Management of laryngopharyngeal reflux disease

To evaluate the efficacy of medical, dietary and lifestyle modification therapy given to Laryngopharyngeal reflux [LPR] patients. Private clinic, Al-Khobar, Saudi Arabia. Prospective study. Twenty-two LPR patients were examined and treated by the author. Patients' larynges were evaluated by either video endoscopy, endoscopy only or indirect laryngoscopy. Belafsky Reflux Finding Score [RFS] and Reflux Symptom Index [RSI] were used to assess symptoms, findings and improvements. The patients were treated with 40 mg Proton Pump Inhibitor [PPI], dietary and lifestyle modification therapy for at least 3 months. Patients were followed up monthly for the first 3 months and then bimonthly for the rest of the year. Improvements were assessed using the RFS and RSI, the scale was from 0-3. Twenty two patients with suspected LPRD were included in the study, 15 males and 7 females; the mean age was 40 year. Eleven had video endoscopy, 8 endoscopy and 3 indirect laryngoscopy [rigid fibro-optic]. The main symptoms were hoarseness, throat clearing, cough and heartburn. The main findings were laryngeal redness, vocal cord [VC] edema, posterior commissure and arytenoid erythema and edema. Thirteen patients were adherent to management and follow up program, nine were excluded. All the 13 patients showed subjective and objective improvement ranging from good to excellent. One patient developed VC polyp and had to be removed surgically. The mean follow up [FU] was 6.5 months. The study showed that 40 mg PPI [Nexium tablet] per day for at least 3 months combined with diet and lifestyle modification therapy were sufficient to improve the symptoms of laryngopharyngeal reflux. RFS and RSI are excellent tools to assess improvement. Long term FU is needed to achieve a satisfactory outcome

efficacy of repositioning maneuver in the management of benign paroxysmal positional vertigo

Benign Paroxysmal Positional Vertigo [BPPV] is a very common vestibular disorder. It is characterized by short lasting positional vertigo. Different etiology may be responsible for it. The diagnosis is based on history and on the nystagmus findings. Treatment of choice is the repositioning maneuver after Epley and/or Semont. To assess the efficacy of the Repositioning Maneuver [RM] in the management of Benign Paroxysmal Positional Vertigo [BPPV]. ENT Clinics, Al Khobar, Saudi Arabia. Prospective study. Fourteen patients complaining of vertigo from May 2007 to May 2009 were included in the study. All patients were seen, examined and treated by the author. After a detailed history, audiological and vestibular tests were performed. The patients either been subjected to Epley and/or the Semont maneuver. Fourteen patients aged 30-64 years [mean 49 years], 8 males and 6 females were included in the study. All were complaining of acute short lived positional vertigo. Examination of patients showed positive Dix-Hallpike test [DHT], some canal paresis, abnormal gait test and sensorineural hearing loss. Thirteen patients were free of symptoms after the maneuvers. One showed no improvement. Patients with dizziness have to be rehabilitated. Mean follow up was 3 months. Epley and Semont maneuvers are very effective procedures to treat benign paroxysmal positional vertigo. In this study, eleven out of fourteen patients were relieved of their symptoms. The recommended time for follow up is 3 months and for reassessment one month

Epistaxis; causes and management at King Fahd hospital of the University

Objective:To study the causes of epistaxis and its management and to compare it to the current literature. Setting: A retrospective study of all cases of epistaxis seen between January 1997 - December 1999 in the ENT department of King Fahd Hospital of the University [KFHU], Al-Khobar. All patients underwent a general evaluation. Vital signs were monitored and resuscitation was carried out when needed. An intravenous line was secured, and a full blood count and coagulation profile were ordered on presentation. All patients were initially treated conservatively, by anterior and/or posterior nasal packing, or by chemical or galvanocautery. There were 204 epistaxis patients during the period under study. Their ages ranged between 2-60 years, and 64.4% were aged 20 or under. Male to female ratio was 2.7:1. The main causes of epistaxis were nose picking in 33%, external trauma 31%, rhinosinusitis in 20%, bleeding disorder in 7.3% idiopathic 6.7%, post septoplasty in 1% and in 1% due to angiofibroma. Eight per cent were hospitalized. The remaining 92% were treated as outpatients cases. Conservative treatment controlled epistaxis in all but three patients who required surgery. Five patients required blood transfusion [1.96%]. At follow-up, 8% reported mild attacks of epistaxis which stopped spontaneously and did not require treatment. Conservative treatment for epistaxis is still successful in controlling epistaxis in the majority of patients. Arterial ligation is rarely required in patients who do not respond to conservative measures. The value of coagulation screening should not be underestimated