Characteristics of Laryngopharyngeal Reflux in Patients with Chronic Cough Induced by Gastroesophageal Reflux Disease.

Objective: To summarize the characteristics of laryngopharyngeal reflux in patients with chronic cough induced by gastroesophageal reflux disease (GERD). Materials and Methods: The clinical data of patients with chronic cough induced by GERD treated at our hospital were retrospectively analyzed, including their reflux symptom index (RSI), reflux finding scores (RFS), and results of oropharyngeal pH monitoring. Results: There were 44 patients in total, including 21 males and 23 females. The average history of chronic cough was 29.60 (29.60 ± 37.60) months. In addition to coughing, all patients had at least 2 symptoms of laryngopharyngeal reflux disease (LPRD), and their RSI averaged 15.66 (15.66 ± 6.33). The most frequent symptoms were cough, throat clearing, excessive phlegm, or postnasal drip. All patients had LPRD signs, with an average RFS of 10.89 (10.89 ± 2.81). The most frequent signs were erythema or hyperemia/vocal cord edema, posterior commissure hypertrophy, and diffuse laryngeal edema. There were 42 patients (42/44, 95.45%) whose RSI and/or RFS were abnormal. Oropharyngeal pH monitoring identified 10 patients (10/44, 22.72%) with abnormal Ryan scores. Conclusions: All patients with chronic cough induced by GERD had symptoms and signs of LPRD, and most of them had an abnormal RSI and/or RFS and could be diagnosed with suspect LPRD. A part of the patients had LPR episodes according to Dx-pH monitoring, most of which occurred in the upright position. These results indicated that most patients with chronic cough induced by GERD may have suspected LPRD simultaneously and that cough was one of their LPRD symptoms.

Reliability and Validity of the Chinese Version of Reflux Symptom Score.

OBJECTIVE: To evaluate the reliability, validity and clinical value of the Chinese version of reflux symptom score (RSS) (RSS in Chinese). METHODS: This was a prospective study that contained 42 healthy volunteers and 135 possible laryngopharyngeal reflux disease (LPRD) patients. Reflux symptom index, reflux finding score, oropharyngeal pH monitoring (Dx-pH monitoring), and RSS of each patient were performed. RSS was performed again after 1 week. Confirmed LPRD patients were treated with proton pump inhibitor (PPI) for 8 weeks. And RSS was performed again after treatment. The reliability and validity of RSS was evaluated. RESULTS: The Cronbach's α coefficient of the Chinese version of RSS was 0.772, which indicated good internal reliability. The results of test-retest found all P values were less than 0.05, which supported good external reliability. The comparison of the results of RSS with oropharyngeal pH monitoring discovered a diagnostic coincidence rate of 83.70% and a positive predictive value of 84.96%, which showed good criterion validity. After 8 weeks treatment of PPI, RSS decreased significantly (pretreatment 84.79 ± 42.50，post-treatment 20.11 ± 22.82, P < 0.001), indicating good responsiveness to change of RSS. The score of quality of life impact of suspected LPRD patients was obviously higher than that of healthy volunteers (t = 7.153, P < 0.001). All patients and volunteers agreed that RSS in Chinese can evaluate their symptoms well. CONCLUSION: RSS in Chinese had good internal and external reliability, good criterion validity and good responsiveness to change. The content and method of evaluation of RSS in Chinese was better and more comprehensive. RSS in Chinese could be a new instrument to evaluate LPRD in China.

Different Characteristics of Oropharyngeal pH Changes in Different Laryngeal Diseases.

OBJECTIVES: To evaluate the different characteristics of oropharyngeal pH changes in patients with different laryngeal diseases. METHODS: A retrospective analysis was performed. The clinical data of 262 patients were summarized. The patients were divided into 4 groups. Group 1 included 123 patients with suspected laryngopharyngeal reflux disease (LPRD). Group 2 included 45 patients with vocal cord polyps. Group 3 included 40 patients with vocal cord leukoplakia. Group 4 included 54 patients with laryngeal carcinoma. Their reflux symptom indexes (RSIs), reflux finding scores (RFSs), and Dx-pH monitoring results were compared. RESULTS: In total, 235 patients had abnormal RSI/RFS, 90 patients had abnormal Ryan scores. The rate of abnormal RSI/RFS of Group 1 was significantly higher than that of Group 4 (P = .001). Significant differences of the rates of abnormal Ryan scores existed between Groups 2 and 4 (P = .021) and Groups 3 and 4 (P = .027). There were obvious differences in upright Ryan scores between Groups 1 and 2 (P = .013), Groups 1 and 3 (P = .002), Groups 2 and 4 (P = .046), and Groups 3 and 4 (P = .009). There were significant differences in time percentage of oropharyngeal pH of upright 5.5∼6.5 and supine 5.0∼6.5 between Groups 1 and 3 as well as Groups 1 and 4 (upright: Groups 1 and 3: P = .017; Groups 1 and 4: P = .019. Supine: Groups 1 and 3: P = .018; Groups 1 and 4: P = .023). CONCLUSIONS: There were different oropharyngeal pH characteristics in patients with different laryngeal diseases, which indicated laryngopharyngeal reflux may play different roles in different diseases through various patterns. Patients with vocal cord polyps, vocal cord leukoplakia, and laryngeal carcinoma had more and different patterns of oropharyngeal pH change than patients with LPRD. Patients with vocal cord polyps and vocal cord leukoplakia had more severe acid oropharyngeal pH change episodes than patients with laryngeal carcinoma.

Cerebral Blood Flow Pattern Changes in Unilateral Sudden Sensorineural Hearing Loss.

Objective: This study analyzed the differences in the cerebral blood flow (CBF) between unilateral Sudden Sensorineural Hearing Loss (SSNHL) patients and healthy controls (HCs). We also investigated CBF differences in auditory-related areas in patients with left- and right-sided SSNHL (lSSNHL and rSSNHL) and HCs. We further explore the correlation between unilateral SSNHL characteristics and changes in the CBF. Methods: 36 patients with unilateral SSNHL (15 males and 21 females, 40.39 ± 13.42 years) and 36 HCs (15 males and 21 females, 40.39 ± 14.11 years) were recruited. CBF images were collected and analyzed using arterial spin labeling (ASL). CereFlow software was used for the post-processing of the ASL data to obtain the CBF value of 246 subregions within brainnetome atlas (BNA). The Two-sample t-test was used to compare CBF differences between SSNHL patients and HCs. One-way ANOVA or Kruskal-Wallis test was used to compare the CBF difference of auditory-related areas among the three groups (lSSNHL, rSSNHL, and HCs). Then, the correlation between CBF changes and specific clinical characteristics were calculated. Results: The SSNHL patients exhibited decreased CBF in the bilateral middle frontal gyrus (MFG, MFG_7_1 and MFG_7_3), the contralateral precentral gyrus (PrG, PrG_6_3) and the bilateral superior parietal lobule (SPL, bilateral SPL_5_1, SPL_5_2, and ipsilateral SPL_5_4), p < 0.0002. Compared with HCs, unilateral SSNHL patients exhibited increased rCBF in the bilateral orbital gyrus (OrG, OrG_6_5), the bilateral inferior temporal gyrus (ITG, contralateral ITG_7_1 and bilateral ITG_7_7), p < 0.0002. lSSNHL showed abnormal CBF in left BA21 caudal (p = 0.02) and left BA37 dorsolateral (p = 0.047). We found that the CBF in ipsilateral MFG_7_1 of SSNHL patients was positively correlated with tinnitus Visual Analog Scale (VAS) score (r = 0.485, p = 0.008). Conclusion: Our preliminary study explored CBF pattern changes in unilateral SSNHL patients in auditory-related areas and non-auditory areas, suggesting that there may exist reduced attention and some sensory compensation in patients with SSNHL. These findings could advance our understanding of the potential pathophysiology of unilateral SSNHL.

Laryngopharyngeal Reflux in Hypertrophic Laryngeal Diseases.

OBJECTIVES: To evaluate the characteristics of laryngopharyngeal reflux (LPR) in patients with different hypertrophic laryngeal diseases and to explore the relationship between LPR and these diseases. METHODS: A retrospective analysis was performed. The clinical data of 154 patients were collected. According to their diagnoses, patients were divided into 3 groups. Group 1 included 49 patients with vocal cord polyps. Group 2 contained 52 patients with vocal cord leukoplakia. Group 3 included 53 patients with laryngeal carcinoma. The reflux symptom indexes (RSIs), reflux finding scores (RFSs), and Ryan scores of all patients were evaluated and compared. RESULTS: Patients with vocal cord polyps were the youngest of the 3 groups, and those with laryngeal carcinoma were the oldest. A male preponderance emerged in each group. In total, 128 patients (83.12%) had positive RSI/RFS values and 60 (60/146, 41.1%) patients had positive Ryan scores. The positive RSI/RFS rates of both groups 1 and 2 (89.80% and 92.16%, respectively) were significantly higher than that of group 3 (69.81%). Moreover, the positive Ryan score rates in both groups 1 and 2 (39.58% and 53.85%, respectively) were significantly higher than that of group 3 (28.26%). CONCLUSIONS: Laryngopharyngeal reflux occurs in many patients with vocal cord polyps, vocal cord leukoplakia, and vocal cord carcinoma, indicating that LPR may be important in the pathogenesis of these diseases. Laryngopharyngeal reflux occurs more common in patients with vocal cord polyps and leukoplakia and less common in those with laryngeal carcinoma, suggesting the role of LPR on these diseases may be different.

Characteristics of laryngopharyngeal reflux in patients with chronic otitis media.

OBJECTIVE: To summarize the characteristics of laryngopharyngeal reflux (LPR) in patients with chronic otitis media. METHODS: This was a prospective study in which 31 patients with chronic otitis media were enrolled. General patient information, reflux symptom index (RSI), reflux finding scores (RFSs), and Ryan scores were summarized. RESULTS: Most (29/31, 93.5%) patients had a negative RSI (RSI ≤ 13). The most common symptoms of these patients were throat clearing (22/31, 71.0%), symptoms of the stomach and esophagus (19/31, 61.3%), and excess throat mucus or postnasal drip (14/31, 45.2%). In contrast to the RSI, most patients (22/31, 71.0%) had a positive RFS (RFS > 7). Among all of the signs found under the transnasal fiber-optic laryngoscope, erythema was the most frequent symptom (31/31, 100.0%), followed by vocal cord edema (27/31, 87.1%), and posterior commissure hypertrophy (27/31, 87.1%). Most cases (24/31, 77.4%) had a positive Ryan score, and most positive scores were upright scores. CONCLUSIONS: Most patients with chronic otitis media had LPR simultaneously. The LPR in these patients manifested mainly by a positive RFS under a laryngoscope and not by symptoms of the larynx and pharynx. This suggests that LPR may be an important factor in the pathogenesis of COM and anti-reflux treatment may play a significant role in the management of chronic otitis media.

[A study of modified lateral pharyngoplasty for the treatment of obstructive sleep apnea hypopnea syndrome: primary outcomes analysis].

OBJECTIVE: To describe a modified lateral pharyngoplasty with partial transsection of levator veli palatine muscle in patients with obstructive sleep apnea hypopnea syndrome (OSAHS) and report the primary outcomes. METHOD: Retrospective review was performed in sixty patients with OSAHS. All the patients underwent modified surgical procedures, including partial transsection of levator veli palatine muscle and high soft palatoplasty. RESULT: The patients with a reduction of the AHI at least 50% were 6 (6/60, 10%). The patients with a reduction of the AHI at least 50% and a postoperative AHI < 20 were 44 (44/60, 73.3%). The patients with a postoperative AHI < 5 were 10 (10/60, 16.7%). Postoperative complications were postoperative bleeding in two cases (3.3%) and short-term velopharyngeal insufficiency in 10 cases (16.7%). CONCLUSION: Lateral pharyngoplasty with partial transsection of levator veli palatine muscle provides a safe and effective procedure for selected OSAHS patients with oropharyngeal collapse as the main site.

[Etiology and treatment of delayed epistaxis after endoscopic surgery].

OBJECTIVE: To evaluate the etiology and management of delayed epistaxis after endoscopic surgery. METHOD: To retrospectively analyze the clinical data of 11 cases for epistaxis after nasal endoscopic surgery. To compare their precipitating factors, their surgical approach, time and site of bleeding and management in order to find the intrinsic rules. RESULT: The precipitating factors, bleeding sites and treatments varied among patients. CONCLUSION: Delayed epistaxis after endoscopic surgery can not be neglected. There may be some precipitating factors. The surgical approach may be related to the bleeding site. It is better to treat the epistaxis using the endoscope to explore the bleeding site and to give corresponding intervention.

Diagnosis and clinical characteristics of congenital anosmia: case series report.

OBJECTIVE: congenital anosmia is extremely rare and tends to present late. We report on a series of patients with congenital anosmia to analyze its clinical characteristics and present illustrative cases. DESIGN: retrospective chart review. SETTINGS: tertiary care centre. METHODS: thirty-five patients with congenital anosmia were reviewed. A thorough medical history taking, physical examination, and nasal endoscopy were performed in all patients. T&T olfactory testing (n = 33), olfactory event-related potentials (OERPs) (n = 33), and sinonasal computed tomography (CT) (n = 35) were carried out. Magnetic resonance images (MRIs) of the olfactory pathway (n = 34) were available. Serum sex hormones were tested (n = 33). MAIN OUTCOME MEASURES: physical examination, olfactory testing, MRI of the olfactory pathway, and serum sex hormones. RESULTS: twenty cases were isolated congenital anosmia (ICA). Fifteen cases were congenital anosmia with other anomalies, including 12 cases with Kallmann syndrome (KS), two with CHARGE syndrome, and one with hypoplasia of the nasal cavity and nasal sinus. T&T olfactory testing indicated anosmia (n = 33). No OERP was obtained (n = 33). CT scans indicated three abnormal patients, including two with unilateral choanal atresia and one with hypoplasia of the nasal cavity and sinus. MRI demonstrated aplasia or hypoplasia of the olfactory bulbs, tracts, and olfactory sulci (n = 34). Serum sex hormones were low in 12 patients with KS. CONCLUSIONS: early diagnosis of congenital anosmia on the basis of olfactory symptoms is difficult. MRI of the olfactory pathway plays an important role in anatomic location. ICA is the most common congenital anosmia. KS is the primary presentation of congenital anosmia with other anomalies.

[Application of mitomycin in laryngeal surgery].

OBJECTIVE: To investigate the application of mitomycin in laryngeal surgery. METHOD: Retrospective analysis of the clinical data of 48 patients who had vocal cord lesion involving anterior commissure. The treatment of 30 patients treated with microsurgery and external application of mitomycin, while that of the others were only done with microsurgery. RESULT: Among the 30 patients who were treated with microsurgery and mitomycin, only 2 patients of which showed slight adhesion of anterior commissure after surgery. While in the group of microsurgery, there were 6 patients who had adhesion of anterior commissure adhesion after surgery. CONCLUSION: Mitomycin could prevent vocal adhesion after laryngeal surgery.

[The management of space-occupying lesion of middle skull base involving sphenoid sinus by transnasal endoscopic surgery].

OBJECTIVE: To investigate the diagnosis and therapy of space-occupying lesion of middle skull base involving sphenoid sinus. METHOD: A retrospective analysis was performed. Eighteen patients with extradural space-occupying lesion of middle skull base involving sphenoid sinus underwent transnasal endoscopic surgery. RESULT: One case of primary empty sella turcica was misdiagnosed as sphenoidal sinus cyst. One case of fibrous dysplasia and one case of meningioma were all misdiagnosed as mycotic sphenoiditis. Total rate of misdiagnosis was 16.7%. Among the 18 cases, 17 cases underwent complete resection of the lesion, and only 1 case underwent major resection of the lesion. The amount of blood loss during surgery ranged between 100 ml and 2,500 ml. One case had bacterial meningitis which was cured after corresponding treatment. One case was blind in both eyes. And the other case died of pulmonary embolism. CONCLUSION: Transnasal endoscopic surgery is feasible and practical to treat benign space-occupying lesion of sphenoidal sinus and extradural lesion of middle skull base involving sphenoidal sinus. Definite diagnosis, accurate location and careful operation are important to complete the surgery successfully.

Effects of vasopressin on gene expression in rat inner ear.

Vasopressin regulates water excretion from the kidney by increasing water permeability of the collecting duct as a hormone secreted from the posterior pituitary. A clinical study reported that plasma levels of arginine vasopressin were significantly higher in patients suffering from Meniere's disease. It was histologically confirmed that chronic administration of vasopressin induced endolymphatic hydrops in guinea pigs. However, the mechanism of endolymphatic hydrops induced by vasopressin is still unclear. We use cDNA microarray to study the effects of vasopressin on gene expression profiles in rat inner ear to elucidate the possible mechanism of the induced hydrolabyrinth. Wistar rats were intraperitoneally injected with 50 microg/kg arginine vasopressin once a day for one week. Hydrolabyrinth in rat inner ear induced by administration of vasopressin was detected by HE stain. The bullae were dissected out for total RNA extraction. cDNAs were synthesized by reverse transcription and labeled with Cyanine3 (Cy3) or Cyanine5 (Cy5). The BiostarR-40s cDNA microarray was hybridized with the above cDNAs and the changes of mRNA expression intensity were showed by data analysis. Furthermore, the changes of aquaporins expression level were measured by reverse transcription polymerase chain (RT-PCR). Endolymphatic hydrops were present in rats intraperitoneally injected with vasopressin. 226 known differentially expressed genes were screened out in rat inner ear induced by vasopressin injection. Of the 226 genes, 18 transcripts were increased by 5-fold or more, and 7 transcripts were decreased to 0.2-fold or less. Ten differentially expressed genes were identified that associate with cell signal transduction, 14 differentially expressed genes were identified that relate to ion transport, 7 differentially expressed genes were involved in vesicle-mediated transport, and 2 differentially expressed genes were aquaporin 2 (AQP2) and aquaporin 7 (AQP7). The expression level of AQP2 was significantly higher and AQP7 was significantly lower. These results suggest that there are obvious differences in gene expression profiles in inner ear between vasopressin injected rats and normal control rats. Vasopressin may disturb fluid homeostasis in inner ear by way of signal transduction, ion transport, vesicle-mediated transport and aquaporins. It is likely that up-regulated expression of AQP2 mRNA and down-regulated expression of AQP7 mRNA in the rat inner ear caused by vasopressin induce an increased production and a decreased absorption of endolymph, resulting in endolymphatic hydrops.

[Expression and its significance of aquaporins in normal guinea pig inner ears].

OBJECTIVE: To investigate the expression and its significance of aquaporins (AQPs) in normal guinea pig inner ears. METHOD: Ten healthy guinea pigs were used. Immunohistochemistry were employed to detect AQP0, 1, 2, 3, 5, 7, 8 in normal guinea pig inner ears,using rabbit anti-rat polyclonal antibodies. RESULT: AQP0, 1, 2, 3, 5, 7, 8 were all expressed in guinea pig inner ears. AQP0 was only located in stria vascularis and spiral ganglion. The distribution of AQP1 consisted of cells lining the bony labyrinth, fibrocytes lining the endolymphatic duct and sac, cells under the basilar membrane, fibrocytes of the spiral ligament and the spiral limbus,Corti's organ, inner and outer spiral sulcus, stria vascularis, saccular and utricular wall, and spiral ganglion. AQP2 located in stria vascularis, Corti's organ, spiral ganglion and endolymphatic sac. AQP3,7,8 distributed in a similar manner which was surrounding the membranous labyrinth, including Corti's organ, inner and outer spiral sulcus, stria vascularis, fibrocytes of the spiral ligament and the spiral limbus, saccular and utricular wall, endolymphatic sac and spiral ganglion. AQP5 located at Corti's organ, inner and outer spiral sulcus, spiral ganglion, fibrocytes in spiral ligament. CONCLUSION: Diverse AQPs are distributed in the normal guinea pig inner ears,which may co-work to maintain the homeostasis of the inner ear.

Changes in serum and histology of patients with chronic hepatitis B after interferon alpha-2b treatment.

AIM: Chronic hepatitis B is a serious health problem. Interferon has long been used to treat Chronic hepatitis B. To evaluate the effects of interferon on chronic hepatitis B better, we designed the study to investigate the changes in sera and liver histology of patients with chronic hepatitis B after interferon alpha-2b treatment. METHODS: Twenty-four patients with chronic hepatitis B were enrolled in this study. They all received interferon alpha-2b treatment as following: 3 million units, i.m. t.i.w., for 18 weeks. Sera of all patients were obtained respectively for evaluation of ALT, HBsAg, HBcAg, HBeAg, HBV DNA and TIMP-1 before and after interferon treatment, also a liver biopsy pre- and post-treatment was performed for comparison of HAI, HBsAg, HBcAg, HBeAg, TIMP-1 and activated HSC in the liver tissue. RESULTS: Patients who had normalization of serum ALT and seroconversion of HBeAg and/or HBV DNA (blot hybridization) after treatment were defined as responders. The response rate in this study group was 37.5 % (7/24). Compared to pretreatment, the serum HBV DNA and TIMP-1 decreased significantly (P<0.05), so did the HAI, HBcAg, HBeAg, TIMP-1 and activated HSC (P<0.05). CONCLUSION: The significant decrease in HBV DNA in sera, the seroconversion of HBeAg, and the decrease of viral expression in liver indicated that interferon alpha-2b treatment can inhibit viral replication. The normalization of ALT in sera and the improvement of HAI in liver showed that interferon alpha-2b can improve the liver histology of patients with chronic hepatitis B. At the same time, interferon alpha-2b treatment can reduce the TIMP-1 in serum and liver and decrease the number of activated HSC, which may alleviate or inhibit hepatic fibrosis. Although the response rate was unsatisfactory, interferon play a beneficial role on patients with chronic hepatitis B in other respects. We still need further studies to improve the therapy effects.