1,721,294 research outputs found
Pharmacological and Biological Relevance in the Medical Treatment of Laryngopharyngeal Reflux: A State-of-the-Art Review.
Full text linkpeer reviewedThe laryngopharyngeal reflux disease (LPRD) treatment remains controversial due to the poor effectiveness of proton pump inhibitors (PPIs). In this paper, the author reviewed the current primary treatments used in clinical studies for managing LPRD and discussed the pharmacological, biological, and physiological properties of medication for providing clinical relevance for otolaryngological practice. A comprehensive review of the PubMed, Cochrane Library, and Scopus literature was conducted to document and analyze the medical treatments of LPRD in the largest case series published in the past 20 years. Fifty-five studies met the inclusion criteria, revealing that 67 different therapeutic regimens were used in the LPRD studies in the past 20 years with nine different therapeutic durations. PPIs have been used as a single therapy in 70.1% of cases. PPIs were combined with another drug in 23.9% of cases. Alginates and antacids were used as single therapy or in association with other drugs in 10.5% and 3.0% of cases, respectively. There was an important variability of molecules, doses, and regimens. There is an important gap between current therapeutic practice and the recent advancements in the pathophysiology of LPRD. The pharmacological and physiological findings of this review can reasonably support the notion that alternative gastroesophageal reflux disease therapies (alginate, antacids) could take a significant place in the treatment of primary or recalcitrant LPRD. Future studies are needed to confirm the stability of the LPRD profile at the hypopharyngeal-esophageal multichannel intraluminal impedance-pH and the role of digestive enzymes in the development of upper aerodigestive tract mucosa inflammation and symptoms
Generative artificial intelligence in otolaryngology-head and neck surgery editorial: be an actor of the future or follower.
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Generative AI and Otolaryngology-Head & Neck Surgery.
Full text linkpeer reviewedThe increasing development of artificial intelligence (AI) generative models in otolaryngology-head and neck surgery will progressively change our practice. Practitioners and patients have access to AI resources, improving information, knowledge, and practice of patient care. This article summarizes the currently investigated applications of AI generative models, particularly Chatbot Generative Pre-trained Transformer, in otolaryngology-head and neck surgery
Is Height a Contributing Factor of Laryngopharyngeal Reflux Disease? A Case-Series of 463 Patients.
Full text linkpeer reviewed[en] OBJECTIVE: To investigate the influence of height on pharyngeal reflux characteristics, clinical presentation, and therapeutic outcomes in patients with laryngopharyngeal reflux disease (LPRD).
METHODS: Data of patients with a positive diagnosis of LPRD at the 24-hour hypopharyngeal-esophageal multi-channel intraluminal impedance-pH monitoring (HEMII-pH) were collected from the European Reflux Clinic and Elsan Hospital from January 2017 to October 2024. Analysis included HEMII-pH parameters (number and pH of pharyngeal reflux events), pretreatment and post treatment reflux symptom scores (RSS), reflux sign assessment (RSA), and gastrointestinal endoscopy findings stratified by patient height.
RESULTS: The study included 463 patients (257 females (55.5%) and 206 males (44.5%). The mean ages of females and males were 51.7 ± 15.4 and 50.4 ± 16.1, respectively. Females demonstrated higher frequency of weakly acidic pharyngeal reflux events and RSS compared to males. Height did not influence HEMII-pH parameters or endoscopic findings in either sex. However, shortest females reported higher baseline digestive symptoms and demonstrated higher 3-month post treatment RSA scores. In males, therapeutic response varied by height, with significant RSS improvements observed in groups <171 cm and 171-180 cm, while the tallest group showed no significant improvement.
CONCLUSION: Height does not influence objective HEMII-pH findings. RSS did not differ across height-stratified cohorts, either at baseline or 3 months post treatment. Future studies should investigate the role of physiological, anatomical, and behavioral factors in height-related therapeutic variations
Beyond the Inability to Burp: A Comprehensive Pathophysiological Theory of Retrograde Cricopharyngeal Dysfunction.
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Sensitivity, Specificity, and Predictive Values of Laryngopharyngeal Reflux Symptoms and Signs in Clinical Practice.
Full text linkpeer reviewed[en] 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
Effectiveness of Diet and Lifestyle Changes for the Treatment of Laryngopharyngeal Reflux Disease: A Prospective Study.
Full text linkpeer reviewed[en] OBJECTIVE: To investigate the effectiveness of diet and lifestyle changes as a single treatment for laryngopharyngeal reflux disease (LPRD).
METHODS: Forty-eight patients with LPRD confirmed by 24-hour hypopharyngeal-esophageal multichannel intraluminal impedance-pH monitoring (HEMII-pH) were prospectively recruited from two European hospitals between January 2022 and January 2025. Patients were treated with a standardized anti-reflux diet for 3 months. Reflux symptom score (RSS) and reflux sign assessment (RSA) were used to evaluate prediet to postdiet changes in symptoms and findings.
RESULTS: Forty-four patients completed the 3-month diet and lifestyle recommendations (mean age 50.2 ± 16.5; 63.6% female). There were 14 (52.3%) mild, 8 (18.2%) moderate, and 13 (29.5%) severe LPRD according to IFOS classification. Most pharyngeal reflux events were non-acid. After dietary and lifestyle modifications, significant improvements occurred in otolaryngological, digestive, and respiratory symptom (items and RSS) scores. Symptom relief occurred in 88.6% of cases, with complete symptom resolution in 40.9% of patients. Laryngeal signs and RSA scores significantly decreased. Nine patients (20.5%) required additional medication despite adherence to recommendations. No baseline predictors of response were identified.
CONCLUSION: A low-fat, high-protein, and low-high-release sugar diet combined with lifestyle changes may be an effective single treatment for LPRD. Future controlled studies are needed to compare diet versus medication in LPRD populations, with consideration of mid- to long-term effects of diet on general health
Detection and Patterns of Pharyngeal Reflux Events With Two Ambulatory Pharyngeal Impedance-pH Monitoring Systems: A Comparative Study.
Full text linkpeer reviewed[en] OBJECTIVE: To investigate the detection and patterns of pharyngeal reflux events in laryngopharyngeal reflux disease (LPRD) patients according to the type of ambulatory hypopharyngeal-esophageal multichannel intraluminal impedance-pH monitoring (HEMII-pH) system used and assessed whether potential HEMII-pH differences impact the pretreatment to post treatment findings.
METHODS: Patients with laryngopharyngeal symptoms and findings and an objective LPRD diagnosis were prospectively recruited from the European Reflux Clinic from January 2017 to December 2024. The objective diagnosis was supported by two different HEMII-pH systems (Medtronic and Sandhill). The profiles of LPRD on the objective testing devices (acid, weakly acid, and alkaline LPRD) of patients from the same clinic were prospectively compared. Reflux symptom scores (RSS) and reflux sign assessment (RSA) were used to document prepersonalized to postpersonalized treatment symptoms and findings. A study of the correlation between HEMII-pH features, symptoms, and signs was conducted.
RESULTS: The study included gender- and age-matched 101 patients with a Sandhill HEMII-pH and 102 patients with a Medtronic HEMII-pH. Both systems detected distal esophageal reflux events similarly, but Medtronic detected significantly more pharyngeal reflux events. The Sandhill group showed higher proportions of acid and weakly acid LPRD, while Medtronic patients predominantly had alkaline reflux. Patients of both groups demonstrated significant RSS reduction after treatment (P = 0.001), with a trend toward higher response rates in the Sandhill group (P = 0.067). Symptom scores were better correlated to the Sandhill pharyngeal reflux event features than the Medtronic one.
CONCLUSION: The patterns of LPRD can substantially vary according to the type and catheter configuration of ambulatory HEMII-pH systems used. The differences between HEMII-pH devices support the need for revising consensus statements defining the thresholds of pharyngeal reflux events for confirming the LPRD diagnosis
Editorial letter: Artificial Intelligence can be used to improve the humanity of care.
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