Potential benefits of pH 8.8 alkaline drinking water as an adjunct in the treatment of reflux disease.

Objectives: At the cellular level, tissue-bound pepsin is fundamental to the pathophysiologic mechanism of reflux disease, and although the thresholds for laryngeal damage in laryngopharyngeal reflux and for esophageal damage in gastroesophageal reflux disease differ, both forms of damage are due to pepsin, which requires acid for its activation. In addition, human pepsin remains stable at pH 7.4 and may be reactivated by hydrogen ions from any source.

Low-acid diet for recalcitrant laryngopharyngeal reflux: therapeutic benefits and their implications.

Objectives: Laryngopharyngeal reflux (LPR) is an expensive, high-prevalence disease with a high rate of medical treatment failure. In the past, it was mistakenly believed that pepsin was inactive above pH 4; however, human pepsin has been reported to be active up to pH 6.5.

Immunologic response of the laryngeal mucosa to extraesophageal reflux.

Objectives: Extraesophageal reflux is common. The treatment costs are high, and there are associations with other diseases, including laryngeal cancer. Our studies of the mucosal immune response to this common inflammatory disease suggest an important role for the nonclassic antigen-presenting molecule CD1d in the response to inflammation.

Differential diagnosis of paradoxical vocal fold movement.

Purpose: To present the differential diagnosis of paradoxical vocal fold movement (PVFM) and its distinguishing features.

Methods: The authors provide an overview of PVFM by drawing from 30 years of clinical and research experience, and relating that experience to literature in this area.

Conclusion: PVFM is characterized by inappropriate adduction of the vocal folds during inspiration.

Transnasal esophagoscopy: a position statement from the American Bronchoesophagological Association (ABEA).

Objective: To review and summarize the current literature on transnasal esophagoscopy, and to compare information with conventional esophagoscopy.

Data Sources: Medline (Ovid), book chapters.

Review Methods: A thorough review of the literature using the Medline database was performed with the following search terms: esophagoscopy, transnasal esophagoscopy, ultrathin endoscopy, and esophagoscope.

Introduction to office-based surgery in laryngology.

Purpose Of Review: To provide an overview and perspective on new developments in office-based surgery in laryngology.

Recent Findings: Transnasal esophagoscopy, unsedated office-based laryngeal laser surgery and, specifically, the technique of topical anesthesia for the latter are emphasized.

Summary: The confluence of new technology allows many unsedated surgical procedures to be performed in the office with safety.

Differentiation of adductor-type spasmodic dysphonia from muscle tension dysphonia by spectral analysis.

Objectives: To determine the utility of spectral analysis in the differentiation of adductor-type spasmodic dysphonia (AdSD) from muscle tension dysphonia (MTD).

Study Design: Prospective blinded study.

Methods: Forty-seven samples of AdSD-connected speech spectrograms from 27 subjects and 17 samples of MTD-connected speech spectrograms from 15 subjects were selected from clinical charts and de-identified.

Office-based laryngeal laser surgery: a review of 443 cases using three wavelengths.

Background: Unsedated office-based laser surgery (UOLS) of the larynx and trachea has significantly improved the treatment options for patients with laryngotracheal pathology including recurrent respiratory papillomas, granulomas, leukoplakia, and polypoid degeneration. UOLS delivered by flexible endoscopes has dramatically impacted office-based surgery by reducing the time, costs, and morbidity of surgery.

Objectives: To review our experience with 443 laryngotracheal cases treated by UOLS.

Activity/stability of human pepsin: implications for reflux attributed laryngeal disease.

Objectives/hypothesis: Exposure of laryngeal epithelia to pepsin during extra-esophageal reflux causes depletion of laryngeal protective proteins, carbonic anhydrase isoenzyme III (CAIII), and squamous epithelial stress protein Sep70. The first objective of this study was to determine whether pepsin has to be enzymatically active to deplete these proteins. The second objective was to investigate the effect of pH on the activity and stability of human pepsin 3b under conditions that might be found in the human esophagus and larynx.

Cost savings of unsedated office-based laser surgery for laryngeal papillomas.

Objectives: Unsedated office-based laryngeal laser surgery (UOLS) is now an effective alternative to traditional operating room-based suspension microdirect laryngoscopy under general anesthesia. This procedure includes pulsed dye laser (PDL) treatment of recurrent respiratory papillomas, granulomas, leukoplakia, and polypoid degeneration. The objective of this study was to determine the magnitude of the cost savings derived by moving these types of procedures from the operating room to the office setting.

Patient tolerance of in-office pulsed dye laser treatments to the upper aerodigestive tract.

Introduction: Recent advances in technology have facilitated a movement toward unsedated in-office treatment of laryngeal, tracheal, and esophageal lesions. The objective of this study was to determine patient tolerance of in-office pulsed-dye laser (PDL) treatment of upper aerodigestive tract pathoses via the transnasal esophagoscope.

Methods: Three hundred twenty-eight unsedated in-office PDL cases were performed at a university-based tertiary referral center in 131 patients.

Treatment of adductor-type spasmodic dysphonia by surgical myectomy: a preliminary report.

Objectives: Despite the belief that it represents a central neurologic dysfunctional process, adductor-type spasmodic dysphonia without tremor is usually effectively treated by injection of botulinum toxin A; however, in most cases such injections must be repeated every few months. A promising new surgical procedure is herein reported.

Methods: Under local anesthesia with intravenous sedation, a large laryngoplasty window is created, and under direct vision with intraoperative voice monitoring, fibers from the thyroarytenoid and lateral cricoarytenoid muscles are removed until breathiness occurs.

Incongruence between histologic and endoscopic diagnoses of Barrett's esophagus using transnasal esophagoscopy.

Objectives: The symptoms, patterns of reflux, and clinical manifestations of laryngopharyngeal reflux (LPR) differ from those of gastroesophageal reflux disease (GERD) in many ways. The purposes of this study were to determine the prevalence of Barrett's esophagus in patients with LPR using transnasal esophagoscopy (TNE) and to determine if there is agreement between TNE clinical findings and pathology results when using TNE for Barrett's screening.

Study Design: This study involved a retrospective review of the records of 200 consecutive patients with LPR undergoing esophageal screening.

Effect of pepsin on laryngeal stress protein (Sep70, Sep53, and Hsp70) response: role in laryngopharyngeal reflux disease.

Objectives: The objectives of this study were to define the conditions that give rise to a stress protein response in laryngeal epithelium and to investigate whether and how stress protein dysfunction contributes to reflux-related laryngeal disease.

Methods: Western analysis was used to measure stress protein (squamous epithelial proteins Sep70 and Sep53 and heat shock protein Hsp70) and pepsin levels in esophageal and laryngeal tissue specimens taken from both normal control subjects and patients with pH-documented laryngopharyngeal reflux (LPR) who had documented lesions, some of whom had laryngeal cancer. A porcine organ culture model was used to examine the effects of low pH and pepsin (0.

Validity and reliability of the glottal function index.

Objective: To evaluate a symptom-focused vocal impairment instrument for the evaluation of patients with voice disorders.

Design: Prospective, nonrandomized study of patients with voice disorders undergoing treatment with validation of a new symptom index, the Glottal Function Index (GFI).

Setting: Voice disorders clinic at an academic tertiary care hospital.

Sensitive pepsin immunoassay for detection of laryngopharyngeal reflux.

Objectives/hypothesis: To determine whether measurement of pepsin in throat sputum by immunoassay could be used as a sensitive and reliable method for detecting laryngopharyngeal reflux (LPR) compared with 24-hour double-probe (esophageal and pharyngeal) pH monitoring.

Study Design: Patients with clinical LPR undergoing pH monitoring provided throat sputum samples during the reflux-testing period for pepsin measurement using enzyme-linked immunoadsorbent assay.

Results: Pepsin assay results from 63 throat sputum samples obtained from 23 study subjects were compared with their pH monitoring data.

Endoscopic management of extruding medialization laryngoplasty implants.

Background: Medialization laryngoplasty (ML) is a commonly performed procedure for vocal fold motion impairment with glottic incompetence. Although implant extrusion is a well-known risk of ML, management of this complication is rarely mentioned in the literature. The aim of this study was to review our experience with endoscopic implant retrieval for a group of patients with extruding ML implants.

Patients with isolated laryngopharyngeal reflux are not obese.

Objectives: The gastroenterology literature suggests that gastroesophageal reflux disease (GERD) is often associated with obesity. The National Institutes of Health uses body mass index (BMI) to identify patients who are overweight (BMI 25-30) or obese (BMI > 30). The aim of this study was to determine whether there is a relationship between laryngopharyngeal reflux (LPR) and elevated BMI.

Validation of a quality-of-life instrument for laryngopharyngeal reflux.

Objectives: To establish the reliability, validity, and responsiveness of a new, disease-specific assessment tool, the LPR-HRQL, which assesses patient-reported outcomes (PRO) with regard to health-related quality of life (HRQL) of patients with laryngopharyngeal reflux (LPR).

Design: A prospective, open-label, repeated-measures study.

Setting: Six centers in 4 states in the eastern United States.

Pulsed dye laser treatment of laryngeal granulomas.

Laryngeal granulomas are effectively treated with antireflux therapy and speech therapy. Failure to respond leads to treatment with Botox or surgical excision. We report on the use of the pulsed dye laser for treating chronic granulomas that do not respond to standard therapy.

Transnasal esophagoscopy: revisited (over 700 consecutive cases).

Background: High-resolution transnasal esophagoscopy (TNE) allows comprehensive, in-office examination of the esophagus without sedation.

Objective: To compare the authors' present experience using TNE with our initial, previously reported experience.

Methodology: Retrospective review of 611 consecutive patients undergoing TNE was compared with 100 consecutive patients previously reported.

Cricoid chondrosarcoma presenting as arytenoid hypertelorism.

Background: Arytenoid hypertelorism (arytenoid cartilages spaced too widely apart) appears to be the most common initial recognizable physical finding of cricoid chondrosarcoma. Nine cases from the Center for Voice Disorders are presented. With arytenoid hypertelorism caused by cricoid chondrosarcoma, usually the posterior larynx is open.