RESUMEN
Globus pharyngeus is a common ENT condition. This paper reviews the current evidence on globus and gives a rational guide to the management of patients with globus. The aetiology of globus is still unclear though most ENT surgeons believe that reflux whether acidic or not plays a significant role. Though proton pump inhibitors are used extensively in practice, there is little evidence to support their efficacy. Most patients with globus can be discharged after simple office investigations. The role of pepsin-induced laryngeal injury is an exciting concept that needs further study. Given the benign nature of globus pharyngeus, in most cases, reassurance rather than treatment or extensive investigation with rigid oesophagoscopy or contrast swallows is all that is needed. We need more research into the aetiology of globus.
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Esófago de Barrett/diagnóstico , Esofagoscopía/métodos , Granuloma/diagnóstico , Enfermedades de la Laringe/diagnóstico , Reflujo Laringofaríngeo/diagnóstico , Esófago de Barrett/complicaciones , Granuloma/complicaciones , Humanos , Enfermedades de la Laringe/complicaciones , Reflujo Laringofaríngeo/complicaciones , Nariz , Pliegues Vocales/patologíaRESUMEN
Neurogenic tumours of the larynx, particularly schwannomas are rare. We report a case report of a schwannoma in a 30-year-old woman which was excised endoscopically. The aim of this paper is to highlight this rare condition and management options to the otolaryngological community.
RESUMEN
INTRODUCTION: Laryngopharyngeal reflux is perhaps the most extensively researched laryngology topic of the last decade. It has been suggested that some supraoesophageal symptoms, most notably asthma and laryngospasm, may be associated with night-time, or supine, reflux. The aim of this review was to assess the levels of evidence regarding a correlation between night-time reflux, snoring and apnoea. METHODS: A Medline search was performed using the terms 'reflux', 'night-time', 'larynx', 'gastroesophageal', 'laryngopharyngeal', 'sleep', 'apnoea', 'snoring' and 'ear nose throat'. The retrieved literature was reviewed, focusing on randomised and non-randomised, controlled, prospective trials. Papers on both paediatric and adult populations were included. Non-English language papers were excluded. RESULTS: We found no randomised, controlled trials or meta-analyses addressing the possible correlation between reflux and snoring and/or apnoea. CONCLUSIONS: The role of night-time reflux in paediatric and adult snoring and apnoea is well described in the literature, but is based on poor levels of evidence from uncontrolled studies and case reports.
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Reflujo Gastroesofágico/complicaciones , Síndromes de la Apnea del Sueño/complicaciones , Ronquido/complicaciones , HumanosRESUMEN
OBJECTIVES: The gold standard test for laryngopharyngeal reflux is 24-hour pH monitoring, which determines the reflux area index with a pH threshold of less than four (i.e. the reflux area index four). However, refluxed pepsin is able to cause laryngeal injury at pH levels above five. STUDY DESIGN: Prospective study. MATERIALS AND METHODS: In order to establish normative values for a reflux area index with a pH threshold of less than five (i.e. the reflux area index five), 29 healthy volunteers underwent pH monitoring. In 45 patients with suspected laryngopharyngeal reflux, reflux area index four and reflux area index five were determined by pH study. RESULTS: In healthy volunteers, the reflux area index five was 72.6 (95th percentile). In 29 of 44 patients, laryngopharyngeal reflux was diagnosed due to a reflux area index four of greater than 6.3. However, the reflux area index five revealed laryngopharyngeal reflux in six more patients. CONCLUSIONS: For exact analysis of pH monitoring results, two pH thresholds (less than four and less than five) must be considered. Further studies with a larger number of healthy volunteers are necessary in order to reveal normative values for the reflux area index five parameter.
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Monitorización del pH Esofágico , Reflujo Gastroesofágico/diagnóstico , Enfermedades de la Laringe/diagnóstico , Enfermedades Faríngeas/diagnóstico , Femenino , Determinación de la Acidez Gástrica , Humanos , Concentración de Iones de Hidrógeno , Laringe/fisiología , Masculino , Persona de Mediana Edad , Pepsina A/metabolismo , Estudios Prospectivos , Valores de ReferenciaRESUMEN
OBJECTIVES: Patients with laryngopharyngeal reflux uncommonly suffer from conditions associated with gastroesophageal reflux disease. However, in some laryngopharyngeal reflux patients, oesophagitis and Barrett's metaplasia can be diagnosed by oesophagogastroduodenoscopy. However, it is unclear which patients with laryngopharyngeal reflux would benefit from routine oesophagogastroduodenoscopy. STUDY DESIGN: Retrospective analysis. MATERIALS AND METHODS: Analysis of the results of oesophagogastroduodenoscopy in 28 patients with pH-documented laryngopharyngeal reflux. RESULTS: Oesophagogastroduodenoscopy showed oesophagitis in five patients (four with grade A, one with grade B), hiatus hernia in 10 patients (36 per cent), Barrett's metaplasia in two patients, Helicobacter pylori-associated chronic gastritis in two patients and gastric mucosal erosions in seven patients (25 per cent). In 13 patients, no abnormalities were detected (46 per cent). Barrett's metaplasia or grade B oesophagitis was diagnosed only in patients with heartburn as their main presenting symptom. CONCLUSIONS: Oesophagogastroduodenoscopy is indicated in at least those laryngopharyngeal reflux patients reporting heartburn as their main complaint.
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Endoscopía del Sistema Digestivo , Reflujo Gastroesofágico/complicaciones , Hipofaringe , Enfermedades Faríngeas/complicaciones , Esófago de Barrett/diagnóstico , Esófago de Barrett/etiología , Monitorización del pH Esofágico , Esofagitis Péptica/diagnóstico , Esofagitis Péptica/etiología , Femenino , Reflujo Gastroesofágico/diagnóstico , Pirosis/etiología , Infecciones por Helicobacter/complicaciones , Helicobacter pylori , Hernia Hiatal/complicaciones , Hernia Hiatal/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Selección de Paciente , Enfermedades Faríngeas/diagnóstico , Estudios RetrospectivosRESUMEN
There is a lot of scepticism surrounding laryngopharyngeal reflux (LPR). Symptoms such as globus pharyngeus, constant throat clearing, chronic cough, idiopathic hoarseness, catarrh and choking episodes may be reflux-related. The aim of this survey was to highlight current treatment trends in LPR. Questionnaires were emailed to 260 members of the British Academy of Otolaryngology-Head and Neck surgery (BAO-HNS). Survey recipients were asked about type, duration and dose of antireflux treatment and length of follow-up appointments, if any. Finally, they were asked about awareness of any reflux symptom and reflux sign questionnaires. Survey response rate was 60%. The vast majority of the otolaryngologists surveyed believe in laryngopharyngeal reflux (90%) and more than 50% prescribe proton pump inhibitors (PPIs). The preferred duration of treatment is 2 months (37%). Only a minority will prescribe PPIs for 6 months or more. Most otolaryngologists will give the standard GORD dose (70%) (once daily) and only a few (20%) will prescribe more aggressive and prolonged doses. The commonest symptoms for which proton pump inhibitors are prescribed are globus (73%), followed by choking episodes (66%) and chronic cough (62%). If LPR is suspected, most of the otolaryngologists will follow-up the patients (61%) and approximately one third (31%) will discharge them back to the general practitioners. Only eight-percent 8% will refer to gastroenterologists. The three commonest laryngoscopic signs that makes them suspect LPR are erythema of the arytenoids (86%) or the vocal cords (57%) and granulomas (42%). The majority of the otolaryngologists (94%) do not use popular questionnaires such as the RFS or RSI. Despite the controversy surrounding laryngopharyngeal reflux, our results suggest that the majority of the otolaryngologists surveyed believe in LPR and attempt to treat it. Interesting findings are: the duration of treatment, the doses used, the length of follow-ups or the lack of, and the fact that the majority does not request any specific diagnostic tests. "symptoms and signs" questionnaires are rarely used.
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Antiulcerosos/farmacología , Antiulcerosos/uso terapéutico , Reflujo Gastroesofágico/tratamiento farmacológico , Reflujo Gastroesofágico/patología , Laringe/patología , Otolaringología , Faringe/patología , Pautas de la Práctica en Medicina/estadística & datos numéricos , Pautas de la Práctica en Medicina/tendencias , Inhibidores de la Bomba de Protones , Encuestas y Cuestionarios , Cartílago Aritenoides , Concienciación , Eritema/epidemiología , Eritema/patología , Reflujo Gastroesofágico/epidemiología , Humanos , Otolaringología/métodos , Otolaringología/estadística & datos numéricos , Otolaringología/tendencias , Factores de Tiempo , Reino Unido/epidemiologíaRESUMEN
INTRODUCTION: The Wiskott-Aldrich-syndrome belongs to the phakomatoses. The hereditary transmission happens x-chromosomal recessive in the domain of Xp 11.3-Xp 11.22. Clinical evidence for that is given by thrombocytopenia, an eczema and a weakness of the immune system with a subsequent increased risk of frequent infections and a predisposition for a malignancies. A further characteristic of that disease is recurrent otitis media as described by Aldrich in 1954. PATIENT: The case--as described above--is about a 28-year-old male patient developing an acute deafness on the left ear while he has been suffering from a surditas on the right ear for 5 years. 8 years ago a splenectomy was made, because of persistent thrombocytopenia. An additional clinical characteristic was a hemiballism, arising after a thalamusbleeding 5 years ago, a both-sided vestibular failure concerning both that has been existing for 2 years, as well as a maculopathia with a highly reduced visus on both sides. CONCLUSIONS: The deafness arising in patients suffering from the Wiskott-Aldrich-syndrome represents a so far not described symptom of that illness.
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Sordera/etiología , Síndrome de Wiskott-Aldrich/complicaciones , Enfermedad Aguda , Adulto , Audiometría , Sordera/diagnóstico , Pérdida Auditiva Unilateral/diagnóstico , Humanos , Imagen por Resonancia Magnética , Masculino , Síndromes Neurocutáneos/diagnóstico , Factores de Tiempo , Síndrome de Wiskott-Aldrich/diagnósticoRESUMEN
OBJECTIVE: To assess the evidence surrounding the use of certain complementary supplements in otolaryngology. We specifically focussed on four commonly used supplements: spirulina, Ginkgo biloba, Vertigoheel and nutritional supplements (cod liver oil, multivitamins and pineapple enzyme). MATERIALS AND METHODS: A systematic review of the English and foreign language literature. INCLUSION CRITERIA: in vivo human studies. EXCLUSION CRITERIA: animal trials, in vitro studies and case reports. We also excluded other forms of 'alternative medicine' such as reflexology, acupuncture and other homeopathic remedies. RESULTS: Lack of common outcome measures prevented a formal meta-analysis. Three studies on the effects of spirulina in allergy, rhinitis and immunomodulation were found. One was a double-blind, placebo, randomised, controlled trial (RCT) of patients with allergic rhinitis, demonstrating positive effects in patients fed spirulina for 12 weeks. The other two studies, although non-randomised, also reported a positive role for spirulina in mucosal immunity. Regarding the use of Ginkgo biloba in tinnitus, a Cochrane review published in 2004 showed no evidence for this. The one double-blind, placebo-controlled trial that followed confirmed this finding. Regarding the use of Vertigoheel in vertigo, two double-blind RCTs and a meta-analysis were identified. The first RCT suggested that Vertigoheel was equally effective in reducing the severity, duration and frequency of vertigo compared with betahistine. The second RCT suggested that Vertigoheel was a suitable alternative to G. biloba in the treatment of atherosclerosis-related vertigo. A meta-analysis of only four clinical trials confirms that Vertigoheel was equally effective compared with betahistine, G. biloba and dimenhydrinate. Regarding multivitamins and sinusitis, two small paediatric pilot studies reported a positive response for chronic sinusitis and otitis media following a course of multivitamins and cod liver oil. Regarding bromelain (pineapple enzyme) and sinusitis, one randomised, multicentre trial including 116 children compared bromelain monotherapy to bromelain with standard therapy and standard therapy alone, for the treatment of acute sinusitis. The bromelain monotherapy group showed a faster recovery compared with the other groups. CONCLUSION: The positive effects of spirulina in allergic rhinitis and of Vertigoheel in vertigo are based on good levels of evidence, but larger trials are required. There is overwhelming evidence that G. biloba may play no role in tinnitus. There is limited evidence for the use of multivitamins in sinus symptoms, and larger randomised trials are required.
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Terapias Complementarias/métodos , Enfermedades Otorrinolaringológicas/tratamiento farmacológico , Fitoterapia , Bromelaínas/uso terapéutico , Niño , Aceite de Hígado de Bacalao/uso terapéutico , Suplementos Dietéticos , Combinación de Medicamentos , Ginkgo biloba , Humanos , Hipersensibilidad/tratamiento farmacológico , Minerales/uso terapéutico , Picrotoxina/uso terapéutico , Extractos Vegetales/uso terapéutico , Preparaciones de Plantas , Rinitis/tratamiento farmacológico , Sinusitis/tratamiento farmacológico , Spirulina , Acúfeno/tratamiento farmacológico , Vértigo/tratamiento farmacológico , Vitaminas/uso terapéuticoRESUMEN
OBJECTIVE: Patients with acid reflux can occasionally present with atypical symptoms such as globus pharyngeus, constant throat clearing, chronic cough, hoarseness, catarrh, choking episodes or asthma-like symptoms. The aim of this survey was to determine whether general practitioners are aware of the atypical manifestations of reflux and the differences in treatment between laryngopharyngeal reflux and gastroesophageal reflux. DESIGN: Questionnaire Survey. SETTING: Primary Care RESULTS: One hundred and sixty general practitioners who routinely refer patients to our Department of Otolaryngology were selected and a postal survey was conducted. One hundred and fifty of these responded (94% response rate). The commonest symptoms for which proton pump inhibitors are prescribed are heartburn (65%), followed by a combination of heartburn and other symptoms (15%), chronic cough (4%), choking episodes (4%), asthma-like symptoms (3%), hoarseness (2%), globus (2%), catarrh (1%), dysphagia (1.5%), frequent throat clearing (1.5%), halitosis and/or bitter taste (1%). CONCLUSIONS: Our results suggest that the majority of the general practitioners surveyed are unaware of the entity laryngopharyngeal reflux or reflux symptom index. More awareness is required in the primary care setting for early recognition of patients with suspected laryngopharyngeal reflux.
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Competencia Clínica , Reflujo Gastroesofágico/diagnóstico , Reflujo Gastroesofágico/terapia , Hipofaringe , Médicos de Familia , Antiulcerosos/administración & dosificación , Reflujo Gastroesofágico/complicaciones , Encuestas de Atención de la Salud , Humanos , Estilo de Vida , Inhibidores de la Bomba de Protones , Reino UnidoRESUMEN
OBJECTIVES: The pathogenesis of middle ear infections in children is multifactorial and includes infection, anatomical factors, impaired immunologic status, allergy, familial predisposition, male sex, method of feeding and environmental factors. Glue ear remains the commonest cause of deafness in childhood. Gastroesophageal reflux (GOR) is a common problem in the newborn and preschool periods. Recent research suggests that it may be related to eustachian tube dysfunction and otitis media. METHODS: We review the literature and discuss the possible relationship between Gastroesophageal reflux and otitis media in children. CONCLUSIONS: The current data are not enough to support antireflux treatment in children with refractory middle ear infections. More prospective randomised placebo-controlled studies are needed.
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Reflujo Gastroesofágico/complicaciones , Otitis Media/etiología , Animales , Niño , Ensayos Clínicos como Asunto , Modelos Animales de Enfermedad , HumanosRESUMEN
BACKGROUND: Patients with gastroesophageal reflux disease may suffer from a variety of symptoms from the upper aerodigestive tract. The objective of this study was to determine the impact of dual-probe 24-hr pH monitoring in the diagnosis of reflux-related otolaryngological disorders. METHODS: Twenty-two patients with symptoms such as chronic cough, globus pharyngeus, heartburn, dysphonia and burning sensation of the tongue underwent a complete ear, nose and throat examination, 24-hr dual-probe pH monitoring, and oesophago-gastro-duodenoscopy. RESULTS: pH monitoring revealed gastroesophageal (distal) reflux in all patients and pharyngeal (proximal) reflux in 21 patients. Treatment consisted of a proton pump inhibitor (esomeprazole). Within 4 weeks 68 per cent of patients had no laryngopharyngeal symptoms; within 8 weeks 95 per cent of patients were symptom-free. CONCLUSIONS: Patients with atypical reflux symptoms such as hoarseness, globus sensation or throat-clearing responded well to anti-reflux treatment.
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Reflujo Gastroesofágico/diagnóstico , Enfermedades de la Laringe/diagnóstico , Monitoreo Ambulatorio/métodos , Adulto , Anciano , Antiulcerosos/uso terapéutico , Tos/etiología , Endoscopía Gastrointestinal , Esomeprazol/uso terapéutico , Femenino , Reflujo Gastroesofágico/complicaciones , Reflujo Gastroesofágico/tratamiento farmacológico , Ronquera/etiología , Humanos , Concentración de Iones de Hidrógeno , Enfermedades de la Laringe/etiología , Masculino , Persona de Mediana EdadAsunto(s)
Reflujo Gastroesofágico/complicaciones , Enfermedades Bronquiales/etiología , Dolor en el Pecho/etiología , Neoplasias del Sistema Digestivo/etiología , Reflujo Gastroesofágico/diagnóstico , Reflujo Gastroesofágico/terapia , Humanos , Laringitis/etiología , Laringoestenosis/etiología , Enfermedades Faríngeas/etiología , Neoplasias del Sistema Respiratorio/etiología , Enfermedades Dentales/etiologíaRESUMEN
BACKGROUND: Carcinoma of unknown primary is defined as histological diagnosis of metastasis without diagnosis of a primary tumor. The incidence of CUP is stated in the literature between 3 % and 15 % of all patients with an malignant disease. Histological examination of CUP-metastasis of the neck most frequently shows a squamous cell carcinoma. A retrospective study of patient data was undertaken. PATIENTS AND METHODS: The study included 167 patients admitted and treated for cervical CUP at the department of Oto-Rhino-Laryngology, Klinikum Grosshadern from 1979 to 1998. Cervical swelling was the first noted symptom in all cases. Other symptoms were pain and dysphagia. Of the 167 patients 134 were men and 33 were women. The average age at admission was 55 years. In the studied collective squamous cell carcinoma had the highest incidence (n = 123). During the 10 year follow-up a primary tumor was found in 36 of the 167 initially diagnosed CUP-patients. In over 90 % of these cases the tumor was localized in the head and neck region. The origin of the tumor was most frequently the tonsilla palatina (n = 7). Of the 167 patients included in the study 118 patients (70,7 %) underwent surgery and additional postoperative radiotherapy. Primary radiotherapy was the treatment of choice in 28 patients, 8 patients received combined radio-chemotherapy as primary treatment and 7 patients were treated with chemotherapy alone. No treatment was performed in 6 patients. RESULTS: By comparing the treatment methods there was a significant difference of patient survival in regard to the treatment. Patients treated according to treatment-plan II, which includes an additional "diagnostic" tonsillectomy, is significantly higher than that of patients simply undergoing neck dissection and postoperative radiotherapy or primary radiotherapy alone. Treatment of choice in patients with cervical CUP should be a surgical procedure including radical neck dissection and diagnostic bilateral tonsillectomy followed by postoperative radiation of the cervical lymph drainage. DISCUSSION: Bilateral tonsillectomy is especially important and is correlated with a significant improvement of the survival rate in CUP patients. Additional postoperative radiation of the pharynx from the base of the skull to the upper oesophagus should also be considered, in order to treat a possible--small--primary tumor in this region.
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Carcinoma de Células Escamosas/secundario , Neoplasias de Cabeza y Cuello/secundario , Neoplasias Primarias Desconocidas , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/tratamiento farmacológico , Carcinoma de Células Escamosas/mortalidad , Carcinoma de Células Escamosas/radioterapia , Carcinoma de Células Escamosas/cirugía , Terapia Combinada , Interpretación Estadística de Datos , Femenino , Estudios de Seguimiento , Neoplasias de Cabeza y Cuello/diagnóstico , Neoplasias de Cabeza y Cuello/tratamiento farmacológico , Neoplasias de Cabeza y Cuello/mortalidad , Neoplasias de Cabeza y Cuello/radioterapia , Neoplasias de Cabeza y Cuello/cirugía , Humanos , Metástasis Linfática , Masculino , Persona de Mediana Edad , Disección del Cuello , Estudios Retrospectivos , Análisis de Supervivencia , Factores de Tiempo , Neoplasias Tonsilares/cirugía , TonsilectomíaRESUMEN
BACKGROUND: Patients with gastroesophageal reflux disease (GERD) may suffer from a large variety of symptoms in the upper aerodigestive tract such as globus sensation, chronic cough, hoarseness and many others. Diagnosis and causal therapy may sometimes be difficult with gastroenterologic evaluation sometimes revealing no pathologic result. The objective of this study was to determine the impact of 24-hour intraesophageal pH monitoring with 2 channels (gastric and laryngeal) in the diagnosis of reflux-induced otolaryngologic disorders. METHODS: This study included 22 patients presenting to the Department of Otolaryngology with symptoms like chronic cough (n = 3), globus sensation and dysphagia (n = 11), heartburn (n = 2), hoarseness and dysphonia (n = 2) or burning sensation of the tongue (n = 1). Three patients had a pathologic formation in the glottic area (leukoplakia, granuloma, polyp). All patients underwent a otolaryngological examination, a gastroenterological investigation and a 24-hour intraesophageal pH monitoring with 2 channels. RESULTS: All 22 patients showed laryngeal mucosal lesions (posterior laryngitis). The gastroenterological evaluation with esophagogastroduodenoscopy was normal in 4 cases. 13 patients showed a hiatal hernia, 4 patients were suffering from a reflux-esophagitis grade I and 2 patients from grade II. One patient had an erythema and 5 patients showed erosions of the gastric mucosa. Seven patients had more than one of the above mentioned diagnoses. Intraesophageal pH-monitoring with 2 channels over 24 hours revealed a gastroesophageal reflux of all 22 patients and a high reflux to the laryngeal level of 21 patients, probably causing laryngopharyngeal symptoms. Therapy of the patients consisted of medical antireflux treatment with proton pump inhibitor esomeprazol (Nexium, 40 mg, 1-0-0). Within 4 weeks 15 of 22 patients had no more laryngopharyngeal symptoms or at least a significant reduction. CONCLUSION: Patients with laryngopharyngeal symptoms such as hoarseness, globus sensation or dysphagia can suffer from GERD, even if typical symptoms such as heartburn or retrosternal pain do not exist and gastroesophageal intervention reveals a normal result. The best diagnostic instrument for the diagnosis of reflux-induced otolaryngologic disorders is a 24-hour intraesophageal pH-monitoring with 2 channels (measure-points at the distal esophagus and laryngeal level). Medical antireflux treatment should consist of proton pump inhibitors (e. g. Nexium) in a dose of 40 mg per day over at least 4 weeks.
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Determinación de la Acidez Gástrica/instrumentación , Reflujo Gastroesofágico/complicaciones , Monitoreo Ambulatorio/instrumentación , Enfermedades Otorrinolaringológicas/diagnóstico , Procesamiento de Señales Asistido por Computador/instrumentación , Adulto , Anciano , Antiulcerosos/uso terapéutico , Esomeprazol/uso terapéutico , Esofagitis Péptica/diagnóstico , Esofagitis Péptica/tratamiento farmacológico , Femenino , Reflujo Gastroesofágico/diagnóstico , Reflujo Gastroesofágico/tratamiento farmacológico , Humanos , Masculino , Persona de Mediana Edad , Enfermedades Otorrinolaringológicas/tratamiento farmacológico , Inhibidores de la Bomba de Protones , Reproducibilidad de los Resultados , Resultado del TratamientoRESUMEN
For a long time heartburn was not considered a symptom for serious illness. By now, however, it is accepted that the incidence of secondary carcinoma of the esophagus caused by chronic GERD has increased dramatically since the nineteen-seventies. Mechanisms leading to GERD are complex and its incidence is not necessarily pathological. However pathological reflux in the lower esophagus (pH lower than 4 in 6 % of 24 hours), caused by decreased sphinctertonus, impaired peristalsis and clearance of the esophagus, may lead to complications. Helicobacter pylori may play a key role in GERD. There is strong evidence for a protective effect of Hp-infection in the development of GERD. In pangastritis, caused by Hp-infection, gastric acid production is inhibited resulting in a reduction of stomach-acid-concentration. This may be caused by either the chronic infection itself and the resulting atrophy of the stomach-mucosa, by the ammonia-producing HP-bacteria, or an increase in acid re-absorbtion of gastric epithelium. Laryngopharyngeal reflux (LPR) often results in atypical manifestations with oral, pharyngeal, laryngeal, and pulmonary disorders. Laryngopharyngeal reflux is known to contribute to posterior acid laryngitis and laryngeal contact ulceration or granuloma formation, laryngeal cancer, chronic hoarseness, pharyngitis, asthma, pneumonia, nocturnal choking, and dental diseases. Today, PPI are the medication of choice in both acute and long-term (prophylactic) therapy of GERD. The so called "step-up-strategy" of medication is no longer recommended. Here, patients were first treated with antacids, then prokinetics followed by H2-blockers and finally low-dose PPI. Only in the case of persisting symptoms medication was further increased to high-dose PPI therapy. In the past this increase in medication lead to a prolonged healing process and consequently to higher medication costs. Studies have shown that a "step-down"-therapy, beginning with high dose PPI, is highly preferable, since it is much more effective. Depending on the degree of the symptoms, however, medication may also be applied "on-demand". The BfArM has approved this kind of medication application only for Esomeprazol (Nexium mups 20 mg).
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Esofagitis Péptica/epidemiología , Reflujo Gastroesofágico/epidemiología , Infecciones por Helicobacter/epidemiología , Helicobacter pylori , Antiulcerosos/administración & dosificación , Estudios Transversales , Esofagitis Péptica/tratamiento farmacológico , Esofagitis Péptica/etiología , Reflujo Gastroesofágico/tratamiento farmacológico , Reflujo Gastroesofágico/etiología , Infecciones por Helicobacter/tratamiento farmacológico , Infecciones por Helicobacter/etiología , Humanos , Incidencia , Laringitis/tratamiento farmacológico , Laringitis/epidemiología , Laringitis/etiología , Inhibidores de la Bomba de ProtonesRESUMEN
INTRODUCTION: The interstitial deletion of chromosome 5q is a disease of rare incidence, which might be hereditary or caused by spontaneous changes within the chromosome respectively. The pathology is based on the loss of chromosomal material within the long arm of chromosome 5. Clinical manifestations are mainly known in hematology, particular such as malignancies or hematopoetic malformation. Other morphological characteristics that have been described following deletion of chromosome 5q are deformity of the skull and the joints as well as heart defects. In the following we will present some pathologic findings focussing on the head and neck. PATIENT: We introduce a young female patient of 8 months with deletion of the long arm of chromosome 5q. In addition to the known skeletal and hematopoetic disorders we discovered a unilateral deafness and a contralateral middle-graded combined hearing-loss as well as laryngomalacia. CONCLUSION: Infants with chromosome 5 syndrome should undergo an otorhinolaryngological examination to investigate anatomic malformations. In particular a brainstem electric response audiometry should be considered for early diagnosis and treatment of a possible hearing-loss. This ensures adequate and early support of the patients physical and psychological development.
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Deleción Cromosómica , Cromosomas Humanos Par 5 , Sordera/congénito , Sordera/genética , Cóclea/diagnóstico por imagen , Sordera/diagnóstico , Potenciales Evocados Auditivos del Tronco Encefálico , Femenino , Humanos , Lactante , Enfermedades de la Laringe/congénito , Emisiones Otoacústicas Espontáneas , Síndrome , Tomografía Computarizada por Rayos XRESUMEN
Gastroesophageal reflux is now a generally accepted risk factor for the development of adenocarcinoma of the esophagus. Less well known is the relationship of reflux disease (GERD) and respiratory disorders. Among the extra-esophageal manifestations of reflux disease is reflux laryngitis, which affects up to 78 patients with chronic hoarseness, Reinke's edema, laryngeal stricture, postnasal drip, asthma and non-cardiac chest pain. Despite popular opinion, changes in lifestyle (for example, cessation of smoking and drinking, avoidance of fatty foods) do not result in an improvement in symptoms. The treatment of choice for GERD is the use of proton pump inhibitors (PPI) in the form of stepdown therapy; in individual cases as symptom-orientated on-demand therapy.
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Neoplasias Esofágicas/etiología , Determinación de la Acidez Gástrica , Reflujo Gastroesofágico/complicaciones , Enfermedades de la Laringe/etiología , Enfermedades Respiratorias/etiología , Erosión de los Dientes/etiología , Humanos , Factores de RiesgoRESUMEN
BACKGROUND: The intratympanic application of ototoxic antibiotics and saccotomia have been well documented in severe cases of one-sided Menière's disease for 30 years now. Both treatment methods are still subject to controversial discussion. PATIENTS AND MATERIAL: This study includes 8 patients suffering from persistent one-sided Menière's disease after treatment with gentamicin application and additional saccotomia (n=2). We performed follow-up visits including the assessment of hearing ability, vestibular function and cranial MRI, 2-10 years after onset of treatment. RESULTS: After therapeutic interventions 7 patients reported to be healed of their symptom vertigo. In 4 patients the gentamicin-treated vestibular organ did not respond to thermic stimulus at the time of follow-up examination. Auditory threshold shift was observed in 3 patients (1 permanent, 2 temporary), whereas hearing threshold improved in 2 patients. Tinnitus was attenuated in 3 patients, while 1 patient suffered from posttherapeutic onset of tinnitus. Morphological and structural changes due to Menière's disease and treatment procedures were ruled out by cranial MRI. CONCLUSION: The intratympanic application of ototoxic medication is a safe and effective treatment method in severe cases of Menière's disease. Saccotomia should be considered as therapeutic regimen for persistent symptoms after repeated application of gentamicin.
Asunto(s)
Gentamicinas/administración & dosificación , Enfermedad de Meniere/terapia , Sáculo y Utrículo/cirugía , Anciano , Umbral Auditivo/efectos de los fármacos , Oído Medio/efectos de los fármacos , Femenino , Estudios de Seguimiento , Gentamicinas/efectos adversos , Humanos , Imagen por Resonancia Magnética , Masculino , Enfermedad de Meniere/etiología , Persona de Mediana Edad , Aceptación de la Atención de Salud , Calidad de Vida , Acúfeno/tratamiento farmacológico , Acúfeno/etiología , Pruebas de Función VestibularRESUMEN
BACKGROUND: Retinoic acid and its natural and synthetic analogs (retinoids) affect a wide array of biological processes. Retinoids are used in the treatment of many skin diseases and are promising drugs for several cancers. Most of their actions are thought to result from changes in gene expression which is done through nuclear retinoic acid receptors and retinoid X receptors. We conducted a study to determine whether the expression of these receptors is different in malignant tumors and tumor cell lines versus normal tissue. METHODS: We performed reverse transcription PCR from 29 tissue specimens of squamous cell carcinomas and one melanoma and of the head and neck as well as from 13 cell lines established from head and neck cancer. We were looking for the expression pattern of RARalpha, beta, gamma and RXRalpha. RESULTS: Only RARgamma was expressed 100 % in cell lines and tissue specimens. RARbeta showed a 100 % expression only in tissue specimens whereas a 54 % expression in cell lines was seen. All other receptors were diminished in their expression. In the positive controls all receptors were expressed 100 %. CONCLUSION: The expression of RARalpha and RARbeta was partially lost in cell lines established from squamous cell carcinoma of the head and neck. The 100 % expression of RARbeta in tissue samples versus 54 % in cell lines can be explained by clonal growth of malignant cells in cell lines and also possible "contamination" by normal cells in the tissue specimen. In concordance with the literature it seems that RARalpha and beta play a pivotal role in mediating the response to retinoids.