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At least 343 records · Page 19Linked to original sources

PubMed2003

Hypopharyngeal pharyngoplasty in the management of pharyngeal paralysis: a new procedure.

Dysphagia after a high vagal nerve injury may be associated with a patulous hypopharynx that serves as a reservoir for pharyngeal secretions, contributing to primary or secondary aspiration. We describe a new hypopharyngeal pharyngoplasty procedure for the paralyzed pharynx to improve swallow. The paralyzed pyriform sinus is resected to remove insensate and redundant mucosa. The inferior constrictor muscle is then advanced anterior to the oblique line of the thyroid cartilage to improve pharyngeal tone and prevent pharyngeal dilatation. The surgery is performed in conjunction with medialization laryngoplasty and arytenoid adduction. The utility of this procedure is reviewed retrospectively in 8 patients. They were evaluated by clinical evaluation, fiberoptic endoscopic evaluation of swallow, and modified barium swallow study. All had significant preoperative dysphagia. Three patients were gastrostomy tube-dependent. After operation, all patients had subjective and objective improvements in swallow and progressed to peroral feeding. There were no operative complications. We conclude that hypopharyngeal pharyngoplasty diminishes pyriform sinus pooling and improves pharyngeal transit. Dysphagia patients with unilateral pharyngeal paralysis secondary to cranial nerve palsies may benefit from this new procedure.

Adult↗

PubMedDate not supplied

Selecting variants in pharyngeal reconstruction.

A dramatic change in the techniques of immediate pharyngeal reconstruction in the last 10 years is largely due to the availability of myocutaneous flaps, microvascular techniques, and the increasing popularity of the "gastric pull-up" operation. The experience of the Head and Neck Service of Memorial Sloan-Kettering Cancer Center in repair of the pharynx following pharyngeal resection between 1974 and 1983 is reviewed and the changing trends in the philosophy of pharyngeal reconstruction are highlighted. The methods of reconstruction used were deltopectoral flap, gastric pull-up, free microvascular bowel transfer, and pectoralis myocutaneous flap. The indications, morbidity, effectiveness, and complications for each of these procedures are discussed. The optimal reconstructive methods for partial and total pharyngeal reconstruction are as follows: 1) primary closure for defects not exceeding one third of the circumference of the pharynx; 2) pectoralis myocutaneous flap repair for pharyngeal defects with loss of up to 70% of the circumference of the pharynx; 3) gastric pull-up with pharyngogastrostomy for defects exceeding 70% of the circumference of the pharynx; 4) gastric pull-up for all pharyngoesophageal defects where the lower margin of resection is below the tracheostome; and 5) reversed pectoralis myocutaneous flap with split thickness skin graft on the muscle for secondary closure of the pharyngostome.

Colon↗

PubMed1984

Adaptation in the function of pharyngeal constrictor muscles.

The palatopharyngeus and pharyngeal constrictor muscles were studied by electromyography (EMG) and by direct observation with a flexible fiberoptic scope in the anesthetized as well as in the alert rhesus monkey. The muscles were monitored to determine the change in their discharge with nasal obstruction, head posture, head extension, and swallowing. The results indicated that certain regions of the middle and inferior pharyngeal constrictors never discharged during deglutition. Extending the head could induce a tonic discharge in fibers of the middle pharyngeal constrictor for the duration of head extension. Placement of water in the hypopharynx not only induced a sustained laryngospasm but also a tonic discharge in the select fibers of the superior and middle pharyngeal constrictors. Changing from a supine to an upright posture, or obstructing the nasal cavity, could induce a rhythmic discharge. These studies indicate that there are functional components of fibers within each of the anatomically recognized pharyngeal constrictors.

Airway Obstruction↗

PubMed2001

Clinical features of pharyngeal cancer: a retrospective study of 258 consecutive patients.

Pharyngeal cancer still presents an unsatisfactory mortality (30-40 per cent in most series, with a slightly better prognosis for nasopharyngeal cancer relative to both oropharyngeal and hypopharyngeal cancers) despite advances in treatment. Therefore, it is critical to know the clinical features of pharyngeal cancer. The purpose of this study was to investigate the most relevant clinical features of pharyngeal cancer (oropharyngeal, hypopharyngeal, and nasopharyngeal) in order to improve knowledge of this malignancy with the aim of ameliorating diagnosis and treatment. The retrospective study was based on a review of medical records from 258 consecutive patients with pharyngeal cancer (oropharyngeal, hypopharyngeal and nasopharyngeal) diagnosed at La Paz University Hospital, Madrid, Spain, between January 1 1991 and and December 31 1995. Medical records were provided by the Departments of Otorhinolaryngology, Head and Neck Surgery, Radiation Oncology, and Medical Oncology. All medical records were analysed for the following clinical variables: 1) incidence, 2) sociodemographics, 3) sites (oropharynx, hypopharynx, nasopharynx) and subsites, 4) clinical and histological staging, 5) pathology, 6) presenting symptoms, 7) time to diagnosis, 8) patients' general performance status at diagnosis, 9) personal cancer history and synchronous head and neck tumours, 10) premalignant lesions, and 11) paediatric cases. Our most outstanding finding was the excessively long time that elapsed between first clinical manifestation appearance and conclusive diagnosis of pharyngeal cancer (4.7 months for pharynx, 4.5 for oropharynx, 4.4 for hypopharynx and 6.5 for nasopharynx cancers). It was found that nasopharyngeal cancer was quite different from both oropharyngeal and hypopharyngeal cancers with respect to its potential aetiology, risk factors and clinical presentation. In addition it has a better prognosis.

Adolescent↗

PubMed2005

The appropriate management of pharyngitis in children and adults.

Acute pharyngitis, or the complaint of a sore throat, is one of the most common illnesses for which both adult and pediatric patients seek medical care from primary care physicians. In the USA, acute pharyngitis accounts for 1-2% of all visits to outpatient departments, physician offices and emergency departments. There are multiple etiologic agents that can cause pharyngitis, and strategies for diagnosis and treatment should be directed at identifying those causes of pharyngitis that require antimicrobial therapy. In some cases, the decision as to which patients to treat with antibiotics remains difficult. This article reviews some of the various causes of pharyngitis and the available therapeutic options.

Adult↗

PubMed2006

Mortality from oral and pharyngeal cancer in Brazil: trends and regional patterns, 1979-2002.

OBJECTIVE: To investigate the trends and regional patterns in mortality from oral cancer and pharyngeal cancer in Brazil from 1979 through 2002. METHODS: Data were obtained from the Mortality Information System (Sistema de Informações sobre Mortalidade) database, which is compiled by the Ministry of Health of Brazil. Mortality rates were adjusted by gender and age. The Prais-Winsten generalized linear regression procedure was used to calculate the annual increase or decrease in mortality rates. The time trends for mortality due to oral cancer and to pharyngeal cancer were analyzed by specific anatomical site and by region of the country (North, Northeast, South, Southeast, and Center-West). RESULTS: In all five regions of Brazil over the period studied, oral cancer mortality remained stable for both genders, but pharyngeal cancer mortality increased for both genders. Mortality from cancer affecting the lips, tongue, gums, mouth floor, palate, other parts of the mouth, and tonsils showed a statistically significant decrease over the period. However, mortality from cancer affecting the oropharynx, hypopharynx, and ill-defined and undefined sites of the oral cavity and the pharynx showed a significant increase. Mortality rates for both oral cancer and pharyngeal cancer were higher in the South and Southeast regions of the country than in Brazil's three other regions. CONCLUSIONS: The relatively larger decrease in mortality from cancer affecting the lips, gums, and other anatomical sites more easily accessible to clinical inspection suggests a possible link between oral and pharyngeal cancer survival and an improved provision of health care services in Brazil in recent decades.

Brazil↗

PubMed2000

Posterior pharyngeal flap and sphincter pharyngoplasty: the state of the art.

Surgical management of velopharyngeal insufficiency by attachment of posterior pharyngeal flap or construction of sphincter pharyngoplasty is reviewed. Posterior pharyngeal flap surgery is well established, with a long history dating back to the 19th century. Flaps have been based superiorly, inferiorly, or laterally. There have been reports of airway obstruction and obstructive sleep apnea associated with posterior pharyngeal flap surgery. The concept of surgical creation of a dynamic sphincter pharyngoplasty to provide velopharyngeal closure was first introduced by Hynes in 1950. Hynes and others have proposed several subsequent anatomic modifications. Airway dysfunction has also been reported following sphincter pharyngoplasty, but may not be as frequent or severe as with posterior pharyngeal flap. While several studies have compared posterior pharyngeal flap and sphincter pharyngoplasty in terms of speech outcome or complications, there is not, as yet, a consensus regarding the specific choice of one versus the other for surgical management of velopharyngeal insufficiency.

Cleft Palate↗

PubMed2003

Validation and modification of streptococcal pharyngitis clinical prediction rules.

OBJECTIVE: To validate a simplified version of the Walsh clinical prediction rules (CPRs) for the presence of streptococcal pharyngitis in an inner-city, ethnically diverse population. PATIENTS AND METHODS: This prospective study conducted in New York City, NY, from January 1,1997, to May 31,1997, consisted of 171 consecutive adult walk-in patients who presented with symptoms of upper respiratory tract infection and/or sore throat. The patients were assessed by using 5 clinical factors: cough, exposure to known streptococcal contact, temperature, tonsillar-pharyngeal exudates, and cervical lymphadenopathy. Throat cultures for group A beta-hemolytic streptococcus were obtained from all patients. Clinicians assessing the patients were unaware of throat culture results, and those processing the throat cultures were blinded to the clinical predictors. RESULTS: The prevalence of streptococcal pharyngitis was 24% (95% confidence interval, 18%-30%). The simplified version of the Walsh CPR for streptococcal pharyngitis predicted accurately the probability of a positive culture in our diverse population (area under the receiver operating characteristic curve, 0.71). The simplified CPR also showed clinically useful likelihood ratios and posterior probabilities. CONCLUSION: A simplified version of the Walsh CPR is accurate for diagnosing streptococcal pharyngitis in an inner-city population. This finding should provide clinicians more confidence in applying the CPR in similar clinical settings.

Adolescent↗

PubMed2003

Predictive value of clinical features in differentiating group A beta-hemolytic streptococcal pharyngitis in children.

Identifying children with acute pharyngitis caused by group A beta-hemolytic Streptococcus (GABHS) is an important task for pediatricians. This study examined the value of certain clinical symptoms and signs in predicting a positive culture result. A total of 442 children who presented at the outpatient department with pharyngeal erythema were enrolled. The clinical features of patients with positive throat cultures for GABHS were compared to those with negative culture results. Throat cultures were positive for GABHS in 120 (27%) patients. Patients aged between 5 and 10 years had a higher prevalence of GABHS pharyngitis. Significant differences between the groups with and without GABHS pharyngitis were noted for the presence of sore throat (p < 0.001), tonsillar swelling (p < 0.001), anterior cervical adenopathy (p = 0.004), and scarlatiniform rash (p < 0.001), but not for the presence of fever, cough, rhinorrhea, abdominal pain, headache, tonsillar exudate, or palatal petechiae. Despite these strong associations, none of these symptoms or signs had both high sensitivity and specificity, and the positive predictive values of these individual findings were never greater than 50%. The results indicate that diagnosis based on clinical grounds alone is unreliable although there are certain individual symptoms and signs that are associated with GABHS pharyngitis. These symptoms and signs may be helpful in modifying estimates of probability of infection with GABHS. Throat cultures in suspected patients remain mandatory.

Child↗

PubMed2003

Etiology of acute pharyngitis in children: is antibiotic therapy needed?

Acute pharyngitis is a common upper respiratory tract disease in children. The aim of this study is to find the associated microorganisms and determinate whether antibiotics is needed. This study included a total of 416 children with a diagnosis of acute pharyngitis who were treated in an outpatient clinic In Taipei. Throat swabs for viral and bacterial cultures were taken. Antibiotics were prescribed when bacterial pharyngitis was suspected on the initial visit. The prescription was adjusted according to the results of bacterial culture and clinical manifestations on the second visit 3 to 4 days later. The mean age of the patients was 52.9 +/- 36.9 months. A total of 297 potential pathogens were isolated in 242 patients. Viruses were isolated in 123 (29.6%) patients. Bacteria were isolated in 73 (17.5%) patients, whereas group A streptococci were isolated in only 7 (1.7%) patients. Viruses mixed with bacteria were found in 46 (11.1%) patients. The mean age of patients with viral infections was lower than those with bacterial infections (47.5 +/- 30.4 vs 62.4 +/- 43.7 months, p = 0.01). There was a longer duration of fever in patients older than 2 years with viral isolates (p < 0.01). Antibiotics were prescribed for acute pharyngitis on the first visit in 43 (10.3%) patients, and on the second visit in 19 (4.6%) patients. In children with viral infection, mixed isolates, or no growth, there was significantly less prescription of antibiotics on the second visit. Given the low isolation rate of significant bacterial pathogens, routine throat cultures and antibiotics are not indicated in children with acute pharyngitis.

Acute Disease↗

PubMed2003

Clinical predictors of streptococcal pharyngitis in adults.

BACKGROUND: Acute pharyngitis in children is one of the most frequent illnesses for which primary care physicians are consulted. It is caused more frequently by viruses than by bacteria, but it is difficult to differentiate the causative agent by clinical signs alone. Group A Streptococcus accounts for 30% of children with a sore throat, and only in these cases is antibiotic therapy definitely indicated. However, the frequency and symptomatology of streptococcal pharyngitis in adults is not well established. OBJECTIVES: To examine the clinical features that could distinguish sore throat caused by beta-hemolytic group A Streptococcus in adults. METHODS: Patients aged over 16 years old (n = 207) who presented with a sore throat to community clinics were examined and throat cultures were taken. The microbiologic confirmation of Group A Streptococcus was correlated with symptoms and clinical signs by univariate analysis. RESULTS: About 24% of the patients with positive cultures were younger individuals. Chills, absence of cough, pain in swallowing, absence of rhinitis, headache, vomiting, tonsillar exudate, oral malodor, fever > 38 degrees C and sweats had high sensitivity but low specificity for streptococcal pharyngitis. Univariate analysis suggested that chills and pharyngeal exudate had the greatest predictive value for streptococcal pharyngitis (P = 0.044, odds ratio 2.45; P = 0.001, OR 5.49, respectively). When compared with a published scoring method (Centor criteria), large inconsistencies were found. CONCLUSION: Our adult population had a relatively high prevalence of group A Streptococcus, and their presentation differed from that of pediatric patients. In primary care, a throat swab culture is not necessary in adults with a low score (0-1 points).

Acute Disease↗

PubMed1992

Clarithromycin vs penicillin in the treatment of streptococcal pharyngitis.

BACKGROUND: Streptococcal pharyngitis, caused by group A beta-hemolytic streptococci (GABHS), is among the most common infections seen by primary care physicians. Because the illness can result in rheumatic fever, early eradication of infection is important. Penicillin has been the standard treatment for GABHS pharyngitis for over four decades, but reports of bacteriologic failure with this drug in recent years have led to trials of alternative antimicrobials. METHODS: In this investigator-blind, randomized multicenter trial (30 centers), oral clarithromycin, 250 mg twice daily, or oral penicillin VK, 250 mg three times daily, was given to outpatients > or = 12 years old with GABHS pharyngitis as documented by positive cultures for Streptococcus pyogenes and positive rapid immunoassay tests. The clinical and bacteriologic efficacy of clarithromycin was compared with that of penicillin in the 356 evaluable patients. Safety analysis was performed in all patients who had received at least one dose of the study drug (N = 453). RESULTS: Overall, clinical outcomes were comparable in the two groups. However, more clarithromycin-treated patients than penicillin-treated patients had resolution of sore throat (94% vs 86%, P = .014) and disappearance of pharyngeal erythema and exudate (89% vs 82%, P = .05). Bacteriologic cure rates were higher in clarithromycin-treated patients (95% vs 87%, P = .009). No serious adverse events were observed in either group. CONCLUSIONS: This study suggests that clarithromycin twice daily is as effective and as well tolerated as penicillin in the treatment of streptococcal pharyngitis.

Adolescent↗

PubMed1992

Streptococcal pharyngitis in a primary care clinic.

A study to determine the sensitivity and specificity of the Directogen Group A Streptococcal Test was carried out in a primary care clinic in University Hospital, Kuala Lumpur. The study also looked at the prevalence of streptococcal pharyngitis in the clinic. We found that the rapid test has a sensitivity of 90.9% and a specificity of 90.7%. Viral pharyngitis is the commonest form (63%) of pharyngitis followed by Group A Beta haemolytic streptococcal pharyngitis (14.2%). The presence of exudates, tonsillar enlargement and the presence of tender cervical lymph nodes have a significantly higher association with streptococcal pharyngitis.

Adolescent↗

PubMed2004

[Analysis of bacterial culture and C. pneumoniae DNA detection of chronic pharyngitis].

OBJECTIVE: To research the pathogenic microorganism characters of chronic pharyngitis. METHOD: Samples taken from pharyngeal swab from patient with chronic pharyngitis were routinely cultured; mp-DNA were detected by polymerase chain reaction (PCR). RESULT: Of all the cases, 5 patients were DNA(+), among which 3 patients got obvious effect after 2 weeks treatment. The bacterial abnormally was present in 15 patients (31.5%), among which 6 patients got obvious effect and 2 patients got no effect after 2 weeks treatment. CONCLUSION: The pathogenic abnormally may be present in some patients with chronic pharyngitis, most of which appeared to be an internal disorder of the proper microflores. C. pneumoniae may be an aetiological agent for chronic pharyngitis. An appropriate antimicrobial treatment should be considered in some cases.

Adolescent↗

PubMed2006

[Prevalence and treatment of pharyngeal Chlamydia trachomatis infections].

In recent years, the number of the patients with pharyngeal infection caused by Chlamydia trachomatis is believed to be on the rise due to diversification in sexual behaviors. In addition, pharyngeal infection by C. trachomatis is often asymptomatic, and this is also believed to be a major factor for the increase of the disease. In this study, we conducted a survey among general females and commercial sex workers (CSWs) to study their sexual behavior and prevalence of chlamydial infections (in uterine cervix and pharynx). The results showed that orogenital contact has become a common act, even for general females. Chlamydial infections of uterine cervix were found in 33.3% and 7.9% of CSWs and general females, respectively. Chlamydial infections of pharynx were found in 22.5% and 5.2% of CSWs and general females, respectively. The evaluation of treatments of these infections with clarithromycin, levofloxacin, and azithromycin showed that 7, 10, and 14 days administrations of 400 mg clarithromycin, 7, 10, and 14 days administrations of 300 mg levofloxacin, and a single dose of 1000 mg of azithromycin, would eradicate 100% of C. trachomatis for infections of uterine cervix. For pharyngeal infections, 10 and 14 days administrations of clarithromycin and levofloxacin were shown to eradicate 100% of C. trachomatis. However, the eradication rates for 7 days administrations of clarithromycin and levofloxacin were 83.9% and 86.2%, respectively, and the rate for a single dose of azithromycin was 85.0%. From these results, it was thought that more than 10 days of administrations of clarithromycin or fluoroquinolone antibacterial agents such as levofloxacin are necessary to treat pharyngeal chlamydial infection. Clinical significance of pharyngeal chlamydial infection is still not clear; however, this study have shown the need for more detailed investigations using culture assay, in corporation with doctors in otolaryngology and internal medicine.

Adult↗

PubMed2006

[Psychiatric disorder profile in patients with chronic pharyngitis].

OBJECTIVES: We investigated the psychopathological condition of patients with chronic pharyngitis. PATIENTS AND METHODS: The study included 27 patients (23 females, 4 males; mean age 41.7+/-10.4 years; range 21 to 63 years) who had persistent symptoms of chronic pharyngitis for more than six months, without any evidence for an acute infection on ENT examination and routine tests. Twenty-seven healthy subjects (23 females, 4 males; mean age 41.8+/-11.9 years) without any symptoms of chronic pharyngitis and a previous diagnosis of a psychiatric disorder formed the control group. All the patients and controls were assessed by a psychiatrist with the use of the Structural Clinical Interview for DSM-IV Disorders (SCID). RESULTS: All the patients were diagnosed to have Axis I psychopathology. The most frequent pathologies were somatisation disorder (n=8, 29.6%) and dysthymic disorder (n=8). Five individuals (15.6%) in the control group received psychiatric diagnoses. Psychiatric disorders were 6.4 times more frequent in the patient group (p=0.00, CI=2.86-14.31). No significant differences were observed between the patient and control groups with respect to educational and occupational levels (p=0.263 and p=0.362, respectively). Comparisons with respect to risk factors associated with chronic pharyngitis showed no significant differences between the two groups. CONCLUSION: We suggest that patients frequently presenting to ENT departments with repeated symptoms of chronic pharyngitis should also receive psychiatric assessment and support.

Adult↗

PubMed1984

Patients' willingness to take risks in the management of pharyngitis.

Choosing a management plan for pharyngitis involves considering the risks and benefits of alternatives. Using a sick-day equivalent scale, this study examined patients' willingness to be ill with pharyngitis compared with their willingness to risk two outcomes: a penicillin reaction and rheumatic fever. On average, patients preferred 1.5 to 2.5 days of illness with pharyngitis over risking a 5-percent chance of developing a mild penicillin reaction. Willingness to risk the outcomes decreased with increasing probabilities of their occurrence. Subjects were more willing to risk a penicillin reaction than rheumatic fever. Healthy subjects receiving sick pay were more willing to risk varying probabilities of a mild penicillin reaction than subjects not receiving sick pay. Patients ill with pharyngitis, however, were not more willing to take similar risks if they received sick pay. Illness may, therefore, modify some aspects of risk-taking behavior. It is reasonable to conclude that some patients with pharyngitis would prefer early antibiotic treatment for the chance of earlier recovery over waiting for throat culture results despite the risk of a penicillin reaction.

Absenteeism↗

PubMed1993

A study of pharyngeal symptoms caused by bronchofiberscopy.

We investigated the occurrence of pharyngeal symptoms in 100 patients who had undergone bronchofiberscopies by conducting a post-examination survey of the patients. Eighty-four patients complained of having a problem. Seventy-five patients, including 26 with dysphagia, complained of pharyngeal symptoms. The proportion with pharyngeal symptoms whose symptoms appeared on the day of examination was a high 89.4%. In 70.6% of cases, the duration of symptoms was less than four days. The pharyngeal symptoms were particularly common among patients who had undergone a bronchofiberscopy on a previous occasion or whose examination lasted for 15 min or more. A greater dysphagia incidence was noted among patients who had required an endotracheal tube (P = 0.03) and among those whose examination had lasted for 15 min or more (P = 0.01). Based on the results, we are now studying methods of alleviating pharyngeal symptoms, including dysphagia.

Adult↗