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Query: UMLS:C0017168 (gastroesophageal reflux disease)
 11,783 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Paradoxical vocal cord motion (PVCM) is characterized by the inappropriate adduction of the true vocal cords during inspiration. Multiple causes have been proposed for this group of disorders, which share the common finding of mobile vocal cords that adduct inappropriately during inspiration and cause stridor by approximation. Management of this group of disorders has been complicated by the lack of a classification scheme to include all types of PVCM. We propose that PVCM be classified according to its underlying etiology and recognize the following causes of the disorder: 1. brainstem compression; 2. cortical or upper motor neuron injury; 3. nuclear or lower motor neuron injury; 4. movement disorder; 5. gastroesophageal reflux; 6. factitious or malingering disorder; 7. somatization/conversion disorder. Case reports are presented to illustrate the characteristic features and diagnostic evaluation used in assessing patients with PVCM. Management varies depending on the cause of PVCM and entails speech therapy, pharmacologic therapy, behavioral modification, and/or surgical intervention. Recognition of the multiple causes of PVCM allows otolaryngologists to formulate well-directed diagnostic evaluation and treatment.
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PMID:A classification scheme for paradoxical vocal cord motion. 936 85

Wheezing and dyspnoea are typical symptoms of asthma but can also be found in diseases of the extrathoracic airways. Functional upper airway obstruction may imitate, as well as complicate asthma. Functional upper airway obstruction was first described as a conversion disorder in young females with inspiratory stridor. Subsequently, it was found that functional upper airway obstruction was more often a secondary phenomenon in chronic asthma also involving the expiratory laryngeal airflow. During a period of 15 months, we diagnosed six cases of functional upper airway obstruction. Five patients were female and one male, and four were also asthmatics. Three cases showed chronic sinusitis with postnasal drip (PND) and/or gastro-oesophageal reflux. Both disorders may irritate the larynx. Treatment of sinusitis and gastro-oesophageal reflux led to a significant improvement of dyspnoea in all three of these patients. In asthma refractory to treatment and in the case of an asthmatic exacerbation without obvious cause, functional upper airway obstruction should be excluded to avoid unnecessary treatment with systemic steroids. Some of the possible causative factors of functional upper airway obstruction, such as postnasal drip and gastro-oesophageal reflux, are easily treatable.
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PMID:Functional upper airway obstruction and chronic irritation of the larynx. 955 60

Laryngomalacia is a common cause of stridor in children. The disorder has a heterogenous presentation, from the mildest form, which resolves with maturation, to the most severe form, requiring tracheotomy. While there is a vast literature on the subject, there is neither stratification nor correlation of clinical presentation, endoscopic appearance, treatment and outcome. In order to statistically evaluate the choice of treatment based upon presentation, patients must first be classified by relevant predictors of disease severity. A form is proposed to classify the clinical presentation of laryngomalacia by recording relevant historical and anatomic factors. Historical factors are classified by (1) severity of stridor; (2) weight gain; (3) age at presentation; and (4) neurologic status, forming the mnemonic SWAN. The principal anatomic site of collapse is recorded as: (1) postero-lateral; (2) posterior; or (3) anterior. Endoscopic findings consistent with gastroesophageal reflux disease (GERD) or gross aspiration are noted. Photographic and/or video documentation is performed when possible. A pilot study was undertaken to determine the ease of use of this instrument. Ten children, four boys and six girls, were classified. Ages ranged from 1-day-old to 19 months, with a mean of 9 months. Five children were examined in the clinic and five in the operating room. The form was readily and easily applied, and allowed the heterogeneity of the disorder to be organized. Wider application of this form across institutions, with classification of patients with laryngomalacia by historical and anatomic factors, should allow the accumulation of sufficient numbers of patients to allow statistical analyses of treatment and outcome as they relate to the initial presentation of this disorder of airway dynamics.
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PMID:Laryngomalacia: a proposed classification form. 1019 Jul 1

Recently, gastroesophageal reflux (GER) has been found to contribute to many types of otolaryngologic pathology in infants and children. The complaints may be intermittent and unresponsive to usual therapies, such as antimicrobial treatments. A high index of suspicion for GER and for the concept of "silent" GER (GER without overt symptoms) is necessary for accurate diagnosis and treatment of otolaryngologic manifestations of GER in these patients. In this prospective historical cohort study, the records were reviewed from 101 children who underwent esophagoscopy and biopsy as a diagnostic test for GER at the time of other otolaryngologic procedures. Significant associations were found between the presence of histologic esophagitis and asthma, recurrent croup, cough, apnea, sinusitis, stridor, laryngomalacia, subglottic stenosis, posterior glottic erythema, and posterior glottic edema. There were no complications. Esophageal biopsy is a rapid, safe and effective diagnostic test for GER that should be considered at the time of other procedures in children with selected GER-associated problems.
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PMID:Esophageal biopsy for the diagnosis of gastroesophageal reflux-associated otolaryngologic problems in children. 1071 66

Respiratory symptoms in children may be associated with underlying gastro-oesophageal reflux (GOR). We reviewed the case notes of 20 children who presented to us from June 1993 to June 1994 with respiratory symptoms and GOR. The patients consisted of 16 Malays, two Chinese and two Indians with equal number of males and females. Their age at diagnosis was less than one year in 17 patients. The earliest age at presentation was at the third day of life. All patients had major respiratory manifestations i.e. recurrent wheezing, recurrent cough and pneumonia. In addition, three patients had stridor and six patients had apparent life threatening episodes (ALTE). Fourteen patients required ventilation because of respiratory failure. Diagnosis of GOR was based on clinical grounds supported by barium oesophagogram in seven patients and ultrasound examination in 11 patients. Eight patients were fundoplicated because of ALTE and recurrent severe bronchospasm. On follow up, 14 patients had hyperactive airways requiring inhaled bronchodilator and steroid therapy.
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PMID:Gastro-oesophageal reflux in children with severe respiratory symptoms--clinical spectrum and management. 1096 86

More attention has been given to vocal cord dysfunction (VCD) in the past years. Even though the disease is known since 1983 and was brought to mind at least casuistically through the years, often VCD was not diagnosed as such, being mistaken for bronchial asthma - at times with grave consequences for the patient. VCD causes the acute onset of stridulous respiration with acute dyspnea making the differential diagnosis of asthma quite suggestive. The inspirational stridor and a peracute progression of the disease should cause doubts as to the diagnosis of asthma. We collected case reports and describe the symptoms and diagnostic approaches to VCD as well as showing discriminating findings towards bronchial asthma. We report on five children suffering from VCD (4 girls, 1 boy) aged from 2 to 13 years. It could be shown that VCD is caused by a multifactoral pathomechanism, which has both somatic and psychological aspects. A surprising find was that all of the children were diagnosed with a pathological gastroesophageal reflux, partly in serious dimensions, without showing the typical symptoms such as retrosternal pain, stomach-ache or recurrent vomiting (so called silent reflux). Since there is a multitude of pathomechanisms involved and the disease often coincides with allergic asthma, an individual therapy plan is needed for each patient.
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PMID:[Vocal cord dysfunction in children and adolescents]. 1150 89

Episodic laryngeal dysfunction (ELD), also known as paradoxical vocal cord dysfunction or laryngeal dyskinesia, is characterized by abnormal closure of the vocal cords during inspiration (and sometimes at the very start of expiration). It can manifest in different ways depending on the patient's age. In the newborn, it is usually associated with stridor restricted to the inspiratory breath following crying, and the natural history is always one of rapid resolution. Occasionally, a more severe form presents with intense dyspnea and marked inspiratory stridor in a baby that usually has extensive gastroesophageal reflux which has not been treated adequately enough to improve the dyspnea or the associated vasovagal attacks. A tracheotomy may be necessary. It is rare for this disease to present between the ages of 2 and 8 years. Thereafter, it may present as a form of pseudo asthma resistant to bronchodilators and anti-inflammatory drugs. The dyspnea can be very severe and lead the family to seek hospital admission, at least during the initial episodes. There is a female preponderance. The key to making the diagnosis is the complete reversibility of the patient's symptoms when they are distracted. Exertion asthma can be mimicked by forms of ELD that occur only by effort (apart from the profile of the lung function tests). There may be significant gastroesophageal reflux. Medical intervention (hospitalization and tracheotomy) must be avoided, treatment being essentially behavioral. Finally, some cases of paradoxical adduction of the vocal cords have been described with the use of neuroleptics, brain stem compression, cortical lesions and, much more rarely, motoneuron disease. This diagnosis requires a high index of suspicion, particularly in patients with asthma whose presentation or clinical course with treatment is atypical.
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PMID:[Episodic laryngeal dysfunction]. 1168 90

Problematic airway responses in infants are common. Reflux-induced apnea affects nearly 1% of infants and involves airway closure or laryngospasm. Recurrent or chronic stridor, caused by dynamic or structural airway abnormalities, occurs in up to 1 in 100 babies. It can be difficult to distinguish microaspiration, which may represent inadequate airway protection mechanisms, from reflexive responses to esophageal refluxate, which may represent overeffective airway protection mechanisms. The diagnosis of gastroesophageal reflux (GER) in babies can be facilitated by a careful history in conjunction with esophageal pH probe monitoring, laryngoscopic evaluation, bronchoalveolar lavage, or nuclear medicine scintigraphy. Conservative lifestyle measures for treating supraesophageal manifestations of infantile GER include prone positioning and thickened feedings. Prokinetic and acid-suppressing therapies are widely used, but their efficacy is incompletely established, and none is currently approved by the US Food and Drug Administration for this purpose. Fundoplication is not indicated if nonsurgical management can prevent serious problems during the child's maturation phase when many of these manifestations spontaneously resolve. Much remains to be learned about the developmental aspects of these supraesophageal manifestations of GER. This information not only will provide a greater understanding of developmental pathophysiology, but also will improve the clinical care of large numbers of infants.
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PMID:An overview of reflux-associated disorders in infants: apnea, laryngospasm, and aspiration. 1174 27

In this article, the literature regarding the effects of gastroesophageal reflux disease (GERD) on otolaryngologic disorders in infants and children is reviewed. We specifically focus on studies that suggest how GERD may be associated with sinusitis, cough, laryngitis, airway obstruction, apnea, recurrent croup, laryngomalacia, stridor, and subglottic stenosis in children.
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PMID:Update on gastroesophageal reflux disease in pediatric airway disorders. 1174 30

A 1.5-month-old boy with Sandifer's syndrome is described. After an uneventful delivery, he presented torticollis, seizure-like dystonic neck movements usually associated with feeding, episodic vomiting, inspiratory stridor and hand tremor in the first month of life. Barium esophagogram demonstrated gastroesophageal reflux, for which medical therapy was started. Children with torticollis and dystonic movements should be evaluated for Sandifer's syndrome. Early diagnosis and treatment of gastroesophageal reflux may prevent complications.
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PMID:A case of Sandifer's syndrome with hand tremor. 1176 69


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