Janet A. Wilson

Globus Pharyngis, Personality, and Psychological Distress in the General Population

The authors approached 1,158 middle-aged women, who were assessed for the presence of the globus sensation in the prior 3 months. Seventy globus cases (6.0%) were identified. Twenty-eight women with globus and 35 control subjects completed a series of questionnaires designed to assess personality traits and psychological distress. The globus subjects were significantly higher on neuroticism and low on extra-version and had significantly elevated levels of psychological distress, including anxiety, low mood, and somatic concern when compared with the control subjects. Severity of throat symptoms, but not personality or psychological distress scores, predicted the degree of medical help sought for the symptom.

Normal pharyngoesophageal motility

Upper esophageal manometry is technically problematic. Published normal values are, therefore, few and wide ranging, reflecting catheter and recording-system variables, while the reproducibility of measurements and the influence of food consistency have been little studied. In this investigation, 50 healthy volunteers were studied with (1) a 2.8-mm-diameter six-sensor catheter-mounted transducer assembly and (2) a 3.2×7.2-mm sleeve device linked to a computerized recorder with a pressure-sample rate of 32/sec. The study protocol included water, bread, and semisolid swallows. Upper esophageal sphincter (UES) tonic pressures measured with the catheter-mounted assembly were lower and more reproducible than pressures measured with the sleeve system. Compared with water, bread swallows showed greater pharnygeal and sphincter after-contraction pressures, while semisolid swallows had less complete sphincter relaxation. Duration of pharyngoesophageal contractions was greater with bread or semisolid than water. The observations have established normal values for measurements of UES function and, in addition, have shown that (1) catheter variables significantly influence the measurement of upper sphincter tonic pressure, (2) pressures recorded with the catheter-mounted transducer are most reproducible, and (3) pharyngoesophageal motility patterns vary significantly according to the substance swallowed.Upper esophageal manometry is technically problematic. Published normal values are, therefore, few and wide ranging, reflecting catheter and recording-system variables, while the reproducibility of measurements and the influence of food consistency have been little studied. In this investigation, 50 healthy volunteers were studied with (1) a 2.8-mm-diameter six-sensor catheter-mounted transducer assembly and (2) a 3.2×7.2-mm sleeve device linked to a computerized recorder with a pressure-sample rate of 32/sec. The study protocol included water, bread, and semisolid swallows. Upper esophageal sphincter (UES) tonic pressures measured with the catheter-mounted assembly were lower and more reproducible than pressures measured with the sleeve system. Compared with water, bread swallows showed greater pharnygeal and sphincter after-contraction pressures, while semisolid swallows had less complete sphincter relaxation. Duration of pharyngoesophageal contractions was greater with bread or semisolid than water. The observations have established normal values for measurements of UES function and, in addition, have shown that (1) catheter variables significantly influence the measurement of upper sphincter tonic pressure, (2) pressures recorded with the catheter-mounted transducer are most reproducible, and (3) pharyngoesophageal motility patterns vary significantly according to the substance swallowed.

Psychiatric disturbance and personality traits in dysphoric patients

A study of 68 consecutive attendees at a voice clinic revealed that 51 (75%) were female. Personality characteristics and the incidence of minor psychiatric disturbances were studied in the 51 female patients with dysphonia and in 42 female ENT outpatient control subjects. Personality was assessed by use of the Eysenck Personality Questionnaire (EPQ) and the Hysteroid-Obsessoid Questionnaire (HOQ), and psychiatric disturbance was assessed by use of the General Health Questionnaire (GHQ), 60-item version. Whereas the 18 patients who were diagnosed as having psychogenic dysphonia had, overall, a greater degree of mild psychiatric disturbance, the 33 patients whose dysphonia was associated with structural laryngeal abnormality were also significantly more disturbed than control subjects (p < 0.01). There were no significant differences in personality traits among the three groups. Ten of the 18 patients with psychogenic dysphonia had evidence of significant psychiatric symptomatology on GHQ testing. More unexpectedly, one in three of the women with structural laryngeal changes showed similar psychiatric disturbance. Such psychological distress cannot therefore be detected solely on laryngeal appearances and voice characteristics. We propose the GHQ to be a quick, simple screening tool to identify those patients who might benefit from a more psychologically based approach to therapy.

Cholesteatoma following stapedectomy.

Among the possible complications of stapedectomy for otosclerosis, cholesteatoma is extremely rare. We report a case which was secondary to implantation of keratinising squamous epithelium inadvertantly included in the fat graft taken from the ear lobe to seal the footplate.

Effect of Esophageal Acid Exposure on Upper Esophageal Sphincter Pressure

To investigate the relationship between gastroesophageal reflux and upper esophageal sphincter (UES) pressure, total esophageal acid exposure times on 23‐hour ambulatory pH monitoring were compared with UES manometric results in 98 subjects, 85 with laryngopharyngeal symptoms and 13 asymptomatic controls. There was no correlation of acid exposure time with tonic UES pressure nor with any UES wet swallow parameter. The response of the UES to acute upper esophageal acid infusion was assessed in another 13 patients by a sleeve catheter. There was no significant increase of tonic sleeve UES pressure during acid infusion. In contrast to most previous reports, our results indicate that esophageal acid exposure, whether acute or chronic, has little influence on the UES.

The effect of laryngeal irradiation on pharyngoesophageal motility

The upper esophageal sphincter (UES) receives the full radiation dose during external beam radiotherapy to the adjacent larynx. The aim of the study was to assess the effects, if any, of radical laryngeal radiotherapy on motility patterns in the pharyngoesophageal segment. A strain gauge assembly and a digital manometric recorder were used to assess 19 patients 13 to 71 months after irradiation of T1 to T3 glottic cancer to a central dose of 52.5 to 55.7 Gy in 20 daily fractions. Results were compared with those of 23 healthy controls. Tonic lower esophageal sphincter (LES) pressure, distal peristaltic contraction, tonic UES pressure, and eight parameters of pharyngoesophageal dynamics during water and bread swallows were studied. No difference was found between the two groups in tonic LES pressure, peristaltic amplitude, or tonic UES pressure. Water swallow pharyngoesophageal wave velocity was significantly lower in patients than in controls, and the irradiated group also showed a trend toward increased duration of the distal esophageal peristaltic wave. The reduction in upper esophageal wave velocity was associated with the interval following irradiation. The post-treatment interval was also inversely related to the amplitude of UES after-contraction, and associated with an increase in wave duration throughout the pharyngoesophageal segment. A study of 23 laryngectomy specimens, 5 of which had been removed following radiotherapy, failed to identify pathological features in nerves or muscle which characterised previous laryngopharyngeal irradiation. We conclude that laryngeal irradiation has no effect on upper or lower esophageal sphincter tone but causes an increase in wave duration and a reduction in wave velocity in the pharyngoesophageal segment. These changes are independent of age and sex and are not associated with pathological features like the neural degeneration described in the myenteric plexus of irradiated rectum.