Atypical Clinical Presentation of Laryngopharyngeal Reflux: A 5-Year Case Series

Background: Laryngopharyngeal reflux (LPR) is a common disease in otolaryngology characterized by an inflammatory reaction of the mucosa of the upper aerodigestive tract caused by digestive refluxate enzymes. LPR has been identified as the etiological or favoring factor of laryngeal, oral, sinonasal, or otological diseases. In this case series, we reported the atypical clinical presentation of LPR in patients presenting in our clinic with reflux. Methods: A retrospective medical chart review of 351 patients with LPR treated in the European Reflux Clinic in Brussels, Poitiers and Paris was performed. In order to be included, patients had to report an atypical clinical presentation of LPR, consisting of symptoms or findings that are not described in the reflux symptom score and reflux sign assessment. The LPR diagnosis was confirmed with a 24 h hypopharyngeal-esophageal impedance pH study, and patients were treated with a combination of diet, proton pump inhibitors, and alginates. The atypical symptoms or findings had to be resolved from pre- to posttreatment. Results: From 2017 to 2021, 21 patients with atypical LPR were treated in our center. The clinical presentation consisted of recurrent aphthosis or burning mouth (N = 9), recurrent burps and abdominal disorders (N = 2), posterior nasal obstruction (N = 2), recurrent acute suppurative otitis media (N = 2), severe vocal fold dysplasia (N = 2), and recurrent acute rhinopharyngitis (N = 1), tearing (N = 1), aspirations (N = 1), or tracheobronchitis (N = 1). Abnormal upper aerodigestive tract reflux events were identified in all of these patients. Atypical clinical findings resolved and did not recur after an adequate antireflux treatment. Conclusion: LPR may present with various clinical presentations, including mouth, eye, tracheobronchial, nasal, or laryngeal findings, which may all regress with adequate treatment. Future studies are needed to better specify the relationship between LPR and these atypical findings through analyses identifying gastroduodenal enzymes in the inflamed tissue.

Download Full-text

Atypical Clinical Presentation of Laryngopharyngeal Reflux: A 5-year Case-Series

10.20944/preprints202104.0409.v1 ◽

2021 ◽

Author(s):

Jerome R. Lechien ◽

Stephane Hans ◽

Francois Bobin ◽

Christian Calvo-Henriquez ◽

Sven Saussez ◽

...

Keyword(s):

Clinical Presentation ◽

Laryngopharyngeal Reflux ◽

Case Series ◽

Clinical Findings ◽

Aerodigestive Tract ◽

Common Disease ◽

Upper Aerodigestive Tract ◽

Suppurative Otitis Media ◽

Adequate Treatment ◽

Atypical Clinical Presentation

Background: Laryngopharyngeal reflux (LPR) is a common disease in otolaryngology characterized by an inflammatory reaction of the mucosa of the upper aerodigestive tract caused by digestive refluxate enzymes. LPR has been identified as etiological or favoring factor of laryngeal, oral, sinonasal or otological diseases. In this case-series, we reported atypical clinical presentation of LPR in patients presenting in our clinic with reflux. Methods: A retrospective medical chart review of 351 patients with LPR treated in the European Reflux Clinic in Brussels, Poitiers and Paris was performed. In order to be included, patients had to report atypical clinical presentation of LPR, consisting of symptoms or findings that are not described in reflux symptom score and reflux sign assessment. The LPR diagnosis was confirmed with 24-hour hypopharyngeal-esophageal impedance pH-study and patients were treated with a combination of diet, proton pump inhibitors and alginates. The atypical symptoms or findings had to be resolved from pre- to posttreatment Results: From 2017 to 2021, 21 patients with atypical LPR were treated in our center. The clinical presentation consisted of recurrent aphthosis or burning mouth (N=9), recurrent burps and abdominal disorders (N=2), posterior nasal obstruction (N=2), recurrent acute suppurative otitis media (N=2), severe vocal fold dysplasia (N=2), and recurrent acute rhinopharyngitis (N=1), tearing (N=1), aspirations (N=1) or tracheobronchitis (N=1). Abnormal upper aerodigestive tract reflux events were identified in all of these patients. Atypical clinical findings resolved and did not recur after an adequate anti-reflux treatment. Conclusion: LPR may present with various clinical presentations including mouth, eye, tracheobronchial, nasal or laryngeal findings, which may all regress with an adequate treatment. Future studies are needed to better specify the relationship between LPR and these atypical findings through analyses identifying gastroduodenal enzyme in the enflamed tissue.

Download Full-text

Lipoma of the left tonsillar fossa

The Journal of Laryngology & Otology ◽

10.1017/s0022215100127252 ◽

1994 ◽

Vol 108 (6) ◽

pp. 507-508 ◽

Cited By ~ 6

Author(s):

R. Benson-Mitchell ◽

N. Tolley ◽

C. B. Croft ◽

D. Roberts

Keyword(s):

Adipose Tissue ◽

Connective Tissue ◽

Literature Review ◽

Clinical Presentation ◽

Aerodigestive Tract ◽

Upper Aerodigestive Tract ◽

Tonsillar Fossa ◽

Subcutaneous Tissues

AbstractLipomas are common benign connective tissue tumours composed of adult adipose tissue. They are relatively rare in the upper aerodigestive tract, although they occur with considerable frequency in other areas, particularly in the subcutaneous tissues of the neck. Although there are several reports of this tumour occurring in the oropharynx, there is no recorded case of a lipoma of the tonsillar fossa. An 83-year-old man with a left tonsillar fossa lipoma is presented. Clinical presentation, management and a literature review are discussed.

Download Full-text

Bile Acid Induces Cyclo-Oxygenase-2 Expression in Cultured Human Pharyngeal Cells: A Possible Mechanism of Carcinogenesis in the Upper Aerodigestive Tract by Laryngopharyngeal Reflux

The Laryngoscope ◽

10.1097/00005537-200306000-00027 ◽

2003 ◽

Vol 113 (6) ◽

pp. 1059-1063 ◽

Cited By ~ 34

Author(s):

Myung-Whun Sung ◽

Jong-Lyel Roh ◽

Bum Jung Park ◽

Seok Woo Park ◽

Tack-Kyun Kwon ◽

...

Keyword(s):

Bile Acid ◽

Laryngopharyngeal Reflux ◽

Aerodigestive Tract ◽

Upper Aerodigestive Tract ◽

Mechanism Of Carcinogenesis

Download Full-text

Case Series: Two Cases of an Atypical Presentation of Oral Granular Cell Tumour

Case Reports in Medicine ◽

10.1155/2012/159803 ◽

2012 ◽

Vol 2012 ◽

pp. 1-3 ◽

Cited By ~ 4

Author(s):

Emma Cole ◽

Naomi Rahman ◽

Roger Webb

Keyword(s):

Soft Tissue ◽

Clinical Presentation ◽

Case Series ◽

Granular Cell ◽

Granular Cell Tumour ◽

Atypical Presentation ◽

Recurrence Rates ◽

Soft Tissue Neoplasm ◽

Atypical Clinical Presentation ◽

Granular Cell Tumours

This paper describes two cases of oral granular cell tumours with an atypical clinical presentation; both are in females aged between 45 and 63 years of age. Granular cell tumours are unusual soft tissue neoplasm of neural or Schwann cell origin. Oral GCTs usually present clinically as pink or yellow small sessile lesions. GCTs are usually benign in nature; however they can present in a malignant form in fewer than 2% of cases. In benign cases treatment is surgical and usually curative with extremely low recurrence rates.

Download Full-text

Laryngopharyngeal Reflux and Inflammatory Responses in Mucosal Barrier Dysfunction of the Upper Aerodigestive Tract

Journal of Inflammation Research ◽

10.2147/jir.s282809 ◽

2021 ◽

Vol Volume 13 ◽

pp. 1291-1304

Author(s):

Danling Liu ◽

Tingting Qian ◽

Shan Sun ◽

Jack J Jiang

Keyword(s):

Inflammatory Responses ◽

Laryngopharyngeal Reflux ◽

Aerodigestive Tract ◽

Mucosal Barrier ◽

Upper Aerodigestive Tract ◽

Barrier Dysfunction

Download Full-text

Henoch-Schönlein Purpura in children: not only kidney but also lung

Pediatric Rheumatology ◽

10.1186/s12969-019-0381-y ◽

2019 ◽

Vol 17 (1) ◽

Cited By ~ 1

Author(s):

Giada Maria Di Pietro ◽

Massimo Luca Castellazzi ◽

Antonio Mastrangelo ◽

Giovanni Montini ◽

Paola Marchisio ◽

...

Keyword(s):

Clinical Presentation ◽

Rare Complication ◽

Pulmonary Involvement ◽

Clinical Findings ◽

Lung Involvement ◽

Henoch Schonlein Purpura ◽

Adequate Treatment ◽

Line Of Therapy ◽

Schonlein Purpura ◽

Henoch Schönlein Purpura

Abstract Background Henoch-Schönlein Purpura (HSP) is the most common vasculitis of childhood and affects the small blood vessels. Pulmonary involvement is a rare complication of HSP and diffuse alveolar hemorrhage (DAH) is the most frequent clinical presentation. Little is known about the real incidence of lung involvement during HSP in the pediatric age and about its diagnosis, management and outcome. Methods In order to discuss the main clinical findings and the diagnosis and management of lung involvement in children with HSP, we performed a review of the literature of the last 40 years. Results We identified 23 pediatric cases of HSP with lung involvement. DAH was the most frequent clinical presentation of the disease. Although it can be identified by chest x-ray (CXR), bronchoalveolar lavage (BAL) is the gold standard for diagnosis. Pulse methylprednisolone is the first-line of therapy in children with DAH. An immunosuppressive regimen consisting of cyclophosphamide or azathioprine plus corticosteroids is required when respiratory failure occurs. Four of the twenty-three patients died, while 18 children had a resolution of the pulmonary involvement. Conclusions DAH is a life-threatening complication of HSP. Prompt diagnosis and adequate treatment are essential in order to achieve the best outcome.

Download Full-text

Radiofrequency ablation in the treatment of paediatric microcystic lymphatic malformations

The Journal of Laryngology & Otology ◽

10.1017/s0022215113000029 ◽

2013 ◽

Vol 127 (3) ◽

pp. 279-284 ◽

Cited By ~ 18

Author(s):

J Goswamy ◽

S E Penney ◽

I A Bruce ◽

M P Rothera

Keyword(s):

Radiofrequency Ablation ◽

Case Series ◽

Oral Intake ◽

Clinical Problem ◽

Aerodigestive Tract ◽

Upper Aerodigestive Tract ◽

Retrospective Case ◽

Lymphatic Malformations ◽

Excessive Bleeding ◽

Satisfactory Outcome

AbstractObjective:Congenital lymphatic malformations are a challenging clinical problem. There is currently no universally accepted treatment for the management of microcystic disease. We describe the novel use of an existing technology (radiofrequency ablation, also termed Coblation) for the debulking of paediatric microcystic lymphatic malformations involving the upper aerodigestive tract.Methods:Five children with microcystic or mixed-type lymphatic malformations were included in this retrospective case series.Results:Each child had a satisfactory outcome following radiofrequency debulking, with improved oral intake and airway symptoms. No serious complications were reported. These findings constitute level IV evidence.Conclusion:We recommend radiofrequency ablation as a safe, viable alternative to existing techniques for the treatment of paediatric microcystic lymphatic malformations of the upper aerodigestive tract. Radiofrequency ablation achieves effective debulking of microcysts whilst avoiding excessive bleeding and thermal damage to surrounding tissues. This paper constitutes the first report of successful treatment of airway obstruction due to paediatric laryngopharyngeal microcystic disease, using radiofrequency ablation.

Download Full-text

Laryngopharyngeal Reflux Disease: Diagnosis and Treatment in 2021

Journal of The Korean Society of Laryngology Phoniatrics and Logopedics ◽

10.22469/jkslp.2021.32.2.56 ◽

2021 ◽

Vol 32 (2) ◽

pp. 56-63

Author(s):

Jeong Wook Kang ◽

Young-Gyu Eun

Keyword(s):

Vocal Cord ◽

Reflux Disease ◽

Laryngopharyngeal Reflux ◽

Morphological Changes ◽

Disease Diagnosis ◽

Aerodigestive Tract ◽

Diagnosis And Treatment ◽

Upper Aerodigestive Tract ◽

Laryngopharyngeal Reflux Disease ◽

Questionnaire Method

Laryngopharyngeal reflux disease (LPRD) is an inflammatory condition of the upper aerodigestive tract mucosa induced by reflux content from stomach. Some of vocal cord diseases are associated with laryngopharyngeal reflux. Because of the pathophysiological features, proton pump inhibitor shows therapeutic effect on some vocal cord diseases. As like that, the gastric reflux contents can make macroscopic or microscopic morphological changes in the upper aerodigestive tract mucosa. Although the pathophysiology of LPRD is relatively clear, clinical diagnosis is still difficult. The diagnosis of LPRD includes objective tests such as 24-hours multichannel intraluminal impedance-pH metry and subjective tests such as questionnaire method. However, the objective verification of reflux is difficult due to invasiveness of the method, and the questionnaire methods have limitations because many symptoms are not specific for LPRD. Moreover, most methods are not fully standardized until now. Despite these limitations, many researchers are struggling to standardize diagnosis and treatment of LPRD, and there are several new achievements recently. Therefore, the purpose of this article is to review the recent literature on the clinical presentation, diagnosis, and treatment of LPRD, and to systematize our knowledge.

Download Full-text

Rare foreign bodies of upper aerodigestive tract: a study of 30 cases

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20202602 ◽

2020 ◽

Vol 6 (7) ◽

pp. 1307

Author(s):

Vivek Samor ◽

Deepchand Sarowa ◽

Pooja D. Nayak ◽

Vaibhav Saini ◽

Gagandeep Kaur ◽

...

Keyword(s):

Foreign Body ◽

Foreign Bodies ◽

Clinical Presentation ◽

Aerodigestive Tract ◽

Upper Aerodigestive Tract ◽

Common Procedure ◽

Female Ratio ◽

Mortality And Morbidity ◽

High Degree ◽

Male To Female

Background: Aero-digestive foreign bodies are prevalent in our part of the country. Apart from the usual foreign body we encountered some unique foreign bodies, the diagnosis and management of which, is difficult due to varied and overlapping clinical presentation. Rare foreign bodies in the aero-digestive tract pose challenges in diagnosis and treatment.Methods: This was a retrospective observational study on thirty patients with aerodigestive foreign bodies who visited our hospital from July 2015 to October 2017. Results: Maximum number of cases was seen in age group of 0-5 years. The male to female ratio was 2:1. Among various types of foreign bodies, majority were metallic (43.3%). The most common site was cricopharynx (53.3%) followed by bronchus (26.6%) and esophageal (16.6%). The most common procedure done was hypopharyngoscopy (53.3%).Conclusions: Aerodigestive tract foreign bodies are one of the emergencies that have considerable mortality and morbidity. High degree of skill and suspicion are required by surgeon for the management of foreign body.

Download Full-text