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PubMed2006

Determinants of long-term outcome of patients with reflux-related ear, nose, and throat symptoms.

Gastroesophageal reflux disease (GERD) is present in up to 75% of patients with chronic refractory ear, nose, and throat (ENT) symptoms, and proton pump inhibitor (PPI) therapy induces symptom relief in the majority of these patients. It has been suggested that endoscopic findings and quantification of esophageal acid exposure may help to predict the long-term outcome of medical therapy, but prospective studies that confirm this hypothesis are lacking. The aim of the present study was to investigate the relationship of endoscopic findings and quantification of reflux with long-term outcome in patients with reflux-related ENT symptoms. One hundred six consecutive patients with chronic refractory unexplained ENT symptoms underwent upper GI endoscopy, 24-hr dual-channel esophageal pH and Bilitec (n = 35) monitoring, and esophageal manometry. Subsequently, all were treated with omeprazole, 20 mg b.i.d., and patients were followed at 2-week intervals until symptom relief. Four weeks later, omeprazole therapy was gradually decreased and the lowest effective omeprazole maintenance dose, if any, was determined. Eighty-one patients (49 men; mean age, 50) experienced a clear or excellent therapeutic response after, on average, 4 weeks of omeprazole, 20 mg b.i.d. In 36 patients (44%; group A), PPI treatment could be stopped completely, 27 patients (33%; group B) required a maintenance dose of omeprazole, 20 mg/day, and 18 patients (22%; group C) required maintenance with omeprazole, 40 mg/day. The prevalence of reflux esophagitis was significantly lower in group A patients, who also had significantly lower distal esophageal acid exposure, proximal esophageal acid exposure, and esophageal duodenogastroesophageal reflux exposure compared to groups B and C. Multivariate analysis identified the presence of esophagitis and pathological distal esophageal acid exposure as risk factors for the need of maintenance therapy. In patients with reflux-related ENT symptoms, initial findings on upper GI endoscopy and 24-hr pH-metry help to predict the need for maintenance therapy.

Anti-Ulcer Agents↗
PubMedDate not supplied

Typing of Streptococcus pyogenes strains isolated from throat infections in the region of Aachen, Germany.

BACKGROUND: Changes in the epidemiology of Streptococcus pyogenes infections may be associated with the introduction and reappearance of individual serotypes within a population. MATERIALS AND METHODS: Typing of 216 consecutive isolates of S. pyogenes from patients with pharyngitis in the region of Aachen, Germany, was performed by sequencing the emm gene, slide-agglutination of the T-antigen and determining the serum opacity reaction (SOR). RESULTS: All 216 isolates were unequivocally emm-typable. emm1 was most common (18.5%), foLlowed by emm12 (15.7%), emm3 (14.4%) and emm28 (13.9%). Only four isolates contained newly validated emm types: emm89 or emm94 were harbored by two isolates each. In one isolate, the sequence type s104 was found. CONCLUSION: Despite an anticipated selective pressure, the prevalence of emm1 among isolates from throat infections in northwestern Germany remains high, but does not reflect the predominance of emm1 among invasive isolates in Germany.

Adolescent↗
PubMed1995

Pharmacokinetics of intravenous ondansetron in healthy children undergoing ear, nose, and throat surgery.

BACKGROUND: To determine the pharmacokinetics of the 5-HT3 antagonist ondansetron in children, informed written consent was obtained from the parents of 21 healthy children aged from 3 to 12 years scheduled for ear, nose, and throat surgery. METHODS: The children were stratified according to age: 3 to 7 years and 7.1 to 12 years, and a single intravenous infusion of 2 or 4 mg ondansetron, respectively, was administered over 5 minutes before induction of anesthesia. After completion of the infusion, anesthesia was induced intravenously and maintained with inhalational anesthesia. Whole blood (3 ml) was obtained before administration of ondansetron, at completion of the infusion, at the beginning and end of surgery, and at 3, 4, 6, 8, 10, and 12 hours after start of the infusion. Pharmacokinetic variables were determined with use of standard noncompartmental techniques. RESULTS: Mean plasma clearance was 0.50 L.hr-1.kg-1 and 0.39 L.hr-1.kg-1, the mean volume of distribution at steady-state was 1.70 L.kg-1 and 1.61 L.kg-1, and the mean plasma terminal half-life was 2.6 hours and 3.1 hours for the 2 mg and 4 mg groups, respectively. On a body surface area basis, mean plasma clearance was 14.0 and 13.7 L.hr-1.m-2 and mean volume of distribution was 47.7 and 55.9 L.m-2 for the 2 and 4 mg groups, respectively. There were no serious adverse events attributable to ondansetron. CONCLUSIONS: These data indicate that the pharmacokinetics of ondansetron in children from 3 to 12 years old are predictable and similar to those in adults. The elimination half-life of ondansetron increases in parallel with age. However, clearance is constant when normalized to body surface area, but the volume of distribution increases over the age range studied.

Adenoidectomy↗
PubMed1987

Plasma androgens and aggressiveness in captive winter white-throated sparrows (Zonotrichia albicollis).

Captive white-throated sparrows (Zonotrichia albicollis), held under a natural photoperiod, were pair tested to evaluate dominance and aggressiveness in relation to plasma androgen levels and plumage morphology. Androgen levels were determined in November, 1 week before behavioral testing began; in January, at the conclusion of behavioral testing; and again in March. November plasma androgen levels of captive birds did not differ from those of a group of feral birds and were greater than androgen levels in January and March. Androgen levels of male and female white-striped and tan-striped birds did not differ for any collection date. November plasma A levels were significantly positively correlated with the display of aggressive behaviors by test birds and were inversely correlated, though not significantly, with hierarchy position. Plasma androgen levels determined in January and March were not related to aggressiveness or dominance. These data suggest that circulating androgens and morphological characters may act synergistically, at the onset of flock formation, to influence avian winter dominance hierarchies.

Aggression↗
PubMed1988

Control of aggression and dominance in white-throated sparrows by testosterone and its metabolites.

In three experiments, we investigated whether testosterone itself or its metabolites activate aggression and dominance in white-throated sparrows Zonotrichia albicollis. Groups of five to six sparrows, each treated with a different steroid implanted subcutaneously, were observed in outdoor aviaries during late winter to determine the birds' rates of aggression (supplantations and attacks scaled to the number of available subordinates) and dominance rankings with opponents not previously encountered. In Experiment 1, testosterone (T) had a greater effect on aggression and dominance than did androstenedione, 5 alpha-dihydrotestosterone (D), androsterone, or estradiol (E). In Experiment 2, birds with T or D + E had higher aggression scores and dominance ranks than birds with either D or E alone. Birds with T and D + E did not differ. The testosterone metabolites, D and E, thus acted synergistically to determine rates of aggression and dominance ranks. To corroborate these results, in Experiment 3 we treated T-implanted birds with the following blocking agents: ATD, expected to reduce conversion of T to E (AT birds); progesterone, expected to reduce conversion of T to D (PT birds); or both (APT birds). The APT birds had lower aggression scores and dominance ranks than did AT or PT birds, despite having higher mean levels of circulating T than AT or PT birds or birds implanted with T alone. Cyproterone acetate also reduced aggression scores and dominance in T-implanted birds. We conclude that the hormonal control of aggression and dominance in these birds requires conversion of testosterone to both androgenic and estrogenic metabolites.

Aggression↗
PubMed1990

Antibiotic prophylaxis in ear, nose and throat surgery: a comparison of a single preoperative dose with three peri-operative doses of ceftazidime.

An open prospective randomized trial was conducted in three Italian ear, nose and throat (ENT) surgery departments on 120 patients aged 10 to 84 years, to compare a single pre-operative dose vs. three peri-operative doses of ceftazidime in surgical prophylaxis. Sixty patients in group I received 1 g ceftazidime intramuscularly (im) or intravenously (iv) 1 h before surgery, and 60 in group II received three 1 g doses of ceftazidime, im or iv, 1 h before, and 6 and 12 h after surgery. Post-operative infections were observed in six group I patients (10.1%) and seven group II patients (11.6%). All infections arose in patients who had undergone 'moderate-risk' (6.7%) or 'high-risk' surgery (30.5%). We conclude that a single pre-operative 1 g dose of ceftazidime is as efficacious as multiple peri-operative doses in the prophylaxis of infectious complications following this type of surgery.

Adolescent↗
PubMed1988

Prevention of sore throat after nasotracheal intubation.

The influence of tube size, cuff inflation, and pharyngeal packing on development of sore throat after nasotracheal intubation was studied. Pharyngeal packing was found to be the most significant factor, followed by tube size and inflation of the cuff.

Adolescent↗
PubMed1992

Incidence of sore throat and patient complaints after intraoperative transesophageal echocardiography during cardiac surgery.

To evaluate the incidence of postoperative side effects and patient complaints following transesophageal echocardiography (TEE), 57 patients were interviewed by questionnaire and examined by pharyngeal inspection, preoperatively. The patients were randomized to undergo surgery with or without intraoperative TEE, and a second interview and examination were performed in 48 patients on the second postoperative day using a double-blind protocol. Twenty-four of the patients were investigated by TEE over a period of 5.4 +/- 2.3 hours and 24 had surgery without TEE. The intubation time for the two groups did not differ. There was no difference between controls and TEE patients with regard to painful swallowing evaluated by a visual analog scale. Furthermore, there was no difference between the controls and TEE patients regarding nausea or time elapsed from extubation to the first oral intake. No differences between the groups were found regarding the findings on pharyngeal inspection and no major complication attributable to the use of TEE occurred. A sore throat with painful swallowing was not a great problem for the patients in the present study; this indicates that endotracheal intubation rather than TEE caused the minor complaints. It is concluded that intraoperative TEE can be used without harmful postoperative pharyngeal side effects.

Aged↗
PubMed2003

Lump sensation in the throat caused by tumors in the preepiglottic space.

Lump sensation in the throat is a common symptom, which accounts for 4% of first patient visits to Otorhinolaryngologic clinics. The etiology includes abnormalities of the thyroid gland, cysts, tumors and chronic infections of the pharynx, larynx, esophagus and tongue base, gastroesophageal reflux and anxiety disorders. In this article we describe two rare cases of lump sensation caused by masses in the preepiglottic space and we stress the importance of thorough investigation to exclude any possible non functional causes.

Aged↗
PubMed2005

Clarithromycin treatment selects for persistent macrolide-resistant bacteria in throat commensal flora.

The aim of the study was to determine the effect of clarithromycin treatment on resistance development in the commensal throat flora. Alpha-haemolytic streptococci and Neisseria spp. were isolated from patients receiving clarithromycin for eradication of Helicobacter pylori. The treatment resulted in an immediate increase in the number of macrolide-resistant streptococci, which remained for one year after treatment, but declined to background level three years later. The most prevalent resistance gene was mef(A). Neisseria spp. were less affected by the treatment: the number of resistant isolates increased in only in one case during treatment. In conclusion, a one-week standard therapy with clarithromycin selects for an increased prevalence of macrolide-resistant streptococci that persisted for more than one year.

Anti-Bacterial Agents↗
PubMed2005

Erythromycin resistance in the commensal throat flora of patients visiting the general practitioner: a reservoir for resistance genes for potential pathogenic bacteria.

The prevalence and mechanism of erythromycin resistance in commensal throat streptococci was determined from October 2000 until December 2002 as part of an ongoing study of the NIVEL in general practice patients (N=678). Resistance prevalence for 1mg/L and 16 mg/L erythromycin was 57% and 20%, respectively. The percentage of total commensal flora resistant within each patient ranged from 1% to 100% (median, 1%). mefA was predominantly found among isolates on the 1mg/L plates, and ermB was found in 64% of the isolates on the 16 mg/L plates. Erythromycin resistance was transferred from a commensal isolate to Streptococcus pneumoniae with a frequency of 1 x 10(-9). Commensal streptococci of general practice patients in The Netherlands form a large reservoir of transferable erythromycin resistance (genes) for potential pathogenic microorganisms.

Anti-Bacterial Agents↗
PubMed2006

Ear, nose and throat foreign bodies in Melanesian children: an analysis of 1037 cases.

OBJECTIVE: Occurrence of foreign bodies (FBs) in ear, nose and throat (ENT) in children are not uncommon in clinical practice. We described our experience with ENT foreign bodies in Melanesian children. METHOD: The study was carried out at the tertiary referral center which is also a University teaching hospital. The 15-year period from 1990 to 2004, 1037 cases of ENT foreign bodies were managed. The clinical, operative and follow up data of these patients were collected from available clinic cards and admission charts. A retrospective analysis was made with these data. RESULTS: Foreign bodies in the external auditory canal constituted 711 (68.6%) cases. It was followed by nose in 258 (24.9%), pharynx in 26 (2.5%), esophagus in 21 (2.0%) and laryngotracheobronchial (LTB) tree in 21 (2.0%) cases. Innumerable varieties of foreign bodies were removed from the ear. The common ones were stones in 277 (39.0%), seeds in 142 (20.0%), plastic ornament beads in 70 (9.8%) and cotton in 48 (6.8%) cases. Six hundred and thirteen (86.2%) of them were removed under microscope at the clinic without any complications. The difficult ones in uncooperative children were removed in the operation theatre. They numbered 98 (13.8%). The nasal foreign bodies were exclusively limited up to the age of 12 years. Common nasal foreign bodies were foam in 54 (20.9%), seeds in 51 (19.8%), stone in 28 (10.9%) and ornament beads in 24 (9.3%) cases. Two hundred and forty-six (95.3%) of them were removed in the clinic. Only 12 (4.7%) were removed in the operation theatre. Fishbone was the commonest (23, 90.2%) foreign body encountered in the pharynx of the children. Coins were the exclusive esophageal foreign bodies in children and all were removed in the operation theatre under general anesthesia. In the LTB tree the FBs were mostly localized to the right main bronchus which occurred in 11 (52.4%) cases. This was followed by the trachea in four (19.1%) cases. The different types of FBs encountered were coffee beans in eight (38.0%), peanuts in five (23.8%), plant seeds in three (14.2%) cases. We encountered two mortalities in these LTB FB patients. CONCLUSIONS: Otolaryngological foreign bodies in children are common. For early diagnosis a high index of suspicion has to be maintained by pediatric otolaryngologist.

Adolescent↗
PubMed2006

Pediatric ear, nose, and throat emergencies.

Acute otitis media is the most common infection for which antibiotics are prescribed in children, resulting in more than 20 million antibiotic prescriptions annually. New practice guidelines published by the American Academy of Pediatrics and the American Academy of Family Physicians call for the judicious use of antibiotics in view of increasing antibiotic resistance and the unclear necessity of the use of antibiotics in children with uncomplicated acute otitis media. This article reviews those guidelines, several other common ear, nose, and throat entities, including sinusitis and dental emergencies, and current strategies in diagnosis and treatment.

Anti-Bacterial Agents↗
PubMed2005

Neuroendocrine correlates of behavioral polymorphism in white-throated sparrows.

Interspecific differences in the neuropeptide systems of the lateral septum (LS) often parallel differences in social behavior. In rodents, some closely related species that differ in aggressive behavior also differ according to the level of vasopressin (VP) innervation of the LS. In songbirds, the neuropeptides vasotocin (VT) and vasoactive intestinal peptide (VIP) affect aggression when administered directly to the LS. Here, we tested whether the density of VT or VIP innervation of the LS reflects patterns of intraspecific behavioral polymorphism in male and female white-throated sparrows (Zonotrichia albicollis), in which the "white-stripe" (WS) morph behaves more aggressively than the "tan-stripe" (TS) morph. We found that the WS birds had more VT-immunoreactivity (IR) than the TS birds in the ventrolateral subdivision of the caudal LS (LSc.vl) and in the medial portion of the bed nucleus of the stria terminalis (BSTm). In addition, the TS birds had more densely stained VIP-IR in the LSc.vl than the WS birds. Males had more VT-IR than females in the LSc.vl and BSTm, and more VIP-IR in the LSc.vl. We also report sex and morph differences in VIP-IR in the basal hypothalamus, where VIP is synthesized and released into the portal vasculature. Males had nearly twice as many VIP-immunoreactive (ir) neurons in the infundibular nucleus than did females, and birds of the WS morph had more densely stained VIP-IR in the median eminence than TS birds. Our results support the hypothesis that differences in these neuropeptide systems underlie inter- and intraspecific differences in social behavior across vertebrates.

Animals↗
PubMed1983

Bacteraemia in streptococcal infections of the throat.

In two patients seen recently in North Yorkshire, systemic infection with Streptococcus pyogenes appeared to originate from the upper respiratory tract; such infection is now rarely reported from the more developed countries. A study was arranged to detect bacteraemia in patients with sore throat: of 343 patients tested 93 yielded beta-haemolytic streptococci from the respiratory tract, but streptococcal bacteraemia was detected in none. These results suggest that clinically unsuspected streptococcal bacteraemia is uncommon in such patients.

Child, Preschool↗
PubMed2001

Mumps vaccine virus genome is present in throat swabs obtained from uncomplicated healthy recipients.

Seven children were followed for up to 42 days post-vaccination with live mumps vaccine and 37 throat swabs were obtained serially. Viral genomic RNA was detected by reverse transcription-polymerase chain reaction (RT-PCR) in the phosphoprotein (P) and hemagglutinin-neuraminidase (HN) regions. Virus isolation was also attempted. Genomic differentiation of detected mumps virus genome was performed by sequence analysis and/or restriction fragment length polymorphism (RFLP). No adverse reaction was observed in these children. Although mumps virus was not isolated from any of the samples, viral RNA was detected in four samples from three vaccine recipients, 18, 18 and 26, and 7 days after vaccination, respectively. Detected viral RNA was identified as the vaccine strain. Our data suggests that vaccine virus inoculated replicates in the parotid glands but the incidence of virus transmission from recipients to other susceptible subjects should be low.

Child, Preschool↗
PubMed2002

Early reproductive success of western bluebirds and ash-throated flycatchers: a landscape-contaminant perspective.

Eggshell quality, clutch size, sex ratio, and hatching success of western bluebirds (Sialia mexicana) and ash-throated flycatchers (Myiarchus cinerascens) were studied on a landscape-soil contaminant gradient at Los Alamos National Laboratory (LANL) in New Mexico from 1997 to 1999. A variety of contaminants (heavy metals, chemicals, insecticides, polychlorinated biphenyls (PCBs), organochlorines, and radioactive isotopes) range across different spatial scales and concentrations on LANL land. This study is an example of a monitoring program over a large area with varying degree of contamination that is used to highlight locations of concern for future research. There were two locations where the flycatcher had a lower hatching success. The bluebirds at Sandia wetland, a location of concern for PCBs. had a thinner eggshell thickness index (RATCLIFFE) and the eggs were smaller than at other locations. The flycatcher had thinner eggshells than bluebirds, which could add to sensitivity to exposure to contaminants. There was no variation in clutch size or sex ratio between locations or areas closer to contaminant release sites for both species. Percent females in the clutch ranged from 0 to 100% in the WEBL and from 33 to 67% for ATFL.

Animals↗
PubMed1997

An unusual foreign body: a whole fish in the throat.

A wide variety of foreign bodies lodging in the upper aerodigestive tract are encountered in otolaryngological practice. These are mostly associated with acute symptoms calling for prompt removal. We report a case where a whole fish was accidentally lodged in the throat of a 17-year-old boy. The patient presented with severe respiratory and swallowing difficulty. The fish was removed as an emergency procedure.

Adolescent↗