A study with pharyngeal and esophageal 24-hour pH-impedance monitoring in patients with laryngopharyngeal symptoms refractory to proton pump inhibitors.

BACKGROUND: The role of gastroesophageal reflux in chronic laryngeal symptoms is difficult to establish. The aim of this study was to characterize pharyngeal and esophageal pH-impedance reflux patterns in a group of patients with suspected laryngopharyngeal reflux and to determine predictive factors of response to proton pump inhibitors. METHODS: Patients with chronic pharyngolaryngeal symptoms were evaluated with a symptom score questionnaire, laryngoscopy, and 24-hour pharyngeal and esophageal pH-impedance monitoring at baseline and after 8-week treatment with esomeprazole 40 mg b.i.d. Response to treatment was defined by a diminution of more than 50% of the score for the primary symptom. Reflux patterns and baseline impedance values were compared to those obtained in 46 healthy subjects. KEY RESULTS: Twenty-four patients were included (17 women, median age 54 years), all previously refractory to antisecretory therapy. Symptom scores were 46 (32-62) and 40 (27-76) off and on therapy, respectively (P=.1). There was no significant difference between patients and controls for pH-impedance reflux parameters and baseline values off and on therapy in distal and proximal esophagus and in the pharynx. Median numbers of pharyngeal reflux were 0 and 0 off and on therapy, respectively. Only two patients were responders to treatment, both with excessive distal reflux but no pharyngeal reflux. Only one patient had abnormal pharyngeal reflux but did not respond to proton pump inhibitors. CONCLUSIONS: Patients with suspected laryngopharyngeal reflux refractory to therapy do not exhibit abnormal pharyngeal or esophageal pH-impedance reflux. In these patients, laryngopharyngeal reflux is unlikely.

Nasal irrigation: From empiricism to evidence-based medicine. A review.

Nasal irrigation plays a non-negligible role in the treatment of numerous sinonasal pathologies and postoperative care. There is, however, a wide variety of protocols. The present review of the evidence-based literature sought objective arguments for optimization and efficacy. It emerged that large-volume low-pressure nasal douche optimizes the distribution and cleansing power of the irrigation solution in the nasal cavity. Ionic composition and pH also influence mucociliary clearance and epithelium trophicity. Seawater is less rich in sodium ions and richer in bicarbonates, potassium, calcium and magnesium than is isotonic normal saline, while alkaline pH and elevated calcium concentration optimized ciliary motility in vitro. Bicarbonates reduce secretion viscosity. Potassium and magnesium promote healing and limit local inflammation. These results show that the efficacy of nasal irrigation is multifactorial. Large-volume low-pressure nasal irrigation using undiluted seawater seems, in the present state of knowledge, to be the most effective protocol.

[Feasibility study of septoplasties and septorhinoplasties in ambulatory surgery]. / Etude de faisabilité des septoplasties et septorhinoplasties en chirurgie ambulatoire.

OBJECTIVES: Feasibility assessment of septoplasty and septorhinoplasty as ambulatory procedures, from analysis of the activity of a university ENT department. METHODS: This is a retrospective analysis over 2 years. The demographic data, the distance between the patient's home and the ENT department, the cause of the septal deviation, the exact kind of surgery, the time of the beginning of the anaesthesia, the duration of the surgery, the postoperative data, the complications and the duration of hospitalization were collected. The operating durations were compared according to the sex, to the cause of the septal deviation, to previous surgery or not and to the kind of surgery performed, using Mann-Whitney's test. The correlations between the age, the operating duration and the time of the beginning of the anaesthesia were estimated using Spearman's test. Then, all the criteria of eligibility for an ambulatory surgical procedure were applied to this population, taking into account or not the distance between the patient's home and the ENT department. A financial analysis was realized on the eligible population, comparing the earnings for a traditional hospitalization with an ambulatory one. RESULTS: 424 patients were included, with an average age of 38 years old. 47 patients had an anaesthetic contraindication for the ambulatory surgery. 226 nasoseptal deviations were congenital (53.3%) and 198 post-traumatic (46.7%). 353 patients had never had a nasoseptal surgery (83.25%). The average time of the beginning of the anaesthesia was 10:55 am. The average durations were 75.8 +/- 32 min for septoplasty versus 127.5 +/- 44 min for the other acts (p < 10-5). There was a strong statistical difference of operating durations between a first surgery and a secondary surgical revision; as well as between a congenital cause and post-traumatic one (p < 10-5). There was an inverse correlation between the age and the operating duration (p < 10-4) and a correlation between the age and the time of the beginning of the anaesthesia (p < 10-5). 23 patients (5.42%) suffered from pains, nausea/vomitings and epistaxis within the 6 postoperative hours, that would have prevented them from going back home. 23 patients (5.42%) presented hematoma, infections, scar disunity, pains and faintness between day 4 and day 8 after surgery. In all, considering a distance shorter then an 1 hour drive from the ENT department, 69 patients (16.3%) were eligible retrospectively for an ambulatory surgery; they would have been 154 (40.8%) in the absence of this criteria. The medico-economic earnings would have been about 39,900 euros for 69 patients, for 2 years. CONCLUSION: 17 to 40% of the patients were potentially eligible for an ambulatory procedure, without endangering them.