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PubMed1999

Comparison of viscoelastic properties of the pharyngeal tissue: human and canine.

The viscoelastic properties of the human and canine pharyngeal tissue in tension were evaluated, based on both an experimental protocol-consisting of cyclic load, tensile stress relaxation, and incremental step load tests-and the quasi-linear viscoelastic theory. The reduced stress relaxation function and the elastic response of the pharyngeal tissues were derived from the experimental results specifically obtained from those tissues. The characteristic features of viscoelastic property were obtained for both human and canine pharyngeal tissues by applying the quasi-linear viscoelastic theory and compared with each other. The material properties of the pharyngeal tissue were sought to facilitate the three-dimensional biomechanical model of the pharyngeal function by using the finite element method.

Aged↗

PubMed2006

The effect of smoking and drinking in oral and pharyngeal cancers: a case-control study in Uruguay.

In the time period 1988-2000, a case-control study on oral and pharyngeal cancers was conducted among men in Montevideo, Uruguay. The study included 776 cases and 1501 controls. The cases were distributed by site in oral cancers (335 patients) and pharyngeal cancers (441 patients). Odds ratios for smoking were higher among participants with pharyngeal cancers compared with those with oral carcinomas, but there was no significant heterogeneity. On the contrary, alcohol drinking displayed statistically higher risks among those with pharyngeal carcinomas compared with patients with oral cancer (P-value for heterogeneity=0.01). The effect of alcohol was particularly strong for cancers of the hypopharynx. Our results raise the possibility that oral and pharyngeal carcinomas are in fact different entities. Further studies are needed in order to clarify this important point.

Adult↗

PubMed2006

Comparison of clinical prediction rules for management of pharyngitis in settings with limited resources.

OBJECTIVE: To compare the effectiveness of several clinical prediction rules for culture-positive streptococcal pharyngitis in a single group of patients in a setting in which clinicians routinely treat all cases of pharyngitis presumptively, without laboratory data. STUDY DESIGN: A MEDLINE search identified clinical prediction rules for streptococcal pharyngitis in children. Each rule was applied analytically to data from 410 children in Cairo, Egypt with clinical pharyngitis, in whom throat cultures were performed. The diagnostic effectiveness of these rules for predicting a positive culture were assessed and compared. RESULTS: Seven prediction rules were identified. Of these 7 rules, 4 were developed in North American children, 1 was recommended by the World Health Organization (WHO), and 2 were developed in Egypt. In the Cairo children, the WHO rule was the least sensitive, at 12%. The 6 other rules had sensitivities ranging from 81% to 99% and specificities ranging from 4% to 40%; 2 rules seemed to be effective, with diagnostic odds ratios of 5.2 and 6.1. CONCLUSIONS: The prediction rules demonstrated variable diagnostic effectiveness in the Egyptian children. Without laboratory testing, 2 clinical rules detected > 90% of cases of pharyngitis with positive culture for group A streptococcus and reduced overtreatment of culture-negative cases by approximately 40%. Selected clinical prediction rules have useful characteristics in settings of limited resources and need further validation.

Ampicillin↗

PubMed1990

Lack of influence of beta-lactamase-producing flora on recovery of group A streptococci after treatment of acute pharyngitis.

Because production of beta-lactamase by normal pharyngeal flora could account for penicillin treatment failure, we studied the effect of anaerobic and aerobic beta-lactamase-producing bacteria on bacteriologic outcome in acute group A beta-hemolytic streptococcal (GABHS) pharyngitis. We compared 10-day courses of orally administered phenoxymethyl penicillin and amoxicillin-clavulanic acid, using a randomized, single-blind treatment protocol. Eligible patients were 2 to 16 years of age and had culture-proven acute GABHS pharyngitis; 89 patients (43 penicillin, 46 amoxicillin-clavulanic acid) were compliant with therapy. beta-Lactamase-producing organisms were isolated before therapy from the throats of 67% of patients treated with penicillin and 63% treated with amoxicillin-clavulanic acid. Throat cultures after completion of therapy were positive for GABHS in 7 (7.9%) of 89 patients. The initial GABHS T type persisted (treatment failure) in only 4 (4.5%) of 89 patients, including 3 (6.5%) of 46 who received amoxicillin-clavulanic acid and in 1 (2.3%) of 43 who received penicillin (not statistically significant). Bacteriologic treatment failure was unrelated to recovery of beta-lactamase-producing bacteria at the time of enrollment or after treatment. We conclude that beta-lactamase production by normal pharyngeal flora does not fully explain the failure of penicillin therapy for acute streptococcal pharyngitis. Using an antibiotic effective against beta-lactamase-producing bacteria will not eliminate the problem of bacteriologic treatment failure.

Adolescent↗

PubMed1999

Respiratory-related pharyngeal constrictor muscle activity in awake goats.

Respiratory-related electromyogram (EMG) activities of the middle (MPC) and inferior (IPC) pharyngeal constrictor (PC) muscles were determined simultaneously with up to six additional upper airway abductor and adductor muscles in awake adult goats. Phasic PC activation began in late inspiration and persisted throughout expiration with a steady, an augmenting or a biphasic pattern of activity. Considerable differences were noted in the EMG responses of the MPC and IPC muscles to respiratory-related stimuli. During hypoxia and hypercapnia, phasic MPC activity decreased or was not recruited whereas phasic IPC activity was augmented with increased chemical drive. During spontaneous augmented breaths and peripheral chemoreceptor stimulation with sodium cyanide, the pattern of activation of the MPC was similar to that of the thyroarytenoid muscle (TA), a laryngeal adductor whereas IPC activity was strikingly similar to activity of the laryngeal and pharyngeal dilators. The expiratory portion of an augmented breath was associated with increased phasic MPC and TA but not IPC activities. Dopamine-induced apneas resulted in tonic activation of the MPC and TA at a level equal to or greater than control activity but no recruitment of IPC activity. The marked differences in MPC and IPC responses to respiratory-related stimuli suggests that these muscles may have different mechanical effects on pharyngeal airway caliber in the goat. The results suggest that the MPC may help brake expiratory flow thus helping to control expiratory timing and lung volume. In contrast, the IPC may promote pharyngeal airway patency by stiffening or dilating the pharyngeal airway. The results demonstrate that a variety of stimuli can influence respiratory-related PC activity and suggest that the PC muscles are important in the regulation of breathing and upper airway patency.

Animals↗

PubMedDate not supplied

Comprehensive analysis of pharyngeal recurrence of laryngeal carcinoma after total laryngectomy.

PURPOSE: This study analyzes the incidence, risk factors, treatment results, and prognosis of local recurrence at the pharynx after total laryngectomy for laryngeal carcinoma. PATIENTS AND METHODS: The records of 292 patients who underwent total laryngectomy for the treatment of laryngeal carcinoma between January 1978 and December 1990 were reviewed. RESULTS: Of these 292 patients, there were 24 patients who developed local recurrence at the pharynx. The 5-year actuarial cumulative local recurrence rate was 10%. There were 17 cases of pharyngeal recurrence alone, five cases of pharyngeal and nodal recurrence, one case of pharyngeal and tracheostomal recurrence, and one case of pharyngeal and distant metastasis. Ten (42%) patients were salvaged surgically; the 5-year actuarial survival rate after surgical salvage was 53%. The other 14 patients were treated with palliative treatment, and all died of tumor, with the longest period of survival being 28 months. CONCLUSION: Surgical salvage of pharyngeal recurrence has acceptable results. Close monitoring of patients is important to have an early diagnosis of salvageable recurrence.

Adult↗

PubMed1983

Clinical spectrum of pharyngeal gonorrhea in children and adolescents: a report of sixteen patients.

Pharyngeal gonorrhea in children and adolescents is probably increasing. During a 1-year period, 16 patients were diagnosed and treated for pharyngeal gonorrhea. This was the result of a search among a high-risk group, consisting of victims of sex abuse, patients suspected of homosexual practices, and adolescents with symptoms or signs suggestive of sexually transmitted diseases. Of the 16 positive throat cultures, 75% represented pharyngeal colonization while only 25% had clinical symptoms. Pharyngeal gonorrhea was found to be a marker in screening for psychosocial pathology, leading in two-thirds of the cases to the discovery of instances of incest, sexual abuse, chaotic family situations, or severe depression, all of which had been previously denied, ignored, or neglected. The purpose of this article is to alert health care providers to the clinical spectrum of pharyngeal gonorrhea in children and adolescents.

Adolescent↗

PubMed1998

A new pharyngitis model using capsaicin in rats.

1. Application of capsaicin solution onto the rat pharyngeal mucosa caused a well-reproducible increase in vascular permeability in the pharynx. 2. Capsaicin-induced pharyngeal inflammation was unaffected by a histamine H1 blocker and non-steroidal anti-inflammatory agents, whereas dexamethasone was effective in its inhibition. 3. FK224, a dual antagonist of tachykinin NK1 and NK2 receptors, and FK888, a selective antagonist of NK1 receptor, significantly inhibited capsaicin-induced plasma exudation in the pharynx. 4. In capsaicinized animals, the application of capsaicin solution in the pharyngeal mucosa did not induce pharyngitis. 5. These results suggest that the mechanism of the capsaicin-induced pharyngitis primarily involves tachykinins.

Animals↗

PubMed1998

Effect of stimulating peripheral and central neural pathways on pharyngeal muscle contraction timing during swallowing in dogs.

The effect of stimulating peripheral and central neural pathways on the electromyographic activity in the hyopharyngeal, thyropharyngeal, and cricopharyngeal muscles was studied in eight dogs during 1) eating, 2) unilateral electrical stimulation of the superior laryngeal nerve, and 3) unilateral electrical stimulation of the solitary nucleus. The duration of pharyngeal swallowing was significantly shorter during eating than during stimulation of the solitary nucleus in the anesthetized dog (mean difference 127 ms, SEM 9, n = 15). The duration of pharyngeal swallowing was significantly shorter during eating than during stimulation of the superior laryngeal nerve in the awake dog (mean difference 84 ms, SEM 13, n = 9). The duration of pharyngeal swallowing during stimulation of the superior laryngeal nerve under anesthesia was significantly shorter than during stimulation of the solitary nucleus under anesthesia (mean difference 58 ms, SEM 18, n = 9). The difference in duration of pharyngeal swallowing during stimulation of the superior laryngeal nerve between the awake state and during anesthesia was not significant (mean 19 ms, SEM 14, n = 9). It was concluded that stimulation of peripheral and central neural pathways resulted in different pharyngeal muscle contraction timing during swallowing in dogs.

Animals↗

PubMed1997

Laryngo-pharyngeal complaints following laryngeal mask airway and endotracheal intubation.

STUDY OBJECTIVE: To investigate the incidence and severity of laryngo-pharyngeal complaints following anesthesia with the use of a laryngeal mask airway (LMA) compared with endotracheal intubation in adults. DESIGN: Prospective study with randomized patient selection. SETTING: University medical center. PATIENTS: 202 adult ASA physical status I, II, and III patients scheduled for elective surgery of either an extremity or breast, or a transurethral resection. INTERVENTIONS: Following intravenous induction of anesthesia, a standard LMA size #3, #4, or #5 corresponding to the patient's body weight, was inserted in 103 patients; 99 patients were intubated with a polyvinylchloride endotracheal tube [7.5 mm inner diameter (ID) in women and 8.0 mm ID in men]. Cuff pressures in the LMA group were initially reduced to a minimum pressure at which an air-tight seal between the LMA and the laryngeal inlet was provided at a positive pressure of 20 cm H2O during manual bag ventilation. Cuffs of endotracheal tubes were inflated and controlled to a volume needed to prevent gas leak at 35 cm H2O pressure. MEASUREMENTS AND MAIN RESULTS: Cuff pressures were continuously monitored in both groups. Patients assessed their laryngo-pharyngeal complaints on a 101-point numerical rating scale on the evening after surgery and the following two days. No difference was found in the incidence and severity of sore throat on the evening following surgery or on the two following days. Dysphonia was more frequent following intubation than following LMA insertion on the day of surgery (46.8% vs. 25.3%) and on the first postoperative day (28.1% vs. 11.6%) (p < 0.05). However, the incidence of dysphonia increased with the duration of anesthesia in LMA patients but not in intubated patients. The incidence of dysphagia was significantly higher following LMA insertion compared with endotracheal intubation on the day of surgery (23.8% vs. 12.5%), and on the first postoperative day (22.3% vs. 10.4%). The severity of the individual complaints of minor laryngo-pharyngeal morbidity was comparable between groups. The type of airway management during anesthesia did not affect patient satisfaction with the anesthesia received. CONCLUSIONS: There is a distinct pattern of laryngo-pharyngeal complaints following the use of the LMA and endotracheal intubation. With regard to minor laryngo-pharyngeal morbidity, the advantage of the LMA to endotracheal intubation is questionable.

Deglutition Disorders↗

PubMed1999

Trends in the incidence of lip, oral, and pharyngeal cancer: Connecticut, 1935-94.

Using Connecticut Tumor Registry data we explored trends in age-adjusted (AARs) and age-specific (ASRs) incidence rates for lip, oral, and pharyngeal cancer over the 60-year period 1935-94. Particular attention was given to findings from the most recent series of 5-year periods that have not been previously analyzed. There was a long-term decline in lip cancer AARs by period, and ASRs generally fell over time and with successive birth cohorts. This notable decrease in rates continued through 1990-94 and with the more recent cohorts, particularly among males. Oral cancer AARs for males peaked in the early 1960s and the late 1970s while rates for pharyngeal cancer increased into the late 1970s. For each of these sites, rates began to decline in 1980-84 and have continued to fall into the first half of the 1990s. Among females AARs for oral and pharyngeal cancer increased more than threefold between 1935-39 and 1980-84; however, encouragingly, and in sharp contrast to the earlier trend, rates fell during the most recent 10-year period. ASRs for oral and pharyngeal cancer were increasing by the birth cohort of 1900 and tended to increase through the cohort of 1920 for males and the cohorts of 1920-30 for females. ASRs for subsequent cohorts have remained relatively unchanged or decreased modestly. It is doubtful that the observed trends in lip, oral and pharyngeal cancer incidence are primarily artifactual, but more likely represent secular changes in exposure to environmental risk factors.

Adolescent↗

PubMed2002

Effects of macrocyclic lactone anthelmintics on feeding and pharyngeal pumping in Trichostrongylus colubriformis in vitro.

The effects of macrocyclic lactone anthelmintics (MLs) on feeding by Trichostrongylus colubriformis nematodes in vitro were examined using inulin uptake as a measure of ingestion and electropharyngeograms as a record of the electrical events associated with pharyngeal pumping. Inulin uptake was inhibited by the 4 MLs tested (EC50s 0.045-4.57 nM), with an order of potency of eprinomectin (most potent), ivermectin, ivermectin monosaccharide, and ivermectin aglycone. The MLs caused both the frequency and amplitude of pharyngeal electrical events to decrease. In individual worms the inhibition of pump frequency preceded the inhibition of pump amplitude. The order of potency of the MLs as inhibitors of frequency was ivermectin aglycone, ivermectin, ivermectin monosaccharide and eprinomectin. The difference compared with the inulin assay results are probably due to the dynamics of drug uptake in the two systems. It was possible that the nematodes in the electrophysiology experiments were effectively orally ligated by enclosure of the worm's head in the recording pipette which contained no drug. Despite this difference in relative potencies, both the ingestion assays and the electrical events indicate that MLs are potent inhibitors of the pharynx in T. colubriformis in vitro. The sequence of effects on pharyngeal electrical activity suggests that ML action involves an initial inhibitory effect on the rate of pharyngeal contractions, followed by a decrease in the amplitude of the potentials associated with pharyngeal pumping events.

Animals↗

PubMed2001

The relationship between the clinical features of pharyngitis and the sensitivity of a rapid antigen test: evidence of spectrum bias.

STUDY OBJECTIVE: We evaluate the test characteristics and test for spectrum bias of a rapid antigen test for group A beta-hemolytic streptococcal (GABHS) pharyngitis among adults. METHODS: Medical record and laboratory results of consecutive adult patients receiving a rapid antigen test for GABHS in the emergency department or urgent care clinic of an urban teaching hospital between August 1999 and December 1999 were analyzed. Patients were stratified according to the number of clinical features present using the following modified Centor criteria: history of fever, absence of cough, presence of pharyngeal exudate, and cervical lymphadenopathy. The sensitivity of the rapid antigen test was defined as the number of patients with positive rapid antigen test results divided by the number of patients with either positive rapid antigen test results or negative rapid antigen test results and positive throat culture results. RESULTS: In the study sample of 498 patient visits, the prevalence of GABHS pharyngitis was 28% (95% confidence interval [CI] 24% to 32%). The prevalence of GABHS pharyngitis increased as modified Centor scores increased: 0 or 1=14%, 2=20%, 3=43%, and 4=52%. An increased number of modified Centor criteria (0 or 1, 2, 3, 4) was associated with increased rapid antigen test sensitivity (61%, 76%, 90%, and 97%, respectively) (Mantel-Haenszel trend test; P =.001). CONCLUSION: The sensitivity of the rapid antigen test for GABHS is not a fixed value but varies with the spectrum of disease. Among adults with 3 or 4 clinical criteria for GABHS pharyngitis, further study may reveal that culture confirmation of negative rapid antigen test results are not necessary.

Adolescent↗

PubMed1985

Pharyngeal infections. Causes, findings, and management.

Pharyngitis is one of the most common clinical problems. Its causes are multiple, two of the best known being streptococcal infection and infectious mononucleosis. Group A beta-hemolytic streptococcal infections are the focus of diagnostic and therapeutic efforts aimed at reducing the risk of both suppurative and nonsuppurative complications. Several non-group A infections are important to recognize as sources of pharyngitis. In addition, mycoplasmal and chlamydial pharyngitis may be more prevalent than is realized. The possibility of gonococcal pharyngitis should be given special attention because of the severity of complications. Recurrent pharyngitis is difficult to manage. Except for certain specific indications, tonsillectomy remains an unproven therapeutic approach.

Adolescent↗

PubMed2001

Increased sensitivity of DNA amplification testing for the detection of pharyngeal gonorrhea in men who have sex with men.

We compared ligase chain reaction (LCR) assay with standard culture for the detection of pharyngeal Neisseria gonorrhoeae infection in men who have sex with men (MSM) presenting at a sexually transmitted diseases clinic in San Francisco. Pharyngeal specimens were obtained from 200 MSM who reported performing fellatio during the previous 2 weeks. Confirmatory testing of discrepant specimens was conducted using N. gonorrhoeae pilin proteins. Prevalence of pharyngeal N. gonorrhoeae was 6% by culture or 11% by LCR. The sensitivity and specificity of LCR were 94.7% and 97.8%, respectively, compared with values of 47.4% and 100% for culture. Prevalence of pharyngeal N. gonorrhoeae infection, as determined by DNA amplification testing, was higher than that suggested by traditional culture. Results support the use of DNA amplification testing in the oropharynx. The high prevalence of pharyngeal N. gonorrhoeae infection among MSM suggests that routine screening should be considered in efforts to reduce the burden of gonorrhea in this population.

Adult↗

PubMed2005

Prevalence of rectal, urethral, and pharyngeal chlamydia and gonorrhea detected in 2 clinical settings among men who have sex with men: San Francisco, California, 2003.

BACKGROUND: The Centers for Disease Control and Prevention developed screening and diagnostic testing guidelines for chlamydia and gonorrhea at urethral, rectal, and pharyngeal sites for men who have sex with men (MSM). However, in most clinical settings, rectal chlamydial testing is not performed for MSM, and primarily sexually transmitted disease (STD) clinics alone perform routine rectal and pharyngeal gonorrhea screening for asymptomatic men. METHODS: We evaluated the prevalence of rectal, urethral, and pharyngeal chlamydial and gonococcal infections among MSM seen at the municipal STD clinic and the gay men's community health center. We also determined the proportion of asymptomatic rectal infections, described the patterns of single and multiple anatomic sites of infection, and evaluated the proportion of chlamydial infections that would be missed and not treated if MSM were not routinely tested for chlamydia. We tested specimens using previously validated nucleic acid amplification tests (NAATs). RESULTS: The prevalence of infection varied by anatomic site (chlamydia: rectal, 7.9%; urethral, 5.2%; and pharyngeal, 1.4%; for gonorrhea, rectal, 6.9%; urethral, 6.0%; and pharyngeal, 9.2%). Approximately 85% of rectal infections were asymptomatic supporting the need for routine screening. Because 53% of chlamydial infections and 64% of gonococcal infections were at nonurethral sites, these infections would be missed and not treated if only urethral screening was performed. In addition, >70% of chlamydial infections would be missed and not treated if MSM were tested only for gonorrhea. CONCLUSIONS: Because these infections enhance both HIV transmission and susceptibility, clinical settings serving MSM should evaluate the prevalence of chlamydial and gonococcal infections by anatomic site using validated NAATs.

Adult↗

PubMed2001

Reconstruction of pharyngeal defects using AlloDerm and sternocleidomastoid muscle flap.

OBJECTIVE: To report our experience in reconstructing pharyngeal defects that cannot be closed primarily, using acellular dermal matrix (AlloDerm, LifeCell Corp., Branchburg, NJ) and sternocleidomastoid (SCM) muscle flap. STUDY DESIGN: Prospective, nonrandomized, nonblinded study in the setting of an academic tertiary care medical center. METHODS: Fourteen patients underwent reconstruction of through-and-through defects of partial pharyngectomy for squamous cell carcinoma using AlloDerm graft. Primary closure of the defects was not possible because of substantial loss of pharyngeal tissue. The graft was reinforced with superiorly based SCM muscle flap in 10 patients. The remaining four patients did not receive any flap. Eleven lesions involved the lateral pharyngeal wall, and three were piriform sinus lesions. Patients were followed for a period ranging from 3 to 20 months. Outcome measures were determined on several parameters including graft take rate, evidence of graft contracture, postoperative complications, resumption of diet, intelligibility of speech, and decannulation. All patients were evaluated by a speech pathologist by means of a bedside swallowing examination. Five patients had videofluoroscopic studies. The three patients with piriform sinus lesions underwent videostroboscopic examination to assess vocal cord function. RESULTS: There was a high success rate for graft take. Two patients developed postoperative fistulas that resolved with conservative management. One of the 10 patients with SCM flap and one of the 4 patients without SCM flap developed fistulas. Clinically significant graft contracture or pharyngeal stenosis was not observed in any patients. All patients resumed oral intake. Ten patients resumed a normal diet, two tolerated a soft diet, and two could take purees. Decannulation was successful in all patients. Two of the three patients with piriform sinus lesions had vocal cord palsies after surgery resulting in breathy dysphonia. They underwent type I thyroplasty for vocal rehabilitation. All patients had intelligible speech. CONCLUSIONS: Thick AlloDerm, reinforced with SCM muscle or cervical soft tissue, provides a useful alternative option for reconstruction of pharyngeal defects that cannot be closed primarily. It is safe and effective and provides excellent functional outcomes.

Biocompatible Materials↗

PubMed1987

Noncomparative, open label, multicenter trial of cefixime for treatment of bacterial pharyngitis, cystitis and pneumonia in pediatric patients.

Cefixime, a new third generation oral cephalosporin antibiotic, was evaluated for safety and efficacy in the treatment of 206 children with acute bacterial pharyngitis, cystitis or pneumonia. Each patient had a throat, urine or sputum culture before therapy and was treated with a 10- to 14-day course of cefixime, 8 mg/kg once daily. Bacterial pathogens were isolated in 167 of 206 (81.1%). Streptococcus pyogenes (73.7% of isolates) and Escherichia coli (9.6%) were the most common Gram-positive and Gram-negative organisms, respectively. All patients were evaluable for safety, and 109 (52.9%) with pharyngitis (96) or cystitis (13) were evaluable for efficacy. Clinical failure occurred in 2 of 109 (1.8%) patients, both with pharyngitis; bacteriologic failure occurred in 1 patient with pharyngitis and 1 with cystitis. Five patients with pneumonia caused by possible pathogens also improved while taking cefixime. Drug-related adverse side effects occurred in 50 of 206 patients (24.3%); these were generally mild and led to discontinuing the antibiotic in only 4 patients (1.9%). The most common were diarrhea or loose stools (33 of 206, or 16%). Results of this study suggest that cefixime given once daily to children is safe and effective in the treatment of streptococcal pharyngitis and bacterial cystitis.

Adolescent↗