Utility of 24-hour pharyngeal pH monitoring and clinical feature in laryngopharyngeal reflux disease

Background: pH monitoring can reflect the changes in H⁺ in the airway.

Objectives: To explore the utility of pharyngeal pH monitoring in the diagnosis of laryngopharyngeal reflux disease (LPRD).

Material and methods: Clinical data from 956 suspected LPRD patients from February 2016 to March 2018 were analyzed retrospectively.

Results: One hundred forty-one patients had positive Ryan score. The positive rates of reflux symptom index (RSI), reflux finding score (RFS), RSI and RFS and RSI or RFS were 14.7%, 32.5%, 21.9%, 7.8% and 46.5%, respectively. The RFS in the positive Ryan score group was higher than that in the negative Ryan score group [(6?±?3.5) vs. (4.8?±?2.9)], while the RSI was not significantly different from that in the negative Ryan score group [(10.9?±?8) vs. (11.3?±?7.1)]. Regarding Ryan score as the gold standard in the diagnosis of LPRD, the sensitivity, specificity, positive and negative predictive value of identifying LPRD by RSI/RFS were 15.9%, 86.3%, 50.4% and 54%, respectively.

Conclusions: Ryan score, RSI and RFS have poor correlation in detecting LPRD. Some patients may be missed with the Ryan score as a diagnostic criterion.

Significance: Pharyngeal pH monitoring is useful and more appropriate index is expected.     

Different cutoffs of the reflux finding score for diagnosing laryngopharyngeal reflux disease should be used for different genders

Objectives: To assess the differences in Reflux Finding Score (RFS) between the genders and determine the suitable RFS threshold for diagnosing laryngopharyngeal reflux disease (LPRD) in each gender.

Methods: Asymptomatic volunteers and patients with LPRD, confirmed with an oropharyngeal Dx-pH monitoring system, were included. All study subjects underwent transnasal flexible fiber-optic video laryngoscopy. Reliability was assessed with intra-class correlation coefficients (ICCs) and Bland-Altman plots. The RFS cutoffs for determining the presence and absence of LPRD between the two genders were examined by receiver operating characteristic (ROC) analysis.

Results: One hundred seven asymptomatic volunteers and fifty-five LPRD patients were recruited. The mean RFS for LPRD subjects (9.4?±?3.2) was significantly higher than that for control subjects (7.1?±?2.6; p?p?p?Conclusions: There was a significant difference in the RFS cutoff between the genders. For male subjects, we recommend a cutoff of 9.0 for diagnosing LPRD, and for female subjects, we recommend a cutoff of 6.0.     

Using RSI and RFS scores to differentiate between reflux-related and other causes of chronic laryngitis

ObjectiveTo establish if the Reflux Symptom Index (RFI) and the Reflux Finding Score (RFC) can help establish the differential diagnosis in patients with distinct causes of chronic laryngopharyngitis.MethodsA group of 102 adult patients with chronic laryngopharyngitis (Group A – 37 patients with allergic rhinitis; Group B – 22 patients with Obstructive Sleep Apnea (OSA); Group C – 43 patients with Laryngopharyngeal Reflux (LPR)) were prospectively studied. Chronic laryngitis was diagnosed based on suggestive symptoms and videolaryngoscopic signs (RSI ≥ 13 and RFS ≥ 7). Allergies were confirmed by a positive serum RAST, OSA was diagnosed with a positive polysomnography, and LPR with a positive impedance-PH study. Discriminant function analysis was used to determine if the combination of RSI and RFS scores could differentiate between groups.ResultsPatients with respiratory allergies and those with LPR showed similar and significantly higher RSI scores when compared to that of patients with OSA (p < 0.001); Patients with OSA and those with LPR showed similar and significantly higher RFS scores when compared to that of patients with Respiratory Allergies (OSA vs. Allergies p < 0.001; LPR vs. Allergies p < 0.002). The combination of both scores held a higher probability of diagnosing OSA (72.73%) and Allergies (64.86%) than diagnosing LPR (51.16%).ConclusionsRSI and RFS are not specific for reflux laryngitis and are more likely to induce a false diagnosis if not used with diligence.     

The effect of obstructive sleep apnea surgery on laryngopharyngeal reflux with obstructive sleep apnea

Abstract

Background: Obstructive sleep apnea (OSA) may play a role in the occurrence of laryngopharyngeal reflux (LPR). OSA surgery also may have a significant curative effect on LPR with OSA.

Objectives: To analyze the role of OSA in LPR and the effect of OSA surgery on LPR with OSA.

Methods: Forty-five OSA patients with LPR symptoms were enrolled and were divided into the LPR positive group (RSI > 13) and the LPR suspicious group (1?≤?RSI ≤ 13) based on reflux symptom index (RSI). All the patients underwent OSA surgery. The RSI scores at three different time points postoperatively were compared with that preoperatively.

Results: In the LPR positive and LPR suspicious group, the result revealed that there were significant differences in RSI score between one month, three months, six months after surgery and before surgery (p?<?.001 for all). Moreover, in the LPR positive group, there was a significant difference in RSI score among one month, three months and six months after surgery (p?=?.01).

Conclusions and significance: The effect of OSA on LPR exists and OSA surgery can improve the symptoms of LPR with OSA obviously. For some LPR patients with OSA, the combination therapy of OSA and LPR is needed.     

窄带成像技术在诊断儿童咽喉反流中的应用

目的 研究窄带成像（NBI）技术在诊断儿童咽喉反流性疾病（LPRD）的应用价值。方法 选取2021年1月—2021年7月因慢性扁桃体炎或扁桃体肥大在徐州医科大学附属医院耳鼻咽喉科施行扁桃体切除手术的4~14岁患儿60例,在耳鼻咽喉医师的指导下,患儿和其父母共同填写《反流症状指数评分量表（RSI）》,并由2名耳鼻咽喉科专业医生填写《反流体征评分量表（RFS）》,切除的扁桃体组织进行免疫组织化学分析,观察扁桃体组织中胃蛋白酶（Pepsin）的表达情况。结果 22例（36.7%）患儿RSI>13分,38例（63.3%）患儿RSI≤13分,35例（58.3%）患儿RFS>7分,25例（41.7%）患儿RFS≤7分,39例（65%）患儿Pepsin （+）,21例（35%）患儿Pepsin （-）。RSI评分在有无咽喉反流症状中比较,两者差异无统计学意义（P>0.05）,RFS评分在有无咽喉反流症状中比较,两者差异具有统计学意义（P<0.05）。普通白光和NBI两种模式下进行RFS评分的比较,差异具有统计学意义（P<0.05）,其中在声带水肿、喉黏膜弥漫性水肿、充血和红斑方面差异较显著。结论 NBI视图比普通白光视图更容易识别声带水肿、喉黏膜弥漫性水肿、充血和红斑等RFS参数,能够提高儿童LPRD诊断的准确性。     

Ryan指数与反流症状指数量表、反流体征量表在咽喉反流性疾病诊断中的相关性分析

目的 探讨Ryan指数与反流症状指数量表(RSI)、反流体征量表(RFS)在咽喉反流性疾病诊断中的相关性。 方法 回顾性分析以咽喉部不适症状就诊,病程1个月以上的行咽部pH检测的230例患者临床资料。所有患者均同时行电子喉镜检测,并行RSI、RFS评估。 结果 Ryan指数阳性率为15.2%(35/230)。RSI、RFS、RSI或RFS及RSI且RFS阳性率分别为46.5%、28.7%、60.9%、13.9%。Ryan指数阳性组患者RFS评分高于Ryan指数阴性组患者,RSI评分与Ryan指数阴性组患者差异无统计学意义。RFS阳性,RSI或RFS,RSI且RFS阳性组Ryan指数阳性率高于RFS阴性,RSI或RFS,RSI且RFS阴性组。Ryan指数阳性与RSI、RFS、RSI或RFS及RSI且RFS阳性的一致性检验的kappa值分别为-0.06,0.394,0.116和0.172。以pH监测作为金标准时,RSI、RFS、RSI或RFS及RSI且RFS的敏感性分别为37.1%,74.3%,82.9%,28.6%;特异性分别为51.8%,79.5%,43.1%,88.2%;阳性预测值分别为12.1%,39.4%,20.7%,30.3%;阴性预测值分别为82.1%,94.5%,93.3%,87.3%。RSI与直立位及平卧位Ryan指数的相关系数分别为-0.056和-0.083;RFS与直立位及平卧位Ryan指数的相关系数分别为0.425和0.166。 结论 咽部pH检测是直接反映咽喉部反流的客观、无创的检测方法。RFS与Ryan指数有一定的正相关性,但量表与Ryan指数一致性差。尚需进一步研究更准确的、反映咽喉反流的量表及pH诊断指数。     

咽喉反流的初步诊断

目的 探讨咽喉反流中反流症状指数量表(The reflux symptom index,RSI)和反流检查计分量表(The reflux finding score,RFS)的作用.方法 2006年8月至2008年1月来北京大学人民医院就诊的可疑有咽喉反流的患者接受RSI及RES评估,以RSI评分>13分,RES>7分定为阳性,RSI评分≤13分和RES≤7分为阴性.均行24 h双探头pH监测.以24 h内咽喉部反流次数不小于6.9次或反流面积指数(reflux area index,RAI)不小于6.3为24 h pH监测阳性.对其中25例24 h pH监测阳性且坚持抗酸治疗的患者,服药3个月后随诊,再次接受RSI和RES评分.结果 RSI及RES评估后1个量表评估阳性25例,2个量表评估均阳性16例,2个量表均阴性的15例.1个量表评估阳性和2个量表评估均阳性的结果 与24 h双探头pH监测结果 具有中度以上的一致性(一致性为73.2%,Kappa值为0.43,u值为3.48,P<0.01).当RSI和RES两个量表均阳性时与24 h pH值监测一致性更高些(一致性为77.4%,Kappa值为0.55,u值为3.06,P<0.01).抗酸治疗前后25例患者RSI和RFS评分差异有统计学意义(配对t检验,t值分别为8.838和5.695,P值均为0.000).结论 RSI和RFS两个量表可作为临床上咽喉反流初步诊断及疗效评估的简单易行方法.     

Open-Label Observational Study for Evaluating the Short-term Benefits of Rabeprazole Medication on Laryngopharyngeal Reflux

Objectives

The aims of this study were to determine the benefits of short-term empirical proton pump inhibitor (PPI) medication on laryngopharyngeal reflux (LPR) and to determine whether scores on the reflux symptom index (RSI) and the reflux finding score (RFS) could be combined to identify subgroups of patients that will more likely to improve with this medication.

Methods

Fifty-one Korean Otolaryngology Board-certified specialists joined this prospective, multi-center, and open-label observational study. A total of 1,142 adult patients with LPR was enrolled for 12 weeks of rabeprazol medication. According to pre-treatment scores on RSI and RFS, patients were divided into 4 subgroups. RFS and RSI were measured repeatedly with a month interval along the treatment period. Changes of RSI and RFS were analyzed in an overall study cohort as well as in each subgroup.

Results

Approximately 40% (n=455) of enrolled patients were followed up until 12 weeks of PPI treatment. Significant improvement in RSI was obtained in 29%, 58%, and 75% of patients after 4, 8, and 12 weeks of PPI medication. RFS was improved in 16%, 42%, and 57% of the patients with 4, 8, and 12 weeks of PPI medication. All subgroups showed improvement regardless of their pre-treatment scores on the RSI and RFS.

Conclusion

Even though RSI and RFS may be used as a general guideline for LPR management, pre-treatment RSI and RFS are not useful in predicting the patients'' response to short-term PPI medication in the usual pattern of practice for LPR, which is mostly based on the physical evaluation and history taking.     

Do the laryngopharyngeal symptoms and signs ameliorate by empiric treatment in patients with suspected laryngopharyngeal reflux?

Objectives

In clinical practice, antireflux medication is given almost always empirically without pH monitorization. We aimed to evaluate the improving effect of empiric antireflux treatment on layngopharyngeal symptoms and signs in patients with gastroesophageal reflux (GER) and suspected laryngopharyngeal reflux (LPR) according to reflux symptom index (RSI) and reflux finding score (RFS).

Methods

GER was determined by esophagogastroduedonoscopy and biopsy in 127 patients. RSI and RFS were calculated for each patient. The patients with a pathology other than LFR which may be responsible from laryngopharyngeal symptoms and signs were excluded from the study. Fifty patients whom were thought to have LPR according to RSI and RFS comprised the study group. After 12-weeks of antireflux treatment, RSI and RFS were calculated again. The statistical analyses were made according to the changes in the severity and frequency of each symptom and sign.

Results

There was statistically significant improvement in RSI and RFS after treatment when compared with initial scores. There was statistically significant improvement in severity of all symptoms and signs. Although there was quantitively decrease in frequency of some signs and symptoms, complete resolution of the disease was not observed generally.

Conclusion

Empiric antireflux treatment according to RSI and RFS is an effective method. Antireflux treatment has a significant improving effect on laryngopharyngeal symptoms and signs. There may be needed longer times of treatment for complete resolution of symptoms and signs.     

Laryngopharyngeal reflux in chronic rhinosinusitis patients and the role of endoscopic sinus surgery

ObjectivesLatest literature proposes laryngopharyngeal reflux (LPR) as the underlying contributory factor for chronic inflammation in both upper and lower airways. In this study, we investigated LPR symptoms and signs of CRS patients and the various factors on their LPR symptoms and signs. We also evaluated the effect of the LPR symptoms and signs of CRS patients after endoscopic sinus surgery (ESS).MethodsWe performed a retrospective analysis from 91 patients who underwent primary ESS. They were assessed for LPR symptoms with Reflux Symptom Index (RSI) and Reflux Finding Scores (RFS) before ESS. Sino-Nasal Outcome Test (SNOT)-22, Lund–Mackay (LM) scoring system, and Lund-Kennedy (LK) scoring system were evaluated for CRS severity. They had to fulfill SNOT-22, RSI, and RFS at 6 months after surgery.ResultsNasal polyps, smoking, asthma, allergy, LM scores and LK scores didn't have significant correlations with preoperative RSI and RFS (P > .05 for all). RSI had significant correlations with SNOT-22 preoperatively and postoperatively (P < .05 for all). RFS had a significant correlation with postoperative SNOT-22 (P = 0.034). RSI and RFS decreased significantly more after ESS (P < 0.001 for both). Smoking had a significant effect on the postoperative RFS (P = 0.003). Non-smoker showed significantly lower scores of postoperative RFS (P = .0.003).ConclusionOur study suggests that subjective CRS symptoms were related with subjective LPR symptoms and ESS was effective in reducing signs and symptoms of LPR in CRS patients. Especially, smoking was associated with less improvement of laryngoscopic findings after ESS.     

Reflux finding score and reflux symptom index as potential predictors for proton pump inhibitor response in globus pharyngeus patients: A prospective study

ObjectiveTo evaluate the patient-reported reflux symptom index (RSI) and the doctors-reported Reflux finding score (RFS) as potential predictors for proton pump inhibitor (PPI) response in patients with suspected lower pharyngeal reflux, presenting with globus pharyngeus as their primary complaint.MethodsThe research project was performed at the ENT department of Isala hospital Zwolle, the Netherlands. A before and after design was used for this single institution prospective exploratory study. 101 participants with globus pharyngeus symptoms as a primary complaint were included. All participants were assessed by an otorhinolaryngologist at enrollment and after eight weeks of esomeprazole use. Fiberoptic laryngoscopy was performed to document the RFS, and RSI questionnaires were self-administered by the participants. Our main outcome measurement was the patient- reported therapeutic response evaluation, that differentiated three categories: responders, partial responders and non-responders. For evaluation of the assessment tools, RFS > 7 and RSI > 13 were considered deviant.ResultsAmong the 101 participants, 43 (42.6%) were responders, 28 (27.7%) partial responders and 30 (29.7%) non-responders. Both baseline RSI > 13 and RFS > 7 were statistically significant associated with treatment response. Also, combined into RSI/RFS baseline categories, a significant overall association between baseline scores and patient-reported treatment response was found. Patients reported success rates for deviant RSI and RFS baseline scores were 76.6% and 96%, respectively. 95.5% of patients with both deviant RSI and RFS baseline scores, reported (partial) treatment response.ConclusionBoth together, as well individually, pre-treatment RSI and RFS ratings can help predict treatment response of empirical PPI treatment in patients experiencing globus pharyngeus symptoms.     

Narrow band imaging might contribute to the diagnosis of laryngopharyngeal reflux

PurposeLaryngopharyngeal reflux (LPR) accounts for 4–10% of outpatient visits. The standard domestic LPR diagnostic tools are the reflux finding score (RFS) and reflux symptom index (RSI). Narrow band imaging (NBI) can identify previously unknown characteristic microvessel features. Our aim was to explore the role of NBI in LPR diagnosis.Materials and methodsWe recruited 56 LPR outpatients and 41 symptom-negative controls. All individuals received RSI and RFS scores and underwent 24-hour multichannel intraluminal impedance-PH (MII-pH) monitoring and endoscopic NBI before and after treatment. The positivity rates in the study and control groups, before and after treatment, and using NBI and the conventional method were evaluated.ResultsFifty-one LPR and six control patients had sparse light brownish dots or tufted light brownish dots in the postcricoid region. The RSI and RFS positivity rates were 31.3% and 87.1%, respectively. NBI is as effective as the RFS (P < 0.05), and has poor consistency with the RSI (P < 0.05). Fifty-three LPR patients underwent posttreatment laryngoscopy. The positivity rate decreased to 17.0% (P < 0.05).ConclusionNBI has good value for LPR diagnosis.     

Characteristics of laryngopharyngeal reflux in patients with chronic otitis media

Objective

To summarize the characteristics of laryngopharyngeal reflux (LPR) in patients with chronic otitis media.

The prognostic value of preoperative derived neutrophil-to-lymphocyte ratio in patients undergoing total laryngectomy with laryngeal carcinoma

Background: Emerging evidence indicate that inflammation plays a crucial role in carcinogenesis and tumor progression. Inflammatory response biomarkers are recognized as promising prognostic factors in laryngeal squamous cell carcinoma (LSCC).

Objective: To evaluate the prognostic significance of preoperative derived neutrophil-to-lymphocyte ratio (dNLR) in patients with total laryngectomy.

Methods: This was a retrospective analysis of 137 patients with LSCC who received total laryngectomy from January 2009 to December 2015. The preoperative neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and dNLR were calculated. Receiver-operating characteristic (ROC) curve was used to determine the cut-off values of these parameters. Univariate analysis and multivariate Cox regression model were used to evaluate the association between these parameters and recurrence-free survival (RFS) and overall survival (OS).

Results: The optimal critical value of dNLR was 1.85, by which cases were divided into high dNLR group (dNLR ≥ 1.85) and low dNLR group (dNLR?<?1.85). The elevated dNLR was significantly associated with decreased RFS (HR 2.72, 95% CI 1.56–4.75, p?=?.000) and remained significant in multivariate analysis (p?=?.034). However, we did not find any significant correlation between dNLR and OS.

Conclusions: An elevated preoperative dNLR may be an independent prognostic biomarker for RFS in patients undergoing total laryngectomy with LSCC.     

Laryngopharyngeal reflux finding scores correlate with gastroesophageal reflux disease and Helicobacter pylori expression

Conclusion. The expression of Helicobacter pylori (HP) positivity and degree of gastroesophageal reflux disease (GERD) correlate with laryngopharyngeal reflux (LPR). HP positivity and degree of GERD were more adverse in patients with a reflux finding score (RFS) of 7 or more. Objective. We aimed to investigate the relationship between RFS and inflammation of the lower part of the esophagus as well as RFS and HP infection. Patients and methods. Forty-five consecutive patients were analyzed prospectively. The degree of LPR was evaluated using the RFS method. The degree of GERD, lower esophageal mucosal inflammation, and antral HP positivity were evaluated using endoscopic surveys. Results. The mean RFS of the whole population was 11.5±4.4. The mean RFS of patients who had lower esophageal mucosal inflammation was 7±0.1, 8.1±1.3, 13.9±3.7, and 16.6±3.5, for grades A, B, C and D, respectively. The RFS of patients according to HP expression was as follows: 7.2±0.4, 9.3±3.07, 12.7±3.16, and 17.8±2.1, for normal (score 0), score I, score II, and score III, respectively.     

悬雍垂腭咽成形术对OSAHS患者咽喉反流的影响

目的探讨悬雍垂腭咽成形术(uvulopalatopharyngoplasty,UPPP)对阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea-hypopnea syndrome,OSAHS)患者咽喉反流(layrngopharyngeal relfux, LPR)的影响。方法对62例确诊为OSAHS的患者行UPPP手术,分别在术前、术后6个月时填写反流症状指数(reflux symptom index,RSI)和反流体征评分(reflux fineling score,RFS)量表,比较患者手术前后的症状及RSI、RFS评分结果。结果术后6个月时,患者睡眠打鼾、呼吸暂停和白天嗜睡等症状较术前均有明显改善。术前RSI>13分和/或RFS>7分的患者共24例(38.71%,24/62),术后6个月仅5例(8.06%,51/62)。术后6个月时,RSI和RFS量表总分较术前显著降低(P<0.01),除了吞咽困难和肉芽肿2个分项外,其余各分项评分差异均有统计学意义(P<0.05)。结论 UPPP手术可明显缓解OSAHS患者咽喉反流症状。     

The value of a liquid alginate suspension (Gaviscon Advance) in the management of laryngopharyngeal reflux

Laryngopharyngeal reflux (LPR) refers to the backflow of stomach contents into the laryngopharynx. Increasing evidence has demonstrated that LPR is a contributing factor in some cases of hoarseness, vocal fatigue, voice breaks, cough and globus and chronic throat clearing. However, several randomised placebo-controlled trials of proton pump inhibitors in the treatment of LPR have been reported with the majority showing no significant benefit in patient symptom scores over placebo. The aim of this pilot clinical study was to investigate whether any improvement in LPR-related symptoms, using the Reflux Symptom Index (RSI), and clinical findings, using the Reflux Finding Score (RFS), could be achieved with treatment with a liquid alginate suspension compared to control (no treatment). Patients presenting with the symptoms of LPR to the Otorhinolaryngology Outpatient Department at the Queen’s Medical Centre, Nottingham, UK were considered eligible if they had an RSI of greater than 10 and an RFS greater than 5 based on a fibreoptic examination of the larynx. A total of 49 patients were randomised into the open, parallel group study; 24 patients were randomised to receive 10 ml liquid alginate suspension (Gaviscon^® Advance) four times daily after meals and at bedtime, and 25 patients into the control group (no treatment). Patients were assessed pre-treatment and at 2, 4 and 6 months post treatment. Mean (SD) RSI and RFS pre-treatment scores were 23.9 (7.0) and 10.4 (3.6) for the treatment group and 24.6 (7.4) and 10.3 (3.3) for the control group, respectively. Significant differences between treatment and control were observed for RSI at the 2-month (11.2 (7.0) vs. 16.8 (6.4), P = 0.005) and 6-month (11.2 (8.1) vs. 18.3 (9.4), P = 0.008) assessments and for RFS at the 6-month (7.1 (2.8) vs. 9.5 (3.4), P = 0.005) assessment. Significant improvement in symptom scores and clinical findings were achieved with liquid alginate suspension (Gaviscon^® Advance) compared to control and further evaluation for the management of patients presenting with LPR is warranted.     

Motor and cognitive performances in pre-lingual cochlear implant adolescents,related with vestibular function and auditory input

Background: Information about the role of auditory input and motor control is limited.

Objectives: Assessment the relationship between auditory and vestibular information with specific motor and cognitive functions.

Methods: Posturography in 17 Pre-lingual Cochlear Implant Adolescents, (PCIA) age 14.06?±?3.05 in four sensory conditions was analyzed: (A) eyes open, cochlear implant (CI) on, (B) eyes open, CI off, (C) eyes closed standing on a foam over a platform (ECFP) with CI on, and (D) ECFP, CI off. Gait velocity (GV) was registered by inertial sensors using a 10-meter test. Vestibulo-ocular reflex (VOR) was evaluated with the video head impulse test (VHIT) and visual spatial skill (VS) assessed with the WISC-V test.

Results: SV had no significant difference between conditions A and B (p?=?.2461). Comparing C and D, SV values decreased when CI was turned on (p?=?.0036). A significant linear relationship between VOR and GV (p?=?.0064) generating the VOR gain loss lower gait. Relationship between VOR and VS scores was no significant (p?=?.685).

Conclusions and significance: Auditory information is a relevant cue when somatosensory and visual inputs are modified and range of vestibular function influence in a dynamic motor activity as gait, facts which must be considered in the neurodevelopment control.     

Speech perception scores in cochlear implant recipients: An analysis of ceiling effects in the CUNY sentence test (Quiet) in post-lingually deafened cochlear implant recipients

Objectives: To evaluate the clinical utility of the City University of New York sentence test in a cohort of post-lingually deafened cochlear implants recipients over time.

Methods: 117 post-lingually deafened, Australian English-speaking CI recipients aged between 23 and 98 years (M?=?66 years; SD?=?15.09) were recruited. CUNY sentence test scores in quiet were collated and analysed at two cut-offs, 95% and 100%, as ceiling scores.

Results: CUNY sentence scores ranged from 4% to 100% (M?=?86.75; SD?=?20.65), with 38.8% of participants scoring 95% and 16.5% of participants reaching the 100% scores. The percentage of participants reaching the 95% and 100% ceiling scores increased over time (6 and 12 months post-implantation).

The distribution of all post-operative CUNY test scores skewed to the right with 82% of test scores reaching above 90%.

Discussion: This study demonstrates that the CUNY test cannot be used as a valid tool to measure the speech perception skills of post-lingually deafened CI recipients over time. This may be overcome by using adaptive test protocols or linguistically, cognitively or contextually demanding test materials.

Conclusion: The high percentage of CI recipients achieving ceiling scores for the CUNY sentence test in quiet at 3 months post-implantation, questions the validity of using CUNY in CI assessment test battery and limits its application for use in longitudinal studies evaluating CI outcomes. Further studies are required to examine different methods to overcome this problem.     

Caracterización de la enfermedad por reflujo faringolaríngeo en pacientes de edad avanzada y ancianos

ObjectivesTo characterize laryngo-pharyngeal reflux (LPR) in patients over 60 years of age.MethodsRetrospective review of patients over 60 years of age with symptoms suspicious of LPR, seen from 2005 to 2014 at an ENT Department of an academic hospital. Eighty-five consecutive patients (54 females, 31 males) who had completed a dual-sensor 24-hour pH-metry were included (considered “gold-standard” in LPR diagnosis).Body mass index, and reflux information and interventions were revised. pH-metries were evaluated according to DeMeester & Johnson's criteria. Symptoms were assessed according to the Reflux Symptom Index (RSI) and classified as abnormal if score was ≥13. A naso-fibro-laryngoscopy enabled findings to be documented according to the Reflux Finding Score (RFS), and they were classified as abnormal if the score was ≥7.ResultsThe patients’ mean age was 67 years. A positive pH-metry was present in 70 patients (82.5%). Fifty patients (59%) had abnormal body mass index, and almost 90% of them had an abnormal pH-metry. Mean RSI score was 9.8, with abnormal results in 24 patients (28%). Only 20 patients (23%) with abnormal RSI had a positive pH-metry. Posterior commissure hypertrophy was the most common finding (90% of patients). Mean RFS score was 9.07, with abnormal results in 69 patients (81%). Sixty-one patients (70%) with abnormal RFS had a positive pH-metry. Only 18 patients (20%) had coincidental abnormal pH-metry, RSI, and RFS.ConclusionsIn ageing patients, abnormal body mass index is strongly associated with abnormal pH-metry. RSI is a weak indicator of LPR, whereas RFS has a moderate value.