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Biomedical subjects

Gregory N Postma

Publications and source records attributed to Gregory N Postma.

At least 19 recordsLinked to original sources
PubMed2003

Topical nasal anesthesia for transnasal fiberoptic laryngoscopy: a prospective, double-blind, cross-over study.

BACKGROUND: Transnasal fiberoptic laryngoscopy (TFL) is frequently performed by otolaryngologists, speech language pathologists, and various other health care providers. Historically, topical sprays have been administered to patients to decongest and anesthetize the nasal mucosa, thus minimizing the discomfort of the procedure. Recently, it was reported that patients undergoing TFL with topical anesthesia experienced no improvement in comfort compared with those who received oxymetazoline or saline. This observation is in direct opposition to our clinical experience that patients tolerate the procedure better with topical anesthesia. PURPOSE: We sought to compare patient comfort levels during TFL after the administration of cocaine, oxymetazoline, or saline. METHODS: Fifteen subjects undergoing TFL were prospectively evaluated. Each had TFL performed on 3 separate occasions. Before TFL, each patient received either 4% cocaine, 0.05% oxymetazoline, or saline topically administered via an atomizer to both nasal cavities (1 spray of 2-second duration). By the conclusion of the study, each patient had undergone TFL with each of the test agents. The subjects rated the discomfort they experienced on a scale ranging from 1 (minimal discomfort) to 5 (severe discomfort). Both patient and examiner were blinded to the test agent used. RESULTS: The mean nasal discomfort score for saline was 2.8 +/- 1.1. The scores for oxymetazoline and cocaine were 3.4 +/- 0.9 and 2.0 +/- 0.9, respectively. Compared with saline and oxymetazoline independently, TFL with topical cocaine appeared to provide more comfort (P < 0.05 and P < 0.005). CONCLUSION: The continued routine use of topical anesthetics such as cocaine before the performance of TFL is justified because it significantly decreases the patient's discomfort.

Administration, Topical↗
PubMed2003

Fiberoptic endoscopic evaluation of swallowing.

OBJECTIVES/HYPOTHESIS: Approximately 8 million people in the United States report some degree of dysphagia annually; as the population continues to age, this will become a greater problem. A comprehensibly performed and interpreted fiberoptic endoscopic evaluation of swallowing provides invaluable information for the evaluation and management of individuals with dysphagia or aspiration, or both. STUDY DESIGN: Review. METHODS: The state-of-the-art technique, interpretation, predictive value, and safety of fiberoptic endoscopic evaluation of swallowing was reviewed.

Deglutition↗
PubMed2003

Topical nasal anesthesia and laryngopharyngeal sensory testing: a prospective, double-blind crossover study.

Laryngopharyngeal sensory discrimination testing (LPSDT) has become a popular means of detecting sensory deficits in patients with voice and/or swallowing complaints. During this procedure, transnasal fiberoptic laryngoscopy (TFL) using a specialized fiberoptic scope is performed in order to deliver discrete pulses of air to the laryngopharyngeal mucosa. Historically, topical anesthesia has been applied to the nasal mucosa to lessen discomfort during TFL. Because of the concern that topical nasal anesthesia could also anesthetize the laryngopharynx, it is usually not used during sensory testing. To prospectively compare LPSDT scores after the nasal administration of cocaine hydrochloride, oxymetazoline hydrochloride, and saline solution, we prospectively evaluated 15 subjects undergoing LPSDT. Each had the procedure performed on 3 separate occasions. Before examination, each patient was administered either 4% cocaine, 0.05% oxymetazoline, or saline solution by atomizer (2 sprays of 1-second duration to each naris). By the conclusion of the study, each patient had undergone sensory testing with each of the test agents. During each examination, the minimal air pulse eliciting the laryngeal adductor reflex was recorded for both sides of the laryngopharynx. Both patient and examiner were blinded to the test agent used. The mean sensory score for saline solution was 3.9 mm Hg. The sensory scores for oxymetazoline and cocaine were 3.4 and 3.5 mm Hg, respectively. When compared to saline solution and oxymetazoline independently, sensory testing of the laryngopharynx during which the nose was anesthetized with cocaine resulted in similar thresholds for eliciting the laryngeal adductor reflex (p = .40 and p = .85). We conclude that topical anesthesia can be applied to the nasal cavity during LPSDT without altering laryngeal sensation.

Administration, Intranasal↗
PubMed2002

Validity and reliability of the reflux symptom index (RSI).

Laryngopharyngeal reflux (LPR) is present in up to 50% of patients with voice disorders. Currently, there is no validated instrument that documents symptom severity in LPR. We developed the reflux symptom index (RSI), a self-administered nine-item outcomes instrument for LPR. The purpose of this investigation was to evaluate the psychometric properties of the RSI. For validity assessment, 25 patients with LPR were evaluated prospectively before and six months after b.i.d. treatment with proton pump inhibitors (PPI). Each patient completed the RSI as well as the 30-item voice handicap index (VHI). For reliability assessment, the study patients were given the RSI on two separate occasions before the initiation of treatment. Normative RSI data were derived from 25 age-matched and gender-matched controls taken from an existing database of asymptomatic individuals without any evidence of LPR. The mean RSI (+/- standard deviation) of patients with LPR improved from 21.2 (+/- 10.7) to 12.8 (+/- 10.0), and the mean VHI improved from 52.2 (+/- 24.7) to 41.5 (+/- 25.0) after 6 months of therapy (p = 0.001 and 0.065, respectively). Of the three VHI subscales (emotional, physical, functional), only the functional subscale improved significantly (p = 0.037). Patients who experienced a five point or better improvement in RSI were 11 times more likely to experience a five-point improvement in VHI (95% confidence interval = 1.7, 76.8). For reliability assessment, the first and second pretreatment RSIs were 19.9 (+/- 11.1) and 20.9 (+/- 9.6), respectively (correlation coefficient = 0.81, p < 0.001). The single-item correlation coefficients ranged from 0.41 to 0.91 (p < 0.05 for all items). The mean pretreatment RSI in patients with LPR was significantly higher than controls (21.2 versus 11.6; p < 0.001). The mean RSI of patients with LPR after 6 months of PPI therapy approached that of asymptomatic controls (p > 0.05). The RSI is easily administered, highly reproducible, and exhibits excellent construct and criterion-based validity.

Adult↗
PubMed2002

The association between laryngeal pseudosulcus and laryngopharyngeal reflux.

BACKGROUND: A pattern of edema on the ventral surface of the vocal fold, called pseudosulcus vocalis, was described in 1995. It refers to infraglottic edema extending from the anterior commissure to the posterior larynx. It can be differentiated from sulcus vergeture, which is caused by adhesion of the vocal fold epithelium to the vocal ligament. Although it has been related to laryngopharyngeal reflux (LPR), this has not been thoroughly investigated. PURPOSE: Our goal was to evaluate the association between pseudosulcus and LPR. METHODS: Thirty patients with a clinical diagnosis of LPR confirmed by double-probe pH monitoring and 30 controls without LPR were enrolled. The prevalence of pseudosulcus was determined with fiberoptic laryngoscopy. RESULTS: Seventy percent (21 of 30) of patients with lpr and 30% (9 of 30) of controls had pseudosulcus. Patients with pseudosulcus were 2.3 times more likely to have pH-documented LPR (95% confidence interval 1.3-4.2). The sensitivity and specificity of pseudosulcus in the diagnosis of LPR are 70% and 77%, respectively. CONCLUSIONS: Pseudosulcus is highly correlated with pH-documented LPR (P < 0.001). The presence of pseudosulcus is suggestive of LPR.

Adult↗
PubMed2002

Muscle tension dysphonia as a sign of underlying glottal insufficiency.

BACKGROUND: Hyperkinetic vocal function (muscle tension dysphonia) may be an indication of underlying glottal insufficiency. In the face of an organic voice disorder such as presbylaryngis or vocal fold paresis. Hyperkinetic laryngeal behaviors may be used to achieve glottal closure. Such compensatory laryngeal behaviors may mask the correct underlying diagnosis. OBJECTIVE: We sought to evaluate the association between vocal fold bowing due to presbylaryngis and abnormal muscle tension patterns (MTPs). METHODS: One hundred consecutive volunteers >40 years old were prospectively evaluated. All underwent a comprehensive head and neck examination that included transnasal fiberoptic laryngoscopy with videostroboscopy. Abnormal MTPs were compared in subjects with and without vocal fold bowing. RESULTS: The mean age of the cohort was 61 years. Eighty-four percent (42 of 50) of the male subjects and 60% (30 of 50) of female subjects had evidence of vocal fold bowing. Of the 72 patients with bowing, 94% (68 of 72) had abnormal MTPs. Compared with subjects without vocal fold bowing, persons with bowing were 17 times more likely to exhibit abnormal MTPs (P < 0.001). CONCLUSIONS: Abnormal MTPs are common in persons with underlying glottal insufficiency. Patients with vocal fold bowing are 17 times more likely to exhibit abnormal MTPs (95% confidence interval, 4.9 to 59.4). Clinicians should be aware that compensatory hyperkinetic laryngeal behaviors may mask an underlying organic condition.

Aged↗
PubMed2002

Prevalence of esophagitis in patients with pH-documented laryngopharyngeal reflux.

OBJECTIVE: To report the prevalence of esophagitis in patients with pH-documented laryngopharyngeal reflux. STUDY DESIGN: Prospective study of 58 consecutive patients with documented laryngopharyngeal reflux, all of whom underwent transnasal esophagoscopy as part of their reflux evaluations. METHODS: All patients with a diagnosis of laryngopharyngeal reflux confirmed by abnormal pharyngeal pH monitoring over a 5-month period were included, and all subjects completed a self-administered reflux symptom index and underwent transnasal esophagoscopy with directed biopsy. RESULTS: Of the 58 study patients with pH-documented laryngopharyngeal reflux, the mean age was 49 years (+/- 13 y), and 53% (31 of 58) were women. Of the study group, 40% (23 of 58) had heartburn and 48% (28 of 58) had abnormal esophageal reflux (by pH monitoring criteria); by transnasal esophagoscopy with biopsy, 12% (7 of 58) had esophagitis and another 7% (4 of 58) had Barrett's metaplasia. Thus, 60% of the study cohort had heartburn, and 81% (47 of 58) had normal esophageal epithelium (i.e., esophagitis or Barrett's metaplasia). CONCLUSIONS: In the present series of patients with documented laryngopharyngeal reflux the prevalence of esophagitis and Barrett's metaplasia was only 19%. These data confirm the clinical impression that the patterns, mechanisms, and manifestations of laryngopharyngeal reflux differ from those of classic gastroesophageal reflux disease. Unlike gastroesophageal reflux disease, patients with laryngopharyngeal reflux uncommonly have esophagitis. Thus, although esophagoscopy may be an excellent method for screening the esophagus, it is not the method of choice for diagnosing laryngopharyngeal reflux.

Barrett Esophagus↗
PubMed2002

Laryngopharyngeal reflux and laryngeal web formation in patients with pediatric recurrent respiratory papillomas.

OBJECTIVE: To determine whether treatment of laryngopharyngeal reflux reduces the laryngeal soft tissue complications encountered in surgery for recurrent respiratory papillomas. STUDY DESIGN: Retrospective chart review. METHODS: Retrospective chart review of all pediatric patients treated for laryngeal recurrent respiratory papillomas between 1984 and 1999 was performed. Thirty-one such patients were identified. Twenty-four were at "high risk" for developing complications based on the number of operating suite visits and the presence of disease at the anterior commissure. Twelve patients underwent 24-hour double pH probe testing. RESULTS: Overall, 13 of 31 patients (42%) developed laryngeal webs. No other soft tissue complications were encountered. Of the patients who had pH probe testing, 12 of 12 (100%) had at least one pharyngeal episode of acid exposure. Of the "high-risk" patients, 10 were treated for reflux and only 2 of 10 (20%) developed webs. Eleven of 14 (79%) of the "high-risk" patients who were not treated for reflux developed webs. The difference in rate of web formation between patients treated for reflux and those not treated for reflux was statistically significant (P =.011). CONCLUSIONS: Antireflux treatments for patients undergoing surgery for laryngeal recurrent respiratory papillomas may reduce the soft tissue complications, especially scarring and web formation. Prophylactic antireflux therapy may be warranted in any patient undergoing surgery during which laryngeal mucosal disruption is anticipated.

Female↗
PubMed2002

The role of transnasal esophagoscopy in head and neck oncology.

OBJECTIVES/HYPOTHESIS: To review the current role of transnasal esophagoscopy (TNE) in all aspects of head and neck cancer patient treatment. STUDY DESIGN: A retrospective database and chart review. METHODS: A retrospective review of head and neck cancer patients undergoing TNE for a variety of diagnostic and therapeutic indications. RESULTS: In a series of 17 patients with presumed head and neck malignancies, TNE provided 100% accuracy in biopsy results and staging of the tumor when compared with standard panendoscopy. The utility of TNE in other areas of head and neck cancer management, such as stricture dilation and secondary tracheoesophageal puncture, is demonstrated. This preliminary report strongly suggests that TNE may play a vital role in the management of head and neck oncology patients. CONCLUSIONS: Transnasal esophagoscopy gives the surgeon the ability to perform a remarkable variety of procedures in the outpatient setting without sedation. It may obviate the need for routine panendoscopy in head and neck cancer patients.

Esophagoscopy↗