Cough Reflex Research Articles

Comparison of nebulisation 0.75% ropivacaine with 2% lignocaine for attenuation of haemodynamic response due to intubation: A prospective randomised study.

Laryngoscopy and intubation are associated with the reflex response of hypertension, tachycardia and other intraoperative complications. Nebulised route drug administration and entropy-guided induction enable optimal intubating conditions. To compare pre-induction nebulisation between 0.75% ropivacaine and 2% lignocaine in blunting the nasotracheal intubation response. A total of 100 patients undergoing elective faciomaxillary surgeries were prospectively randomised to receive pre-induction nebulisation: 5mL of 2% lignocaine (100mg) (Group L) or 5mL of 0.75% ropivacaine (37.5mg) (Group R). Patients were induced and intubated (nasotracheal) with entropy monitoring. Observed parameters included systolic blood pressure, diastolic blood pressure, mean arterial pressure, heart rate, entropy at baseline, induction, intubation, post-intubation one, three and five minutes, propofol induction dose, electrocardiogram changes and peri-intubation cough reflex. Ropivacaine aerosol proved significantly better than lignocaine aerosol on haemodynamics (systolic blood pressure, diastolic blood pressure, mean arterial pressure, heart rate) and cough reflex (p < 0.05). Both groups experienced similar entropy changes and propofol induction dose requirements and no fresh electrocardiogram changes (compared with the baseline). Pre-induction nebulised ropivacaine offers superior intubating conditions than lignocaine regarding haemodynamic response and cough reflex for faciomaxillary surgeries.

Factors Influencing Early Diagnosis and Poor Prognosis of Dysphagia After Senile Ischemic Stroke.

Dysphagia is often a long-term problem after ischemic stroke, which are often accompanied by complications and results in poor outcome. This study aimed to investigate the influencing factors associated with the prognosis of dysphagia after senile ischemic stroke and evaluate the diagnostic performance of crucial factors. A total of 192 elderly ischemic stroke patients (96 patients without dysphagia with average age of 69.81 ± 4.61years and 96 patients with dysphagia with average of 70.00 ± 6.66years) were enrolled in the retrospective study. The clinical factors of the patients were collected and recorded for chi-square analysis and logistic analysis. The receiver operating characteristic (ROC) curve was performed to evaluate the diagnostic performance of international normalized ratio (INR) and homocysteine (Hcy) in senile ischemic stroke patients. The age, cough reflex, history of stroke, mechanical ventilation, eating posture, insufficient elevation of the larynx, standard swallowing assessment (SSA) score, Hcy value, and INR were closely related to endpoint events of patients with dysphagia. The joint model (combined INR and Hcy value) can increase the area under the curve (AUC) value (0.948) with higher sensitivity and specificity for predicting patients with dysphagia occurred endpoint events.The influencing factors for older ischemic stroke patients with dysphagia include age, cough reflex, history of stroke, mechanical ventilation, eating posture, insufficient elevation of the larynx, SSA score, Hcy value, and INR. INR and Hcy were independent risk factors for prognosis and diagnostic markers for patients with dysphagia after senile ischemic stroke.

Derivation and validation of a quantitative risk prediction model for weaning and extubation in neurocritical patients.

Patients with severe neurological conditions are at high risk during withdrawal and extubation, so it is important to establish a model that can quantitatively predict the risk of this procedure. By analyzing the data of patients with traumatic brain injury and tracheal intubation in the ICU of the affiliated hospital of Hangzhou Normal University, a total of 200 patients were included, of which 140 were in the modeling group and 60 were in the validation group. Through binary logistic regression analysis, 8 independent risk factors closely related to the success of extubation were screened out, including age ≥ 65 years old, APACHE II score ≥ 15 points, combined chronic pulmonary disease, GCS score < 8 points, oxygenation index <300, cough reflex, sputum suction frequency, and swallowing function. Based on these factors, a risk prediction scoring model for extubation was constructed with a critical value of 18 points. The AUC of the model was 0.832, the overall prediction accuracy was 81.5%, the specificity was 81.6%, and the sensitivity was 84.1%. The data of the validation group showed that the AUC of the model was 0.763, the overall prediction accuracy was 79.8%, the specificity was 84.8%, and the sensitivity was 64.0%. These results suggest that the extubation risk prediction model constructed through quantitative scoring has good predictive accuracy and can provide a scientific basis for clinical practice, helping to assess and predict extubation risk, thereby improving the success rate of extubation and improving patient prognosis.

Eosinophilic Cationic Protein and Immunoglobulin E: Unraveling Biomarkers in Chronic Pediatric Cough

Although the cough reflex is one of the essential protective mechanisms in the respiratory tract, it is considered a considerable health problem in adults and children when it becomes chronic and hypersensitive. However, the need for biomarkers for chronic cough in children and adults is critical. The problem with cough is also a severe symptom in hypersensitivity children. Respiratory infections are a considerable challenge for pediatricians, especially in allergic children. The term cough hypersensitivity syndrome, although introduced in adults, was questioned for children. Eosinophil cationic protein (ECP) is a promising marker for chronic cough but still needs to be validated and proved in clinical settings. In this review article, we aimed to discuss the possible role of ECP in connection to IgE for chronic cough in children.

Pharmacokinetic Analysis of Levodropropizine and Its Potential Therapeutic Advantages Considering Eosinophil Levels and Clinical Indications.

Levodropropizine is a non-narcotic, non-centrally acting antitussive that inhibits the cough reflex triggered by neuropeptides. Despite the active clinical application of levodropropizine, the exploration of its inter-individual pharmacokinetic diversity and of factors that can interpret it is lacking. The purpose of this study was to explore effective covariates associated with variation in the pharmacokinetics of levodropropizine within the population and to perform an interpretation of covariate correlations from a therapeutic perspective. The results of a levodropropizine clinical trial conducted on 40 healthy Korean men were used in this pharmacokinetic analysis, and the calculated pharmacokinetic and physiochemical parameters were screened for effective correlations between factors through heatmap and linear regression analysis. Along with basic compartmental modeling, a correlation analysis was performed between the model-estimated parameter values and the discovered effective candidate covariates for levodropropizine, and the degree of toxicity and safety during the clinical trial of levodropropizine was quantitatively monitored, targeting the hepatotoxicity screening panel. As a result, eosinophil level and body surface area (BSA) were explored as significant (p-value < 0.05) physiochemical parameters associated with the pharmacokinetic diversity of levodropropizine. Specifically, it was confirmed that as eosinophil level and BSA increased, levodropropizine plasma exposure increased and decreased, respectively. Interestingly, changes in an individual's plasma exposure to levodropropizine depending on eosinophil levels could be interpreted as a therapeutic advantage based on pharmacokinetic benefits linked to the clinical indications for levodropropizine. This study presents effective candidate covariates that can explain the inter-individual pharmacokinetic variability of levodropropizine and provides a useful perspective on the first-line choice of levodropropizine in the treatment of inflammatory respiratory diseases.

Paraneoplastic Syndrome: A Missed Diagnosis

AbstractParaneoplastic syndrome can involve a single organ or diverse organ systems. It is one of the rare manifestations of occult malignancy. A 47-year-old female patient with history of recent suspected herpes infection presented with features of extensive skin darkening and thickening, associated with poor swallowing and cough reflex. Patient was not able to lift both arms nor able to sit or stand which was suggestive of proximal muscle weakness involving the shoulders and hip. Patient's initial workup for autoimmune disorders including dermatomyositis was negative. With paraneoplastic syndrome as differential diagnosis contrast-enhanced computed tomography chest and abdomen and tumor markers CA125 and CA19.9 done showed no evidence of occult malignancy. Patient was started on empirical steroids for polyradiculoneuropathy. After starting steroids patients was able to sit and walk with support. Patient was able to swallow liquids without aspiration. On regular follow-up over a period of 3 months, patient developed abdomen pain and abdominal distention which on evaluation showed ascites and multiple new cystic ovarian lesions suggestive of ovarian malignancy. Patient's CA125 was repeated and was markedly elevated. Patient was referred to an oncologist and was started on chemotherapy along with immunosuppressants. This case report emphasizes the need for regular follow-up of patients suspected of paraneoplastic syndrome. Although the initial workup for malignancy did not give a clue, on periodic review we were able to make the primary diagnosis and start appropriate treatment and achieve a better patient survival.

Transcutaneous auricular vagus nerve stimulation alters cough sensitivity depending on stimulation parameters: potential implications for aspiration risk.

Transcutaneous auricular vagus nerve stimulation (taVNS) is considered a safe and promising tool for limb rehabilitation after stroke, but its effect on cough has never been studied. It is known that the ear and larynx share vagal afferent pathways, suggesting that stimulating the ear with taVNS might have effects on cough sensitivity. The specific stimulation parameters used can influence outcomes. To investigate the effect of various stimulation parameters on change in cough sensitivity, compared to the reference parameter of 25 Hz stimulation at the left concha (most commonly-used parameter for stroke rehabilitation). Design, setting, and participants: Randomized, single-blind, active-controlled, eight-period cross-over design conducted March to August 2022 at a New Zealand research laboratory with 16 healthy participants. All participants underwent eight stimulation conditions which varied by stimulation side (right ear, left ear), zone (ear canal, concha), and frequency (25 Hz, 80 Hz). Main outcome measures: Change in natural and suppressed cough threshold (from baseline to after 10 min of stimulation) assessed using a citric acid cough reflex test. When compared to the reference parameter of 25 Hz stimulation at the left concha, there was a reduction in natural cough threshold of -0.16 mol/L for 80 Hz stimulation at the left canal (p = 0.004), indicating increased sensitivity. For the outcome measure of suppressed cough threshold, there was no significant effect of any of the stimulation conditions compared to the active reference. Since stroke patients often have cough hyposensitivity with resulting high risk of silent aspiration, using 80 Hz taVNS at the left canal may be a better choice for future stroke rehabilitation studies than the commonly used 25 Hz taVNS at the left concha. Treatment parameters should be manipulated in future sham-controlled trials to maximize any potential treatment effect of taVNS in modulating cough sensitivity. ACTRN12623000128695.

Predicting time to asystole following withdrawal of life-sustaining treatment: a systematic review.

The planned withdrawal of life-sustaining treatment is a common practice in the intensive care unit for patients where ongoing organ support is recognised to be futile. Predicting the time to asystole following withdrawal of life-sustaining treatment is crucial for setting expectations, resource utilisation and identifying patients suitable for organ donation after circulatory death. This systematic review evaluates the literature for variables associated with, and predictive models for, time to asystole in patients managed on intensive care units. We conducted a comprehensive structured search of the MEDLINE and Embase databases. Studies evaluating patients managed on adult intensive care units undergoing withdrawal of life-sustaining treatment with recorded time to asystole were included. Data extraction and PROBAST quality assessment were performed and a narrative summary of the literature was provided. Twenty-three studies (7387 patients) met the inclusion criteria. Variables associated with imminent asystole (<60 min) included: deteriorating oxygenation; absence of corneal reflexes; absence of a cough reflex; blood pressure; use of vasopressors; and use of comfort medications. We identified a total of 20 unique predictive models using a wide range of variables and techniques. Many of these models also underwent secondary validation in further studies or were adapted to develop new models. This review identifies variables associated with time to asystole following withdrawal of life-sustaining treatment and summarises existing predictive models. Although several predictive models have been developed, their generalisability and performance varied. Further research and validation are needed to improve the accuracy and widespread adoption of predictive models for patients managed in intensive care units who may be eligible to donate organs following their diagnosis of death by circulatory criteria.

Risk Factors of Non-Invasive Ventilation Failure in COPD Patients Presenting with Acute Exacerbation

Background: Non-invasive ventilation (NIV) is the first-line management for acute exacerbation of COPD (AECOPD), but some patients don’t improve and need invasive ventilation, leading to high mortality. We conducted a study to determine risk factors associated with NIV outcomes in these patients. Identifying predictive parameters of NIV failure could help timely intervention and prevent mortality. Methods: A Quasi Single Arm study was conducted at a tertiary care Hospital, in Karachi, from July to December 2022. We studied 170 COPD patients admitted to Medicine Department and Medical ICU with acute respiratory failure, among those 170 patients 80 were male and 90 were female, aged above 40 and below 80 years. Results: Among 170 AECOPD patients studied, 38% experienced NIV failure, while 61% had NIV success. In the NIV failure group, 38.46% of patients died in hospital. Most factors like quadrant infiltrate, weak cough reflex, low consciousness level, more requirements of oxygen, low pH, more respiratory rate, and positive blood cultures (p-value &lt;0.001) were significantly associated with NIV failure and mortality, while others with no significant association still contributed towards NIV failure, like co-morbidities. Out of the 66 patients with NIV failure, 56% experienced immediate failure, 33% had early NIV failure, and 11% had late NIV failure. Conclusion: Most identified risk factors significantly predicted NIV failure, suggesting they may serve as useful early indicators to guide intervention. Even non-significant factors still exhibited some association with NIV failure. Further research exploring additional predictors could optimize NIV outcomes and reduce mortality from AECOPD.

Cough Correlates of Functional Swallow Outcomes in Atypical Parkinsonism.

Swallow and cough impairments lead to aspiration and reduced clearance of aspirate material. Both behaviors are impaired in Parkinson's disease, but it is unknown whether a similar relationship of dysfunction exists in forms of atypical Parkinsonism (APD). Elucidating this association in APD may lead to early, comprehensive airway protection treatment. We tested the hypotheses that swallow deficits in APD are associated with impaired cough and that airway protective dysfunction is associated with longer disease duration. Swallowing difficulty was described by 11 participants with APD. Penetration-Aspiration Scale (PAS) and DIGEST scores for thin liquid trials were extracted from medical records of videofluoroscopic swallow study reports. Voluntary and capsaicin induced-reflex cough measures of flow, volume, and timing were analyzed. While most participants did not have post-swallow residue, ~80% received abnormal PAS scores and reported swallowing difficulty. Those with abnormal PAS scores had lower voluntary cough expired volume (P = 0.037; mean rank difference = 5.0); lower reflex inspiratory flow rate (P = 0.034; mean rank difference = 5.5); and longer reflex expiratory flow rise time (P = 0.034; mean rank difference = 5.5). Higher PAS scores and reduced reflex cough volume acceleration were significantly correlated (r = -0.63; P = 0.04) and longer disease duration predicted larger voluntary cough expired volume (R2 = 0.72) and longer flow rise times (R2 = 0.47). As swallow safety worsens, so might the ability to clear the airways with effective cough in in APD; particularly with longer disease duration. Assessing cough in conjunction with swallowing is important for informing airway protection treatment plans in APD.

Efficacy and safety of fospropofol disodium sedation for same-day bidirectional endoscopy in elderly patients: protocol for a prospective, single-center, randomized, double-blind, non-inferiority trial.

Fospropofol disodium is a novel prodrug that has improved pharmacokinetic and pharmacodynamic properties when compared with propofol. This trial aims to compare the efficacy and safety of fospropofol versus propofol sedation for same-day bidirectional endoscopy in elderly patients. This is a prospective, single-center, double-blind, randomized, propofol-controlled, non-inferiority trial. A total of 256 patients aged 65years or older, who are scheduled for same-day bidirectional endoscopy under sedation, will be randomly allocated, in a 1:1 ratio, to either fospropofol group or propofol group (n = 128 in each group). All patients will receive analgesic pre-treatment with sufentanil 5μg. Two minutes later, an initial bolus dose of fospropofol 6.5mg/kg or 1.5mg/kg propofol and supplemental doses of fospropofol 1.6mg/kg or 0.5mg/kg propofol will be titrated as needed to achieve target sedation levels during the procedures. The primary outcome is the success rate of same-day bidirectional endoscopy. Secondary outcomes include the time to successful induction of sedation, duration, time to being fully alert, time to patient discharge, endoscopist satisfaction, patient satisfaction, and the top-up frequency and dosage of sedative medications. The safety endpoints consist of adverse events concerning cough reflex, gag reflexes, body movement, muscular tremor, and pain on injection. Sedation-related AEs, including episodes of desaturation, severe desaturation (SpO2 < 90%), hypotension, severe hypotension (decrease in MBP ≥30% of baseline), and bradycardia, will also be recorded. Data will be analyzed on an intention-to-treat basis. We hypothesize that the efficacy and safety of fospropofol sedation for elderly patients undergoing same-visit bidirectional endoscopy will not be inferior to that of propofol. Our findings will potentially provide a new sedation regimen for same-visit bidirectional endoscopy in elderly patients. clinicaltrials.gov, identifier NCT02875639.

Inducing Cough Reflex by Capsaicin Spray Stimulation in Patients with Acquired Brain Injury: A Preliminary Test and Proof of Concept.

Individuals with acquired brain injuries (ABIs) may experience various complications related to poor coughing or impaired cough reflex (including risk of aspiration pneumonia or respiratory infections). For this reason, cough assessment is an important component in the clinical evaluation since patients with ABI are not able to cough voluntarily due to severe motor deficits. When voluntarily coughing is not possible, it is essential for clinical practices to find a quick and minimally invasive way to induce a cough reflex. In the present study, we evaluated the cough reflex in ABI patients using a new method based on a capsaicin spray stimulation test. In total, 150 healthy controls demographically matched with 50 ABI patients were included in this study. Clinical observations demonstrated robust cough response in both healthy controls and ABI patients, as well as the safety and tolerability of capsaicin spray stimulation. ABI patients with dysphagia were characterized by slower and delayed cough responses. Further studies are needed to validate this feasible, less-invasive, and simple-to-comprehend technique in inducing cough reflex. According to this preliminary evidence, we believe that this test might be translated into a simple and effective treatment to improve reflexive cough modulation in ABI patients.

RECENT ADVANCEMENTS IN COUGH MANAGEMENT: EMERGING STRATEGIES AND THERAPIES

The management of cough, a prevalent symptom impacting the quality of life, has undergone transformative developments propelled by recent research. Cough syrups, longstanding components in cough management, have witnessed substantial progress aimed at refining efficacy, safety, and targeted delivery. Modern formulations exhibit innovations in drug delivery systems, heightening bioavailability and allowing targeted drug release. Extended-release preparations and mucoadhesive syrups offer prolonged cough suppression or augmented expectorant effects. The incorporation of innovative compounds introduces diverse treatment options; transient receptor potential (TRP) channel antagonists, targeting cough receptors, prove effective in inhibiting cough reflex hypersensitivity, while anti-inflammatory agents address underlying airway inflammation. Natural remedies like ivy leaf extract, thyme, or licorice gain prominence for their antitussive and expectorant properties. Advancements in understanding cough pathophysiology enable tailored therapies for specific cough types or underlying causes. Specialized cough syrup formulations now address neuropathic cough, chronic cough associated with respiratory diseases, or cough triggered by gastroesophageal reflux, targeting the root causes of cough. This comprehensive review underscores the evolving landscape of cough management, encompassing enhanced formulations, novel compounds, and a nuanced understanding of cough pathophysiology. These advancements signify a paradigm shift in optimizing symptomatic relief and fostering an accelerated recovery process, marking a notable stride towards improving the overall well-being of individuals affected by cough.

Chronic cough and refractory chronic cough: An important distinction

Cough is the most common concern for which patients in the United States seek medical attention. Cough is typically classified according to its duration: acute cough (&lt;3 weeks), subacute cough (3‐8 weeks), and chronic cough (&gt;8 weeks). The vast majority of cases of acute cough in patients are due to an acute viral upper respiratory tract infection (common cold) and are self limited. Subacute cough is often due to a prolonged postviral cough. Once a cough meets the definition of chronic, it becomes likely that the cough is due to one or more treatable underlying etiologies: upper airway cough syndrome (formerly, postnasal drip syndrome), asthma and non-asthmatic eosinophilic bronchitis, and gastroesophageal reflux disease. Refractory chronic cough (RCC) refers to chronic cough that persists despite adequate therapeutic trials aimed at the known causes of chronic cough. The term cough hypersensitivity syndrome has recently been introduced to stress the concept that RCC is a distinct disease entity due to vagal hyperactivity causing hypersensitivity of the cough reflex. No medications have ever been approved for chronic cough or RCC in the United States and most of the world. Thus, physicians are limited to the use of off-label medications for their patients with this chronic and often debilitating condition. However, recent insights into the mechanisms of cough have resulted in multiple molecules currently being evaluated as potential antitussives. Among these, furthest along in the drug development pipeline are the P2X3-antagonists, of which, gefapixant has completed phase III trials, and camlipixant is currently in phase III studies.

Sensorimotor Cough Dysfunction in Cerebellar Ataxias.

Cerebellar ataxias are neurological conditions with a high prevalence of aspiration pneumonia and dysphagia. Recent research shows that sensorimotor cough dysfunction is associated with airway invasion and dysphagia in other neurological conditions and may increase the risk of pneumonia. Therefore, this study aimed to characterize sensorimotor cough function and its relationship with ataxia severity. Thirty-seven participants with cerebellar ataxia completed voluntary and/or reflex cough testing. Ataxia severity was assessed using the Scale for the Assessment and Rating of Ataxia (SARA). Linear multilevel models revealed voluntary cough peak expiratory flow rate (PEFR) estimates of 2.61L/s and cough expired volume (CEV) estimates of 0.52L. Reflex PEFR (1.82L/s) and CEV (0.34L) estimates were lower than voluntary PEFR and CEV estimates. Variability was higher for reflex PEFR (15.74% coefficient of variation [CoV]) than voluntary PEFR (12.13% CoV). 46% of participants generated at least two, two-cough responses following presentations of reflex cough stimuli. There was a small inverse relationship between ataxia severity and voluntary PEFR (β = -0.05, 95% CI: -0.09 - -0.01L) and ataxia severity and voluntary CEV (β = -0.01, 95% CI: -0.02 - -0.004L/s). Relationships between reflex cough motor outcomes (PEFR β = 0.03, 95% CI: -0.007-0.07L/s; CEV β = 0.007, 95% CI: -0.004-0.02L) and ataxia severity were not statistically robust. Results indicate that voluntary and reflex cough sensorimotor dysfunction is present in cerebellar ataxias and that increased severity of ataxia symptoms may impact voluntary cough function.

Comprehensive review of laryngeal nerve

The laryngeal nerve plays a crucial role in vital functions of the larynx, such as breathing, phonation, and airway protection. This review explores its intricate origination, extracranial pathways, anatomical variations, and functions. Emerging from the vagus nerve, it descends through the jugular foramen, exhibiting distinct pathways on each side of the body. Understanding these pathways is vital in surgery to prevent complications. Anatomical variations, including the non-recurrent laryngeal nerve and extralaryngeal branching, pose challenges during thyroid surgery. Surgeons must be vigilant, as failure to recognize these variations can lead to nerve injuries. Meticulous preoperative evaluation and surgical expertise are essential. The superior laryngeal nerve triggers protective reflexes like the cough reflex, safeguarding the respiratory tract. The recurrent laryngeal nerve controls crucial laryngeal muscles for phonation and respiration. Understanding these functions is paramount, especially for surgeons, ensuring optimal patient outcomes. In conclusion, this review underscores the laryngeal nerve's complexity and the need for in-depth knowledge, particularly in surgery. Ongoing research and medical advancements are crucial for refining techniques and enhancing patient care. Acknowledging these complexities empowers medical surgeons contributing to safer and more effective surgeries.

Maximal Expiratory Pressure and Its Link With Cough Airflow Before and After Expiratory Muscle Strength Training in Parkinson's Disease

Purpose: Expiratory muscle strength training (EMST) improves maximal expiratory pressure (MEP), and several researchers have reported improvements to voluntary cough airflow in people with Parkinson's disease (PD). However, the link between the change in MEP and cough and whether patient-specific factors impact the training response is not well understood. Therefore, study aims were to examine (a) the relationship between MEP and cough pre- and post-EMST, (b) the associations between the change in MEP and change in cough, and (c) if patient-specific factors predict the change MEP. Method: This is a secondary analysis of data from 30 people with PD who completed MEP and voluntary and reflex cough testing via spirometry pre– and post–5 weeks of EMST. Pearson's r correlations were used for Aims 1 and 2. Multivariable linear regression was used for Aim 3. Results: Pre-EMST correlations between MEP and cough as well as correlations between the change in MEP and change in cough were nonsignificant. Post-EMST, MEP was correlated with voluntary cough expired volume (CEV, r = .58 , p &lt; .001), peak expiratory flow rate (PEFR, r = .56 , p = .001), and cough volume acceleration ( r = .47 , p = .009 ) , as well as reflex CEV ( r = .5, p = .005). Patient-specific factors did not predict the change in MEP. Conclusions: This study showed that there was a larger correlation between expiratory muscle strength and cough airflow post-EMST than pre-EMST for voluntary and reflex cough in PD; however, the correlation between the change was small. Future research is needed to identify additional physiologic changes that are impacting cough airflow after EMST. Supplemental Material: https://doi.org/10.23641/asha.24602565

Laryngeal office-based procedures: A safe approach

PurposeLaryngeal surgeries using a flexible nasopharyngoscope equipped with an operative channel has gained popularity, with gradual increase in the variety of interventional office-based procedures, under local anesthesia. The purpose of this study is to analyze the tolerance of such procedures. Materials and methodsRetrospective cohort study. 337 cases were performed during 2 years. We collected the following data: type of pathology, type of procedure and modalities of anesthesia, adverse events. Results19 % of the visits were for the purpose of Biopsy, 65 % for an injection, and Trublue Laser was utilized in 12 % of the procedures. Regarding the pathologies, 27 % were vocal fold paralysis, 18 % leukoplakia or another suspicious lesion, 15 % recurrent respiratory papillomatosis, 13 % neuromuscular disorder, 9 % vocal fold scarring, 7 % vocal cord atrophy and 6 % had an inflammatory presentation. Side effects were documented in 26 visits (7.7 %) and were minor in almost all the encounters: they included strong reflexive cough, deep throat pain, discomfort, gag reflex, anxiety, vagal discomfort, malaise, hypersalivation, nose pain, labile hypertension. More severe side effects were very rare and included septal wound and epistaxis, erythematous rash, dyspnea, and transient dysarthria. 13 procedures were either aborted, or canceled at initial steps, due to inability of the patient to tolerate the procedure and were rescheduled for general anesthesia. 97 % of the cases were released home after 1 h of surveillance. ConclusionOffice-based flexible interventional laryngoscopy under local anesthesia is a safe and well-tolerated procedure, with abundance of various interventions feasible on ambulatory, office-based setup.

Comparison of direct effects of rice-thickened formula vs routine feeds on symptoms and gastroesophageal reflux indices: A crossover cohort study.

We compared the direct effects of routine vs rice-thickened formula on 24-h pH-impedance and symptom characteristics and then examined if dietary effects were modified by acid reflux index severity in infants. Forty infants under consideration for gastroesophageal reflux disease and therapies were evaluated at 43 ± 1 weeks postmenstrual age. Each infant was equally fed routine diet and thickened formula during evaluations. Postprandial sessions were analyzed for acid reflux index, reflux events, clearance times, distal baseline impedance, and symptoms. Thickened formula has no effect (P ≥ 0.05) on acid reflux events' characteristics or overall symptom frequency. However, refluxate height and frequency of weakly acidic events and cough were decreased (P < 0.05). Prolonged bolus clearance and a decrease in distal baseline impedance were noted with thickened feeds (vs routine feeds) when acid reflux index was >7 (P < 0.05). Our pH-impedance testing protocol identifies direct effects of potential therapies at the point of care. Acutely, thickened formula does not impact acid-specific reflux indices but decreases full-column reflux and cough reflexes. In those with an acid reflux index of >7, thickened formula prolongs the distal esophageal bolus clearance (the mechanisms of which are uncertain). Clinical trials are needed to clarify objective indications and therapeutic use of thickened formulas for infants with gastroesophageal reflux disease, along with short- and long-term side effects.

Cough and swallow after laparotomy in anesthetized cats

An anesthetized cat animal model was used to evaluate changes in cough and swallow after a small midline upper abdominal incision (laparotomy). Two additional conditions were tested: sealing the laparotomy with gentle suctioning via a small cannula, and subsequent closure of the abdominal wall with suture. These abdominal wall manipulations resulted in no changes in the cough reflex, but produced higher motor drive to pharyngeal musculature (thyropharyngeus and geniohyoid muscles) during swallow. Swallow-breathing coordination phase preference shifted towards swallow occurring more during the inspiratory phase. There were no significant changes in cough motor pattern, or cough and swallow number and temporal features. The respiratory changes were limited to reduced inspiratory motor drive to the diaphragm. The results are consistent with an important role of sensory feedback from the abdominal wall in regulation of swallow motor pattern. The level of reflex modulation may depend on the extent of injury and likely on its position in the abdomen.