Journal articles: 'Laryngopharyngeal sensitivity'

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Masaany, M., M. B. Marina, W. P. Sharifa Ezat, and A. Sani. "Empirical treatment with pantoprazole as a diagnostic tool for symptomatic adult laryngopharyngeal reflux." Journal of Laryngology & Otology 125, no. 5 (February 28, 2011): 502–8. http://dx.doi.org/10.1017/s0022215111000120.

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AbstractObjective:To determine the sensitivity and specificity of intensive empirical treatment with pantoprazole in diagnosing laryngopharyngeal reflux in adults.Study design:This was a prospective, double-blind study.Subjects and methods:Fifty-five patients with either a Reflux Symptom Index of more than 13 or a Reflux Finding Score of more than 7 were enrolled. All patients underwent 24-hour, double-probe pH monitoring before commencing pantoprazole 40 mg twice daily; both investigators and patients were blinded to pH monitoring results. The Reflux Symptom Index and Reflux Finding Score were reassessed during the second, third and fourth month of follow up.Results:The sensitivity of empirical pantoprazole treatment in diagnosing laryngopharyngeal reflux was 92.5 per cent. The specificity was 14.2 per cent, the positive predictive value 86 per cent and the negative predictive value 25 per cent. There was significant reduction in the total Reflux Symptom Index and Reflux Finding Score after the second, third and fourth month of treatment. There was no correlation between laryngopharyngeal reflux and body mass index.Conclusion:Our results suggest that intensive empirical treatment with proton pump inhibitors is effective in diagnosing laryngopharyngeal reflux.

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Ni, X.-G., Q.-Q. Zhang, and G.-Q. Wang. "Narrow band imaging versus autofluorescence imaging for head and neck squamous cell carcinoma detection: a prospective study." Journal of Laryngology & Otology 130, no. 11 (October 6, 2016): 1001–6. http://dx.doi.org/10.1017/s0022215116009002.

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AbstractObjectives:This study aimed to compare the diagnostic effectiveness of narrow band imaging and autofluorescence imaging for malignant laryngopharyngeal tumours.Methods:Between May 2010 and October 2010, 50 consecutive patients with suspected laryngopharyngeal tumour underwent endoscopic laryngopharynx examination. The morphological characteristics of laryngopharyngeal lesions were analysed using high performance endoscopic systems equipped with narrow band imaging and autofluorescence imaging modes. The diagnostic effectiveness of white light image, narrow band imaging and autofluorescence imaging endoscopy for benign and malignant laryngopharyngeal lesions was evaluated.Results:Under narrow band imaging endoscopy, the superficial microvessels of squamous cell carcinomas appeared as dark brown spots or twisted cords. Under autofluorescence imaging endoscopy, malignant lesions appeared as bright purple. The sensitivity of malignant lesion diagnosis was not significantly different between narrow band imaging and autofluorescence imaging modes, but was better than for white light image endoscopy (χ2 = 12.676, p = 0.002). The diagnostic specificity was significantly better in narrow band imaging mode than in both autofluorescence imaging and white light imaging mode (χ2 = 8.333, p = 0.016).Conclusion:Narrow band imaging endoscopy is the best option for the diagnosis and differential diagnosis of laryngopharyngeal tumours.

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Zelchan, Roman, Vladimir Chernov, Anna Titskaya, Ivan Sinilkin, Svetlana Chizhevskaya, and Yevgeniy Ts Choynzonov. "Diagnostic Efficiency of Single-Photon Emission Computed Tomography with ^99MTc-MIBI in Visualization of Malignant Tumors of the Larynx and Laryngopharynx." Advanced Materials Research 1084 (January 2015): 373–76. http://dx.doi.org/10.4028/www.scientific.net/amr.1084.373.

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To study the diagnostic efficiency of single-photon emission computed tomography (SPECT) with 99mTc-MIBI 40 patients were chosen for diagnosing primary and recurrence of laryngeal or laryngopharyngeal cancer and as well as patients with benign diseases of the larynx. All patients underwent SPECT with 99mTc-MIBI. As a result it has been found that the sensitivity, specificity and accuracy of SPECT with 99mTc-MIBI in the diagnostics of primary tumors of the larynx are 95%, 80% and 92%, respectively. The visualization of recurrent tumors of the larynx and laryngopharynx has showed 100% sensitivity. The obtained results have proved the consistency of SPECT with 99mTc-MIBI as an additional method of diagnostics of laryngeal and laryngopharyngeal cancer.

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Clayton, Nicola A., Giselle D. Carnaby-Mann, Matthew J. Peters, and Alvin J. Ing. "The Effect of Chronic Obstructive Pulmonary Disease on Laryngopharyngeal Sensitivity." Ear, Nose & Throat Journal 91, no. 9 (September 2012): 370–82. http://dx.doi.org/10.1177/014556131209100907.

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Powell, Jason, and Helen C. Cocks. "Mucosal changes in laryngopharyngeal reflux-prevalence, sensitivity, specificity and assessment." Laryngoscope 123, no. 4 (December 3, 2012): 985–91. http://dx.doi.org/10.1002/lary.23693.

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Zeleník, Karol, Viktória Hránková, Adéla Vrtková, Lucia Staníková, Pavel Komínek, and Martin Formánek. "Diagnostic Value of the PeptestTM in Detecting Laryngopharyngeal Reflux." Journal of Clinical Medicine 10, no. 13 (July 5, 2021): 2996. http://dx.doi.org/10.3390/jcm10132996.

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Background: The PeptestTM is a non-invasive diagnostic test for measuring the pepsin concentration in saliva, which is thought to correlate with laryngopharyngeal reflux (LPR). The aim of this study was to investigate the diagnostic value of the Peptest in detecting LPR based on 24-h multichannel intraluminal impedance-pH (MII-pH) monitoring using several hypopharyngeal reflux episodes as criterion for LPR. Methods: Patients with suspected LPR were examined with the Reflux Symptom Index (RSI), Reflux Finding Score (RFS), fasting Peptest, and MII-pH monitoring. We calculated the accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the Peptest, RSI, and RFS based on the threshold of one and six hypopharyngeal reflux episodes. Results: Altogether, the data from 46 patients were analyzed. When one hypopharyngeal reflux episode was used as a diagnostic threshold for LPR, the accuracy, sensitivity, specificity, PPV, and NPV were, respectively, as follows: 35%, 33%, 100%, 100%, and 3%, for the Peptest; 39%, 40%, 0%, 95%, and 0%, for the RSI; and 57%, 58%, 0%, 96%, and 0%, for the RFS. The accuracy, sensitivity, specificity, PPV, and NPV of the Peptest for diagnosing gastroesophageal reflux disease (GERD) were 46%, 27%, 63%, 40.0%, and 48%, respectively. Conclusions: A positive Peptest is highly supportive of a pathological LPR diagnosis. However, a negative test could not exclude LPR.

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Son, Joseph, Jana Havranova, and Aaron Jaworek. "3095 Non-Celiac Gluten Sensitivity (NCGS) Presenting as Laryngopharyngeal Reflux (LPR)." American Journal of Gastroenterology 114, no. 1 (October 2019): S1663—S1664. http://dx.doi.org/10.14309/01.ajg.0000601912.80809.d4.

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Clayton, Nicola A., Giselle D. Carnaby, Matthew J. Peters, and Alvin J. Ing. "Impaired laryngopharyngeal sensitivity in patients with COPD: The association with swallow function." International Journal of Speech-Language Pathology 16, no. 6 (February 24, 2014): 615–23. http://dx.doi.org/10.3109/17549507.2014.882987.

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Zhou, Yu, Ruixia Ma, Jiangbo Luo, Zhikai Wang, and Pei Yang. "Role of Laryngopharyngeal Reflux Changes in Children with Adenoid Hypertrophy: A Randomized Controlled Prospective Study." Evidence-Based Complementary and Alternative Medicine 2023 (February 6, 2023): 1–6. http://dx.doi.org/10.1155/2023/5628551.

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Objectives. This prospective randomized controlled analysis aimed to assess the changes in laryngopharyngeal reflux (LPR) in children with adenoid hypertrophy (AH). Study design: a prospective, randomized, and controlled analysis. Methods. The reflux symptom index (RSI) and the reflux finding score (RFS) scores were used to evaluate the laryngopharyngeal reflux changes in children diagnosed with adenoid hypertrophy. The pepsin concentration in salivary samples was examined, and the positive pepsin was used to assess the sensitivity and specificity of RSI, RFS, and RSI combined with RFS in forecasting LPR. Results. In 43 children with AH, the sensitivity of the RSI and RFS scale (used alone or in combination) in diagnosing pharyngeal reflux in children with adenoid hypertrophy was lower. Pepsin expression was identified in 43 items of salivary samples, with a total positive rate of 69.77%, most of which were optimistic. The expression level of pepsin was positively correlated with the grade of adenoid hypertrophy (r = 0.576, P < 0.01 ). Based on the positive rate of pepsin, we found that the sensitivity and specificity of RSI and RFS were 5.77%, 35.03%, and 91.74%, 55.89%. Moreover, there was a noticeable distinction in the number of acid reflux episodes between the LPR-positive and LPR-negative groups. Conclusion. There is a special connection between LPR change and children’s AH. LPR exerts a crucial role in the progression of children’s AH. Because of the low sensitivity of RSI and RFS, it is not suitable for LPR children to choose AH.

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Belafsky, Peter C., Gregory N. Postma, and James A. Koufman. "The Association between Laryngeal Pseudosulcus and Laryngopharyngeal Reflux." Otolaryngology–Head and Neck Surgery 126, no. 6 (June 2002): 649–52. http://dx.doi.org/10.1067/mhn.2002.125603.

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BACKGROUND: A pattern of edema on the ventral surface of the vocal fold, called pseudosulcus vocalis, was described in 1995. It refers to infraglottic edema extending from the anterior commissure to the posterior larynx. It can be differentiated from sulcus vergeture, which is caused by adhesion of the vocal fold epithelium to the vocal ligament. Although it has been related to laryngopharyngeal reflux (LPR), this has not been thoroughly investigated. PURPOSE: Our goal was to evaluate the association between pseudosulcus and LPR. METHODS: Thirty patients with a clinical diagnosis of LPR confirmed by double-probe pH monitoring and 30 controls without LPR were enrolled. The prevalence of pseudosulcus was determined with fiberoptic laryngoscopy. RESULTS: Seventy percent (21 of 30) of patients with LPR and 30% (9 of 30) of controls had pseudosulcus. Patients with pseudosulcus were 2.3 times more likely to have pH-documented LPR (95% confidence interval 1.3–4.2). The sensitivity and specificity of pseudosulcus in the diagnosis of LPR are 70% and 77%, respectively. CONCLUSIONS: Pseudosulcus is highly correlated with pH-documented LPR ( P < 0.001). The presence of pseudosulcus is suggestive of LPR.

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Janiak, Maria. "Itopride in treatment of laryngopharyngeal symptoms of gastroesophageal reflux disease." Otolaryngologia Polska 75, no. 6 (December 31, 2021): 38–44. http://dx.doi.org/10.5604/01.3001.0015.5165.

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In everyday otolaryngological and gastroenterological practice, the diagnosis and treatment of extraesophageal forms of gastroesophageal reflux disease are often challenging. It is sometimes the case that treatment ordered by other specialists proves ineffective or even worsens the symptoms. There is no golden standard of diagnosis for otolaryngological forms of GERD, and currently used tools (gastroscopy, laryngoscopy, impedance and pH testing) have low sensitivity and specificity. After finishing a course of successful treatment, the patients often come back to our offices with the very same symptoms. In order to improve the efficacy of treatment, a prokinetic agent can be added to the standard proton pump inhibitor therapy.

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Lloyd, Adam T., Bari Hoffman Ruddy, Erin Silverman, Vicki M. Lewis, and Jeffrey J. Lehman. "Quantifying Laryngopharyngeal Reflux in Singers: Perceptual and Objective Findings." BioMed Research International 2017 (2017): 1–10. http://dx.doi.org/10.1155/2017/3918214.

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This study examines the relationship between laryngopharyngeal reflux (LPR) symptoms and oropharyngeal pH levels in singers. We hypothesized that reported symptoms would correlate with objective measures of pH levels from the oropharynx, including the number and total duration of reflux episodes. Twenty professional/semiprofessional singers completed the Reflux Symptom Index (RSI) and underwent oropharyngeal pH monitoring. Mild, moderate, or severe pH exposure was recorded during oropharyngeal pH monitoring. Correlations were performed to examine potential relationships between reflux symptoms and duration of LPR episodes. Symptom severity did not correlate with pH levels; however, we found a number of covariances of interest. Large sample sizes are necessary to determine if true correlations exist. Our results suggest that singers may exhibit enhanced sensitivity to LPR and may therefore manifest symptoms, even in response to subtle changes in pH. This study emphasizes the importance of sensitive and objective measures of reflux severity as well as consideration of the cumulative time of reflux exposure in addition to the number of reflux episodes.

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Zelchan, Roman, Vladimir Chernov, Anna Titskaya, Ivan Sinilkin, Svetlana Chizhevskaya, and Evgeniy Ts Choynzonov. "Single-Photon Emission Computed Tomography with ¹⁹⁹Tl in Diagnostics of Malignant Tumors of the Larynx and Laryngopharynx." Advanced Materials Research 1084 (January 2015): 476–78. http://dx.doi.org/10.4028/www.scientific.net/amr.1084.476.

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The purpose of research was to investigate the diagnostic capabilities of single-photon emission computed tomography (SPECT) with Thallium-199 in the diagnostics of malignant tumors of the larynx and laryngopharynx. The study included patients with primary and recurrent malignant tumors of the larynx or laryngopharynx, and patients with benign diseases of the larynx. All patients underwent SPECT of the larynx after intravenous administration of 199Tl. It turned out that SPECT with 199Tl is an effective method for diagnosing laryngeal and laryngopharyngeal cancer, having indices of sensitivity, specificity, and accuracy of 95%, 100% and 96.7% respectively. According to our data, in the visualization of regional metastases the sensitivity of SPECT with 199Tl has amounted to 75%.

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Joshi, Anagha Atul, Bhagyashri Ganesh Chiplunkar, Renuka Anil Bradoo, and Kshitij Dhaval Shah. "Posterior Commissure Hypertrophy as Diagnostic and Prognostic Indicator for Laryngopharyngeal Reflux." International Journal of Phonosurgery & Laryngology 5, no. 2 (2015): 57–60. http://dx.doi.org/10.5005/jp-journals-10023-1106.

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ABSTRACT Purpose To establish posterior commissure hypertrophy as tool to diagnose laryngopharyngeal reflux (LPR) and to determine whether it can be used as a reliable marker for response to treatment. Materials and methods A prospective study of 100 patients with voice disorder was conducted. Patients were evaluated using reflux symptom index (RSI) and reflux finding score (RFS) by 70° Hopkins’ rigid laryngoscope. Those patients in whom RFS score was 7 or more were diagnosed to have LPR. These patients were then started on antireflux therapy along with lifestyle modification and were evaluated regularly over a period of 6 months. Results The prevalence of LPR in patients with voice disorders was found to be 25%. Mean age was 41.48 years and the male and female ratio was 0.85:1. Posterior commissure hypertrophy was present in 60 out of 100 patients (60%). Among laryngopharyngeal reflux disease (LPRD), 23 out of 25 patients (92%) had posterior commissure hypertrophy, out of which only 2 (8.6%) patients showed complete resolution of posterior commissure hypertrophy after 6 months of treatment. A total of 10 patients (43.47%) did not show any change in grading of posterior commissure hypertrophy. And 11 patients (47.82%) showed downgrading of posterior commissure hypertrophy. Sensitivity of posterior commissure hypertrophy for diagnosis of LPR was found to be 92%, whereas specificity was 50.66%. Conclusion Posterior commissure hypertrophy can be used as a screening tool for diagnosis of LPR but cannot be used reliably as a clinical marker for response to therapy. How to cite this article Joshi AA, Chiplunkar BG, Bradoo RA, Shah KD. Posterior Commissure Hypertrophy as Diagnostic and Prognostic Indicator for Laryngopharyngeal Reflux. Int J Phonosurg Laryngol 2015;5(2):57-60.

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Nakamura, Kazuhiro, Hidenori Kanebayashi, Yusuke Watanabe, Nobuhiko Oridate, Tomoyuki Yoshida, and Mamoru Suzuki. "Sensitivity and Specificity of the PPI Test in the Diagnosis of Laryngopharyngeal Reflux Disease (LPRD)." Nihon Kikan Shokudoka Gakkai Kaiho 63, no. 2 (2012): 211–15. http://dx.doi.org/10.2468/jbes.63.211.

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Casciaro, Sabrina, Matteo Gelardi, Rossana Giancaspro, Vitaliano Nicola Quaranta, Giuseppe Porro, Brigida Sterlicchio, Antonia Abbinante, and Massimo Corsalini. "Dental Disorders and Salivary Changes in Patients with Laryngopharyngeal Reflux." Diagnostics 12, no. 1 (January 9, 2022): 153. http://dx.doi.org/10.3390/diagnostics12010153.

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Background: Laryngopharyngeal reflux (LPR) is a common inflammatory condition of the upper aerodigestive tract tissues related to the effects of gastroduodenal content reflux, characterized by a wide variety of clinical manifestations. The aim of our study was to evaluate the possible association between dental disorders and LRP, focusing on the role of salivary changes. Methods: Patient’s dental status was evaluated according to Schiff Index Sensitivity Scale (SISS), Basic Erosive Wear Examination (BEWE) and Decayed, Missing, and Filled Teeth (DMFT) scores. Reflux-associated symptoms were assessed according to Reflux symptom index (RSI). A qualitative and quantitative examination of saliva was performed. Results: Patients suffering from LPR had a higher incidence of dental disorders, regardless the presence of salivary pepsin, and thus, statistically significant higher scores of RSI (p = 0.0001), SISS (p = 0.001), BEWE (p < 0.001) and VAS (p < 0.001). Moreover, they had lower salivary flow compared with healthy patients. Conclusions: The finding of demineralization and dental caries on intraoral evaluation must raise the suspicion of LRP. Reflux treatments should also be aimed at correcting salivary alterations, in order to preserve the buffering capacity and salivary pH, thus preventing mucosal and dental damage.

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Horvath, Lukas, Patricia Hagmann, Emanuel Burri, and Marcel Kraft. "Evaluation of Oropharyngeal pH-Monitoring in the Assessment of Laryngopharyngeal Reflux." Journal of Clinical Medicine 10, no. 11 (May 29, 2021): 2409. http://dx.doi.org/10.3390/jcm10112409.

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Background: Laryngopharyngeal reflux (LPR) is a prevalent disorder. The aim of the present retrospective cohort study was to evaluate oropharyngeal pH-monitoring using a novel scoring system for LPR. Methods: In a total of 180 consecutive patients with possible LPR, reflux symptom index (RSI), reflux finding score (RFS), oropharyngeal pH-monitoring and transnasal esophagoscopy were carried out for further investigation. Results: In our series, 99 (55%) patients had severe LPR, 29 (16%) cases presented with moderate and 23 (13%) with mild severity, 9 (5%) subjects revealed neutral values, and 7 (4%) individuals were alkaline, while 13 (7%) patients had no LPR. In detecting LPR, the sensitivity, specificity and accuracy of oropharyngeal pH-monitoring was 95%, 93% and 94%, respectively. Conclusion: Oropharyngeal pH-monitoring is a reliable tool in the assessment of LPR, but the pH graphs have to be precisely analyzed and interpreted in context with other validated diagnostic tests.

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Du, Chen, Paige Thayer, Yan Yan, Qingsong Liu, Li Wang, and Jack Jiang. "Changing Trends of Color of Different Laryngeal Regions in Laryngopharyngeal Reflux Disease." Ear, Nose & Throat Journal 99, no. 8 (June 2, 2019): 543–47. http://dx.doi.org/10.1177/0145561319854745.

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Introduction: In our previous study, we demonstrated that there might be correlations between laryngopharyngeal reflux disorder and the hue value of laryngoscopic images. And we found that different regions of larynx have different hue values. It was hypothesized that the degree of inflammation varies between different laryngeal regions, due to an acid reflux pattern. Objective: The objective of this study was to compare the changing trends of hue values of different laryngeal regions in patients with laryngopharyngeal reflux (LPR) disease. Methods: Ninety-seven patients, including 20 pH-positive, 19 pH-negative were tested for LPR through multichannel intraluminal impedance 24-hour pH monitoring, and 58 controls with reflux symptom index less than 13. Laryngoscopic images of all patients were obtained. The hue values of 7 areas of interest, including both sides of the true vocal folds, the false vocal folds, the arytenoids, and the interarytenoid space, were quantified using a hue calculation. The analysis of variance analysis was applied to find if there was significant difference between different groups within each region. Results: (1) In the regions of both sides of the true vocal folds and interarytenoid, there was no significant difference between positive group and negative group; (2) in the regions of both sides of false vocal folds, there was no significant difference between negative group and control group; (3) in the regions of both sides of arytenoids, there was neither significant difference between positive group and negative group nor between negative group and control group; (4) in other comparisons, there were significant differences. Conclusion: Hue values of separate laryngeal regions are different. In negative group, the hue values of interarytenoid region are similar with positive group, and the sensitivity to the acid are different from different regions. The sensitivity in the true vocal folds may be present.

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K, Ramya, Munish K S, Ajith K M, and Venkatesha B K. "Effect of Rabeprazole on Pachydermia Laryngis in Patients with Laryngopharyngeal Reflux." Bengal Journal of Otolaryngology and Head Neck Surgery 30, no. 1 (December 3, 2022): 46–50. http://dx.doi.org/10.47210/bjohns.2022.v30i1.609.

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Introduction Laryngopharyngeal reflux (LPR) is defined as the retrograde flow of gastric content into larynx and pharynx. It is a multifactorial syndrome. Empiric trial of PPI therapy represents the first step to confirm LPR and to treat it accordingly as all currently available diagnostic tests have poor sensitivity and specificity. However, there is no accepted protocol for the most effective treatment of patients with LPR. Objective of the study was to assess the effect of Rabeprazole on pachydermia laryngis (posterior commissure hypertrophy) in patients with LPR. Materials and Methods In this prospective study, 75 subjects diagnosed with LPR using Reflux symptom index (RSI) and Reflux finding score (RFS) tools were recruited. Using RFS, posterior commissure hypertrophy was scored at presentation and after 8 weeks of rabeprazole therapy. The mean pre- and post-treatment posterior commissure hypertrophy scores for each patient were compared using paired T-test. Results Posterior commissure hypertrophy did not show statistically significant improvement following 8 weeks of 20 mg once daily oral rabeprazole therapy. Conclusion Eight weeks of oral therapy with Rabeprazole 20 mg once daily did not show statistically significant improvement in posterior commissure hypertrophy.

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Duricek, Martin, Peter Banovcin, Lenka Nosakova, Rudolf Hyrdel, and Marian Kollarik. "Sa1184 – Increased Sensitivity of Cough Reflex is Not the Mechanism of Cough Attributed to Laryngopharyngeal Reflux." Gastroenterology 156, no. 6 (May 2019): S—299. http://dx.doi.org/10.1016/s0016-5085(19)37566-3.

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Korkmaz, Murat, Erkan Tarhan, Hakan Unal, Haldun Selcuk, Ugur Yilmaz, and Levent Ozluoglu. "Esophageal Mucosal Sensitivity: Possible Links with Clinical Presentations in Patients with Erosive Esophagitis and Laryngopharyngeal Reflux." Digestive Diseases and Sciences 52, no. 2 (January 12, 2007): 451–56. http://dx.doi.org/10.1007/s10620-006-9514-5.

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Hoppo, Toshitaka, Ali H. Zaidi, Daisuke Matsui, Samantha A. Martin, Yoshihiro Komatsu, Emily J. Lloyd, Juliann E. Kosovec, et al. "Sep70/Pepsin expression in hypopharynx combined with hypopharyngeal multichannel intraluminal impedance increases diagnostic sensitivity of laryngopharyngeal reflux." Surgical Endoscopy 32, no. 5 (December 20, 2017): 2434–41. http://dx.doi.org/10.1007/s00464-017-5943-9.

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Kamal, Mohammad Shah, Rubina Farzana, Md Hafiz Ehsanul Hoque, and Md Guljar Hossain. "Distribution of Laryngopharyngeal Malignancy in the North-East Part of Bangladesh: Fiberoptic Laryngoscopic (FOL) Study of 300 Cases." Journal of Bangladesh College of Physicians and Surgeons 40, no. 2 (April 10, 2022): 99–104. http://dx.doi.org/10.3329/jbcps.v40i2.58690.

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Introduction: In Bangladesh, laryngeal and hypopharyngeal cancers in 2018 were 3.3% and 4.7% of total cancer cases, 2.6% and 2% of total cancer deaths. Fiber optic laryngoscopy (FOL) has been established as a valuable tool for diagnosis in outpatient department (OPD) setting. The primary objective of this study was to see the distribution of laryngeal and hypopharyngeal cancers and secondary objective was to assess the role of Flexible Endoscopic Biopsy (FEB) in the diagnosis of laryngopharyngeal cancers. Methods: This descriptive cross-sectional study was performed from March 2020 to March 2021 at Mount Adora Hospital, Sylhet, Bangladesh. All suspected patients attending in this hospital for FOL and FEB were included in this study. Results: Total 300 patients of laryngopharyngeal growth were included in this study. The age of the patients ranged from 25 to 100 years with a mean age of 58.1 year (SD=11.8). Male: Female ratio was 4.8:1. Hypopharyngeal growth was most common (47.3%) followed by laryngeal (31.7%) and tongue base growth (21%). In laryngeal growth, supraglottic was more common (69.47%). In hypopharyngeal growth, pyriform fossa was the most common site (88.3%). Synchronous pathology was found in two patients (0.67%). FEB was obtained from 95% of cases. Histopathological examination showed 95.85% positive for malignancy. Sensitivity of FEB was 95.8%. All malignancies were squamous cell carcinoma (100%). Conclusion: Supraglottic region is the most common site for laryngeal cancers and pyriform sinus is the most common site for hypopharyngeal cancers. FEB is highly sensitive in acquiring a definite diagnosis. J Bangladesh Coll Phys Surg 2022; 40: 99-104

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Horvath, Lukas, Karolos Fostiropoulos, Emanuel Burri, and Marcel Kraft. "Value of Transnasal Esophagoscopy in the Workup of Laryngo-Pharyngeal Reflux." Journal of Clinical Medicine 10, no. 14 (July 20, 2021): 3188. http://dx.doi.org/10.3390/jcm10143188.

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Background: Laryngopharyngeal reflux (LPR) can display a variety of symptoms, and upper endoscopy is occasionally used for its investigation. The aim of the present study was to determine the value of transnasal esophagoscopy (TNE) in the workup of LPR. Methods: In 200 consecutive patients with suspected LPR, reflux symptom index (RSI), reflux finding score (RFS), oropharyngeal pH-monitoring (PHM) and transnasal esophagoscopy (TNE) were carried out and rated according to the Horvath Score. Results: In the investigation of LPR, TNE showed a sensitivity, specificity and accuracy of 96%, 85% and 95%, respectively. The most common pathologic TNE findings in LPR patients were an insufficient cardia, hiatal hernia, lymphoid follicles and visible reflux. Conclusions: TNE is a supportive method in the workup of LPR, which can display the underlying pathology and directly affect therapeutic decisions.

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Lechien, Jerome R. "Clinical Update Findings about pH-Impedance Monitoring Features in Laryngopharyngeal Reflux Patients." Journal of Clinical Medicine 11, no. 11 (June 1, 2022): 3158. http://dx.doi.org/10.3390/jcm11113158.

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Purpose: The diagnosis of laryngopharyngeal reflux (LPR) is commonly based on non-specific symptoms and findings and a positive response to an empirical therapeutic trial. The therapeutic response is, however, unpredictable, and many patients need pH-impedance monitoring to confirm the diagnosis. Methods: A review of the recent literature was conducted in PubMED, Scopus, and Embase about the pH-study features of LPR patients. A summary of last evidence was proposed. Results: The awareness of otolaryngologists about indications and interpretation of pH-impedance monitoring is low. The hypopharyngeal-esophageal multichannel intraluminal impedance-pH monitoring (HEMII-pH) is the most reliable examination determining the type and composition of hypopharyngeal reflux events (HRE) and the LPR features. The use of HEMII-pH is important to confirm the diagnosis in selected patients because non-specificity of symptoms and findings. There are no international consensus guidelines for the LPR diagnosis at the HEMII-pH. However, most studies supported the occurrence of >1 acid/weakly acid/nonacid HRE as diagnostic threshold. HREs are more frequently gaseous, weakly/nonacid compared with reflux events of gastroesophageal reflux. HREs occurred as daytime and upright, which does not support the value of double proton pump inhibitors or bedtime alginate. Oropharyngeal pH-monitoring is another approach reporting different sensitivity and specificity outcomes from HEMII-pH. The use of Ryan score for the LPR diagnosis at the oropharyngeal pH monitoring may be controversial regarding the low consideration of alkaline HREs. Conclusions: The awareness of otolaryngologists about HEMII-pH indication, features, and interpretation is an important issue regarding the high prevalence of LPR in outpatients consulting in otolaryngology. The HEMII-pH findings may indicate a more personalized treatment considering type and occurrence time of HREs.

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Sulfaro, Sandro, Francesco Querin, Luigi Barzan, Mario Lutman, Roberto Comoretto, Rachele Volpe, and Antonino Carbone. "Pathologic Assessment of Computerized Tomography Accuracy for the Evaluation of the Laryngeal Cartilaginous Frame Work in Laryngopharyngeal Carcinomas." Tumori Journal 75, no. 2 (April 1989): 156–62. http://dx.doi.org/10.1177/030089168907500216.

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Sixty-six whole-organ sectioned laryngopharyngectomy specimens removed for cancer during a seven-year period were uniformly examined to determine the accuracy of preoperative high resolution computerized tomography (CT) for detection of cartilaginous involvement. Our results indicate that CT has a high overall specificity (88.2%) but a low sensitivity (47.1 %); we observed a high false-negative rate (26.5%) and a fairly low false-positive rate (5.9%). Massive cartilage destruction was easily assessed by CT, whereas both small macroscopic and microscopic neoplastic foci of cartilaginous invasion were missed on CT scans. Moreover, false-positive cases were mainly due to proximity of the tumor to the cartilage. Clinical implications of these results are discussed.

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Friedman, Michael, Craig Hamilton, Christian G. Samuelson, Kanwar Kelley, Renwick Taylor, Robert Darling, David Taylor, Michelle Fisher, and Alexander Maley. "The Value of Routine pH Monitoring in the Diagnosis and Treatment of Laryngopharyngeal Reflux." Otolaryngology–Head and Neck Surgery 146, no. 6 (February 2, 2012): 952–58. http://dx.doi.org/10.1177/0194599812436952.

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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.

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Medvedeva, А. A., V. I. Chernov, R. V. Zelchan, O. D. Bragina, A. A. Rybina, V. S. Skuridin, E. S. Stasyuk, S. Yu Chizhevskaya, A. V. Goldberg, and E. Yu Garbukov. "Clinical Testing of a New Radiopharmaceutical [99mТс]-Al2O3 for the Diagnosis of Sentinel Lymph Nodes." Drug development & registration 11, no. 4 (November 27, 2022): 246–52. http://dx.doi.org/10.33380/2305-2066-2022-11-4-246-252.

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Introduction. In modern oncology, the identification of sentinel lymph nodes (SLN), the first nodes that stand on the way of malignant tumor metastasis, is of increasing interest. Detection of SLN followed by morphological examination allows personalizing the surgical intervention for early breast cancer, melanoma, head and neck tumors, neoplasms of the cervix and endometrium. Currently, there is an active development of specific radiopharmaceuticals for SLN imaging. Within the framework of the grant from the Federal Target Program "Pharma-2020", an original radiopharmaceutical using gamma aluminum oxide – [99mТс]-Al2O3 was developed. Preclinical studies have been demonstrated its effectiveness and safety. Pharmacokinetic studies of [99mTc]-Al2O3 showed that 24 hours after its subcutaneous administration, about 12 % of the administered dose is accumulated in the SLN, which gives possibility for its detection.Aim. To study the possibility of clinical [99mTc]-Al2O3 using for visualization of SLN in breast, larynx and laryngopharyngeal cancer.Materials and methods. The definition of SLN was carried out in 55 patients with breast cancer and 30 patients with malignant tumors of the larynx and laryngopharynx. The study included peritumoral radiopharmaceutical injection, single-photon emission computed tomography with qualitative and quantitative analysis of the images and radioguided surgery detection of lymph nodes with their subsequent morphological examination.Results and discussion. Clinical studies have shown that radionuclide imaging of SLN using [99mTc]-Al2O3 is characterized by high sensitivity in breast cancer, larynx and laryngopharyngeal cancer patients (94.5 and 90 %, respectively), due to the high-intensity accumulation of this radiopharmaceutical in the lymph nodes. The optimal time point for SPECT and radioguided examination is an interval of 18–20 hours after injection of [99mTc]-Al2O3, which allows visualizing the maximum possible number of lymph nodes with the most optimal level of radioactivity for their detection.Conclusion. Application of radionuclide imaging of SLN with the use of [99mTc]-Al2O3 as a radiopharmaceutical is useful in planning surgical treatment of patients with tumors of the breast, larynx and laryngopharynx to determine the extent of surgery.

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Nacci, Andrea, Luca Bastiani, Maria Rosaria Barillari, Jerome R. Lechien, Massimo Martinelli, Nicola De Bortoli, Stefano Berrettini, and Bruno Fattori. "Assessment and Diagnostic Accuracy Evaluation of the Reflux Symptom Index (RSI) Scale: Psychometric Properties using Optimal Scaling Techniques." Annals of Otology, Rhinology & Laryngology 129, no. 10 (May 29, 2020): 1020–29. http://dx.doi.org/10.1177/0003489420930034.

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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.

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Hoppo, Toshitaka, Ali H. Zaidi, Daisuke Matsui, Samantha Martin, Yoshihiro Komatsu, Emily J. Lloyd, Albert A. Civitarese, et al. "A Ratio of Sep70 and Pepsin Expression in Hypopharynx Combined with Hypopharyngeal Multichannel Intraluminal Impedance Increases the Diagnostic Sensitivity of Laryngopharyngeal Reflux." Gastroenterology 152, no. 5 (April 2017): S1240—S1241. http://dx.doi.org/10.1016/s0016-5085(17)34127-6.

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Ozer, E., B. Naiboglu, U. Karapinar, A. Agrawal, H. G. Ozer, and D. E. Schuller. "Clinicopathological determinants of positron emission tomography computed tomography fluorodeoxyglucose standardised uptake value in head and neck carcinoma." Journal of Laryngology & Otology 127, no. 7 (June 21, 2013): 676–80. http://dx.doi.org/10.1017/s002221511300128x.

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AbstractBackground:Although positron emission tomography computed tomography has proven diagnostic and staging value in head and neck carcinoma, it does not have optimal sensitivity or specificity. The positron emission tomography computed tomography fluorodeoxyglucose standardised uptake value has been shown to be associated with carcinoma stage. This study evaluated the impact of major clinicopathological factors on the standardised uptake value at the primary site and at neck lymph node metastases.Subjects and methods:Two hundred and forty-three oral cavity and laryngopharyngeal carcinoma patients who underwent positron emission tomography computed tomography were included. Correlation between the positron emission tomography computed tomography standardised uptake value and various clinicopathological factors was analysed.Results:A positive correlation was found between the standardised uptake value and the size and depth of tumour infiltration, and lymph node positivity. Higher standardised uptake values were seen for more advanced tumour stages. The presence of perineural invasion, lymphatic invasion and extracapsular spread were all associated with increased standardised uptake values.Conclusion:Most of the clinicopathological features of head and neck carcinoma which are well known to be poor prognostic factors have a significant impact on positron emission tomography computed tomography fluorodeoxyglucose standardised uptake value.

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O'Brien, Timothy J., and Kourosh Parham. "Transnasal Esophagoscopy: White-Light versus Narrowband Imaging." Annals of Otology, Rhinology & Laryngology 117, no. 12 (December 2008): 886–90. http://dx.doi.org/10.1177/000348940811701204.

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Objectives: Transnasal esophagoscopy (TNE) is rapidly becoming integrated into otolaryngological practice. A recent report has shown an incongruence between an endoscopic diagnosis of Barrett's esophagus and biopsy-proven Barrett's esophagus in patients with laryngopharyngeal reflux (LPR). The goal of this study was to determine whether performing TNE with narrowband imaging (NBI) improves on the diagnostic yield in the otolaryngologist's hands. Narrowband imaging involves the use of filtered light to enhance the mucosal microvasculature pattern and has been shown to be highly sensitive to detecting Barrett's esophagus under conventional esophagoscopy. Methods: A retrospective chart review of 111 patients with LPR who underwent TNE by the same otolaryngologist was carried out. Pentax EE-1580K (white light only) and Olympus GIF-N180 (with NBI) endoscopes were used in 58 and 53 patients, respectively. Microcup biopsy of the squamocolumnar junction was obtained when Barrett's esophagus was suspected. Results: Biopsy-proven Barrett's esophagus was found in 13.5% of the patients. According to white light only and NBI, 7 of 58 (12.1%) and 8 of 53 (15.1%), respectively, had biopsy-proven Barrett's esophagus. Three patients had dysplasia on biopsy (2.7%), and all of these cases were detected under NBI (5.7%). Conclusions: Narrowband imaging may be a useful adjunct in increasing the diagnostic sensitivity of TNE in the hands of the otolaryngologist.

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Wang, Lu, Jia-Jie Tan, Ting Wu, Rui Zhang, Jia-Nuan Wu, Fang-Fang Zeng, You-Li Liu, Xiao-Yan Han, Yan-Fei Li, and Xiang-Ping Li. "Association between Laryngeal Pepsin Levels and the Presence of Vocal Fold Polyps." Otolaryngology–Head and Neck Surgery 156, no. 1 (November 14, 2016): 144–51. http://dx.doi.org/10.1177/0194599816676471.

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Objective To determine whether pepsin, the main component of refluxed gastric contents, is significantly associated with vocal fold polyps and to evaluate the diagnostic value of pepsin in vocal fold polyps’ tissues. Study Design Cross-sectional study. Setting Nanfang Hospital of Southern Medical University. Subjects and Methods The study included 32 patients with vocal fold polyps and 16 healthy controls between 2011 and 2012. Reflux symptom index and reflux finding score assessments, 24-hour combined multichannel intraluminal impedance and pH monitoring, and biopsy of the vocal fold polyp tissues or posterior laryngeal mucosa (healthy controls) for immunohistochemical pepsin staining were performed. Results The expression of pepsin was significantly higher in patients with vocal fold polyps than in controls (28/32, 75% vs 5/16, 31.25%; P < .001). The pepsin levels were significantly positively correlated with upright position pharyngeal acid reflux and esophageal reflux parameters adjusted by age. Based on pepsin staining data, the sensitivity and negative predictive values of 24-hour pH monitoring, the reflux symptom index, and the reflux finding score were 70% to 84.62%, whereas their specificity and positive predictive values were relatively low (20%-31.58%). Conclusion Pepsin reflux may be a risk factor for vocal fold polyps formation. In addition, pepsin immunohistochemical analysis of polyp biopsy samples appears to be a more sensitive and effective test for diagnosing laryngopharyngeal reflux than the reflux symptom index, the reflux finding score, and 24-hour pH monitoring in a clinical setting.

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Altman, Kenneth W., Yayoi Kinoshita, Melin Tan, David Burstein, and James A. Radosevich. "Western Blot Confirmation of the H+/K+-ATPase Proton Pump in the Human Larynx and Submandibular Gland." Otolaryngology–Head and Neck Surgery 145, no. 5 (July 13, 2011): 783–88. http://dx.doi.org/10.1177/0194599811415589.

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Objective. The authors have previously demonstrated the H+/K+-ATPase (proton pump) in human larynx and lung glands via immunohistochemistry (IHC). The present hypothesis is that the proton pump is expressed in other seromucinous glands of the digestive tract that can be confirmed by IHC and Western blot analysis. Study Design. Prospective controlled tissue analysis study. Setting. Academic medical institution. Methods. Ten anonymous fresh-frozen donor specimens were obtained, comprising 3 submandibular glands, 4 larynges, and 3 normal stomach specimens for control. Submandibular gland sections were immunostained with 2 monoclonal antibodies selectively reactive with α or β subunits of the H+/K+-ATPase. Western blot analysis was performed on all specimens. Results. Consistent IHC staining was observed in the submandibular gland specimens for both α and β subunits. Western blot analysis revealed very strong expression for the stomach at 100 kDa, corresponding to the α protein, and weak but notable banding for all larynx and submandibular gland specimens. Similar findings were noted for the 60- to 80-kDa glycosylated β subunit protein, as well as the 52-kDa β subunit precursor for all specimens. Conclusion. The H+/K+-ATPase (proton) pump is present in the human larynx and submandibular gland although in much lower concentrations than in the stomach. Proton pump involvement in human aerodigestive seromucinous glands may have a role in protecting mucosa from acid environments (local or systemic), explain heightened laryngeal sensitivity in those patients with laryngopharyngeal reflux, and be a site of action for proton pump inhibitor pharmacotherapy.

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Patterson, Joanne M., Anthony Hildreth, and Janet A. Wilson. "Measuring Edema in Irradiated Head and Neck Cancer Patients." Annals of Otology, Rhinology & Laryngology 116, no. 8 (August 2007): 559–64. http://dx.doi.org/10.1177/000348940711600801.

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Objectives: Edema is a common side effect of radiotherapy for head and neck cancer. Systems have been developed to record and monitor changes that occur after radiotherapy. These lack the sensitivity to record edema in specific laryngopharyngeal structures. The aim of this study was to develop a rating scale to measure edema in the larynx and pharynx. Methods: This was an exploratory study to develop a new measure, with the help of an expert panel, assessing interrater and intrarater reliability. A consensus group developed the rating scale. Eleven structures and 2 spaces were identified as areas sensitive to the development of edema. The terms no, mild, moderate, and severe were used to describe the degrees of edema. The scale was piloted and then tested for interrater and intrarater reliability on 5 speech and language therapists. They viewed 25 nasendolaryngoscopic images (23 patients who had had radiotherapy and 2 healthy volunteers). The images were rated with the scale. This process was repeated 1 week later. Results: Images were taken from patients with oral, oropharyngeal, nasopharyngeal, or laryngeal cancer. All had had radiotherapy or chemoradiotherapy. All raters were experienced in viewing larynges via nasendolaryngoscopy. The interrater reliability for scoring the edema rating scale was moderate (weighted kappa, 0.54). Lower levels of agreement were found for the tongue base, valleculae, pharyngeal walls, and anterior commissure. The intrarater reliability was very good (weighted kappa, 0.84). Conclusions: The edema rating scale can be scored with very good test-retest reproducibility and moderate levels of agreement between clinicians. Modifications to the method are suggested to increase interrater reliability.

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Altman, Kenneth W., Joshua D. Waltonen, Neal D. Hammer, James A. Radosevich, and G. Kenneth Haines. "Proton Pump (H+/K+-ATPase) Expression in Human Laryngeal Seromucinous Glands." Otolaryngology–Head and Neck Surgery 133, no. 5 (November 2005): 718–24. http://dx.doi.org/10.1016/j.otohns.2005.07.036.

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OBJECTIVE: Recent pilot research suggested that the H+/K+-ATPase (proton pump), which is the target of pharmacotherapy for laryngopharyngeal reflux disease (LPRD), is associated with human laryngeal submucosal glands. The hypothesis of this study is that proton pump is expressed in the human larynx, and is not solely associated with the parietal cells of the stomach. METHODS: Fifteen surgical larynx subjects (27 pathologic specimens) containing seromucinous glands from banked tissue were retrospectively obtained after approval from Human Subjects Committee. Banked human stomach tissue was also obtained for comparative positive and negative controls. Sections were immunostained with two monoclonal antibodies selectively reactive with alpha or beta subunits of the H+/K+-ATPase (proton) pump. RESULTS: In the human larynx, positive staining was seen in 14 of 15 subjects. Twenty-six specimens showed consistent staining in the seromucinous cells and ducts for the alpha subunit, and 23 specimens for the beta subunit. Stomach parietal cells exhibited strongly positive staining for both the alpha and beta subunits of the proton pump. There was no staining in stomach cells that were not morphologically consistent with the parietal cell. CONCLUSION: The H+/K+-ATPase (proton) pump is present in seromucinous cells and ducts in the human larynx, with some variable expression noted. Proton pump involvement in human laryngeal seromucinous glands may explain heightened laryngeal sensitivity in those patients with chronic laryngitis believed to have LPRD. Also, proton pump inhibitor pharmacotherapy may have a site of action in the human larynx, explaining some of the controversies attributable to LPRD.

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Dettmar, Peter W., Mark Watson, Julian McGlashan, Taran Tatla, Andreas Nicholaides, Kirsty Bottomley, Nabil Jarad, et al. "A Multicentre Study in UK Voice Clinics Evaluating the Non-invasive Reflux Diagnostic Peptest in LPR Patients." SN Comprehensive Clinical Medicine 2, no. 1 (December 6, 2019): 57–65. http://dx.doi.org/10.1007/s42399-019-00184-0.

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AbstractQuestionnaires and invasive diagnostic tests are established for diagnosing gastro-esophageal reflux disease (GERD) but shown not to be sensitive or specific for diagnosing laryngopharyngeal reflux (LPR) where vast majority of reflux events are weakly acidic or non-acidic. The research question addressed in the current multicentre study was to determine if the measurement of salivary pepsin is a sensitive, specific and reliable diagnostic test for LPR. Five UK voice clinics recruited a total of 1011 patients presenting with symptoms of LPR and a small group of subjects (n = 22) recruited as asymptomatic control group. Twenty-six patients failed to provide demographic information; the total patient group was 985 providing 2927 salivary pepsin samples for analysis. Study participants provided 3 saliva samples, the first on rising with two samples provided post-prandial (60 min) or post-symptom (15 min). The control group provided one sample on rising and two post-prandial providing a total of 66 samples. Pepsin analysis was carried out using Peptest as previously described. High prevalence of pepsin in patient groups (75%) represents a mean pepsin concentration of 131 ng/ml. The greatest prevalence for pepsin was in the post-prandial sample (155 ng/ml) and the lowest in the morning sample (103 ng/ml). The mean pepsin concentration in the control group was 0 ng/ml. Patients across all 5 clinics showed high prevalence of salivary pepsin (ranging from 69 to 86%), and the overall sensitivity was 76.4% and specificity 100%. Pepsin was shown to be an ideal biomarker for detecting airway reflux and LPR.

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Kim, Ted, Kathy Goodhart, Jonathan E. Aviv, Ralph L. Sacco, Beverly Diamond, Sarah Kaplan, and Lanny G. Close. "FEESST: A New Bedside Endoscopic Test of the Motor and Sensory Components of Swallowing." Annals of Otology, Rhinology & Laryngology 107, no. 5 (May 1998): 378–87. http://dx.doi.org/10.1177/000348949810700503.

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We here introduce an office or bedside method of evaluating both the motor and sensory components of swallowing, called fiberoptic endoscopic evaluation of swallowing with sensory testing (FEESST). FEESST combines the established endoscopic evaluation of swallowing with a technique that determines laryngopharyngeal (LP) sensory discrimination thresholds by endoscopically delivering air pulse stimuli to the mucosa innervated by the superior laryngeal nerve. Endoscopic assessment of LP sensory capacity followed by endoscopic visualization of deglutition was prospectively performed 148 times on 133 patients with dysphagia over an 8-month period. The patients had a variety of underlying diagnoses, with stroke and chronic neurologic disease predominating (n = 94). Subsequent to LP sensory testing, a complete dysphagia evaluation was conducted. Various food and liquid consistencies were dyed green, and attention was paid to their management throughout the pharyngeal stage of swallowing. Evidence of latent swallow initiation, pharyngeal pooling and/or residue, laryngeal penetration, laryngeal aspiration, and/or reflux was noted. Recommendations for therapeutic intervention were based on information obtained during the FEESST and often involved the employment of compensatory swallowing strategies, modification of the diet or its presentation, placement on non-oral feeding status, and/or referral to other related specialists. All patients successfully completed the examination. In 111 of the evaluations (75%), severe (>6.0 mm Hg air pulse pressure [APP]) unilateral or bilateral LP sensory deficits were found. With puree consistencies, 31% of evaluations with severe deficits, compared to 5% of evaluations with either normal sensitivity or moderate (4.0 to 6.0 mm Hg APP) LP sensory deficits, displayed aspiration (p <.001, χ2 test). With puree consistencies, 69% of evaluations with severe deficits, compared to 24% with normal or moderate deficits, displayed laryngeal penetration (p <.001, χ2 test). FEESST allows the clinician to obtain a comprehensive bedside assessment of swallowing that is performed as the initial swallowing evaluation for the patient with dysphagia.

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Morozov, P. V., and S. V. Novoseltsev. "Infants after artificial lung ventilation. New approaches to rehabilitation." Voprosy praktičeskoj pediatrii 17, no. 1 (2022): 24–35. http://dx.doi.org/10.20953/1817-7646-2022-1-24-35.

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Objective. To improve rehabilitation of infants who received respiratory support at birth. Patients and methods. This prospective comparative study was conducted in the Children's City Polyclinic No 13 of Yekaterinburg and included 131 infants who received different types of artificial lung ventilation (ALV) for some respiratory disorders. All patients were followed up by a pediatrician, neurologist, pulmonologist, and an infectious disease specialist; all of them received appropriate therapy. The experimental group comprised 99 infants who additionally received a course of osteopathic (manual) correction for 8–10 weeks, whereas the control group included 32 infants who received standard therapy only. Patients in the experimental and control groups were matched for all parameters. In addition to chest X-ray, all study participants underwent an assessment of their neurological, somatic, and biomechanical statuses. Osteopathic treatment (4 to 6 sessions lasting 30–40 minutes each) was performed by one osteopathic doctor. Statistical analysis was conducted using the SPSS Statistics.26 software; we calculated Pearson's linear correlation coefficient and used Fisher's exact test and McNemar's test. Differences were considered significant at p < 0.05. Results. Seventy-nine infants (79.8%) initially had both neurological and somatic disorders. Ten patients (10.1%) had either somatic disorders (such as labored nasal breathing, regurgitation, constipation, thermoregulation disorder) or neurological disorders (weather sensitivity, sleep disorders, delayed motor and/or neuropsychiatric development, impaired blood and cerebrospinal fluid dynamics) alone. We identified three groups of major somatic dysfunctions (SDs) in the biomechanical status: local (levels: С0–СI, sternum, thoracoabdominal diaphragm, sacrum); regional (cervical spine–level СII–СVI, laryngopharyngeal complex, lungs, abdominal cavity, skull); and global dysfunction of the dura mater. After treatment, the frequency of all neurological and somatic disorders, as well as the frequency of all SDs reduced in the experimental group (p < 0.001). Pathological changes on chest X-rays (elevated diaphragm, low mobility of the thoracic diaphragm, bullae, pleurodiaphragm atic adhesions, etc.) were detected in 89 patients (67.9%), including 66 infants from the experimental group (66.7%) and 23 infants from the control group (71.8%). Osteopathic (manual) treatment significantly reduced the number of patients with abdominal diaphragm dysfunction (56.6% vs. 26.3%), bullae (35.3% vs. 11.1%), and middle lobe syndrome (8.1% vs. 2%) (p < 0.001). The number of patients with thoracoabdominal diaphragm dysfunction in the control group did not change (n = 18; 56.2%). Positive radiological dynamics was observed in 90.9% of patients from the experimental group and 43.5% of patients from the control group. Moreover, only infants from the control group demonstrated negative radiological dynamics (17.4%). Conclusion. Newborns (both preterm and full-term) with different respiratory disorders who had received all types of ALV were found to have a typical spectrum of SDs. The key aspect of their pathogenesis is primary lesions to the phrenic nerve. Correction of SDs using osteopathic manipulations significantly increased the efficacy of comprehensive treatment, which is confirmed by the results of X-ray examination. Key words: somatic dysfunctions, thoracic diaphragm, phrenic nerve, artificial ventilation, manual therapy, preterm newborns, newborns, osteopathic correction

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Vora, Anish, Dylan Vance, Ghiath Alnouri, and Robert T. Sataloff. "Food Sensitivity and Laryngopharyngeal Reflux: Preliminary Observations." Journal of Voice, November 2019. http://dx.doi.org/10.1016/j.jvoice.2019.09.005.

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Wang, Jiasen, Jinrang Li, Qian Nie, and Ran Zhang. "Are Multiple Tests Necessary for Salivary Pepsin Detection in the Diagnosis of Laryngopharyngeal Reflux?" Otolaryngology–Head and Neck Surgery, July 13, 2021, 019459982110268. http://dx.doi.org/10.1177/01945998211026837.

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Objectives To evaluate the necessity of multiple salivary pepsin tests within a day when diagnosing laryngopharyngeal reflux. Study Design Prospective cohort study. Setting Tertiary hospitals. Methods A total of 138 patients with signs and/or symptoms associated with laryngopharyngeal reflux were included. Salivary pepsin was detected on the day of 24-hour pH monitoring, and the results of salivary pepsin detected once in the morning and multiple times in 1 day were compared with the results of pH monitoring. Results Among the 138 patients, pH monitoring results were positive in 112. Salivary pepsin was positive in 47 cases in the morning, which was not consistent with the results of pH monitoring (kappa value = 0.117). With the pH monitoring results as the standard, the salivary pepsin detected once in the morning had a sensitivity of 38.4% (43/112) and a specificity of 84.6% (22/26) for the diagnosis of laryngopharyngeal reflux. When salivary pepsin was detected multiple times per day, 102 patients tested positive. The consistency with pH monitoring was moderate (kappa value = 0.587). The sensitivity was 86.6% (97/112), and the specificity was 80.8% (21/26). Of the 97 patients with positive results from pH monitoring and salivary pepsin detected multiple times a day, 54 had negative findings for a single detection in the morning, indicating that 55.7% (54/97) of the true positive cases were missed. Conclusion Although a single detection of salivary pepsin in the morning is more economical, the sensitivity is too low, and it is necessary to detect it multiple times a day.

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Alnouri, Ghiath, Nicholas Cha, and Robert T. Sataloff. "Histamine Sensitivity: An Uncommon Recognized Cause of Living Laryngopharyngeal Reflux Symptoms and Signs—A Case Report." Ear, Nose & Throat Journal, August 26, 2020, 014556132095107. http://dx.doi.org/10.1177/0145561320951071.

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A 45-year-old female who had undergone Nissen fundoplication for long-standing laryngopharyngeal reflux (LPR) developed episodes of coughing and throat clearing. Strobovideolaryngoscopy demonstrated evidence of LPR with a reflux finding score of 11. A cough workup including a chest X-ray and pulmonology consultation was negative. Consultation with a nutritionist revealed Histamine intolerance. Histamine-free diet resulted in marked improvement in patient’s symptoms and examination.

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Lechien, Jérôme R. "Sensitivity, Specificity, and Predictive Values of Laryngopharyngeal Reflux Symptoms and Signs in Clinical Practice." Otolaryngology–Head and Neck Surgery, August 30, 2022, 019459982211218. http://dx.doi.org/10.1177/01945998221121822.

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Objective To investigate the sensitivity (SE), specificity (SP), and positive and negative predictive value (PPV and NPV) of symptoms and signs of laryngopharyngeal reflux (LPR). Study Design Prospective controlled. Setting University medical center. Methods Patients presenting with LPR symptoms and signs were consecutively included after diagnosis confirmation through 24-hour hypopharyngeal-esophageal multichannel intraluminal impedance–pH monitoring. Healthy individuals were recruited to compose a control group. Symptoms and signs were evaluated with the reflux symptom score and reflux sign assessment. The SE, SP, PPV, and NPV of symptoms and signs were assessed. Results The study included 403 patients with LPR and 144 healthy individuals. Throat clearing, globus sensation, heartburn, and excess throat mucus were symptoms with the highest SE (67.5%-69.7%), SP (12.5%-20.8%), and NPV (48.3%-49.2%). The combination of throat clearing, heartburn, globus sensation, and excess throat mucus led to a high SE (96.0%) and NPV (85.2%). Anterior pillar erythema, tongue tonsil hypertrophy, and posterior commissure hypertrophy resulted in the highest SE (75.5%-83.5%). The highest SP was found for uvula erythema/edema, epiglottis erythema, and interarytenoid granulatory tissue (97.1%-97.2%). The association of nonendoscopic signs (anterior pillar erythema, uvula erythema/edema, and coated tongue) had an SE and SP of 80.1% and 47.2%, respectively. The association of throat clearing, heartburn, globus, anterior pillar erythema, and uvula erythema/edema had the highest SE (98.8%), SP (33.3%), PPV (94.3%), and NPV (70.6%). Conclusion LPR symptoms and signs reported low SP and NPV. The SE, SP, PPV, and NPV may be maximized with the association of throat clearing, heartburn, globus sensation, anterior pillar erythema, and uvula erythema/edema.

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Im, Nu-Ri, Byoungjae Kim, Kwang-Yoon Jung, and Seung-Kuk Baek. "Usefulness of matrix metalloproteinase-7 in saliva as a diagnostic biomarker for laryngopharyngeal reflux disease." Scientific Reports 11, no. 1 (August 23, 2021). http://dx.doi.org/10.1038/s41598-021-96554-7.

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AbstractSeveral diagnostic methods are currently being used to diagnose LPRD (laryngopharyngeal reflux disease), but have the disadvantage of being invasive, subjective, or expensive. Our purpose in this study was to investigate the correlation between pepsin and MMP-7 (Matrix Metalloproteinase-7) in pharyngeal secretions of subjects according to RSI (Reflux Symptom Index) score to find out the diagnostic value of MMP-7. We recruited 173 subjects aged between 19 and 85 years who completed the RSI scale. All samples were taken after waking up, and the amount of the pepsin and MMP-7 in saliva were measured by means of an enzyme activity assay. There was a significant increase of pepsin and MMP-7 activity in the study group with an RSI score of 13 or higher. The sensitivity and specificity of MMP-7 for predicting the possibility of an RSI of 13 or more was higher than that of pepsin. When MMP-7 and pepsin were combined, this sensitivity and specificity increased. An enzyme assay of MMP-7 in saliva may be a noninvasive and easy technique for diagnosing LPRD.

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Asyari, Ade, Novialdi -, Bonny Murizky, Wahyu Julianda, Esmaralda Nurul Amany, Tuti Handayani, and Hafni Bachtiar. "Diagnostic of lingual tonsil hypertrophy with lateral soft tissue cervical X-ray on laryngopharyngeal reflux." Oto Rhino Laryngologica Indonesiana 51, no. 1 (July 2, 2021). http://dx.doi.org/10.32637/orli.v51i1.381.

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Background: Lingual tonsil hypertrophy (LTH) evaluation could be performed by flexible fiberoptic laryngoscopy, lateral soft tissue cervical roentgen, CT scan, and magnetic resonance imaging (MRI).Lateral soft tissue cervical roentgen examination was considered as substitutes for diagnostic testing of LTH, which, aside from being cheaper, the examination could also be conducted in all hospitals and easy to be performed on children. Objective: To compare the lingual tonsil enlargement with examination procedure using lateral soft tissue cervical roentgen as an LTH diagnosis measure compared to the flexible fiberoptic laryngoscopy examination as the gold standard examination. Methods: A cross-sectional design study on 30 respondents of laryngopharyngeal reflux (LPR) patients whose conducted routine ENT physical examination, followed by flexible fiberoptic laryngoscopy examination along with lateral soft tissue cervical roentgen. Results: The sensitivity level of 65.38% was acquired from the statistical tests, along with specificity level of 100%, positive predictive value (PPV) of 100%, and negative predictive value (NPV) of 30.37%. Conclusions: Based on sensitivity and specificity, lateral soft tissue cervical roentgen examination could already be used as a diagnostic measure and have an accurate capability to diagnose LTH.

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Park, Jin-soo, Leticia Burton, Hans Van der Wall, and Gregory Falk. "709 PL11.05 NOVEL DIGITAL REFLUX SCINTIGRAPHY DETECTS PULMONARY MICROASPIRATION IN SEVERE GASTRO-OESOPHAGEAL AND LARYNGOPHARYNGEAL REFLUX DISEASE." Diseases of the Esophagus 34, Supplement_1 (September 2021). http://dx.doi.org/10.1093/dote/doab052.709.

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Abstract No gold-standard diagnostic test for laryngopharyngeal reflux (LPR) exists. Symptoms alone are non-diagnostic, and pH-impedance studies have poor sensitivity. Pulmonary micro-aspiration is under-recognised in LPR and gastro-oesophageal reflux disease (GORD). The present study aimed to describe the results of a novel digital technique for scintigraphic reflux studies in two groups with severe reflux: those with typical reflux symptoms and those with laryngopharyngeal manifestations of reflux. Methods A prospective database of severely symptomatic, treatment-resistant reflux patients was grouped based upon predominant symptom profile of typical GORD or LPR. All patients underwent novel reflux scintigraphy. Results were obtained for early scintigraphic reflux contamination of the pharynx and proximal oesophagus, and delayed contamination of the pharynx and lungs after two hours. Results The LPR patients were predominantly female (70.5% vs. 56.1%; p = 0.042) and older than the GORD group (median age 60 years vs. 55.5 years; p = 0.002). Early scintigraphic reflux was seen at the pharynx in 89.2% (GORD 87.7%, LPR 90.4%; p = 0.133), and at the proximal oesophagus in 89.7% (GORD 88.9%, LPR 90.4%; p = 0.147). Delayed contamination of the pharynx was seen in 95.2% (GORD 93.9%, LPR 96.2%; p = 0.468). Delayed pulmonary aspiration was seen in 46% (GORD 36.6%, LPR 53.3%; p = 0.023). Conclusion Reflux scintigraphy demonstrated a high rate of digitally identified reflux pulmonary aspiration. Contamination of the proximal oesophagus and pharynx was observed frequently in both groups of severe disease. The likelihood of pulmonary aspiration and potential pulmonary disease needs to be entertained in severe GORD and LPR.

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Sabry, Manal, Tarek Mohamed Yosef, Ahmed Mohammed Mahmoud, and Tari M. A. George Michael. "Fasting salivary pepsin level as a reliable non-invasive method of screening for laryngopharyngeal reflux in Egyptian patients." Egyptian Journal of Internal Medicine 34, no. 1 (February 5, 2022). http://dx.doi.org/10.1186/s43162-022-00100-4.

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Abstract Background Laryngopharyngeal reflux (LPR) is caused by the regurgitation of gastric contents above the upper esophageal sphincter. Diagnostic gold standard tests like multichannel intraluminal impedance (MII) and 24-h dual-probe pH-metry are invasive and expensive which limits their accessibility especially in resource-limited settings. Since pepsin is only produced in the stomach, detecting pepsin in the laryngopharynx would make it a specific marker for reflux. Therefore, in this study, we measured fasting salivary pepsin in patients with symptoms suggestive of LPR. We aimed to confirm the role of fasting salivary pepsin as a non-invasive diagnostic tool of LPR, to detect a cut-off value for it in Egyptian patients and to study predictors of changes in its level. Methods We conducted a prospective case control study at the gastroenterology clinic in Ain Shams University Hospitals. After testing with esophageal pH-metry, 25 symptomatic patients with confirmed LPR and 25 healthy controls were enrolled in the study. Patients diagnosed with organic upper gastrointestinal disorders, autoimmune diseases, diabetes, malignancy or organ failure were excluded. Patients on PPI were advised to stop 2 weeks before testing. All patients were tested for fasting salivary pepsin levels, esophageal pH-metry, and indirect laryngoscopy in addition to routine laboratory parameters. Results Out of the 25 LPR patients, 16% of patients had laryngoscope abnormality in the form of mucosal hyperemia and inflammation, and the average percentage of time pH < 4 in esophageal pH-metry testing was 29.14 ± 39.5%. Comparative study between the 2 groups revealed a significant increase in salivary pepsin in LPR group compared to control group (p < 0.001). By using ROC-curve analysis, salivary pepsin at a cut-off point > 5 ng/ml diagnosed patients with LPR, with fair (77.9%) accuracy, sensitivity = 100% and specificity = 56% (p = 0.0001) while pH-metry (% Time pH < 4) at a cut-off point > 14% diagnosed patients with LPR, with good (87%) accuracy, sensitivity = 80%, and specificity = 100% (p < 0.0001) Conclusion Fasting salivary pepsin level at a cut-off value of > 5 ng/ml is a reliable, non-invasive method for detection of LPR especially in resource-limited settings.

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Zhang, Michael, Clemente Chia, Claire Stanley, Debra J. Phyland, and Paul M. Paddle. "Diagnostic Utility of Salivary Pepsin as Compared With 24-Hour Dual pH/Impedance Probe in Laryngopharyngeal Reflux." Otolaryngology–Head and Neck Surgery, September 8, 2020, 019459982095118. http://dx.doi.org/10.1177/0194599820951183.

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Objective Laryngopharyngeal reflux (LPR) is defined as the retropulsion of gastric contents into the larynx, oropharynx, and/or nasopharynx. The 24-hour combined hypopharyngeal-esophageal multichannel intraluminal impedance with dual pH probe (24h-HEMII-pH) is currently the gold standard in LPR diagnosis; however, it is invasive, user dependent, and not always tolerated. This study assesses the diagnostic utility of salivary pepsin (Peptest) at different thresholds and during symptomatic periods as compared with the 24h-HEMII-pH probe in diagnosing LPR. Study Design Prospective cohort study. Setting Private laryngology clinic in Melbourne, Australia. Subjects and Methods Thirty-five patients with a clinical history and endoscopic findings of LPR were recruited and simultaneously evaluated for LPR via 24h-HEMII-pH probe and salivary pepsin analysis at 5 key time points over the same 24-hour period. Results Salivary pepsin was 76.9% sensitive and had a positive predictive value (PPV) of 87.0% at a threshold of 16 ng/mL when compared with the 24h-HEMII-pH probe. If the pathologic pepsin threshold was raised to 75 ng/mL, salivary pepsin had a sensitivity of 57.7%, a specificity of 75.0%, and a PPV of 93.8%. Symptomatic testing conferred a superior specificity at 16 ng/mL (66.7%) and 75 ng/mL (100.0%) and a superior PPV at 16 ng/mL (92.3%) and 75 ng/mL (100.0%). Conclusion Salivary pepsin detection is a simpler, more cost-effective, and less traumatic universal first-line alternative to 24h-HEMII-pH probe in diagnosing LPR. Superior specificities conferring greater diagnostic value may be achieved with higher thresholds and symptomatic testing. If clinical suspicion remains high following negative salivary pepsin analysis, a 24h-HEMII-pH study could provide further diagnostic information.

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Kim, Su Il, Su Jin Jeong, Oh Eun Kwon, Jung Min Park, Young Chan Lee, Young-Gyu Eun, and Seong-Gyu Ko. "24-Hour Multichannel Intraluminal Impedance–pH in Proton Pump Inhibitor Nonresponders vs Responders in Patients With Laryngopharyngeal Reflux." Otolaryngology–Head and Neck Surgery, July 13, 2021, 019459982110268. http://dx.doi.org/10.1177/01945998211026843.

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Objective This study aimed to evaluate the characteristics of reflux in proton pump inhibitor (PPI) nonresponders vs responders in patients with laryngopharyngeal reflux (LPR) by using 24-hour multichannel intraluminal impedance–pH (MII-pH) monitoring. Study Design Prospective cohort study. Setting A tertiary care otolaryngology clinic. Methods Patients with typical LPR symptoms showing >1 proximal reflux episode were considered to have LPR and investigated prospectively. Patients were prescribed high-dose PPI twice daily and followed up for at least 2 months. Patients with LPR showing a ≥50% decrease in the follow-up reflux symptom index score during treatment periods as compared with pretreatment were defined as responders; others were defined as nonresponders. Various parameters in 24-hour MII-pH monitoring between nonresponders and responders with LPR were compared with Student’s t test and receiver operating characteristic curve. Results Eighty patients were diagnosed with LPR and categorized as nonresponders (n = 19) and responders (n = 61). Proximal all reflux time and proximal longest reflux time in various MII parameters were higher in responders than in nonresponders ( P = .0040 and .0216, respectively). Proximal all reflux time >0.000517% was a better cutoff value to predict responders with LPR as compared with the proximal longest reflux time >0.61 minutes (sensitivity + specificity: 1.317 vs 1.291). Conclusion Proximal all reflux time in various 24-hour MII-pH monitoring parameters can be helpful to predict the response to PPI therapy in patients with LPR. These findings will help establish a personalized therapeutic scheme for patients with LPR.

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Lechien, Jerome R., Francois Bobin, Alexandra Rodriguez, Didier Dequanter, Vinciane Muls, Kathy Huet, Bernard Harmegnies, et al. "Development and Validation of the Short Version of the Reflux Symptom Score: Reflux Symptom Score–12." Otolaryngology–Head and Neck Surgery, July 21, 2020, 019459982094100. http://dx.doi.org/10.1177/0194599820941003.

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Objective To develop and validate a short version of the Reflux Symptom Score—the 12-question Reflux Symptom Score–12 (RSS-12)—for patients with laryngopharyngeal reflux disease (LPR). Study Design Prospective study. Setting Multicenter academic hospitals. Methods Patients with LPR diagnosed via multichannel intraluminal impedance pH monitoring were enrolled from 3 European hospitals. Healthy individuals completed the study. Individuals completed the Reflux Symptom Score, Reflux Symptom Index (RSI), and Voice Handicap Index (VHI) at baseline and 3 months posttreatment. The Reflux Symptom Score was completed twice within a 7-day period to assess test-retest reliability. Cronbach’s α was used for assessing internal consistency. The RSS-12 was developed and validity assessed through a comparison of the RSS-12, RSI, and VHI. Responsiveness to change was evaluated through the pre- to posttreatment evolution of the RSS-12 total score. Receiver operating characteristic analysis was used to determine the RSS-12 threshold that is suggestive of LPR. Results The RSS-12 was characterized by high test-retest reliability ( rs = 0.956) and adequate internal consistency reliability (α = 0.739). The RSS-12 was significantly correlated with the RSI ( rs = 0.845), suggesting high external validity. The RSS-12 total and item scores were significantly higher in patients with LPR as compared with healthy individuals ( P = .001), supporting high internal validity. RSS-12, VHI, and RSI significantly improved throughout treatment. Regarding the receiver operating characteristic curve, an RSS-12 score >11 is suggestive of LPR, exhibiting a sensitivity of 94.5% and a specificity of 86.2%. Conclusion The RSS-12 is a shorter, reliable, and valid self-administered patient-reported outcome measure questionnaire that can be used in the outpatient setting to suggest and monitor LPR.

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Journal articles on the topic 'Laryngopharyngeal sensitivity'

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