An approach to the management of paroxysmal laryngospasm

2007 ◽  
Vol 122 (1) ◽  
pp. 57-60 ◽  
Author(s):  
R J Obholzer ◽  
S A R Nouraei ◽  
J Ahmed ◽  
M R Kadhim ◽  
G S Sandhu
Keyword(s):  
Risk Factors ◽  
Botulinum Toxin ◽  
Proton Pump ◽  
Laryngopharyngeal Reflux ◽  
Botulinum Toxin Injection ◽  
Symptomatic Relief ◽  
Proton Pump Inhibitor Therapy ◽  
Symptom Resolution ◽  
Primary Risk Factor ◽  
Viable Treatment

AbstractObjective:To review the presentation, risk factors and management of paroxysmal laryngospasm.Study design:Retrospective review of cases.Setting:A teaching hospital otolaryngology department with a subspecialty interest in airway disorders.Patients:All patients diagnosed with laryngospasm over a two-year period were reviewed. Information was obtained about disease presentation, risk factors, management and symptom resolution.Results:Laryngospasm was diagnosed in nine women and six men. The average age at presentation was 56±6.5 years, and there was an 80 per cent association with gastroesophageal reflux disease. Proton pump inhibitors led to complete symptom resolution in six patients and to partial symptomatic relief, requiring no further treatment, in a further four patients. Of the remaining five patients unresponsive to proton pump inhibitor therapy, two continued to experience syncopal episodes due to laryngospasm. Both these patients achieved complete remission after laryngeal botulinum toxin injection. Symptoms recurred after three to four months and were successfully treated with a repeat injection.Conclusions:The primary risk factor for spontaneous laryngospasm is laryngopharyngeal reflux. Symptoms are distressing and may be relieved in most cases by treatment aimed at suppressing gastric acid secretion. Laryngeal botulinum toxin injection appears to be a viable treatment modality in selected patients with refractory symptoms.

scholarly journals Risk factors of incomplete response to proton pump inhibitor therapy in patients with mild erosive esophagitis

2014 ◽  
Vol 2 (1) ◽  
pp. 18-24
Author(s):  
Sung-Shuo Kao ◽  
Deng-Chyang Wu ◽  
Seng-Kee Chuah ◽  
Chao-Hung Kuo ◽  
Ching-Liang Lu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Proton Pump Inhibitor ◽  
Proton Pump ◽  
Erosive Esophagitis ◽  
Proton Pump Inhibitor Therapy ◽  
Inhibitor Therapy ◽  
Incomplete Response

The effect of anti-reflux treatment on subjective voice measurements of patients with laryngopharyngeal reflux

2013 ◽  
Vol 127 (6) ◽  
pp. 590-594 ◽  
Author(s):  
T J Beech ◽  
G Campbell ◽  
A L McDermott ◽  
A J Batch
Keyword(s):  
Proton Pump ◽  
Speech Therapy ◽  
Laryngopharyngeal Reflux ◽  
Proton Pump Inhibitor Therapy ◽  
Reflux Symptom ◽  
Reflux Symptom Index ◽  
Symptom Scale ◽  
Symptom Index ◽  
Scale Scores ◽  
The Impact

AbstractObjective:To assess the impact of anti-reflux treatment and speech therapy on subjective voice measurements of patients with laryngopharyngeal reflux.Methods:This paper reports a prospective study of patients seen in a voice clinic over a three-year period who were being treated for laryngopharyngeal reflux. Patients were assessed at presentation using the reflux symptom index and voice symptom scale, and were reassessed at three months and six months post-treatment. Treatment entailed twice daily proton pump inhibitor therapy and speech therapy.Results:The study comprised 74 patients. The reflux symptom index and voice symptom scale scores significantly improved following treatment at both three and six months. There was a correlation between improved reflux symptom index scores and improved voice symptom scale scores.Conclusion:Treatment of laryngopharyngeal reflux with twice daily proton pump inhibitors and speech therapy resulted in improved subjective voice measurements for patients.

Ptosis following botulinum toxin injection in hemifacial spasm

2020 ◽  
Author(s):  
Mansooreh Jamshidian-Tehrani ◽  
Hadi Z. Mehrjardi ◽  
Abolfazl Kasaee ◽  
Samira Yadegari
Keyword(s):  
Botulinum Toxin ◽  
Hemifacial Spasm ◽  
Botulinum Toxin Injection ◽  
Symptomatic Relief ◽  
Symptom Relief ◽  
Spontaneous Remission ◽  
Cataract Extraction ◽  
Glaucoma Surgery ◽  
Term Treatment ◽  
Long Term Treatment

Hemifacial spasm (HFS) is characterized by irregular involuntary tonic or clonic contractions of muscles innervated by the seventh cranial nerve. Patients usually need long-term treatment, as spontaneous remission is infrequent. Repeated botulinum toxin injection has been shown as a safe and successful treatment for symptomatic relief in patients with HFS.1 Side effects are usually mild and transient. Ptosis has been reported in about 24% of patients with HFS probably due to diffusion of toxin to levator palpebrae superioris muscle.2 However, the frequency of ptosis in patients with HFS has not been addressed yet, due to causes other than botulinum toxin side effect. Herein, we present a case of HFS who presented to our clinic with complaint of complete ptosis and progressive pain early after botulinum toxin injection. Despite initial negative evaluations, further work up revealed a compressive lesion. A 75-year-old man presented with left severe ptosis since 3 weeks ago (Figure 1). He was known case of left HFS since 4 years ago, and botulinum toxin had been regularly injected for his symptom relief in orbicularis oculi, corrugator, and procerus muscles.   Figure 1. Left Blepharoptosis one week after botulinum toxin injection   The patient stated that this new ptosis had begun within a week after his last Dysport (Ipsen, Ltd., Slough, Berkshire, UK) injection while he had no ptosis in his previous injections. In past medical history, he had ischemic heart disease, hypertension, cataract extraction of both eyes, and glaucoma surgery on his right eye. He had been admitted to the neurology ward of a general hospital.

Effects of Proton Pump Inhibitor Therapy for Laryngopharyngeal Reflux on Posttreatment Symptoms and Hypopharyngeal pH

2014 ◽  
Vol 150 (6) ◽  
pp. 1010-1017 ◽  
Author(s):  
Jonathan Waxman ◽  
Sreeya Yalamanchali ◽  
Elizabeth Shay Valle ◽  
Thomas Pott ◽  
Michael Friedman
Keyword(s):  
Proton Pump Inhibitor ◽  
Proton Pump ◽  
Laryngopharyngeal Reflux ◽  
Proton Pump Inhibitor Therapy ◽  
Inhibitor Therapy

scholarly journals A clinical study of symptomatic profile and response in objective and subjective parameters to proton pump inhibitor in laryngopharyngeal reflux

2016 ◽  
Vol 2 (4) ◽  
pp. 238
Author(s):  
Kavitha Y. ◽  
Angshuman Dutta ◽  
Sabarigirish K. ◽  
Joish Upendra Kumar
Keyword(s):  
Proton Pump Inhibitor ◽  
Proton Pump ◽  
Laryngopharyngeal Reflux ◽  
Proton Pump Inhibitor Therapy ◽  
Common Finding ◽  
Therapeutic Trial ◽  
Dietary Recommendations ◽  
Reflux Symptom Index ◽  
Presumptive Diagnosis ◽  
Symptom Index

<p class="abstract"><strong>Background:</strong> The study was conducted to identify the various clinical presentations and findings in cases of LPR and also to study the role of proton pump inhibitor in the management of laryngopharyngeal reflux by observing the effect of proton pump inhibitor on reflux finding score (RFI) and reflux symptom index (RSI).</p><p class="abstract"><strong>Methods:</strong> A prospective, interventional, cohort study of 50 diagnosed cases of LPR with RSI &gt;13 and RFS &gt;7 (based on fibreoptic laryngoscopic findings) at the time of initial presentation was done. They were treated with a 6 month course of oral cap omeprazole (20 mg twice daily 30 minutes before meals) and followed up at 0, 4, 8 and 24 weeks for any improvement in RSI and RFS scores.  </p><p class="abstract"><strong>Results:</strong> Most frequent symptoms detected in the cases were frequent clearing of throat, dry cough and sensation of lump in the throat all of which showed significant improvement at follow up at 4 weeks. Most common finding on fibreoptic laryngoscopy was erythema and diffuse laryngeal oedema, both of which showed significant improvement on follow up.There was also a significant change in RSI and RFS after receiving Omeprazole at 4 weeks, 8 weeks and at 24 weeks duration (p &lt;0.0001).</p><p><strong>Conclusions:</strong> This study dealt mainly with study of combination of clinical features that LPR presents time line of improvement of these features with capsule omeprazole.   It is proposed that a presumptive diagnosis of LPR can be made based on the criteria of RSI and patients be given an empirical therapeutic trial including behavioral and dietary recommendations and 6 months of twice-daily proton-pump inhibitor therapy  for an excellent  clinical response.</p>

scholarly journals Proton Pump Inhibitors versus Solitary Lifestyle Modification in Management of Laryngopharyngeal Reflux and Evaluating who is at Risk: Scenario in a Developing Country

2014 ◽  
Vol 7 ◽  
pp. CMENT.S13799 ◽  
Author(s):  
Preetam Chappity ◽  
Rakesh Kumar ◽  
Ramesh C. Deka ◽  
Venkatakarthikeyan Chokkalingam ◽  
Anoop Saraya ◽  
...  
Keyword(s):  
Risk Factors ◽  
At Risk ◽  
Proton Pump Inhibitor ◽  
Proton Pump ◽  
Lifestyle Modification ◽  
Laryngopharyngeal Reflux ◽  
Treatment Protocol ◽  
Complete Analysis ◽  
Risk Population ◽  
Early Management

Background Laryngopharyngeal reflux disease can present with a varied symptomatology because of the involvement of multiple sub-sites of the upper aero-digestive tract. It is a very common disease to be encountered in routine practice by both medical and ENT personnel. Its association with multiple pathologies including malignancy warrants an early diagnosis and management. The lack of cost effective and non-invasive tests constitutes a major hurdle in its early management. Objectives 1. To define the “at risk” population, prone to developing laryngopharyngeal reflux. 2. To formulate major and minor risk factors for the clinical diagnosis of patients with laryngopharyngeal reflux. 3. To evaluate the efficacy of lifestyle management alone as a treatment option. 4. To formulate a treatment protocol for the management of patients and to prevent recurrence. Study Design We performed a prospective analysis of 234 patients diagnosed with laryngopharyngeal reflux. Patients were randomized into study and control groups based on the treatment protocol, using a computer generated randomization table and were single blinded to the type of therapy received. A complete analysis of the possible risk factors, symptoms, and signs was performed with statistical analysis. Results and Conclusion The data has helped us define the “at risk” population and formulate the criteria to diagnose cases of laryngopharyngeal reflux, clinically. The results emphasize the non-requirement of invasive or costly investigations for all patients and indicate the probable protocol to be followed prior to considering further investigation. The role of long term proton pump inhibitor treatment along with lifestyle modification in the initial phase of treatment, as mentioned in the literature, was re-confirmed by our study. However, in addition to the initial treatment, the study establishes the need for continuing lifestyle modification further for at least six months after the cessation of proton pump inhibitor therapy to prevent early recurrence of symptoms.

A Prospective Randomized Clinical Trial of Combination Therapy with Proton Pump Inhibitors and Mucolytics in Patients with Laryngopharyngeal Reflux

2020 ◽  
Vol 129 (8) ◽  
pp. 781-787
Author(s):  
Minsuk Chae ◽  
Dong Hyuk Jang ◽  
Ho Chan Kim ◽  
Minsu Kwon
Keyword(s):  
Combination Therapy ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Laryngopharyngeal Reflux ◽  
Symptomatic Relief ◽  
Control Group ◽  
Reflux Symptom Index ◽  
Symptom Index ◽  
Significant Difference

Objectives: To identify whether combination therapy with mucolytics and proton pump inhibitors (PPIs) leads to faster and more effective symptomatic relief in patients with laryngopharyngeal reflux (LPR). Methods: Patients diagnosed as LPR with a reflux symptom index (RSI) ≥ 13 and a reflux finding score (RFS) ≥ 7 were enrolled in this prospective study. Patients were randomly allocated to control (PPI only) or experimental (PPI + mucolytics) groups and changes in RSI and RFS values were assessed at 1- and 3-month follow-up. Results: One hundred sixteen patients were randomly allocated into either the control group ( n = 59) or the experimental group ( n = 57). The RSI and RFS scores significantly decreased in both groups (all P < .001) after 1 month of treatment; however, there was no significant difference in RSI change between groups ( P = .223). After 3 months of treatment, there remained no significant difference in RSI change between groups ( P = .592). Conclusions: Combination therapy with mucolytics and PPI compared to PPI alone did not lead to faster or more effective symptomatic relief in LPR patients.

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