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PubMed1981

Cervical dysphagia: pharyngeal protrusions and achalasia.

Cervical achalasia, webs, and pharyngeal protrusions, particularly Zenker's diverticula, are prominent sources of upper alimentary tract dysphagia. Since achalasia and webs can secondarily cause pharyngeal protrusions, they may coexist, and must be ruled out before commencing treatment. The nature and origin of these entities and means of radiographic distinction are discussed. Emphasis is placed on the various forms of lateral pharyngeal protrusion, which are the most poorly understood.

Adult↗

PubMed1992

Prechewing of food by adults and streptococcal pharyngitis in infants.

Three infants with group A streptococcal pharyngitis were found to have eaten food prechewed by their parents. One parent had a history of recent pharyngitis and another had frequent episodes of tonsillitis. Prechewing of babies' food, which may be more common in the United States than is generally recognized, may be a mode of transmission of group A streptococcal pharyngitis to infants.

Adult↗

PubMed1986

Once daily therapy for streptococcal pharyngitis with cefadroxil.

To determine if a single daily dose of cefadroxil would be effective in the treatment of group A beta-hemolytic streptococcal (GABHS) pharyngitis, 196 patients with GABHS pharyngitis were randomly assigned to receive either penicillin V 250 mg three times daily or cefadroxil 30 mg/kg once daily, for 10 days. Outcome was measured by the ability to isolate GABHS from the upper respiratory tract 18 to 24 hours after the onset of therapy, the impact on the clinical course, and the bacteriologic treatment failure rate. There was no significant difference in the number of patients in the cefadroxil and penicillin V treatment groups with throat cultures positive for GABHS at the 18 to 24-hour follow-up visit (0% and 2%, respectively), and the clinical responses of the patients in the two treatment groups were similar. Of the 99 patients in the three times daily penicillin V group, six (6%) had strains of GABHS isolated on one of the follow-up cultures that were identical to the strains isolated from their initial throat cultures and were considered to have bacteriologic treatment failures. Of the 96 patients in the once daily cefadroxil group, two (2%) were considered to have bacteriologic treatment failures. A single daily dose of cefadroxil appears to be as effective in the treatment of GABHS pharyngitis in this population as penicillin V given three times daily.

Adolescent↗

PubMed1986

Antigen detection test for streptococcal pharyngitis: evaluation of sensitivity with respect to true infections.

The clinical significance of false-negative results on antigen detection tests for group A beta-hemolytic streptococcal (GABHS) pharyngitis (negative test results and positive culture) has yet to be determined. We recently compared the Culturette Brand Ten-Minute Group A Strep ID Kit with blood agar cultures in 313 patients with pharyngitis, 257 (82%) of whom had positive throat cultures for GABHS. The Culturette Brand test had a sensitivity of 88%, specificity of 96%, a positive predictive value of 99%, and negative predictive value of 64%. More than half of the false-negative Culturette Brand test results occurred in children with less than 10 GABHS colonies on throat culture (1+ culture). When these 1+ cultures were not considered positive, the sensitivity of the Culturette Brand test was 93%. The sensitivity of the Culturette Brand test increased with an increased degree of positivity of the corresponding throat culture. Of the 31 children with false-negative Culturette Brand test results, 14 (45%) had a significant streptococcal antibody response; of the 224 children with true-positive Culturette Brand test results (positive test results and positive culture) from whom serologic data were available, 114 (51%) had a significant streptococcal antibody response. This difference is not statistically significant. These findings suggest that almost half of patients with false-negative results on antigen detection tests for GABHS pharyngitis have true infections (positive culture and antibody rise) and are not merely streptococcal carriers.

Adolescent↗

PubMed2002

A case of fatal pharyngitis.

Pharyngitis is a common condition and usually does not lead to any major complication. We report a case in which the patient presented with pharyngitis resulting in an unusual fatal complication of pharyngeal and cerebral abscess. The causative organism was Streptococcus milleri that should be readily treatable by penicillin if the condition was recognised earlier.

Adolescent↗

PubMed1993

Dexamethasone as adjuvant therapy for severe acute pharyngitis.

STUDY OBJECTIVE: To determine the efficacy of dexamethasone as adjuvant therapy to improve pain relief in patients with severe, acute exudative pharyngitis. DESIGN: Prospective, randomized, double-blinded, placebo-controlled clinical trial. SETTING: Large, urban community hospital emergency department with an emergency medicine residency program. TYPE OF PARTICIPANTS: Patients aged 12 to 65 years old with exudative pharyngitis and severe dysphagia/odynophagia. Patients with cancer, AIDS, diabetes mellitus, recent steroid use, pregnancy, or suspicion of peritonsillar abscess were excluded. INTERVENTIONS: All patients received oral penicillin (500 mg Pen VK) or erythromycin (333 mg base) three times daily for ten days in addition to either 10 mg single-dose dexamethasone or saline placebo IM injection. MEASUREMENTS AND RESULTS: Fifty-eight patients graded their initial degree of throat pain on a visual-analog scale that was 15 cm long and scored from 0 to 3.0 in 0.5-cm increments. Follow-up was obtained on 51 patients to determine their condition at 24 hours. At entry, there was no difference in age, weight, antibiotic assignment, or initial pain score between groups. Improvement in pain score (initial versus 24 hours) was 1.8 +/- 0.8 in the 26 patients of the dexamethasone group and 1.2 +/- 0.9 in the 25 patients of the placebo group (P < .05). Time to onset of pain relief was also faster in steroid-treated patients who demonstrated relief beginning at 6.3 +/- 5.3 hours, compared with 12.4 +/- 8.5 hours in the placebo group (P < .01). Of the 26 patients evaluated at seven days (13 in each group), time to complete lack of pain averaged 15.0 +/- 11.4 hours in the dexamethasone group and 35.4 +/- 17.9 hours in the placebo group (P < .02). Complications attributable to dexamethasone were not observed. CONCLUSION: In patients with severe, acute exudative pharyngitis, single-injection dexamethasone adjuvant compared with placebo resulted in statistically and clinically significant improvement, as evidenced by more rapid onset and greater degree of pain relief.

Acute Disease↗

PubMedDate not supplied

Thorium-dioxide--induced pharyngeal hemorrhage.

Thorium dioxide, a producer of alpha particle radiation, was used in the United States from 1930 to 1950 for carotid and cerebral angiography. Cervical thorium dioxide granuloma is a well-recognized sequela of extravasation of this material near the carotid bifurcation. Radical neck dissection to remove the granuloma for aesthetic and functional reasons may lead to massive postoperative hemorrhage if a patent, but radiation-weakened, carotid artery is present. Additionally, hemorrhage may occur spontaneously because of pharyngeal necrosis or following infection of a pharyngeal biopsy site. The case described illustrates that life-threatening, thorium-dioxide--induced pharyngeal hemorrhage may occur even with an occluded carotid system. The bleeding site may go unrecognized, and laryngopharyngectomy with radical neck debridement may be required for hemostasis. Extension of an infection into the retroesophageal space and thoracic inlet requires exteriorization of the entire neck wound to prevent placing the great vessels of the superior mediastinum at risk for rupture. Spontaneous rupture of the aorta may occur due to thorium-dioxide--induced necrosis of its wall.

Arterial Occlusive Diseases↗

PubMed2002

Arterial baroreflex and peripheral chemoreflex function after radiotherapy for laryngeal or pharyngeal cancer.

PURPOSE: Denervation of the carotid sinus causes baroreflex and chemoreflex failure, resulting in labile hypertension and loss of hypoxic responsiveness. We investigated whether radiation therapy for laryngeal or pharyngeal cancer affects baroreflex and chemoreflex function. METHODS AND MATERIALS: Twelve patients were studied after radiation therapy for locally advanced laryngeal or pharyngeal cancer (11 male, 1 female, age: 56.0 +/- 7.9 years), 3.3 years (median; range 1.0-4.7) after radiotherapy and 15 healthy controls (11 male, 4 female, 53.4 +/- 9.2 years). We measured baroreflex sensitivity (phenylephrine), blood pressure level and variability (24-h Spacelabs and 5-h Portapres recordings), responses to cardiovascular reflex tests, and the ventilatory responses to normocapnic and hypercapnic hypoxia. RESULTS: Baroreflex sensitivity was lower in patients (9.7 +/- 7.8 ms/mm Hg) than in controls (17.5 +/- 10.3 ms/mm Hg, p = 0.011). Mean office blood pressure was significantly higher in patients (141.5 +/- 27.8/89.2 +/- 10.6 mm Hg, 63.3 +/- 12.3 bpm) than in controls (117.3 +/- 10.1/75.1 +/- 6.8 mm Hg, 61.8 +/- 10.8 bpm). Blood pressure variability was not different between groups, nor were the responses to reflex tests. The normo/hypercapnic ventilatory response to hypoxia was similar in patients (0.21 +/- 0.10/1.37 +/- 0.60 L/min/%) and controls (0.22 +/- 0.16/1.19 +/- 0.78 L/min/%). CONCLUSIONS: Radiation therapy for laryngeal or pharyngeal carcinoma does not affect chemoreflex function, but results in an attenuated baroreflex sensitivity. Clinically relevant blood pressure lability is absent however.

Baroreflex↗

PubMed1997

Salvage brachytherapy of posterior pharyngeal wall squamous cell carcinoma in a previously irradiated area.

PURPOSE: Brachytherapy performed in patients with posterior pharyngeal wall carcinoma in a previously irradiated area is evaluated in terms of local control, survival, and complications. METHODS AND MATERIALS: Between January 1982 and July 1993, 14 patients were treated with interstitial low dose rate brachytherapy alone for posterior pharyngeal wall squamous cell carcinoma in a previously irradiated area (local recurrences in five cases and second tumors in nine cases). Tumor size ranged from 1 to 4 cm. No patient had a macroscopic nodal involvement or metastase at the time of diagnosis. Median dose delivered was 55 Gy (39 to 60 Gy). RESULTS: Thirteen patients were assessed for local control. Twelve of them achieved complete macroscopic response within 2 months after brachytherapy. Local relapse occurred in five patients, from 5 to 29 months after brachytherapy. One patient developed distant metastatis without loco-regional relapse. Disease free survival was 69, 59, and 37% at 1, 2, and 5 years, respectively; overall survival was 78, 50, and 21% at 1, 2, and 5 years, respectively. Three patients were still alive without recurrence (8, 8, and 10 years after treatment). We did not observe any severe acute or delayed toxicity. CONCLUSION: Based on these results, interstitial brachytherapy should be considered as a potentially curative treatment for selected patients with posterior pharyngeal wall squamous cell carcinoma in a previously irradiated area. There are no reports in the literature on this subject.

Aged↗

PubMed2002

Comparative efficacy and safety of 5-day cefaclor and 10-day amoxycillin treatment of group A streptococcal pharyngitis in children.

A total of 384 children with group A beta-haemolytic streptococcal (GABHS) pharyngitis were randomized to receive either 40 mg/kg/day of cefaclor in two doses for 5 days (192 patients), or 40 mg/kg/day of amoxycillin in three doses for 10 days (192 patients). The signs and symptoms of pharyngitis were recorded and throat cultures were obtained at presentation and on days 6-7, 11-15, 16-20 and 28-35. Patient compliance was significantly higher in the children treated with cefaclor (100 vs. 95.1%; P = 0.003). At the end of follow-up, the percentage of clinical success was 91.4% for cefaclor and 91.9% for amoxycillin (P = 0.974); bacteriological success was obtained in 85.7 and 89.6% children (P = 0.348), respectively. Both treatments were well-tolerated with adverse event rates of 8.3% in the cefaclor group and 9.4% in the amoxcillin group (P = 0.857). Our study shows that five days' treatment with cefaclor is as effective and safe as the conventional 10-day course of amoxycillin in the treatment of GABHS pharyngitis, but compliance seems to be significantly greater.

Amoxicillin↗

PubMed1997

Functional anatomy observations of the pharyngeal orifice of the equine guttural pouch (auditory tube diverticulum).

The pharyngeal orifice of the equine auditory tube has not been adequately described. Its larger size and position, further rostral within the nasopharynx compared with other species, cannot be easily explained, but could be important for the proposed brain-cooling function of the guttural pouches; however, unlike other species, it may not be the sole regulator of auditory tube aeration. A 'second orifice' (representing the final entrance to the auditory tube diverticulum) deserves recognition in performing a role in air exchange between the auditory tube, diverticulum and middle ear. The results of this investigation suggest that regular guttural pouch ventilation during resting respiration does not occur. Previous reports may reflect, at least in part, a misinterpretation of air pressure measurements within the guttural pouches and nasopharynx. Small decreases in simulated inspiratory pressure consistently caused the passive opening of both the pharyngeal orifice and pouch ostium in horse cadavers suggesting that an active counter process may exist in the live horse to maintain closure of the guttural pouch openings during rest and light exercise. Intrinsic tone of the stylopharyngeus and pterygopharyngeus muscles may be part of this active process. The investigation offers theoretical evidence that opening of the equine auditory tubes to ventilate the guttural pouch occurs in two different ways, active and passive. The active process has two stages: (1) opening of the pharyngeal orifices by simultaneous contractions of the levator and tensor veli palatini and pterygopharyngeus muscles; then (2) opening of the pouch ostia by contractions of dorsal portions of the palatopharyngeus muscles. The alternative passive route involves reduction in tone of the stylopharyngeus and pterygopharyngeus muscles accompanied by increased inspiratory pressure.

Anatomy, Comparative↗

PubMed2003

Larynx preservation surgery for advanced posterior pharyngeal wall carcinoma with free flap reconstruction: a critical appraisal.

To report the functional and oncologic results of larynx preservation surgery with free flap reconstruction for posterior pharyngeal wall carcinoma. Retrospective medical chart review. Tertiary care referral center. We present a series of seven patients, who were treated for an advanced stage posterior pharyngeal wall carcinoma between 1995 and 1998. All patients underwent posterior pharyngectomy with larynx preservation via a suprahyoidal approach for carcinoma of the posterior pharyngeal wall, with radial forearm free flap reconstruction. Complications occurred in three patients with grade 3 comorbidity, one of whom suffered flap loss. After a mean follow-up of 48 months, three patients are alive without disease. One patient is alive with a second primary tongue carcinoma. Two patients died of disease, whereas one patient died of another cause. All patients could be decannulated and maintain their voice. Six out of seven patients were able to take oral nutrition, although four patients needed additional PEG-tube feeding. Posterior pharyngectomy with larynx preservation and radial forearm free flap reconstruction is feasible in selected patients, with acceptable functional results and survival. However, the patient must be aware of the risk of chronic aspiration and the possibility of long-term PEG feedings.

Adult↗

PubMed2000

Alterations of p53, pRb, cyclin D(1) and cdk4 in human oral and pharyngeal squamous cell carcinomas.

Alteration of expression of tumour suppressor genes and cell cycle regulators may be responsible for oral and pharyngeal cancer development. We have studied the expression of p53, pRb, cyclin D(1) and cdk4 in 53 cases of oral and pharyngeal squamous cell carcinomas using immunohistochemistry. Tumour expression of all nuclear proteins was scored according to the percentage of positive cancer nuclei. Positive p53 expression was detected in 27/53 (50.94%) cases. Lack of pRb immunostaining was observed in 39/53 (73.58%) cases. Overexpression of cyclin D(1) was shown in 21 (39.62%) tumours. The overexpression of cdk4 was detected in 43/53 (81.13%) cases. There was no significant association among these cell cycle regulatory proteins. This implies that the aberration of an important cell cycle regulator may be sufficient to disrupt regulatory mechanism in a manner favouring tumourigenesis. In summary, our results suggest that inappropriate expression of p53, pRb, cyclin D(1) or cdk4 is likely to contribute to the development of oral and pharyngeal cancers. The lack of pRb expression and/or overexpression of cdk4 play a crucial role in the development of this malignancy.

Adult↗

PubMed1989

Repair of post-laryngectomy pharyngeal fistulae.

Post-laryngectomy pharyngeal fistulization is an unpleasant occurrence. Presented herein is the author's approach to this problem, along with two cases in which closure was effected by sternocleidomastoid (SCM) myoplasty. SCM myocutaneous flaps have previously been considered for pharyngocutaneous fistulae and then disregarded due to the doubtful nature of the blood supply to the skin. The SCM myoplasty obviates this problem as it relies on muscle rather than skin. SCM myoplasty has been used as a bolster in pharyngeal reconstruction after the pharynx has been closed by pharyngeal mucosal advancement or rotation. The author has extended this idea utilizing the raw muscle of the SCM to directly reconstruct the defect in fistulae deemed too large for primary closure. Anatomical, oncological and technical considerations are discussed, as well as the author's protocol for post-laryngectomy pharyngocutaneous fistulae.

Fistula↗

PubMed1993

The relationship between SIgA and chronic granular pharyngitis.

A survey of the SIgA content in saliva, serum and pharyngeal mucosa with lymphoid tissue (PMLT) of chronic granular pharyngitis patients was conducted by a double antibody PEG radio-immune method. These data were compared with those from a healthy control group. Result shows that SIgA in patients with chronic granular pharyngitis had dissociation of saliva, serum and PMLY. There was low salivary SIgA level but higher levels in serum and PMLT. These data suggest that the saliva and serum immunoglobulin pools are under separate regulation.

Adolescent↗

PubMed1997

Actions of the anthelmintic ivermectin on the pharyngeal muscle of the parasitic nematode, Ascaris suum.

The anthelmintic invermectin has a number of effects on nematodes which result in changes in behaviour, particularly locomotion, including paralysis and an inhibition of feeding. This paper describes the application of an in vitro pharmacological approach to further delineate the action of ivermectin on feeding behaviour. Contraction of Ascaris suum pharyngeal muscle was monitored using a modified pressure transducer system which detects changes in intrapharyngeal pressure and therefore contraction of the radial muscle of the pharynx. The pharynx did not contract spontaneously. However, serotonin (5-HT, 100 microM) stimulated rhythmic contractions and relaxations (pumping) at a frequency of 0.5 Hz. gamma-Aminobutyric acid (GABA) and glutamic acid inhibited the pumping elicited by 5-HT. The duration of inhibition was concentration dependent (1-1000 microM) with a threshold of 1 microM and 10 microM respectively (n = 8). Ivermectin also inhibited pharyngeal pumping (1-1000 nM). At lower concentrations, ivermectin (1-10 pM) potentiated the GABA and glutamate inhibition, so that inhibition occurred at concentrations which were below threshold in the absence of ivermectin. These data provide evidence that the pharynx is a site for the action of ivermectin. Thus interruption of pharyngeal processes such as, feeding, regulation of hydrostatic pressure and secretion may provide a new site of anthelmintic action.

Animals↗

PubMed2001

Streptococcal contamination of food: an unusual cause of epidemic pharyngitis.

The purpose of this article is to define the distinguishing characteristics of food-borne streptococcal pharyngitis by reviewing the literature. The main cause of this infection lies in poor handling and preservation of cold salads, usually those which contain eggs and are prepared some hours before serving. A shorter incubation period and a higher attack rate (51-90%) than in transmission by droplets was noted. The epidemics tend to occur in warm climates and in the hottest months of the year. Streptococcus pyogenes seems to originate from the pharynx or hand lesions of a food handler. In comparison to airborne transmission symptoms such as sore throat, pharyngeal erythema, and enlarged tonsils, submandibular lymphadenopathy are more frequent than coughing and coryza. Seven out of 17 reports revealed an M-untypeable serotype, which may possess virulent characteristics. Penicillin prophylaxis was shown to limit additional spread of the infection. There were no non-suppurative sequels, and suppurative sequels were very rare. We assume that the guidelines for the prevention of food poisoning would apply to food-borne streptococcal pharyngitis. Food handlers should be supervised to ensure they comply with strict rules of preparation and storage of food. Cold salads, especially those containing eggs, should not be left overnight before serving.

Climate↗

PubMed2004

Racial differences in oral and pharyngeal cancer treatment and survival in Florida.

OBJECTIVE: This study examined racial differences in treatment and survival for blacks and whites in Florida diagnosed with oral or pharyngeal cancer. METHODS: Data for 21,481 malignancies of the oral cavity or pharynx diagnosed from 1988 to 1998 were derived from the Florida Cancer Data System. Type of cancer treatment was compared by race, stratified by anatomic site and summary stage at diagnosis. Kaplan-Meier survival curves were used to compare survival rates and Cox regression models were used to estimate hazard ratios for race. Covariates included age, sex, census tract income, and treatment. RESULTS: Stratifying by tumor site and stage, blacks consistently had poorer survival rates than whites. Across tumor stages, blacks with oral cavity cancer were consistently more likely than whites to have received only radiotherapy and less likely to have received cancer-directed surgery. Trends were similar for pharyngeal cancer, although statistically significant only for regional stages. Across site and stage, blacks consistently had elevated hazard ratios (range: 1.20-1.53) relative to whites. CONCLUSIONS: In Florida, there were racial differences in patient treatment for oral or pharyngeal cancer. Blacks had lower survival rates than whites, but differences in treatment did not entirely account for racial disparities in survival.

Adult↗