Globus Sensation Research Articles

A review of frequently used Kampo prescriptions: Part 2—Hangekobokuto

AbstractBackgroundThe origin of hangekobokuto (HKT) is from Jin Gui Yao Lue (Kinkiyōryaku in Japanese), and it has been indicated for treating throat discomfort in women.Key FindingsHKT consists of five crude drugs. Clinical studies have shown that HKT can improve the swallowing reflex by increasing the substance P level in saliva; improve the cough reflex; reduce pneumonia in patients with dementia, cerebrovascular disease, Alzheimer's disease, or Parkinson's disease; reduce postoperative aspiration pneumonia in patients who undergo cardiovascular surgery; and improve depression and anxiety scores in patients with globus hystericus. Furthermore, HKT has been reported to increase serotonin (5‐HT) and noradrenaline levels in the hypothalamus, and dopamine (DA) levels in the striatum in a healthy rodent model; improve 5‐HT levels in the striatum and hippocampus, and ameliorate 5‐HT and DA reductions in the whole brain in an acute stress model; improve 5‐HT levels in the striatum, and ameliorate 5‐HT and DA reductions in the prefrontal cortex in a chronic stress model; and decrease corticosterone and corticotropin‐releasing factor levels in a chronic stress model. Reported adverse events of HKT include interstitial pneumonia (0.38 per 100 000 cases) and liver damage (0.89 per 100 000 cases), which are rare.ConclusionHKT is widely used and shows a low rate of adverse events. Several clinical studies have reported its effects in reducing aspiration pneumonia and improving depression and anxiety, some of which may be explained by the regulation of monoamines and stress hormones in the brain and substance P levels in the oral cavity.

The dynamics of deglutition during head rotation using dynamic 320-row area detector computed tomography.

We aimed to elucidate the dynamics of deglutition during head rotation by acquiring 320-row area detector computed tomography (320-ADCT) images and analyzing deglutition during head rotation. This study included 11 patients experiencing globus pharyngeus. A 320-ADCT was used to acquire images in two types of viscosity (thin and thick), with the head rotated to the left. We measured the movement time of deglutition-related organs (soft palate, epiglottis, upper esophageal sphincter [UES], and true vocal cords) and pharyngeal volume (bolus ratio at the start of UES opening [Bolus ratio], pharyngeal volume contraction ratio [PVCR], and pharyngeal volume before swallowing [PVBS]). A two-way analysis of variance was performed for statistical analysis, and all items were compared for significant differences in terms of head rotation and viscosity. EZR was used for all statistical analyses (p-value <.05). Head rotation significantly accelerated the onset of epiglottis inversion and UES opening compared with no head rotation. The duration of epiglottis inversion with the thin viscosity fluid was significantly longer. The bolus ratio increased significantly with thick viscosity. There was no significant difference in viscosity and head rotation in terms of PVCR. PVBS increased significantly with head rotation. The significantly earlier start of epiglottis inversion and UES opening due to head rotation could be caused by: (1) swallowing center; (2) pharyngeal volume; and (3) pharyngeal contraction force. Thus, we plan to further analyze swallowing with head rotation by combining swallowing CT with manometry and examine its relationship with pharyngeal contraction force. 3b.

Feasibility, and barriers to use escitalopram in functional gastrointestinal disorders.

Background and study aims: The feasibility and barriars of escitalopram use in patients with functional gastrointestinal disorders (FGIDs) are still debated. We aimed to evaluate the feasibility, safety and efficacy and barriars of escitalopram use in managing FGIDs in the Saudi population. Patients and Methods: We included 51 patients who received escitalopram for irritable bowel syndrome (n = 26), functional heartburn (n = 10), globus sensation (n = 10) or combined disorders (n = 5). We used an irritable bowel syndrome-severity scoring system IBS-SSS), GerdQ questionnaire and Glasgow Edinburg Throat Scale (GETS) to assess disease severity change before and after treatment. Results: The median age was 33 years (25th- 75th percentiles: 29-47), and 26 (50.98%) were males. Forty-one patients experienced side effects (80.39%), but most side effects were mild. The most common side effects were drowsiness/fatigue/dizziness (54.9%), xerostomia (23.53%), nausea/vomiting (21.57%) and weight gain (17.65%). IBS-SSS was 375 (255-430) and 90 (58-205) before and after treatment, respectively (p < 0.001). GerdQ score was 12 (10-13) before treatment and 7 (6-10) after treatment (p = 0.001). GETS score before treatment was 32.5 (21-46) and after treatment became 22 (13-31) (p = 0.002). Thirty-five patients refused to take the medications, and seven patients discontinued the medication. Possible causes of the poor compliance were fear of the medications and not being convinced of taking psychiatric medications for functional disorders (n = 15). Conclusion: Escitalopram could be a safe and effective treatment for functional gastrointestinal disorders. Targeting and managing factors leading to poor compliance could further improve the treatment outcome.

43/f-Cervical pain and globus sensation : Preparation for the medical specialist examination: part 40

43/f-Cervical pain and globus sensation : Preparation for the medical specialist examination: part 40

Vallecular Cholesterol Granuloma: Case Report

Introduction. Cholesterol granuloma is a rare benign cystic neoplasm characterised by a fibrous capsule, and a cystic fluid containing cholesterol crystals, multinucleated giant cells, erythrocytes and haemosiderin. Cholesterol granulomas are usually found in diverse parts of the temporal bone, most commonly – petrous apex. Very few cases of cholesterol granulomas in other organs have been reported, to our knowledge none are reported in the larynx. The main purpose of this case report is to highlight this extremely rare laryngeal lesion and its unique macroscopic appearance. Case report. A 55-year-old man is referred to the Ear, Nose and Throat Centre because of persistent hoarseness, globus sensation and complicated intubation due to a mass in the larynx. Videolaryngoscopy showed a large cyst-like mass in the vallecula, epiglottis was displaced towards the posterior pharyngeal wall and erythema of interarytenoid notch and arytenoid tubercle was present. A computerized tomography scan confirmed a cystic mass on the lingual surface of the epiglottis. On the basis of the examination and clinical symptoms, a diagnosis of chronic laryngitis, gastro-oesophageal reflux and an unspecified benign tumour of the respiratory system was made, surgical treatment was planned. The patient underwent microlaryngoscopy and surgical extirpation of the cyst using a CO2 laser, as the cyst was opened a yellowish, shiny, viscous fluid was observed. Two days later, laryngoscopy revealed fibrin plaque at the site of the cyst. Final diagnosis of cholesterol granuloma was formed based on histological examination of the mass. Conclusions. Cholesterol granulomas and masses in vallecula are extremly rare, but this case shows that cholesterol granuloma can be included in the differential diagnosis of cystic neoplasms of the larynx.

Outpatient Clinical Markers for Laryngopharyngeal Reflux Disease: A Correlational Study.

Laryngopharyngeal reflux disease (LPRD) is the result of retrograde flow of gastric contents to the laryngopharynx which comes in contact with tissues of the upper aerodigestive tract. Due to ill defined criteria for diagnosis & followup, LPRD patients are underdiagnosed & undertreated. Reflux Symptom Index (RSI) and the Reflux Finding Score (RFS) are two clinical methods which can be utilised especially in the outpatient setup. This study was done with the aim to assess various laryngoscopic findings in patients with LPRD diagnosed symptomatically and examine the correlation between the RSI & RFS by comparing these two indices. This prospective analytical study was conducted at a tertiary care centre in Bangalore in the Department of ENT for a period of 24months between Dec 2020 to Dec 2022. The study included patients aged 18 to 60years diagnosed with LPRD based on symptoms as per RSI score (> 13). RSI & RFS were assessed on diagnosis and patients were followed up for 1, 3 & 6months for assessment. Total 96 patients were enrolled, with mean age of be 42.49 ± 11.33 years. Prevalence was found to be more in females (61.5%). The most common symptom according to RSI was frequent throat clearing & globus sensation (sensation of something sticking in throat) and most common finding according to RFS was erythema/hyperemia. The mean score of RSI and RFI was found to reduce with treatment at different intervals in follow-up visits. There was a significant strength of association between the RSI and RFS at baseline, 1st month, 3rd month and 6th month of follow-up (r = 0.568, r = 0.684, r = 0.774, r = 0.736 respectively) (p < 0.001).The RFS and RSI showed statistically significant strong relationships between total scores and sign and symptom characteristics. On follow-up, there was a significant reduction in the RSI which was also correlated with a reduction in RFS.

Cribriform adenocarcinoma of the minor salivary glands: a case report

BackgroundPolymorphous adenocarcinoma is the third most common malignant salivary gland tumor. Within polymorphous adenocarcinoma, cribriform adenocarcinoma of salivary glands is a rare subtype and resembles papillary thyroid carcinoma histopathologically. Diagnostically, cribriform adenocarcinoma of salivary glands is challenging for pathologists and surgeons alike as initial presentation and cytologic nuclear features can be easily confused with papillary thyroid carcinoma arising from a thyroglossal duct remnant or lingual thyroid.Case presentationA healthy 64-year-old Caucasian woman presented to a community otolaryngologist with a 4-year history of progressive postnasal drip, globus sensation, and eventual dysphonia. Flexible fiberoptic laryngoscopy showed a large, smooth, vallecular lesion filling the oropharynx. Computed tomography imaging of the neck showed a rounded heterogeneous mass centered within the right aspect of the oropharynx measuring 4.2 × 4.4 × 4.5 cm. Fine needle aspiration biopsy was suspicious for papillary carcinoma due to microscopic findings of malignant cells, nuclear grooves, and a powdery chromatin pattern. In the operating room, the tumor was resected en bloc using a lateral pharyngotomy approach with partial resection of the right lateral hyoid. A limited cervical lymphadenectomy was performed to facilitate the lateral pharyngotomy approach and two out of three lymph nodes demonstrated regional metastatic disease. Nuclear grooves, nuclear membrane notching, and occasional intranuclear pseudoinclusions were identified, which are overlapping histopathological characteristics of papillary thyroid carcinoma and cribriform adenocarcinoma of salivary glands. It was negative for thyroglobulin and thyroid transcription factor-1, which was in keeping with cribriform adenocarcinoma of salivary glands rather than papillary thyroid carcinoma.ConclusionIt is difficult to distinguish cribriform adenocarcinoma of salivary glands from papillary thyroid carcinoma solely by cytology, and the distinct characteristics of regional lymph node metastasis coupled with nuanced histologic differences should be emphasized in the evaluation of patients presenting with neck lymphadenopathy and an unknown primary or tongue mass. If sufficient fine needle aspiration biopsy material is available, thyroid transcription factor-1, thyroglobulin, or molecular testing may prove useful in differentiating cribriform adenocarcinoma of salivary glands from papillary thyroid carcinoma. A misdiagnosis of papillary thyroid carcinoma may lead to inappropriate treatment including unnecessary thyroidectomy. Therefore, it is critical for both pathologists and surgeons to be aware of this uncommon entity to avoid misdiagnosis and subsequent mismanagement.

Nasal and laryngeal sporotrichosis in an immunocompetent individual: a case report

BackgroundSporotrichosis is a subcutaneous mycosis caused by a dimorphic fungus, Sporothrix schenckii infection, that usually results from the traumatic implantation of the fungus into the skin and subcutaneous tissue. Disseminated cutaneous sporotrichosis is a rare entity that usually presents in the immunosuppressed individual. They are sometimes mimicking malignancy and tuberculosis. Here, a rare case of disseminated cutaneous sporotrichosis involving the larynx and nasal cavity in an immunocompetent patient is reported.Case presentationA 54-year-old healthy lady presented with hoarseness and globus sensation over the throat with prior history of multiple skin lesions over the face, limbs, and trunk. Examination revealed erythematous papular lesions over the face, limbs, and trunk. Nasoendoscopy showed sloughy mucosa over bilateral nasal cavities, nasopharynx, base of the tongue, arytenoids, and both vocal folds with bony hard mass at the left frontal recess opening. Overall imaging features were suggestive of generalized fungal infections. Multiple biopsies from multiple sites revealed Sporothrix schenckii infection. She had resolution of the lesion after being treated with intravenous Amphotericin B for a month, oral Voriconazole for another month then oral Itraconazole for 6 months.ConclusionDiagnosis of disseminated sporotrichosis can be tricky and difficult to diagnose as it can mimic other diagnoses. Education is paramount important in identifying the illness as it can be seen in immunocompetent individuals, although it is more common in the immunosuppressed individual.

“Lump In The Throat”: Approach To Patient, Differential Diagnosis And Management

Feeling of lump in the throat is a common reason for referral of patients to the oto-rhinolaryngology and head and neck clinic. The impression of the referring physician notwithstanding, the onus is on the otorhinolaryngologist to objectively evaluate every patient and manage as appropriate. This review is a summary of scientific information search outcome from Medline bibliographic database, published scholarly references, abstracts and/or full texts of articles and textbooks. The focus is on clinical approach to the patient, differential diagnoses and management options, and the search terms were globus pharyngeus, lump in the throat, laryngopharyngeal reflux. In the present paper, we highlight a useful working guide for history taking, physical examination, investigation and management of a patient with complaint of lump in the throat.

Utilizing Trans-Oral Robotic Surgery (TORS) in head and neck malignancy – is it practical in oropharyngeal squamous cell carcinoma (OPSCC)? A case report

Introduction: Oropharyngeal squamous cell carcinoma (OPSCC) is often managed by multimodal methods, including open surgical resection and reconstruction in advanced cases. Trans-oral Robotic Surgery (TORS) was introduced to minimize and avoid complications caused by the open surgery method and chemo-radiation therapy in treating oropharyngeal squamous cell carcinoma (OPSCC). In Malaysia, TORS is still a new, rare, and limited surgical technique practiced in our healthcare system. Case Presentation: We present a case of the base of tongue lesion which presented with chronic globus sensation for four months associated with chronic dysphagia and cough. Endoscopy examination revealed a lobulated mass situated at the left side base of the tongue. Contrast Enhanced Computed Tomography (CECT) of the neck revealed an enhancing lesion at the same site. There were multiple subcentimeter cervical lymph nodes bilaterally from level II to level V. The patient underwent a TORS procedure using the da Vinci Surgery System for incisional biopsy. By using TORS, we were able to obtain a good tumor sample including the margins for the biopsy. Histopathology examination (HPE) of the sample reported moderate to poorly differentiated squamous cell carcinoma. Based on the HPE and CECT results, the patient was diagnosed with oropharyngeal squamous cell carcinoma (OPSCC) with a clinical stage of T3N2cMx. Conclusion: Management strategies for patients with OPSCC continue to evolve to minimize the morbidities and complications of treatments. Minimally invasive surgical techniques such as TORS offer impressive functional and oncologic outcomes particularly for patients (therapeutic function) compared to the traditional method of treatments.

Laryngeal Anaplastic Lymphoma Kinase-Positive B-cell Lymphoma: Case Report and Review.

Larynx is an uncommon extranodal site for non-Hodgkin lymphoma (NHL). Anaplastic lymphoma kinase (ALK)-positive B-cell lymphoma is a rare and aggressive form of NHL. A 19-year-old male presented to the ENT department with globus sensation, hoarseness, cervical lymphadenopathy and weight loss. A 70-degree rigid endoscopic examination of the larynx showed a vascular, irregular, submucosal mass arising from the right aryepiglottic fold causing near complete obstruction of the laryngeal airway. PET-CT showed hypermetabolic lesions in the supraglottis, cervical lymph nodes, cervical spine, ribs and abdominal lymph nodes. Biopsy was taken from the supraglottic mass as well as the enlarged cervical lymph nodes, which revealed ALK-positive large B-cell NHL. In this report, we present a rare case of ALK-positive large B-cell NHL of the larynx, discussing its clinical, radiological and pathological features. A limited review of literature is also presented. There is a need to develop a database for the description of lymphomas affecting the larynx and this case report adds to the existing knowledge of this rare entity.

Laryngeal Schwannoma Triggered Life-threatening Acute Airway Obstruction- A Rare Case Report with Review of Literature.

Schwannoma in larynx is a rare presentaion. Laryngeal schwannomas are characterstically slow growing benign tumour usually arising from false cord and aryepiglottic fold with globus sensation being the most common presentation. Seldom it can present as stridor which need immediate intervention for survival of the patient. We present a case of 53 year female who presented with stridor at emergency and emergency tracheostomy was done. This patient had a history of dysphagia to solid food, hoarseness of voice and symptoms of aspirations. 70 degree rigid endoscopy and CEMRI of neck was performed to see the extent of the laryngeal lesion causing stridor. Tumor was excised completely by external transcervical approach. Histopathological reports suggested this tumor as schwannoma. Large obstructive laryngeal schwannoma though a unusual presentation but with immediate tracheostomy, proper diagnostic work up and precise surgical approach can give excellent recovery and post operative outcome for the patient.

Current possibilities and challenges in the treatment of laryngopharyngeal reflux

Laryngopharyngeal reflux (LPR) is characterized by backflow of gastric or gastroduodenal content and gases into the upper aerodigestive tract, which can damage the mucus membranes of the larynx and pharynx. It is associated with avariety of symptoms such as retrosternal burning and acid regurgitation, or other unspecific symptoms such as hoarseness, globus sensation, chronic cough, or mucus hypersecretion. Due to the lack of data and the heterogeneity of studies, diagnosis of LPR is problematic and challenging, as recently discussed. Moreover, the different therapeutic approaches are also discussed controversially in the face of the poor evidence base, and include pharmacologic and conservative dietary measures. Hence, in the following review, the available options for treatment of LPR are critically discussed and summarized for daily clinical use.

Neurofibrolipoma of Hypopharynx: A Rare Entity.

A Large pedunculated neurofibrolipoma involving the hypopharynx is a very rare entity. Patient with hypopharyngeal polyp usually presents with progressive dyaphagia, sensation of persistent lump in throat and difficulty in breathing. Regurgitation of the mass into the airway can led to fatal asphyxiation on several occasions and may rarely cause death also if not evaluated and treated timely. Malignant degeneration of these large polyps occurs infrequently. We encountered a case with similar complaints in our outpatient department. After complete clinical examination, radiological investigations and anaesthetic evaluation; patient was taken for elective tracheostomy first and subsequently followed by successful transoral endoscopic excision of hypopharyngeal polypoidal mass. The histopathological examination of mass revealed it to be a neurofibrolipoma.

Subtotal esophagectomy with esophagogastroplasty after esophageal perforation and stent insertion: Case report of a challenging situation

We present a case of failure of uncovered metal esophageal stent removal, which was inserted after iatrogenic esophageal perforation during endoscopy. A 58-year-old male patient presented with dysphagia, chest pain, globus sensation and vomiting. Based on the data of the performed preoperative studies and to avoid the possibility of developing fatal complications (primarily aortoesophageal fistula) the surgical intervention was recommended. The successful subtotal esophagectomy with immediate esophagogastroplasty was then performed. The control X-Ray examination was performed at 6th p/o day, which reveals no extravasation and free passage of contrast to the distal part of GI tract. The patient started peroral eating and was discharged the Hospital at 7th p/o day. We consider, that this surgical procedure seems to be the most optimal and radical surgical intervention in case of failed esophageal stent placement.

"Hwabyeong", a Korean Cultural Syndrome

Hwabyeong is known as a Korean cultural-bound syndrome which is situated at the intersection between depression and anger syndrome. Translated as “anger illness” or “fire illness”, hwabyeong is a mental illness resulted from repressed feelings, which has a specific somatization in middle-aged Korean women: lump in throat or chest, feeling of suffocation, palpitations, heat sensation, burning feeling in the stomach, insomnia etc. While this syndrome is often stressed as a clinical study case, hwabyeong can also be found in Korean literature, proving the power it holds within the society. Two such cases from Korean contemporary literature are The Vegetarian, by Han Kang, and Kim Jiyeong, born 1982, by Cho Nam-joo. Despite the fact that no one mentions hwabyeong, the main characters show clear symptoms of the disorder. They also match the pattern of those who suffer from this disease. At first glance, someone might say they are gone mad, but looking more closely at their background, their symptoms and behavior, they are no different from many other Korean women. Yeong-hye and Kim Jiyeong are two women from South Korea who experience body rebellion because of society’s failure to let them express as individuals with personal needs, ambitions and feelings.

A Case Study of Korean Medical Treatment for Epigastric Pain and Insomnia after Gastrectomy

Objective: The purpose of this case study was to report the effects of Korean medicine treatment on a patient diagnosed with postgastrectomy syndrome (PGS).Methods: The patient was treated with herbal medicine, acupuncture, and moxibustion in combination with Western medicine for 3 months.Results: Though abdominal tenderness was maintained at a similar level, other clinical symptoms (epigastric pain, globus pharyngis, and epigastric pain) were improved after Korean medicine treatment.Conclusions: These results suggest that the need to promote practical research on PGS, should receive greater attention in the Korean medical community.

Burning mouth syndrome and Reflux Disease: relationship and clinical implications.

An association between reflux and burning mouth syndrome (BMS) has been proposed. Aims of this study were: 1) to investigate the frequency of BMS in a sample of GERD patients; 2) to measure G17, in a sample of BMS patients; 3) to assess the efficacy of different therapeutical schedules for GERD in BMS patients. We divided the study in 3 main steps. In step one, we analyzed 500 consecutive GERD patients' type and frequency of extraesophageal manifestations including BMS. In step two, we collected 124 consecutive BMS patients' symptoms and G17. In step three, we evaluate the efficacy of 3 different drugs on BMS. In step one, 204 patients complained heartburn; 31 globus pharyngeus; 52 chronic cough; 54 pharyngitis; 31 postnasal drip; 56 burning mouth symptoms; 34 noncardiac chest pain; 17 asthma and 21 sleep apnea. In step two, 29 patients had G17 ≤ 1 pg/L; 64 patients between 1 and 3; and 31 patients ≥ 3. In step three, 49 patients reported slight benefit with PPI, 75 no benefit. 61 patients reported slight benefit with sodium alginate and sodium bicarbonate, 63 no benefit. 23 reported an almost complete remission with HYCHSA, 26 slight benefit, 33 no benefit. Prevalence of BMS in GERD patients was similar to that reported for chronic chough and pharyngitis. Low levels of G17 were found in the majority of BMS patients. Finally, we observed a greater benefit from barrier drugs therapy than from PPI therapy in BMS patients. (www.actabiomedica.it).

An Ecological Context That Scars: Reflections on Three Nature Documentaries of 2020

An Ecological Context That Scars: Reflections on Three Nature Documentaries of 2020

Prevalence, Clinical Characteristics, and Treatment Response in Patients with Post Cricoid Inlet Patch—A Descriptive Retrospective Study

Abstract Objectives The aim of this study was to determine the incidence of post cricoid inlet patch (PC-IP) and to assess the clinical characteristics, pathological features, and treatment response. Materials and Methods A retrospective cross-sectional study was conducted from April 2016 to April 2021 in the tertiary gastroenterology unit of urban India. All patients with symptoms of globus sensation, chronic cough, heartburn, hoarseness, throat pain, dysphagia, and acid regurgitation after a thorough clinical examination underwent esophagogastroduodenoscopy by experienced endoscopists including biopsy. Sociodemographic data, symptoms and its duration, previous hospital visits, and chronic proton pump inhibitor (PPI) use were noted during the study. Results Three-thousand two-hundred fifty upper gastrointestinal endoscopies were performed during the study period. The prevalence of PC-IP was 2.7%, comprising 36.3% males and rest females. Mean age was 36.2 ± 17years. The most common symptom among these patients was globus sensation (81.8%) followed by acid regurgitation (75%), dyspepsia (64.7%), dysphagia (48.8%), throat pain (29.54%), chronic cough (22.72%), hoarseness (22.72%), and others (6.81%). Mean diameter of PC-IP was 1.5 ± 0.5 cm, more than one patch was found in 23.76% of patients. Histopathological examination showed heterotrophic gastric mucosa in 77.27%, out of which 38.23% had oxyntic type, 44.11% had mucoid type, and the rest had mixed cell type. On median follow-up after 20 months, 68.18% of patient had persistent symptoms, 77.27% were PPI responsive, and 22.73% were PPI refractory. On follow-up, 38.63% of patients had a repeat endoscopic procedure and biopsy (20.45%); none showed any changes in size or dysplasia. Conclusion Prevalence of PC-IP could be higher than the estimated. Careful examination of upper esophagus and use of narrow band imaging will increase the possibility of identifying IP. Those symptomatic patients need treatment with PPI, sometimes for long term. Ablative therapy with radiofrequency or argon plasma coagulation needs further clarification.