Association between inferior turbinate hypertrophy and extraesophageal reflux

IMPORTANCE To the authors' knowledge, no prior studies have examined the association between inferior turbinate hypertrophy (ITH) and extraesophageal reflux (EER). If EER were a cause or cofactor of ITH, antireflux treatment can be considered prior to surgical intervention. OBJECTIVE To evaluate EER presence and severity in patients with different degrees of ITH. DESIGN, SETTING, AND PARTICIPANTS Prospective multicentric cohort study conducted at 3 referral centers treating patients with EER and certified for 24-hour monitoring of oropharyngeal pH. The monitoring was performed between October 2020 and October 2021. A total of 94 adult patients with EER symptoms were recruited, 90 of whom were analyzed. INTERVENTIONS Nasal endoscopy was performed to determine the degree of ITH, according to the Camacho classification. Presence and severity of EER were examined using 24-hour monitoring of oropharyngeal pH. MAIN OUTCOMES AND MEASURES Primary outcomes were presence of EER according to RYAN Score, total percentage of time below pH 5.5, and total numbers of EER events below pH 5.5. RESULTS Of the 90 analyzed patients (median [IQR] age, 46 [33-58] years; 36 [40%) male patients), 41 had a maximum of second-degree ITH (group 1), and 49 patients had at least third-degree ITH (group 2), according to the Camacho classification. On the basis of the RYAN Score, EER was diagnosed more often in group 2 (69.4%) than in group 1(34.1%; difference, 35.3% [95% CI, 13.5%-56.9%]). Moreover, compared with group 1, group 2 exhibited higher median total percentage of time below pH 5.5 (median [IQR], group 1: 2.1% [0.0%-9.4%], group 2: 11.2% [1.5%-15.8%); difference, 9.1% [95% CI, 4.1%-11.8%)) and higher median total number of EER events (median [IQR], group 1: 6 [1-14] events, group 2: 14 [4-26] events; difference, 8 [95% CI, 2-15] events). Patients with proven EER demonstrated no difference in the degree of ITH between the right and left nasal cavity (Cohen g, -0.17 [95% CI, -0.50 to 0.30)), or between the anterior and posterior parts of the nasal cavity (Cohen g, -0.21 [95% CI, -0.50 to 0.17]). CONCLUSIONS AND RELEVANCE In this cohort study, patients with a higher degree of ITH had more severe EER. A possible association between severe ITH and EER was demonstrated.Web of Science148877877

Analysis of the marketing strategy of Travellers Hostel Praha

Práce se věnuje marketingové strategii vybraného hostelu. Je rozdělena do osmi částí. První kapitola je věnovaná teoretickému popisu marketingu a jeho zvláštnostem na trhu cestovního ruchu. Druhá část charakterizuje hotelový průmysl v Praze a ČR. Třetí část popisuje hostel a jeho historii. Čtvrtá část analyzuje marketingový mix hostelu. Další částí jsou věnovany analýzam hostelu, jeho prostředím a konkurenci. V poslední částí jsou navrženy řešení na zlepšení marketingové komunikace hostelu.This work analyzes the marketing strategy of a hostel situated in the Prague downtown. It is divided into eight parts. The first section describes the theoretical marketing definitions. The second section is dedicated to tourism in Prague and Czech republic. The third section describes the chosen hostel and its history. The fourth section analyzes marketing activities of the hostel. The fifth and the sixth sections were dedicated to analyses of hostel environment and competition. The last sections describe a relationship of a hostel with its guests and bring suggestions for improving the propagation.Práca sa zaoberá analýzou marketingovej stratégie a činnosti ubytovacieho zariadenia Travellers Hostel Praha. Skladá sa z ôsmych kapitol. V prvej časti je popísaný marketing všeobecne a jeho špecifiká v cestovnom ruchu. Druhá časť charakterizuje cestovný ruch a hotelierstvo v Prahe a Českej republike. Tretia časť popisuje základné informácie o hosteli, jeho históriu a vybrané ekonomické ukazovatele. Štvrtá časť analyzuje marketingový mix hostela. V piatej a šiestej časti sú vykonané analýzy vnútorného a vonkajšieho prostredia hostela. V siedmej časti je opísaná analýza spokojnosti zákazníkov a jej výsledky. Posledná časť sa venuje návrhom na zlepšenie komunikačného mixu vybraného hostela

Mulberry posterior inferior nasal turbinate is associated with a lower pharyngeal pH environment

Objectives:Mulberry-like changes of the posterior inferior nasal turbinate (MPINT) can lead to nasal obstruction.Extraesophageal reflux (EER) characterized by lower pH causes mucosal inflammation and therefore can contribute tosinonasal pathologies. No prior studies have objectively examined the possible association between acidic pH and MPINT for-mation. Therefore, this study is aimed to investigate the 24-h pharyngeal pH value in patients with MPINT. Study design:Prospective case–control multi-center study. Methods:Fifty-five patients with chronic EER symptoms were included in the study. Theyfilled in questionnaires aimedat reflux and sinonasal symptoms (RSI®, SNOT-22) and underwent video endoscopy evaluating the laryngealfindings (RFS®)and the presence or absence of the MPINT. And, 24-h oropharyngeal pH monitoring was used to detect the acidic pH environ-ment in the pharynx. Results:Out of the 55 analyzed patients, 38 had the MPINT (group 1), and in 17 patients, the MPINT was absent (group2). Based on the pathological RYAN Score, in 29 (52.7%) patients, severe acidic pH drops were detected. In group 1, the acidicpH drops were diagnosed significantly more often (68.4%) compared with those in group 2 (p=0.001). Moreover, in group1, a significantly higher median total percentage of time spent below pH 5.5 (p=0.005), as well as a higher median number ofevents lasting more than 5 min (p=0.006), and higher median total number of events with pH drops (p=0.017) wereobserved. Conclusion:In this study, the MPINT was significantly more often present in patients with acidic pH events detected by24-h oropharyngeal pH monitoring. Acidic pH in the pharynx might lead to MPINT formation.Web of Scienc