A comparative study of supraglottic airway devices Baska mask and ProSeal-laryngeal mask airway in short gynaecological procedures

Background: Baska Mask® (BM) a newer Supraglottic Airway Device (SAD) considered to cause low incidence of Postoperative Pharyngolaryngeal Complications (POPC). This study was designed to assess efficacy, safety and early and late POPC between BM and commonly use ProSeal LMA (PMLA).Methods: Patients between 18 to 60 years of age undergoing elective short gynecological procedures were randomized into two groups, to receive ventilation with either BM (group 1, n=50) or an PMLA (group 2, n=50).Results: There was no significant difference in the ease of insertion for both the devices (p<0.24). There was no significant difference in the number of attempts for both the devices (p<0.69). When compared to PLMA, the time (in seconds) required for insertion of BM was significantly less in duration (20.9 vs. 16) (p<0.0001). Between the two groups significant hemodynamic changes noticed after removal of SGA. The blood staining of device was similar in both groups. Failure to place device, postoperative complication like laryngospasm and bronchospasm did not occur in both BM and PLMA groups.Conclusions: In conclusion, findings of this study support that BM takes significantly shorter placement time and provides a better seal as compared to PLMA but without any reduction in laryngopharyngeal complications.

​Comparison Of Effects Of Laryngeal Mask Airway Supreme Cuff Inflation With Air, Air: Oxygen Mixture, And Oxygen: Nitrous Oxide Mixture In Adults: A Randomized Double-Blind Study

Introduction: Laryngeal mask airway (LMA) cuff pressure has been implicated as a prime reason for post-operative sore throat.LMA cuff pressure increases when the air is used for the cuff inflation during oxygen: Nitrous oxide (O2: N2O) anesthesia, whichresults in post-operative pharyngolaryngeal adverse events. We conducted this study to compare the effect of LMA supremecuff inflation with air, air: Oxygen, and oxygen: Nitrous oxide mixture in adults.Aim: The aim of the study was to compare the changes in cuff pressure intraoperatively with different gas composition (air,air: Oxygen mixture, and oxygen: Nitrous oxide mixture) used to inflate the LMA supreme by a manometer and post-operativepharyngolaryngeal morbidity.Design: It was a potential randomized double-blind study which was conducted on 120 patients admitted for elective surgeryunder general anesthesia.Materials and Methods: A total of 120 patients were randomly allocated into three groups of 40 each according to thecomposition of gases used to inflate the supreme LMA cuff to achieve 40 cm H2O cuff pressure, air was used as cuff inflationmedium in Group A, air: Oxygen mixture in Group AO, and oxygen: Nitrous oxide mixture in Group ON.Statistical Analysis: The cuff pressure, ventilatory parameters, and post-operative pharyngolaryngeal complications werenoted. The analysis was done by Student’s t-test and Chi-square test. P < 0.05 was considered statistically significant.Results: In Group A and Group OA cuff pressure significantly increased from initial cuff pressure of 40 cm H2O until the end ofthe surgery to 74.35 ± 7.41 cm H2O and 56.35 ± 3.63 cm H2O, respectively. An initial decrease in cuff pressure was observedat 15 min to a mean of 32.85 ± 1.42 cm H2O in Group ON which again gradually increased to near initial pressures to a meanof 40.10 ± 2.31 cm H2O toward the end of surgery. Cuff volume increased in Group A and Group AO; however, it decreased inGroup ON (23.18 ± 4.45 ml, 18.73 ± 2.61 ml, and 11.50 ± 1.93 ml, respectively) from initial values. Ventilatory and hemodynamicparameters were comparable in all the three groups. A significant difference in pharyngolaryngeal morbidity was observedbetween Group A and Group ON.Conclusion: Cuff inflation with 50% O 2: N2O mixture provided more stable cuff pressure in comparison to air and O2: Air mixtureduring O2: N2O anesthesia. Ventilatory parameters and hemodynamic parameters did not change with variation in SLMA cuffpressure. Post-operative pharyngolaryngeal morbidity had a strong correlation with cuff pressure and was more in Group Aand least in Group ON.

Correlación diagnóstica entre fibronasolaringoscopía y videoendoscopía digestiva alta en pacientes con reflujo gastroesofágico y reflujo faringolaríngeo / Diagnostic correlation between fibronasolaringoscopy and upper gastrointestinal endoscopy video in patients with gastroesophagic reflux and faringolaryngeal reflux / Correlação do diagnóstico entre fibronasolaringoscopia eendoscopia digestiva alta em pacientes com refluxo gastroesofágico e refluxo faringolaríngeo

Introducción: el reflujo faringolaríngeo se origina por el flujo retrógrado de contenido gástrico hacia la faringe, pero existen factores capaces de perpetuarlo: disfunción del esfínter esofágico, tiempo de exposición y sensibilidad del tejido al material refluido, estos elementos permiten considerar al reflujo faringolaríngeo como una entidad diferente del reflujo gastroesofágico. Material y método: Estudio observacional, retrospectivo y analítico. Se incluyeron pacientes que consultaron al servicio de Otorrinolaringología y Gastroenterología de la Clínica Universitaria Reina Fabiola Córdoba Argentina, por sintomatología de reflujo faringolaríngeo y gastroesofágico. Entre mayo/2016 y mayo/2017. Los hallazgos de reflujo faringolaríngeo por fibrolaringoscopía flexible y de esofagitis por videoendoscopía digestiva alta de cada paciente se compararon con la prueba de Chi cuadrado. Se consideró significativo un valor de p ≤0,05. Resultados: Se incluyeron 49 pacientes entre 7 y 80 años; de éstos, el 45% son de género masculino, y 55% femenino. El 100% de los pacientes presentaron criterios fibrolaringoscópicos diagnósticos de reflujo faringolaríngeo; por el contrario, la videoendoscopía digestiva alta mostró que solo el 55% de los pacientes tenían signos de esofagitis (p= 0,24). Conclusiones: En este estudio no se observó una correlación diagnóstica entre los signos de la fibrolaringoscopía y videoendoscopía digestiva alta en relación al diagnóstico de reflujo faringolaríngeo y esofagitis. No se encontró una diferencia entre ambos géneros y los signos de reflujo faringolaríngeo y esofagitis. La frecuencia de las manifestaciones otorrinolaringológicas del reflujo faringolaríngeo se relaciona directamente con el incremento de la edad; sobre todo, la cuarta década de la vida.

Introduction: pharyngolaryngeal reflux. Its etiology, the retrograde flow of gastric contents towards the pharynx would be the origin, but there are factors, capable of perpetuating it: dysfunction of the esophageal sphincter, time of exposure and sensitivity of the tissue to the refluxed material, which allows pharyngolaryngeal reflux to be considered as a different entity from gastroesophageal reflux. Material and method: Observational, retrospective and analytical study of patients who have consulted the service of Otorhinolaryngology and Gastroenterology of the Reina Fabiola University Clinic, due to symptomatology of pharyngolaryngeal reflux and gastroesophageal reflux. Between May/2016 and May/2017. The findings of pharyngolaryngeal reflux by fiber-optic laryngoscopy and esophagitis by upper gastrointestinal endoscopy of each patient were compared with the Chi square test. A value of p ≤0.05 was considered significant. Results: We included 49 patients between 7 and 80 years old; 45% of them were male and 55% were female. 100% of the patients had fiber-optic laryngoscopy diagnostic criteria of pharyngolaryngeal reflux. In contrast, upper digestive endoscopy showed that only 55% of the patients had signs of esophagitis (p = 0.24). Conclusions: In this study, wasn´t observed a diagnostic correlation between the signs of fiber-optic laryngoscopy and upper gastrointestinal endoscopy in relation to the diagnosis of pharyngolaryngeal reflux and esophagitis. We did not find a difference between both genders and signs of esophageal pharyngolaryngeal reflux. The frequency of otorhinolaryngological manifestations of pharyngolaryngeal reflux is directly related to the increase in age.

Introdução: o refluxo faringolaríngeo. Sua etiologia é o fluxo retrógrado de conteúdo gástrico para a faringe, mas existem fatores capazes de perpetuá- lo: disfunção do esfíncter esofágico, tempo de exposição e sensibilidade do tecido ao material refluído, o que permite considerar o refluxo faringolaríngeo como uma entidade diferente do refluxo gastroesofágico. Material e métodos: Estudo observacional, retrospectivo e analítico de amostra de pacientes que consultaram o serviço de Otorrinolaringologia e Gastroenterologia da Clínica Universitária Reina Fabiola, devido à sintomatologia de refluxo faringolaríngeo e refluxo gastroesofágico, entre maio/2016 e maio/2017. Os achados do refluxo faringolaríngeo por fibrolaringoscopia flexível e esofagite por endoscopia digestiva alta de cada paciente foram comparados com o teste do chi-quadrado. Um valor de p ≤ 0,05 foi considerado significativo. Resultados: Foram estudados 49 pacientes entre 7 e 80 anos; destes, 45% do sexo masculino e 55% do sexo feminino. 100% os pacientes apresentavam critérios fibrolaringoscópicos para refluxo faringolaríngeo. Em contraste, a endoscopia digestiva alta mostrou que apenas 55% dos pacientes apresentavam sinais de esofagite (p = 0,24). Conclusões: Neste estudo, não foi observada correlação diagnóstica entre os sinais de fibrolaringoscopia e endoscopia digestiva alta em relação ao diagnóstico de refluxo faringolaríngeo e esofagite. Não foi encontrada diferença entre os sexos e os sinais de refluxo faringoaríngeo e esofagite. A freqüência das manifestações otorrinolaringoló- gicas do refluxo faringolaríngeo está diretamente relacionada ao aumento de idade.

Reflujo faringolaringeo y su relación con la ausencia de porción intra abdominal del esfínter esofágico inferior / Pharyngolaryngeal reflux and its relationship with no portion of intra abdominal lower esophageal sphincter

Objetivo: Determinar la relación entre el reflujo faríngolaríngeo y la ausencia de porción intra-abdominal del esfínter esofágico inferior. Materiales y métodos: Estudio analítico, prospectivo y de corte transversal evaluando 65 pacientes referidos a la consulta de Gastroenterología por la Consulta de Otorrinolaringología con el diagnóstico de reflujo faríngolaríngeo, del Centro Medico Docente La Trinidad en el período Enero 2013 a Noviembre 2014. Se les realizo interrogatorio evaluando síntomas típicos (regurgitación y pirosis) y síntomas atípicos (tos, carraspeo y disfonía), manometría y monitoreo del pH esofágico de 24 horas. Posteriormente se seleccionaron dos grupos a comparar: Grupo A con ausencia de porción intra-abdominal del esfínter esofágico inferior y grupo B con presencia de porción intra-abdominal del esfínter esofágico inferior. Resultados: Las variables: edad, sexo, síntomas típicos (pirosis, regurgitación), atípicos (tos, carraspeo, ronquera), presión del esfínter esofágico inferior y la motilidad del cuerpo esofágico no fueron significativas al compararse los grupos Grupo A N=17, y grupo B N=48. El monitoreo de pH esofágico de 24 horas fue estadísticamente significativo al compararse los grupos, evidenciándose que el grupo A tenía mayor porcentaje de resultados positivos para reflujos patológicos. Conclusión: La ausencia de porción intra-abdominal determinada por manometría esofágica se relaciona con la presencia de reflujos patológicos determinados por el monitoreo de pH esofágico de 24 horas, demostrando que esta puede ser un factor desencadenante de ERGE y por consiguiente de reflujo faríngolaríngeo.

Objetive: To determine the relationship between pharyngolaryngeal reflux and the absence of intra-abdominal portion of the lower esophageal sphincter. Materials and methods: Analitical, prospective study. Evaluating 65 patients referred to the consultation of the Gastroenterology from Consultation of the Otorhinolaryngology diagnosed with reflux pharyngolaryngeal of Medical Teaching Center La Trinidad period January 2013 to November 2014. They were interviewed to assess typical symptoms (heartburn and regurgitation) and atypical symptoms (cough, hawking and hoarseness), esophageal manometry and ambulatory 24 hour esophageal pH monitoring. Two groups were selected to compare: group A with no intra-abdominal portion of the lower esophageal sphincter and group B with presence of intra-abdominal portion of the sphincter upper esophageal. Results: The variables: age, gender, typical symptoms (heartburn and regurgitation) and atypical symptoms (cough, hawking and hoarseness), pressure of the lower esophageal sphinter and the motility of the esophagic body, they were not significant when compared groups. The ambulatory 24 hours esophageal pH monitoring was significant statistically when compared groups, demostrating that the group A had the highest percentage of positive results for pathological reflux. Conclusion: the absence of intra-abdominal portion determined by esophageal manometry is related to the presence of pathological reflux determined by ambulatory 24 hour esophageal pH monitoring, demonstrating that this can be a trigger factor of Gastroesophageal reflux disease and therefore pharyngolaryngeal reflux.

Laringitis fúngica en pacientes inmunocompetentes / Fungal laryngitis in immunocompetent patients

Introducción: La laringitis fúngica es una patología poco planteada en pacientes inmunocompetentes, sin embargo se debería tener en consideración en el diagnóstico diferencial de leucoplaquias en estos pacientes, más aún con factores predisponentes como reflujo faringolaríngeo, tabaquismo crónico y/o uso de corticoides. Objetivo: Presentar una serie de casos de pacientes inmunocompetentes con diagnóstico clínico de laringitis fúngica y tratamiento antimicótico empírico. Describir la asociación con factores predisponentes claves. Material y método: Estudio retrospectivo que incluyó a 11 pacientes con diagnóstico clínico de laringitis fúngica por correlación de la clínica, factores predisponentes y hallazgos en la videoestroboscopía laríngea (leucoplaquias múltiples en los pliegues vocales) sumado a la respuesta a tratamiento empírico con fluconazol oral. Se realizó además una revisión de la literatura disponible hasta el año 2015. Resultados: Todos los diagnósticos fueron clínicos correlacionando síntomas con hallazgo de leucoplaquias características en la laringe. El principal factor asociado fue el reflujo faringolaríngeo (91%) seguido por uso de corticoides (55%). Todos los pacientes fueron tratados con un esquema empírico de fluconazol oral por 14-21 días. El 100% de los pacientes respondió de forma exitosa al uso de este fármaco con remisión de los síntomas y de las lesiones laríngeas. Conclusión: El diagnóstico clínico y tratamiento con fluconazol oral como tratamiento de primera línea generarían buena tasa de respuesta, siempre que se correlacionen los síntomas y signos del paciente con los hallazgos encontrados en la laringe.

Introduction: The fungal laryngitis is an unusual disease in immunocompetent patients, however should take into consideration in the differential diagnosis of leukoplakias, especially in patients with predisposing factors such as pharyngolaryngeal reflux, use of inhaled, oral or intravenous corticosteroids. Aim: Describe a series of cases of fungal laryngitis in immunocompetent patients with clinical diagnosis and empirical antifungal treatment. In addition, finding the association with predisposing factors keys. Material and method: Retrospective study of 11 patients with diagnosis of fungal laryngitis according to clinical presentation, predisposing factors and findings in the laryngeal videostroboscopy (vocal folds leukoplakias) joined the response to empirical treatment with oral fluconazole. Also an extensive literature review was conducted until 2015. Results: The main predisposing factor was the pharyngolaryngeal reflux (91%) followed by use of corticosteroids (55%). All patients were treated empirically with fluconazole for 14-21 days. 100% of patients responded successfully, with remission of symptoms and laryngeal lesions. Conclusion: Clinical diagnosis and treatment with fluconazole as first-line treatment generate good response rate, provided that the patient's symptoms and signs with the findings in the larynx are correlated.

Comparison of pharyngolaryngeal diseases among pediatric inpatient in Hue central Hospital Vietnam and Aue Hospital, West Germany

A comparison study was carried out on 1,242 medical records of pharyngolaryngeal disease among pediatric inpatients with ages of 1 -15 in Hue Central Hospital and 2852 medical records of pharyngolaryngeal diseases among pediatric inpatients with the same ages in Aue hospital, West Germany. Results showed that the pharyngolaryngeal diseases were leading diseases among diseases of ear, nose and pharynx in both hospitals. The rate of these diseases treated by operation in Aue hospital was higher than this in Hue hospital. There was difference of the morbidity rate between age groups. The rate of treatment of infection disease and infections complication in Hue hospital was higher than this in Aue hospital. The Aue hospital considered in prophylactic operation, diagnosis and rehabitation better than Hue hospital. There was no death in Aue hospital while there were 6 deaths in Hue hospital.

Pharyngolaryngeal closure after supraglottic partial laryngectomy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES:Although the various methods of pharyngolaryngeal closure after supraglottic partial laryngectomy(SPL) have been reported, the difference of postoperative function and complications has not been adequately analyzed. Therefore, We investigated the relationship between different pharyngolaryngeal closure methods and postoperative function and complications. PATIENTS AND METHODS: According to the methods of pharyngolaryngeal closure, postoperative complications, decannulation day and postoperative day when to start oral feeding were retrospectively investigated on 22 patients who underwent SPL. We divided the patients into two groups according to the methods of pharyngolaryngeal closure. In cartilage group(13 cases), the closure of pharyngolaryngeal defect was done with direct suture between the thyroid cartilage and base of the tongue. In perichondrial group(9 cases), the closure was done between preserved thyroid perichondrium and base of the tongue. RESULTS: There was no case requiring either a gastrostomy or a persistent tube feeding in our series. Fistula occurred more often in perichodrial group(3 cases) than cartilage group(0 case). In one case of perichondrial group, total laryngectomy was performed because of a fistula. Also, aspiration pneumonia occurred more often in perichodrial group(2 cases) than cartilage group(0 case). Decannulation could be performed relatively earlier in cartilage group than in perichondrial group. Also, oral feeding could be performed relatively earlier in cartilage group than in perichondrial group. CONCLUSION: Direct approximation between cut margin of the thyroid cartilage and base of tongue was safe, time-saving and reliable method of pharyngolaryngeal closure after SPL.