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Paediatrics
Published in Adnan Darr, Karan Jolly, Jameel Muzaffar, ENT Vivas, 2023
Paula Coyle, Eishaan Bhargava, Adnan Darr, Karan Jolly, Kate Stephenson, Michael Kuo
Differential diagnoses (paediatric): Chronic laryngitisVocal cord nodulesVocal cord polyps
Voice Disorders and Laryngitis
Published in R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne, Scott-Brown's Essential Otorhinolaryngology, 2022
Laryngitis is a descriptive term indicating a degree of erythema, oedema, epithelial change that may include ulceration, leukoplakia, and/or stiffness of the mucosa of the vocal fold. Often there is an increased amount of thick mucus present. Most acute laryngitis is associated with upper respiratory tract infections. Chronic laryngitis has close links with smoking, alcohol, reflux, occupational exposures, social activities, allergies, and vocal/throat hygiene. The voice is usually hoarse (rough, strained, breathy, or whispery), which may be due to vocal fold stiffness from the inflammatory process and/or secondary to muscle tension imbalance. The majority of acute infections are self-limiting. Treatment of chronic laryngitis consists of voice hygiene (VH) with reduced use/abuse and rest.
The spectrum of voice disorders – presentation
Published in Stephanie Martin, Working with Voice Disorders, 2020
Chronic laryngitis is a more persistent disorder and is rarely caused by an inflammatory illness or an infection such as sarcoidosis or tuberculosis related to the vocal folds. As noted by Khidr et al. (2003), the laryngeal symptoms are most commonly caused by vocal misuse, for example, laryngeal irritation from exposure to chemicals, dust, smoking, alcohol abuse, GORD or LPR (Allen et al., 2019). In addition, irritation due to hypersensitivity type of occupational laryngitis (OL) has been noted by Hannu et al. (2009). Less often, chronic laryngitis is caused by chronic sinusitis with post-nasal drip.
Asymptomatic marginal zone lymphoma of mucosa-associated lymphoid tissue in the hypopharynx, detected with esophagogastroduodenoscopy
Published in Acta Oto-Laryngologica Case Reports, 2018
Takuya Okada, Kenro Kawada, Taro Sugimoto, Takashi Ito, Kazuya Yamaguchi, Yudai Kawamura, Masafumi Okuda, Yuichiro Kume, Tairo Ryotokuji, Akihiro Hoshino, Yutaka Tokairin, Yasuaki Nakajima
MALT lymphomas originate at various extranodal sites, including the GI tract (50%), head and neck region (15%), lungs (14%), ocular adnexa (12%), skin (11%), thyroid (4%) and breasts (4%). Damage of the mucosa or epithelium by chronic inflammation, or an underlying autoimmune disorder, may be of significance in MALT lymphomas; for example, there is a well-established association between H. pylori infection and MALT lymphomas of the stomach [6]. Several previously published reports have also suggested that MALT lymphomas of the larynx may be caused by chronic laryngitis, extraesophageal reflux disease, or H. pylori infection of the stomach [7,8]. Kania et al. described an incidence of laryngeal MALT lymphoma, which was successfully managed by a combination of surgical excision, reflux therapy and eradication of H. pylori [9–11]. The relationship between these conditions and MALT lymphomas of the head and neck region, however, remains unclear. In our case, the patient did not present with pharyngitis, gastroesophageal reflux disease, or a gastric H. pylori infection. The etiologic factors were unidentified, and we did not add treatments for reflux therapy or eradication of H. pylori.
Proton pump inhibitors: use and misuse in the clinical setting
Published in Expert Review of Clinical Pharmacology, 2018
Vincenzo Savarino, Elisa Marabotto, Patrizia Zentilin, Manuele Furnari, Giorgia Bodini, Costanza De Maria, Gaia Pellegatta, Claudia Coppo, Edoardo Savarino
Many papers have reported that GERD can present with extra-esophageal symptoms, such as hoarseness, chronic cough, and asthma [28], although the causal relationship between these respiratory symptoms and reflux episodes remains highly controversial. Indeed, anti-reflux therapy with PPIs has been shown to be not superior to placebo in many of these patients, unless the relationship between GERD and atypical symptoms has been clearly proven by functional testing or concomitant typical symptoms are complained by patients. In fact, a recent review [29] suggests a therapeutic benefit by acid suppressing drugs in patients with a chronic cough and this advocates a rigorous patients’ selection that could allow the identification of a patients’ subgroup likely to be PPI responsive. Conversely, no systematic reviews or meta-analyses showed any significant success of PPI therapy over placebo in patients with chronic laryngitis [30]. Moreover, asthma and GERD can often coexist as abnormal reflux has been found in 40%-90% of cases [31]. However, a Cochrane review [32] has denied any benefit from PPIs compared with placebo and only a more recent study has shown that asthma responds in patients with proven reflux and nocturnal symptoms [33]. Nevertheless, in many cases the origin of extra-esophageal manifestations is multifactorial and an evident responsability of abnormal reflux cannot be documented even by means of modern sophisticated functional examinations [34]. As the use of PPI doses higher than the standard ones and for the longer duration than usual are suggested in these patients according to international guidelines, the efforts should be addressed to identify people with reasonable atypical symptoms–GERD association before embarking on a costly and prolonged PPI treatment.