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PubMed1976

Electromyographic biofeedback for relief of tension in the facial and throat muscles of a woodwind musician.

Electromyographic (EMG) biofeedback, for the relaxation of specific throat and facial muscles, was given to a woodwind musician. The patient had a nineteen-year history of tics and high levels of tension in his throat and facial muscles. Eventurally these problems progressed to a point that interfered with his ability to perform as a professional woodwind musician. Following detoxification from alcohol and Dexamyl, and after a period of psychotherapy, EMG biofeedback relaxation training was started for the muscles specifically showing chronically high tension levels. The EMG training consisted of four phases designed to help the patient progressively lower tension and generalize these newly learned techniques to his professional life. He had a total of twenty treatments of approximately 45 minutes each. This procedure resulted in dramatic reductions in tension levels of the specific throat and facial muscles along with increased proficiency as a musician and in psychological functioning.

Adult↗
PubMedDate not supplied

Evaluation of a rapid latex agglutination test (Directigen) for the direct detection of group A streptococci from throat swabs.

A rapid group A beta-hemolytic streptococci (GAS) antigen detection test using latex agglutination (Directigen, Becton Dickinson) was compared with a conventional culture method for the direct detection of GAS from throat swabs. One throat specimen was collected from each of 229 patients. After standard inoculation onto sheep blood agar plates, all swabs were tested for GAS antigen. Of the 229 specimens tested, 46 (20%) were GAS-positive by culture. Direct latex agglutination agreed with culture in 222 of them (97%). The sensitivity of the test was 93% (43/46), the specificity 98% (179/183), the positive predictive value 91%, and the negative predictive value 98%. The detection of GAS antigen by coagglutination (Phadebact, Pharmacia) was also carried out. 81% (35/43) of the cultures and Directigen-positive specimens gave a positive coagglutination for GAS. 100% (179/179) of the cultures and Directigen-negative specimens were also negative by the coagglutination test. We conclude that the Directigen rapid latex agglutination test for the direct detection of GAS from throat swabs compares favorably with culture and has the advantage of providing same-day results.

Humans↗
PubMedDate not supplied

Rational decision making based on history: adult sore throats.

Primary care physicians are often required to make preliminary evaluations based only on the patient's history, especially during telephone encounters about sore throats. The authors studied adults with sore throats to determine whether patients can be stratified into higher and lower risks of strep throat by history alone. They first obtained data from 517 patients seen in an emergency room. Providers graded symptoms on a four-point scale (absent, mild, moderate, or severe). Initial analyses showed that prediction based on history should include three variables: fever, difficulty in swallowing, and cough. For ease of computation, these were consolidated into one score, "history" (= fever history + difficulty in swallowing - cough). This score was used to develop a model that predicts the probability of infection with group A beta-hemolytic streptococcus, and the model's performance was tested in two additional patient groups. The predictive accuracy of the "history" score was confirmed in all patient groups, despite differences in providers and disease prevalences. Primary care physicians may use this model to help them make decisions in situations such as telephone encounters without using additional data.

Adult↗
PubMed2004

Ultrasonic singing by the blue-throated hummingbird: a comparison between production and perception.

Blue-throated hummingbirds produce elaborate songs extending into the ultrasonic frequency range, up to 30 kHz. Ultrasonic song elements include harmonics and extensions of audible notes, non-harmonic components of audible syllables, and sounds produced at frequencies above 20 kHz without corresponding hearing range sound. To determine whether ultrasonic song elements function in intraspecific communication, we tested the hearing range of male and female blue-throated hummingbirds. We measured auditory thresholds for tone pips ranging from 1 kHz to 50 kHz using auditory brainstem responses. Neither male nor female blue-throated hummingbirds appear to be able to hear above 7 kHz. No auditory brainstem responses could be detected between 8 and 50 kHz at 90 dB. This high-frequency cutoff is well within the range reported for other species of birds. These results suggest that high-frequency song elements are not used in intraspecific communication. We propose that the restricted hummingbird hearing range may exemplify a phylogenetic constraint.

Acoustic Stimulation↗
PubMedDate not supplied

Detection of group A streptococcal antigen from throat swabs with five diagnostic kits in general practice.

During a 5-month period, 248 general practitioners from 164 general practice offices obtained duplicate throat swabs from 2469 patients with acute pharyngotonsillitis. At the general practice office, one of the swabs was assayed for the presence of group A streptococcal antigen, using one of five commercially available diagnostic kits. (The participants did not receive instruction in the use of the kits). The other swab was cultured in our laboratory for the presence of group A streptococci. The diagnostic parameters for the five kits were as follows: Abbott TestPack Strep A--sensitivity, 79% (110/139) and specificity, 98% (490/501); Direct Strep A EIA (Roche)--sensitivity, 79% (104/132) and specificity, 63% (178/281); Respirastick--sensitivity, 55% (46/84) and specificity, 96% (298/309); Reveal Colour Strep A--sensitivity, 82% (114/139) and specificity, 83% (223/268); Tandem ICON Strep A--sensitivity, 78% (111/143) and specificity, 98% (362/368). The antigen detection test results were heavily influenced by the clinical prediction of a streptococcal or viral etiology. It is concluded that in the absence of a standard throat culture, the Abbott TestPack Strep A kit and the Tandem ICON Strep A kit both offer a more safe diagnostic alternative than clinical assessment. Depending on the current prevalence of group A streptococci, the additional use of a throat swab culture should be considered in case of negative antigen detection test results.

Antigens, Bacterial↗
PubMedDate not supplied

Evaluation of the modified Visuwell Strep-A enzyme immunoassay for detection of group-A Streptococcus from throat swabs.

The modified Visuwell Strep-A enzyme immunoassay (EIA) was compared with culture for detection of group-A Streptococcus from throat swabs. Throat swabs in modified Stuarts medium obtained after culture at two institutions were tested in Visuwell. Cumulative results were n = 417, sensitivity 87.8%, specificity 89.9% predictive value positive (PVP) 67.9%, predictive value negative (PVN) 96.8%, and accuracy 89.5%. At another site, swabs were delivered to the laboratory without transport medium, cultured, and subsequently tested by Visuwell (n = 202, sensitivity 79.6%, specificity 84.5%, PVP 65.2%, PVN 91.9%, accuracy 83.2%). When 1+ culture-positive specimens were considered negative, the sensitivity and PVN increased from 79.6% to 90.2% and 91.9% to 97.1% respectively. Overall performance of the modified Visuwell was comparable with that of the initial assay for throat swabs transported with or without modified Stuarts medium. Cross reaction with organisms other than group-A Streptococcus normally found in the oropharynx was negligible in Visuwell and the limit of detection of group-A Streptococcus was 5 x 10(4) colony-forming units.

Cross Reactions↗
PubMed2005

Sore throats.

This work looks at how a nurse practitioner can assess, diagnose and treat a patient that presents to the Accident and Emergency (A&E) department with a sore throat. A brief look is taken at the common causes of sore throat. The reader is then introduced to a simple scoring system (McIsaac scoring) to determine whether a patient requires antibiotics to treat their sore throat. A list is then given of alternative diagnoses and how they should be treated.

Diagnosis, Differential↗
PubMed2006

Onset of analgesia of a paracetamol tablet containing sodium bicarbonate: A double-blind, placebo-controlled study in adult patients with acute sore throat.

OBJECTIVE: The aim of this study was to determine the time to onset of pain relief from a single dose of a tablet formulation of paracetamol (acetaminophen) containing sodium bicarbonate (PSC). METHODS: A single oral dose of PSC or placebo was randomly administered to patients with acute sore throat under double-blind conditions. Patients rated their pain relief using a conventional categorical relief scale every 5 minutes during the first hour postdose to determine the time to onset of pain relief. They continued evaluations of pain relief at less frequent intervals to 6 hours postdose to confirm the overall analgesia of PSC compared with placebo. To determine if food had any effect on the onset of action of PSC, time to onset of analgesia by PSC was compared between patients in the fed and fasted states. Patients were randomized 3:1 to PSC:placebo based on whether they had eaten food within 2 hours of baseline. Adverse events were recorded by questioning throughout the study period. RESULTS: A total of 241 patients were enrolled. Both treatment groups were well matched for age (mean, 20 years), sex (male:female ratio, approximately 1:1.5), sore throat duration (mean, 3 days) and severity (mean score, 8). PSC separated significantly from placebo beginning at 15 minutes postdose (P < or = 0.03). There was no difference for onset of analgesia between PSC in the fed and fasted states. PSC showed significantly greater total pain relief over 30 minutes, 1 hour, and 6 hours compared with placebo (all, P < 0.05). Both treatments were well tolerated and there were no serious adverse events. CONCLUSION: PSC was effective beginning 15 minutes postdose and well tolerated compared with placebo in this population of adults with acute onset of sore throat pain.

Acetaminophen↗
PubMed2026

Predictive value of Rectal and Throat-nose Screening for the presence of Multidrug-Resistant Organisms in Duodenal Fluid as a Risk of Duodenoscope Contamination: A Multicenter Study.

BACKGROUND: Duodenoscopes have been implicated in patient-to-patient transmission of multidrug-resistant organisms (MDROs). Current gastrointestinal MDRO surveillance relies on rectal screening, yet the duodenum is the primary site of duodenoscope exposure. This study evaluated the predictive value of rectal and throat-nose screening for detecting duodenal MDROs as a marker of duodenoscope contamination risk. METHODS: Adult patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) at tertiary care centers in the Netherlands and India were included. Rectal swabs, throat-nose swabs, and duodenal aspirates were analyzed for MDROs. The detected MDROs were compared using species identification, antibiotic susceptibility patterns, and whole-genome sequencing. RESULTS: Among 512 participants (Netherlands: 339; India: 173), rates of duodenal and rectal MDRO carriage were higher in India (56.6% (98/173); 79.8% (138/173), respectively) than in the Netherlands (5.6% (19/339); 10.3% (35/339)). Given the low prevalence of throat-nose carriage, only the predictive value of rectal screening was assessed. Rectal screening sensitivity for genetically related strains in duodenal fluid was 32.7% in India and 68.4% in the Netherlands . For detecting any duodenal MDRO, sensitivity reached 91.8% in India and 84.2% in the Netherlands, with specificities of 36.0% and 94.1%. Positive predictive value (PPV) was low (India: 65.2%; Netherlands: 45.7%), while negative predictive value was 77.1% and 99%, respectively. CONCLUSIONS: Rectal screening is unreliable for detecting strain-specific duodenal MDROs and overestimates true carriage due to low PPV values. However, it provides excellent rule-out value in low-prevalence settings. Consequently, its utility for guiding infection prevention strategies for duodenoscope contamination is greatest in low-MDRO-prevalence regions.

Bacterial↗
PubMed1997

Aerosol particle transport and deaggregation phenomena in the mouth and throat.

The results of recent numerical simulations of aerosol particle transport and deaggregation phenomena in the mouth and throat are summarized. These results are used to comment upon the roles played by important factors influencing extrathoracic particle deposition and deaggregation phenomena. The results also provide a basis for comparing the performance of in vitro systems presently used for testing dry powder inhaler devices. Total deposition of aerosol particles in a 'physiologically faithful' three-dimensional (3D) reconstruction of the human mouth and throat closely mimics in vivo deposition data. On the other hand, aerosol particle deposition in a 3D 90 degrees -bend geometry does not accurately simulate aerosol filtration in the human mouth and throat. The numerically predicted regional deposition of aerosol particles closely matches that measured experimentally, in vitro, using the oropharyngeal cast from which the numerical reconstruction was made. A relatively weak dependence of particle deposition on flow-rate is observed with both 90 degrees -bend and 'real' oropharyngeal geometries, inconsistent with extrathoracic deposition in vivo. Two dimensional numerical simulations do not, in general, accurately simulate the conditions in the associated three-dimensional system. Quantitative differences between flow in the 90 degrees -bend and 'real' oropharyngeal geometries are especially significant in regards to the ability of the airstream to break apart particle agglomerates. For both geometries, it is observed that increasingly small particle agglomerates may be separated as the airflow rate increases from 30 to 200 lmin(-1). At flow-rates exceeding 60 lmin(-1), aggregated particles less than approximately 10-µm diameter may be separated by the airflow.

Journal Article↗
PubMed2000

Amoxicillin for fever and sore throat due to non-exudative pharyngotonsillitis: beneficial or harmful?

OBJECTIVES: To determine duration of signs and symptoms and adverse reactions after treatment with amoxicillin of patients with fever and sore throat due to non-exudative pharyngotonsillitis. DESIGN: This was a randomized, double-blinded, placebo-controlled trial. Outpatients at four medical centers were enrolled. Patients over 5 years of age presented with fever and sore throat for less than 10 days due to non-exudative pharyngotonsillitis. Cases with any of the following symptoms or illness were excluded: earache, nasal discharge with foul smell, rheumatic fever, valvular heart disease, renal disease, and penicillin hypersensitivity. Amoxicillin or identical placebo at the dosage of 50 mg/ kg per day was given three or four times daily for 7 days. RESULTS: There were 1217 patients enrolled in this study. Some were lost to follow-up, which is the reason for the variability in number of cases in these analyses. After therapy, duration of fever was 2.46 and 2.48 days (P = 0.78) and of sore throat 3.01 and 3.04 days (P = 0.80) in amoxicillin (n = 431) and placebo (n = 436) groups, respectively. Complications were clinically documented in 13 (2.5%) and 16 (3.0%) cases in amoxicillin (n = 527) and placebo (n = 524) groups (P = 0.56). Two cases (0.46% and 0.46%) from each group (n= 433 and 431) were positive by antistreptolysin O antibody determination. The history of carditis and abnormal urinalysis after treatment were not obtained. CONCLUSIONS: Amoxicillin therapy for non-exudative pharyngotonsillitis conferred no beneficial or harmful effect.

Adenoids↗
PubMed1971

Bacteriological monitoring in penicillin treatment of streptococcal sore throat.

Bacteriological monitoring of penicillin therapy in 30 children with streptococcal sore throats was performed by means of salivary and throat-swab culture, on the first, third, fifth and ninth days after therapy had started. Counts of beta-haemolytic streptococci per ml. of saliva were also performed.Results showed that salivary culture and estimation of the numbers of beta-haemolytic streptococci in the saliva were much more sensitive indices of the effectiveness of penicillin treatment than throat-swab culture.

Adolescent↗
PubMed2006

Ice cold carbonated water: a therapy for persistent hyperawareness of pharyngeal mucus and throat clearing.

Chronic throat clearing or a feeling of 'something' at the back of the oropharynx or nasopharynx is a common cause for referral to otorhinolaryngology services. While treatment of an underlying causative condition might be expected to improve these symptoms, in many cases a clear underlying cause is not found. Currently, there is no recognized treatment which is effective against these troublesome symptoms. This observational study investigated the effectiveness of a regime of sipping ice cold carbonated water to try to break the vicious cycle of throat clearing. Seventy-two patients with these symptoms who had previously been advised to use the regime were contacted with a postal questionnaire. Sixty-three per cent of patients documented an improvement in their symptom severity score. The most severely and most frequently affected patients had the greatest benefit. We conclude that the suggested regime can be effective in breaking the vicious cycle of persistent throat-clearing.

Adult↗
PubMed1987

Food-borne outbreak of group G streptococcal sore throat in an Israeli military base.

A food-borne outbreak of sore throat caused by Lancefield group G beta-haemolytic streptococci and involving 50 persons occurred in May 1983 in an Israeli military camp. All of the patients available for clinical examination had sore throat and difficulty in swallowing. Exudative tonsillitis occurred in 46% of the patients and the body temperature was above 37.5 degrees C in 81%. The pattern of attack was uniform over the base and 37 became ill during the night and morning of the 5 May. Thirty-two (84%) of the throat cultures taken from 37 patients grew group G beta-haemolytic streptococci. Eight of 29 contacts were positive for group G beta-haemolytic streptococci and 6 of the 28 foodhandlers examined had positive cultures of the same group. The organism was also isolated from one food sample. The epidemiological and laboratory investigations indicated that a food handler, a convalescent carrier of group G streptococci, might have been the source of infection. Assumptions on the potential of non-group A streptococci to cause epidemics are discussed.

Acute Disease↗
PubMed2000

Differences in teaching about the acute sore throat within one medical faculty.

OBJECTIVES: To examine the consistency of teaching about the acute sore throat in four departments in one medical faculty, and to determine whether there is agreement between what is taught and the evidence-based literature. DESIGN: Cross-sectional study. SUBJECTS: 71 undergraduates and 15 postgraduate general practice registrars and four lecturers. RESULTS: Differences were identified in teaching about the diagnostic value of a throat swab, a full blood count and clinical scoring, as well as on the use of penicillin in suspected streptococcal pharyngitis. Only one department based their teaching on the evidence-based literature. No department discussed issues of cost-effectiveness. Half of the students identified discrepancies in the teaching about the sore throat and were initially confused by them. CONCLUSION: One method of resolving disagreement between teachers from different disciplines is to rely on the evidence-based literature. This type of study can be useful in curricular development and in correcting teaching inconsistencies within a faculty.

Acute Disease↗
PubMed1998

Safety trial with the 5HT1B/1D agonist avitriptan (BMS-180048) in patients with migraine who have experienced pressure, tightness, and/or pain in the chest, neck, and/or throat following sumatriptan.

We investigate whether symptoms of pressure, tightness, and/or pain in the chest, neck, and/or throat after administration of the 5HT1B/1D agonist avitriptan were associated with objective impairment of the myocardial function on 12-lead electrocardiogram (ECG), continuous ECG (Holter) monitoring, and echocardiography. Migraine sufferers who in two-thirds of all attacks treated with sumatriptan had experienced chest/throat/neck symptoms were chosen for study. Baseline measures included vital signs, a 12-lead ECG and an echocardiogram. Patients (n = 51) who had no clinically significant abnormality at baseline received a high dose (150 mg) of avitriptan orally outside of a migraine attack. If pressure, tightness, and/or pain in the chest, neck, and/or throat occurred, an ECG was obtained, and a repeat echocardiogram was done while the symptoms were present in order to monitor for impairment of myocardial function. If symptoms of these types did not occur within 60 min after administration of the study drug, a second echocardiogram was obtained. Forty-five patients (88%) reported at least one adverse event and 23 (45%) experienced pressure, tightness, and/or pain in the chest, neck, and/or throat after administration of avitriptan. No clinically significant myocardial abnormalities were observed in any patients, even in those who had experienced the targeted symptoms. No other serious adverse event occurred. We concluded that the typical 5HT1B/1D agonist-induced chest/throat/neck symptoms are most unlikely to be of cardiovascular origin.

Adult↗
PubMed2002

Postoperative sore throat after routine oral surgery: influence of the presence of a pharyngeal pack.

A randomized clinical trial was conducted to investigate the effect of the presence of a pharyngeal pack during endotracheal anaesthesia on the incidence of postoperative sore throat. The patients were anaesthetized with fentanyl, thiopentone and atracurium. Thirty-six patients were anaesthetized without placement of pharyngeal packs while 26 patients had pharyngeal packs inserted. There were no significant differences in the incidence or severity of sore throat postoperatively in the two groups (P=0.23). These results contradict previous studies, which showed an increase in the incidence of postoperative sore throat after the use of pharyngeal packs.

Anesthesia, Dental↗
PubMed1978

History of recurrent sore throat as an indication for tonsillectomy. Predictive limitations of histories that are undocumented.

As part of a prospective study of indications for tonsillectomy and adenoidectomy, we followed closely 65 children with histories of recurrent throat infection that seemed impressive (at least seven episodes in one year, five in each of two consecutive years or three in each of three consecutive years), but lacked documentation. During the first year of observation, only 11 children (17 per cent) had episodes of throat infection with clinical features and patterns of frequency conforming to those described in their presenting histories. Of the remaining 54 children, 43 (80 per cent) experienced no, one or two observed episodes each, and most of the episodes were mild. We conclude that undocumented histories of recurrent throat infection do not validly forecast subsequent experience and hence do not constitute an adequate basis for subjecting children to tonsillectomy.

Adenoidectomy↗