Laryngeal Manifestations of Gastroesophageal Reflux Disease in Children

Although the association between gastroesophageal reflux disease (GERD) and laryngeal disorders in adults is well established there is still a lack of information concerning the true extent of the laryngeal complications of GERD in children. The aim of this study was to determine the laryngeal status of children with diagnosed GERD. We sought to identify the initial appearance of their larynges and then to determine the clinical response to antireflux therapy. GERD was recognized in 90/100 children examined. Using 24-h pH monitoring we found that most of the patients experienced episodes of gastroesophageal reflux during the daytime when they were in an upright position. The hallmark of GERD affecting the larynx in our group was posterior laryngitis, which is characterized by erythema of the mucous membrane overlying the arytenoid cartilages and the posterior mucosal wall of the glottis. The findings regarding the effectiveness of therapy were that, in children with severe laryngeal alterations, voice quality improved significantly after 12 weeks of antireflux treatment ( p < 0.001) and laryngeal status was significantly better after 6 weeks of treatment ( p < 0.001). This study provides evidence that gastroesophageal reflux in children is the underlying cause of inflammatory and morphological lesions, and that antireflux treatment is effective in reducing or eliminating these lesions.     

Effect of Aggressive Therapy on Laryngeal Symptoms and Voice Characteristics in Patients with Gastroesophageal Reflux

Gastroesophageal reflux (GER) is associated with a variety of laryngopharyngeal signs and symptoms. Injury of the laryngopharynx as a result of GER can be refractory to conventional antireflux therapy. This prospective study was undertaken to evaluate the prevalence of laryngopharyngeal signs and symptoms in patients with documented GER and to assess the response to a high-dose combination antireflux therapy consisting of cisapride and pantoprazole. Twenty-two patients with symptoms of GER were enrolled. After baseline evaluation using a history questionnaire for symptoms, laryngeal endoscopy and vocal acoustic analysis, patients were started on treatment consisting of pantoprazole 40 mg b.d. and cisapride 20 mg twice daily. Repeat history and otolaryngologic evaluation was performed at 4 weeks. Laryngopharyngeal symptoms were frequent in most patients, with throat clearing and globus being the most prevalent symptoms followed by vocal fatigue and excess mucus production. Almost 90% of the patients had abnormal endoscopic laryngeal findings but the acoustic parameters did not show any abnormal results except for mild elevation in the shimmer. After treatment, all symptoms and endoscopic abnormalities improved significantly except for intermittent dysphonia and laryngeal mucosal redness. Acoustic abnormalities did not change significantly following therapy. Laryngeal symptoms and voice abnormalities are highly prevalent in patients with GER. Combination antireflux therapy with a proton pump inhibitor and a prokinetic agent results in rapid symptomatic and endoscopic response in the majority of patients.     

艾司奥美拉唑与奥美拉唑治疗胃食管反流病的临床疗效及应用价值比较研究

目的探析胃食管反流病采取艾司奥美拉唑和奥美拉唑诊疗的临床效果。方法选取2019年4月~2020年5月在我院就诊56例胃食管反流病患者,以双色球法分为对照组和治疗组,每组28例,对照组予奥美拉唑,治疗组予艾司奥美拉唑,比较两组效果。结果治疗组有效率相比于对照组明显提升(P<0.05);治疗组复发率、各症状积分较对照组显著下降(P<0.05)。结论较奥美拉唑,胃食管反流病采取艾司奥美拉唑效果更为理想,可有效改善症状,减小复发风险。     

Globus symptoms,referral patterns and natural history

Introduction. An inventory was carried out of (1) referral patterns by General Practitioners (GPs) in patients with globus symptoms and (2) the symptoms after 1 year. Material and methods. In the period between November 1995 and June 1996 50 patients (18 men and 32 women) with globus symptoms were referred. In these patients no organic substrate could be assessed afterwards. A questionnaire was answered by the patient about history, symptoms and ‘throat score’.¹ After a year the patients were interviewed again. Results. Neither severity of the symptoms, throat score, age, carcinophobia nor smoking habits appeared to lead to GPs making more prompt referrals. After 1 year the symptoms were gone almost completely in 31 patients. Conclusion. No factors could be demonstrated to influence the patterns of referral of GPs. In these patients globus symptoms frequently disappeared spontaneously.     

Gastroesophageal reflux, allergy and chronic tubotympanal disorders in children

The purpose of this study is to examine the relation between gastroesophageal reflux and allergy as possible causes of chronic tubotympanal pathology. The 30 examined children (ages 2-13) were divided into two groups based on the otological criteria. The 16 examined children suffered from a secretory otitis, which lasted more than four months. Upon further examination with a microscope, seven of these children exhibited symptoms of the adhesive process of the middle ear. Furthermore, 14 patients suffered from a recurrent otitis, i.e. more than five cases of otitis per year, while five patients from this group suffered from a chronic otitis with a central defect of the tympanum. The method used for the examination of the gastroesophageal reflux consisted of a continual 24 h esophageal pH monitoring. The particular apparatus used for this included antimony electrode (Synetics Medical, Sweden), while the analysis we performed was processed through the PC software program Gastrosoft Inc. The reflux index higher than five was considered pathological. At the time of the gastroesophageal reflux examination, we also performed the allergological analysis. The presence of allergy was confirmed by three methods: the positive allergological anamnesis, the positive skin pick test and by the elevated quantities of specific IgEs (Pharmacia CAP system). The examination resulted in the following: 18 of the examined children suffered from the pathological gastroesophageal reflux (60%); further seven of our patients tested positive on the allergological test (23%); and the four who tested positive for allergy also suffered from the pathological gastroesophageal reflux (13%). In comparison with allergies, the pathological GER was substantially more frequent in the patients who suffered from chronic tubotympanal disorders.     

三种原因不明内耳病抗内耳组织自身抗体的检测

提取、制备豚鼠内耳膜迷路抗原，成功地建立了免疫转印法（ｉｍｍｕｎｏｂｌｏｔｔｉｎｇ），对３３例不明原因内耳病（不明原因进行性感音性聋１０例、突发性聋１５例、Ｍｅｎｉｅｒ病８例）进行分析，发现１０例（３０．３％）患者血清中存在抗内耳组织自身抗体，提示自身免疫反应可能参与部分原因不明内耳病的发病过程。本研究表明：应用免疫转印技术检测抗内耳组织自身抗体，对进一步认识和探讨自身免疫因素在原因不明内耳病的发病机制中的作用有重要价值。     

Therapeutic Effect of Multilevel Surgery on Laryngopharyngeal Reflux in Obstructive Sleep Apnea Patients: Impact on the Reflux Symptom Index and Reflux Finding Score

Objectives.Our previous study found that multilevel obstructive sleep apnea (OSA) surgery mitigated laryngopharyngeal reflux (LPR) symptoms in terms of the reflux symptom index (RSI), but no studies have investigated the impact of OSA surgery on laryngoscopic parameters. The aim of this study was to examine the clinical outcome of LPR improvement following OSA surgery, with a focus on both the RSI and the reflux finding score (RFS).Methods.Prospectively collected data from 28 patients who underwent multilevel OSA surgery from 2017 to 2021 were retrospectively analyzed. Patients were asked to complete the RSI questionnaire and underwent a laryngoscopic examination to evaluate the RFS before and after surgery. Age, height, weight, body mass index (BMI), and polysomnography data before and after surgery were also reviewed.Results.After surgery, the total RSI and RFS decreased significantly from 11.96±8.40 to 7.68±6.82 (P=0.003) and from 6.57±3.49 to 3.21±1.87 (P<0.001). The positive rates of RSI and RFS decreased from 28.6% to 17.9% and 32.1% to 0%, respectively. Significant improvements were found in the RSI subdomains of throat clearing, throat mucus, breathing difficulty, troublesome cough, and heartburn sensation, while all RFS subdomains except granuloma improved significantly. In subgroup analyses, no significant differences were found between subgroups based on age, OSA severity, or BMI.Conclusion.OSA surgery has the potential to alleviate both LPR symptoms and laryngoscopic results. Additional research integrating more objective techniques and novel treatment strategies is required to better comprehend the clinical impact of OSA surgery on LPR.     

Gastroesophageal reflux disease: its importance in ear, nose, and throat practice

OBJECTIVE: Gastroesophageal reflux disease (GERD) has been implicated in various extra-gastroesophageal diseases, especially in the upper and lower airways (atypical GERD). The objective of the present study was to determine the frequency of gastroesophageal and extra-gastroesophageal symptoms in pediatric patients with GERD and their response to the general treatment. MATERIAL AND METHODS: A retrospective study was conducted on 45 children of both sexes aged 3 months-12 years with GERD diagnosed by clinical examination and 24h single-channel pHmetry. The gastroesophageal and extra-gastroesophageal symptoms, the treatment instituted and the response of the patients to the latter were determined. RESULTS: Five symptomatologic groups were identified: gastroesophageal (51.11%), pulmonary (recurrent pneumonia, 40%, and bronchial asthma, 46.67%), chronic cough (64.44%), rhinologic (chronic nasal obstruction, 68.88%, nasal secretion, 55.55%, and nose itching, 46.66%), and pharyngo-otologic (recurrent acute middle ear infection, 35.56%, and recurrent tonsillitis, 24.44%). The response to treatment (antireflux drugs, antiallergic drugs, and surgical procedures) resulted in cure in 24 patients (53.34%), while 21 continued to be symptomatic. The cure rate was 69.56% for the gastroesophageal group, 100% for the recurrent pneumonia group, 80.95% for the bronchial asthma group, 68.96% for the chronic cough group, 83.87% for the chronic nasal obstruction group, 80% for the nasal secretion group, 85.71% for the nose itching group, 100% for the recurrent acute middle ear infection group, and 90.90% for the recurrent tonsillitis group. Total treatment time was 1.8 times longer for the remission of extra-gastroesophageal symptoms. Exclusive antireflux treatment promoted full remission of the otorhinolaryngologic symptoms in 38.89% of patients (nasal-41.17%, recurrent acute middle ear infection-12.5%, and recurrent tonsillitis-18.18%). CONCLUSION: GERD can cause otorhinolaryngologic symptoms in children and remission of these symptoms can be obtained with antireflux therapy.     

Etiology,pathophysiology of symptoms,and pathogenesis of Meniere's disease

Endolymphatic hydrops is the pathologic feature associated with Meniere's disease. The development of endolymphatic hydrops appears to arise from multifactorial inheritance with alteration of endolymphatic homeostasis. Various factors associated with the phenomenon of hydrops include functional or anatomic obstruction of endolymphatic flow, malabsorption of endolymph, genetic anomalies, vasodilation, allergy, viral infection, and autoimmunity.     

Gene Expression Profiles of the Rat Cochlea,Cochlear Nucleus,and Inferior Colliculus

High-throughput DNA microarray technology allows for the assessment of large numbers of genes and can reveal gene expression in a specific region, differential gene expression between regions, as well as changes in gene expression under changing experimental conditions or with a particular disease. The present study used a gene array to profile normal gene expression in the rat whole cochlea, two subregions of the cochlea (modiolar and sensorineural epithelium), and the cochlear nucleus and inferior colliculus of the auditory brainstem. The hippocampus was also assessed as a well-characterized reference tissue. Approximately 40% of the 588 genes on the array showed expression over background. When the criterion for a signal threshold was set conservatively at twice background, the number of genes above the signal threshold ranged from approximately 20% in the cochlea to 30% in the inferior colliculus. While much of the gene expression pattern was expected based on the literature, gene profiles also revealed expression of genes that had not been reported previously. Many genes were expressed in all regions while others were differentially expressed (defined as greater than a twofold difference in expression between regions). A greater number of differentially expressed genes were found when comparing peripheral (cochlear) and central nervous system regions than when comparing the central auditory regions and the hippocampus. Several families of insulin-like growth factor binding proteins, matrix metalloproteinases, and tissue inhibitor of metalloproteinases were among the genes expressed at much higher levels in the cochlea compared with the central nervous system regions.     

Sudden sensorineural hearing loss in children: Etiology,management, and outcome

Background and objectivesPediatric sudden sensorineural hearing loss (SSNHL) is uncommon, and the current guidelines for its management refer to adults. Our objective was to review cases of SSNHL in children and examine their etiologies, management, and outcome.MethodsWe performed a retrospective chart review of all children under the age of 18 years treated for SSNHL between January 2003 and September 2014. Data recorded included age, gender, symptoms, onset of hearing loss, audiometric results, diagnostic studies, treatment, and outcome.ResultsNineteen children were included. Mean age was 14 years (range 7–18 years). Male: female ratio was 9:10. Degree of hearing loss varied from mild to profound across the tested frequencies. Most common accompanying symptom was tinnitus. Serologic tests demonstrated recent Epstein–Barr virus infection in one patient and previous cytomegalovirus infection in six patients. Imaging studies included computed tomography scan (n = 3) and/or magnetic resonance imaging (n = 12). All imaging studies did not demonstrate any pathology. Treatment included systemic steroids in 19 (100%) children and intratympanic steroids in eight (42%). Hearing completely improved in three (16%) children, partially improved in nine (47%), and there was no improvement in six (32%). One child was lost to follow-up.ConclusionsViral infection was a common finding in children with SSNHL and no pathological changes were demonstrated on imaging studies. In most patients (63%), hearing improvement was observed. Intratympanic steroid injection can benefit these children. Further studies are required to investigate the etiologies and establish guidelines for the management of SSNHL in children.