1/30. role of esophageal pH recording in management of chronic laryngitis: an overview.Chronic laryngitis typically produces symptoms of frequent throat-clearing, soreness, decreased voice quality with use, nonproductive cough, globus sensation, and odynophagia. The endoscopic laryngeal examination usually demonstrates posterior glottic edema, erythema, and increased vascularity and nodularity. There is increasing support for the hypothesis that reflux of acidic gastric contents is often responsible for the symptoms and findings of chronic laryngitis. Prospective trials of acid suppression therapy demonstrate not only efficacy in symptom reduction, but also objective improvement in measurements of voice quality and mucosal erythema. Although traditionally considered the "gold standard" for diagnosis of reflux causing laryngitis, routine esophageal pH recording may result in false negatives in up to 50% of patients. This may confound the diagnosis of chronic laryngitis and delay treatment. Conversely, a positive study during comprehensive therapy may help identify patients who need additional treatment. A single distal probe is probably insufficient for evaluation of a supraesophageal disorder. Current recommendations for double-probe pH study in the evaluation of chronic laryngitis fall into 2 categories: 1) a double-probe pH study is indicated if there is ongoing moderate-to-severe laryngitis despite antireflux precautions and proton pump inhibitor treatment for at least 6 to 12 weeks; and 2) a double-probe pH study is indicated as a baseline measurement before Nissen or Toupet fundoplication. The pH study would also be indicated in patients who have symptoms after fundoplication. There is clearly much more work to be done on the technical issues of obtaining accurate objective data related to laryngeal acidification. In addition, although acid reflux appears to be causative in many cases of chronic laryngitis, further work is indicated to identify reliable testing methods that will predict treatment success.- - - - - - - - - - ranking = 1keywords = throat (Clic here for more details about this article) |
2/30. Steroid inhaler laryngitis: dysphonia caused by inhaled fluticasone therapy.OBJECTIVE: To describe a condition that is referred to as steroid inhaler laryngitis, a clinical entity that is caused by the use of inhaled fluticasone propionate and manifested by dysphonia, throat clearing, and fullness. DESIGN: Case series. SETTING: An outpatient clinic of an academic referral center. patients: The study population consisted of 20 patients with reactive airway disease and dysphonia who were receiving inhaled fluticasone therapy and who were diagnosed as having steroid inhaler laryngitis during the period from January 1998 to June 2000. INTERVENTION: Cessation of inhaled fluticasone therapy when possible, as well as treatment of other underlying causes of dysphonia, such as laryngopharyngeal reflux and infectious processes. MAIN OUTCOME MEASURE: The resolution of dysphonia with cessation of inhaled fluticasone therapy. RESULTS: patients with steroid inhaler laryngitis were found to have laryngeal findings ranging from mucosal edema, erythema, and thickening to leukoplakia, granulation, and candidiasis. patients with more severe mucosal findings were more likely to have laryngopharyngeal reflux as well. Resolution of dysphonia occurred only after discontinuation of the inhaled fluticasone therapy. CONCLUSIONS: Steroid inhaler laryngitis is a form of chemical laryngopharyngitis induced by topical steroid administration. Symptoms and physical findings mimic laryngopharyngeal reflux, but only respond completely to discontinuation of the inhaled steroid therapy. The otolaryngologist should be familiar with this cause of dysphonia.- - - - - - - - - - ranking = 3.4084286487687keywords = pharyngitis, throat (Clic here for more details about this article) |
3/30. Laryngopharyngitis by corynebacterium ulcerans.A 71-year-old female patient was hospitalized with membranous laryngopharyngitis typical of classical diphtheria. A toxigenic strain of corynebacterium ulcerans was isolated from the throat. The patient was treated for 6 days with amoxicillin-clavulanic acid and recovered without complications. This second reported case of diphtheric laryngopharyngitis caused by C. ulcerans in switzerland is a reminder that C. ulcerans should be included as a possible agent in patients with classical diphtheria symptoms.- - - - - - - - - - ranking = 15.450571892612keywords = pharyngitis, throat (Clic here for more details about this article) |
4/30. coxiella burnetii: an unusual ENT pathogen.coxiella burnetii, the causative agent of q fever, is a prevalent zoonotic disease manifestating usually as atypical pneumonia or hepatitis. We describe 2 cases of serologically proven infection by coxiella burnetii whose primary manifestations arose from the upper respiratory tract and were initially referred to the ear, nose, and throat (ENT) department. This is the first related report in medical literature. A 20-year-old woman with fever, bilateral tonsillitis, lymphadenopathy, and mild aminotransferase elevation, and a 30-year old man with spiking fever and laryngitis are presented. Diagnosis in both cases was achieved through evolving serological response to coxiella burnetii. The importance of including the pathogen in the differential diagnosis of ENT patients, in assorted epidemiological settings, and the significance of the proper antibiotic selection are further discussed.- - - - - - - - - - ranking = 1keywords = throat (Clic here for more details about this article) |
5/30. Acute profound deafness in Ramsay Hunt syndrome. Two case reports.Two patients with sudden progressive profound hearing loss resulting from Ramsay Hunt syndrome are reported. Case 1: A 63-year-old woman was admitted to Jichi Medical School Hospital with sudden, progressing deafness of the left ear, vertigo, sore throat, and hoarseness. An otoscopic examination revealed the external ear and the tympanic membrane to be normal. Pure-tone audiometry revealed profound deafness in the left ear. A horizontal nystagmus in the non-affected direction was observed by gaze nystagmus test. An endoscopic examination revealed herpetic vesicles and shallow ulcers on the left side of the pharynx and the larynx. There was complete paralysis of the left recurrent nerve. Hearing acuity of the left ear did not recover at all with steroid hormone therapy. Case 2: A 75-year-old man was referred to the ENT Clinic by a dermatologist for hearing evaluation in Ramsay Hunt syndrome. The man had noticed severe otalgia and sudden progressive deafness of the right ear approximately 2 weeks prior to admission. physical examination revealed herpetic vesicles and ulcers in the right external ear and lateral neck. Complete paralysis of the right facial nerve was noted. Profound hearing loss in the affected ear was observed by pure-tone audiometry. A gaze nystagmus test revealed a horizontal nystagmus in the non-affected direction. No recovery of the cochlear function was noted following administration of antiviral drug. The pertinent literature is briefly reviewed.- - - - - - - - - - ranking = 10.836922504842keywords = sore throat, throat (Clic here for more details about this article) |
6/30. Atypical epiglottitis.early diagnosis of acute epiglottitis may be difficult in the child presenting atypically. The cases of four patients who displayed atypical presentation are reported. The initial diagnosis in three children was croup and in one, pharyngitis. In the fourth patient, a child who had coexisting meningitis, epiglottitis was an incidental finding. All patients recovered with no sequelae.- - - - - - - - - - ranking = 2.4084286487687keywords = pharyngitis (Clic here for more details about this article) |
7/30. Chronic herpetic laryngitis with oropharyngitis.Chronic herpetic laryngitis, with or without involvement of the oropharynx, is uncommon. We describe a case that was initially diagnosed and treated as squamous cell carcinoma. The subsequent course of the disease, review of the histologic material, and additional laboratory investigation suggested that the lesion was of viral origin and probably was caused by herpes simplex.- - - - - - - - - - ranking = 9.6337145950747keywords = pharyngitis (Clic here for more details about this article) |
8/30. Acute supraglottic laryngitis in adults.Four cases of supraglottic laryngitis in adults have been presented. All were treated conservatively with I.V. hydrocortisone and I.V. antibiotics under close observation. No intubation or tracheostomy was carried out. The author recommends the use of I.V. cefuroxime as an initial form of antibiotic treatment. Mirror laryngoscopy is mandatory in any adult patient who presents with sore throat if epiglottitis is not to be missed as the first consultation.- - - - - - - - - - ranking = 10.836922504842keywords = sore throat, throat (Clic here for more details about this article) |
9/30. Recurring epiglottitis in an adult.We report a case of recurring epiglottitis in an adult. The patient presented with complaints of a sore throat and fever. The presence of a muffled voice led to radiologic and indirect laryngoscopic examination confirming the diagnosis. The patient responded promptly to glucocorticoids and parenteral antibiotics. Over the ensuing six months, he was readmitted to the hospital on three separate occasions with recurrent symptoms and findings of epiglottitis. On each occasion, he responded promptly to therapy. An exhaustive investigation failed to reveal a cause for this unique occurrence of recurring disease.- - - - - - - - - - ranking = 10.836922504842keywords = sore throat, throat (Clic here for more details about this article) |
10/30. candida epiglottitis in immunocompromised patients.candida seldom has been reported to be a cause of epiglottitis. The clinical manifestations and management of three patients with candida epiglottitis complicating their neoplastic disease are described. All patients were granulocytopenic. candida epiglottitis occurred either as a localized infection, as a source of candida bronchopneumonia, or as a manifestation of disseminated infection. candida epiglottitis may be under-diagnosed and should be considered, especially in immunocompromised patients with symptoms of refractory pharyngitis. Treatment of candida epiglottitis with intravenous amphotericin b is warranted in patients with sustained granulocytopenia. Prompt endotracheal intubation is indicated if the airway patency cannot be maintained.- - - - - - - - - - ranking = 2.4084286487687keywords = pharyngitis (Clic here for more details about this article) |
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