scholarly journals Neurogenic Dyspnea: Is Idiopathic Dyspnea Related to a Post-Viral Sensory Neuropathy? A Case Series Supporting a New Hypothesis

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Zalvan C ◽  
◽  
Yuen E1 ◽  
Cole J ◽  
Loftus C ◽  
...  
Keyword(s):  
Treatment Protocol ◽  
Case Series ◽  
Retrospective Chart Review ◽  
Previous Treatment ◽  
Unknown Etiology ◽  
Continuous Variables ◽  
Reflux Symptom Index ◽  
Symptom Index ◽  
Saline Irrigation ◽  
Reduction Approach

Objective: To propose a hypothesis of a novel potentially post-viral sensory neuropathic disorder, termed neurogenic dyspnea, and assess the therapeutic efficacy of a trigger reduction approach in this unique patient population. Methods: A retrospective chart review of patients seen between January 2011 and April 2018 for persistent dyspnea of unknown etiology was conducted. All patients failed to improve with treatment for presumptive diagnoses of allergy, asthma, sinus disease, and reflux. Patients were educated on our treatment protocol consisting of a Mediterranean style, plant-based diet with alkaline water, saline irrigation, and combined azelastine/fluticasone nasal spray. Treatment response was followed using two validated symptom questionnaires, Reflux Symptom Index (RSI) and Dyspnea Index (DI). Results: Of 57 initial patients, 8 were included in the final analysis. Mean age was 38.8 years (range 11-68). Six (75%) patients were female. All patients were followed for a minimum of 4 weeks. Using the reduction in DI and RSI as continuous variables to assess response, patients experienced a 9.4 (95% CI: 3.9-14.9) and 14.1 (95% CI: 6.0-22.2) mean point reduction, respectively. One patient saw a 100% and another a 95% reduction in DI. Six of eight patients experienced more than a 50% reduction in RSI. Conclusion: We hypothesize that Neurogenic Dyspnea is a newly described clinical phenomenon with a possible post-viral etiology. This pilot study demonstrated that our trigger reduction approach improved subjective symptoms in the majority of patients with unexplained dyspnea with previous treatment failure for common etiologies. Further studies are required to validate these findings.

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.

Shar Pei Larynx: Supraglottic and Postcricoid Mucosal Redundancy and Its Association With Medical Comorbidities

2018 ◽  
Vol 128 (2) ◽  
pp. 121-127 ◽  
Author(s):  
Yin Yiu ◽  
Kathleen M. Tibbetts ◽  
C. Blake Simpson ◽  
Laura A. Matrka
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Laryngopharyngeal Reflux ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Future Research ◽  
Morbidly Obese ◽  
Reflux Symptom Index ◽  
Symptom Index ◽  
Obstructive Sleep

Objectives: The aim of this study is to describe a clinical entity the authors term “Shar Pei larynx,” characterized by redundant supraglottic and postcricoid mucosa that the authors hypothesize coexists in patients with obstructive sleep apnea, laryngopharyngeal reflux, and obesity. By exploring this hypothesis, the authors hope to set the foundation for future research with the goal of identifying whether Shar Pei larynx is a marker for untreated sleep apnea or other diseases. Study Design: Retrospective chart review. Setting: Two tertiary care academic institutions. Methods: Data were collected from a 5-year period by querying for patients described to have “Shar Pei larynx” or “posterior supraglottic and/or postcricoid mucosal redundancy” on laryngoscopic findings. Relevant demographic and clinical characteristics were analyzed, with a focus on associations with obesity, sleep apnea, and laryngopharyngeal reflux. Results: Thirty-two patients were identified with physical findings consistent with Shar Pei larynx. Twenty-six patients (81.3%) were obese; 16 (50%) were morbidly obese. Twenty-two patients (68.8%) either had an existing diagnosis of obstructive sleep apnea or were diagnosed on polysomnography performed after initial evaluation. Sixteen patients (50%) had type 2 diabetes mellitus, and 87.5% of these patients were obese. Twenty-eight patients (87.5%) noted histories of reflux, with a median reflux symptom index of 27 of 45. Five patients underwent procedures to reduce mucosal redundancy related to Shar Pei larynx. Conclusions: This pilot study confirms that the majority of patients diagnosed with Shar Pei larynx also had diagnoses of obesity, obstructive sleep apnea, and reflux disease. The demonstrated association is strong enough to warrant further study.

scholarly journals The role of magnesium supplement in laryngopharyngeal reflux disease

2021 ◽  
Vol 8 (1) ◽  
pp. 47
Author(s):  
Adhira Gobind
Keyword(s):  
Reflux Disease ◽  
Laryngopharyngeal Reflux ◽  
Tertiary Care ◽  
Treatment Protocol ◽  
Care Hospital ◽  
Reflux Symptom Index ◽  
Symptom Index ◽  
Regular Treatment ◽  
Laryngopharyngeal Reflux Disease

<p class="abstract"><strong>Background:</strong> Laryngopharyngeal reflux disease (LPRD) is one of the most prevalent upper gastrointestinal disorder encountered in clinical practice and its optimal treatment is not standardized. The role of magnesium in the human body functions is often underestimated. Since magnesium (Mg) plays a major role in the regulation of smooth muscle contractionby relaxing the pyloric sphincter and enhancing gastric emptying, thereby decreasing the pressure on the LES, it was hypothesized that adding magnesium supplements along with the regular treatment for LPRD, can improve LPRD symptoms. Magnesium has a neutralizing action on the gastric acid and therefore, it may be pertinent to achieve optimal Mg intakes in patients with LPRD.</p><p class="abstract"><strong>Methods:</strong> This is a prospective study done over a period of 1 year conducted in a tertiary care hospital in central India in patients presenting with LPRD of the age group 18-65 years.  </p><p class="abstract"><strong>Results:</strong> The study patients were divided into two groups-one treated with esmoprazole 40 mg capsules and alginate syrup and the other with esmoprazole capsules, alginate syrup and magnesium glycinate (250 mg) supplement. Both the groups showed appreciable improvement in their mean reflux symptom index (RSI) and reflux finding score (RFS) at 1 month and 3 months follow-up. Females showed a higher preponderance than males in the disease, symptoms and the mean RSI and RFS score.</p><p class="abstract"><strong>Conclusions:</strong> Addition of magnesium supplements along with the regular treatment for LPRD, can improve LPRD symptoms and should be considered in the treatment protocol of LPRD.</p>

The Value of Routine pH Monitoring in the Diagnosis and Treatment of Laryngopharyngeal Reflux

2012 ◽  
Vol 146 (6) ◽  
pp. 952-958 ◽  
Author(s):  
Michael Friedman ◽  
Craig Hamilton ◽  
Christian G. Samuelson ◽  
Kanwar Kelley ◽  
Renwick Taylor ◽  
...  
Keyword(s):  
Predictive Value ◽  
Laryngopharyngeal Reflux ◽  
Ph Monitoring ◽  
Linear Regression Analysis ◽  
Tertiary Care ◽  
Case Series ◽  
Reflux Symptom ◽  
Reflux Symptom Index ◽  
Symptom Index ◽  
Significant Difference

Objective. To assess the need for pH testing in diagnosing laryngopharyngeal reflux (LPR). Study Design. Case series with planned data collection. Setting. Tertiary care center. Subjects and Methods. On the basis of symptoms and/or abnormal endoscopic findings, more than 500 patients underwent 24-hour pharyngeal pH testing at a single center (using the Dx-pH probe) between January 2009 and June 2011. A total of 163 patients not on proton-pump inhibitors at the time of study and with complete data available for analysis (pH results, body mass index, smoking status, pretest reflux symptom index) were divided into 2 groups by positive (n = 70) and negative (n = 93) Ryan Score. The Reflux Symptom Index (RSI) was compared between groups and assessed overall against Ryan Score parameters at different pH thresholds. The diagnostic utility of an RSI ≥ 13 for prediction of Ryan Score was assessed. Results. No significant difference in RSI was seen between Ryan-positive (17.50 ± 11.47) and Ryan-negative (14.95 ± 11.43) patients ( P = .161). Overall, RSI correlated poorly with percentage time spent below pH thresholds 6.5, 6.0, 5.5, and 5.0 and upright and supine Ryan parameters at these thresholds (as determined by linear regression analysis). The sensitivity, specificity, positive predictive value, and negative predictive value of RSI ≥ 13 for Ryan positivity were 55.7%, 47.3%, 44.3%, and 58.7%, respectively. Conclusion. Our findings show that in our population of otolaryngology patients, the diagnosis of LPR cannot be reliably made on the basis of symptoms alone. Diagnosis, and in particular treatment decisions, should ideally be made on the basis of a combination of symptoms, signs, and confirmatory testing.

Association of Heartburn and Laryngopharyngeal Symptoms with Endoscopic Reflux Esophagitis, Smoking, and Drinking

2009 ◽  
Vol 141 (2) ◽  
pp. 264-271 ◽  
Author(s):  
Chang-Chun Lin ◽  
Ya-Yu Wang ◽  
Kai-Li Wang ◽  
Han-Chung Lien ◽  
Ming-Tai Liang ◽  
...  
Keyword(s):  
Reflux Esophagitis ◽  
Case Series ◽  
Clinical Importance ◽  
Whole Body ◽  
Reflux Symptom Index ◽  
Voice Change ◽  
Symptom Index ◽  
Taiwanese People ◽  
Patients At Risk ◽  
Endoscopic Esophagitis

OBJECTIVES: This study was conducted to investigate the association of laryngopharyngeal symptoms and heartburn with endoscopic esophagitis, smoking, and drinking. The clinical importance of the Reflux Symptom Index (RSI) in predicting endoscopic esophagitis was also evaluated. STUDY DESIGN: Case series with planned data collection. SUBJECTS AND METHODS: From November 2006 to February 2007, 156 adults received a whole-body physical check-up. They filled out the RSI questionnaire and were dichotomized into either a “no problem group” or a “possible patients group” according to their scores on the RSI. All subjects received an esophagoscopy. The relationship between RSI score and endoscopic esophagitis, smoking, and drinking was analyzed. RESULTS: Voice change, but not heartburn, was significantly associated with endoscopic reflux esophagitis. Based on the RSI scores, some items in addition to voice change were significantly associated with smoking or drinking but not with endoscopic esophagitis. CONCLUSIONS: While screening patients for reflux esophagitis by using the RSI questionnaire, there is little value in using heartburn to predict endoscopic esophagitis in Taiwanese people. On the other hand, a husky voice might be a good clinical indicator of patients at risk of having reflux esophagitis.

scholarly journals Cross sectional study of prevalence of LPRD at tertiary care hospital

2019 ◽  
Vol 5 (2) ◽  
pp. 445
Author(s):  
Raghvendra Singh Gaur ◽  
Paromita Patra
Keyword(s):  
Laryngopharyngeal Reflux ◽  
Tertiary Care ◽  
Treatment Protocol ◽  
Stomach Contents ◽  
Cross Sectional Study ◽  
Care Hospital ◽  
Sectional Study ◽  
Reflux Symptom Index ◽  
Symptom Index ◽  
Cross Sectional

<p class="abstract"><strong>Background:</strong> Reflux means return or regurgitation of fluid. When symptoms arise due to reflux of stomach contents into the pharynx and larynx it is termed as laryngopharyngeal reflux disease (LPRD). GERD and LPRD are two different entities and the management principle of GERD doesn’t apply to LPRD. We designed a cross sectional study to evaluate the prevalence of laryngopharyngeal reflux among the patients visiting the ENT outpatient department over a duration of one year.</p><p class="abstract"><strong>Methods:</strong> Patients presenting with throat and voice symptoms for more than a month were included in the study. The reflux symptom index (RSI) put forward by Belafsky et al was used to assess the symptoms of reflux. A diagnosis of reflux was made if the patient had an RSI score &gt;13.  </p><p class="abstract"><strong>Results:</strong> A total of 2669 patients included in study period, out of which 1316 (49.3%) were males and 1353 (50.7%) were females. Out of the 2669, 1938 (72.6%) patients were found to have a RSI of &gt;13. Out of the 1938 patients subjected to 70 laryngoscopy 1842 patients (95%) were found to have a RFS &gt;7. Of the 1842 patients with RFS &gt;7, 1234 were males (67%) and 608 were females (33%).</p><p class="abstract"><strong>Conclusions:</strong> In a developing country like India, where resources and man power are limited, symptoms of laryngopharyngeal reflux might often be overlooked. The diagnosis and treatment protocol for LPRD needs to be standardized through more long term studies in the manner it has been done for GERD.</p>

The Impact of Laryngopharyngeal Reflux on Patient-reported Measures of Chronic Rhinosinusitis

2020 ◽  
Vol 129 (9) ◽  
pp. 886-893 ◽  
Author(s):  
Hannah J. Brown ◽  
Hannah N. Kuhar ◽  
Max A. Plitt ◽  
Inna Husain ◽  
Pete S. Batra ◽  
...  
Keyword(s):  
Chronic Rhinosinusitis ◽  
Laryngopharyngeal Reflux ◽  
Care Center ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Reflux Symptom Index ◽  
Symptom Index ◽  
Patient Reported ◽  
The Impact ◽  
Snot 22

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.

Utility of Audiometry in the Evaluation of Patients Presenting with Dysphonia

2019 ◽  
Vol 129 (4) ◽  
pp. 333-339 ◽  
Author(s):  
Justin Ross ◽  
William L. Valentino ◽  
Alyssa Calder ◽  
David Bigly ◽  
Sammy Othman ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Linear Regression Analysis ◽  
Retrospective Chart Review ◽  
Population Data ◽  
Female Gender ◽  
Multivariate Linear Regression Analysis ◽  
Speech Discrimination ◽  
Reflux Symptom Index ◽  
Symptom Index ◽  
Primary Investigator

Objectives: Hearing loss has been implicated in dysphonia secondary to voice misuse, although the data supporting this claim are scant. Determining the prevalence of hearing loss in patients with dysphonia and correlating it with self-perception of vocal handicap may help clarify the value of audiometry in evaluation of patients with dysphonia. Methods: This is a retrospective chart review of all new voice patients (n = 405) presenting with dysphonia to the primary investigator between 2015 and 2018. Each new patient routinely undergoes audiometric and voice objective analyses. Main outcomes measured include prevalence, severity of hearing loss, and voice handicap index-10 (VHI-10). Results: Of the 405 subjects reviewed, mean age was 49.0 years (SD = 17.4). 60.7% of subjects were female and 39.3% male. Patients with hearing loss defined as >25 dB in worse ear with pure tone average (PTA) thresholds at 0.5, 1, 2, and 3 kHz (PTA-S) accounted for 18% of the total cohort. The prevalence of previously undiagnosed hearing loss in this cohort was 13.1% (53 of 405 subjects). Of these subjects, 62.3% (33 subjects) reported no perception of hearing loss while 37.7% (20 subjects) suspected they had some hearing loss, yet never sought evaluation. Only increased PTA-S, speech discrimination, Reflux Symptom Index, and female gender demonstrated a significant relationship with VHI-10 when analyzed with multivariate linear regression analysis. Conclusions: The prevalence of hearing loss in patients presenting with dysphonia in this cohort is similar to normative population data. This study has also demonstrated that the majority of these patients did not perceive any hearing loss. The reasons behind this may be a result of or associated with the patients’ dysphonia. Furthermore, clinicians should consider performing audiometric evaluation in patients with abnormal VHI-10 scores in the appropriate clinical context.

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.

Sign in / Sign up

Export Citation Format

Share Document