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This study aimed to investigate the change in the incidence and variance of otorhinolaryngologic diseases during the coronavirus disease 19 (COVID-19) pandemic. The entire Korean population (~50 million) was evaluated for the monthly incidence of 11 common otorhinolaryngologic diseases of upper respiratory infection (URI), influenza, acute tonsillitis, peritonsillar abscess, retropharyngeal and parapharyngeal abscess, acute laryngitis and bronchitis, stomatitis and related lesions, acute sinusitis, rhinitis, otitis media, and dizziness from January 2018 through March 2021 using the International Classification of Disease (ICD)-10 codes with the data of the Korea National Health Insurance Service. The differences in the mean incidence of 11 common otorhinolaryngologic diseases before and during COVID-19 were compared using the Mann-Whitney U test. The differences in the variance of incidence before and during COVID-19 were compared using Levene's test. The incidence of all 11 otorhinolaryngologic diseases was lower during COVID-19 than before COVID-19 (all p < 0.05). The variations in disease incidence by season were lower during COVID-19 than before COVID-19 for infectious diseases, including URI, influenza, acute tonsillitis, peritonsillar abscess, retropharyngeal and parapharyngeal abscess, acute laryngitis and bronchitis, acute sinusitis, and otitis media (all p < 0.05), while it was not in noninfectious diseases, including stomatitis, rhinitis, and dizziness. As expected, the incidences of all otorhinolalryngolgic diseases were decreased. Additionally, we found that seasonal variations in infectious diseases disappeared during the COVID-19 pandemic, while noninfectious diseases did not.

Objectives: Acute laryngitis is a common disease with self-limiting nature. Since the leading cause is attributed to viral infections and thus self-limiting, many affected individuals do not seek professional medical help. However, because the major symptom of hoarseness imposes a substantial burden in everyday life, it might be speculated that web-based search interest on this condition follows incidence rates, with highest peaks during winter months. The aim of this study was to evaluate global public health-information seeking behaviour on laryngitis-related search terms., Methods: We utilized Google Trends to assess country-specific, representative laryngitis-related search terms for English and non-English speaking countries of both hemispheres. Extracted time series data from Australia, Brazil, Canada, Germany, the United Kingdom, and the United States of America, covering a timeframe between 2004 and 2019 were first assessed for reliability, followed by seasonality analysis using the cosinor model., Results: Direct comparisons revealed different, representative laryngitis-related search terms for English- and non-English speaking countries. Extracted data showed a trend of higher reliability in countries with more inhabitants. Subsequent graphical analysis revealed winter peaks in all countries from both hemispheres. Cosinor analysis confirmed these seasonal variations to be significant (all P < 0.001)., Conclusion: Public interest in laryngitis-related, online health information displayed seasonal variations in countries from both hemispheres, with highest interest during winter months. These findings emphasize the importance to optimize the distribution of reliable, web-based health education in order to prevent the spread of misinformation and to improve health literacy among general populations., (Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: To improve the diagnosis of laryngeal disease in patients with gastroesophageal reflux disease (GERD)., Material and Methods: 171 patients (89 (52%) men, 82 (48%) women) with non-erosive (39 (23%) people) and erosive (132 (77%) people) forms of GERD were examined. None of the patients made active complaints about the condition of the larynx and pharynx. The examination included a questionnaire, examination by an otorhinolaryngologist, and videoendolaryngoscopy., Results: The survey revealed the presence of symptoms of otorhinolaryngological pathology in 74% of patients. Videolaryngoscopy revealed no laryngeal pathology in 55 (32%) patients, and signs of GERD-associated laryngitis were detected in 116 (68%) patients. The most common pathology was pachydermia in interarytenoid region - in 89 people, laryngeal granuloma was detected in 7 patients, leukoplakia - in 2 patients, chronic edematous polypous laryngitis - in 2 patients, benign laryngeal formations - in 9 patients. In patients with GERD (erosive and non-erosive forms), an asymptomatic course of chronic laryngitis associated with this pathology was observed in 44% of cases. In 52% of patients, pachydermia in interarytenoid region was diagnosed, of which every second had pronounced hyperplasia and folding of the mucous membrane in interarytenoid region, which must be differentiated from laryngeal cancer (in this case, patients should be under the dynamic supervision of an otorhinolaryngologist). Other precancerous formations of the larynx (granulomas and leukoplakia) were found in 5% of patients. Benign neoplasms of the larynx (polyps and cysts) were also detected in 5% of cases., Conclusions: Despite the high frequency of detection of otorhinolaryngological diseases in the examined patients with gastroesophageal reflux disease, none of the patients presented complaints related to the pathology of the larynx, which indicates the need for active detection of this pathology in this category of patients by questioning, questioning, as well as examination by an otorhinolaryngologist.

Objective: The objective of this study is to evaluate the impact of social distancing resulting from COVID-19 in hospitalizations for infections of the upper airways (URTI), such as acute laryngitis, tracheitis, and otitis media in children aged 0 to 9 years in Brazil, considering that they share the same forms of transmission., Methods: Data on hospitalizations for acute airway changes and their complications in children <9 years old were obtained from the Database of the Brazilian Department of Public Health Informatics for the period 2015 to 2020. These data were also analyzed by macroregions of Brazil (North, Northeast, Southeast, South, and Midwest). The effect of the social distancing strategy on the increase of acute laryngitis, tracheitis, otitis media, and mastitis, as absolute and relative reductions, was calculated by analyzing the annual calculation of 2015-2019 vs 2020., Results: All the hospitalizations compared in the Unified Health System (SUS) for laryngitis and acute tracheitis and otitis media decreased, considering all states of Brazil. The largest reduction in hospitalization reduction was in the North, with -94% in 2015-2019 vs 2020 in cases of laryngitis and acute tracheitis, and in the Midwest, with - 85% in 2015-2019 vs 2020 in cases of otitis media., Conclusion: Hospitalizations for laryngitis, acute tracheitis, and acute otitis media in children <9 years old decreased between March and July 2020 in Brazil, when social distancing measures were adopted due to the COVID-19 pandemic.

Background: Whether herpes zoster infection (HZI) affects laryngitis incidence remains unknown., Objective: The purpose of this population-based retrospective study was to analyze the relationship between laryngitis and HZI using data from the Korean Health Insurance Review and Assessment Service-National Sample Cohort., Methods: This study analyzed 1,197,093 medical claim codes from 2018. Patients with HZI (ICD-10: B02) were retrospectively identified. Laryngeal diseases were defined by ICD-10 codes for five subgroups: 1) malignant disease, 2) benign disease, 3) vocal cord palsy, 4) inflammatory disease, and 5) reflux disease., Results: Among the Korean population older than 20 years, 12,809 experienced HZI. Subjects with HZI were more likely to be older (mean age: 51.54 years vs. 48.06 years, p <0.0001). The proportion of subjects with laryngeal disease was higher in those with HZI than in those without HZI (55.55% vs. 41.37%, p <0.0001). Laryngeal disease was significantly associated with HZI in multiple regression analysis (odds ratio (OR) = 1.77, 95% confidence interval: 1.71-1.84) after adjusting for age, sex, hypertension, diabetes, dyslipidemia, ischemic heart disease, cerebral stroke, and depression. Among laryngeal disease subgroups, inflammatory disease (OR = 1.05; 95% CI: 1.01-1.09) and reflux (OR = 1.20; 95% CI: 1.15-1.25) were associated with HZI., Conclusions: HZI is independently associated with laryngitis. Results of this study have implications for etiological investigations and prevention strategies for laryngitis., Competing Interests: NO authors have competing interest.

Objectives: Infection with herpes simplex virus (HSV) typically causes limited oral and genital symptoms, however HSV can also affect the larynx and result in severe aerodigestive symptoms. Due to the rarity of HSV laryngitis, the symptoms and clinical course of are not well understood. This study aims to more completely characterize HSV laryngitis in order to aid clinicians in understanding and recognition of HSV laryngitis., Methods: Comprehensive literature search of MEDLINE, EMBASE, and Cochrane Database of Systematic Reviews to identify articles relating to HSV laryngitis. Patient demographics, presenting signs and symptoms, treatment and clinical course were extracted from the selected manuscripts., Results: There were 31 studies on HSV laryngitis that identified 36 patients (17 pediatric, 19 adult). The average age for pediatric patients was 11 months (9 M, 8F) and 52 years for adults (11 M, 8F). In the pediatric population, stridor was more common at presentation in comparison to the adult population (p < .01). Adults more commonly presented with dysphagia (p = .03) and dysphonia (p < .01) Adult patients were significantly more likely to undergo tracheotomy than pediatric patients (p = .047). The mean length of inpatient hospital stay was 21.2 days in pediatric patients and 15.8 days for adult patients., Conclusion: HSV laryngitis has a unique presentation in pediatrics and adults, but is nonspecific in both populations leading to delays in diagnosis and treatment. HSV laryngitis is associated with significant morbidity including multi-week hospital stay and risk for needing tracheostomy in both adults and pediatric population which demonstrates need for clinical awareness of this complication of HSV infection., (Copyright © 2020. Published by Elsevier B.V.)

Laryngeal inflammation causes not only benign diseases of the larynx, such as laryngitis and granuloma, but also malignancy. Dietary factors are known to control or modulate the inflammatory reaction in the body. To date, the association between laryngeal inflammation and dietary factors has not been reported using nationwide population-based data. The aim of this study was to analyze the association between several dietary factors and inflammatory laryngeal disease in the Korean population. This study analyzed the data from Korean National Health and Nutrition Examination Surveys which is cross-sectional nationwide-population-based study. Association between the dietary nutrient intake and the prevalence of inflammatory laryngeal diseases was analyzed in 21,116 participants who underwent a laryngoscopy and filled in the dietary intake questionnaires. Of the 21,116 participants included in the analysis, 758 (3.59%) were diagnosed with inflammatory laryngeal disease. Prevalence of inflammatory laryngeal disease was higher in men (4.58%) than in women (2.84%). The mean age of patients was 53.77 years. When analyzing the risk using propensity score matching, ILD group tend to consume more coffee and to intake less fiber and iron than normal group. On Logistic regression analysis, an increased intake of carbohydrate, fiber, and iron was associated with lowered risk of having ILD in female. The association between inflammatory laryngeal disease and dietary factors was prominent in the group aged ≥50 years and female. Increased intake of fiber, iron, and vitamin A were associated with lower risk in the group aged ≥50 years. In female, increased intake of fiber, iron were associated with lower risk of having ILD. In the group aged ≤50 years, only an increased consumption of makgeolli, Korean traditional rice wine, was associated with a higher risk of ILD., Competing Interests: The authors have declared that no competing interests exist.

Introduction: Herpes zoster laryngitis (HZL) is a recently recognized rare disease, easily mistaken for common viral laryngopharyngitis. There are only a few case reports in the English literature. No study has evaluated the clinical characteristics of HZL. In this study, we analyzed the clinical characteristics of HZL and compared them to those of Ramsay Hunt syndrome (RHS)., Materials and Methods: Seventy-three patients who were initially diagnosed with HZL or RHS were enrolled in this study. Their medical records, including laryngoscopic findings, were analyzed retrospectively. The demographic factors, cranial nerve involvement, and recovery rate of both groups were evaluated., Results: Sixty patients in the non-HZL group and 13 patients in the HZL group were analyzed. Five more patients in the non-HZL group were newly identified with HZL during the retrospective chart review. The mean age of the patients in the HZL group was higher than that of the non-HZL group (p = 0.016). The prevalence of hypertension was higher in the HZL group (p = 0.012). Patients with multiple cranial nerve involvement were more common in the HZL group (p < 0.001). In addition, the prognosis of facial weakness (p = 0.002) and multisensory dizziness (p = 0.006) was poor in HZL group., Conclusion: This study showed that a considerable proportion of HZL cases were misdiagnosed or overlooked if not suspected. Considering the poor prognosis of HZL patients with facial paralysis and dizziness, HZL should be diagnosed earlier and treated properly.

Background: Although breastfeeding is touted as providing many health benefits to infants, some aspects of this relationship remain poorly understood., Methods: The Environmental Determinants of Diabetes in the Young (TEDDY) is a prospective longitudinal study that follows children from birth through childhood, and collects data on illness events, breastfeeding duration, and time to introduction of formula or foods at 3 month intervals up until 4 years of age and at 6 months intervals thereafter. Exclusive and non-exclusive breastfeeding is examined in relation to the 3-month odds of a respiratory or gastrointestinal infection for 6861 children between the ages of 3-18 months, and 5666 children up to the age of 4 years. Analysis was performed using logistic regression models with generalized estimating equation methodology. All models were adjusted for potential confounding variables., Results: At 3-6 months of age, breastfeeding was found to be inversely associated with the odds of respiratory infections with fever (OR = 0.82, 95% CI = 0.70-0.95), otitis media (OR = 0.76, 95% CI = 0.62-0.94), and infective gastroenteritis (OR = 0.55, 95% CI = 0.46-0.70), although the inverse association with respiratory illnesses was observed only for girls during the winter months. Between 6 and 18 months of age, breastfeeding within any 3 month period continued to be inversely associated with the odds of ear infection and infective gastroenteritis, and additionally with the odds of conjunctivitis, and laryngitis and tracheitis, over the same 3 month period within this age range. However, breastfeeding in this group was associated with increased reports of common cold. Duration of exclusive breastfeeding was inversely associated with the odds of otitis media up to 48 months of age (OR = 0.97, 95% CI = 0.95-0.99) after breastfeeding had stopped., Conclusions: This study demonstrates that breastfeeding can be protective against multiple respiratory and gastrointestinal acute illnesses in some children up to at least 6 months of age, with duration of exclusive breastfeeding being somewhat protective of otitis media even after breastfeeding has stopped., Trial Registration: ClinicalTrials.gov Identifier: NCT00279318 . Date of registration: January 17, 2006 (proactively registered). First Posted: January 19, 2006.

Purpose: The study analysed the presence of HPV in samples tissue from laryngeal chronic hyperplastic inflammation, with and without pre-neoplastic potential, and from squamous cell carcinoma of the larynx. The aim of this analysis was to evaluate the presence/absence of different types of HPV and their relationship to the clinical profile of the patients studied (habit of smoking and drinking)., Methods: Sixty cases were randomly selected from patients undergoing surgical treatment of the larynx for inflammatory/ neoplastic lesions and of neck nodes. Patients underwent standard clinical workup, comprising medical history and physical examination, panendoscopy, whole-body CT scan (in cancer patients), diagnostic or therapeutic microlaryngoscopy with laryngeal biopsy, and HPV evaluation., Results: The HPV analysis showed an increased risk for heavy smokers of HPV positivity, as well as precancer lesions and cancer. Type 6 and 16 seem to be prevalent in all types of laryngeal mucosa disease, but pre-neoplastic conditions versus cancer seem to show a wider variety of HPV infections while cancer patients are invariably affected by types 6 and 66. Heavy smoking is related to HPV infection likewise alcohol in association with smoking. Advanced T is more associated with HPV positivity., Conclusions: These data impose a closer follow-up of smokers and pre-neoplastic cases and the utility of the broadspectrum polymerase chain reaction assay in laryngeal dysplastic and cancer lesions. This study may allow to develop biomarkers for early detection or recurrence surveillance, to identify therapeutic targets, and to begin individualization of treatment based on the biology of these tumours., Key Words: HPV infection, Larynx, Laryngeal chronic hyperplastic inflammation, Squamous cell carcinoma.

Objectives: Chronic bacterial infection of the larynx is characterized by long-standing hoarseness and exudative laryngitis. Prolonged antibiotic therapy is required to clear the infection, and methicillin-resistant staphylococcus aureus (MRSA) may be the responsible pathogen. The objective of this study was to describe the presentation, comorbidities, treatment response, and underlying etiology- including the incidence of MRSA-in our patient population with chronic bacterial laryngitis., Methods: A review of patients with a diagnosis of chronic bacterial laryngitis from 2012 to 2016 was performed. Diagnosis of chronic bacterial laryngitis was based on clinical history and findings on flexible laryngoscopy. In selected cases, the diagnosis of bacterial laryngitis was confirmed by operative biopsy. Information regarding clinical presentation and course was collected., Results: Twenty-eight patients were included in the study. Twenty-three were treated empirically with Amoxicillin-clavulonic acid for a minimum of 21 days. Twelve of the 23 (52%) had recurrence or nonresolution of infection. Seven of the 12 nonresponders (58%) were found to have MRSA by laryngeal tissue culture. Five patients were treated initially with Sulfamethoxazole and trimethoprim, and all resolved the infection without the need for further treatment. There was a nonstatistically significant increase in smoking and reflux in the MRSA population compared to the non-MRSA group., Conclusion: MRSA infection was documented in 30% of patients overall with chronic bacterial laryngitis. Based on the results of the study, a treatment algorithm for management of this unusual patient population is suggested., Level of Evidence: 4. Laryngoscope, 128:921-925, 2018., (© 2017 The American Laryngological, Rhinological and Otological Society, Inc.)

This study aimed to identify a broad spectrum of respiratory pathogens from hospitalized and not-preselected children with acute respiratory tract infections in the Farhat Hached University-hospital of Sousse, Tunisia. Between September 2013 and December 2014, samples from 372 children aged between 1 month and 5 years were collected, and tested using multiplex real-time RT-PCR by a commercial assay for 21 respiratory pathogens. In addition, samples were screened for the presence of Streptococcus pneumoniae 16S rDNA using real-time PCR. The viral distribution and its association with clinical symptoms were statistically analyzed. Viral pathogens were detected in 342 (91.93%) of the samples of which 28.76% were single positive and 63.17% had multiple infections. The most frequent detected viruses were rhinovirus (55.64%), respiratory syncytial virus A/B (33.06%), adenovirus (25.00%), coronavirus NL63, HKU1, OC43, and 229E (21.50%), and metapneumovirus A/B (16.12%). Children in the youngest age group (1-3 months) exhibited the highest frequencies of infection. Related to their frequency of detection, RSV A/B was the most associated pathogen with patient's demographic situation and clinical manifestations (p<0.05). Parainfluenza virus 1-4 and parechovirus were found to increase the risk of death (p<0.05). Adenovirus was statistically associated to the manifestation of gastroenteritis (p = 0.004). Rhinovirus infection increases the duration of oxygen support (p = 0.042). Coronavirus group was statistically associated with the manifestation of bronchiolitis (p = 0.009) and laryngitis (p = 0.017). Streptococcus pneumoniae DNA was detected in 143 (38.44%) of tested samples. However, only 53 samples had a concentration of C-reactive protein from equal to higher than 20 milligrams per liter, and 6 of them were single positive for Streptocuccus pneumoniae. This study confirms the high incidence of respiratory viruses in children hospitalized for acute respiratory tract infections in the Sousse area, Tunisia.

Gastroesophageal reflux disease encompasses a wide spectrum of disorders related to the reflux of gastric contents into the esophagus. Extraesophageal reflux (EER) may be suspected in patients with unexplained chronic cough, pharyngolaryngeal symptoms, and asthma. For physicians, suspected EER is challenging as there is currently no tool that can reliably make a definitive diagnosis. Endoscopic signs are not specific, pharyngeal and proximal reflux monitoring are not reliable, and if distal pH or pH-impedance monitoring can identify patients with abnormal reflux, they cannot predict the response to therapy. Controlled randomized trials have failed to reliably demonstrate any benefit of high-dose proton-pump inhibitors over placebo in patients with laryngeal symptoms, chronic cough, and asthma. Overall, the role of gastroesophageal reflux has been largely overestimated in patients with suspected EER. Especially when proton-pump inhibitors failed to improve symptoms, other diagnosis should be considered, such as functional laryngeal disorders which are probably much more prevalent in these patients than pathologic gastroesophageal reflux.

Objective: Voice disorders are common conditions that may have a significant impact on patient quality of life, yet their prevalence and epidemiology are poorly documented. In this study, we estimated the prevalence, demographics, and occupation of patients with dysphonia., Methods: Using the Commercial and Medicare MarketScan databases of 146.7 million lives (2008-2012), the prevalence of dysphonia was estimated. Patient demographics and industry occupation were evaluated. Prevalence estimates overall and by industry were made using Medical Expenditure Panel Survey. Industry estimates were compared with US government employment statistics to assess differences between dysphonia and the general population., Results: A gradual increase in the diagnosis of dysphonia was noted from 1.3% to 1.7% of the population from 2008 to 2012, with an associated increase in the diagnosis of acute laryngitis, the largest diagnostic category. A strong correlation was present between diagnosis and age, with acute laryngitis more common in the younger populations and malignancies in older ages. Benign neoplasms were more prevalent in the service industry, with 2.6 times increased likelihood compared with the general population, and malignancies were more prevalent in the manufacturing industry, with 1.4 times increased likelihood. Almost 3 million laryngoscopies and stroboscopies were performed with $900 million in costs., Conclusion: Prevalence rates of the diagnosis of dysphonia are increasing and are associated with large healthcare costs. Prevalence rates also differ somewhat between industries, and there appears to be a higher percentage of malignant neoplasms in the manufacturing industry and benign neoplasms in the service industry., (Copyright © 2017. Published by Elsevier Inc.)

Background: Globus pharyngeus has been linked to salivary hypofunction. We hypothesise that a considerable portion of the globus experienced by patients is due to a drying effect secondary to anticholinergic medication use; this study aimed to determine their association., Methods: A cross-sectional study was conducted of 270 patients who presented to a laryngology practice over 6 months. Participants rated globus sensation on a 5-point severity scale, with those scoring 0 considered as controls (non-globus). Participants were excluded if they had a likely cause of globus. Scores were compared with participants' medication lists, co-morbidities, age and gender, and evaluated using multivariate analysis, with significance set at p < 0.05., Results: Any participant taking at least 2 anticholinergic medications had a 3.52 increased odds (p = 0.02) of experiencing globus. A previous diagnosis of gastroesophageal reflux disease was also significantly associated with globus (p = 0.004), with an odds ratio of 3.75., Conclusion: A substantial portion of idiopathic globus may be due to anticholinergic use or reflux. The findings implicate medication use as a risk factor for globus. An awareness of these associations is invaluable for identifying cause and treating globus.

Aim: To investigate the frequency of extraesophageal syndromes in elderly patients with gastroesophageal reflux disease (GERD)., Materials and Methods: This cross-sectional study was conducted to compare the clinical manifestations of GERD in 1100 patients aged 60 to 75 years and in 453 patients aged 36 to 60 years. A control group consisted of 154 elderly patients without GERD and 178 mature-aged patients without this condition. GERD was diagnosed via analysis of its symptoms, esophagogastroduodenoscopy, and 24-hour pH monitoring on the basis of the Montreal consensus guidelines. Extraesophageal syndromes were detected actively using the current methods accepted to treat lung, heart, and ENT diseases and a simultaneous gastroesophageal examination., Results: Chronic cough, asthma, chronic laryngitis, cardialgias and cardiac arrhythmias were much more common in elderly patients with GERD than in those without this condition and prevalent in patients with erosive esophagitis and Barrett's esophagus as compared with those with non-erosive reflux disease. The mature-aged patients were recorded to have similar but less pronounced trends. The authors proposed an algorithm for the management of patients with extraesophageal manifestations of GERD, the important aspect of which was two-month acid-suppressive therapy used as both diagnostic testing and empirical treatment for this pathology., Conclusion: The extraesophageal manifestations of GERD in elderly patients are a serious clinical problem calling for considerable attention.

Unlabelled: Objective of research was to study features of ontogenesis and feeding in the first months of life in children with laryngotracheitis (LT), recurrent laryngotracheitis (RLT) and asthma., Methods: Questionnaire-based survey was performed to collect data on anamnesis of 1004 children aged 6-14 years (575 children with a history of LT, 60 children with asthma, and 369 children of control group) pertaining to preeclampsia in mothers, history of birth asphyxia, preterm birth and feeding during the first months of life in children. Children with LT were divided into two groups: 458 children with 1-3 episodes of LT and 117 children with RLT (4 or more episodes of LT)., Results: The frequency of preeclampsia among mothers of children with RLT exceeded the corresponding frequency among mothers of children with 1-3 episodes of LT and children of control group in 2.1 and 2.8 times, respectively. The frequency of birth asphyxia or preterm birth among children with RLT exceeded the corresponding frequency among children with 1-3 episodes of LT and children of control group by a factor of 2. The frequency of breastfeeding initiation after 24 hours of birth among children with asthma or RLT exceeded the corresponding frequency among children with 1-3 episodes of LT (in 1.4 and 1.5 times, respectively) and among children of control group (in 2.4 and 2.6 times, respectively)., Conclusion: The frequency of preeclampsia in mothers, birth asphyxia, preterm birth and late initiation of breastfeeding among children with RLT exceeded the corresponding frequency among children with 1-3 episodes of LT and children of control group. There was no significant difference between the frequency of preeclampsia in mothers, birth asphyxia, initiation of breastfeeding among children with RLT and children with asthma. Formula feeding in the first months of life was equally often observed among children with LT, RLT and asthma and significantly exceeded the corresponding percentage among children in control group.

Objectives/hypothesis: Despite the high prevalence of voice disorders, the prevalence of laryngeal disease in the general population has not been determined using laryngoscopy. Factors considered associated with laryngeal disease have mostly been assessed using patient data or highly specific populations. We evaluated the prevalence of and associated factors with laryngeal diseases in the general Korean population., Study Design: Cross-sectional study., Methods: We analyzed data from the Korea National Health and Nutrition Examination Survey for 19,039 participants assessed between 2008 and 2011. The prevalence, subjective discomforts rates of, and odd ratios (demographics, life-style factors, and diseases factors) for laryngeal disease were analyzed using simple and multiple logistic regression analyses, taking into account the complex sampling structure of the data., Results: The top five laryngeal diseases in prevalence were laryngitis (3,513/100,000), vocal nodules (1,487/100,000), vocal polyp (404/100,000), Reinke's edema (347/100,000), and epiglottic cyst (296/100,000). Prevalence of laryngeal disease was higher in males, whereas the rate of subjective voice complaints was higher in females. In the logistic regression analysis, gender was not associated with laryngeal diseases after adjusting for other factors. We observed a positive association between low body mass index (BMI) and vocal nodules, and between high BMI and laryngitis, smoking and epiglottic cyst/hyperkeratosis/laryngeal cancer, higher education level and vocal nodules, and allergic rhinitis and vocal nodules/laryngitis/epiglottic cyst., Conclusions: The rate of subjective voice complaints and laryngeal disease co-occurrence was low. This study provides more reliable information of laryngeal disease because it includes participants without subjective complaints., Level of Evidence: 2b., (© 2015 The American Laryngological, Rhinological and Otological Society, Inc.)

Metabolic syndrome (MetS) is associated with a higher risk of morbidity and/or mortality for various chronic diseases. The aim of this study was to investigate the relationship of chronic laryngitis (CL) with MetS and its components in a representative Korean population.Data from the Korean National Health and Nutrition Examination Survey (2008-2010) were analyzed. A total of 10,360 adults who had undergone otolaryngological examination were evaluated.The prevalence of CL in the study population was 3.1%. The prevalence of MetS was significantly higher in patients with CL than in those without CL for both sexes (men: 34.7 ± 4.0% versus 25.9 ± 0.8%, P = 0.0235; women: 40.6 ± 5.3% versus 23.7 ± 0.7%, P = 0.0003). Elevated fasting glucose, triglycerides, and blood pressure, however, were only significantly associated with CL in women. After controlling for confounders, CL was only significantly associated with MetS in women (odds ratio: 2.159; 95% confidence interval: 1.2974, 3.594). Furthermore, the association between CL and MetS was most robust in women who were classified as obese.In Korea, MetS and its components are significantly associated with CL in women.

Background: Chronic laryngitis (CL) has been described as chronic inflammation of the larynx. CL have various causes such as long-term smoking, acid reflux, voice overuse, bronchitis, allergies, pneumonia, excessive exposure to toxic chemicals and complications from the flu or a chronic cold. However, the prevalence of CL and role of air pollution in the etiology is uncertain., Objective: The aim of this study was to investigate the relationship between CL and particulate matter with aerodynamic diameter less than 10 μm (PM10) in South Korea using data from the Korea National Health and Nutrition Examination Surveys (KNHANES) during 2008-2012., Methods: KNHANES is a cross-sectional survey of the civilian, non-institutionalized population of South Korea (n = 21,116). A field survey team that included an otolaryngologist moved with a mobile examination unit and performed interviews and physical examinations. The mean annual concentrations of ambient PM10, SO2, O3, NO2, and CO levels in Korea were determined from monitoring station data. Multiple logistic regression was used to examine the relationship of air pollution to CL., Results: Among the population ≥ 19 years of age, the weighted prevalence of CL was 3.37 ± 0.30% (95% confidence interval, 2.79-3.95%). CL was more prevalent in men, current smokers, and those with lower household income and prevalence increased with age. A significant decrease over time was observed in the prevalence of CL (P for trend = 0.0049) and the annual average concentrations of PM10 (P for trend < 0.0001) from 2008 to 2012. In a multivariate model, the factors associated with CL included PM10 (odds ratio [OR], 1.378, p = 0.0457), age (OR, 1.020, p<0.0001), sex (OR, 0.734, p = 0.0179), and smoking status (OR, 1.438, p = 0.0054)., Conclusion: Elevated PM10 exposures could be associated with increased risk of CL in South Koreans. Further epidemiological and experimental studies are necessary to clarify the impact of chronic PM10 exposure on CL.

Objective: To describe the presence of laryngeal eosinophils and associated symptomatology in patients with aerodigestive dysfunction., Study Design: Case series with chart review., Setting: Single tertiary pediatric referral center., Subjects: Eighty-one consecutive pediatric patients referred to a multidisciplinary aerodigestive clinic with upper airway concerns., Methods: Microlaryngoscopy and posterior arytenoid biopsy, flexible bronchoscopy, esophagogastroduodenoscopy and esophageal biopsy, and impedance probe testing were performed as indicated by clinical symptoms. Positive versus negative posterior arytenoid biopsy for eosinophils and the presence or absence of concomitant histopathological laryngitis and/or esophagitis were measured., Results: Nine of 81 (11%) patients had positive laryngeal biopsy for eosinophils (range, 1-29 eosinophils/high-powered field [HPF]). Three of these 9 patients also had concurrent biopsy-proven eosinophilic esophagitis, while 8 of 81 total patients had biopsy-proven eosinophilic esophagitis. The frequency of biopsy-proven eosinophilic esophagitis was higher in patients with posterior arytenoid eosinophils versus patients without laryngeal eosinophils (33% versus 6.9%, P = .0408)., Conclusions: Eosinophilic inflammation in the larynx has not been described in children with complex aerodigestive complaints. Posterior arytenoid eosinophils may serve as a marker of chronic laryngeal inflammation in children with aerodigestive dysfunction, although their exact role in this inflammation remains unclear. In our population, >15 eosinophils/HPF within posterior arytenoid biopsies was associated with concomitant eosinophilic esophagitis., (© American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.)

It was analyzed the incidences of laryngotracheitis (LT) in children aged 0 to 14 years in Vinnytsya between 1995 and 2008. It was studied seasonal and circadian rhythms of LT in children. The seasonal variations of LT are characterized by two-wave curve with peaks in October and March, and with a significant decrease in July and August. The incidences of LT in October and March exceed the incidences of LT in July and August in 2.6 times. Circadian variation of LT is characterized by peak at night. The incidences of LT at night exceed the incidences in the morning in 2.6 times. The total number of the incidences of LT in the evening and at night exceed the total number of the incidences of LT in the morning and in the afternoon in 1.7 times. The maximum of incidences of LT to minimum of incidences of LT per hour ratio is 5:1 in girls compared to 4:1 in boys.

Background: This study aimed to investigate the relationship between obesity and chronic laryngitis in South Korea using data from the Korea National Health and Nutrition Examination Surveys (KNHANES) collected during 2008-2010., Methods: KNHANES was a cross-sectional survey of the civilian, non-institutionalized population of South Korea (n = 13,819). Obesity status was measured by using BMI and waist circumference., Results: Among the population over 19 years of age, the prevalence of chronic laryngitis was 4.0 ± 0.4%. Chronic laryngitis was significantly associated with age, BMI, waist circumference, fat proportion, both systolic and diastolic blood pressure, fasting blood sugar, triglycerides, and high-density lipoprotein cholesterol in women. Old age and current smoking were significantly associated with chronic laryngitis in men. Obese women were at a higher risk for chronic laryngitis than women without obesity (odds ratio (OR) 2.022, 95% confidence interval (95% CI) 1.412-2.895) after further adjustment for confounders. Women with abdominal obesity were also at higher risk for chronic laryngitis (OR 1.475, 95% CI 1.024-2.126)., Conclusion: Obese women in Korea have an elevated risk for developing chronic laryngitis. Further epidemiological and experimental studies are necessary to clarify the impact of obesity on this condition., (© 2015 S. Karger GmbH, Freiburg.)

Infectious laryngotracheitis (ILT) is an economically important respiratory disease of poultry that affects the poultry industry worldwide. The disease is caused by gallid herpesvirus I (GaHV-1), a member of the genus Iltovirus, family Herpesviridae, subfamily Alphaherpesvirinae. The current incidence of the disease is heavily influenced by live attenuated vaccines, which have been used extensively since their introduction in the mid-twentieth century. The capability of current live attenuated vaccine viruses to revert to virulence and spread from bird to bird has shaped the molecular epidemiology of ILT. Because of the antigenic homogeneity among GaHV-1 strains, differentiation of strains has been achieved by targeting genomic differences between outbreak-related isolates and vaccine strains. Numerous genes and genomic regions have been utilized in the development of DNA-based diagnostic assays to differentiate outbreak-related isolates from vaccine strains in countries where ILT outbreaks have occurred. More recently, full genome sequences have allowed determination of the origin of some of the outbreak-related isolates circulating in some poultry production countries. Overall, molecular typing data collected worldwide have identified live attenuated vaccine-related isolates as the primary source for outbreaks of the disease.

Acute laryngitis is most often caused by viral illnesses through direct inflammation of the vocal cords or from irritation due to postnasal drainage. Bacterial infections, such as acute epiglottitis, also can cause dysphonia but typically have other systemic symptoms as well as respiratory distress. Chronic laryngitis is characterized by symptoms lasting more than 3 weeks. Chronic vocal cord issues can be related to overuse or stress on the vocal cords resulting in nodules or polyps. Individuals in certain occupations, such as singers, school teachers, and chemical workers, are at greater risk of chronic laryngitis. The diagnostic approach to chronic laryngitis should include visualization of the vocal cords to rule out potential malignant lesions. For acute and chronic overuse symptoms, the best treatment is vocal rest. The use of antibiotics or decongestants should be discouraged., (Written permission from the American Academy of Family Physicians is required for reproduction of this material in whole or in part in any form or medium.)

Objectives: We describe the incidence of chronic laryngitis (CL) and identify the most common presenting symptoms and initial treatments used., Methods: We retrospectively identified patients with a diagnosis of CL who were seen among a primary care cohort at an urban academic medical center from 2009 to 2010. The incidence of CL was calculated. Symptoms, first-visit treatment, smoking, and demographics were recorded., Results: Of a population of 40,317 people, 280 received a new diagnosis of CL over a 2-year period, representing a yearly incidence of 3.47 cases per 1,000 people. The subjects consisted of 160 women and 120 men. Race was recorded as black (126), Hispanic (47), white (68), or other (39). The mean age was 52.9 years (range, 20 to 90 years). The initial therapies included proton pump inhibitors (79%), voice therapy (17%), nasal steroid (13%), antihistamine (4%), amitriptyline (4%), other (17%), and none (11%). The most common symptoms were dysphonia (53%), pain/soreness (45%), globus sensation (40%), cough (33%), excessive throat clearing (28%), and dysphagia (32%). An otolaryngologist saw 93% of the cases., Conclusions: The yearly CL incidence was 3.47 per 1,000 people. Up to 21% of the population may develop CL in their lifetime. Most of the patients in this cohort were referred to otolaryngologists, and the majority were treated with proton pump inhibitors. Dysphonia, globus sensation, and pain were the most common symptoms. Population surveys could be used to define undiagnosed disease and the overall prevalence of CL.

Objectives: The objective was to apply quality indicators in respiratory disease triage during a set time period., Methods: This was a retrospective, descriptive, and comparative study of all patients attending the emergency department of Acosta Ñu Children's Hospital with breathing difficulty, between January 1 and July 31, 2011., Results: Two thousand five hundred eighty-two patients were included in the study. The delay in medical care according to severity of breathing difficulty was as follows: for critical patients, 1 minute (100% compliance); for emergencies, 6.4 minutes (93.4% compared with 95% standard); for urgencies, 15.8 minutes (90% compared with the standard 90%); and for semiurgencies, 35 minutes (92.4% vs. 85% standard). Regarding to the admission-triage time indicator: mean time was 6.1 minutes; 2220 patients (86%) were classified in less than 10 minutes from the time of hospital admission, and 2453 (95%) were evaluated before 15 minutes. Respiratory rate was recorded in 2368 patients (91.7%), and pulse oximetry in 2443 (94.6%). Both parameters were recorded in 2271 children (88%). Errors in classification were detected, mainly tendency to underestimate the risk or exacerbate the clinical situation; 441 patients underwent subtriage (20.5%), and 44 overtriage (1.7%). There were drawbacks to classify emergencies error rate 45.8% (P < 0.00001). Relationship between pathophysiologic diagnosis and triage level was significant (P < 0.00001)., Conclusions: Indicators of triage quality were acceptably met in respiratory disease. Breathing difficulty was identified and classified as urgent, although problems arouse at differentiation between moderate and severe dyspnea.

Background: Unnecessary use of resources for common illnesses has substantial effect on patient care and costs. Evidence-based guidelines do not recommend antibiotics or imaging for uncomplicated upper respiratory infections (URIs). The objective of the current study was to examine medical care providers' compliance with guidelines in treating uncomplicated URIs in emergency departments (EDs) in the US., Methods: Nationally representative data from the NHAMCS 2007 and 2008 were used. Uncomplicated URIs were identified through ICD-9 codes of nasopharyngitis, laryngitis, bronchitis, URI not otherwise specified and influenza involving upper respiratory tract. Exclusion criteria were concurrent comorbidities, follow-up visits, and age < 18 or >64 years. Most frequently prescribed classes of antibiotics were identified. Multivariate analyses were conducted to identify the factors associated with the prescribing of antibiotics and use of imaging studies., Results: In 2007 and 2008, there were 2.2 million adult uncomplicated URI visits without any other concurrent diagnoses in EDs in the US. Approximately 52% were given antibiotic prescriptions, over one-third of which were macrolides, and nearly half of the visits performed imaging studies. About 51% had a diagnosis of bronchitis, 35% URI NOS, 9% nasopharyngitis, laryngitis or influenza, and 4% multiple URI diagnoses. The diagnosis of bronchitis, fever at presentation, older ages, male gender, longer waiting time, and metropolitan areas were associated with a greater likelihood of prescribing antibiotics or imaging studies, controlling for confounding factors., Conclusion: Despite the recommendations and campaign efforts by the CDC and many medical associations, the prescribing of antibiotics in treating uncomplicated URIs in the EDs remains prevalent. Furthermore, overutilization of imaging studies is prevalent. Changes at levels of health care system and hospitals are needed to avoid unnecessary resource utilization. In addition, further patient education about antibiotic use in the community may greatly facilitate the transition out of an antibiotic-dependent consumer culture.

Introduction: In 2006 The Global Consensus Group in Montreal pointed out that chronic laryngitis is highly associated with gastroesophageal reflux disease (GERD)., Aim of the Study: To evaluate the frequency of LPR in a selected group of patients with chronic hoarseness. We were also interested in assessment of the relationship between Reflux Symptoms Index (RSI) scores, Ryan scores from the pharyngeal pH monitoring and the morphological changes in the larynx according to Reflux Findings Score (RFS). In addition, we wanted to assess the frequency of various clinical symptoms included in the RSI questionnaire among patients with LPR., Materials and Methods: 42 patients from an outpatient ENT clinic with chronic hoarseness and RSI ≥ 13. All subjects underwent pharyngeal pH monitoring with the Dx-pH System Restech ™ and laryngoscopy., Results: Among 42 patients with chronic hoarseness, LPR was confirmed in 35 patients (83.33%). In 7 subjects pharyngeal pH monitoring was normal. Among all patients with confirmed LPR, only 5 out of 8 elements of RFS laryngoscopic changes were observed. The most frequent inflammatory changes noticed included erythema of the arytenoids and interarytenoid regions (posterior laryngitis). These findings were found in 30 out of 35 patients with LPR. Median value of RFS in patients with LPR was 4.45, which is lower than the cut off value of 7 necessary for recognition of LPR. There is statistically significant positive correlation between Ryan scores and the RFS scale results (correlation coefficient 0.91, p<0.001)., Conclusions: Pharyngeal pH monitoring confirmed LPR in 83.33% selected group of patients with chronic hoarseness and RSI ≥ 13. Isolated erythema of arytenoid and interarytenoid region was the most frequent inflammatory abnormality found in the larynx. RFS values below 7 do not exclude the diagnosis of LPR. We can use RFS scales as a prognostic test of severity of LPR - due to statistically significant positive correlation between Ryan score and RFS values. The use of RSI scale revealed that the most frequent symptom among patient with LPR was throat clearing followed by hoarseness., (Copyright © 2012 Polish Otolaryngology Society. Published by Elsevier Urban & Partner Sp. z.o.o. All rights reserved.)

The pathological gastroesophageal reflux disease may lead to the gastroesophageal reflux disease (GERD), manifested as a spectrum of conditions including erosive esophagitis, Barrett esophagus and has been linked to the development of adenocarcinoma of the esophagus. The gastroesophageal reflux has been incriminated in the occurence of a number of pulmonary symptoms and diseases, otolaryngologic symptoms, and other extraesophageal manifestations. Clinicians must be aware of the possibility of some extraesophageal reflux-related manifestations, even in the absence of heartburn and acid reflux, classic esophageal symptoms of GERD. Although the correlation between gastroesophageal reflux disease and the extraesophageal manifestations has been established, a cause-and-effect relationship has not been proved yet. In this article, we present the respiratory manifestations of gastroesophageal reflux disease, referring to epidemiology, pathogenesis, diagnosis and treatment.

Objectives: Adult supraglottitis is a potentially life-threatening airway infection. We reviewed the management and outcome of supraglottitis in 169 adults admitted to Liverpool Hospital between 1999 and 2009., Methods: A retrospective review was conducted of all admissions with supraglottitis in patients at least 18 years of age. The diagnosis was confirmed by fiberoptic nasolaryngoscopy or direct laryngoscopy under general anesthesia. The main outcome measure was the need for intubation or tracheotomy. Univariate analysis was performed to determine factors that led to a worse outcome., Results: There were 80 men and 89 women in the cohort, with a median age of 51 years. Of these, 140 patients were admitted to the intensive care unit for a mean duration of 2 days. The common symptoms and signs at presentation were odynophagia and dysphagia (94%), dysphonia (65%), and stridor (33%). Endotracheal intubation was performed in 16 patients, and an awake tracheotomy was required in 4 patients. Dexamethasone acetate was used in 103 patients. Thirty-five patients had diabetes mellitus as a comorbidity. The presence of diabetes was predictive of the need for intubation or tracheotomy (p < 0.05), and the use of steroids was predictive of an intensive care unit stay of 24 hours or less (p < 0.05)., Conclusions: Fiberoptic laryngoscopy is the gold standard for diagnosis of supraglottitis, and close airway monitoring is crucial. Conservative management of the airway is a viable option, but the presence of diabetes makes airway intervention more likely. The use of steroids aids in symptom alleviation and hastens resolution of airway swelling, with no negative sequelae.

Methyl methacrylate (MMA) is a respiratory irritant and dermal sensitizer that has been associated with occupational asthma in a small number of case reports. Those reports have raised concern that it might be a respiratory sensitizer. To better understand that possibility, we reviewed the in silico, in chemico, in vitro, and in vivo toxicology literature, and also epidemiologic and occupational medicine reports related to the respiratory effects of MMA. Numerous in silico and in chemico studies indicate that MMA is unlikely to be a respiratory sensitizer. The few in vitro studies suggest that MMA has generally weak effects. In vivo studies have documented contact skin sensitization, nonspecific cytotoxicity, and weakly positive responses on local lymph node assay; guinea pig and mouse inhalation sensitization tests have not been performed. Cohort and cross-sectional worker studies reported irritation of eyes, nose, and upper respiratory tract associated with short-term peaks exposures, but little evidence for respiratory sensitization or asthma. Nineteen case reports described asthma, laryngitis, or hypersensitivity pneumonitis in MMA-exposed workers; however, exposures were either not well described or involved mixtures containing more reactive respiratory sensitizers and irritants. The weight of evidence, both experimental and observational, argues that MMA is not a respiratory sensitizer.

Objective: We report on a clinical case of simultaneous and unilateral involvement of the facial and superior laryngeal nerve in a patient with chronic renal disease undergoing haemodialysis., Method: A 75-year-old man with chronic renal failure was referred to our department suffering from severe odynophagia. During flexible endoscopy, vesicles were found on the mucosa of his right supraglottic larynx. Two days later, peripheral facial nerve palsy with a mild auricular rash appeared in the patient., Results: The clinical presentation suggested varicella-zoster virus reactivation, which was confirmed serologically, and appropriate treatment was administered., Conclusions: Involvement of more than one cranial nerve in herpes zoster infection is possible, especially in vulnerable patients such as those with chronic renal failure. It is also important to suspect involvement of the superior laryngeal nerve in cases of odynophagia and throat pain, even when hoarseness is absent.

Background:   Chronic laryngitis and/or vocal fold minimal lesions (VFMLs) are common associations with gastro esophageal reflux disease. Helicobacter pylori (HP) is a Gram-negative spiral organism accused of being a common cause of gastritis, gastroesophageal reflux disease and peptic ulcer. HP has been recently isolated from tonsils, adenoids, sinus and middle ear mucosa in patients with chronic sinusitis or chronic middle ear effusion., Objective:   The objective of this study is to assess the presence of HP in VFMLs., Methods:   The study included 14 patients with VFMLs [six cases with vocal fold polyps and four cases with vocal fold nodules, and four cases with posterior granulomas; one of them associated with right vocal fold (VF) nodule]; all underwent carbon-13 urea breath test, esophago-gastro-duodenoscopy with gastric biopsy and direct laryngoscopy with microlaryngosurgery to extract the VF lesions. Biopsies were subjected for two tests: detection of the 23S ribosomal RNA gene of HP by real-time polymerase chain reaction (RT-PCR) and immunohistochemical reactions (IHC)., Results:   HP was detected by RT-PCR in 10 of 14 patients with VFML; HP was also detected by IHC in the same number of VFML and gastric mucosa specimens., Conclusion:   HP is a common finding in cases of VFML; its eradication should be considered when dealing with a patient with VFML., (© 2010 Blackwell Publishing Ltd.)

Objectives: Voice problems affect up to 30% of the population at some time during their life, and in particular it affects those who use their voice professionally. Patients who commonly present with dysphonia are often found to have symptoms of both allergy and reflux. Clinical examination of the larynx often makes it difficult to differentiate between the main causative factors of dysphonia, as the clinical findings on nasendoscopy between reflux and allergy are similar. Laryngopharyngeal reflux (LPR), an entity of gastro-oesophageal reflux, is a common diagnosis made in the voice out-patient clinic. Few studies have been able to successfully correlate management of LPR and outcome of dysphonia. Allergy or more specifically allergic rhinitis is said to affect approximately 24% of the population, but few studies have investigated its role in dysphonia., Design: Prospective observational study., Settings: University teaching hospital otolaryngology department., Participants: Fifteen new patients with primary voice disorder were investigated for possible LPR and allergy from April 2007 to October 2007. All patients were tested using the validated reflux symptom index (RSI), reflux finding score (RFS) to diagnose LPR, and both skin prick tests (SPT) and nasal nitric oxide (NO) levels to diagnose the presence of allergy., Main Outcome Measures: Prevalence of symptoms of reflux and allergy in patients presenting with primary voice disorders, and also whether dysphonia thought to be caused by LPR could actually be due to allergy., Results: No positive correlation or statistical significance was found between reflux and allergy. From our sample 20% (three patients) were diagnosed with LPR and 67% (ten patients) with allergy. The three patients diagnosed with LPR also had concomitant allergy., Conclusions: In our patient cohort, three times as many patients demonstrated allergy compared with LPR. This has led us to question if some patients with allergic laryngitis are being misdiagnosed with LPR and thereby being over-treated with proton pump inhibitors (PPIs).

The World Trade Center disaster and its recovery work involved a range of hazardous occupational exposures that have not been fully characterized but that can be reasonably assumed to have the potential to cause mucosal inflammation, preferentially (but not exclusively) in the upper airway. A high prevalence of rhinosinusitis and upper airway disease (UAD) symptoms was reported by several early surveys. Clinical studies demonstrated objective, clinically significant, and persistent chronic perennial rhinosinusitis and UAD-with or without seasonal exacerbation-in a large proportion of patients. Demonstration of an association between UAD and available exposure indicators has been limited. Atopy seemed to be associated with increased UAD symptom severity and to be a risk factor for upper, but not lower, airway disease. World Trade Center-related UAD is considered an irritant-induced disease but not, in many cases, of acute onset. No data thus far suggest an increased upper airway cancer incidence.

Introduction: The 24-hours pH-monitoring is the "gold standard" to verify the presence of pathologic reflux and confirmation of GERD. But there is lack of data whether it is helpful to verify the link between extraesophageal manifestations with GERD., Aim: To evaluate the utility of proximal 24-hours pH monitoring for diagnosing ENR manifestations of GERD., Methods: Ninety one GERD patients were enrolled to the study. The allergic, infectious and toxic etiology of comorbid diseases were exclusion criteria. Dual-probe 24-hours pH studies were performed to all of the patients. Distal probe was placed 5 cm above esophago-gastric junction, the proximal one--at the upper 1/3 of esophagus over upper esophageal sphincter. The presence of high gastroesophageal reflux (HGR) was diagnosed when at least one episode of drop of pH < 4 for 20 sec at proximal probe during the study occurred. The evaluation of sensitivity and specificity of the method was calculated by the standard protocol., Results: Comorbid ENR pathology (GERD + CP) was found in 59 patients. Presence of HGR was found in 76.27% of patients of GERD + CP group and in 43.75% of controls (p = 0.0026). Number of HGR was higher in GERD + CP group: M +/- s: 12.51 +/- 18.56 compared to 2.84 +/- 7.11 accordingly, p = 0.0003. Mean pH values were lower in the main group: 6.32 +/- 0.52 compared to 6.58 +/- 0.42 in controls, p = 0.011. Acid exposure time was greater in the main group: 3.19 +/- 6.76 min, compared to 2.42 +/- 10.02 min in controls, p = 0.003. The correlation was found between each of the studied pH-metric parameters and presence of ENR pathology in GERD patients. The results of calculated diagnostic efficacy of the 24-hrs pH monitoring for evaluating the link between GERD and comorbid pathology were as follows: Diagnostic sensitivity--76.27% (95% Confidence Interval's limits (CI): 0.6403-0.8531); Diagnostic specificity: 56.25% (95% CI [0.3933-0.7183]); likelihood ratio for a positive test result 1.743 (95% CI [1.148-2.648]); likelihood ratio for a negative test result 0.422 (95% CI [0.243-0.731])., Conclusion: There is correlation between parameters of 24-hours pH-monitoring in the proximal esophagus and comorbid ENR pathology in GERD patients. High gastroesophageal reflux is more common in GERD patients with comorbid ENR pathology than in GERD patients without ENR diseases. Detection of high gastroesophageal reflux with placing the distal probe in the upper esophagus may be helpful for the diagnosing of extraesophageal manifestations of GERD.

Considering hospitalization as an indicator of the severity of acute subglottic laryngitis (ASL), the aim of this study was to determine the correlation between meteorological parameters and the incidence of ASL in children from the Tuzla area. The study included fifty-nine boys and girls from the Tuzla area, which were referred and hospitalized due to the ASL at the Clinic for diseases of ear, nose, throat, cervical and maxillofacial Surgery, University Clinical Center in Tuzla, Bosnia and Herzegovina, during the period of March 21st 2006 until March 20th 2007. We formed two databases: 1. the database on each hospitalized child included data on Body Mass Index (BMI), sex and age. 2. Meteorology database which included information on humidity, air temperature, wind direction and atmospheric pressure, sorted by day, month and season. The results of this study indicate that the number of hospitalized boys due to ASL was significantly higher than girls (48 boys and 11 girls). Boys with an average BMI of 34.53 kg/m2 and 6.77 years of age suffered more frequently from the ASL (81.35%) than girls (18.64%) with an average BMI of 21.59 kg/m2 and the age of 3.8 years. The largest number of children with ASL was admitted during the period of lowest temperature (Fall-12.27 degrees C; Winter-0.50 degrees C), and the largest value of relative humidity (fall 77.33 mmHg-winter 82.50 mmHg). Therefore, this study indicates that meteorological factors (temperature, humidity, wind direction, atmospheric pressure) increase the risk of ASL with young children, primarily boys.

Heterotopic gastric mucosal patch (HGMP) in the upper esophagus has been suggested to play a role in the pathogenesis of laryngopharyngeal reflux. The aim of this study was to evaluate the prevalence and possible clinical significance of HGMPs in patients who underwent laparoscopic Nissen fundoplication for gastroesophageal reflux disease-induced reflux laryngitis.Forty consecutive patients with pH-proven reflux laryngitis referred to surgery by a specialist in otorhinolaryngology underwent laparoscopic Nissen fundoplication between 1998 and 2002. Twenty-seven (67.5%) of these patients underwent a postoperative upper gastrointestinal endoscopy paying special attention for detecting possible HGMPs in the proximal esophagus. When HGMP was found, biopsies were taken for histologic confirmation. A small histologically confirmed HGMP was detected in 1 out of 27 patients (3.7%). The prevalence of HGMPs in the upper esophagus in this specific patient group operated on for gastroesophageal reflux disease-induced reflux laryngitis equals the reported general prevalence rates of HGMPs detected in patients referred for upper gastrointestinal endoscopy as a part of gastrointestinal tract evaluation. The role of at least small HGMPs in the proximal esophagus in the pathogenesis of laryngopharyngeal reflux is clinically insignificant.

Objectives/hypothesis: Determine the incidence of bordetella pertussis and mycoplasma pneumonia infection in patients with chronic laryngotracheitis., Study Design: A prospective case study., Methods: Fifty-four consecutive adult patients presenting with symptoms (throat clearing, hoarseness, cough, globus) and signs (laryngeal and subglottic erythema and edema) of chronic laryngotracheitis (CLTR) for >6 weeks were included in the study. A single blood draw for anti-pertussis toxin IgG, IgA, IgM, and mycoplasma IgM was performed at presentation. Duration of symptoms, symptom score (Reflux Symptom Index [RSI]), and physical exam score were recorded., Results: Thirteen patients (24%) had elevated IgA and IgG to pertussis toxin. Nine patients (17%) had elevated IgM to pertussis toxin. Eight patients (15%) had elevated IgM to mycoplasma pneumoniae. There were no significant differences in symptom duration, RSI score, or Voice Handicap Index-10 score among patients with current infection, recent past infection, or no infection. Subglottic erythema scores were significantly higher for patients with current or recent past infection compared to the no infection group. Patients with current infection or recent past infection had significantly more tracheal erythema than supraglottic or vocal fold erythema., Conclusions: Bordetella pertussis and mycoplasma pneumoniae infection play a significant role in the etiology of CLTR. Pertussis can be a mild but chronic presentation and may not produce typical symptoms of severe cough. Symptom duration and severity cannot differentiate between CLTR of infectious or other etiology. Infection should be considered in patients with CLTR that have significant tracheal erythema.

Objectives/hypothesis: Laryngeal symptoms are increasingly recognized to occur in chronic persistent cough and may result from the sensory hyperresponsiveness that characterizes this condition. Apart from cough, the motor consequences of sensory activation have not been well described in chronic persistent cough. The efficacy of speech pathology treatment for chronic cough suggests that laryngeal dysfunction may be relevant in chronic persistent cough. This study investigated the relationship between cough reflex sensitivity and laryngeal dysfunction, which was assessed as paradoxical vocal cord movement (PVCM) and extrathoracic airway hyperresponsiveness, in patients with chronic cough., Study Design: Cross-sectional case-control comparison of subjects with chronic cough and healthy controls., Methods: Adults with chronic persistent cough (n = 25) and healthy controls (n = 11) were assessed by cough-specific quality of life questionnaire, extrathoracic airway hyperresponsiveness to hypertonic saline provocation, capsaicin cough reflex hypersensitivity, and fibreoptic laryngoscopy to assess PVCM., Results: Laryngeal dysfunction was present in many patients with chronic persistent cough. PVCM was present in 56% of subjects with chronic cough and accompanied by cough reflex hypersensitivity and impaired quality of life. Inspiratory airflows were reduced in cough with PVCM, and there was significant extrathoracic airway hyperresponsiveness., Conclusions: Laryngeal dysfunction is common in chronic cough, where it is manifest as paradoxical vocal cord movement and extrathoracic airway hyperresponsiveness. Laryngeal dysfunction in chronic cough is associated with reduced quality of life. Laryngeal hypersensitivity may be a common mechanism that can be effectively treated by speech language therapy.

Gastroesophageal reflux disease (GERD) is a common disorder. A significant percentage of patients with GERD may experience extra-esophageal manifestations, such as asthma, cough, and laryngitis. Epidemiologic studies consistently demonstrate strong associations between GERD and potential extra-esophageal manifestations. However, randomized controlled studies evaluating the use of proton-pump inhibitors for treatment of extra-esophageal GERD have inconsistent results. In asthma, few randomized controlled studies have shown improvement in objective measures, such as forced expiratory volume or peak flow. For chronic cough, studies are all small and have not demonstrated consistent improvement with acid suppression. Even a recent well-designed large randomized controlled study in laryngitis demonstrated no difference in resolution of symptoms with acid suppression. Given the examples from the literature, the current treatment of extra-esophageal symptoms with acid suppression is controversial. Although improvement in symptoms has been shown in case series, it has not been consistent in randomized controlled studies. We offer potential explanations for the discrepancy between the epidemiologic associations and the lack of response to therapy in clinical trials.

Objectives: To investigate and compare the prevalence of pharyngeal reflux (PR) events in normal controls and patients with clinically diagnosed reflux laryngitis., Method: A systematic review of the literature was performed to identify all prospective studies on the results of 24-hour double-probe (pharyngeal and esophageal) pH monitoring in normal controls and in patients with symptoms and/or signs of reflux laryngitis., Results: Eleven relevant studies on 192 normal controls and 13 studies on 512 patients with reflux laryngitis were identified. One or more PR events were detected in 51 normal controls (22.9%; 95% CI, 13.9% to 33.3%) and in 154 of 422 patients (38.3%; 95% CI, 25.4% to 52.1%). There is no significant difference in the prevalence of PR events between normal controls and patients with reflux laryngitis (P = 0.079). In addition, the prevalence of PR events in patients with reflux laryngitis is much lower than reported in previous reviews on this subject., Conclusion: This systematic review calculated that (1) only a minority of patients with clinically diagnosed reflux laryngitis will show PR events, and (2) there is no significant difference between the prevalence of PR events in patients with reflux laryngitis and healthy controls. At the moment, there is no reliable means to confirm reflux of gastric juice in patients with suspected reflux laryngitis. This diagnostic vacuum is fundamental and may pose important questions at the current concept of reflux of gastric juice as a common cause of laryngopharyngeal inflammation.

Gastroesophageal reflux disease has frequently been implicated in a wide variety of complications beyond the esophagus. These so-called "extraesophageal" disorders range from diseases of the respiratory tract, such as asthma and bronchitis, to more remote sites and conditions such as otitis and dental erosion. Many articles proposing a link between reflux disease and a multitude of extraesophageal complications have been published, but indisputable evidence that these conditions are caused by reflux disease is rare. Much of the support for a link between reflux disease and a number of extraesophageal complications is based on the observation that reflux disease frequently coexists with other disorders. A causal link is difficult to prove, however, and this review aims to critically evaluate the available evidence, looking, where possible, at longitudinal studies, expert diagnoses, and response to acid-suppressive therapy as a means of determining the true relationship between GERD and its putative extraesophageal complications.

Introduction: The laryngostroboscopy allows analysis of the vocal fold vibrations during phonation. Disruption of normal viscoelastic properties of the superficial lamina propria results in aberrant vocal fold vibration and mucosal wave propagation. Therefore, an investigation was performed to relate the stroboscopic results with the anatomopathologic results of chronic laryngitis and glottic cancer., Material and Methods: We performed a retrospective study, which included 30 direct laryngoscopies with biopsy of 25 patients and their corresponding laryngostroboscopies., Results: 60% of the cases of "absence of mucosal wave" displayed severe dysplasia or carcinoma. 20% of the cases of "limited or present mucosal wave" were carcinoma., Conclusions: The probability of finding severe dysplasia or carcinoma is significantly greater when we find absence of mucosal wave. The presence of mucosal wave does not exclude the possibility of malignant lesion of the vocal fold.