Tom I. Abelson

The Prevalence of Hypopharynx Findings Associated with Gastroesophageal Reflux in Normal Volunteers

Routine laryngeal examination of patients with otolaryngologic complaints often reveals findings thought to result from gastroesophageal reflux. The direct association between these mucosal findings and uncontrolled reflux is not well established. To begin exploring the specificity of tissue signs, 105 normal, healthy, adult volunteers were examined by routine video fiber-optic endoscopy for the presence of findings attributed to reflux disease. Medical conditions, lifestyle factors, and ENT complaints were surveyed to reveal potential airway irritants, while the study design attempted to eliminate silent reflux. The majority of subjects (86%) had findings associated with reflux and certain signs reached a prevalence of 70%. Prevalence was not affected by ENT complaint, smoking, alcohol, or asthma. Intraexaminer and interexaminer agreement information is provided. The traditional attribution of hypopharynx irritation signs to reflux is challenged; the need for improved diagnostic specificity is highlighted.

Laryngeal Signs and Symptoms and Gastroesophageal Reflux Disease (GERD): A Critical Assessment of Cause and Effect Association

Gastroesophageal reflux disease (GERD) has been associated increasingly with ear, nose, and throat (ENT) signs and symptoms. However, the cause and effect relationship between these two clinical entities are far from established. Many patients diagnosed initially with GERD as the cause of laryngeal signs do not symptomatically or laryngoscopically respond to aggressive acid suppression and do not have abnormal esophageal acid exposure by pH monitoring. This has resulted in frustration on the part of both gastroenterologists and ENT physicians and confusion on the part of patients. In this article we discuss the reasons for this controversy and highlight the recent data attempting to clarify this complex area.

Laryngopharyngeal reflux: prospective cohort study evaluating optimal dose of proton-pump inhibitor therapy and pretherapy predictors of response.

Purpose: Laryngopharyngeal reflux (LPR) is frequently treated with empiric proton‐pump inhibitors (PPI), but the optimal dosing and duration is unknown. We performed an open label prospective cohort study to evaluate whether twice‐daily (BID) PPI is more effective than once‐daily (QD) PPI for the treatment of LPR.

Prevalence of laryngeal irritation signs associated with reflux in asymptomatic volunteers: impact of endoscopic technique (rigid vs. flexible laryngoscope).

Objectives: The objectives of this study were to 1) determine the prevalence of ENT findings in the normal asymptomatic population and 2) to compare findings between flexible and rigid laryngoscopes in an attempt to increase specificity of diagnosis of reflux in endoscopic laryngeal examinations.

Intracapsular tonsillar reduction (partial tonsillectomy): reviving a historical procedure for obstructive sleep disordered breathing in children

OBJECTIVE We sought to reintroduce a historical procedure-intracapsular tonsillar reduction (partial tonsillectomy or tonsillotomy)-for tonsillar hypertrophy causing obstructive sleep disordered breathing (OSDB) in children, as well as to determine whether partial tonsillectomy, compared with conventional (total) tonsillectomy when performed by more than one surgeon, is equally effective for the relief of OSDB while resulting in less pain and more rapid recovery. STUDY DESIGN We conducted a retrospective case series at a tertiary childrens hospital. The charts of children who underwent partial tonsillectomy and total tonsillectomy (1998 through 2002) for postoperative complications were reviewed. The caregivers were surveyed to assess postoperative pain, rapidity of recovery, and effectiveness of surgery for relieving symptoms of OSDB. RESULTS Two hundred forty-three children underwent partial tonsillectomy and 107 children underwent total tonsillectomy. There were no significant differences in immediate and delayed complications between the groups. Both operations were equally effective in relieving OSDB. Children who had partial tonsillectomy had significantly less postoperative pain and significantly more rapid recovery. CONCLUSION Intracapsular tonsillar reduction with an endoscopic microdebrider relieves OSDB as effectively as conventional tonsillectomy, but results in less postoperative pain and a more rapid recovery.

Correlation between Symptoms and Laryngeal Signs in Laryngopharyngeal Reflux

Objective/Hypothesis: Laryngopharyngeal reflux (LPR) is diagnosed by the presence of laryngeal signs and symptoms. Some studies have noted that signs and symptoms may be nonspecific and may have poor correlation. However, many such studies were either observational or had short‐term follow‐up. Therefore, we conducted subgroup analysis of a prospective concurrent controlled study with a 1 year follow‐up to study the correlation between signs and symptoms.

Chronic Laryngitis Associated with Gastroesophageal Reflux: Prospective Assessment of Differences in Practice Patterns Between Gastroenterologists and ENT Physicians

OBJECTIVES:Ear, nose, and throat (ENT) physicians often diagnose gastroesophageal reflux disease (GERD)-related laryngitis on the basis of symptoms and laryngeal signs; and may refer patients to gastroenterologists who contend that many such patients do not have reflux. Because of this dichotomy we designed this study to assess the practice pattern differences among ENT physicians and gastroenterologists in relation to the diagnosis and treatment of patients with GERD-related laryngitis.METHODS:Separate surveys were specifically designed for ENT physicians and gastroenterologists to assess the following: the percentage of patients diagnosed with GERD-related laryngitis, dose and duration of therapy, treatment response, and other diagnostic options in nonresponders. A total of 2000 surveys were mailed randomly to members of both the American Academy of Otolaryngology Head and Neck Surgery and the American Gastroenterological Association.RESULTS:Of the total 4,000 surveys sent, 782 (39%) ENT physicians and 565 (28%) gastroenterologists responded. Most respondents (both specialties) were private practitioners (82% and 74%, respectively). From the ENT survey, the diagnosis was most commonly suspected based on the following symptoms: globus = throat clearing > cough > hoarseness. The most useful signs were laryngeal erythema and edema reported by 70% of respondents. Seventy-four percent of ENT physicians reported they made the diagnosis more on symptoms than on laryngeal signs, and initiated therapy most often with proton pump inhibitor (PPI) once daily for 2 months. Gastroenterologists were divided on pre-therapy testing, 50% reporting testing with esophagogastro-duodenoscopy followed by pH monitoring (distal > proximal) prior to therapy, while the remaining 50% reported treating empirically with PPI twice daily for 3 months. Seventy percent of gastroenterologists reported treatment response of less than 60%, while 62% of ENT physicians reported response rate of greater than 60% (p < 0.05).CONCLUSIONS:(1) Globus and throat clearing were considered the most useful symptoms in diagnosing GERD-related laryngitis, while laryngeal erythema and edema were considered the most useful signs for diagnosis and treatment of this condition by ENT physicians. However, these symptoms and signs may represent the least specific markers for reflux. (2) Many gastroenterologists perform pre-therapy testing which has low sensitivity in GERD-related laryngitis. (3) There is a dichotomy in treatment dose, duration, and perceived patient response to therapy between the two specialists. (4) Our study highlights a need for cross communication and education between these two disciplines in understanding and treating GERD-related laryngitis better.

Long‐term Effects of Micronized Alloderm Injection for Unilateral Vocal Fold Paralysis

Objectives: Micronized Alloderm (Cymetra) is a relatively new product used for vocal fold augmentation. Previous studies evaluating possible long‐term effectiveness of this product have shown mixed results. The objective of this present study is to reassess possible long‐term results of Cymetra injection laryngoplasty in patients with unilateral true vocal fold paralysis.

Laryngeal Findings in Superior Laryngeal Nerve Paralysis: A Controversy

The diagnosis of superior laryngeal nerve paralysis is infrequently made because of disagreement concerning the laryngeal findings in unilateral cricothyroid muscle dysfunction. Results of experimental unilateral superior laryngeal nerve paralysis in dogs and humans are shown with a review of the literature. The findings are documented by electromyographic studies and laryngeal photographs, and serve to clarify aspects of the functional anatomy of the cricothyroid muscle and the cricoid and thyroid cartilages.