Posterior laryngitis: a study of persisting symptoms and health-related quality of life.

Posterior laryngitis is a common cause of chronic cough, hoarseness, voice fatigue and throat pain. The aim of the present study was to examine how patients with posterior laryngitis have been examined, treated and followed up, and to assess their present health-related quality of life (HRQOL). Patients treated for posterior laryngitis at consultation at the ear-, nose- and throat clinic during 2000-2008 were contacted by mail. The letter contained questionnaires addressing the current symptoms and medication, and the HRQOL 36-item short-form questionnaire (SF-36). Medical records were scrutinized. One hundred and twenty-two patients with verified signs and symptoms of posterior laryngitis were included. Forty percent of the patients had been treated for acid-related symptoms prior to consultation. The most common symptoms at the time of consultation were the sensation of hoarseness (women 40 %, men 37 %), globus (women 35 %, men 33 %) and cough (women 33 %, men 26 %). The most frequent diagnosis was gastro-oesophageal reflux disease. Ninety percent of the women and 92 % of the men were treated with proton pump inhibitors (PPIs). At the time of study, 63 % of the patients still had symptoms. The results of the SF-36 questionnaire showed significantly lower HRQOL for women. Patients with posterior laryngitis present varying symptoms, and are often not adequately treated or followed up. When PPI treatment fails, other aetiologies of their complaints, such as visceral hypersensitivity, weakly gaseous acid reflux or non-acid reflux are not considered. Symptoms from posterior laryngitis have a negative impact on the HRQOL for women

The selective COX-2 inhibitor etoricoxib reduces acute inflammatory markers in a model of neurogenic laryngitis but loses its efficacy with prolonged treatment

The selective COX-2 inhibitor Etoricoxib reduces acute inflammatory markers in a model of neurogenic laryngitis but loses its efficacy with prolonged treatment.OBJECTIVE: A randomised experimental study was used to evaluate the therapeutic effect of a selective cyclooxygenase-2 (COX-2) inhibitor in neurogenic laryngitis. MATERIALS AND METHODS: Male Wistar Han rats were subjected to the nasogastric intubation model (NGI) of laryngitis for 1 and 2 weeks. The NGI animals were divided into three groups: (1) treated with COX-2 inhibitor Etoricoxib, (2) vehicle and (3) non-intubated animals. A fourth group of animals was submitted to NGI only. Laryngeal sections were immunostained for substance P (SP) and calcitonin gene-related peptide (CGRP) fibre-immunoreactivity (IR) and quantification of COX-2 positive cells through stereological analysis. The expression of COX-2, interleukins IL-1beta, IL-6, IL-10 and tumour necrosis factor-alpha (TNF-alpha) was determined by quantitative real time QRT-PCR. TREATMENT: Etoricoxib (6 mg/kg/day) was prepared in 0.9% sterile saline with 5% glucose (vehicle) and administered daily during 1 or 2 weeks. RESULTS: Treatment for 1 week with Etoricoxib attenuated the CGRP-IR fibre depletion, the COX-2-IR increased cell number and the TNF-alpha and COX-2 mRNA increased levels induced by NGI. Two weeks of treatment had no beneficial effect. CONCLUSIONS: Etoricoxib is effective in neurogenic laryngitis for limited periods of administration, indicating that selective COX-2 inhibitors should be evaluated in the future.This study was supported by Fundacao Calouste Gulbenkian Project No 74551 and Fundacao Grunenthal (Portugal)

Subglottic laryngitis - changes in therapy approach over the past 20 years

OBJECTIVE: To show changes in the management of subglottic laryngitis over the last twenty years in Croatia. ----- METHODS: We sent questionnaires to paediatricians and otolaryngologists (ENT) in 9 Croatian hospitals in 1993, 2003 and 2013. In the questionnaire we presented a case of a child with moderately difficult subglottic laryngitis, after which they had to answer questions about the management of this kind of a patient and common therapy practice in their hospitals. All data were categorical, described in absolute frequencies and with relative percentages. The Cochran-Armitage test for trend was used in the analysis of different treatments over the years among ENT and paediatricians. Associations were statistically significant if p<0.05. ----- RESULTS: During a twenty-year period main novelties included the introduction of racemic epinephrine use (ENT from 3.3% in 1993 to 92.3% in 2013; paediatricians from 17.2% in 1993 to 100.0% in 2013) and downfall of humidification (ENT from 60.0% to 23.3%; paediatricians from 60.0% to 12.0%), antibiotic (ENT from 53.0% to 2.3%; paediatricians from 21.0% to 0.0%) and antihistaminic use (ENT from 67.7% to 0%; paediatricians from 43.2% to 2%), while corticosteroids (both parenteral and nebulized form) remained the cornerstone in treatment of moderately severe subglottic laryngitis. ----- CONCLUSION: Main novelties included the use of racemic epinephrine and downfall of antibiotic, antihistaminic and humidification therapy use, while corticosteroids remained the cornerstone in the treatment of moderately severe subglottic laryngitis. Differences between approaches among specialities are minimized during 20-year period

Risk Factors for Hyperfunctional Voice Disorders Among Teachers

The aim of the study was to assess the prevalence of voice problems among teachers, and identify risk factors for developing voice pathology. In this study we evaluated 448 teachers (400 females and 48 males) between the age range of 25 to 55 years, from primary school as well as secondary school which were selected randomly. A questionnaire was given to them to find out how many of them had a voice problem. All the positive cases were further evaluated by an Otorhinolaryngologist, an Audiologist and a Speech Language Pathologist. Out of the 448 teachers, 39 of them(9%) had an indication of voice disorder based on the positive respose got from the questionnaire. Among the 39 cases identified 11 were males (28%) and 28 were females (71%). We tried to investigate on the factors that would have contributed to voice problem in the identified 9% of cases .Detailed history was taken and was examined by an otorhinolaryngologist, an audiologist and a Speech Language Pathologist.Out of the 39 cases identified 26% had history of recurrent allergic rhinitis and laryngitis, 18% had sinusitis and post nasal drip, 18% had asthma, 26% had gastoesophageal reflux disorder, (8%) had minimal sensori neural hearing loss and hypothyroidism was found in 8%. Interaction of multiple factors like hereditory, behavioral, lifestyle, medical and environmental can contribute to voice disorders in occupational voice users. Teachers need to be educated regarding vocal mechanism, vocal hygiene and effective voice use , dust free and noise free work environment, diet modification like drinking adequate water, avoiding spicy and deep fried food, regularizing meals and avoiding sleeping immediately after food. The underlying medical issues like allergy, sinusitis, laryngitis, hypothyroidism, gastroesophageal reflux, hearing loss etc also need to be addressed , since vocal hygiene alone will not help until and unless the underlying cause is taken care of

Efficacy of combined nebulized aerosol inhalation and pulmicort respules in the treatment of emergency pediatric laryngitis, and its effect on adverse reactions

Purpose: To determine the efficacy of combined use of nebulized epinephrine inhalation and pulmicortrespules in the treatment of emergency pediatric laryngitis and, its impact on the incidence of adverse reactions.Methods: A total of 100 cases of pediatric laryngitis admitted in The People’s Hospital of Zhangqiu District between December 2018 and December 2020 were randomly assigned (1:1) to receive either pulmicort respules (control group) or pulmicort respules plus nebulized epinephrine inhalation treatment (study group).&nbsp; Outcome measures included level of effectiveness and adverse reactions.Results: Pulmicort respules plus nebulized epinephrine inhalation treatment was associated with shorter remission time for dyspnea, wheeze, croup, and hoarseness versus pulmicort respules. The combination treatment produced higher total effectiveness of 96 % than pulmicort respules with total effectiveness of 82 % (p &lt; 0.05). After treatment, both groups had decreased serum levels of interleukin-8 (IL-8), IL-6, C-reactive protein (CRP), and tumor necrosis factor (TNF)-α, with markedly lower levels in the group given nebulized epinephrine inhalation in combination with pulmicort respules (p &lt; 0.05). Compared with patients given pulmicort respules only, those given combination treatments had a significantly shorter hospitalization time and a lower incidence of adverse reactions (4 vs 8 %; p &lt; 0.05).Conclusion: Nebulized epinephrine inhalation in combination with pulmicort respules has high safety in the treatment of emergency pediatric laryngitis, and it significantly reduces clinical symptoms, inflammatory response, and hospital stay. However, further clinical trials are required prior to its use in clinical practice

Chronic cough and esomeprazole: A double-blind placebo-controlled parallel study

Background and objective: Gastro-oesophageal reflux has been implicated in the pathogenesis of chronic cough. Guidelines on management suggest a therapeutic trial of anti-reflux medication. Esomeprazole is a proton pump inhibitor licensed for the long-term treatment of acid reflux in adults and we compared the effects of esomeprazole and placebo on patients with chronic cough. Methods: This was a prospective, single-centre, randomized, double-blind, placebo-controlled, parallel group study conducted over 8 weeks. Fifty adult non-smokers with chronic cough and normal spirometry were randomized. Patients completed cough-related quality-of-life and symptom questionnaires and subjective scores of cough frequency and severity at the beginning and end of the study. They also kept a daily diary of symptom scores. Citric acid cough challenge and laryngoscopic examination were performed at baseline and the end of the study. The primary outcome was improvement in cough score. Results: There were no differences in cough scores in the placebo and treatment arms of the study although some significant improvements were noted when compared to baseline. In the cough diary scores there was a trend towards greater improvement in the treatment arm in patients with dyspepsia. Conclusions: Esomeprazole did not have a clinically important effect greater than placebo in patients with cough. It suggests a marked placebo effect in the treatment of cough. There is paucity of evidence on which to base the treatment of reflux-associated cough. We demonstrate that acid suppressive therapy does not lead to a significant clinical effect in these patients. There may be some improvement in those with coexisting dyspeptic symptoms and therapy should be restricted to this group. © 2011 Asian Pacific Society of Respirology

Perceived vocal morbidity in a problem asthma clinic

&lt;p&gt;Aims: Asthma treatment has the potential to affect patients' voices. We undertook detailed characterisation of voice morbidity in patients attending a problem asthma clinic, and we determined how patients' perceptions related to objective assessment by an experienced observer.&lt;/p&gt; &lt;p&gt;Methods: Forty-three patients took part in the study. Subjects completed the self-administered voice symptom score (VoiSS) questionnaire and underwent digital voice recording. These voice recordings were scored using the grade–roughness–breathiness–asthenicity–strain system (GRBAS). Laryngoscopy was also performed.&lt;/p&gt; &lt;p&gt;Results: The median VoiSS was 26 (range three to 83). VoiSS were significantly lower in the 17 patients with normal laryngeal structure and function (range four to 46; median 22), compared with the 26 patients with functional or structural laryngeal abnormality (range three to 83; median 33) (95 per cent confidence intervals for difference 0.0–21.0; p = 0.044). The overall grade score for the GRBAS scale did not differ between these two groups, and only 13 patients had a GRBAS score of one or more, recognised as indicating a voice problem. There were positive correlations between related GRBAS score and voice symptom score subscales. Although voice symptom scores were significantly more abnormal in patients with structural and functional abnormalities, this score performed only moderately well as a predictive tool (sensitivity 54 per cent; specificity 71 per cent). Nevertheless, the voice symptom score performed as well as the more labour-intensive GRBAS score (sensitivity 57 per cent; specificity 60 per cent). Patients' inhaled corticosteroid dose (median dose 1000 µg beclomethasone dipropionate or equivalent) had a statistically significant relationship with their overall grade score for the GRBAS scale (r = 0.56; p &#60; 0.001), but not with their VoiSS. Only one patient had evidence of laryngeal candidiasis, and only two had any evidence of abnormality suggesting steroid-induced myopathy.&lt;/p&gt; &lt;p&gt;Conclusions: Vocal morbidity is common in patients with asthma, and should not be immediately attributed to steroid-related candidiasis. The VoiSS merits further, prospective validation as a screening tool for ENT and/or speech and language therapy referral in patients with asthma.&lt;/p&gt

Состояние иммунного статуса больных хроническим ларингитом с сопутствующим аутоиммунным тиреоидитом

Представлены результаты исследования клеточного и гуморального иммунитета у больных хроническим ларингитом с сопутствующим тиреоидитом. Обоснована необходимость помимо традиционного ЛОР−лечения таких больных в компетенции эндокринолога и иммунолога.The findings of investigation of cellular and humoral immunity in patients with chronic laryngitis accompanied by thyroiditis are presented. The necessity of endocrinologist and immunologist consultation in addition to the traditional ENT treatment is substantiated