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PubMedDate not supplied

Gastroesophageal reflux and pharyngeal function.

Pharyngeal function and gastroesophageal reflux were compared in 84 dysphagic patients examined clinically and radiologically. Cricopharyngeal muscle incoordination, assessed cineradiographically, was revealed in 5 of 41 patients (12%) without and 17 of 43 patients (40%) with gastroesophageal reflux assessed clinically (p less than 0.05). Thus, there was a positive correlation between dysfunction of the cricopharyngeal muscle and gastroesophageal reflux. There was no correlation with other types of pharyngeal dysfunction. Our results support the assumption of a positive relationship between gastroesophageal reflux and pharyngeal function in terms of cricopharyngeal dysfunction. The pathogenesis of this relation was, however, not revealed.

Adult↗

PubMedDate not supplied

Pharyngeal flap and the internal carotid in velocardiofacial syndrome.

Internal carotid artery anomalies have been documented as a common clinical feature in velocardiofacial syndrome. There has been some controversy over the need for preoperative imaging procedures, such as magnetic resonance angiography, when planning pharyngeal surgery for correcting velopharyngeal insufficiency. The purpose of this article is to describe 20 patients with velocardiofacial syndrome who received comprehensive evaluation and underwent pharyngeal flap surgery within a 2-year period and to report the technique used for dissecting the flap and the surgical outcomes. Anomalies of the major neck vessels were present in all cases, but 5 of these 20 cases had particularly severe anomalies of the internal carotid arteries that placed the vessels directly deep within the donor site for the pharyngeal flap. Surgery was carried out successfully in all 20 cases using a modified approach after radiographic imaging was performed to locate the arteries. In the 5 cases with severe malpositioning of the internal carotid arteries, it was clear that the vessels could have been injured had their location not been identified and the surgical approach modified to avoid them.

Adolescent↗

PubMed1985

Pharyngeal wall cancer. A reappraisal after comparison of treatment methods.

We retrospectively examined 89 patients with pharyngeal wall cancer treated in our institution between 1964 and 1981, to compare the results of treatment after low-dose preoperative irradiation and surgery (R + S) with those achieved with radiation therapy alone (RA). Age, sex, and stage of tumor were comparable for the 41 patients who had R + S and the 34 who had RA. Treatment outcome, survival, and tumor and nodal control were better for the R + S treatment group than for the RA treatment group. Patterns of relapse differed for the two treatment methods and suggested that each might complement the other. Low-dose preoperative irradiation and surgery more often controlled the pharyngeal tumor than did RA, while high-dose irradiation more often controlled nodal disease than did low-dose irradiation and surgery. Our experience suggests that surgical treatment combined with high doses of radiation might improve treatment results for pharyngeal wall cancer.

Aged↗

PubMed1992

The pectoralis major myofascial flap for intraoral and pharyngeal reconstruction.

The pectoralis myocutaneous flap has been widely used for reconstruction of oral cavity and pharyngeal defects. However, it has several disadvantages, such as chest distortion, hair growth at the reconstructed site, and excessive bulk, all of which can be avoided by the use of the pectoralis myofascial flap. Oral cavities and pharyngeal defects, ranging in size from 4 to 9 cm in largest' dimension, in 26 patients were reconstructed with the pectoralis myofascial flap. All but three defects were successfully reconstructed. The surface of the flap was covered by squamous epithelium in 1 month. The flap remained healthy during and after radiotherapy. The pectoralis myofascial flap is ideal for soft-tissue coverage of small- to medium-size oral cavity and pharyngeal defects. Its major advantages over the pectoralis myocutaneous flap are decreased bulk and improved cosmesis.

Female↗

PubMed1980

Cefaclor in treatment of otitis media and pharyngitis in children.

The safety and efficacy of cefaclor were compared with amoxicillin trihydrate in the treatment of 130 cases of otitis media, and with penicillin V potassium in 88 cases of streptococcal pharyngitis in two single-blind controlled studies. Patients with otitis media received approximately 40 mg/kg/day of cefaclor or amoxicillin trihydrate for ten days to three weeks; patients with pharyngitis received 20 mg/kg/day of cefaclor or penicillin V potassium for ten days. Overall, patients who received cefaclor for otitis media had fewer acute failures and better total success, especially in cases caused by Haemophilus influenzae; however, the difference between cefaclor and amoxicillin was not statistically significant. There also was no significant difference between the clinical effectiveness of cefaclor and penicillin in the treatment of streptococcal pharyngitis. Cefaclor was well tolerated with no serious side effects.

Amoxicillin↗

PubMed1989

Failure of once-daily penicillin V therapy for streptococcal pharyngitis.

To determine if a single daily dose of penicillin V would be effective in the treatment of group A beta-hemolytic streptococcal (GABHS) pharyngitis, 154 patients with GABHS pharyngitis were randomly assigned to receive 750 mg of penicillin V once daily for ten days or 250 mg of penicillin V three times daily for ten days. The two regimens were comparable in their ability to eradicate GABHS from the upper respiratory tract in 18 to 24 hours and in their impact on the clinical course of the disease. However, a bacteriologic treatment failure occurred in six (8%) of the 76 patients in the three-times-daily group and in 16 (22%) of the 74 patients in the once-daily group. These findings support the current recommendation that penicillin V be given in two or more divided doses for a full ten days for the treatment of GABHS pharyngitis.

Adolescent↗

PubMed1996

Computer instruction in learning concepts of streptococcal pharyngitis.

OBJECTIVE: To evaluate a computer-assisted instruction unit covering the basic concepts of streptococcal pharyngitis for effectiveness as a learning tool. DESIGN: Randomized control trial. SETTING: A medical school associated with a tertiary care hospital. PARTICIPANTS: Third-year medical students on a pediatric clerkship from December 1, 1992, to October 31, 1993. INTERVENTION: Students were randomized into a study or a control group and given a pretest on streptococcal pharyngitis. The study group then completed the computer-assisted instruction unit. No attempt was made to distinguish among the clinical experiences of the two groups during the next 4 weeks, after which a second test on streptococcal pharyngitis was given to both groups. MAIN OUTCOME MEASURES: Outcome was measured by scores (percentage correct) from tests given at day 1 and week 4 of the clerkship. RESULTS: The posttest scores of the study group increased by an average of 12.1 above the pretest scores, but the scores of the control group were only 3.4 points higher. The difference between these increases is statistically significant (P < .01, Student's t test). CONCLUSION: Short, well-designed computer-assisted instruction units can be effective tools in medical education.

Adult↗

PubMed1985

Streptococcal pharyngitis. Placebo-controlled double-blind evaluation of clinical response to penicillin therapy.

Forty-four children with a clinical diagnosis of streptococcal pharyngitis had throat cultures performed at the initial evaluation and were assigned by randomization to receive either oral penicillin or a placebo for 72 hours. The treating physician, who remained blind to the treatment regimen, recorded the child's temperature and assessed the presence and severity of other signs and symptoms initially and at 24, 48, and 72 hours. The throat culture was positive for group A beta-hemolytic streptococci in 26 (59%) of the initial study group, and most of these children developed a fourfold or greater titer rise in antistreptococcal antibodies in their serum, confirming the diagnosis of streptococcal pharyngitis. Statistically significant clinical improvement was observed in the group of 11 children who were later shown to have been taking penicillin compared with the group of 15 who had taken the placebo. Significant differences in the presence and degree of fever and severity of symptoms persisted in the placebo-treated group for 48 hours. We conclude that early penicillin treatment of children with streptococcal pharyngitis significantly alters the acute clinical course of the disease.

Adolescent↗

PubMed1998

Food groups and risk of oral and pharyngeal cancer.

The role of specific food groups and diet variety on the risk of oral and pharyngeal cancer has been considered using data from a case-control study conducted between 1992 and 1997 in the Swiss Canton of Vaud. Cases were 156 patients (126 males, 30 females) aged under 75 (median age 56) years with incident, histologically confirmed cancer of the oral cavity and pharynx, and controls were 284 subjects (246 males, 38 females, median age 57 years), admitted to the same university hospital for a wide spectrum of acute, non-neoplastic conditions unrelated to tobacco and alcohol consumption or to long-term modification of diet. After allowance for education, alcohol, tobacco and total energy intake, significant trends of increasing risk with more frequent intake emerged for eggs (OR = 2.3 for the highest tertile), red meat (OR = 2.1) and pork and processed meat (OR = 3.2). Inverse trends in risk were observed for milk (OR = 0.4 for the highest tertile), fish (OR = 0.5), raw vegetables (OR = 0.3), cooked vegetables (OR = 0.1), citrus fruit (OR = 0.4) and other fruits (OR = 0.2). The addition of a serving per day of fruit or vegetables was associated with an about 50% reduction in oral cancer risk. The most favourable diet for oral cancer risk is therefore given by infrequent consumption of red and processed meat and eggs and, most of all, frequent vegetable and fruit intake. Diet diversity was inversely related to oral and pharyngeal cancer: ORs were 0.35 for the highest tertile of total diversity, 0.24 for vegetable and 0.34 for fruit diversity. In terms of attributable risk, high meat intake accounted for 49% of oral and pharyngeal cancers in this population, low vegetable intake for 65% and low fruit intake for 54%.

Adult↗

PubMedDate not supplied

Posterior pharyngeal carcinoma resection with larynx preservation and radial forearm free flap reconstruction: a preliminary report.

BACKGROUND: Surgical management of selected posterior pharyngeal wall lesions can be performed with pharyngectomy, allowing for larynx preservation, with radial forearm free flap (RFFF) reconstruction. METHODS: Retrospective review of our experience using RFFF reconstruction in 9 patients. RESULTS: All 9 patients had a posterior pharyngectomy with larynx preservation, neck dissection (3 bilateral, 6 unilateral), and RFFF reconstruction. Six patients experienced 8 postoperative complications including one postoperative death. Only 3 patients were able to obtain all nutrition orally. Tracheotomy decannulation occurred in 4 patients and voice was maintained in all patients. American Society of Anesthesiologists score (ASA) was an accurate predictor of postoperative medical complications. CONCLUSIONS: Posterior pharyngeal resections with larynx preservation and RFFF reconstruction can be accomplished with acceptable morbidity in healthy patients with carefully selected lesions of the posterior pharyngeal wall. However, in patients with significant co-morbidities as reflected by an ASA of 3 or more, larynx preservation and RFFF reconstruction was fraught with significant morbidity and is not recommended.

Aged↗

PubMed2001

Multiple enhancers contribute to expression of the NK-2 homeobox gene ceh-22 in C. elegans pharyngeal muscle.

Gene expression in the pharyngeal muscles of C. elegans is regulated in part by the NK-2 family homeodomain factor CEH-22, which is structurally and functionally related to Drosophila Tinman and the vertebrate Nkx2-5 factors. ceh-22 is expressed exclusively in the pharyngeal muscles and is the earliest gene known to be expressed in this tissue. Here we characterize the ceh-22 promoter region in transgenic C. elegans. A 1.9-kb fragment upstream of ceh-22 is sufficient to regulate reporter gene expression in a pattern identical to the endogenous gene. Within this promoter we identified two transcriptional enhancers and characterized their cell type and temporal specificity. The distal enhancer becomes active in the pharynx near the time that ceh-22 expression initiates; however, it becomes active more broadly later in development. The proximal enhancer becomes active after the onset of ceh-22 expression, but it is active specifically in the ceh-22-expressing pharyngeal muscles. We suggest these enhancers respond to distinct signals that initiate and maintain ceh-22 gene expression. Proximal enhancer activity requires a short segment containing a CEH-22 responsive element, suggesting that CEH-22 autoregulates its own expression.

Animals↗

PubMed2002

Nutrition and pharyngeal cancer: results from a case-control study in Spain.

BACKGROUND: Oropharyngeal and hypopharyngeal cancer is increasing all over the world, frequently affecting more and more women and younger individuals and not only the typical 50- to 60-year-old heavy smoker and drinking man. In addition, 5-year overall survival rate remains poor (30% to 40% in most series), despite advances in treatment. Therefore, it is crucial to understand as accurately as possible the risk factors for these malignancies to improve primary prevention. METHODS: We report the results from a case-control study of pharyngeal cancer risk factors conducted in Spain involving 232 consecutive patients who were gender- and age-matched with 232 controls. Data were collected by interviewer-administered personal interview. RESULTS: Our results show that low intake of fruit, fruit juice, uncooked vegetables, dietary fiber-containing foods (legume and cereals), fish, milk, and dairy products is an independent risk factor for pharyngeal cancer and that high consumption of meat and fried foods also increases the risk once data are adjusted for tobacco smoking and alcohol drinking. CONCLUSIONS: Although findings for fruit, juice, and uncooked vegetables are in accordance with those from other authors and can be explained on a biologic basis, the relationship between pharyngeal cancer and dietary excess of saturated fatty acids needs experimental investigation. Findings for milk, dairy products, and fish also warrant more detailed epidemiologic research because of conflicting data reported in the literature and because of the reportedly ambiguous role of retinol in human cancers. No conclusive explanations for the protective effect of dietary fiber-containing foods can be put forward today. Our results are uniquely attributable to oropharyngeal and hypopharyngeal cancers because of the small size of our nasopharyngeal cancer subsample.

Adolescent↗

PubMed2005

Oral and pharyngeal cancer: analysis of patient delay at different tumor stages.

BACKGROUND: The aim of this study was to examine which factors are related to patient delay in a cohort of consecutive patients with pharyngeal cancer and oral cancer and to determine whether the different stages of patient delay (ie, appraisal, illness, behavioral, and scheduling) were related to different tumor stages. METHODS: Before treatment, 55 patients with pharyngeal cancer and 134 patients with oral cancer were interviewed about their prediagnostic period. To verify the data, a questionnaire was sent to the general practitioner and/or dentist and a close relative. RESULTS: Patients with a delay of more than 30 days were significantly more often diagnosed with late-stage (T3-T4) disease (pharynx, p = .01, odds ratio [OR] = 4.5; oral, p = .01, OR = 3.2). No sociodemographic characteristics were associated with patient delay. CONCLUSIONS: Prolonged patient delay was associated with late-stage disease for both patients with pharyngeal cancer and patients with oral cancer. Although for most patients the symptoms are vague or might look like a common cold or infection, the general public should be better informed about tumor symptoms. This may enhance earlier visits to a health care professional.

Adult↗

PubMed2003

Independent and combined effects of tobacco smoking, chewing and alcohol drinking on the risk of oral, pharyngeal and esophageal cancers in Indian men.

Oral, pharyngeal and esophageal cancers are 3 of the 5 most common cancer sites in Indian men. To assess the effect of different patterns of smoking, chewing and alcohol drinking in the development of the above 3 neoplasms and to determine the interaction among these habits, we conducted a case-control study in Chennai and Trivandrum, South India. The cases included 1,563 oral, 636 pharyngeal and 566 esophageal male cancer patients who were compared with 1,711 male disease controls from the 2 centers as well as 1,927 male healthy hospital visitors from Chennai. We observed a significant dose-response relationship for duration and amount of consumption of the 3 habits with the development of the 3 neoplasms. Tobacco chewing emerged as the strongest risk factor for oral cancer, with the highest odds ratio (OR) for chewing products containing tobacco of 5.05 [95% confidence internal (CI) 4.26-5.97]. The strongest risk factor for pharyngeal and esophageal cancers was tobacco smoking, with ORs of 4.00 (95% CI 3.07-5.22) and 2.83 (95% CI 2.18-3.66) in current smokers, respectively. An independent increase in risk was observed for each habit in the absence of the other 2. For example, the OR of oral cancers for alcohol drinking in never smokers and never chewers was 2.56 (95% CI 1.42-4.64) and that of esophageal cancers was 3.41 (95% CI 1.46-7.99). Furthermore, significant decreases in risks for all 3 cancer sites were observed in subjects who quit smoking even among those who had quit smoking 2-4 years before the interview.

Adult↗

PubMed2005

Different impact from betel quid, alcohol and cigarette: risk factors for pharyngeal and laryngeal cancer.

The risks of betel quid chewing with or without tobacco, alcohol drinking and cigarette smoking have been well explored in the oral cavity but not in the pharynx and larynx. We conducted a case-control study to investigate the association of these three risk factors to cancers of the pharynx and larynx in Taiwan. A total cases of 148 pharyngeal cancer, 128 laryngeal cancer and 255 hospital controls, all men, were recruited. Betel quid chewing was a significant independent risk factor (adjusted odds ratio [aOR] = 7.7; 95% confidence interval [CI] = 4.1-15.0) similar to that of alcohol drinking (aOR = 6.6; 95% CI = 3.5-13.0) for pharyngeal cancer, but not for laryngeal cancer (aOR = 1.3; 95% CI = 0.7-2.5) on which cigarette smoking (aOR = 7.1) exerts a stronger significant independent risk than alcohol drinking (aOR = 3.8). For pharyngeal cancers, chewers who consumed >20 quid/day, chewed with inflorescence in the quid or swallowed the betel quid juice were at higher risks; significant dose-response effects were found in daily quantity of drinking and chewing, and cumulative quantity of drinking. Synergistic effects from the 3 risk factors existed both on the pharynx (aOR = 96.9) and the larynx (aOR = 40.3), and attributed for 93.1% and 92.9% respectively. Our study is the first evidence to show that betel quid chewing without tobacco has different impact on the pharynx (digestive tract) and the larynx (airway), and supports the concept that exposure quantity and direct mucosal contact with the betel quid juice may contribute to carcinogenesis. Our results show an important insight into the impact of betel quid chewing on other sites of the digestive tract other than the oral cavity.

Adult↗

PubMed2002

Cost-effectiveness of treatment options for prevention of rheumatic heart disease from Group A streptococcal pharyngitis in a pediatric population.

BACKGROUND: We set out to examine which treatment option available in the United States was most cost-effective in treating children with endemic group A streptococcal pharyngitis to prevent rheumatic heart disease. METHODS: Cost-effectiveness was calculated from the societal perspective and expressed in cases of rheumatic heart disease prevented annually in the U.S. pediatric population aged 5 to 17 based on U.S. Census data. We used a decision-analysis model to assess the cost-effectiveness of five treatment options for patients with pharyngitis: (1) "treat all," (2) "treat none," (3) "rapid test," where only patients with a positive rapid antigen test are treated, (4) "culture," where only patients with a positive throat culture are treated, and (5) "rapid test with culture" or (RTCX), where confirmatory cultures are used on patients with negative rapid tests. Cost data were gathered from existing empirical data or estimated. We performed sensitivity analyses of the antigen test sensitivity and antibiotic effectiveness and examined whether changes in these variables would alter our outcome. RESULTS: The "rapid test" was the most cost-effective option. Using "rapid tests" prevented 85 cases of rheumatic heart disease annually and cost society $727,000 per case prevented. Performing throat cultures instead of "rapid tests" would pick up an additional 11 cases of rheumatic heart disease but would cost $13.7 million for each of these additional cases prevented. The current standard of using throat cultures as a confirmatory test on patients with a negative "rapid" test would detect an additional 21 cases of rheumatic heart disease but cost society an additional $8 million per case prevented. CONCLUSIONS: To reduce the incidence of rheumatic heart disease cost-effectively, the management of pediatric pharyngitis may best be accomplished by using antigen testing. The added costs associated with the remaining treatment options may not be justified, especially, as the sensitivity of the antigen tests continues to improve and closely approaches the sensitivity of the practice standard, throat culture.

Adolescent↗

PubMed1989

Association of penicillin-tolerant streptococci with epidemics of streptococcal pharyngitis in closed communities.

The association of penicillin-tolerant streptococci with reported epidemics of streptococcal pharyngitis in Israel was studied. The streptococcal strains had been isolated during 11 epidemics of community-acquired pharyngitis and 6 food-borne epidemics of pharyngitis occurring in the last 15 years. Strains were stocked lyophilized. Isolates were defined as tolerant if the MBC/MIC ratio for penicillin was greater than or equal to 32. All 122 group A streptococcal strains isolated during the epidemics of community-acquired infection showed tolerance to penicillin. In contrast, none of the 52 strains from food-borne epidemics (24 group A, 18 group C and 8 group G) was tolerant.

Disease Outbreaks↗

PubMedDate not supplied

Group A beta-hemolytic streptococcal pharyngitis in children.

Group A beta-hemolytic streptococcus (GABHS) is the most common bacterial cause of acute pharyngitis in children. Because clinical findings can be nonspecific, even experienced physicians cannot reliably diagnose GABHS pharyngitis solely on the basis of clinical presentation. Suspected cases should be confirmed by a throat culture or a rapid antigen detection test before antibiotic therapy is initiated. Microbiologic testing is generally not necessary in patients with pharyngitis whose clinical and epidemiologic findings are not suggestive of GABHS. Clinical score systems have been developed to help physicians decide which patients should undergo diagnostic testing and to reduce the unnecessary use of antibiotics. Antibiotic therapy should be initiated as soon as the diagnosis is confirmed. Penicillin V remains the drug of choice. Alternative therapy, e.g., with cephalosporin or macrolide, is often sought because of penicillin allergy, noncompliance, and treatment failure.

Acute Disease↗