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Quiet please, Owen McPhee!
\"A nonstop talker learns about the power of listening when he comes down with a case of laryngitis\"-- Provided by publisher.
Book
Proton Pump Inhibitor Therapy for Suspected GERD-Related Chronic Laryngitis: A Meta-Analysis of Randomized Controlled Trials
The role of proton pump inhibitors (PPIs) in suspected GERD-related chronic laryngitis (CL) is controversial. Hence, we performed a meta-analysis of the existing randomized controlled trials (RCTs) to evaluate the efficacy of PPIs in this disorder.
Data extracted from MEDLINE (1966 to August 2005), Cochrane Controlled Trials Register (1997 to August 2005), EMBASE (1980 to August 2005), ClinicalTrials.gov website, and meetings presentations (1999-2005). Published and unpublished randomized placebo-controlled trials of PPIs in suspected GERD-related CL were selected by consensus. Random effects model was utilized with standard approaches to quality assessment, sensitivity analysis, and an exploration of heterogeneity and publication bias. The primary outcome measure was defined as the proportion of patients with >or=50% reduction in self-reported laryngeal symptoms.
Pooled data from 8 studies (N = 344, PPI 195, placebo 149; mean age 51 yr; males 55%; study duration 8-16 wk) were analyzed. No significant quantitative heterogeneity was found among the studies (chi2= 11.22, P= 0.13). Overall, PPI therapy resulted in a nonsignificant symptom reduction compared to placebo (relative risk 1.28, 95% confidence interval 0.94-1.74). No clinical predictors of PPI response were identified on meta-regression analysis done at study level.
PPI therapy may offer a modest, but nonsignificant, clinical benefit over placebo in suspected GERD-related CL. Validated diagnostic guidelines may facilitate the recognition of those patients most likely to respond favorably to PPI treatment.
Journal Article
Postbiotics for Preventing and Treating Common Infectious Diseases in Children: A Systematic Review
Postbiotics have recently been tentatively defined as bioactive compounds produced during a fermentation process (including microbial cells, cell constituents and metabolites) that supports health and/or wellbeing. Postbiotics are currently available in some infant formulas and fermented foods. We systematically reviewed evidence on postbiotics for preventing and treating common infectious diseases among children younger than 5 years. The PubMed, Embase, SpringerLink, and ScienceDirect databases were searched up to March 2019 for randomized controlled trials (RCTs) comparing postbiotics with placebo or no intervention. Seven RCTs involving 1740 children met the inclusion criteria. For therapeutic trials, supplementation with heat-killed Lactobacillus acidophilus LB reduced the duration of diarrhea (4 RCTs, n = 224, mean difference, MD, −20.31 h, 95% CI −27.06 to −13.57). For preventive trials, the pooled results from two RCTs (n = 537) showed that heat-inactivated L. paracasei CBA L74 versus placebo reduced the risk of diarrhea (relative risk, RR, 0.51, 95% CI 0.37–0.71), pharyngitis (RR 0.31, 95% CI 0.12–0.83) and laryngitis (RR 0.44, 95% CI 0.29–0.67). There is limited evidence to recommend the use of specific postbiotics for treating pediatric diarrhea and preventing common infectious diseases among children. Further studies are necessary to determine the effects of different postbiotics.
Journal Article
A case report of Talaromyces marneffei Oro-pharyngo-laryngitis: a rare manifestation of Talaromycosis
Background
The incidence of
Taralomyces marneffei
infection in HIV-infected individuals has been decreasing, whereas its rate is rising among non-HIV immunodeficient persons, particularly patients with anti-interferon-gamma autoantibodies
. T. marneffei
usually causes invasive and disseminated infections, including fungemia.
T. marneffei
oro-pharyngo-laryngitis is an unusual manifestation of talaromycosis.
Case presentation
A 52-year-old Thai woman had been diagnosed anti-IFNɣ autoantibodies for 4 years. She had a sore throat, odynophagia, and hoarseness for 3 weeks. She also had febrile symptoms and lost 5 kg in weight. Physical examination revealed marked swelling and hyperemia of both sides of the tonsils, the uvula and palatal arches including a swelling of the epiglottis, and arytenoid. The right tonsillar biopsy exhibited a few intracellular oval and elongated yeast-like organisms with some central transverse septum seen, which subsequently grew a few colonies of
T. marneffei
on fungal cultures. The patient received amphotericin B deoxycholate 45 mg/dayfor 1 weeks, followed by oral itraconazole 400 mg/day for several months. Her symptoms completely resolved without complication.
Conclusion
In patients with anti-IFN-ɣ autoantibodies,
T. marneffei
can rarely cause a local infection involving oropharynx and larynx. Fungal culture and pathological examination are warranted for diagnosis
T
.
marneffei
oro-pharyngo-laryngitis. This condition requires a long term antifungal therapy.
Journal Article
The value of a liquid alginate suspension (Gaviscon Advance) in the management of laryngopharyngeal reflux
Laryngopharyngeal reflux (LPR) refers to the backflow of stomach contents into the laryngopharynx. Increasing evidence has demonstrated that LPR is a contributing factor in some cases of hoarseness, vocal fatigue, voice breaks, cough and globus and chronic throat clearing. However, several randomised placebo-controlled trials of proton pump inhibitors in the treatment of LPR have been reported with the majority showing no significant benefit in patient symptom scores over placebo. The aim of this pilot clinical study was to investigate whether any improvement in LPR-related symptoms, using the Reflux Symptom Index (RSI), and clinical findings, using the Reflux Finding Score (RFS), could be achieved with treatment with a liquid alginate suspension compared to control (no treatment). Patients presenting with the symptoms of LPR to the Otorhinolaryngology Outpatient Department at the Queen’s Medical Centre, Nottingham, UK were considered eligible if they had an RSI of greater than 10 and an RFS greater than 5 based on a fibreoptic examination of the larynx. A total of 49 patients were randomised into the open, parallel group study; 24 patients were randomised to receive 10 ml liquid alginate suspension (Gaviscon
®
Advance) four times daily after meals and at bedtime, and 25 patients into the control group (no treatment). Patients were assessed pre-treatment and at 2, 4 and 6 months post treatment. Mean (SD) RSI and RFS pre-treatment scores were 23.9 (7.0) and 10.4 (3.6) for the treatment group and 24.6 (7.4) and 10.3 (3.3) for the control group, respectively. Significant differences between treatment and control were observed for RSI at the 2-month (11.2 (7.0) vs
.
16.8 (6.4),
P
= 0.005) and 6-month (11.2 (8.1) vs. 18.3 (9.4),
P
= 0.008) assessments and for RFS at the 6-month (7.1 (2.8) vs. 9.5 (3.4),
P
= 0.005) assessment. Significant improvement in symptom scores and clinical findings were achieved with liquid alginate suspension (Gaviscon
®
Advance) compared to control and further evaluation for the management of patients presenting with LPR is warranted.
Journal Article
Respiratory manifestations of gastro-oesophageal reflux in children
Gastro-oesophageal reflux disease (GORD) is a complex problem in children. Suspected respiratory manifestations of GORD, such as asthma, chronic cough and laryngitis, are commonly encountered in the paediatric practice, but continue to be entities with more questions than answers. The accuracy of diagnostic tests (ie, pH or pH-impedance monitoring, laryngoscopy, endoscopy) for patients with suspected extraoesophageal manifestations of GORD is suboptimal and therefore whether there is a causal relationship between these conditions remains largely undetermined. An empiric trial of proton pump inhibitors can help individual children with undiagnosed respiratory symptoms and suspicion of GORD, but the response to therapy is unpredictable, and in any case what may be being observed is spontaneous improvement. Furthermore, the safety of these agents has been called into question. Poor response to antireflux therapy is an important trigger to search for non-gastro-oesophageal reflux causes for patients’ symptoms. Evidence for the assessment of children with suspected extraoesophageal manifestations of GORD is scanty and longitudinal studies with long-term follow-up are urgently required.
Journal Article
The risk of laryngitis with herpes zoster infection: A nested case-control study using data from the Korean National Sample Cohort
Whether herpes zoster infection (HZI) affects laryngitis incidence remains unknown.
The purpose of this population-based retrospective study was to analyze the relationship between laryngitis and HZI using data from the Korean Health Insurance Review and Assessment Service-National Sample Cohort.
This study analyzed 1,197,093 medical claim codes from 2018. Patients with HZI (ICD-10: B02) were retrospectively identified. Laryngeal diseases were defined by ICD-10 codes for five subgroups: 1) malignant disease, 2) benign disease, 3) vocal cord palsy, 4) inflammatory disease, and 5) reflux disease.
Among the Korean population older than 20 years, 12,809 experienced HZI. Subjects with HZI were more likely to be older (mean age: 51.54 years vs. 48.06 years, p <0.0001). The proportion of subjects with laryngeal disease was higher in those with HZI than in those without HZI (55.55% vs. 41.37%, p <0.0001). Laryngeal disease was significantly associated with HZI in multiple regression analysis (odds ratio (OR) = 1.77, 95% confidence interval: 1.71-1.84) after adjusting for age, sex, hypertension, diabetes, dyslipidemia, ischemic heart disease, cerebral stroke, and depression. Among laryngeal disease subgroups, inflammatory disease (OR = 1.05; 95% CI: 1.01-1.09) and reflux (OR = 1.20; 95% CI: 1.15-1.25) were associated with HZI.
HZI is independently associated with laryngitis. Results of this study have implications for etiological investigations and prevention strategies for laryngitis.
Journal Article
Acute Infectious Laryngitis: A Case Series
Although acute laryngitis is common, it is often managed by primary physicians. Therefore, video images documenting its signs are scarce. This series includes 7 professional voice users who previously had undergone baseline strobovideolaryngscopy (SVL) during routine examinations or during evaluations for other complaints and who returned with acute laryngitis. Sequential SVL showed not only the expected erythema, edema, cough, and dysphonia, but also new masses in 5 of the 7 subjects. All the signs returned to baseline. This series is reported to highlight the reversible structural changes that can be expected in patients with acute laryngitis and the value of conservative management.
Journal Article
Effective treatment with sirolimus in a 6-year-old boy with tracheal vascular malformation initially misdiagnosed as acute laryngitis: a case report
Background
Tracheal vascular malformations are rare congenital lesions that often mimic pediatric acute laryngitis, causing misdiagnosis and delayed care—with greater challenges when caregivers decline angiography and evidence for such scenarios is scarce. Though sirolimus works for vascular malformations, its use in misdiagnosed pediatric tracheal cases is underreported, making this case novel for addressing angiography refusal and showing sirolimus-induced rapid symptom resolution to guide complex pediatric airway care.
Case presentation
A 6-year-old Han Chinese boy had 6 days of cough, wheezing, and dyspnea, initially misdiagnosed as acute laryngitis and transferred. On admission (day 6), he showed mild three-depression sign, laryngeal stridor, heart rate of 94 beats per minute, and respiratory rate of 42 respirations per minute. Contrast-enhanced neck computed tomography on day 7 revealed a subglottic mass causing airway compression; bronchoscopy on day 8 induced cyanosis (oxygen saturation 85%) requiring intubation, and magnetic resonance imaging on day 9 suggested vascular malformation. His parents refused digital subtraction angiography. Oral sirolimus (0.08 milligrams per square meter per day) was initiated on day 11, achieving complete lesion resolution by day 22 (with a serum sirolimus trough level of 5.16 nanograms per milliliter). The patient successfully underwent mechanical ventilation weaning on day 20, was discharged in stable condition on day 28, and maintained stable status during follow-up on days 106 and 158, with no adverse events observed.
Conclusions
This case highlights considering tracheal vascular malformation in refractory pediatric laryngeal obstruction, supports multimodal imaging for diagnosis without digital subtraction angiography, and confirms sirolimus as a safe, rapid first-line option to guide care and personalized dosing research.
Journal Article