Mutsumi Sugiura

To what extent do evaluations of facial paralysis by physicians coincide with self-evaluations by patients: Comparison of the Yanagihara method, the House-Brackmann method, and self-evaluation by patients

Objectives To understand to what extent evaluations of facial paralysis by physicians coincide with self-evaluations by patients. Study Design Prospective clinical study. Patients One hundred thirty-one patients (68 male patients and 63 female patients) with facial paralysis were included in the study. Interventions The relationship between the evaluation of facial paralysis using the Yanagihara system, the House-Brackmann grading system, and self-evaluation by patients was studied. Main Outcome Measures The paralysis scores and grade determined by physicians using the above two systems were well correlated with the self-evaluations by patients. Results The evaluation of subjective symptoms differed among individuals. Even patients who were evaluated as either completely paralyzed or cured according to the Yanagihara and House-Brackmann methods did not always rate their subjective symptoms as being consistent with these scores. Conclusion Evaluations with the two systems correlated significantly with self-evaluations by patients on the whole. These two methods of evaluation are considered appropriate not only for physicians but also for patients. In contrast, some discrepancies were observed. This point should be taken into account in routine patient care.

Value of barium swallow studies in predicting the response to rabeprazole in elderly patients with laryngopharyngeal reflux disease and nonerosive reflux disease in particular.

Objectives Laryngopharyngeal reflux disease (LPRD) is an important cause of throat discomfort in the elderly. Our objective was to investigate the usefulness of barium swallow studies for the diagnosis of LPRD. Methods The subjects were 59 patients at least 60 years of age with LPRD suspected on laryngoscopy findings. We evaluated esophageal clearance using a barium swallow study and the upper gastrointestinal tract endoscopic findings of gastroesophageal reflux disease according to the revised Los Angeles classification, and correlated these findings with the effect of rabeprazole, a proton pump inhibitor. Results Among subjects with positive reflux findings in the esophageal phase of the barium swallow, rabeprazole was significantly effective (p = 0.0025). To identify nonerosive reflux disease, we analyzed the 50 cases with a negative Los Angeles classification of upper gastrointestinal tract endoscopic findings. Rabeprazole was again significantly effective in patients with positive findings for esophageal reflux (p = 0.0025). Conclusions Among elderly patients with suspected LPRD, there was a positive correlation between impaired esophageal clearance on the barium swallow study and the effectiveness of rabeprazole. The barium swallow study could be a screening test for LPRD in elderly patients with throat discomfort.