was performed as a rescue procedure during attempted myotomy following multiple perforations of friable mucosa. In the other three patients, laparoscopic hand-sewn cardioplasty was performed for end-stage achalasia. None of the patients had post-operative complications and all patients were discharged on the second post-operative day. All patients experienced improvement in swallowing symptoms (EAT-10; p = 0.03) but developed post-operative gastroesophageal reflux. Conclusion To our knowledge, this is the first published case series of laparoscopic hand-sewn cardioplasty for end-stage achalasia. It appears to be a safe and effective procedure for the treatment of end-stage achalasia, offering an alternative minimally invasive procedure to oesophagectomy. Laparoscopic hand-sewn cardioplasty can also be used as a ‘rescue’ procedure during myotomy in patients who have poor-quality mucosa which perforates intra-operatively or is at high risk of perforation/leaking post-operatively.

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