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Objective@#To evaluate the feasibility of pepsin strip test in the diagnosis of laryngopharyngeal reflux.@*Methods@#From August 2017 to September 2018,80 patients in Department of Otorhniolaryngology Head and Neck Surgery,Chinese People′s Liberation Army General Hospital-Six Medical Centre, underwent pepsin strip test and 24-hour multichannel intraluminal impedance(MII)-pH monitoring. The results of the two methods were analyzed for consistency,and 24-hour MII-pH monitoring was used as a statistical reference for the sensitivity and specificity of pepsin strip test in the diagnosis of laryngopharyngeal reflux. Data were analyzed by SPSS 19.0 software.@*Results@#There were 57 patients with positive pepsin test strip and 23 patients with negative pepsin test strip. The score of reflux symptoms and signs, and the positive rate of laryngopharyngeal reflux events in patients with positive pepsin strip test were significantly higher than those in patients with negative pepsin test strip. If there was one or more throat reflux events (including acid reflux,weak acid reflux and alkali reflux) as the positive results of 24-hour MII-pH monitoring,the consistency between the results of pepsin strip and 24-hour MII-pH was moderate (Kappa=0.614). The sensitivity and specificity of pepsin strip were 86.9% (53/61) and 78.9% (15/19) respectively.@*Conclusions@#Pepsin strip detection has the advantages of non-invasive,cheap and easy to operate.As an objective method for early diagnosis of laryngopharyngeal reflux, pepsin strip detectionis feasible,but can not be the final diagnosis for laryngopharyngeal reflux disease.
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Objective@#To observe the incidence and to determine the significance of laryngopharyngeal reflux (LPR) in laryngeal cancer and vocal leukoplakia.@*Methods@#The patients who had been diagnosed as laryngeal cancer or vocal leukoplakia between January 2014 and June 2017 were included in this study. All of them received 24-hour multichannel intraluminal impedance-pH monitoring. The prevalence of LPR and numerous parameters from the 24-hour pH monitoring in laryngeal cancer patient and vocal leukoplakia patient groups were analyzed. The chi-square test was used for counting data, t test and Mann-Whitney U were used for measuring data.@*Results@#In the 91 laryngeal cancer patients, the prevalence of pathologic LPR was 28.6%(26/91), the median number[P25, P75, P95]of acid reflux events was 0[0, 3, 5], time of acid exposure was 0[0, 14, 234]s, number of weakly acidic reflux events was 3[0, 6, 11]. In the 54 vocal leukoplakia patients, the prevalence of pathologic LPR was 29.6%(16/54), the number of acid reflux events was 0[0, 3, 4], time of acid exposure was 0[0, 13, 118]s, number of weakly acidic reflux events was 1.5[0, 5, 9]. The incidence of LPR did not vary in the laryngeal cancer patient and vocal leukoplakia patient groups, but were both higher than healthy Chinese volunteers according to a report in the other literature. Furthermore, all the three patients with no history of tobacco or alcohol existed acid or weakly acidic reflux episodes.@*Conclusions@#Laryngopharyngeal reflux might play a role as an etiologic factor in laryngeal cancer and vocal leukoplakia.
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Objective@#The consistency and characteristics of 24-hour multichannel intraluminal impedance(MII)-pH monitoring and Dx-pH monitoring in the diagnosis of laryngopharyngeal reflux were investigated.@*Methods@#Fifty-two patients with laryngopharyngeal reflux related symptoms or disease between March and October 2017 were included in this study.All patients were evaluated with 24-hour MII-pH monitoring and Dx-pH monitoring at the same time, recording each patient′s number of positive laryngopharyngeal reflux events, time of acid clearance and Ryan index.The data was analysed with Mann-Whitney U test and consistency check.@*Results@#Among all 52 patients, 16 patients(30.7%) had a positive MII-pH monitoring result and 14 patients(26.9%) had a positive Dx-pH monitoring results.The consistency of both technique for measurement of laryngopharyngeal reflux was general(κ=0.626). With MII-pH monitoring for reference, the sensitivity and specificity of 24-hour pH monitoring were 68.8% and 91.7%.A total of 62 positive reflux events(pH<4) were measured with MII-pH monitoring, and 50 positive reflux events(upright pH<5.5 or supine pH<5.0)were detected by Dx-pH monitoring.There were 44 positive reflux events detected by both techniques, the mean time of acid clearance was 22.8[13.5; 42.6] s. Correspondingly, 18 reflux events were measured by MII-pH monitoring without positive results of Dx-pH monitoring, the mean time of acid clearance was 5.2[3.5; 6.5] s. There was significant difference in the time of acid clearance between two groups(U=858.5, P<0.05).@*Conclusions@#Dx-pH monitoring can accurately measure the change of pH value in airway, but exists the possibility of misdiagnosis especially when the time of acid clearance in laryngopharynx is short. MII-pH and Dx-pH monitoring can be complementary technique in the diagnosis of laryngopharyngeal reflux.
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OBJECTIVE To study the short term outcome of modified Semont maneuver for posterior semicircular canal benign paroxysmal positional vertigo (PSC-BPPV).METHODS A total of 93 patients with PSC-BPPV were diagnosed using the methods of Dix-Hallpike test and Roll test from Oct. 2015 to April 2016. All the patients were treated with the modified Semont maneuver. The 3 and 7 day outcome were recorded. RESULTS During the treatment, some patients had different degrees of vertigo and nausea, but all the patients completed the treatment successfully. The number of cured, improved and ineffective patients were 72, 16 and 5 respectively with a cure rate of 77.4% and total effective rate of 94.6% at 3 days follow up, and 84, 5 and 4 respectively with a cure rate of 90.3% and total effective rate of 95.7% at 7 days follow up.CONCLUSION Modified Semont maneuver is an effective method for management of posterior semicircular canal BPPV.
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OBJECTIVE@#To investigate the feasibility and efficacy of CO2 laser assisted posterior cordotomy for patients with bilateral paralysis of the vocal cord.@*METHOD@#Twenty-one patients with bilateral paralysis of the vocal cord underwent CO2 laser assisted posterior cordotomy in our hospital from Jul. 2009 to Jun. 2015. The causes of the bilateral paralysis of the vocal cord were thyroidectomy in 15 cases, cervical trauma in 2 cases, resection of pituitary tumor in 1 case, inflammation in 1 case and without cause in 2 cases. Ten patients underwent tracheotomy before the operation; 9 patients underwent tracheotomy after the operation; 2 cases without tracheotomy.@*RESULT@#The tracheotomy tube was plugged next day after posterior cordotomy. Lots of patients were breathing well without any effort. A few patients were breathing hard, so the tracheotomy tube was plugged discontinuously. Seventeen patients were decannulated 1 year after operation. Two patients were failed to decannulated. The patients were followed up for 3 months 6 years after operation, and all of them were breathing well.@*CONCLUSION@#Our limited experience showed that CO2 laser assisted posterior cordotomyis an effective and reliable surgical procedure for patients with bilateral paralysis of the vocal cord.
Subject(s)
Humans , Cordotomy , Methods , Inflammation , Laser Therapy , Lasers, Gas , Neck Injuries , Pituitary Neoplasms , General Surgery , Thyroidectomy , Tracheotomy , Treatment Outcome , Vocal Cord Paralysis , General Surgery , Vocal CordsABSTRACT
Objective:To study the risk factors related to level Ⅵ lymph node metastasis in clinical N0 (cN0) papillary thyroid carcinoma (PTC). Method:A total of 107 cases with cN0 PTC treated in the same group were analyzed retrospectively. The frequency and risk factors for level Ⅵ lymph node metastasis in these patients were analyzed. Result:Level Ⅵ lymph node metastasis existed in 51.40% (55/107) cases. In univariate analysis, level Ⅵ lymph node metastasis was associated with age (χ²＝9.090,P<0.01), gender (χ²＝5.061,P<0.05), tumor maximum diameter (χ²＝8.772,P<0.01), tumor multifocality (χ²＝8.120,P<0.01), capsular invasion (χ²＝4.960,P<0.05), and surrounding tissue invasion (χ²＝3.858,P<0.05), but not with nodular goiter or Hashimoto's thyroiditis. Multivariate logistic analysis indicated that age,tumor maximum diameter, multifocal tumors and surrounding tissue invasion were independent risk factors for level Ⅵ lymph node metastasis. Conclusion:A high risk level Ⅵ lymph node metastasis exists in DTC with clinical N0. Prophylactic level Ⅵ neck dissection is strongly recommended in patients with PTC who are younger, tumor size more than 2 cm, multifocal tumor and surrounding tissue invasion.
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[ABSTRACT]OBJECTIVETo investigate the relationship between self-assessment of Voice Handicap Index (VHI) and objective detection of Dysphonia Severity Index (DSI) in vocal ford polyp patients.METHODSAll 104 vocal cord polyp patients assessed the Chinese version of VHI scale by themselves. The DSI was calculated by acoustic analysis of DIVAS2.5. The correlation between VHI and DSI was analyzed in Pearson test.RESULTS There was no significant difference in each index of VHI scale score by side and shape, but the Shimmer of larger or wide-base polyps was more severe. The female patients' function, physiology, and VHI total score were higher than that of male patients, but the DSI was lower than that of male patients. The physiology score was higher in bilateral vocal cord polyp patients, so as well as DSI. There was no significant correlation between each item of VHI scale score and DSI.CONCLUSIONNeither the current subjective VHI nor objective DSI in clinical assessment of voice disorders disability is ideal, further research and better evaluation methods should be further explored.
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BPPV is the most common cause of dizziness in adults, and the symptoms, causes, behavior of adult patients are clearly defined. Pregnant woman may also suffer from BPPV. To our knowledge, there are few reports on BPPV in pregnant women. In this paper, the clinical characteristics and results of 3 pregnant women with BPPV are reported.
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Adult , Female , Humans , Pregnancy , Benign Paroxysmal Positional Vertigo , Diagnosis , Dizziness , Pregnancy Complications , DiagnosisABSTRACT
Objective To investigate the application of the straight head-hanging test in the diagnosis of the benign paroxysmal positional vertigo (BPPV ) .Methods The clinical manifestations of 324 patients with benign paroxysmal positional vertigo treated in our department from July 2009 to April 2014 were retrospectively analyzed . All of the patients were tested by Dix -Hallpike and roll test first ,then the straight head-hanging test was carried out .Results Of the 324 cases ,53 cases(16 .36% ) had signs of simultaneous multiple canal involvement ,and 27 ca‐ses of them could be triggered the symptom of vertigo in the straight head -hanging test .In patients with single semicircular canal BPPV ,85 cases (26 .2% )were evoked vertigo with or without positional nystagmus by Dix -Hallpike tests and 120 cases (37 .04% )were triggered the symptom of vertigo with or without nystagmus through roll test ,another 66 cases(20 .37% ) were induced vertigo with or without nystagmus in the straight head-hanging test .66 patients with positive straight head-hanging test were rotated along the sagittal plane for repositional treat‐ment .When these patients were re-evaluated at one week and 3 months ,the total improvement were 86 .36% (57/66) and 83 .33% (55/66) ,respectively .Conclusion The straight head -hanging test can improve the diagnostic rate and it is especially helpful for the diagnosis of superior semicircular canal benign paroxysmal positional vertigo . In patients with a history of typical vertigo ,the straight head -hanging test should be performed if they showed negative Dix -Hallpike test and roll test.
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<p><b>OBJECTIVE</b>To explore the diagnostic characteristics of 24 hours multichannel intraluminal impedance-pH (MII-pH) monitoring in patients with laryngopharyngeal reflux (LPR).</p><p><b>METHODS</b>Patients who were suspected to have laryngopharyngeal reflux (LRP) between February and December 2014 were included. The frequency of pH < 4 waveform, artifacts, numbers of acid reflux events, weakly acidic reflux events, weakly alkaline reflux events, time of acid exposure, time of acid clearance, acid reflux events in upright position and supine position, reflux symptom index(RSI) and reflux findings score (RFS) were analyzed.</p><p><b>RESULTS</b>Forty-five times pH < 4 reflux waveform were identified according to software analysis.140 pH drops of 4 were observed according to manual analysis, in which 78 times were caused by reflux and 62 artifacts. The consistency of manual analysis and software automatically analysis was general (κ = 0.234). The positive rate of 60 patients was 28.3% (17/60). In the 17 LPR patients, the median number [P25, P75] of acid reflux events was 5.0 [4.0, 8.8], weakly acidic reflux events was 6.5 [5.3, 10.3], weakly alkaline reflux events was 1.0 [0.0, 2.0], time of acid exposure was 3.8 [2.3, 7.2] min, time of acid clearance was 36.0 [21.5, 57.6] s, acid reflux events in upright position was 4.0[3.0, 4.8] and in supine position was 1.5 [0.0, 2.3]. All the data were approximately identical with the domestic and foreign literature. 24 hours MII-pH monitoring and RSI + RFS had medium consistency (κ = 0.590).</p><p><b>CONCLUSIONS</b>24 hours MII-pH monitoring has ideal repeatability, but false positive and false negative can not be avoided completely. The diagnosis of laryngopharyngeal reflux should be combined with medical history and laryngoscopy.</p>
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Humans , Electric Impedance , Esophageal pH Monitoring , Laryngopharyngeal Reflux , Diagnosis , Pilot Projects , Reproducibility of ResultsABSTRACT
<p><b>OBJECTIVE</b>To explore the morbidity of laryngopharyngeal reflux in patients with dysphonic diseases and to investigate the influence of LPR on the patients.</p><p><b>METHODS</b>One hundred and twenty-seven patients with dysphonic diseases were encountered in Peking University of the People Hospital. Under the agreement, the patients were asked to fill in the scales of RSI, RFS, VHI and SF-36.24-hour ambulatory double pH monitoring was applied to diagnose LPR definitely. 2643 volunteers were recruited to fill in the RSI scale through physical examination, outpatient, the ward and web survey.</p><p><b>RESULTS</b>46.46% (59/127) patients were diagnosed with LPR definitely. 1241 of 2643 volunteer, who filled in the RSI, score more than zero in the first entry of hoarseness or dysphonia, 65.0% (807/1241) of them, scoring 13 points or higher, were diagnosed with clinically suspected LPR. Based on the 24-hour ambulatory double pH monitoring, VHI total scores and subscores in the emotional domains were higher in positive group than in negative group. There was no statistical difference (P>0.05) in functional and physical domains. The SF-36 scale was used to evaluate the quality of life of the patients. The difference of 6 dimensionality, scores had statistical significance (P<0.05), including role-physical, general health, validity, social function, role-emotional and mental health. There was no statistical difference in dimensionalities of role-physical and bodily pain.</p><p><b>CONCLUSIONS</b>The volunteers who were diagnosed with hoarseness or dysphonia had the higher morbidity rate of LPR. At the time of treatment, more attention should be paid to the quality of life.</p>
Subject(s)
Humans , Dysphonia , Esophageal pH Monitoring , Hoarseness , Laryngopharyngeal Reflux , Quality of Life , Surveys and QuestionnairesABSTRACT
<p><b>OBJECTIVE</b>To study the surface electromyography (sEMG) changes of globus patients during swallowing and to discuss the cause of the globus.</p><p><b>METHODS</b>The sEMG during swallowing was recorded in 126 healthy volunteers (control group) and 34 globus patients (globus group).Swallow included dry swallow and 20 ml water swallow. The durations and amplitudes of muscle activities during every swallow were recorded. The durations and amplitudes of the sEMG in two groups were compared using t test.</p><p><b>RESULTS</b>The durations of sEMG at dry swallow and 20 ml water swallow were (1.128 ± 0.191)s and (1.091 ± 0.208)s, while the amplitudes were (0.313 ± 0.110) mV and (0.286 ± 0.106) mV in control group. The durations of sEMG at dry swallow and 20 ml water swallow were (1.178 ± 0.252)s and (1.127 ± 0.178)s, while the amplitudes were (0.341 ± 0.116) mV and (0.316 ± 0.094) mV in globus group. There were no significant differences between globus patients and healthy volunteers in the durations and amplitudes of sEMG at dry swallow and 20 ml water swallow (P > 0.05).Furthermore, there were also no significant differences in the durations and amplitudes of the sEMG between the two groups in the same gender (P > 0.05).</p><p><b>CONCLUSION</b>The results of swallowing sEMG suggested that the swallowing function in globus patients has not been damaged and psychological intervention should be considered in the treatment.</p>
Subject(s)
Adult , Humans , Deglutition , Physiology , Deglutition Disorders , Electromyography , Mental DisordersABSTRACT
[ABSTRACT]OBJECTIVETo assess the efficacy of proton pump inhibitor (PPI) on the treatment for laryngeal contact granuloma.METHODSSixty seven patients with laryngeal contact granuloma who were diagnosed in our department from March 2010 to October 2014 were enrolled in this study and all patients received PPI therapy, meanwhile the clinical data of the patients was analyzed. The follow-up period was at least half a year.RESULTS The 67 patients were treated well with the PPI. Fifty patients were cured, 11 patients were obvious improved, 4 patients were improved and 2 patients were invalid. The total efficacy rate was 97.01%. The average time of PPI used in small lesion group was shorter than that in large lesion group.CONCLUSIONPPI is effective for laryngeal contact granuloma, it can be recommended the first choice for the treatment of the disease.
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Laryngopharyngeal reflux has become increasingly prevalent and received more and more attention. The "gold standard" for identifying and measuring laryngopharyngeal reflux disease is 24-hour multichannel intraluminal impedance pH monitoring. In this paper, we review the clinical application of this monitoring technology.
Subject(s)
Humans , Electric Impedance , Esophageal pH Monitoring , Gastroesophageal Reflux , Laryngopharyngeal Reflux , DiagnosisABSTRACT
OBJECTIVE@#To investigate the effect of nasal surgery alone for OSAHS using Meta-analysis.@*METHOD@#The published articles were searched from PubMed, Chinese Biomedical Literature CD-ROM databases, China Academic Journals Full-text database. The quality of the searched original studies were assessed and the outcomes with the requirements were analyzed.@*RESULT@#Nineteen articles and 621 cases were finally included, including 15 English literatures and 4 Chinese literatures. The results of Meta analysis showed that: (1)The weighted mean between pre-and postoperative AHI was no significantly difference [weighted mean difference (WMD) = 0. 11, 95% CI (-0. 02,0. 23), P>0. 05]. (2) The nasal surgery alone significantly reduced theEpworth sleepiness scale scores in thirteen studies [WMD=0. 94,95% CI (0. 62,1. 26), P<. 01].@*CONCLUSION@#The meta-analyses show that nasal surgery alone can effectively improve the subjective clinical symptoms of patients with OSAHS. However, nasal surgery alone has a limited efficacy in treating OSAHS.
Subject(s)
Humans , China , Nasal Surgical Procedures , Sleep Apnea, Obstructive , General SurgeryABSTRACT
OBJECTIVE@#To discuss the effect of age on hyoid movement and the openness of UES in swallowing process, and to investigate the correlation between hyoid movement and openness of UES.@*METHOD@#The X-ray dynamic swallowing videofluoroscopy was performed on 100 healthy adult volunteers(20-74 years). They were divided into three groups: young (ages 20 to 45), middle-aged (45 to 65) and older (65 and up). Then the software Avidemux 2. 5 and Image J were used to measure the time and distance of hyoid movement, and the maximal opening of the UES in swallowing process.@*RESULT@#The time of hyoid moving to the maximal displacement was delayed along with the ages, and there were significant differences among the three groups (P0. 05), however, the antedisplacement of hyoid had significant relation to UES opening in the three groups (P<0. 05).@*CONCLUSION@#In swallowing process, the time and space parameters of hyoid movement and the maximal degree of UES opening were related to age. There was significant difference between the antedisplacement of hyoid and the openness of UES (P<0. 05).
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Adult , Aged , Humans , Middle Aged , Young Adult , Deglutition , Esophageal Sphincter, Upper , Physiology , Hyoid Bone , Physiology , Movement , SoftwareABSTRACT
OBJECTIVE@#To observe the short and long-term efficacy of quick repositioning maneuver for posterior semicircular canal benign paroxysmal positional vertigo (PC-BPPV) in different age groups.@*METHOD@#The clinical data of 113 adult patients with single PC-BPPV who underwent quick repositioning maneuver from July 2009 to February 2015 were retrospectively analyzed. The quick repositioning maneuver was to roll the patient from involved side to healthy side in the coronal plane for 180° as quickly as possible. The patients were divided into 3 groups according to different ages: young group ( 0.05). The recurrence rate of the three groups was 5.0%, 6.4% and 15.4% respectively, also no significant difference (P > 0.05).@*CONCLUSION@#The quick repositioning maneuver along the coronal plane for PC-BPPV has a definite effect for every age groups. The method is simple, rapid and easy to master, and the patients are tolerated the maneuver well without evident side effect.
Subject(s)
Adult , Humans , Middle Aged , Benign Paroxysmal Positional Vertigo , Therapeutics , Patient Positioning , Retrospective Studies , Semicircular CanalsABSTRACT
The main purpose of this paper was to review the role of the hyoid movement in the swallowing process and the effect of swallowing posture, age, gender, bolus properties on the hyoid movement. The displacement of the hyoid bone was divided into vertical and forward displacement. The vertical displacement of the hyoid bone contributes primarily to epiglottic and laryngeal closure, while the anterior displacement contributes primarily to opening of the UES. The dysphagia patients often experienced a reduction in hyoid bone displacement. Therefore, further research on the movement of the hyoid bone in the deglutition, especially the relationship between anterior displacement and UES opening is necessary.
Subject(s)
Female , Humans , Male , Age Factors , Deglutition , Physiology , Deglutition Disorders , Epiglottis , Physiology , Hyoid Bone , Physiology , Larynx , Physiology , Movement , Physiology , Sex FactorsABSTRACT
OBJECTIVE@#To compare the advantages and disadvantages of real time recurrent laryngeal nerve (RLN) monitoring and conventional exposure during thyroid operation by Meta analysis.@*METHOD@#The published articles of randomized controlled clinical trials were searched in data bases to compare the therapeutic outcomes of using real-time RLN monitoring and conventional exposure in thyroid surgery. The quality of the searched original studies was assessed and the outcomes which are in line with the requirements were analyzed.@*RESULT@#Six articles met the inclusion criteria, which contained 12,646 RLN in total. There were 5,535 cases in the RLN monitoring group and 7,111 cases in the conventional exposure group. The results of Meta analysis showed that: the transient injury rate of the RLN in the monitoring group (OR=0.60, 95% CI=0.49-0.73, P0.05). The RLN identification rate also had no statistical difference between the two groups (OR=9.79, 95% CI=0.17-548. 64, P>0.05).@*CONCLUSION@#The transient injury rate of the RLN is lower in the monitoring group than that in conventional exposure group, but the permanent injury rate and the RLN identification rate had no statistical difference between the two groups. The intraoperative nerve monitoring was useful in the prevention of the RLN injury in thyroid surgery.
Subject(s)
Humans , Monitoring, Intraoperative , Parathyroid Glands , Quality of Life , Recurrent Laryngeal Nerve , Recurrent Laryngeal Nerve Injuries , Thyroid Gland , General Surgery , ThyroidectomyABSTRACT
The patient complained of painless mass in the right ear for 3 months. The ipsilateral ear was 1/2 thicker than contralateral one and felt stiff without elasticity. There was limited eminence in cavum conchae about 1 mm in height and about 6 mm x 10 mm in size with clear boundary. which felt hard without tenderness. X-ray showed a long oval nodular calcification with clear but irregular boundary in cavum conchae under the right auricle, the size of which was about 4 mm x 7 mm. The patient was diagnosed right auricle cartilage calcification.