Claudia Alessandra Eckley

Laryngeal Electromyography in Adults With Parkinson's Disease and Voice Complaints

Objective: To study the laryngeal electromyography (LEMG) pattern in patients with Parkinsons disease (PD) and vocal complaints.

Salivary Epidermal Growth Factor Concentration in Adults with Reflux Laryngitis

OBJECTIVE: The mechanisms involved in the muco-sal alterations of laryngopharyngeal reflux (LPR) have not been well established. Reports indicate a decrease in the salivary epidermal growth factor (EGF) of patients with reflux esophagitis, but there are no reports of its behavior in LPR. Our objective was to determine the salivary concentration of EGF in adults with LPR. STUDY DESIGN AND SETTING: Salivary EGF concentration of 26 patients with LPR and 20 healthy controls was determined using a commercially available ELISA kit. Patients with LPR were graded according to endoscopic and laryngoscopic criteria. RESULTS: Salivary EGF concentration was significantly lower in the LPR group when compared with controls (P = 0.002). No correlation between the severity of laryngeal findings or esophagitis and salivary EGF concentration could be determined. CONCLUSIONS: The decreased salivary concentration of EGF in adults with LPR suggests that a deficiency in this polypeptide could be associated to the disease.

Doença do refluxo gastroesofágico: análise de 157 pacientes

O refluxo gastroesofagico e o refluxo laringofaringeo sao definidos, respectivamente, como o movimento do conteudo gastrico para dentro do esofago e para dentro da area laringofaringea. Pacientes com Doenca do Refluxo Gastroesofagico (DRGE) tem queixas otorrinolaringologicas como rouquidao, tosse cronica, pigarro, globus faringeo, odinofagia, estridor, disfagia, entre outras, alem de azia. FORMA DE ESTUDO: Clinico retrospectivo. MATERIAL E METODO: Foi realizado um estudo retrospectivo de 157 pacientes portadores de sinais de refluxo laringofaringeo na videolaringoscopia no periodo de marco de 1998 a maio de 2000. Os pacientes foram divididos em tres grupos: refluxo leve, moderado e severo; avaliados segundo a idade, sexo, queixas principais nos diferentes grupos, principal queixa nos diferentes grupos, e segundo queixas digestivas em cada grupo. RESULTADOS E CONCLUSOES: Havia 110 pacientes do sexo feminino e 47 do masculino. A faixa etaria estendia-se de 21 a 85 anos. As queixas principais foram disfonia (69,42%), pigarro (52,86%), globus faringeo (65,60%), azia (33,12%), tosse (18,97%), odinofagia (11,46%), disfagia (10,82%) e engasgos (2,54%). Trinta e quatro pacientes apresentavam RLF leve, 60 moderado e 63 severo. A principal queixa de todos os grupos foi a disfonia, seguida pelo globus para os refluxos leve e moderado, e pigarro para o severo. A queixa gastrica, azia, foi mais frequente nos grupos moderado e severo. Das queixas principais nos diferentes grupos, a disfonia foi a mais frequente nos tres grupos, seguida pelo pigarro e globus faringeo nos grupos de refluxo moderado e severo. A azia esteve presente numa frequencia semelhante nos tres grupos.

Complicações extralaríngeas das cirurgias por laringoscopia direta de suspensão

Although suspension laryngoscopy is routinely used in laryngeal surgery, there are only few studies on the complications of this procedure. AIM: to evaluate the complications outside the larynx following suspension laryngoscopy and analyze their relation with surgery duration. MATERIALS AND METHODS: Thirty-seven procedures were prospectively analyzed for intervention-related complications. The study included patient preoperative and postoperative assessment, focusing on dental, mucosal and nerve status (hypoglossal and lingual nerves). RESULTS: Most procedures (27/37) were associated to some kind of complication, and mucosal injuries were the most common; temporary nerve lesions were observed in five cases and dental injuries in one case. Statistic significance was found between surgery duration and mucosal injury (lesions smaller than 1 centimeter), showing that longer procedure pose higher risks for these complications. CONCLUSION: These findings suggest that suspension laryngoscopy is frequently associated with complications outside the larynx. Although these injuries represent a low risk of significant morbidity, they can be avoided if more accurate techniques are used.

Extra-laryngeal complications of suspension laryngoscopy

UNLABELLED Although suspension laryngoscopy is routinely used in laryngeal surgery, there are only few studies on the complications of this procedure. AIM to evaluate the complications outside the larynx following suspension laryngoscopy and analyze their relation with surgery duration. MATERIALS AND METHODS Thirty-seven procedures were prospectively analyzed for intervention-related complications. The study included patient preoperative and postoperative assessment, focusing on dental, mucosal and nerve status (hypoglossal and lingual nerves). RESULTS Most procedures (27/37) were associated to some kind of complication, and mucosal injuries were the most common; temporary nerve lesions were observed in five cases and dental injuries in one case. Statistic significance was found between surgery duration and mucosal injury (lesions smaller than 1 centimeter), showing that longer procedure pose higher risks for these complications. CONCLUSION These findings suggest that suspension laryngoscopy is frequently associated with complications outside the larynx. Although these injuries represent a low risk of significant morbidity, they can be avoided if more accurate techniques are used.

Is There a Relationship Between the pH and Volume of Saliva and Esophageal pH-metry Results?

There are several implications in the buffer capacity and in the protective role of saliva in gastroesophageal reflux disease (GERD) and other digestive disorders. The lack of knowledge about the production and quality of saliva and the fact that saliva plays an important role in digestive homeostasis motivated the authors to study the relationship between reflux measured by esophageal pH-metry and the pH and volume of saliva in individuals with GERD and its laryngopharyngeal manifestations (LPR). The study was designed as a randomized clinical trial. The studied population consisted of 39 adults with GERD and LPR confirmed by a positive 24-hour double-probe esophageal pH-metry. Unstimulated whole saliva was collected and its pH and volume were compared to pH-metry results. Patients were divided into four groups according to the number of distal episodes of reflux and two groups according to the presence or absence of proximal reflux. A highly significant difference was found between the groups with distal reflux when comparing salivary volume alone and salivary volume/salivary pH. The same occurred for the presence or absence of proximal reflux. These results suggest a direct correlation between salivary volume and “salivary pH × volume” with the number of distal and proximal episodes of reflux on the esophageal pH-metry. If larger studies confirm this finding, in the future it might be possible to diagnose GERD and LPR through a simple “spit test,” avoiding more costly and invasive procedures.

Correlação do pH e volume salivares com sintomas laringofaríngeos

In spite of the great enthusiasm wakened up by the progress of the concepts of the denominated syndrome of the larygopharyngeous reflux (LFR), it is still difficult for the otorrinolaringologist to establish with safety if this illness can be considered in the future as a disease similar to the gastro esophageal reflux. The inflammatory signs in the segment, found in some patient that present phmetry with pH below 4 in the proximal probe can be found in other situations aggressive to the area, not being, therefore, patognomonic of LFR. The conditions of saliva, the volume, clearence and alterations of the eletrolitic conditions can influence the capacity of protection of the regional mucous membrane. AIM: To observe the relationship between the inflammatory symptoms and the pH and volume of saliva. STUDY DESIGN: Observacional cohort with transversal cut. MATERIAL AND METHOD: 59 subjects were studied, with ages varying from 24 to 76 years, with average 50,5 years, being 44 women and 15 men. All the patients answered to a questionnaire on laryngopharyngeous symptoms and they had his/her saliva collected and measured its volume and pH. RESULTS: The median volume of saliva collected in the patients was 4,3 ml, with the minimum of 1,5 and a maximum of 7,5. The median pH was of 7,1, extending from 6 to 8. Of the total of symptoms 31 patients presented dysphonia, 39 throat clearing, 2 dyspnea, 24 halitosis, 4 caseum, 4 recurrent tonsillitis, 6 teeth and gingival problems, 9 oral ulcers, 6 xerostomia, 12 glossodynia, 36 globus pharingeus, 2 odinophagia and 8 dysphagia. The several correlations among pH, volume to salivate and symptoms were observed showing, in some cases, strong positive or negative correlation. CONCLUSION: The pH of saliva, in the dependence of its volume can have strong interference in the laryngopharyngeous inflammatory symptoms.

Estudo da concentração salivar do fator de crescimento epidérmico em indivíduos com laringite crônica por refluxo laringofaríngeo

INTRODUCTION: Gastroesophageal Reflux Disease (GERD) may cause intense inflammation and symptoms in the larynx and pharynx (Laryngopharyngeal Reflux LPR). Studies have not been able to establish a direct link between the refluxed acid and the typical laryngeal findings in LPR. The Epidermal Growth Factor (EGF) is a polypeptide produced by the salivary glands and shown to induce epithelial development, inhibit gastric acid secretion and accelerate wound healing. This factor is decreased in the saliva of patients with reflux esophagitis, but there are no reports of its behavior in LPR. AIM: The objective of this study was to determine the salivary concentration of EGF in adults with LPR compared to normal controls. STUDY DESIGN: Control study. MATERIAL AND METHOD: The salivary EGF concentration of 39 patients with LPR and 20 healthy controls was determined using a commercially available ELISA kit. LPR was diagnosed based on history and typical laryngopharyngeal signs. The 39 patients with LPR were graded according to endoscopic (presence of associated esophagitis) and laryngoscopic criteria (severity of laryngitis). Patients with LPR were also submitted to esophageal manometry and 24-hour double probe pH-metry. RESULTS: Salivary EGF concentration was significantly lower in the LPR group when compared to controls (p= 0,002). No correlation between the severity of laryngeal findings or presence/absence of esophagitis and salivary EGF concentration could be determined. CONCLUSIONS: This study suggests that a decreased salivary concentration of Epidermal Growth Factor could be associated to the pathogenesis of GERD and that this same deficiency could also be related to LPR.

Estudo comparativo do pH e do volume salivar em indivíduos com laringofaringite crônica por doença do refluxo gastroesofágica antes e após o tratamento

INTRODUCAO: A Doenca do Refluxo Gastroesofagico (DRGE) e a doenca digestiva mais prevalente da atualidade e, recentemente, tem sido implicada em uma gama de alteracoes do seguimento laringofaringeo (RLF). No entanto, pouco se sabe dos mecanismos fisiopatologicos destas manifestacoes supraesofagicas da DRGE. Os achados clinicos contraditorios e recentes pesquisas sugerem haver deficiencias na capacidade de defesa deste seguimento. Uma das principais responsaveis pela homeostase da mucosa oral e do trato digestivo e a saliva com seu conteudo orgânico e inorgânico. Tanto alteracoes do pH quanto do volume salivar ja foram correlacionados com os sintomas e sinais sugestivos da DRGE e RLF. Estudo recente de nossa autoria demonstra diminuicao estatisticamente significante do pH salivar de individuos com RLF quando comparado a controles sem a doenca. Outro estudo constatou correlacao entre a reducao do volume X pH da saliva em individuos com DRGE, estando esta reducao diretamente relacionada aos niveis de pH esofagico constatados durante pH-metria esofagica de 24 horas. OBJETIVOS: Avaliar como se comportam o pH e volume da saliva em um mesmo individuo com DRGE e RLF antes e apos o tratamento clinico. MATERIAL E METODO: Vinte e tres pacientes com RLF tiveram o pH e volume da saliva total testados antes e apos receberem tratamento com droga bloqueadora de bomba de protons durante 12 semanas. RESULTADOS: Houve uma diferenca estatisticamente significante (p<0,001) entre o pH da saliva antes e apos o tratamento, estando este maior apos o controle clinico da doenca. O volume de saliva no paciente tratado foi significativamente maior do que no paciente pre-tratamento (p=0.009). DISCUSSAO: Os achados sugerem que o pH salivar e influenciado pela presenca de refluxo gastroduodenal a regiao laringofaringea. Caso estudos futuros com populacoes maiores realmente comprovem esta correlacao, poderemos cogitar a possibilidade de usar a mensuracao do pH salivar, que e feita de forma rapida e nao invasiva, como um meio de diagnosticar e avaliar o comportamento e controle do Refluxo Laringofaringeo.

Comparative study of salivary pH and volume in adults with chronic laryngopharyngitis by gastroesophageal reflux disease before and after treatment

INTRODUCTION Gastroesophageal Reflux Disease (GERD) is the most prevalent digestive disease of the modern society and has been associated with abnormalities in the larynx and pharynx (LPR). Nonetheless, little is known about the mechanisms involved in this atypical form of the disease. Contradictory clinical data suggest a defense deficit at this segment. Saliva with its organic and inorganic components is responsible for the homeostasis of the oral mucosa and the digestive tract. Salivary pH and volume abnormalities have been linked to laryngopharyngeal symptoms of GERD and LPR. In a recent study we demonstrated significant salivary pH reduction in patients with LPR. Another study found correlation between reduced salivary pH and volume directly related to esophageal pH-metry results. AIM To evaluate salivary pH and volume before and after clinical treatment of LPR. MATERIAL AND METHOD Twenty-three adults with LPR had total fasting saliva tested before and after a 12-week course of oral proton pump inhibitor. RESULTS A statistically significant difference was found in salivary pH before and after treatment with increase of pH values after control of the disease (p<0.001). Salivary volumes of treated patients were also significantly higher than in pre-treated patients (p=0.009). DISCUSSION These findings suggest that salivary pH and volume are influenced by the presence of gastroesophageal contents and that salivary pH monitoring can potentially become a cost-effective method for diagnosing and controlling LPR.