RESUMO
To study the relationship between laryngopharyngeal reflux (LPR) and gastroesophageal reflux disease (GERD) using clinical scoring and endoscopy. Data was collected from a sample of 100 patients with GERD symptoms who presented to ENT out-patient department, for a duration of 2 years. Patients were evaluated using Reflux Symptom Index (RSI) questionnaire and Reflux Finding Score (RFS). All patients underwent videolaryngoscopy and upper gastrointestinal endoscopy. Patient with positive findings underwent treatment with proton pump inhibitors and were followed up for 3 months. Out of 100 patients, 23 had LPR, 19 had GERD, 40 had LPR + GERD, 18 were normal. Among the LPR group, the predominant symptoms were hoarseness of voice, globus sensation and heartburn. Majority of GERD group had globus sensation, dysphagia and heartburn as their predominant symptoms. On laryngoscopy, in both LPR and LPR + GERD group, most common finding was interarytenoid erythema and vocal cord edema. On esophagogastroduodenoscopy, in both GERD and LPR + GERD group, esophagitis was the most common finding. RSI value was highest in patients with LPR + GERD. RFS value was high in LPR group followed by groups of LPR + GERD and GERD. RSI and RFS are easily administered, highly reproducible, low cost clinical scoring symptom questionnaire which can identify the patients with LPR. 82.6% of LPR patients had significant RFS scoring but with no significant findings in OGD. This study also illustrates the importance of PPI therapy in LPR patients with no evidence of GERD.
RESUMO
Vascular headache and chronic rhinosinusitis (CRS) are diseases that share similar symptoms and demographics, including headache, facial pain and nasal symptoms. Contribution of chronic sinusitis as a cause of chronic headache is controversial, as there are scarce studies to know incidence of vascular headache in patients with CRS. To evaluate incidence of vascular headache in patients with CRS. Using descriptive study design, group of 100 patients with symptoms of CRS with headache were included in study. Patients underwent surgical management and 3% managed medically. Patients were assessed for associated factors with headache and further evaluated for persistence of headache postoperatively. Inferential statistics was done by Chi square test using SPSS for Windows Software (Version 21.0). Leading symptoms of CRS were headache (100%), nasal obstruction (93%), and nasal discharge (90%). Pre-treatment 25% had exposure to sunlight as aggravating factor and associated nausea vomiting in 30%. Post-treatment, follow-up at 6 months, 20% reported persisting headache, with duration of headache >1 year in 37.5% (p = 0.01). Those with pre-operative sunlight exposure as aggravating factor, headache persisted in 60% (p < 0.0001) and those with nausea/vomiting pre-treatment; headache persisted in 56.7% (p < 0.0001). These results were statistically significant. In CRS patients who had other factors contributing to headache like duration of headache more than 1 year, associated nausea/vomiting, and aggravating factors like exposure to sunlight, headache persisted after medical and surgical treatment of CRS. It signifies that 20% CRS patients with headache were having co existing vascular headache.
RESUMO
Lemierre's syndrome is an acute oropharyngeal infection with secondary septic thrombophlebitis of the internal jugular vein and frequent metastatic infections. Despite its rarity, it is important to have a high degree of clinical suspicion to recognise it early. A history of sore throat followed by metastatic infections and abscesses should alert the clinician to the possibility of this unusual infection. We present a case of Lemierre's syndrome presenting with meningitis in a previously healthy young adult along with a review of the pathophysiology of necrobacillosis and its diagnosis, diagnostic difficulty and treatment.
