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PubMed1989

Changes in pharyngeal properties after uvulopalatopharyngoplasty.

Uvulopalatopharyngoplasty is a commonly used modality for surgical treatment of snoring and obstructive sleep apnea. Although this procedure is thought to alter pharyngeal properties, its effect on pharyngeal mechanics has not been studied. The acoustic reflection technique was used to measure pharyngeal area at functional residual capacity and residual volume before and after uvulopalatopharyngoplasty in eight patients referred because of loud snoring. We also calculated the lung volume dependence of pharyngeal area, defined as the percent change in pharyngeal area between functional residual capacity and residual volume, normalized to the area at functional residual capacity. This parameter, which may be related to pharyngeal collapsibility, was obtained before and after uvulopalatopharyngoplasty. Preoperative sleep studies showed that one patient had obstructive sleep apnea (apnea index greater than 10). Uvulopalatopharyngoplasty resulted in a significant increase (p less than 0.01) in pharyngeal area (from 3.14 +/- 0.71 cm2 to 4.25 +/- 1.07 cm2) and residual volume (from 2.49 +/- 0.53 cm2 to 3.91 +/- 0.83 cm2). Following uvulopalatopharyngoplasty, the pharynx became stiffer, as manifested by a reduction in lung volume dependence of pharyngeal area from 19 +/- 12% to 8 +/- 13% (p less than 0.05). Six patients, including the patient with obstructive sleep apnea, reported improvement in snoring. Two patients reported worsening in snoring. One of the two was found to have reduction in pharyngeal area and lung volume dependence of pharyngeal area, and an increase in apnea index from 3 to 33. In selected snorers, uvulopalatopharyngoplasty results in improvement in snoring with a concomitant increase in pharyngeal area and a tendency toward lower pharyngeal collapsibility.

Adult↗

PubMed1996

Mechanisms of oral-pharyngeal dysphagia in patients with Parkinson's disease.

BACKGROUND & AIMS: Oral-pharyngeal dysphagia in Parkinson's disease is well recognized. The aim of this study was to establish the mechanisms of oral-pharyngeal dysphagia in these patients. METHODS: Using simultaneous videoradiography and pharyngeal manometry, we studied 19 patients with Parkinson's disease (12 with oral-pharyngeal dysphagia and 7 without oral-pharyngeal dysphagia) and compared them with 23 healthy controls. RESULTS: the clinical severity of Parkinson's disease predicted neither the presence nor the severity of dysphagia. Minor alterations in oral function were common in controls and patients, but pharyngeal dysfunction was significantly more prevalent in patients. Incomplete upper esophageal sphincter (UES) relaxation was present in 4 patients (21%), all of whom showed increased hypopharyngeal intrabolus pressure, but not all of whom had a diminished UES opening. The patients had a reduced UES diameter (P = 0.004) and a higher intrabolus pressure compared with the controls (P = 0.007). Pharyngeal contraction pressures were lower in patients, but 6 patients with dysphagia and an abnormal pharyngeal wall motion had normal peak pressures. CONCLUSIONS: An incomplete UES relaxation and a reduced UES opening, both associated with high intrabolus pressure, are prevalent in Parkinson's disease. Oral-pharyngeal dysphagia in Parkinson's disease is multifactorial, with the majority of patients showing oral and pharyngeal dysfunction, even before the clinical expression of dysphagia. Impaired pharyngeal bolus transport is the major determinant of dysphagia.

Aged↗

PubMed2003

Diagnosis and management of adults with pharyngitis. A cost-effectiveness analysis.

BACKGROUND: Rheumatic fever has become uncommon in the United States while rapid diagnostic test technology for streptococcal antigens has improved. However, little is known about the effectiveness or cost-effectiveness of various strategies for managing pharyngitis caused by group A beta-hemolytic streptococcus (GAS) in U.S. adults. OBJECTIVE: To examine the cost-effectiveness of several diagnostic and management strategies for patients with suspected GAS pharyngitis. DESIGN: Cost-effectiveness analysis. DATA SOURCES: Published literature, including systematic reviews where possible. When costs were not available in the literature, we estimated them from our institution and Medicare charges. TARGET POPULATION: Adults in the general U.S. population. TIME HORIZON: 1 year. PERSPECTIVE: Societal. INTERVENTIONS: Five strategies for the management of adult patients with pharyngitis: 1) observation without testing or treatment, 2) empirical treatment with penicillin, 3) throat culture using a two-plate selective culture technique, 4) optical immunoassay (OIA) followed by culture to confirm negative OIA test results, or 5) OIA alone. OUTCOME MEASURES: Cost per lost quality-adjusted life-days (converted to life-years where appropriate) and incremental cost-effectiveness. RESULTS OF BASE-CASE ANALYSIS: Empirical treatment was the least effective strategy at a GAS pharyngitis prevalence of 10% (resulting in 0.41 lost quality-adjusted life-day). Although the other four strategies had similar effectiveness (all resulted in about 0.27 lost quality-adjusted life-day), culture was the least expensive strategy. RESULTS OF SENSITIVITY ANALYSES: Results were sensitive to the prevalence of GAS pharyngitis: OIA followed by culture was most effective when GAS pharyngitis prevalence was greater than 20%. Observation was least expensive when prevalence was less than 6%, and empirical treatment was least expensive when prevalence was greater than 71%. The effectiveness of strategies was also very sensitive to the probability of anaphylaxis: When the probability of anaphylaxis was about half the baseline probability, OIA/culture was most effective; when the probability was 1.6 times that of baseline, observation was most effective. Only at an OIA cost less than half of baseline did the OIA alone strategy become less expensive than culture. Results were not sensitive to other variations in probabilities or costs of diagnosis or treatment of GAS pharyngitis. CONCLUSIONS: Observation, culture, and two rapid antigen test strategies for diagnostic testing and treatment of suspected GAS pharyngitis in adults have very similar effectiveness and costs, although culture is the least expensive and most effective strategy when the GAS pharyngitis prevalence is 10%. Empirical treatment was not the most effective or least expensive strategy at any prevalence of GAS pharyngitis in adults, although it may be reasonable for individual patients at very high risk for GAS pharyngitis as assessed by a clinical decision rule.

Adult↗

PubMed2004

[Effect of specific immunoglobulin Y in the treatment of acute and chronic pharyngitis].

OBJECTIVE: To evaluate the effect and safety of the specific immunoglobulin Y (IgY) for treatment of acute and chronic pharyngitis. METHODS: Double-blind, randomized, placebo-controlled trial was conducted on 50 adults with acute pharyngitis. Experimental group received a 6 times-daily total 30 doses of IgY stomat-spray which contained specific immunoglobulin Y (titer = 512) prepared from the egg yolk of hens immunized with a variety of bacteria. Another open label trial included 50 patients, whose ages ranged from 21-69 years, including 25 cases of acute pharyngitis and 25 cases of chronic pharyngitis were also treated using IgY stomat-spray. The therapeutic effect were objectively evaluated 7 days later by the decreased scores based on both the symptoms and physical signs. If the symptom did not improve or became severe three days later, these patients with acute pharyngitis was inefficiency and antibiotic medicine would be added to them. RESULTS: In Double-blind trial, 8 cases (32%) received IgY had apparent effect with the decreased scores 5 or more than 5, 13 cases (52%) had effective with the decreased scores 3-4, and other 4 cases (16%) had inefficacy with the decreased scores only 2 or no more than 2. While in placebo-controlled group, only 2 (8%) cases had apparent effect, 5 (20%) cases showed effective and 18 (72%) cases had non-effect. The difference between the two groups was significant (chi 2 = 16.06, P < 0.01). In open label trial, 19 cases (38%) showed apparent effect, in which 14 cases were acute pharygitis. 23 cases (46%) had effective, in which 10 cases were acute pharyngitis. The left 8 cases (16%) had ineffective, in which one case was acute pharyngitis. There was significantly difference (chi 2 = 8.90, P < 0.05) between acute pharyngitis and chronic pharyngitis. An average of three months followup showed that there were no side effect or toxic effect and no allergic reaction. CONCLUSION: The IgY stomat-spray is a safe and effective agent in treating acute and chronic pharyngitis, especially for acute pharyngitis.

Acute Disease↗

PubMed2000

A pilot study of pharyngeal pulse oximetry with the laryngeal mask airway: a comparison with finger oximetry and arterial saturation measurements in healthy anesthetized patients.

UNLABELLED: We compared pharyngeal SpO(2) by using the laryngeal mask airway (LMA) to finger SpO(2) and oxygen saturation from arterial blood samples (SaO(2)). We studied 20 hemodynamically stable, well oxygenated, anesthetized patients (ASA physical status I-III, aged 18-80 yr). A single-use pediatric pulse oximeter was attached to the back plate of a size 5 LMA. Pharyngeal and finger SpO(2) (dominant index finger) and SaO(2) (nondominant radial artery) were measured with the cuff volume at 0-40 mL in the neutral position. The intracuff pressure was then set at 60 cm H(2)O in the neutral position, and readings were taken with the head-neck flexed, extended, and rotated. SaO(2) was the same as pharyngeal SpO(2) at 20 and 30 mL cuff volume, but higher than pharyngeal SpO(2) at all other cuff volumes and head-neck positions (P < 0.04). SaO(2) was always higher than finger SpO(2) (P < 0.01). Pharyngeal SpO(2) was higher than finger SpO(2) at cuff volumes 10-40 mL and in the flexed and rotated head-neck positions (all: P < 0.007), but was lower at 0 cuff volume (P < 0.0001) and similar in the extended head-neck position. There was an increase in pharyngeal SpO(2) between 0 and 10 mL cuff volume (P < 0.0001), but no changes thereafter. Pharyngeal SpO(2) was similar in the flexed, rotated and extended head-neck positions. Pharyngeal SpO(2) agrees more closely with SaO(2) (mean difference < 0.7%) than finger SpO(2) (mean difference > 1.1%) at 10-40 mL cuff volume and in head-neck flexion. The standard error of limits was identical (0.09) for both finger SpO(2) and pharyngeal SpO(2) if data at 0 cuff volume are excluded. We conclude that pharyngeal SpO(2) with the LMA is feasible and generally provides more accurate readings than finger SpO(2) in hemodynamically stable, well oxygenated, anesthetized patients. IMPLICATIONS: Pharyngeal oximetry with the laryngeal mask airway is feasible and generally provides more accurate readings than finger oximetry in hemodynamically stable, well oxygenated, anesthetized patients.

Adult↗

PubMed1976

Further observations on the pharyngeal hypophysis and the postsphenoid in the mature male rat.

In an investigation into the pharyngeal hypophysis and the postsphenoid using seven hypophysectiomized mature male rats, a pharyngeal hypophysis and a craniopharyngeal canal was found in each of two rats. Cellular differentiation was noted in the pharyngeal hypophysis in both rats. In one rat the pharyngeal hypophysis was markedly larger than any seen to date. In both rats the pharyngeal hypophysis was continuous with tissue of similar histological appearance which extended the full length of the cranio-pharyngeal canal. The histological appearance of the pharyngeal hypophysis and of the specific intra-canal tissue was also similar to that of cystic areas in the sellar adenohypophysis in the normal rat. The data arising from the present investigation indicate that a well-defined cranio-pharyngeal canal can occur in the rat. The data also support the assumption that the sellar adenohypophysis may be continuous with specific tissue within a cranio-pharyngeal canal. The significance of the data in terms of reactive hypertrophy and cellular differentiation of the pharyngeal hypophysis and the specific intra-canal tissue following hypophysectomy must await further data on the volume and histology of such tissue in normal rats which possess a cranio-pharyngeal canal.

Animals↗

PubMed2003

Botulinum neurotoxin for pharyngeal constrictor muscle spasm in tracheoesophageal voice restoration.

OBJECTIVES/HYPOTHESIS: The purpose of the study was to evaluate the effectiveness of Botulinum neurotoxin (Botox) for elimination of pharyngeal constrictor muscle spasm in tracheoesophageal voice restoration. STUDY DESIGN: A retrospective review was made of 62 patients between 1991 and 2002 who had Botox as the initial treatment for pharyngeal constrictor muscle spasm. METHODS: One hundred units of Botox properly diluted in 3 mL saline was instilled unilaterally under electromyographic guidance after fluoroscopic identification and marking of the contracted pharyngeal constrictor muscles. The patients were divided into three groups based on their response to the first Botox injection: group I, complete relaxation of the pharyngeal constrictors resulting in fluent voice, intratracheal phonation pressure of 20 to 40 cm H2O, and the ability to say 15 to 20 uninterrupted syllables; group II, hypertonic or incomplete relaxation of the pharyngeal constrictors resulting in intratracheal phonation pressure of 45 to 70 cm H2O and the ability to say 7 or 8 syllables; and group III, failure to produce relaxation of the pharyngeal constrictors. RESULTS: After the first injection of Botox, 49 (79%) patients were in group I or II (41 in group I and 8 in group II) and group III consisted of 13 patients. Thirty-four patients (55%) had group I (28) or II (6) responses for greater than 6 months. A second Botox injection enabled 6 of the 13 failures to move into group I. In all, 8 pharyngeal constrictor muscle myotomies (13%) were ultimately required in the 62 patients. The group I speaker for the longest period has enjoyed 11 years of fluency and successful daily use of a tracheostoma valve after two Botox injections. CONCLUSION: Botox relaxation of the pharyngeal constrictor muscles has proven to be effective, has replaced secondary pharyngeal myotomy for the initial treatment of pharyngeal muscle spasm, and is the only treatment in patients who are not candidates for elective surgery. Radiographic assessment, electromyographically monitored injection, and the number of Botox units appear to be important to successful outcomes.

Botulinum Toxins, Type A↗

PubMedDate not supplied

Food-borne and air-borne streptococcal pharyngitis--a clinical comparison.

Different vehicles of transmission of the same pathogen may induce different clinical manifestations of the disease. The hypothesis was tested that the clinical manifestation of food-borne streptococcal pharyngitis is different from air-borne streptococcal pharyngitis. The symptoms and signs of 77 patients with endemic air-borne streptococcal pharyngitis compared to 103 patients with epidemic food-borne streptococcal pharyngitis (T type 8/25/imp19, M protein negative) and 11 patients with secondary air-borne epidemic streptococcal pharyngitis (T type 8/25/imp19, M protein negative) were prospectively evaluated. The patients with food-borne streptococcal pharyngitis had a significantly higher frequency of sore throat, fever, pharyngeal erythema, tonsillar enlargement and submandibular lymphadenopathy and a lower frequency of coryza and cough compared to the patients with endemic air-borne streptococcal pharyngitis. Although both food-borne and air-borne streptococcal infection caused upper respiratory tract infection, the clinical manifestation of food-borne streptococcal pharyngitis was more severe and more confined to the pharynx compared to the endemic air-borne disease. Involvement of the nasal mucosa and bronchial tree was more common in air-borne streptococcal pharyngitis than in the food-borne disease.

Air Microbiology↗

PubMed1988

Rapid group A streptococcal antigen detection kit: effect on antimicrobial therapy for acute pharyngitis.

Newly introduced rapid diagnostic tests for group A streptococcal pharyngitis should facilitate appropriate antimicrobial use in patients with group A streptococcal pharyngitis. Because of high rates of acute pharyngitis in Tuba City, AZ, at the Navajo Indian reservation, the use of rapid diagnostic test was prospectively evaluated. The sensitivity and specificity of the test was measured and changes in physician prescribing patterns attributable to use of the test were correlated. Of 320 patients with pharyngitis enrolled during the present 3-week study, 86 met the study's definition of a patient with streptococcal pharyngitis and 163 met the study's definition of a patient with nonstreptococcal pharyngitis. The rapid test was 62.8% sensitive and 96.9% specific in identifying patients from whom group A streptococci were isolated. Although treatment of patients with streptococcal pharyngitis at the time of the first visit increased from 36.5% in a retrospective sample to 72.5% during the study, treatment of patients in whom cultures were negative remained the same. Further analyses showed that physicians tended to treat patients with signs characteristic of streptococcal pharyngitis and, as the study progressed, to rely less on negative rapid test results as a reason to withhold antimicrobial agents. It was concluded that rapid tests with good specificity but limited sensitivity may improve treatment of patients with streptococcal pharyngitis by allowing earlier specific therapy. A more sensitive test with a higher negative predictive value would be necessary to prevent treatment of persons with nonstreptococcal pharyngitis.

Adolescent↗

PubMedDate not supplied

[Significance of normal oropharyngeal flora in the development of streptococcal pharyngitis and outcome of penicillin therapy].

Pharyngitis is one of the most frequent diseases in children. The most important of the bacterial infections is due to Streptococcus pyogenes. For many years, penicillin is considered to be the drug of choice for streptococcal pharyngitis, although failure rates of up to 20% have been reported. One of possible explanations for penicillin treatment failure is presence of other species of bacteria in the normal oropharyngeal flora that can interfere with colonization and growth of Streptococcus pyogenes and influence the development of pharyngitis. A wide variety of microorganisms, including alpha-haemolytic streptococci and anaerobic bacteria, are present within the oropharynx (table 1). The strain of alpha-haemolytic streptococci is in interference with Streptococcus pyogenes. By producing bacteriocins, they inhibit colonization and growth of Streptococcus pyogenes and assist in its eradication. Anaerobic bacteria may play a direct or indirect role in development of pharyngitis. They may be directly responsible for specific forms of pharyngitis or contribute indirectly with possibility of synergy between them and Streptococcus pyogenes. Beta-lactamase-producing aerobic and anaerobic organisms may contribute to penicillin treatment failure. By producing beta-lactamase within the tonsillar tissue, they destroy penicillin and protect streptococci from the antibacterial effect of penicillin. Pharyngeal bacterial flora may vary according to the state of the patient (Figure 1). During an acute infection and in the cases of treatment failure and recurrent pharyngitis the number of alpha-haemolytic streptococci declines, while there is an increase in the number of anaerobic and beta-lactamase-producing organisms. After successful treatment the number and type of bacteria is similar to those found within normal tissue. Knowing the distribution and changes in pharyngeal bacterial flora is important for choosing the optimal drug for treatment of streptococcal pharyngitis. Although penicillin reduces the number of interfering beta-haemolytic streptococci, because of its advantages, if remains the drug of choice for the treatment of streptococcal pharyngitis. In cases of treatment failure and recurrent infections cephalosporins and macrolides may be a useful alternative to penicillin because they possess relatively poor activity against alpha-haemolytic streptococci, resistance to beta-lactamase and because of better penetration into tonsilar tissue.

Humans↗

PubMed2005

Group A streptococcal surface GAPDH, SDH, recognizes uPAR/CD87 as its receptor on the human pharyngeal cell and mediates bacterial adherence to host cells.

Streptococcal surface dehydrogenase (SDH) is a multifunctional, anchorless protein present on the surface of group A Streptococcus (GAS). It plays a regulatory role in GAS-mediated intracellular signaling events in human pharyngeal cells. Using ligand-binding assays, we have identified an approximately 55 kDa protein as an SDH-specific receptor protein on the surface of Detroit human pharyngeal cells. LC-MS/MS analyses identified this SDH-binding pharyngeal cell-surface-exposed membrane-bound protein as uPAR (urokinase plasminogen activator receptor)/CD87. Ligand-binding assays also revealed that only the N-terminal domain (D1) of uPAR bound to SDH. uPAR-D1 more specifically bound to the C-terminal alpha-helix and two immediate flanking regions of the S-loop of the SDH molecule. Site-directed mutagenesis in GAS resulting in SDH with altered C-terminal ends, and the removal of uPAR from pharyngeal cells by phosphatidylinositol-phopsholipase C treatment decreased GAS ability to adhere to pharyngeal cells. When compared to uninfected Detroit pharyngeal cells, GAS-infected pharyngeal cells showed a transient but a significant increase in the expression of uPAR-specific mRNA, and a prolonged recycling process of uPAR on the cell surface. Together, these results indicate that the specific streptococcal surface protein-pharyngeal cell receptor interaction mediated by SDH and uPAR is modulated during GAS infection of human pharyngeal cells. This interaction significantly contributes to bacterial adherence and thus may play a significant role in GAS pathogenesis by regulating intracellular signaling events in pharyngeal cells.

Amino Acid Sequence↗

PubMed2003

Plasminogen-mediated group A streptococcal adherence to and pericellular invasion of human pharyngeal cells.

Alpha-enolase (SEN) is a strong plasminogen-binding protein on the surface of group A streptococci (GAS). By flow cytometry and immunofluorescence analyses and using human enolase-specific antibody, human pharyngeal cells (Detroit 562) also were found to express enolase on their surface. Detroit 562 cells preferentially bound to Lys-plasminogen and this binding was inhibited in the presence of a lysine analog, epsilon-aminocaproic acid and by carboxypeptidase-B treatment suggesting that the C-terminal lysine residue of the putative pharyngeal cell receptor(s) may play an important role in plasminogen-binding. The increased plasminogen-binding in the presence of free enolase indicated the presence of an enolase/SEN-specific receptor on the pharyngeal cell surface. GAS, when precoated with Lys-plasminogen, adhered to pharyngeal cells significantly more in numbers than when precoated with fibronectin or laminin. Similarly, GAS adhered also significantly more in numbers to pharyngeal cells which were precoated with Lys-plasminogen. GAS adhered similarly in high numbers when incubated with pharyngeal cells in the presence of soluble plasminogen. The de novo pharyngeal cell-bound protease activity, created as a result of activation of bound plasminogen by t-PA, indicated its potential role in pericellular fibrinolytic activity. Further GAS with tPA-activated plasminogen bound on their surface penetrated through Transwell-grown pharyngeal cells in significantly higher numbers. Together, the results presented in this study highlight a novel function of plasminogen in streptococcal adherence to pharyngeal cells and a newly discovered streptococcal ability to pericellularly invade pharyngeal cells as a result of tPA/endogenous plasminogen activator-mediated proteolytic activity.

Bacterial Adhesion↗

PubMed1994

Involvement of 5-HT3 receptors in the initiation of pharyngeal reflex.

Activation of peripheral serotonin (5-HT) receptors, classified as 5-HT3, was shown to elicit the pharyngeal reflex in anesthetized rats. Intravenous bolus injection of 5-HT (6.25-50 micrograms/kg) evoked rhythmic bursts in the efferent pharyngeal branch of the vagus nerve in a dose-related manner, whereas afferent superior laryngeal nerve activity was not altered by even a high dose of 5-HT. The pharyngeal branch response was blocked by pretreatment with a selective 5-HT3-receptor antagonist YM060 (1 and 10 micrograms/kg). A 5-HT3-receptor agonist, 2-methyl-5-HT, also produced a rhythmic burst in the pharyngeal branch, and this effect was blocked by YM060. Intrapharyngeal pressure was rhythmically increased by both 5-HT (12.5-50 micrograms/kg) and 2-methyl-5-HT (6.25-50 micrograms/kg) in a dose-related manner. Both of these effects were antagonized by YM060 (10 micrograms/kg). In addition, a neuromuscular blocking agent vecuronium (1 mg/kg iv) completely inhibited the 5-HT-induced increase in pharyngeal pressure. After a bilateral vagotomy was performed below the nodose ganglia, the 5-HT-induced increase in pharyngeal branch activity was abolished, whereas a bilateral sectioning of the superior laryngeal nerve did not alter the 5-HT-induced increase in pharyngeal branch activity. Retrograde tracing with fluorescent dye (fast blue) was used to identify the cell bodies of the pharyngeal branch. Pharyngeal motoneuron cell bodies were distributed along the entire length of the nucleus ambiguus. Our results suggest that exogenous 5-HT-induced increases in pharyngeal branch activity and intrapharyngeal pressure may be initiated by the peripheral 5-HT3-receptors of the vagal nervous system and that this may be a viscerosomatic reflex.

Animals↗

PubMedDate not supplied

The emphatic and pharyngeal sounds in Hebrew and in Arabic.

This study addresses physiological, acoustic, and linguistic issues in the production of the emphatic sounds [in text] and the pharyngeal sounds [in text]. Approximately 300 minutes of video recordings were obtained from nine Hebrew and Arabic speakers, using a fiberscope positioned in the upper pharynx and simultaneous audio recording through an external microphone. We also studied a cineradiographic film of three Arabic speakers. Results clearly show that all the emphatic sounds, when pronounced as such, share pharyngealization as a secondary articulation. A constriction is formed between the pharyngeal walls and the tip of the epiglottis, which tilts backwards. To a lesser degree, the lower part of the root of the tongue is also retracted. The data show that all the emphatic and pharyngeal sounds we studied are made with qualitatively the same pharyngeal constriction. However, the pharyngeal constriction is more extreme and less variable for the pharyngeal sounds, where it is the primary articulation, than for the emphatic sounds, where it is a secondary articulation. Because the same sort of pharyngealization is seen for all the emphatics, we use a common notational symbol, [in text], for all of them, including [in text] in place of /q/. We note that where pharyngeals and pharyngealized sounds were realized, the Hebrew and Arabic speakers produced them in essentially the same way.

Humans↗

PubMed1997

Surgical management of velopharyngeal dysfunction: outcome analysis of autogenous posterior pharyngeal wall augmentation.

Posterior pharyngeal wall augmentation has been advocated for patients having velopharyngeal dysfunction with a small coronal gap. Nonautogenous augmentation has not been accepted widely because of migration or extrusion of alloplastic implants and resorption of injected materials. Autogenous posterior pharyngeal wall augmentation has been performed for decades by Italian surgeons. A retrospective study was conducted to evaluate the efficacy of this procedure. Autogenous posterior pharyngeal wall augmentation, using a rolled superiorly based pharyngeal myomucosal flap, was performed on 14 patients, between November of 1989 and June of 1992, who fulfilled two criteria: velopharyngeal dysfunction unresponsive to speech therapy and a small (< 20 percent) coronal gap on velopharyngeal nasendoscopy. Of these, 3 patients had prior prosthetic velopharyngeal management, including 2 patients with Robin sequence. All patients were evaluated preoperatively and 3 months postoperatively with recorded (audio-videotape) perceptual, nasendoscopic, and fluoroscopic standardized speech and airway evaluations. The tapes were used for construction of a randomized master tape that was presented in blinded fashion and random order to three skilled raters for independent assessment of numerous perceptual and instrumental parameters of speech. The raters were uninvolved in the care of the patients or this study, and their intraobserver and interobserver reliabilities were known. Preoperatively, the majority of patients had nasal turbulence. All patients had variable degrees of hypernasality ranging from intermittent to pervasive. Parameters rated included (1) resonance (hypernasality, hyponasality, mixed), (2) auditory nasal emission (including nasal turbulence), and (3) visual characteristics regarding velopharyngeal closure. The visual parameters consisted of questions about whether a pharyngeal bulge was present or absent, descriptions of posterior pharyngeal wall movements with speech, level of closure, completeness of velopharyngeal closure, and quantitative descriptions of the percentage of velopharyngeal closure postoperatively. Examiners were instructed to look for a static and/or dynamic projection or bulge (i.e., Passavant's ridge) and, if a bulge was present, whether the level of velopharyngeal closure was on the same plane as the neoposterior pharyngeal bulge. Results of the extramural judgments of these parameters showed that there was no statistically significant tendency for patients' speech to be rated as more normal after the augmentation procedure than before it. We conclude that (1) autogenous posterior pharyngeal wall augmentation does not result in speech improvement and (2) autogenous posterior pharyngeal wall augmentation does not impair the nasal airway.

Child, Preschool↗

PubMed2001

Gastroesophageal reflux disease is a risk factor for laryngeal and pharyngeal cancer.

OBJECTIVE: Gastroesophageal reflux disease (GERD) is a proposed risk factor for developing laryngeal and pharyngeal cancers. No controlled study has examined this association. METHODS: A case-control-study was performed using the computerized hospitalization and outpatient databases of the US Department of Veterans Affairs. All patients, who were veterans, had been identified as being hospitalized with laryngeal or pharyngeal during 1991 to 1997. In addition, all persons diagnosed with laryngeal or pharyngeal cancer in 1999 in the outpatient files were identified. From the same patient populations, four nonmatched control subjects were randomly assigned for each case. The medical history for cases and controls was retrospectively searched for GERD diagnoses, tobacco use, and alcohol dependence. Multivariable logistic regression analyses were performed to assess the risk factors for laryngeal and pharyngeal cancers. RESULTS: A total of 8,228 hospitalized patients with laryngeal cancers and 1,912 with pharyngeal cancers were compared to 32,912 and 7,648 hospitalized controls, while 9,292 outpatients with laryngeal cancer and 2,769 outpatients with pharyngeal cancer were compared with 37,168 and 11,076 outpatient controls without cancer. Among hospitalized persons, the prevalence of GERD was higher among patients with laryngeal cancer (8.9 vs 4.0%, p < 0.0001) and pharyngeal cancer (6.2 vs 3.8%, p < 0.0001). In a multivariable logistic regression analysis that was controlled for age, gender, ethnicity, smoking, and alcohol, GERD was associated with an adjusted odds ratio (OR) of 2.40 for laryngeal cancer among hospitalized patients (95% CI 2.15-2.69, p < 0.0001) and an adjusted OR of 2.38 (95% CI 1.87-3.02, p < 0.0001) for pharyngeal cancer. For outpatients, GERD was associated with an adjusted OR = 2.31 (95% CI 2.10-2.53) for laryngeal cancer and adjusted OR = 1.92 (95% CI 1.72-2.15). CONCLUSIONS: Among US veterans, the risk for laryngeal or pharyngeal cancers is modestly increased in the presence of GERD. This effect seems to be independent of age, gender, smoking, and alcohol intake.

Aged↗

PubMed2004

Pharyngeal airway wall mechanics using tagged magnetic resonance imaging during medial hypoglossal nerve stimulation in rats.

To better understand pharyngeal airway mechanics as it relates to the pathogenesis and treatment of obstructive sleep apnoea, we have developed a novel application of magnetic resonance imaging (MRI) with non-invasive tissue tagging to measure pharyngeal wall tissue motion during active dilatation of the airway. Eleven anaesthetized Sprague-Dawley rats were surgically prepared with platinum electrodes for bilateral stimulation of the medial branch of the hypoglossus nerve that supplies motor output to the protrudor and intrinsic tongue muscles. Images of the pharyngeal airway were acquired before and during stimulation using a gated multislice, spoiled gradient recalled (SPGR) imaging protocol in a 4.7 T magnet. The tag pulses, applied before stimulation, created a grid pattern of magnetically imbedded dark lines that revealed tissue motion in images acquired during stimulation. Stimulation significantly increased cross-sectional area, and anteroposterior and lateral dimensions in the oropharyngeal and velopharyngeal airways when results were averaged across the rostral, mid- and caudal pharynx (P < 0.001). Customized software for tissue motion-tracking and finite element-analysis showed that changes in airway size were associated with ventral displacement of tissues in the ventral pharyngeal wall in the rostral, mid- and caudal pharyngeal regions (P < 0.0032) and ventral displacement of the lateral walls in the mid- and caudal regions (P < 0.0001). In addition, principal maximum stretch was significantly increased in the lateral walls (P < 0.023) in a ventral-lateral direction in the mid- and caudal pharyngeal regions and principal maximum compression (perpendicular to stretch) was significantly increased in the ventral walls in all regions (P < 0.0001). Stimulation did not cause lateral displacement of the lateral pharyngeal walls at any level. The results reveal that the increase in pharyngeal airway size resulting from stimulation of the medial branch of the hypoglossal nerve is predominantly due to ventral displacement of the ventral and lateral pharyngeal walls.

Animals↗

PubMed1995

Pharyngeal narrowing/occlusion during central sleep apnea.

We hypothesized that subatmospheric intraluminal pressure is not required for pharyngeal occlusion during sleep. Six normal subjects and six subjects with sleep apnea or hypopnea (SAH) were studied during non-rapid-eye-movement sleep. Pharyngeal patency was determined by using fiber-optic nasopharyngoscopy during spontaneous central sleep apnea (n = 4) and induced hypocapnic central apnea via nasal mechanical ventilation (n = 10). Complete pharyngeal occlusion occurred in 146 of 160 spontaneously occurring central apneas in patients with central sleep apnea syndrome. During induced hypocapnic central apnea, gradual progressive pharyngeal narrowing occurred. More pronounced narrowing was noted at the velopharynx relative to the oropharynx and in subjects with SAH relative to normals. Complete pharyngeal occlusion frequently occurred in subjects with SAH (31 of 44 apneas) but rarely occurred in normals (3 of 25 apneas). Resumption of inspiratory effort was associated with persistent narrowing or complete occlusion unless electroencephalogram signs of arousal were noted. Thus pharyngeal cross-sectional area is reduced during central apnea in the absence of inspiratory effort. Velopharyngeal narrowing consistently occurs during induced hypocapnic central apnea even in normal subjects. Complete pharyngeal occlusion occurs during spontaneous or induced central apnea in patients with SAH. We conclude that subatmospheric intraluminal pressure is not required for pharyngeal occlusion to occur. Pharyngeal narrowing or occlusion during central apnea may be due to passive collapse or active constriction.

Adult↗