Laryngopharyngeal reflux disease (LPRD) might be associated with reflux symptoms, and its severity is correlated with the Reflux Symptoms Index. Diagnosis is often challenging because of a lack of accurate diagnostic tools. Although an association between LPRD and gastroesophageal reflux disease (GERD) exists, the extent to which esophageal pressure changes in patients with LPRD with GERD has been unknown. Therefore, this study surveys the clinical assessments and extent of esophageal pressure changes in LRPD patients with various GERD severities, and compares esophageal sphincter pressures between ages, genders, and body mass index (BMI). This observational study assessed patients with LPRD and GERD. High-resolution esophageal manometry was used to gather data pertaining to the area pressure on the upper esophageal sphincter (UES) and lower esophageal sphincter (LES), and the correlation between such pressure and symptom severity was determined. We compared the esophageal pressure of different UES and LES levels in the following categories: gender, age, BMI, and GERD severity. We analyzed correlations between esophageal pressure and clinical assessments among 90 patients with throat globus with laryngitis with LPRD. LPRD was measured using laryngoscopy, and GERD was measured using esophagoscopy and 24 h PH monitoring. There were no significant differences in the clinical assessments among the four grades of GERD. The LPRD patients with serious GERD had a lower UES and LES pressure. The lowest pressure and longer duration of LES and UES were also observed among patients with LPRD of grade D GERD. No significant differences in UES and LES pressures among ages, genders, or BMIs were noted.
Background: Unilateral vocal palsy (UVFP) affects the voice and swallowing function and could be treated by various materials to achieve improved mucosal wave and better closure during phonation. Injection laryngoplasty is considered an exemplary method for these patients and could be injected as early as possible. We conducted a systematic review and meta-analysis for the subjective and objective outcomes of autologous fat injection laryngoplasty (AFIL) and assessed the effects for patients with UVFP. Methods: We searched studies from PubMed and EBSCO databases with PRISMA appraisal to search for articles about the effects of AFIL on UVFP. The published articles were reviewed according to our inclusion and exclusion criteria. The short- and long-term outcomes of perceptual, acoustic analysis, and quality of life were also analyzed by meta-analysis. Results: Eleven articles were reviewed, and seven studies were selected for meta-analysis. AFIL improves the perceptual outcome and some voice parameters in short-term and long-term results, i.e., jitter, shimmer, and maximal phonation time (MPT). It also significantly improved the voice handicap index (VHI) in the long term, suggesting an increase in quality of life. Conclusions: AFIL is considered a reliable treatment method for UVFP and could even last for over 12 months.
Sulcus vocalis is a frequent cause of glottic insufficiency that leads to incomplete vocal fold closure during phonation. Type II sulcus vocalis is defined as a partial defect of the lamina propria (LP). Treatment with fillers, such as fat or hyaluronic acid (HA), in the vocal folds is widely used, but the duration of effect is variable. Platelet-rich plasma (PRP) can enhance the survival of autologous fat in fat grafting, and also is used to treat sulcus vocalis. This study aimed to compare the effectiveness of autologous fat graft versus fat graft plus PRP to treat type II sulcus vocalis. Thirty-four patients with a voice handicap index (VHI) ≥ 11 were randomized to two groups, which received LP injections of fat graft (n = 17) or fat graft plus PRP (n = 17). At 1 month and 6 months after injection, the VHI decreased significantly in both groups. The fat plus PRP group had better Jitter, Shimmer, and noise to harmonic ratio (NHR) in 1 month and 6 months after surgery. The fat plus PRP group resulted in lower VHI scores one month after surgery, and stroboscopy revealed sustained smaller gaps after six months. These results indicate that a combination of fat graft plus PRP is safe and effective for treating sulcus vocalis type II and associated vocal atrophy.
We read with great interest the article entitled "Validity and Reliability of the Reflux Symptom Score [RSS]," which developed a new questionnaire for diagnosing and monitoring laryngopharyngeal reflux (LPR) disease. 1 However, we found that some of the conclusions seemed arbitrary, and further discussion is necessary. First of all, in 2002, Belafsky et al. 2 published a nineitem "Reflux Symptoms Index (RSI)" questionnaire (maximum score of 45). The mean value of RSI for their LPR patients dropped from 21.2 AE 10.7 at baseline to 12.8 AE 10.0 after 6 months of treatment, and 12.8 AE 10.0 approached the baseline RSI value (11.6) in the healthy control group. Therefore, they defined RSI > 13 as indicating LPR. Interestingly, in the new 22-item RSS questionnaire (maximum score of 550), the authors also suggested an RSS value of >13 to indicate diagnosis of LPR. However, the baseline RSS total score of 112.49 AE 78.41 only improved to 77.19 AE 63.36 after treatment. The value of 77.19 AE 63.36 was much higher than 13, and the baseline value of 9.68 AE 17.51 in the normal control group. Therefore, an RSS value of 13 does not appear to be suitable for defining LPR. Secondly, the authors emphasized that RSS has the advantage of including some common abdominal/chest symptoms associated with LPR, which had been ignored before. 2-4 However, their data do not support this claim because there was no significant difference between baseline and 12 weeks after treatment for some items (P = .58 for odynophagia; P = .875 for tongue burning; P = .184 for halitosis). Only 77 (68%) of their 113 enrolled patients completed the study, which probably reflects that a redundant questionnaire with unrelated items may reduce the completion rate and limit its value in clinical practice. Thirdly, the authors also used the Quality of Life Impact score (QoL-RSS) simultaneously with the RSS in their study. QoL-RSS had the same 22 items as RSS but with a narrower range from 0 to 110. According to the data in Table III of the study (page E102), QoL-RSS had a higher Spearman rank-order correlation coefficient than RSS (0.950 vs. 0.921). In Tables IV (page E104) and V (page E105), QoL-RSS is also as good as RSS; however, QoL-RSS is much simpler to use because it is not necessary to multiply the severity score by the frequency score to obtain a symptoms score ranging from 0 to 25 for each of the 22 symptom items. Therefore, we think QoL-RSS is better than RSS itself.
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