Effectiveness of Behavioral Therapy versus Proton Pump Inhibitor Therapy in the Treatment of Laryngopharyngeal Reflux-Related Voice Disorders Laryngopharyngeal Reflux (LPR) is the retrograde movement of stomach contents above the upper esophageal sphincter and into the larynx, pharynx, and upper aerodigestive tract (Belafsky, Postma, & Koufman, 2001). This condition is seen in high numbers in voice clinics across the country. In a study of 113 consecutive new patients seen for voice disorders, Koufman, Amin, and Panetti (2000) found that the prevalence of LPR was 50% and symptoms and exam findings were found in 69% of new patients. The epithelial lining of the larynx and pharynx do not have the cellular structure to withstand acidic stomach contents like the epithelium of the esophagus, and small …show more content…
The literature shows that symptoms tend to return when medical therapy is stopped, thus creating a medical treatment that cannot be discontinued and may be financially difficult to sustain (Koufman et al., 2002). Behavioral therapy is often included with medical therapy, with recommended modifications to diet and/or lifestyle (i.e. smoking cessation, eliminating caffeine, reducing citrus, avoiding meals before bedtime, avoiding lying down after meals, elevating the head of the bed, and more). In addition, voice therapy is often prescribed if the reflux leads to significant voice changes or maladaptive compensatory behaviors (such as hyperfunction to compensate for hoarseness or reduced loudness). Very few studies have separated out each therapy technique to determine the efficacy of each on its own. The aim of this review is to determine whether behavioral treatment (voice therapy and dietary/lifestyle changes) results in better outcomes than medical treatment with daily PPIs in adults with LPR-related voice
A relatively newer biologic, rituximab provides an alternative strategy for treating the presenting patient. A genetically engineered chimeric anti-CD20 monoclonal antibody, rituximab exerts it therapeutic action by selectively targeting CD-20 positive B-cells1212, 18. As CD-20 is expressed exclusively on pre-B and mature B lymphocytes; stem cells and plasma cells are not implicated in rituximab therapy. The over expression of B-cells expressing the CD-20 surface antigen in the synovium of RA-affected joints has been well established18. The potential mechanisms by which these B-cells contribute to the immunopathogenesis of RA are as follows: they can act as antigen presenting cells, secrete pro-inflammatory cytokines (including tumour necrosis factor-alpha), and generate rheumatoid factor (RF) and other auto-antibodies whilst also activating T cells12. Hence, the rituximab mediated depletion of B-cells is thought to prevent these potential mechanisms from occurring thus controlling the progression of the disease18.
•Jose symptoms is derived from a disorder called Gastroesophageal reflux disease (GERD) occurring in the digestive system with the consumption of food, irritating the esophagus generally causing notable clinical symptoms such as the following: vomiting, chronic cough, angina, & regurgitation immediately after the consumed food. Jose's experience of the lump in his throat is caused by esophageal sphincter pressure.
Hegde, M. N. (2001). Pocketguide to treatment in speech-language pathology. (2nd ed., pp. 193-203). San Diego, CA: Singular Thomson Learning.
couple of authors on the subject. Wells (1982) states that, “Short -term treatment, as I shall use the
The clinician administered the Bedside Swallow Evaluation. The purpose of this evaluation is to determine if further testing is warranted due to performance of swallowing function. The patient will consume a variety of textures and consistencies. The patient is first presented with water from a spoon and asked to swallow it as the clinician places a gloved hand on the patient’s throat, as for the clinician to feel the typical anterior-superior movement of the larynx. After the patient finishes swallowing the clinician asks the patient to produce a prolonged phonation to observe voice quality. The patient is then instructed to take a single sip form a cup with thin liquid (clinician checks larynx movement present and vocal quality), take three
In this article, you are informed about a disease that is occurring more often in our society. It is commonly referred to as “heartburn” but is more appropriately named acid reflux disease or gastroesophageal reflux disease (GERD). Most people suffer from this disease, but think nothing of it. Perhaps they have felt it after a big meal, lying down after eating, during pregnancy, or even when bending over. Most people feel that GERD occurs after eating spicy foods, when in fact the major cause of GERD is fatty foods and the quantity of foods eaten.
...fined by this chronic condition. I do not take any medication, choosing instead to use supplements and non-invasive therapies. The information on the internet and in journal reviews continues to grow and I continue to learn about treatments and living a positive life. The steps I mentioned above are changes I have already made, and plan to make in the very near future.
When evaluating Suzy for the first time, the Speech Language Pathologist could utilize several screening tools to address the possible need for further exploration. As Calis et al. (2008) explained in their article regarding screenings, the Dysphagia Disorders Survey (DDS) and the Schedule for Oral-Motor Assessment (SOMA) are both a quick check, which can be completed in a naturalistic environment and are non-invasive screening tools. It is also extremely important to
Recurrent esophageal stricture. Patient with personal history of stage I adenocarcinoma of the esophagus in the setting of Barrett's esophagus, diagnosed elsewhere. He has a history of a distal esophagectomy with a gastroesophageal reanastomosis performed at or near 09/2016. The patient at one point, had a tracheostomy which has been removed. At one point, a feeding jejunostomy tube that has been removed. He has recurrent dysphagia and previous endoscopic dilatation. He presents today for a repeat endoscopy with probable dilatation of the EG junction.
Acid is produced naturally in your stomach to help you digest food and to kill bacteria. This acid irritates the stomach lining so our body produces a natural mucus barrier which protects it. Sometimes this barrier may be damaged thus allowing the acid to damage the stomach causing inflammation, ulcers and other conditions. Other times, there may be a problem with the muscular band at the top of the stomach that keeps the stomach tightly closed and this allows the acid to escape and irritate the oesophagus. This is called 'acid reflux' and can cause heartburn and/or oesophagitis. Proton pump inhibitors such as omeprazole stop cells in the lining of the stomach from producing too much acid. This can help prevent ulcers from forming or assist the healing process. By decreasing the amount of acid, they can also help to reduce acid reflux related symptoms such as heartburn.
The ability to respond to the environment is an essential aspect of life. The various sensory systems are all fine-tuned to respond to a myriad of signals from the environment allowing perception. Physiologically, a sensory system will take a physical stimulus from the environment, such as heat or a sound wave, and transduce it into an electrical response that it transmitted to the central nervous system. In the central nervous system, the signal is interpreted, and a signal is sent back via efferent neurons. The interpretation of a range of stimuli, and their respective responses, is the basis of an input-output function. In the auditory system, this is the means through which mechanical sound waves are taken in, and their varying frequencies
The subspecialty I plan on focusing my career around is medication therapy management (MTM), whether I work in a retail setting or not. Pharmacy informatics will be important to me, as the programs I use to fill prescriptions will also monitor the possible interactions, duplicative therapies, contraindications, etc. of the medications my patients will be receiving. This system will be my resource to ascertain which patients are in need of MTM and why, and by combining the information contained in the pharmacy’s records of the patient with information I may get from the patient’s other health care providers and the patient themselves, I will be able to see what points I need to bring up during an MTM session.
Sleeping with two pillows or by Elevating your head may help in breathing easily and encourage tongue to not fall to the back of your throat by keeping your airways open.
The larynx, known as the voice box, consists of an outer casing of nine cartilages that are connected to one another by muscles and ligaments. There are three unpaired cartilages and six paired. The unpaired cartilages include the thyroid, cricoid, and epiglottis. The thyroid cartilage is the largest and better known as the Adam’s apple. The cricoid cartilage is the most inferior cartilage of the larynx which forms the base of the larynx on which the other cartilages rest. Together, the thyroid and cricoid cartilages maintain an open passageway for air movement. The epiglottis and vestibular folds, or false vocal chords, prevent swallowed material from moving into the larynx. The paired cartilages, accounting for the remaining six, include the arytenoid (ladl...