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The spectrum of voice disorders – classification
Published in Stephanie Martin, Working with Voice Disorders, 2020
Irritation to the larynx may also be the result of acute or chronic inflammation, which may be secondary to upper respiratory infection or caused by allergy or the presence of irritants in the environment such as fumes, airborne particles or cigarette smoke. Laryngeal irritation may be caused by acid repeatedly refluxing from the stomach into the oesophagus alone, known as gastroesophageal reflux disease (GORD). However, if the stomach acid travels up the oesophagus and spills into the pharynx and larynx, even on occasion into the back of the nasal airway, leading to inflammation in areas not protected against gastric acid exposure, such as the vocal folds, it is known as laryngopharyngeal reflux (LPR). With LPR, you may not have the classic symptoms of GORD, such as a burning sensation in your lower chest (heartburn). That’s why it can be difficult to diagnose and why it is often called ‘silent reflux’. Both LPR and GORD are frequently described as the cause of laryngeal irritation and proton pump inhibitors (PPIs) prescribed to treat the GORD/LPR. Khidr et al. (2003) report significant reduction in hoarseness and throat clearing after two months of such treatment, which reinforces the view that if the root of the irritation is correctly diagnosed and treated, the problem may resolve spontaneously and relatively quickly. However, there still remains some ambivalence about the side effects of long-term PPI use (British Medical Journal, 2012; Ambizas and Etzel, 2017).
Larynx
Published in Neeraj Sethi, R. James A. England, Neil de Zoysa, Head, Neck and Thyroid Surgery, 2020
Lifestyle changes in terms of stopping smoking must be encouraged. The role of laryngopharyngeal reflux is unclear, but there is some limited evidence that the incidence of reflux is high in patients with premalignant disease [22].
Reflux and Eosinophilic Oesophagitis
Published in John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed, Paediatrics, The Ear, Skull Base, 2018
Gastro-oesophageal reflux occurs when stomach contents travel in a retrograde direction above the level of the lower oesophageal sphincter. The ‘refluxate’ will usually contain hydrochloric acid and pepsin and may include bile and pancreatic enzymes. This may occur to some extent physiologically in which case it is known as gastro-oesophageal reflux (GOR). At the point at which the patient develops symptoms, signs or histological changes, the term gastro-oesophageal reflux disease (GORD) is used. This refluxate may travel the length of the oesophagus and emerge from the upper oesophageal sphincter and result in disease within the realm of the otolaryngologist, particularly at the level of the larynx. The term in widespread use for this phenomenon is laryngopharyngeal reflux (LPR). However, there is now a greater appreciation that this may impact not just the laryngopharynx but also areas such as the lingual tonsil, pharyngeal tonsils, sinuses, Eustachian tubes and trachea. Hence a more appropriate term is extra-oesophageal reflux (EOR). The term extra-oesophageal reflux disease (EORD) may be used when this reflux causes symptoms and pathology. For reasons that will be explained, patients may have EORD in the absence of GORD.
Case report of a laryngeal tuberculosis during pregnancy – challenges in diagnosis and management
Published in Acta Oto-Laryngologica Case Reports, 2023
Julian Pfäffli, Amina Nemmour, Philipp Kohler, Sandro J. Stoeckli
Regarding its pathogenesis, laryngeal TB can be divided into primary laryngeal TB from direct invasion of bacilli into the larynx or secondary laryngeal TB due to direct bronchogenic spread from advanced pulmonary TB or via hematogenous or lymphatic spread from extrapulmonary sources. While older publications from the 1940s reported a vast majority of secondary laryngeal TB, a more recent review revealed a higher proportion of primary laryngeal TB. Due to its rarity and unspecific symptoms, laryngeal TB is easily misdiagnosed. Symptoms may mimic common disorders like laryngopharyngeal reflux (LPR) or malignancy. The most common symptoms of laryngeal TB are dysphonia (96%), weight loss (47%), cough (38%), dysphagia (26%) and odynophagia (25%). Stridor has been described in 9% of the cases with a potential need of tracheotomy for safe airway management [3].
Prevalence of vocal fatigue and associated risk factors in university teachers
Published in Speech, Language and Hearing, 2022
Shruthi Padmashali, Srikanth Nayak, Usha Devadas
Furthermore, experiencing acid reflux was found to be significantly associated with reporting voice problems in university teachers. Similar findings were reported in the literature, indicating a strong association between experiencing voice problems and having Laryngopharyngeal reflux (LPR) (Cantor-Cutiva et al., 2022a; Devadas, Bellur, & Maruthy, 2017; Koufman, Radomski, Joharji, Russell, & Pillsbury, 1996; Lowden, McGlashan, Steel, Strugala, & Dettmar, 2009; Pribuisiene, Uloza, Kupcinskas, & Jonaitis, 2006; Sataloff, 2008). According to these authors, LPR induces functional laryngeal movement disorders such as muscle tension dysphonia, laryngospasm, and frequent throat clearing. Frequent throat clearing can cause laryngeal mucosa damage and a change in voice quality. This could be the reason for the significant association between acid reflux symptoms in university teachers and vocal fatigue.
Assessment of vaping devices as an alternative respiratory drug delivery system
Published in Drug Development and Industrial Pharmacy, 2022
Zaid Khaled, Eman Zmaily Dahmash, Jasdip Koner, Raad Al Ani, Hamad Alyami, Abdallah Y. Naser
Further analysis of the results showed low deposition of FP on the extra thoracic area (oropharyngeal area of the respiratory system), 5–10% for vaping devices versus 50% for the marketed pMDI. Reduction of deposition in the oropharyngeal area is favorable, as several studies have reported on the adverse effect of a chronic deposition of steroid (particularly a potent one such as FP) in the larynx results in steroid inhaler laryngitis. A study in 2002 reported that 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 [38].