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PubMed2003

Comparison of pharyngoesophageal segment pressure in total laryngectomy patients with and without pharyngeal neurectomy.

BACKGROUND: To compare pharyngoesophageal segment (PES) pressure values in total laryngectomy patients with and without pharyngeal neurectomy (PN) in the early postoperative period. METHODS: Forty-five previously untreated laryngeal carcinoma patients were enrolled into this prospective randomized study. Twenty of them underwent total laryngectomy with PN, and 25 underwent total laryngectomy without PN. PES pressures were measured on the tenth postoperative day with a four-channel catheter. RESULTS: Average PES pressures in patients with and without pharyngeal neurectomy were 12.82 +/- 6.11 mmHg and 17.40 +/-.72 mmHg respectively (p <.05). When compared with the critical point of 20 mmHg that is closely related to voice attainment in the group without pharyngeal neurectomy, 10 (40%) patients had pressure levels greater than 20 mmHg and in the other group only 1 (5%) patient had a pressure level greater than 20 mmHg. The difference between the groups with pressure levels greater than 20 mmHg was found to be statistically significant (p <.05). CONCLUSIONS: Pharyngeal neurectomy results in a statistically significant decrease of PES pressures in total laryngectomy patients.

Adult↗

PubMed2006

Health-related quality of life in patients with pharyngeal carcinoma: a five-year follow-up.

PURPOSE: The purpose was to evaluate the health-related quality of life (HRQL) of patients with pharyngeal carcinoma at diagnosis and after 1 and 5 years in relation to tumor location and treatment modality in a prospective multicenter study. METHODS: Eighty-nine patients with pharyngeal carcinoma (mean age, 60.0 years; 76% men) were evaluated using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Head and Neck Cancer Module (EORTC QLQ-H&N35). RESULTS: Problems with dry mouth and teeth became worse between diagnosis and the 5-year follow-up. Problems with thick secretions and teeth increased between 1 and 5 years. The HRQL at diagnosis was associated with survival. Patients with oropharyngeal carcinoma reported better HRQL than patients with hypopharyngeal carcinoma. CONCLUSIONS: For patients with pharyngeal carcinoma, the HRQL at diagnosis seems to be an important factor for the prognosis of both HRQL over time and survival. Treatment of pharyngeal carcinoma often results in long-term side effects such as dry mouth, problems with teeth, and thick secretions.

Aged↗

PubMedDate not supplied

Surgical management of carcinoma of the posterior pharyngeal wall.

Carcinoma of the posterior pharyngeal wall is an aggressive disease that demands vigorous therapy, often in the form of combined surgery and radiotherapy. Surgical excision of wide areas of the posterior pharyngeal wall may allow acceptable swallowing function in many patients. This article reviews the methods of surgical exposure utilized in conservation pharyngeal surgery and emphasizes the important principles involved in the preservation of laryngeal and pharyngeal functions.

Aged↗

PubMed1977

Pharyngeal reconstruction after laryngectomy.

A method of pharyngeal reconstruction following laryngectomy is described. In 44 successive laryngectomies using this technique, no postoperative pharyngocutaneous fistulas occurred. Ten of the patients had received full courses of radiation therapy prior to the surgical procedure and had recurrent carcinomas. Other reports have noted that laryngectomy following full courses of "unplanned preoperative" radiation therapy is usually associated with a high incidence of postoperative pharyngeal fistula. The pharyngeal fistula problem, and the pharyngeal repair that was used in our series, are discussed. The pharynx was closed carefully in three layers with fine, absorbable sutures, and a submucosal inverting technique was used for the important mucous membrane closure. Tube feedings were used for two weeks after surgery. A high incidence of pharyngocutaneous fistula after laryngectomy in the irradiated patient can be prevented.

Carcinoma, Squamous Cell↗

PubMedDate not supplied

Regulation of pharyngeal motility by FMRFamide and related peptides in the medicinal leech, Hirudo medicinalis.

The medicinal leech possesses FMRFamide-like immunoreactivity in neural processes and somata associated with the pharynx and pharyngeal ganglia. The pharynx possessed about 25 immunoreactive somata; about half of the approximately 20 neurons of the pharyngeal ganglia were immunoreactive. We provide brief descriptions of several neurons located in the first neuromere of the subesophageal ganglion involved in controlling pharyngeal motility. Double-labeling experiments indicate that one of these cells, named Swallow neuron 1 (SW1), contains a FMRFamide-like peptide. Stimulation of SW1 caused the mouth to open and the pharynx to dilate. Upon termination of SW1 stimulation, the mouth closed, and a peristaltic wave progressed from the mouth down the length of the pharynx. Stimulation of SW1 did not produce 1:1 postsynaptic potentials in pharyngeal muscle cells. Thus, SW1 is apparently not a motor neuron. The pharynx responded to application of FMRFamide and related peptides by producing a series of 20- to 35-s phasic contractions superimposed upon an increase in basal tonus. The peptide-induced response was quantified by measuring increases in basal tonus, peak tension, and integrated area. Although there were some differences in the order of potency depending upon which parameter was considered, the approximate order of potency of RFamide peptides tested was: pQDPFLRFamide > or = FMRFamide approximately YGGFMRFamide > or = YMRFamide approximately FLRFamide approximately GGKYMRFamide approximately YLRFamide > leucomyosuppressin approximately perisulfakinin. Except for differences in potency, each of the RFamide peptides produced similar contractile waveforms. FMRFamide-induced responses were reduced by the protein kinase C inhibitor bisindolylmaleimide I (10 microM), the nonspecific protein kinase inhibitor H-7 (50 microM), and were increased by the protein phosphatase inhibitor okadaic acid (1 microM). However, the FMRFamide-induced response was unaffected by the protein kinase A inhibitor H-89 (1 microM), the phosphodiesterase inhibitor theophylline (1 mM), the phospholipase A(2) inhibitor OBAA (0.1 microM) or the cation channel blocker amiloride (100 microM).

Animals↗

PubMed2002

Topographical analysis of lymphatic pathways from the meso- and hypopharynx based on minute cadaveric dissections: possible application to neck dissection in pharyngeal cancer surgery.

To facilitate the development of new operative procedures for pharyngeal cancer, it is important to understand the precise location of the lymph nodes and their pathways. Minute dissection of 22 neck-halves (11 adult cadavers) was undertaken to determine the location and topographical relationships of the lymphatics of the pharynx. Four groups of lymph nodes on the drainage pathways from the meso- and hypopharynx to the internal jugular nodes were classified according to their topographical relationships to the carotid arteries: lateral pharyngeal, superior thyroid, lateral retropharyngeal and medial retropharyngeal nodes. Lymphatics from the mesopharynx passed laterally to lateral pharyngeal or jugulodigastric nodes or slightly upward to lateral retropharyngeal nodes. Lymphatic drainage from the hypopharynx was multidirectional with the pathways being classified as follows: ascending pathway to the lateral pharyngeal and lateral retropharyngeal nodes, lateral pathway to the internal jugular chain, and descending pathway connecting to the uppermost vessels ascending from the recurrent laryngeal nerve chain. In addition, a contralateral pathway was found originating from the hypopharynx extending to the contralateral internal jugular chain. These findings provide valuable information for comparison with CT and MRI studies, as well as with clinicopathological data, to clarify the precise mode of metastasis in head and neck cancers. These results are also applicable to neck dissection in meso- and hypopharyngeal cancers.

Aged↗

PubMed1989

Neuronal analysis of pharyngeal peristalsis in the gastropod Navanax in terms of identified motoneurons innervating identified muscle bands. I. Muscle band identifiability.

The neuronal basis of pharyngeal ingestion and swallowing can be conveniently studied in the marine mollusc Navanax inermis because of the small number of neurons involved in the behavior, reproducible identifiability of many individual neurons and simple muscle arrangement. The Navanax pharynx contains 3 approximately orthogonal muscle groups, circumferential, longitudinal and radial, arranged in well defined layers. Pharyngeal peristalsis involves sequential circumferential constriction, apparently with coordinated local pharyngeal expansion produced by radial muscle. Circumferential and longitudinal muscles consist of discrete, well defined bands. The number, position and arrangement of circumferential and longitudinal bands show little interanimal variability; these bands are individually identified by sequential number. Regional morphologic specializations of circumferential bands presumably facilitate peristalsis. Circumferential and longitudinal bands form a two dimensional reference system defining position on the pharyngeal surface. In the accompanying paper circumferential motor fields are described in terms of identified motoneurons innervating identified bands, and radial motor fields are located with respect to the coordinate system of overlying longitudinal and circumferential bands.

Animals↗

PubMed1995

Comparative effects of aging on pharyngeal and diaphragm muscles.

We hypothesized that aging is associated with alterations in pharyngeal muscle structural and contractile properties. Sternohyoid and geniohyoid muscles from young (3-4 months) and old (20-21 months) Fischer 344 rats were compared with diaphragm muscle. The pharyngeal muscles had significantly lower proportions of slow oxidative (SO) fibers compared to the diaphragm, and the percentage of fast glycolytic (FG) fibers was significantly higher in the sternohyoid than in both the geniohyoid and the diaphragm. With senescence, there was a small but significant increase in the proportion of FG fibers and a corresponding reduction in the proportion of fast oxidative glycolytic (FOG) fibers in all three muscles. The sternohyoid muscle had significantly faster isometric contractile kinetics and lower fatigue indexes than the diaphragm. Aging was associated with significant worsening of sternohyoid endurance, but no significant alterations in sternohyoid twitch kinetics or diaphragm properties. These results indicate that in rats the pharyngeal dilator muscles have larger proportions of fast fibers, fast contractile kinetics and worse endurance than the diaphragm. Furthermore, aging was associated with a shift to a higher proportion of FG fibers with a concomitant reduction in proportion of FOG fibers, as well as a decline in pharyngeal muscle endurance.

Aging↗

PubMed1987

Role of rapid tests for streptococcal pharyngitis in hospital infection control.

Rapid streptococcal antigen detection tests are now an alternative to throat cultures for diagnosing group A streptococcal pharyngitis. Used alone, they are not suitable for hospital infection control applications because of the risk that individuals with streptococcal pharyngitis and a falsely negative test will spread the infection within the institution. However, a rapid test may be an economical method for screening employees with pharyngitis, provided that a throat culture is performed for everyone with a negative test. Compared with the use of throat cultures alone, this strategy reduces the number of missed diagnoses and the number of work days lost. Cost-benefit analysis shows that over a wide range of streptococcal prevalence and carrier rate the total cost is also less with the use of rapid tests first. If the prevalence of streptococcal pharyngitis is very low, the use of cultures alone is more cost-effective.

Antigens, Bacterial↗

PubMed1986

Comparative evaluation of PathoDx Strep A test and culture for the detection of group A streptococci in pharyngeal specimens.

The PathoDx Strep A kit, a 10-min acid extraction and latex agglutination test, was compared with routine culture for the direct detection of group A beta-hemolytic streptococci (BHS) in 414 pharyngeal specimens collected from children with pharyngitis. The results showed that the latex test compared favorably with culture for detecting group A BHS in pharyngeal specimens (sensitivity 96.7%, specificity 97.9%, and positive and negative predictive values of 97.2% and 97.4%, respectively). The comparable number of false-positive (five) and false-negative (six) latex tests along with review of patient histories suggest that these discrepant results were attributable to sampling error during specimen procurement rather than deficiencies in the latex kit. In addition, clear-cut, agglutination reactions were obtained in over 96% of positive latex tests regardless of the amount of group A BHS that was recovered by culture. The PathoDx Strep A test is a rapid, reliable noncultural alternative for the detection of group A BHS in pharyngeal specimens.

Antigens, Bacterial↗

PubMed1995

Well-being and coping in oral and pharyngeal cancer patients.

Patients with oral and pharyngeal cancer often suffer serious functional impairments. To achieve a broader understanding of the patients' situation it is important to include their appraisal of present functioning. There may also be other factors of importance in the evaluation of well-being such as personality and coping. 42 patients with oral and pharyngeal cancer answered the Oral and Pharyngeal Nursing Care Questionnaires 12 months after treatment. The questionnaires contain 25 conditions (grouped as Therapy- or Psychosocial-related Conditions) from three perspectives: perceived severity, received support and received information. Other questionnaires included in the study were the Sense of Coherence Scale, Somatic Anxiety Scale (from the Karolinska Scale of Personality) and Health Index. The patients were classified with regard to the extensiveness of their surgery. Severe disturbances related to therapy were significantly correlated to weaker sense of coherence (r = -0.34), more anxiety (r = 0.31) and to worse feelings about general health (r = -0.37). The corresponding data with regard to severe disturbances related to psychosocial situation were r = -0.44, 0.52 and -0.65, respectively. There was no significant correlation between perceived severity and surgical extensiveness. The support and information concerning Psychosocial-related Conditions were evaluated as less than those concerning Therapy-related Conditions. The level of support and information was not significantly correlated to sense of coherence, anxiety, general health or surgical procedure. The patient's subjective appraisal of the seriousness of the circumstances connected with oral and pharyngeal cancer and its treatment is an important parameter in the care of these patients.

Adaptation, Psychological↗

PubMed2005

Typical GERD symptoms and esophageal pH monitoring are not enough to diagnose pharyngeal reflux.

BACKGROUND: Abnormal pharyngeal reflux of acid (PR) (as measured by pH monitoring) is associated with microaspiration, and is a good predictor of airway symptom response to medical and surgical anti-reflux therapy. However, in clinical practice the link between airway disease and Gastroesophageal reflux disease (GERD) is still based on the presence of typical symptoms (e.g., heartburn) and/or standard esophageal function testing (manometry and 24-pH monitoring). PR is rarely measured directly. We undertook this study to determine if typical symptoms and standard testing could reliably predict the presence of PR. METHODS: The study group consisted of 518 patients with suspected reflux induced airway disease evaluated from December 1998 through January 2002. Each patient completed a standardized symptom questionnaire, underwent esophageal manometry, and 24-h esophageal and pharyngeal pH monitoring. Patients were classified having abnormal pharyngeal reflux (PR+) if they had >1 episode of PR detected during pH monitoring. RESULTS: One hundred eighty-one patients were PR+ and 337 were PR-. The most common symptoms, namely cough (PR +73%, PR- 68%), hoarseness (PR +64%, PR- 66%), and dyspnea (PR +59%, PR- 59%) were present with similar incidence in PR+ and PR- patients. The incidence of heartburn was 54% in the PR+ and 52% in the PR- patients. Logistic regression analysis revealed that abnormal esophageal acid exposure was a predictor of PR+ (P < 0.001). Neither the presence of heartburn or specific respiratory symptoms, the pressure of the lower esophageal sphincter (LES) or upper esophageal sphincter (UES), or amplitude of esophageal contractions predicted PR+. There was substantial variability in esophageal length (UES to LES), thus the placement of the distal pH probe from the LES varied considerably (median = 13 cm, 2-20 cm). Using established normal values of acid exposure at multiple levels of the esophagus, 24% of PR+ patients had normal amounts of esophageal acid exposure. CONCLUSIONS: Typical GERD symptoms, such as heartburn, and typical symptoms of aspiration such as hoarseness, cough, or dyspnea are not enough to positively identify PR. While patients with abnormal esophageal acid exposure are three times more likely than those with normal values to have PR, abnormal esophageal acid exposure alone does not identify all patients with PR. Therefore, relying on symptoms and standard diagnostic testing may fail to identify patients with extraesophageal reflux. Pharyngeal pH monitoring should be considered for patients with suspected reflux-induced airway disease.

Diagnostic Techniques, Digestive System↗

PubMed2004

pha-2 encodes the C. elegans ortholog of the homeodomain protein HEX and is required for the formation of the pharyngeal isthmus.

The pha-2 mutant was isolated in 1993 by Leon Avery in a screen for worms with visible defects in pharyngeal feeding behavior. In pha-2 mutant worms, the pharyngeal isthmus is abnormally thick and short and, in contrast to wild-type worms, harbors several cell nuclei. We show here that pha-2 encodes a homeodomain protein and is homologous to the vertebrate homeobox gene, Hex (also known as Prh). Consistent with a function in pharyngeal development, the pha-2 gene is expressed in the pharyngeal primordium of Caenorhabditis elegans embryos, particularly in pm5 cells that form the bulk of the isthmus. We show that in the pha-2 mutant there is a failure of the pm5 cells to elongate anteriorly while keeping their nuclei within the nascent posterior bulb to form the isthmus during the 3-fold embryonic stage. We also present evidence that pha-2 regulates itself positively in pm5 cells, that it is a downstream target of the forkhead gene pha-4, and that it may also act in the isthmus as an inhibitor of the ceh-22 gene, an Nkx2.5 homolog. Finally, we have begun characterizing the regulation of the pha-2 gene and find that intronic sequences are essential for the complete pha-2 expression profile. The present report is the first to examine the expression and function of an invertebrate Hex homolog, that is, the C. elegans pha-2 gene.

Amino Acid Sequence↗

PubMed1982

Pharyngeal constrictor paresis in patients with dysphagia: a cineradiographic study.

Among 250 patients examined by cineradiography because of dysphagia 25 were found to have a more or less pronounced paresis of the pharyngeal constrictor muscle. The paresis included all three portions of the muscle in six patients. A localised lesion was found in 19 patients and included the superior portion of the pharyngeal constrictor muscle in one patient, the middle portion in 16 patients and the middle and inferior portions in two patients. All 25 patients exhibited concomitant cineradiographic abnormalities, including impairment of the tilting down of the epiglottis, dysfunction of the cricopharyngeal muscle and retention of barium in the pharynx. With the aid of cineradiography it is possible to disclose an underlying pharyngeal constrictor paresis in about 10% of patients with dysphagia who are referred for radiographic examination. In most patients suffering from a localised pharyngeal paresis the diagnosis will be overlooked in a routine examination, but will be easily demonstrated with cineradiography.

Aged↗

PubMed1990

Lack of impact of early antibiotic therapy for streptococcal pharyngitis on recurrence rates.

To determine whether recurrence rates for group A beta-hemolytic streptococcal (GABHS) pharyngitis are related to the time of initiation of antibiotic therapy, we randomly assigned 113 patients with GABHS pharyngitis either to a group that began a 10-day course of penicillin V at the time of diagnosis or to a group that began the same antibiotic regimen after a dealy of 48 hours. Follow-up throat culture specimens were obtained 4 days, 2 months, and 4 months after the completion of antibiotic therapy, as well as during any interim episodes of acute pharyngitis. Serotyping of all GABHS isolates was performed to distinguish between recurrences with homologous serotypes and new acquisitions with heterologous serotypes. There was no significant difference between the two treatment groups in age, gender, duration of illness before enrollment in the study, initial clinical presentation, or compliance. Of the 50 patients in the immediate-treatment group, 6 (12%) had homologous serotypes of GABHS isolated on one of the follow-up throat cultures. Of the 63 patients in the delayed-treatment group, 9 (14%) had homologous serotypes of GABHS isolated on one of the follow-up throat cultures. These data indicate that a 48-hour delay in the initiation of penicillin therapy for GABHS pharyngitis does not reduce the recurrence rate.

Adolescent↗

PubMed1986

Viral and bacterial organisms associated with acute pharyngitis in a school-aged population.

To investigate the causes and clinical characteristics of acute pharyngitis among school-aged children (4 to 18 years), we obtained throat cultures for respiratory viruses, Mycoplasma pneumoniae, group A streptococcus, and Chlamydia trachomatis from 320 patients with sore throat and 308 controls without respiratory complaints. The study was conducted from January to April 1985 in a private pediatric practice in central New York State. Sixty percent of the patients and 26% of the control subjects had positive cultures for at least one organism. Forty percent of patients had positive cultures for group A streptococcus, compared with 11.9% of the controls. Fifty (16%) patients had positive viral cultures, compared with eight (2.6%) controls; the predominant viral isolate was influenza A Philippines. Patients infected with influenza A were significantly more likely to complain of cough and hoarseness, and were less likely to have pharyngeal exudate or tender cervical adenopathy, than were patients who had positive cultures for group A streptococcus. Although 49 (15.8%) patients with acute pharyngitis had cultures positive for M. pneumoniae, 53 (17.6%) asymptomatic controls were also had M. pneumoniae-positive cultures. Thus detection of M. pneumoniae in the throat of school-aged children with pharyngitis may not be sufficient to establish a diagnosis of disease caused by this organism. C. trachomatis was not isolated from any patient or control.

Acute Disease↗

PubMed1988

Standardized symptomatic treatment versus penicillin as initial therapy for streptococcal pharyngitis.

A multicenter, double-blind, randomized, placebo-controlled trial was conducted to determine whether the addition of penicillin was superior to patient education and anti-inflammatory drug therapy for relief of the acute discomforts of pharyngitis caused by group A beta-hemolytic streptococcus (GABHS). One hundred seventy-eight patients, aged 4 to 29 years, received appropriate symptomatic therapy, including specific doses of aspirin or acetaminophen, plus penicillin (91 patients) or placebo (87) for the initial 48 hours of illness. All had 24-hour office and 48-hour telephone reevaluations. In 123 patients (57 with clinically severe pharyngitis), throat cultures yielded GABHS. Penicillin provided a margin of 20% improvement over anti-inflammatory therapy for the complaint of sore throat only after 48 hours of treatment (for the 123 patients with GABHS, p = 0.01; for the 57 with both severe pharyngitis and GABHS, p = 0.05). No significant improvement was noted for fever, malaise, odynophagia, exudate, adenitis, or pharyngitis. The failure of penicillin to provide much additional benefit makes its routine early prescription specifically for symptomatic relief questionable.

Acetaminophen↗

PubMed1998

Aphagia due to pharyngeal constrictor paresis from acute lateral medullary infarction.

Although swallowing difficulties (dysphagia) frequently occur in acute brainstem infarction, physiological studies of dysphagia (videofluoroscopy, manometry) are rarely reported. We present a patient with ipsilateral Horner's syndrome, palatal and laryngeal weakness, aphagia, and ipsilateral face and contralateral extremity pin and temperature loss due to lateral medullary infarction confined to the rostral dorsolateral medulla (RDM). Videofluoroscopy showed that the patient was unable to initiate a swallow. Manometry showed a markedly reduced peak pharyngeal pressure and weak pharyngeal contractions. Within 20 months, the patient's neurological deficits resolved, videofluoroscopy showed a normal swallow, and manometry showed normal peak pharyngeal pressure. Correlation of the clinical, physiological, and imaging evaluations shows that aphagia and severe bilateral pharyngeal paresis can result from unilateral RDM infarction. We suggest that, in man, the bilateral medullary swallowing centers function as one integrated center, and that infarction of a portion of this center is sufficient to cause complete loss of swallowing.

Acute Disease↗