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ABSTRACT: Gastroesophageal reflux disease typically manifests as heartburn and regurgitation, but it may also present with atypical or extraesophageal symptoms, including asthma, chronic cough, laryngitis, hoarseness, chronic sore throat, dental erosions, and noncardiac chest pain. Diagnosing atypical manifestations of gastroesophageal reflux disease is often a challenge because heartburn and regurgitation may be absent, making it difficult to prove a cause-and-effect relationship. Upper endoscopy and 24-hour pH monitoring are insensitive and not useful for many patients as initial diagnostic modalities for evaluation of atypical symptoms. In patients with gastroesophageal reflux disease who have atypical or extraesophageal symptoms, aggressive acid suppression using proton pump inhibitors twice daily before meals for three to four months is the standard treatment, although some studies have failed to show a significant benefit in symptomatic improvement. If these symptoms improve or resolve, patients may step down to a minimal dose of antisecretory therapy over the following three to six months. Surgical intervention via Nissen fundoplication is an option for patients who are unresponsive to aggressive antisecretory therapy. However, long-term studies have shown that some patients still require antisecretory therapy and are more likely to develop dysphagia, rectal flatulence, and the inability to belch or vomit.
Hoarseness in Adults - Article
ABSTRACT: Numerous conditions can cause hoarseness, ranging from simple inflammatory processes to more serious systemic, neurologic, or cancerous conditions involving the larynx. Evaluation of a patient with hoarseness includes a careful history, physical examination, and in many cases, laryngoscopy. Any patient with hoarseness lasting longer than two weeks in the absence of an apparent benign cause requires a thorough evaluation of the larynx by direct or indirect laryngoscopy. The management of hoarseness includes identification and treatment of any underlying conditions, vocal hygiene, voice therapy, and specific treatment of vocal cord lesions. Vocal hygiene education is an integral aspect of the treatment of hoarseness in most cases. Referral to a speech-language pathologist for voice therapy may be particularly helpful for patients whose occupation depends on singing or talking loudly or for prolonged periods. Voice therapy is an effective method for improving voice quality and vocal performance in patients with nonorganic dysphonia and for treating many benign pathologic vocal cord lesions. Referral for surgical or other targeted interventions is indicated when conservative management of vocal cord pathology is unsuccessful, when dysplasia or carcinoma is suspected, or when significant airway obstruction is present.
ABSTRACT: Hoarseness is the term often used by patients to describe changes in their voice quality. The causes of hoarseness are determined after obtaining a detailed medical history of the circumstances preceding the onset of hoarseness and performing a thorough physical examination. The latter may include visualization of the vocal cords, possibly using indirect laryngoscopy, flexible nasolaryngoscopy or strobovideolaryngoscopy. In the absence of an upper respiratory tract infection, any patient with hoarseness persisting for more than two weeks requires a complete evaluation. When the patient has a history of tobacco use, cancer of the head and neck must be considered and ruled out. Voice abuse is one of the most common causes of hoarseness and can lead to other vocal pathologies such as vocal nodules. Good vocal hygiene can prevent and treat some pathologies, and voice therapy is a cornerstone of management in some cases of hoarseness.