Ear-nose-throat Symptoms Research Articles

Association between upper and lower respiratory disease among patients with primary ciliary dyskinesia: an international study.

Nearly all patients with primary ciliary dyskinesia (PCD) report ear-nose-throat (ENT) symptoms. However, scarce evidence exists about how ENT symptoms relate to pulmonary disease in PCD. We explored possible associations between upper and lower respiratory disease among patients with PCD in a multicentre study. We included patients from the ENT Prospective International Cohort (EPIC-PCD). We studied associations of several reported ENT symptoms and chronic rhinosinusitis (defined using patient-reported information and examination findings) with reported sputum production and shortness of breath, using ordinal logistic regression. In a subgroup with available lung function results, we used linear regression to study associations of chronic rhinosinusitis and forced expiratory volume in 1 s (FEV1) accounting for relevant factors. We included 457 patients (median age 15 years, interquartile range 10-24 years; 54% males). Shortness of breath associated with reported nasal symptoms and ear pain of any frequency, often or daily hearing problems, headache when bending down (OR 2.1, 95% CI 1.29-3.54) and chronic rhinosinusitis (OR 2.3, 95% CI 1.57-3.38) regardless of polyp presence. Sputum production associated with daily reported nasal (OR 2.2, 95% CI 1.20-4.09) and hearing (OR 2.0, 95% CI 1.10-3.64) problems and chronic rhinosinusitis (OR 2.1, 95% CI 1.48-3.07). We did not find any association between chronic rhinosinusitis and FEV1. Reported upper airway symptoms and signs of chronic rhinosinusitis associated with reported pulmonary symptoms, but not with lung function. Our results emphasise the assessment and management of upper and lower respiratory disease as a common, interdependent entity among patients with PCD.

Clinical Profile and Outcome Analysis of Ear-Nose-Throat Symptoms in SARS-CoV-2 Omicron Subvariant Infections.

Objective: This study aimed to investigate the clinical characteristics and outcomes of ear-nose-throat (ENT) symptoms in SARS-CoV-2 Omicron infected patients resulting from local transmission. Methods: A convenience sampling network survey was conducted among individuals infected with SARS-CoV-2 to examine the characteristics and progression of ENT symptoms associated with local transmission. The survey comprised 52 questions, and univariable and multivariable logistic regression analyses were employed to assess the rate, severity, and outcome of ENT symptoms across different genders and age groups. Results: Among the 1,366 individuals included in the investigation, a peak in new infections occurred on 20th December, and the majority (78.4%) were female. The most common symptoms reported were coughing (90.6%), nasal congestion (77.2%), and runny nose (74.3%). Otologic symptoms were predominantly represented by tinnitus (29.7%). Conclusion: The rate of specific symptoms showed a significant correlation with age and gender. It is crucial to provide timely medical intervention, especially for female patients. This study offers a comprehensive understanding of the symptom spectrum in individuals infected with the virus, providing valuable insights for the development of targeted symptom management strategies.

Frequency and severity of general and ear nose throat (ENT)- related symptoms in COVID-19 patients in a tertiary care hospital – A retrospective observational study

Background: Coronavirus disease 2019 (COVID-19) is a contagious respiratory and vascular disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a specific type of coronavirus. This human RNA coronavirus was isolated in December 2019 in the city of Wuhan, China. In March 2020, World Health Organization (WHO) declared that COVID-19 is a pandemic disease. The aim of this study was to determine the frequency and severity of the general symptoms of patients diagnosed with SARS-CoV-2, as well as the frequency and severity of ENT-related symptoms. Material & Methods: This was a retrospective observational study and was conducted in the Department of Otolaryngology & Head Neck Surgery of Dr Sirajul Islam Medical College & Hospital, Dhaka, Bangladesh during the period from July, 2020 to June,2021. In this study, we included 250 patients who had a history of SARS-CoV-2 infection, confirmed by PCR testing. Results: The majority (26.8%) of our patients were aged > 65 years, & most of our patients were male (55%). Mean age was 50.35 ± 17.41 years. Majority (38.4%) of our patients had HTN, 33.6% had DM, & only 15.2% had asthma. Among all patients, runny nose (81.6%), fever (74.8%), loss of sense of smell (73.6%) , loss of sense of taste (67.6%) were the most common symptoms. Olfactory dysfunction (78.4%) was the most common. We found severe cases of taste disturbance while dyspnea & headache indicates a moderate level of severity. Sore throat, runny nose & tinnitus were assessed as mild levels of severity. Conclusion: In our study, we found patients infected with SARS-CoV-2 may present to hospitals with a variety of general and ENT symptoms. Age, vertigo/dizziness, sore throats, and tinnitus was significantly related to frequency & severity of ENT symptoms associated with COVID-19 infection. Symptoms related to the sense of smell, taste and hearing are some of the most common symptoms in the course of COVID-19, which is important in the therapeutic and epidemiological management of patients.

The Clinical Significance of Otolaryngology Manifestations in COVID-19 Pneumonia: A Single-center Retrospective Cohort Study.

Objective Although the absence of a runny nose and sore throat, both ear-nose-throat (ENT) symptoms, suggests community-acquired pneumonia (CAP), the association between ENT symptoms and coronavirus disease 2019 (COVID-19) pneumonia remains unclear. We therefore investigated the association between ENT symptoms and COVID-19 pneumonia. Methods We retrospectively recruited consecutive confirmed COVID-19 inpatients with and without pneumonia admitted to a single institution from April 1, 2020, to July 31, 2021. After a descriptive analysis, we implemented univariable and multivariable regression analyses to assess the association between ENT symptoms and COVID-19 pneumonia. Results The present study included 385 patients. Pneumonia patients exhibited lower rates of positive runny nose and sore throat than non-pneumonia patients. Univariable analyses found mean odds ratios of 0.59 and 0.61 and 95% confidence intervals (CIs) of 0.30-1.16 and 0.32-1.17 for runny nose and sore throat, respectively, and multivariable analyses found mean odds ratios of 0.73 and 0.70 and 95% CIs of 0.34-1.56 and 0.34-1.46, respectively. Conclusion Our study found no statistically significant association between ENT symptoms and COVID-19 pneumonia. Clinicians should be aware that, unlike CAP, there is no correlation between ENT symptoms and pneumonia among patients with COVID-19, so it is necessary to consider the possibility of pneumonia even in the presence of ENT symptoms.

Investigation of Reflux Characteristics in Outpatients of Otorhinolaryngology-Head and Neck Surgery by Age and Gender in the Chinese Population

To investigate the characteristics of patients with reflux diseases in the otorhinolaryngology-head and neck surgery clinics through the Reflux Symptom Scale-12 (RSS-12) and the Gastroesophageal Reflux Disease Questionnaire (GERD-Q). All included patients completed the RSS-12 and GERD-Q scales and were considered to have LPR with an RSS-12 score >11 and GERD with a GERD-Q score >7. Data were analyzed according to genders (male and female) and age (18-40, 41-60, and >60 years). A total of 977 patients were included. the mean RSS-12 and GERD-Q score were 11.32±21.34 and 6.31±1.21, and the positive rate of LPR and GERD were 28.76% and 8.90%, respectively. Males had a higher positive rate of LPR and GERD than females, and there were more males with LPR who also had GERD. Among those with both LPR and GERD, males had significantly higher ear-nose-throat (ENT) symptom scores such as hoarseness and excess throat mucus than females. However, females had significantly higher scores of gastrointestinal (GI) symptoms, mainly indigestion and abdominal pain, and elder patients (>60 years) had higher scores of ENT, GI, respiratory symptoms, as well as the impact of symptoms on quality of life than the young patients (18-40, and 41-60 years). Patients in the otorhinolaryngology-head and neck surgery clinics have different reflux characteristics by gender and age in the Chinese population. Males had more severe ENT-related symptoms of distress, while females had more complaints of GI symptoms. Older patients had higher scores for ENT, GI and respiratory symptoms.

Frequency and Severity of Ear-Nose-Throat (ENT) Symptoms during COVID-19 Infection.

Background and Objectives: Coronavirus disease 2019 (COVID-19) is a new disease entity caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The main symptoms of infection at the onset of the pandemic include dyspnea, cough and high fever. Ear–nose–throat (ENT) symptoms are among the ones presented by patients in the course of infection. The aim of the study was to analyze the frequency of ENT symptoms and to assess their severity and duration in COVID-19 patients. Materials and Methods: The study included 337 patients who had been infected with SARS-CoV-2, as confirmed by a PCR test. The study participants were >18 years old; the mean age was 43.98 years ± 13.47 SD. The convalescents completed a questionnaire that contained 26 questions, including 9 detailed questions related to ENT symptoms, such as sore throat, vertigo, dizziness, hearing disorders, olfactory disorders, taste disturbance, headache, cough and dyspnea. The severity of symptoms was assessed using a Visual Analogue Scale (VAS). Results: The most reported ENT symptoms were olfactory disorders, which occurred in 72% of patients. The second most frequent symptom was taste disturbance (68%), VAS = 6.79 ± 3.01. Vertigo and dizziness were reported by 34% of respondents (VAS = 4.01 ± 2.01). Tinnitus was observed in 15% of patients, VAS = 3.87 ± 1.98; 14% of the subjects reported hearing impairment (VAS = 3.81 ± 2.37). Conclusions: Symptoms related to the sense of smell, taste and hearing are some of the most common symptoms in the course of COVID-19, which is important in the therapeutic and epidemiological management of patients. Delayed diagnosis and treatment of symptoms, especially those related to the hearing organ, may result in greater permanent damage.

Otorhinolaryngological Manifestations and Its Management in COVID 19 Patients.

COVID 19 pandemic is caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). The first case was identified in December 2019, in Wuhan, China. It is an infectious disease and has led to the ongoing global pandemic. This pandemic has also started in Assam, with its first case reported on 31 March, 2020. A prospective study was conducted on 2000 laboratory confirmed coronavirus cases. Proper history were taken and clinical examinations were performed. They were also advised to do the necessary blood investigations, electrocardiogram and chest X- rays. Olfactory functions were assessed using substances like scented soap, mint toothpaste, vicks vaporub, etc. Gustatory functions were also assessed. In our study, we found that 83% (1650) patients presented with otorhinolaryngological or ENT (Ear, nose, throat) manifestations and 17% (350) did not have any otorhinolaryngological manifestations. The most common ENT symptoms with which the patients presented were sore throat (80%) and headache (76%). The other ENT symptoms were hyposmia (44%), dysgeusia (32%) and nasal congestion (28%). The most common non-ENT symptoms were fever (92%) and cough (85%). The other non-ENT symptoms with which the patient presented were malaise, generalized bodyache and abdominal symptoms (like diarrhea). This prospective study gives a view of the incidence of otorhinolaryngological manifestations in COVID 19 patients. But, no significant co-relation was seen between presence of ENT symptoms and the severity of the disease. However, further studies are required to know the pathogenesis of causing ENT symptoms properly and also for definitive treatment of these symptoms.

Self-perceived general and ear-nose-throat symptoms related to the COVID-19 outbreak: a survey study during quarantine in Italy.

ObjectiveTo survey perceived general and ear-nose-throat (ENT) symptoms of COVID-19 in relation to psychological impact, mental health, perception of information and demographic characteristics in quarantined subjects during a lockdown period in Italy.MethodsParticipants were 1380 respondents who completed an online survey. A logistic regression model was used to evaluate the association between the independent variables and perceived symptoms.ResultsParticipants reported different prevalences of perceived ENT and general symptoms. Coryza, cough, sore throat and tinnitus were the most common symptoms, and there was a low prevalence of anxiety, depression and stress compared with the psychological impact of the symptom. Comparison of the two symptom groups demonstrated a common need for updates, their relationship with the media and correct information about the route of transmission.ConclusionsThe health information provided during a disease outbreak must be grounded in evidence. This would help to prevent adverse psychological reactions and somatization symptoms that can engulf healthcare systems, especially in clinical areas like ENT, which frequently treat airway problems.

Ear nose throat-related symptoms with a focus on loss of smell and/or taste in COVID-19 patients.

PurposeTo determine the frequency and severity of general and ear nose throat (ENT)- related symptoms, especially smell and/or loss of sense of taste (STL) in COVID-19 disease, as well as to investigate the recovery process of STL.Materials and methodsPatients with a positive COVID-19 diagnosis were given a questionnaire consisting of general questions (age, sex, date of symptoms, smoking history, concomitant diseases), questions about the most obvious symptom at presentation (one option only), the severity and frequency of symptoms (general and ENT), and STL (recovery time and degree of recovery).ResultsThe study population consisted of 172 patients, 18–65 years old (mean age, 37.8 ± 12.5 years; 51.2% female; 76.2% nonsmokers). Cough (n = 30, 17.4%) and loss of sense of smell (n = 18, 10.4%) were the most obvious general and ENT symptoms, respectively. Eighty-eight patients (51.2%) reported loss of sense of smell, and 81 patients (47.1%) reported loss of sense of taste. The mean recovery times for loss of sense of smell and loss of sense of taste were 8.02 ± 6.41 and 8.20 ± 7.07 days, respectively. The loss of sense of smell and loss of sense of taste were the unique symptoms in four (4.54%) and one (1.23%) patients, respectively.ConclusionSTL is a common symptom in COVID-19 and may be the first and/or only symptom of this disease. In patients presenting with STL complaints, surveillance for possible COVID-19 disease and screening tests will facilitate the struggle against the disease.

Clinical features of 1487 COVID-19 patients with outpatient management in the Greater Paris: the COVID-call study.

Clinical features of COVID-19 have been mostly described in hospitalized patients with and without ICU admission. Yet, up to 80% of patients are managed in an outpatient setting. This population is poorly documented. In France, health authorities recommend outpatient management of patients presenting mild-to-moderate COVID-19 symptoms. The aim of this study was to describe their clinical characteristics. The study took place in an emergency medical dispatching center located in the Greater Paris region. Patients included in this survey met confirmed COVID-19 infection criteria according to the WHO definition. We investigated clinical features and classified symptoms as general, digestive, ear–nose–throat, thoracic symptoms, and eye disease. Patients were included between March 24 and April 6 2020. 1487 patients included: 700 (47%) males and 752 (51%) females, with a median age of 44 (32–57) years. In addition to dry cough and fever reported in more than 90% of cases, the most common symptoms were general symptoms: body aches/myalgia (N = 845; 57%), headache (N = 824; 55%), and asthenia (N = 886; 60%); shortness of breath (N = 479; 32%) and ear–nose–throat symptoms such as anosmia (N = 415; 28%) and ageusia (N = 422; 28%). Chest pain was reported in 320 (21%) cases and hemoptysis in 41 (3%) cases. The main difference between male and female patients was an increased prevalence of ear–nose–throat symptoms as well as diarrhea, chest pains, and headaches in female patients. General symptoms and ear–nose–throat symptoms were predominant in COVID-19 patients presenting mild-to-moderate symptoms. Shortness of breath and chest pain were remarkably frequent.Electronic supplementary materialThe online version of this article (10.1007/s11739-020-02379-z) contains supplementary material, which is available to authorized users.

Protontherapy of head and neck paragangliomas: A monocentric study

PurposeThe aim of this study was to assess efficacy and safety of proton beam therapy of paragangliomas of the head and neck, rare benign tumours developed close to crucial structures such as cranial nerves and vascular tissues. Patients and methodsTen patients with a paraganglioma of the head and neck were treated from 2001 to 2014 with image-guided proton therapy. Neurological and ear nose throat symptoms were collected in addition to audiometric testing, before and after the treatment. Acute and late toxicities were assessed according to the Common Terminology Criteria for Adverse Events (CTCAE) v4. ResultsMedian age at diagnosis was 52.6years (range: 18.2–65.8years). Proton therapy was the exclusive treatment in six patients and four patients had a postoperative radiotherapy. Median dose was 50.4Gy relative biological effectiveness (RBE; range: 45.0–67.0Gy). With a median follow-up of 24.6months (range: 6.7–46.2 months), local tumour control rate was 100% (stable, n=10). No upper grade 2 acute toxicity was reported. To the latest news, seven patients had controlled symptoms (improved, n=1, stabilized, n=6). One patient out of seven with initial tinnitus had a decrease in his symptoms, while the six other patients had a sustained stabilization. ConclusionProton beam therapy is an effective and well-tolerated treatment modality of skull base paragangliomas, with documented functional benefit. A longer follow-up is planned in order to assess local control and long-term toxicities.

Association of dental and maxillary sinus pathologies with ear, nose, and throat symptoms.

To investigate the correlation between cone-beam computerized tomography (CBCT) findings in the maxillary sinus, ear-nose-throat (ENT) symptoms and dental pathologies in asymptomatic patients. A total 81 patients were referred for CBCT and filled a standard ENT visual analog scale (VAS) questionnaire. CBCT images were analyzed for sinus ostium obstruction, Schneiderian membrane thickening, sinus floor turbidity, and the presence of polyps. Dental pathologies were evaluated with the aid of CBCT images, periapical X-rays, and clinical examination. A possible correlation between the CBCT findings and the ENT/dental parameters was examined by applying Student's t test and the chi-squared test. Despite being asymptomatic, most of the 81 patients reported ENT symptoms in the questionnaire, thereby indicating that these symptoms were mainly subclinical. A significant correlation was found between the presence of polyps in the sinus and a decrease in smell/taste. Obstruction of the sinus meatus was associated with coughing; turbidity was associated with ear congestion. Thickening of the Schneiderian membrane showed an association with both coughing and ear congestion. The mean number of missing posterior teeth correlated with postnasal drip and nasal congestion. Periapical pathology was associated with nasal discharge/runny nose. The results emphasize the need to evaluate ENT symptoms when radiographic findings are identified in CBCT.

Granulomatosis With Polyangiitis Masquerading as Bilateral Trigeminal Neuralgia

A 32-year-old woman presented with symptoms of bilateral trigeminal neuralgia (TN) that has been refractory to empiric therapy. Imaging showed normal caliber trigeminal nerves with no evidence of nerve compression. Autoimmune etiology was considered due to unnatural presentation of symptoms. Workup revealed elevated perinuclear antineutrophil cytoplasmic antibody (P-ANCA) and elevated myeloperoxidase (MPO) antibodies suggestive of localized ANCA-related vasculitis. A literature review revealed one case, which illustrates granulomatosis with polyangiitis (GPA) causing the classical symptoms of TN in absence of its more common symptoms. Patient was started on methotrexate 15 mg weekly and low-dose prednisone daily with significant improvement in symptoms. Ear-nose-throat (ENT) manifestations of rheumatologic disorders represent a diagnostic challenge. ENT symptoms can often represent the initial sign of an otherwise asymptomatic and undiagnosed autoimmune disease process, which often calls for prompt and aggressive immunosuppressive treatment which leads to not only better control of TN symptoms but also we speculate that early immunosuppressive therapy will control the progression of the underlying autoimmune disease. J Med Cases. 2016;7(9):384-385 doi: http://dx.doi.org/10.14740/jmc2636e

Granulomatosis With Polyangiitis Masquerading as Bilateral Trigeminal Neuralgia

A 32-year-old woman presented with symptoms of bilateral trigeminal neuralgia (TN) that has been refractory to empiric therapy. Imaging showed normal caliber trigeminal nerves with no evidence of nerve compression. Autoimmune etiology was considered due to unnatural presentation of symptoms. Workup revealed elevated perinuclear antineutrophil cytoplasmic antibody (P-ANCA) and elevated myeloperoxidase (MPO) antibodies suggestive of localized ANCA-related vasculitis. A literature review revealed one case, which illustrates granulomatosis with polyangiitis (GPA) causing the classical symptoms of TN in absence of its more common symptoms. Patient was started on methotrexate 15 mg weekly and low-dose prednisone daily with significant improvement in symptoms. Ear-nose-throat (ENT) manifestations of rheumatologic disorders represent a diagnostic challenge. ENT symptoms can often represent the initial sign of an otherwise asymptomatic and undiagnosed autoimmune disease process, which often calls for prompt and aggressive immunosuppressive treatment which leads to not only better control of TN symptoms but also we speculate that early immunosuppressive therapy will control the progression of the underlying autoimmune disease. J Med Cases. 2016;7(9):384-385 doi: http://dx.doi.org/10.14740/jmc2636e

Outcome of Stretta radiofrequency and fundoplication for GERD-related severe asthmatic symptoms.

This study aimed to investigate the outcome of treatment with Stretta radiofrequency (SRF) or laparoscopic Nissen fundoplication (LNF). A total of 137 gastroesophageal reflux disease (GERD) patients with severe asthmatic symptoms who responded inadequately to medical treatment for asthma were investigated. The patients were followed up 1 year and 5 years after SRF (n = 82) or LNF (n = 55) treatment. A questionnaire covering 29 related symptoms and medication use was employed. Digestive, respiratory, and ear-nose-throat (ENT) symptom scores significantly decreased after antireflux treatment. Symptom scores respectively changed from 17.2 ± 10.1, 31.9 ± 6.6, and 21.1 ± 11.8 to 5.0 ± 6.2, 11.5 ± 10.2, and 6.3 ± 6.8 at 1 year and to 5.6 ± 6.5, 13.1 ± 10.1, and 7.8 ± 7.2 at 5 years (P < 0.001). The outcome of LNF was significantly better than that of SRF in terms of digestive (P < 0.001, P = 0.001), respiratory (P = 0.006, P = 0.001), and ENT symptoms (P = 0.006, P = 0.003) at both 1 year and 5 years. SRF and LNF were both effective against the digestive symptoms of GERD as well as GERD-related severe asthmatic and ENT symptoms, with better outcomes exhibited by the LNF group. Severe asthmatic symptoms and GERD were closely associated, and this finding warrants further study.

Diagnostic Value of Biopsies in Identifying Cytoplasmic Antineutrophil Cytoplasmic Antibody–negative Localized Wegener's Granulomatosis Presenting Primarily with Sinonasal Disease

A substantial proportion of Wegener's disease (WG) patients present with localized disease of the upper airways, i.e., sinonasal and other ear/nose/throat (ENT) symptoms. Because of the oligosymptomatic presentation a timely diagnosis of this potentially fatal disease is challenging. This study evaluates diagnostic peculiarities between WG in its localized and generalized form of the disease. Retrospective analysis was performed of 82 patients with suspected WG manifesting in the ENT region between 1989 and 2009. Comparison was performed of the clinical and laboratory results between patients with localized (n = 15) and generalized stage (n = 16) as well as non-WG patients (n = 50). ENT signs and symptoms were subtle, especially in the population presenting with localized disease. Therapy refractory rhinosinusitis or serous otitis media were the most frequent presentations of WG. In testing for localized WG, mucosal biopsy had the highest sensitivity (53%) compared with cytoplasmic antineutrophil cytoplasmic antibodies (c-ANCAs) with a lower sensitivity (47%) but highest specificity (96%) and highest positive predictive value (PPV; 78% versus 73%). Patients with generalized WG typically revealed a pathological urine sediment, hemoptysis, or rheumatological symptoms. In the generalized stage, c-ANCA had the highest sensitivity (81%), specificity (96% versus 95%), and highest PPV (87%). Timely diagnosis and treatment of localized WG limited to the ENT region remains problematic. Even with adequate therapy, nearly one-half of patients with sinonasal localization suffer from relapse, at least 1 in 10 will progress to generalized disease, and up to two-thirds may develop permanent tissue damage. Unfortunately, the diagnostic usefulness of c-ANCA is significantly reduced at this early stage compared with cases with generalized disease (p = 0.04). Hence, the relative diagnostic value of mucosal biopsy increases especially for the significant proportion of c-ANCA(-) localized WG patients (47%). Sinonasal tissue sampling represents a cornerstone for diagnosis, which unlike c-ANCA testing can be repeated in short intervals and is associated with low morbidity.

Penerapan Metode Certainty Factor Dalam Mendiagnosa Dini Penyakit Telinga Hidung Dan Tenggorokan

This study aims to diagnose ENT (Ear Nose Throat) disease through a computer-based system. Often people do not understand about the disease, and doctors are limited in serving the community. For the expert, the expert system can be used as an inexperienced assistant. Also for substituting human knowledge in the form of the system, so it can be used by many people. This application will assist in finding a conclusion illness with appropriate prevention. The application system is analyzed data ENT diseases and symptoms of the ENT disease. The method used is the Certainty Factor. Application development using PHP and MySQL for the database. The results showed that the system is built to provide information to visitors about the type of disease and its definition, diagnose symptoms experienced visitors, danmemberikan initial solution treatment. Keyword: certainty factor, expert system, ENT disease

8 OP Gastroesophageal reflux in patients with respiratory and ENT (Ear-Nose-Throat) symptoms: Role of 24-hour pH-monitoring

8 OP Gastroesophageal reflux in patients with respiratory and ENT (Ear-Nose-Throat) symptoms: Role of 24-hour pH-monitoring