Voice symptoms in patients with autoimmune disease: a cross-sectional epidemiological study.

OBJECTIVE: To assess the prevalence and severity of voice symptoms in individuals with a diagnosis of autoimmune disease. STUDY DESIGN: Cross-sectional survey. SETTING: Study participants were recruited from a rheumatology tertiary referral clinic at Norfolk and Norwich University Hospital. SUBJECTS AND METHODS: A cross-sectional questionnaire analyzing 109 patients with autoimmune disease (rheumatoid arthritis, seronegative spondyloarthritis, connective tissue disease) and a control group of 41 patients with non-autoimmune disease (osteoarthritis/osteoporosis). Main outcome measures were the Voice Handicap Index-10 (VHI-10), xerostomia scale, acid reflux inquiry, and anxiety/depression scale. RESULTS: Patients with autoimmune disease were more likely to experience voice symptoms as assessed by the VHI-10 questionnaire (P = .0035). Subgroup analysis showed autoimmune patients were more likely to report voice symptoms regardless of whether they were on a disease-modifying antirheumatic drug (DMARD; P = .0010) or non-DMARD (P = .017), suggesting autoimmune disease may be an independent risk factor from pharmacotherapy. Xerostomia was more common in an autoimmune population compared with the control group (P = .02). A positive correlation between xerostomia and VHI-10 scores was found for the DMARD group (Spearman rank coefficient = 0.49, P < .001). No significant difference in acid reflux inquiry (P = .44) or the anxiety/depression scale (P = .36) was found when comparing the autoimmune and control groups. CONCLUSION: Patients with autoimmune disease have increased likelihood of voice symptoms when compared with a control population with non-autoimmune disease. Further prospective studies to elucidate the cause of voice disorder would be valuable.

Did one ear infection in France change the history of Britain? The illness and death of Francis II (1544-60).

The middle ear has long been considered a continuum of the upper respiratory tract and modern physicians recognize the impact of upper respiratory tract pathology on the middle ear and are familiar with the possible neurosurgical complications of any resultant chronic or acute middle ear infection. In the 16th century, lack of this knowledge may have led to a sequence of events and one of the most important turning points for the British monarchy. This paper on the illness and death of King Francis II of France uncovers interesting aspects of ENT practice from the French Renaissance period and the intrigue surrounding this royal patient's well-documented but little discussed illness.

Rhinologic symptoms and quality-of-life in patients with Churg-Strauss syndrome vasculitis.

BACKGROUND: The purpose of this study was to investigate the presentation pattern, sinonasal symptoms, and quality of life (QOL) in patients with Churg-Strauss syndrome (CSS) vasculitis. METHODS: A cross-sectional study was performed. Twenty-five patients with CSS belonging to a patient self-help group participated. Main outcome measures included mode of initial presentation, treatment, rhinologic symptoms, and disease-specific QOL (Sinonasal Outcome Test [SNOT-22] scores) and comparisons were made with general rhinosinusitis and other nasally affected vasculitis patients (Wegener's granulomatosis [WG]). RESULTS: Overall, 80% of CSS patients had active sinonasal symptoms at the time of the study. Twenty-eight percent of CSS patients reported worsening of their nasal symptoms as the main event leading to their diagnosis. Forty-eight percent of CSS patients had undergone nasal surgery. Nasal symptoms that are of particular relevance to this patient group are nasal obstruction (95%), rhinorrhea (95%), anosmia (90%), and excessive sneezing (80%). Other symptoms included nasal crusting (75%), purulent nasal discharge (65%), and epistaxis (60%). SNOT-22 scores were significantly higher than normal, reaching average values similar to those of patients from the general rhinosinusitis population. CONCLUSION: Sinonasal symptoms are common at initial presentation of CSS, emphasizing the role of otolaryngologists in its diagnosis. Overall, CSS-related sinonasal morbidity is significant and comparable with that of the general rhinosinusitis population. It predominantly results from symptoms of allergic rhinitis, but a significant proportion of CSS patients also report milder forms of crusting, epistaxis, and of purulent sinusitis, symptoms which are more commonly attributed to patients with WG.

Diagnostic cervical lymphadenectomy in children: a case for multidisciplinary assessment and formal management guidelines.

A retrospective review was carried out of all children under 16 years of age that underwent cervical lymphadenectomy in our department within a 7-year period. The pathway of their referral from the community to hospital care was noted. The circumstances surrounding the decision for surgery, including clinical features of lymph nodes and investigation results were also recorded. We concluded that cervical lymphadenectomy is an uncommon occurrence in children with an incidence of 2.5/100,000 per year and a yield rate of 15.8% for serious conditions requiring treatment. We demonstrate the importance of joint decision-making between surgeons and paediatricians to reduce the rate of unnecessary biopsies. We also reveal the inconsistency in the pre-operative investigation of these children leading to a low number of positive biopsies and highlighting the need for formal management guidelines.