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Query: UMLS:C0010200 (cough)
 23,843 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The laryngeal amyloidosis is an uncommon disease accounting for 1% of all benign lesions of larynx. The commonest symptom is the dysphonia, sometimes accompanied by stridor, laryngeal globus sensation, dysphagia and, in rare occasions, cough, dyspnea and hemoptysis, specially when the tracheobronchial tree is also affected. This paper describes the case of a 30-year-old female patient, whose main symptoms were progressive dysphonia and dyspnea, admitted at allergy service to rule out asthma. The respiratory function tests showed obstruction in the medium and small caliber ways without reversibility with salbutamol. Biopsies of ventricular band, vocal cord and arytenoid stained with positive Congo red for amyloid tissue, established the laryngeal amyloidosis diagnosis. The complementary studies to rule out amyloid tissue in the remaining tracheobronchial tree were negative. Dyspnea had characteristics of laryngeal origin, caused by a pulmonary ventilation disorder provoked by the difficult arrival of air to alveoli, which caused the decreased partial pressure of oxygen and CO2.
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PMID:[Asthma or laryngeal amyloidosis? A report of a case and literature review]. 1663 59

Gastroesophageal disease, a common cause of chronic cough, is often poorly recognised. We reviewed the presenting history of 47 chronic cough patients who had been proven to have gastroesophageal disease by oesophageal function testing. Fourty-seven patients (26 female), were enroled. Symptoms which were most common included: cough on phonation, on rising from bed, associated with certain foods or with eating in general. Symptoms known to be associated with laryngopharyngeal reflux, such as throat clearing, dysphonia, globus and dysphagia were also associated. Heartburn or indigestion was present in 63% of those questioned. These data show that symptoms associated with reflux in chronic coughers differ from those commonly perceived to be characteristic of classical heartburn-associated reflux. These data suggest that, contrary to previous reports, a symptom complex which is characteristic of reflux cough can be identified.
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PMID:Clinical history in gastroesophageal cough. 1678 44

This retrospective study determined whether specific neurological features were associated with initial and final swallowing outcomes in acute stroke patients. A chart review of 65 acute stroke patients suggested that certain clinical and neurocognitive behaviors were associated with swallowing outcomes. Hemispatial neglect was significantly associated with initial nonoral dietary intake, whereas aphasia was not associated with swallowing outcome. Results from the initial clinical swallowing evaluations suggested that the presence of at least four of six clinical features (cough after swallow, voice change after swallow, abnormal volitional cough, abnormal gag reflex, dysphonia, and dysarthria) were associated with poor initial and final swallowing outcomes. Whether specific lesion location, size, or a combination of clinical neurological deficits are associated with poor initial and final swallowing outcomes is unclear. Prospective studies are warranted for further investigation of these relationships.
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PMID:Clinical and cognitive predictors of swallowing recovery in stroke. 1704 16

The pharmacokinetic and pharmacodynamic effects of inhaled corticosteroids (ICS) have shaped the efficacy and safety of these agents in the treatment of asthma. Important pharmacokinetic and pharmacodynamic characteristics that can enhance the efficacy of ICS include small particle size, high glucocorticoid-receptor-binding affinity, long pulmonary residence time and lipid conjugation. These characteristics can increase or prolong the anti-inflammatory effects of an ICS. Important pharmacokinetic characteristics that can enhance the safety of ICS include on-site activation in the lung, low oropharyngeal exposure, negligible oral bioavailability, high protein-binding and rapid systemic clearance. The degree of oropharyngeal exposure is relevant to local side-effects, such as oropharyngeal candidiasis, dysphonia and coughing. Pharmacokinetic properties that influence the degree of systemic exposure are relevant to the pharmacodynamic effect of ICS-induced hypothalamic-pituitary-adrenal axis suppression and cortisol suppression, an indicator of potential long-term systemic side-effects, such as reduced growth velocity and bone density, fractures, and skin bruising and thinning. Therefore, significant differences in the pharmacokinetic and pharmacodynamic characteristics of the currently available inhaled corticosteroids warrant careful consideration when used in clinical practice as they may result in differences in efficacy and local and systemic safety profiles.
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PMID:Relevance of pharmacokinetics and pharmacodynamics of inhaled corticosteroids to asthma. 1707 19

Clinical pictures of laryngopharyngeal reflux, described in the literature, often differ considerably and are described with wide severity. Some classifications employ a total score i.e., addition of the assigned scores to single aspects of video-laryngoscopy. These classifications have the disadvantage of being complex, not reproducible and, in part, subjective. In this study, an original video-laryngoscopic classification is proposed, based on a topographic criterion with distinction of anterior, from posterior and lateral, lesions and an anatomo-pathological criterion that assigns a marked severity to the granulomatous and erosive lesions, in comparison with the erythematous and oedematous lesions. Four classes are proposed or grades of patients (A, B, C, D). The study was multicentric on 178 patients. Results were considered estimating the clinical parameters and the symptoms, correlating them at the stages of the classification proposed. The data obtained indicate that our classification presents an indicative distribution as far as concerns severity and it seems acceptable for efficacy and simplicity: no significant correlation emerged between the single manifestations and the severity of the objective picture; in the majority of cases, the most constant symptomatological triad was globus, cough and dysphonia.
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PMID:Multicentric study: statistical correlation between clinical data and instrumental findings in laryngo-pharyngeal reflux: proposal for a new ENT classification of reflux. 1734 30

Voice problems have been reported to occur in association with chronic cough (CC) and can interfere with quality of life. Voice symptoms can improve following behavioral intervention for CC that persists despite medical management; however, formal measures of voice changes have not been reported. The aim of this study was to measure the changes in perceptual, acoustic, and electroglottographic voice characteristics after a SPEech Pathology Intervention Program for CHronic Cough (SPEICH-C) compared to a Healthy Lifestyle Education intervention program (HLE control). Eighty-two participants with CC that was refractory to medical management were randomly allocated to receive either the SPEICH-C or an HLE control. Participants in the SPEICH-C group demonstrated a significant reduction in perceptual ratings of breathy, rough, strain, and glottal fry qualities (P<0.001) in comparison to the HLE control group. There was a significant improvement between pre- and postintervention maximum phonation time, jitter, and harmonic-to-noise ratio values in the SPEICH-C group; however, the magnitude of change was not significantly different between groups. There was no significant change in fundamental frequency, standard deviation of fundamental frequency, phonation range, or closed phase of vocal fold vibration after intervention for either group. These results demonstrated that SPEICH-C can improve perceptual aspects of voice quality suggesting that dysphonia may be a fundamental characteristic of CC.
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PMID:A comparison of two approaches to the treatment of chronic cough: perceptual, acoustic, and electroglottographic outcomes. 1748 95

Voice problems have been reported in chronic cough (CC) and paradoxical vocal fold movement (PVFM), however, there is a lack of a systematic description of voice characteristics in these conditions. This study examined the perceptual voice characteristics of 56 individuals with CC, 8 with PVFM and 55 with both CC and PVFM, compared to 25 people with muscle tension dysphonia (MTD) and 27 healthy controls. There was a high prevalence of abnormal voice quality in the CC and PVFM groups compared with healthy controls. More than one third of participants with CC and PVFM demonstrated strained, rough and/or breathy voices to a moderate or severe degree. The perceptual features in CC and PVFM were similar to those in MTD with greater severity evident in MTD. Possible mechanisms for abnormalities in voice quality include the presence of muscle tension and the frequency of coughing. These results have implications for the identification and management of voice disorders in CC and PVFM and suggest that clinicians should be alert to the incidence of voice abnormalities in these populations.
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PMID:Perceptual voice characteristics in chronic cough and paradoxical vocal fold movement. 1772 29

The diagnosis of laryngopharyngeal reflux (LPR) is increasingly common in otolaryngology practice. Patients with nonspecific throat and voice symptoms, such as throat clearing, hoarseness, cough, sore throat, and globus, are frequently treated empirically with antireflux medication by otolaryngologists and primary care physicians. Physical findings such as laryngeal erythema, edema, and posterior laryngeal mucosal thickening are also frequently attributed to LPR. The literature has been inconsistent, with few prospective, randomized trials showing efficacy for this clinical practice. Because of the lack of specific signs and symptoms of LPR, clinicians should be aware of other potential causes for these clinical presentations. Recently published studies describe the association between allergy or asthma and many of the same symptoms attributed to reflux disease. Muscle tension dysphonia can also present with hoarseness and symptoms of throat irritation. Although LPR can cause the symptoms and signs described previously, it should not be the only diagnosis considered by the evaluating physician. Failure to consider other possible causes may result in unnecessary treatment and potential delay in diagnosis. This article discusses this topic, citing some of the pertinent literature published over the past 2 years.
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PMID:Otolaryngological perspective on patients with throat symptoms and laryngeal irritation. 1862 26

Laryngopharyngeal reflux (LPR) is the disease process by which gastric contents affect the extraesophageal structures of the head and neck. The symptoms of LPR include intermittent dysphonia, excessive throat clearing, globus pharyngeus, cough, and dysphagia. These symptoms can be assessed with the Reflux Symptom Index. Signs of LPR, as determined with laryngoscopy, can be described with the Reflux Findings Score, which includes assessment of site-specific laryngeal edema and other inflammatory changes. This article discusses the current understanding of LPR pathophysiology, taking into account pepsin stability and reactivation.
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PMID:Laryngopharyngeal reflux: the value of otolaryngology examination. 1862 39

The aim of this study was to investigate the prevalence of gastroesophageal reflux disease (GERD) in patients with laryngopharyngeal symptoms, the relationship between laryngopharyngeal reflux (LPR) and Helicobacter Pylori infection and treatment response to proton pump inhibitors. Forty-five patients with suspected gastroesophageal reflux diseases related symptoms (sore throat, throat burning, throat clearing, globus sensation, cough, halitozis, dysphonia, dysphagia, postnasal dripping, vocal fatigue, and sputum) were included in this study. For pre-therapeutic and post-therapeutic comparison, symptoms and laryngological findings were graded on a 4-point scale. The patients underwent upper gastrointestinal system endoscopy. During endoscopy, antral biopsies from the stomach were obtained to detect H. Pylori. Antireflux medication with proton pump inhibitors (PPI) and H. Pylori eradication therapy if present were prescribed to the patients. The improvement in symptoms and laryngological findings were evaluated after treatment. By means of esophagogastroduodenoscopy (EGD), reflux was detected in only 11% of patients. But there can be reflux patients other than the detected ones. Although, H. Pylori was present in 62% of patients, no correlation was found between H. Pylori positivity and symptoms. All patients responded well to antireflux treatment and H. Pylori eradication therapy. Laryngopharyngeal symptoms and findings can be predictors of gastroesophageal diseases when response to reflux treatment is taken into account.
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PMID:Association of laryngopharyngeal manifestations and gastroesophageal reflux. 1864 36


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