Objective, Non-symptomatizing larynageal affection in patients with GERD symptoms, and correlation with upper GIT endoscopy findings

Gastroesophageal reflux is a very common disease that is sometime associated with laryngeal symptoms, that may even precede the esophageal symptoms. Laryngeal affection in symptomatizing patients has been studied extensively, but the manifestations in non-symptomatizing patients were seldom investigated. Our study included 35 patients, 25 with biopsy proven GERD, and 10 volunteers. The patients underwent direct laryngeal endoscopy and upper GIT endoscopy. It aimed to determine the incidence of asymptomatic abnormal laryngeal affection in patients with GERD symptoms, their pattern of affection, and change with treatment of GERD. The results showed that over 75% of patients with GERD had a degree of laryngeal affection, mostly in the interarytenoid area, which might point to minimal laryngeal spillover of acid, which improves with the treatment of GERD. This suggests that the laryngeal condition goes hand in hand with the lower esophageal condition, and may implicate that although a 24 hour pH monitoring is the most sensitive and specific test in diagnosis and follow-up of GERD, a simple laryngeal examination may suffice to demonstrate response of GERD to treatment

Indirect laryngoscopy and soft tissue neck radiographs as predictors of direct laryngoscopic view

Prediction of difficult intubation markedly reduces the incidence of anesthesia related morbidity and mortality, several protocols and examination techniques were suggested by investigators, none is fault-proof, and many are expensive. Aim of the study was to examine whether there is correlation between the laryngoscopic grade on direct laryngoscopy and that on indirect laryngoscopy, and if there is correlation between the laryngoscopic grade and two proposed radiological parameters on soft tissue neck radiographs, aiming to find a cheap and reliable mode of preoperative determination of direct laryngoscopic view, Fifty consecutive ASA I or II adult patients scheduled for otolaryngologic procedures under general anesthesia were enrolled into this study. Recruited subjects underwent preanesthetic evaluation of the airway that comprised: 1] indirect mirror laryngoscopy by the otolaryngologist to score the laryngeal view. [2] clinical examination of the airway by the anesthesiologist to determine the Mallampati class, the thyromental distance [TMD], and the sternomental distance [SMD], [3] A lateral-view soft-tissue radiograph of the neck to determine two radiological parameters, viz, the distance between the posterior-most point of the hard plate and the superior-most point of the epiglottis [Radiological Parameter A], and the angle between the plane of the epiglottis and the plane of the vocal folds [Radiological Parameter B]. After induction of general anesthesia and skeletal muscle relaxation, the direct laryngoscopic view was scored according to the Cormack-Lehane classification. All laryngoscopies were conducted by the same anesthesiologist, who was blinded to the information obtained by indirect laryngoscopy or by neck radiographs. There was moderate correlation between the laryngoscopic grade on direct laryngoscopy and that on indirect laryngoscopy [rho = -0.618, P < 0.001. There was only mild correlation between Radiological Parameter A and both the direct [rho = -0.346, P < 0.05] and the indirect [rho = -0.337, P < 0.05] laryngoscopic grades. On the other hand, there was high correlation between Radiological Parameter B and the direct laryngoscopic grade [rho = -0.777, P M 0.001], and a moderate correlation between that parameter and the indirect laryngoscopic grade rho = - 0.574, P < 0.001]. A moderate correlation was demonstrated between the direct laryngoscopic grade and the Mallampati class [rho = -0.64, P < 0.001], the TMD [rho = - 0.94, P M 0.0021], and the SMD [rho = -0.564, P < 0.001]. On the other hand, a high correlation was demonstrated between the indirect laryngoscopic grade and he Mallampati class [rho = -768, P < .01], the TMD [rho = -0.713, P < 0.01], and the SMD [rho = -0.747, P < 0.001]. It was concluded that anticipation of difficult laryngoscopy may be enhanced by an integrated approach combining a comprehensive clinical examination of the airway with simple diagnostic aids, which can readily be applied in the clinical setting. In this respect, both indirect laryngoscopy and a plain soft-tissue radiograph of the neck may act as valuable assets to the anesthesiologist

Depressive symptoms in patients with allergic rhinitis, correlation to severity and response to treatment

Symptomatic allergic rhinitis has been associated with variable degrees of depressive symptoms, the degree of which is directly related to the severity of symptoms and the response to treatment. In this study we aimed to assess the depressive symptom score in allergic rhinitis patients and its affection by response to treatment. In this study we aimed to compare the results between the male and female populations. The study included 60 patients in 2 groups, one received full treatment course for allergy, and the second received only a placebo. We used the SNOT for assessment of nasal symptoms, and the Beck Scale for assessment of the depressive symptoms. The over all results showed that a degree of depression is present in most patients with allergic rhinitis, the severity of which is directly related to the severity of allergic symptoms, and improves with the reduction of allergic symptoms. Lack of improvement or poor response to treatment exacerbates the depressive status. with a more severe affection and increased liability in female population than in the male one

new approach to control of symptoms in vasomotor rhinitis of pregnancy

Vasomotor rhinitis of pregnancy has long been identified as a problem encountered by many pregnant females, this accompanies the drastic physiologic changes that occur during pregnancy. We aimed to determine the validity and efficacy of use of a well known safe drug which can be used in pregnancy, namely micronised purified diosminhesperidin combination [Daflon[R] Servier] in the improvement of symptoms of females suffering from vasomotor rhinitis of pregnancy [VMRP] and comparing it to the use of a local nasal steroid Fluticasone propionate [Flixonase[R], GSK], and a combination of both drugs. Forty-eight pregnant females suffering from symptoms and signs of VMRP contributed in the study. Subjective grading was done using the 7 most related items from the modified sinonasal outcome test [SNOT] scale scoring system, and objective grading using the rhinoscan acoustic rhinometer [by Rhinometrics[R]]. Results showed that the Diosmin-hesperidin combination only group showed similar response to combination of Diosmin-hesperidin combination and Fluticasone propionate, and both groups gave better response than the Fluticasone propionate only group. In conclusion, Diosmin-hesperidin combination is a safe and effective treatment line in control of symptoms of VMRP, either alone or in combination with Fluticasone propionate