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Salt (NaCl), is an essential nutrient for survival, while excessive salt can be detrimental. In the fruit fly, Drosophila melanogaster, internal taste organs in the pharynx are critical gatekeepers impacting the decision to accept or reject a food. Currently, our understanding of the mechanism through which pharyngeal gustatory receptor neurons (GRNs) sense high salt are rudimentary. Here, we found that a member of the ionotropic receptor family, Ir60b, is expressed exclusively in a pair of GRNs activated by high salt. Using a two-way choice assay (DrosoX) to measure ingestion volume, we demonstrate that IR60b and two co-receptors IR25a and IR76b are required to prevent high salt consumption. Mutants lacking external taste organs but retaining the internal taste organs in the pharynx exhibit much higher salt avoidance than flies with all taste organs but missing the three IRs. Our findings highlight the vital role for IRs in a pharyngeal GRN to control ingestion of high salt.

Cerebrospinal fluid (CSF) in the subarachnoid space around the brain has long been known to drain through the lymphatics to cervical lymph nodes1-17, but the connections and regulation have been challenging to identify. Here, using fluorescent CSF tracers in Prox1-GFP lymphatic reporter mice18, we found that the nasopharyngeal lymphatic plexus is a major hub for CSF outflow to deep cervical lymph nodes. This plexus had unusual valves and short lymphangions but no smooth-muscle coverage, whereas downstream deep cervical lymphatics had typical semilunar valves, long lymphangions and smooth muscle coverage that transported CSF to the deep cervical lymph nodes. α-Adrenergic and nitric oxide signalling in the smooth muscle cells regulated CSF drainage through the transport properties of deep cervical lymphatics. During ageing, the nasopharyngeal lymphatic plexus atrophied, but deep cervical lymphatics were not similarly altered, and CSF outflow could still be increased by adrenergic or nitric oxide signalling. Single-cell analysis of gene expression in lymphatic endothelial cells of the nasopharyngeal plexus of aged mice revealed increased type I interferon signalling and other inflammatory cytokines. The importance of evidence for the nasopharyngeal lymphatic plexus functioning as a CSF outflow hub is highlighted by its regression during ageing. Yet, the ageing-resistant pharmacological activation of deep cervical lymphatic transport towards lymph nodes can still increase CSF outflow, offering an approach for augmenting CSF clearance in age-related neurological conditions in which greater efflux would be beneficial.

ObjectiveThe purpose of this study was to evaluate long-term outcomes of sphincter pharyngoplasties, including speech outcomes, revision surgeries, and postoperative incidence of obstructive sleep apnea (OSA).DesignRetrospective matched-cohort study SETTING: Two craniofacial centers in Los Angeles, CA PATIENTS: Patients (n = 166) with cleft lip and palate (CLP) or isolated cleft palate (iCP) who underwent sphincter pharyngoplasty from 1992 to 2022 were identified. An age- and diagnosis-matched control group of 67 patients with CLP/iCP without velopharyngeal insufficiency (VPI) was also identified.InterventionsThe pharyngoplasty group underwent sphincter pharyngoplasty, whereas the non-VPI group had no history of VPI surgery or sphincter pharyngoplasty.Main outcome measuresPostoperative speech outcomes, revision surgeries, and incidence of OSA were evaluated. Multivariable regression was used to evaluate independent predictors of OSA.ResultsAmong the patients in the pharyngoplasty cohort, 63.9% demonstrated improved and sustained speech outcomes after a single pharyngoplasty, with a median postoperative follow-up of 8.8 years (interquartile range [IQR], 3.6-12.0 years). One-third of the patients who underwent pharyngoplasty required a revision surgery, with a median time to primary revision of 3.9 years (IQR, 1.9-7.0 years). OSA rates increased significantly among the pharyngoplasty cohort, from 3% before surgery to 14.5% after surgery (p

Pharyngitis is an inflammatory condition of the pharynx and/or tonsils commonly seen in both children and adults. Viruses and bacteria represent the most common encountered etiologic agents—yeast/fungi and parasites are infrequently implicated. Some of these are predominantly observed in unique populations (eg, immunocompromised or unvaccinated individuals). This article (part 1 of 3) summarizes the impact of acute pharyngitis on the health care system and reviews the etiologic agents of acute pharyngitis, including both emerging and reemerging pathogens that health care providers should consider when evaluating their patients. Finally, it sets the stage for parts 2 and 3, which discuss the current and evolving state of diagnostic testing for acute pharyngitis. [ABSTRACT FROM AUTHOR]

Background Although polioviruses (PVs) replicate in lymphoid tissue of both the pharynx and ileum, research on polio vaccine–induced mucosal immunity has predominantly focused on intestinal neutralizing and binding antibody levels measured in stool. Methods To investigate the extent to which routine immunization with intramuscularly injected inactivated polio vaccine (IPV) may induce nasal and pharyngeal mucosal immunity, we measured PV type-specific neutralization and immunoglobulin (Ig) G, IgA, and IgM levels in nasal secretions, adenoid cell supernatants, and sera collected from 12 children, aged 2–5 years, undergoing planned adenoidectomies. All participants were routinely immunized with IPV and had no known contact with live PVs. Results PV-specific mucosal neutralization was detected in nasal and adenoid samples, mostly from children who had previously received 4 IPV doses. Across the 3 PV serotypes, both nasal (Spearman ρ ≥ 0.87, P ≤.0003 for all) and adenoid (Spearman ρ ≥ 0.57, P ≤.05 for all) neutralization titers correlated with serum neutralization titers. In this small study sample, there was insufficient evidence to determine which Ig isotype(s) was correlated with neutralization. Conclusions Our findings provide policy-relevant evidence that routine immunization with IPV may induce nasal and pharyngeal mucosal immunity. The observed correlations of nasal and pharyngeal mucosal neutralization with serum neutralization contrast with previous observations of distinct intestinal and serum responses to PV vaccines. Further research is warranted to determine which antibody isotype(s) correlate with polio vaccine–induced nasal and pharyngeal mucosal neutralizing activity and to understand the differences from intestinal mucosal immunity. [ABSTRACT FROM AUTHOR]

Purpose: Respiratory-swallow coordination (RSC) frequently changes in people with Parkinson's disease (PwPD). Little is known about how these changes relate to impairments in swallowing safety (penetration and aspiration) and efficiency (pharyngeal residue). Therefore, the aims of this study were to assess the relationships between RSC, pharyngeal residue, penetration, and aspiration in PwPD. Method: Twenty-four PwPD were recruited to undergo simultaneous assessment of RSC, swallowing safety, and swallowing efficiency. RSC was assessed using respiratory inductive plethysmography and nasal airflow and included measurements of respiratory pause duration, respiratory phase patterning, and lung volume during swallowing. Swallowing safety and efficiency were assessed using flexible endoscopic evaluation of swallowing, analyzed using the Visual Analysis of Swallowing Efficiency and Safety, and included measurements of pharyngeal residue, penetration, and aspiration. All data were blindly analyzed, with 20% of the data repeated for interrater reliability assessment. Multilevel statistical models were used to examine the relationships between RSC and swallowing. Results: A total of 812 swallows were analyzed from 24 participants. Only 33.4% of swallows exhibited the typical exhale-swallow-exhale pattern. Additionally, 95% of participants exhibited abnormal swallow function. More severe hypophar-yngeal residue ratings were associated with inhaling before the swallow compared to exhaling before the swallow. Additionally, more severe events of penetration and aspiration were associated with (a) inhaling before the swallow compared to exhaling before the swallow, (b) inhaling after the swallow compared to exhaling after the swallow, and (c) longer swallow-related respiratory pause durations. Inhaling after the swallow exhibited the strongest relationship with impairments in swallowing safety when compared to all other RSC variables. Conclusions: RSC exhibited significant relationships with pharyngeal residue, penetration, and aspiration in these PwPD. Clinicians should attend to RSC when assessing swallowing in PwPD. Future research is needed to examine if training an exhale-swallow-exhale pattern can be used to improve disordered swallowing in PwPD. [ABSTRACT FROM AUTHOR]

Purpose: Age- and disease-related changes in oropharyngeal anatomy and physiology may be identified through quantitative videofluoroscopic measures of pharyngeal area and dynamics. Pixel-based measures of nonconstricted pharyngeal area (PhAR) are typically taken during oral bolus hold tasks or on post-swallow rest frames. A recent study in 87 healthy adults reported mean post-swallow PhAR of 62%(C2-4)², (range: 25%-135%), and significantly larger PhAR in males. The fact that measures were taken after initial bolus swallows without controlling for the presence of subsequent clearing swallows was identified as a potential source of variation. A subset of study participants had completed a protocol including additional static nonswallowing tasks, enabling us to explore variability across those tasks, taking sex differences into account. Method: Videofluoroscopy still shots were analyzed for 20 healthy adults (10 males, 10 females, Mage = 26 years) in head-neutral position, chin-down and chin-up positions, a sustained /a/ vowel vocalization, and oral bolus hold tasks (1-cc, 5-cc). Trained raters used ImageJ software to measure PhAR in %(C2-4)² units. Measures were compared to previously reported mean postswallow PhAR for the same participants: (a) explorations of sex differences; (b) pairwise linear mixed-model analyses of variance (ANOVAs) of PhAR for each nonswallowing task versus postswallow measures, controlling for sex; and (c) a combined mixed-model ANOVA to confirm comparability of the subset of tasks showing no significant differences from postswallow measures in Step 2. Results: Overall, PhAR measures were significantly larger in male participants; however, most pairwise task comparisons did not differ by sex. No significant differences from postswallow measures were seen for 5-cc bolus hold, chin-down and chin-up postures, and the second (but not the first) of two repeated head neutral still shots. PhAR during a 5-cc bolus hold was most similar to postswallow measures: mean ± standard deviation of 51 ± 13%(C2-4)² in females and 64 ± 16%(C2-4)² in males. Conclusions: PhAR is larger in men than in women. Oral bolus hold tasks with a 5-cc liquid bolus yield similar measures to those obtained from postswallow rest frames. [ABSTRACT FROM AUTHOR]

Objective To describe Neisseria gonorrhoeae treatment failure to the recommended antimicrobial regimens (azithromycin, cefixime and ceftriaxone). Methods Our study was a longitudinal analysis of treatment failures from an observational open cohort of gonococcal infection cases collected in Québec, Canada (n  = 2547) between September 2015 and December 2019. Epidemiological and clinical data were collected using a self-administered questionnaire, direct case interviews and chart reviews. Antimicrobial susceptibility testing was performed using the agar dilution method. To be retained as a treatment failure, cases must have had (i) a laboratory-confirmed gonococcal infection; (ii) a documented treatment; (iii) a positive test of cure (TOC) performed within a defined period and (iv) no sexual contact (vaginal, oral or anal), even protected with a condom, between the beginning of treatment and the positive TOC. A broader definition, including suspected cases, was also examined. Results Among 1593 cases where a TOC was performed, 83 had a positive TOC: 11 were retained as treatment failure, and 6 were considered suspected cases (overall = 17/1593; 1.1%). Possible explanations for retained or suspected treatment failure included resistance to the antibiotics used for treatment (n  = 1), pharyngeal infection (n  = 9, of which 5 had been treated with ceftriaxone and 4 with other regimens); and azithromycin monotherapy (n  = 1). Some cases had more than one potential explanation. Conclusions Treatment failure occurred in 1.1% of cases of Neisseria gonorrhoeae infection for which a TOC was performed, including some cases of pharyngeal infection treated with ceftriaxone. [ABSTRACT FROM AUTHOR]

Dynamic nasopharyngeal collapse (NPC) is an obstructive upper airway disease that affects mainly the inspiratory phase of respiration in horses undergoing strenuous exercise. It occurs when the neuromuscular activity of the nasopharynx is overwhelmed by the intense negative pressures generated during exercise. This leads to collapse of at least one of the four components of the nasopharynx which is comprised of the two lateral walls, the dorsal roof and the ventral soft palate. As a result, the airway diameter and thus airflow become compromised. Even small changes in the airway diameter produces profound increases in negative inspiratory pressure, perpetuating the cycle of collapse. Compared to other dynamic upper respiratory tract disorders, the amount of literature on NPC as a disease entity is limited. The exact pathophysiology of NPC is unknown; however, it impacts up to one quarter of high‐performance equine athletes presenting for poor performance. There is currently no definitive treatment for this severely performance‐limiting condition. Thus, the prognosis for future athletic prognosis is guarded, with most horses being retired from racing or athletic use in general. Further research is warranted in this field to reduce the impact of disease and in turn, reduce the turnover rate and economic loss by enhancing the career longevity of elite equine athletes diagnosed with NPC. [ABSTRACT FROM AUTHOR]

Objective: To introduce a highly innovative imaging method to study the complex velopharyngeal (VP) system and introduce the potential future clinical applications of a VP atlas in cleft care. Design: Four healthy adults participated in a 20-min dynamic magnetic resonance imaging scan that included a high-resolution T2-weighted turbo-spin-echo 3D structural scan and five custom dynamic speech imaging scans. Subjects repeated a variety of phrases when in the scanner as real-time audio was captured. Setting: Multisite institution and clinical setting Participants: Four adult subjects with normal anatomy were recruited for this study. Main Outcome: Establishment of 4-D atlas constructed from dynamic VP MRI data. Results: Three-dimensional dynamic magnetic resonance imaging was successfully used to obtain high quality dynamic speech scans in an adult population. Scans were able to be re-sliced in various imaging planes. Subject-specific MR data were then reconstructed and time-aligned to create a velopharyngeal atlas representing the averaged physiological movements across the four subjects. Conclusions: The current preliminary study examined the feasibility of developing a VP atlas for potential clinical applications in cleft care. Our results indicate excellent potential for the development and use of a VP atlas for assessing VP physiology during speech. [ABSTRACT FROM AUTHOR]

Early detection of severe acute respiratory syndrome coronavirus 2 infection by diagnostic tests can prompt actions to reduce transmission and improve treatment efficacy, especially for vulnerable groups such as immunocompromised individuals. Recent evidence suggests that sampling the throat in addition to the nose improves clinical sensitivity during early infection for both antigen and molecular coronavirus disease 2019 tests. We urge test manufacturers to validate tests for use with throat swab, in combination with nasal swabs. [ABSTRACT FROM AUTHOR]

Objective: Oxaliplatin is a platinum-group chemotherapeutic agent commonly used in the treatment of colorectal cancer. In addition to hematological and gastrointestinal side effects, laryngopharyngeal dysesthesia associated with cold is reported as a rare side effect. In this article, seven cases with pharyngolaryngeal dysesthesia were presented and the diagnosis and treatment planning were reviewed in the light of literature findings. Material and Methods: Patient records of cancer patients with laryngopharyngeal dysesthesia were retrospectively analyzed between 2020 and 2023. Demographic characteristics, presenting complaints, vital signs, physical examination, and laboratory tests of the patients diagnosed with laryngopharyngeal dysesthesia were recorded. Results: Seven patients who had gastrointestinal malignancy and oxaliplatin chemotherapy were diagnosed with laryngopharyngeal dysesthesia. The symptoms most commonly developed due to cold weather. The symptoms of three patients had developed while receiving treatment, while four patients were admitted to emergency service after oxaliplatin infusion. The physical examinations revealed no pathological findings of the allergic reaction at presentation or during follow-up skin. Patients were monitored and nasal oxygen therapy was administered. A 5 mg intravenous infusion was given for anxiety symptoms in three patients. Patients were discharged after 4 hours of follow-up with resolution of all symptoms Conclusion: Laryngopharyngeal dysesthesia should be kept in mind in patients treated with oxaliplatin and presenting with shortness of breath and a feeling of suffocation after cold exposure. [ABSTRACT FROM AUTHOR]

Although swallowing has been reviewed extensively, the coordination of the phases of swallowing have not. The phases are controlled by the brainstem, but peripheral factors help coordinate the phases. The occurrence, magnitude, and duration of esophageal phase depends upon peripheral feedback activated by the bolus. The esophageal phase does not occur without peripheral feedback from the esophagus. This feedback is mediated by esophageal slowly-adapting mucosal tension receptors through the recurrent and superior laryngeal nerves. A similar reflex mediated by the same peripheral pathway is the activation of swallowing by stimulation of the cervical esophagus. This reflex occurs primarily in human infants and animals, and this reflex may be important for protecting against aspiration after esophago-pharyngeal reflux. Not only are there inter-phase excitatory processes, but also inhibitory processes. A significant inhibitory process is deglutitive inhibition. When one swallows faster than peristalsis ends, peristalsis is inhibited by the new pharyngeal phase. This process prevents the ongoing esophageal peristaltic wave from blocking the bolus being pushed into the esophagus by the new wave. The esophageal phase returns during the last swallow of the sequence. This process is probably mediated by mucosal tension receptors through the superior laryngeal nerves. A similar reflex exists, the pharyngo-esophageal inhibitory reflex, but studies indicate that it is controlled by a different neural pathway. The pharyngo-esophageal inhibitory reflex is mediated by mucosal tension receptors through the glossopharyngeal nerve. In summary, there are significant peripheral processes that contribute to swallowing, whereby one phase of swallowing significantly affects the other. [ABSTRACT FROM AUTHOR]

By summarizing and analyzing the diagnostic and treatment process of a case with atypical Stevens–Johnson syndrome (SJS) characterized by mucosal ulcerations of the pharynx and larynx, and reviewing related literature, we would like to remind that in the presence of unexplained mucosal lesions, atypical SJS should not be ignored. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of the present study is to (a) provide quantitative data on the growth of levator veli palatini (LVP), velopharyngeal (VP), and craniofacial dimensions in children under 12 months while controlling for corrected age and sex and (b) compare variability within age and sex groups. Method: Magnetic resonance imaging scans of 75 infants between 0 and 12 months were measured and divided into four age groups. These data were obtained as part of a larger retrospective study. Following exclusion criteria, scans were analyzed, and dependent variables were obtained. Results: There was a statistically significant (p < .0001) difference between corrected age groups on LVP muscle, VP, and craniofacial variables while controlling for sex. Significant growth effects were observed for LVP length (p < .0001), extravelar length (p < .0001), intravelar length (p = .048), midline thickness (p = .0001), origin-origin distance (p < .0001), velar length (p < .0001), velar thickness (p = .003), nasion-sella turcica distance (p < .0001), sella turcica-basion distance (p < .0001), and hard palate length (p < .0001). Significant sex effects were observed for pharyngeal depth (p = .026) and effective VP ratio (p = .014). When age was treated as a continuous variable, similar results were observed for all variables except pharyngeal depth. Within-group comparisons revealed the most variability occurs between 3 and 5.99 months for LVP and craniofacial variables and between 9 and 11.99 months of age for VP variables. Male participants demonstrated greater variability than female participants. Conclusions: Differences were observed in LVP, VP, and craniofacial variables in children under 12 months while controlling for sex. Males demonstrated larger values and greater variability for most variables. [ABSTRACT FROM AUTHOR]

Background: Many infectious diseases are diagnosed in emergency departments (ED) and patients are prescribed antimicrobial therapy. Results from cultures typically take a few days to become finalized. Following up on these results is necessary when medication changes are indicated due to results that show bacteria are resistant to the prescribed antibiotics. Involving pharmacists in assessing the culture and sensitivity results, and making interventions when needed, is an innovative way to ensure that patients receive appropriate antimicrobial therapy based on the culture and sensitivity data. This study analyzed the impact of pharmacist involvement in the ED's post-discharge positive culture review process on ED re-visits and hospitalizations. Methods : This single-center, pre- and post-implementation study examined the impact of pharmacist involvement in the post-ED visit culture review process on ED re-visits and hospitalizations. Positive microbiological results included documented growth from urine, skin and soft tissue, throat, blood, or stool cultures. Patients included in the study were of 18 years of age or older and had a positive culture result post ED-discharge. Patients were excluded from the study if they were admitted to the hospital or transferred to another facility. The primary outcomes included ED re-visits within 7 days and hospital readmissions within 30 days for the same condition. The secondary outcomes were percentage of pharmacist interventions accepted and types of pharmacist interventions implemented. Results : A total of 141 patients were included in the study, with 65 in the pre-implementation group and 76 in the post-implementation group. The primary outcome of ED re-visits within 7 days for the same condition occurred in 11 (17%) patients in the pre-implementation group and 5 (7%) patients in the post-implementation group (P =.0454). The primary outcome of hospitalizations within 30 days for the same condition occurred in 5 (8%) patients in the pre-implementation group and 1 (1%) patient in the post-implementation group (P =.0137). Seventeen (94%) out of the 18 pharmacist interventions were accepted and implemented. The intervention types implemented were to recommend to: change antibiotic (35%), not initiate antibiotic (24%), initiate antibiotic (24%), and continue antibiotic (18%). Conclusion : Pharmacist involvement in the ED post-discharge positive culture review process showed a decrease in ED re-visits and hospitalizations for the same condition. [ABSTRACT FROM AUTHOR]

This study evaluated the validity of pharyngeal 2D area measurements acquired from the lateral view for predicting the actual 3D volume in healthy adults during swallowing. Seventy-five healthy adults (39 females, 36 males; mean age 51.3 years) were examined using 320-row area detector computed tomography (320-ADCT). All participants swallowed a 10 mL honey-thick barium bolus upon command while seated in a 45° semi-reclining position. Multi-planar reconstruction images and dynamic 3D-CT images were obtained using Aquilion ONE software. Pharyngeal 2D area and 3D volume measurements were taken before swallowing and at the frame depicting maximum pharyngeal constriction. Pharyngeal volume before swallowing (PVhold) was accurately predicted by 2D area (R2 = 0.816). Adding height and sex to the model increased R2 to 0.836. Regarding pharyngeal volume during maximum constriction (PVmax), 2D area also exhibited acceptable predictive power (R2 = 0.777). However, analysis of statistical residuals and outliers revealed a greater tendency for prediction errors when there is less complete constriction of the pharynx as well as asymmetry in bolus flow or movement. Findings highlight the importance of routinely incorporating anterior–posterior views during VFSS exams. Future work is needed to determine clinical utility of pharyngeal volume measurements derived from 320-ADCT. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to investigate the normal volumetric space and variations in the measurements of different landmarks in adults with different skeletal relations of the maxilla and the mandible based on CBCT data. The study also analyses these landmarks to locate any correlations. Background: Numerous studies in orthodontics have found a relationship between orthodontic treatment and changes in the anatomy and function of the airway. Severe changes in airway morphology can cause breathing difficulties, lower quality of life, and even result in life-threatening conditions such as obstructive sleep apnoea. Consequently, orthodontic diagnosis and treatment planning require a thorough understanding of the airway space and its function. Methods: The present retrospective study was conducted using CBCT records of 120 adult patients, containing 40 samples of each skeletal class (20 males and 20 females). The boundaries were defined for the 3 major regions: the nasopharynx, the oropharynx, and the hypopharynx. Various measurements were recorded across these regions, as well as selective cephalometric landmarks. The obtained data was used to calculate average and standard deviation, while regression analysis was used to evaluate correlations and t-test was used to test statistical significance of gender differences. Results: The results demonstrate that skeletal Class III individuals exhibit a reduced airway volume in the nasopharynx compared to other groups, whereas skeletal Class II individuals displayed a diminished airway volume in the hypopharynx. A strong correlation was observed for Sella turcica parameters. There were no significant differences in skeletal parameters across genders. Nasopharynx cavity volume demonstrated significant differences between skeletal Class I–Class III as well as between skeletal Class II–Class III. Hypopharynx cavity volume also demonstrated significant differences between skeletal Class I–Class II and between skeletal Class II–Class III. Conclusion: The major findings are the presence of a reduced nasopharyngeal volume in skeletal Class III malocclusions while skeletal Class II individuals displayed a diminished hypopharyngeal volume, making these critical areas to consider during the diagnostic and orthodontic treatment planning stages. This study also revealed a consistent correlation between Sella turcica parameters across various facial skeletal profiles, with skeletal Class II patients exhibiting a distinct pattern and skeletal Class I and Class III demonstrating an average relationship. [ABSTRACT FROM AUTHOR]

Benign dendritic melanocytic proliferation is usually observed in the skin. We report an extremely rare case of a melanocytic lesion in the middle ear mucosa. Only 3 cases of melanocytic lesions in the middle ear have been reported. Our report is the only one that describes an adult with a melanocytic lesion in the middle ear that extended to the inner ear and nasopharyngeal mucosa. A 23-year-old female presented with profound sensory neural hearing loss and recurrent discharge from the right ear. Examination revealed a blue right tympanic membrane with a small perforation. Computed tomography scans and magnetic resonance imaging were performed. After surgical exploration and histopathological examination, the patient was found to have a benign melanocytic lesion in the right middle ear. Melanocytic lesions are commonly found in the skin. There are no previous reports have described adult patients with melanocytic lesions in the middle ear that extend to the inner ear and nasopharynx, which cause profound hearing loss with recurrent ear discharge. These patients require regular follow-up to assess the progression of the lesion and to watch for any malignant behavior. [ABSTRACT FROM AUTHOR]

Stilbonematinae are nematodes commonly found in shallow marine sands. They are overgrown by a genus- and species-specific coat of chemoautotrophic sulphur-oxidizing ectosymbiotic bacteria which profit from the vertical migration of their hosts through the chemocline by alternately gaining access to oxidizing and reducing chemical species, while in return, the host feeds on its symbionts. The subfamily exhibits a large morphological variability; e.g. the anterior pharynx is cylindrical in genera possessing a voluminous coat, but species with a bacterial monolayer possess a distinctly swollen corpus and therefore a tripartite pharynx. Since 18S-based phylogenetic analyses do not show close relationships between corpus-bearing species, we investigated the pharynx morphology using phalloidin staining in combination with confocal laser scanning microscopy, transmission electron microscopy and light microscopy in order to assess an independent evolution. The class-wide stable position of the subventral pharynx ampullae was used as a morphological marker. Ampullae are positioned at the anterior-most end of the isthmus in Cyathorobbea, further posterior in Catanema and Robbea and inside the corpus in Laxus oneistus. We therefore conclude an independent evolution of corpus enlargements within Stilbonematinae. This further suggests that pharynx morphology is driven by the volume of the symbiotic bacterial coat rather than phylogeny. Based on an existing mathematical model, an enlarged corpus should enable its bearer to ingest food in smaller quantities, in gourmet style, whereas a cylindrical pharynx would restrict its bearer to ancestral gourmand feeding. A review of pharynx types of Nematoda showed that the Stilbonematinae pharynx is substantially different compared to other tripartite pharynges. The lack of pharyngeal tubes and valves, the undivided corpus and evenly distributed nuclei in the isthmus warrant the definition of the "stilbonematoid" three-part pharynx. [ABSTRACT FROM AUTHOR]

The article focuses on a case study of a 15-year-old girl exhibiting chronic throat-squeezing behavior as a form of nonsuicidal self-injury (NSSI) following trauma. Topics include the prevalence and implications of NSSI among adolescents, the psychological impact of negative childhood experiences on such behaviors, and the effectiveness of sertraline treatment in reducing both depressive symptoms and the frequency of throat-squeezing behavior.

Introduction Laryngopharyngeal reflux (LPR) is a syndrome caused by reflux of gastric contents into the pharynx or larynx which leads to symptoms of throat clearing, cough, pain, sensation of something stuck in the throat and change in voice. Evaluation of symptoms using the Reflux Symptom Index is considered to be the basic diagnostic procedure. LPR therapy is complex and requires modification of patient’s lifestyle and habits. LPR treatment and management is supposed to reduce the acidity or stomach contents and neutralize acidopeptidic activity in larynx, pharynx and oesophagus. High dosages of PPI (proton pump inhibitors) have shown the best effects in reducing reflux. Aims and objectives: The goal of the current study is 1. To determine the effects of gastric reflux on larynx and pharynx both clinically and endoscopically. 2. To evaluate the effect of proton pump inhibitors along with lifestyle modifications on laryngeal reflux symptom index and reflux finding score. LPR was treated with PPI, alkaline alginates and standard reflux precautions (avoidance of coffee, tea, chocolate, soda, greasy, fried, fatty, and spicy foods, alcohol and smoking). Results: The study constituted of 150 patients coming to ENT OPD with symptoms of laryngopharyngeal reflux and having RSI >13. All patients were examined by 70-degree video-laryngoscope and were treated with proton pump inhibitors, alginates and lifestyle modifications. 80 of them recovered after 2 weeks of lifestyle modification and treatment and 63 recovered after a month while 7 remained symptomatic after 3 months of treatment as well. Conclusion: Laryngopharyngeal reflux (LPR) is common in ENT practice but requires careful diagnosis due to its non-specific symptoms. Accurate diagnosis ensures appropriate management and avoids the pitfalls of overdiagnosis in LPR cases. [ABSTRACT FROM AUTHOR]

Background: Natural head position (NHP), pharyngeal airway and maxillofacial growth pattern are correlated. The author's previous studies proved that following surgical correction of Skeletal Class II malocclusion, the over‐extended NHP returned upright, and the pharyngeal airway space (PAS) dimension expanded. Objective: The present study compares the post‐operative change in NHP and PAS after orthognathic surgery in Skeletal Class II and III malocclusion patients. Methods: Patients receiving orthognathic procedures to correct Skeletal Class II or III malocclusions were reviewed in this retrospective study. Pre‐operative and 6‐week post‐operative cone‐beam computed tomography datasets were collected. Variables representing the craniofacial pattern, the NHP and the PAS were measured three‐dimensionally. Post‐operative variables were compared with their pre‐operative counterparts using either repeat‐measure 2‐way analysis of variance or Wilcoxon matched‐pairs signed rank test. Results: Thirty cases of Skeletal Class II malocclusion and 13 cases of Skeletal Class III malocclusion were collected. Preoperatively, the inter‐group differences were significant in craniofacial pattern (68.14 ± 3.552 degree vs. 79.63 ± 2.497 degree, p <.0001) and the NHP (68.77 ± 11.02 degree vs. 82.83 ± 7.738 degree, p =.0002) while not significant in PAS; after surgery, the intergroup differences in craniofacial pattern and the NHP between groups decreased, and the PAS increased in both groups. Conclusion: Orthognathic surgery may improve compromised NHP and increase PAS in Skeletal Class II and III malocclusion patients. [ABSTRACT FROM AUTHOR]

Abstract Background While prior research on the SPC (second primary cancer) risk among pharyngeal carcinoma (PC) patients has been conducted in other regions, the European perspective is underrepresented. Our register-based cohort study aims to assess the subsite-specific risk of SPC among individuals initially diagnosed with a pharyngeal index tumour. Methods Standardized incidence ratios (SIR) of SPC were calculated relative to the general population for all patients diagnosed with a primary oropharyngeal, nasopharyngeal, and hypopharyngeal carcinoma (OPC, NPC, and HPC) in Finland during 1953–2021. Results A total of 4701 PC patients – 3320 men (71%) and 1381 women (29%) – were identified. The average and median follow-up times were 5.7 and 2.8 years, respectively. A SPC was diagnosed in 561 patients (11.9%): in 12.3% of men (n = 410) and 10.9% of women (n = 151). For male PC patients, the overall SIR for an SPC at any primary site was 1.83 (95% CI: 1.65–2.01). For female patients, the corresponding SIR was 1.89 (95% CI: 1.60–2.22). OPC and HPC showed increased risks for SPCs of the mouth/pharynx (SIR 4.41 and 6.91, respectively) and respiratory organs (SIR 3.51 and 4.80). OPC patients also had an increased risk in digestive organs (SIR 1.83). Male NPC patients exhibited increased risks for oral/pharyngeal, brain, and haematolymphoid SPCs (SIRs 5.14, 6.60, and 3.05, respectively). Conclusion PC patients face an 80% higher SPC risk, which persists decades after treatment. Healthcare professionals must be aware of this, providing counselling and encouraging a healthy lifestyle, including smoking cessation, while monitoring symptoms.

Laryngopharyngeal reflux (LPR) is characterized by the reflux of gastric contents into the pharynx or larynx and often presents with symptoms including but not limited to cough, throat clearing, sore throat, globus, and dysphonia. Unlike gastroesophageal reflux disease (GERD), LPR is a relatively understudied syndrome, and knowledge regarding the diagnostic and treatment strategies, as well as the psychosocial impact continues to evolve. No singular test or procedure currently exists as a gold standard for LPR diagnosis. While laryngoscopy or pH monitoring may be positive, this does not exclude the contribution of non-gastroenterological processes. Prior research into psychosocial impact demonstrates a significant increase in symptom burden when comparing patients with laryngeal symptoms to controls and those with isolated GERD symptoms. However, these data are limited by the absence of physiologic data to correlate with the reported symptoms and survey responses. This knowledge gap highlights the need for further research to investigate the relationship between symptom burden and pathologic acid reflux on quality of life (QOL), anxiety, and depression. Ultimately, future studies to directly analyze these variables will help to guide treatment strategies and improve QOL in these patients.

Background: The functional relationship of striated esophagus (St.Eso) motor function with pharyngeal deglutitive biomechanical events has not been systematically studied. The aim of this study was to determine the spatio‐temporal characteristics of St.Eso function and its correlation with pharyngeal biomechanics and bolus transport. Methods: We studied 50 healthy volunteer subjects (age range: 21–82 years, 31 female) by digital videofluoroscopy. All subjects were studied in a seated, upright position. Thirteen of these 50 volunteers also underwent high‐resolution manometry (HRM) concurrent with fluoroscopy. We used laryngeal excursion as a surrogate for St.Eso excursion. Key Results: Median duration of St.Eso excursion was 2.35 [1.93,2.85, 5th and 95th percentile] seconds. Mean maximum extent of St.Eso excursion was 2.84 ± 0.72 cm. We identified four distinct periods in deglutitive St.Eso motor function: P1. Anterosuperior ascent without bolus or peristaltic activity, P2. Non‐peristaltic bolus receiving at the apogee of St.Eso excursion concurrent with UES opening and pharyngeal peristalsis P3. Peristaltic bolus transport as St.Eso descends and P4. Continued peristalsis in resting position. Conclusions and Inferences: 1. St.Eso motor function spans both pharyngeal and esophageal phases of swallowing for receiving and transporting the bolus, 2. Pressure signatures in HRM recordings currently attributed to St.Eso deglutitive motor activity does not represent the entirety of St.Eso peristalsis, only the part that occurs in its resting position. St.Eso peristalsis that occurs during its descent is recorded by pressure sensors initially in the pharynx. This finding needs to be considered when interpreting HRM recordings of the pharynx and proximal esophagus. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the influence of common pediatric orthodontic appliances on velopharyngeal (VP) MRI and to compare MR image sequences to determine if sequence parameters impact the visibility of key VP structures commonly assessed in clinical VP MRI. Design: Participants undergoing orthodontic treatment completed a VP MRI study. Level of distortion caused by orthodontic devices on 8 anatomical sites of interest and using variable MRI sequences was evaluated. Setting: Single institution Participants: Nineteen participants undergoing orthodontic treatment. Main Outcome: Level of distortion caused by metal artifacts and MR sequence used. Results: The results of this study demonstrate that appliances such as hyrax palatal expanders and braces with stainless steel brackets are acceptable for a VP MRI, while class II corrector springs are not recommended. The HASTE MRI sequence with 2D imaging techniques should be utilized if the child has orthodontic devices, while FSE and 3D imaging techniques are not recommended. The presence of wire spring coils and molar bands are likely to not to interfere with the MRI evaluation. Conclusions: Findings from this study suggest that the presence of orthodontic appliances does not hinder visualization of all velopharyngeal structures during an MRI. Therefore, careful consideration must be made prior to disqualifying or recommending patients for VP MRI. [ABSTRACT FROM AUTHOR]

The mouthparts of the pterygosomatid mite, Pterygosoma pseudotrapelus (Bochkov, Melnikov et Nazarov, 2009) (Acariformes, Pterygosomatidae), were studied with light microscopy, scanning (SEM) and transmission (TEM) electron microscopy. The mouthparts are located within the (pseudo)tagma gnathosoma. The gnathosoma is formed of the two frontal body segments with their appendages – chelicerae and pedipalps (palps). The two-segmented chelicerae occupy a dorsal position, whereas the infracapitulum – a derivative of the fused palp coxae – occupies a ventral position. The basal cheliceral segments are widen basally, and contain protractors and retractors of the movable digits and nerve fibres. The distal cheliceral segments, the movable digits, are small and stout, bear a lateral spur, and are provided with tips looking aside. The fixed digits are long and branched. The frontal projection of the infracapitulum, the hypostome, partly envelopes laterally the distal cheliceral portions. The dorsal wall, or the roof of the infracapitulum, consists of the long labrum anteriorly possessing its own muscles and the complexly organized epistome posteriorly. The epistome and its posterior projections – the epistomal apodemes serve for origin of the pharyngeal dilators. The wide cap-shaped pharynx goes along the bottom of the infracapitulum and attaches to it. The two sigmoid pieces articulate posteriorly to the epistome and serve for origin of different sets of muscles performing retraction and protraction of the chelicerae and retraction of the gnathosoma. The peritremes are exceedingly long and protrude freely above the chelicerae. The general architecture of the mouthparts of P. pseudotrapelus corresponds more to the anystid than eleutherengonid ground pattern. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to compare the effects of two different mandibular advancement devices on the upper airway volume, polysomnographic parameters, and sleepiness scale scores in patients with obstructive sleep apnea and Temporomandibular disorders (TMD). Materials and methods: Monoblock and twinblock mandibular advancement devices were applied to patients with obstructive sleep apnea syndrome for 3 months separated by a wash-out period of 2 weeks. Research Diagnostic Criteria for TMD (RDC/TMD), Polysomnographic parameters and cone-beam computed tomography findings were recorded before and after the use of the mandibular advancement devices. A three-dimensional analysis of the airway was then performed. Results: The use of the monoblock device significantly increased the upper airway volume compared with the use of the twinblock device (p = 0.032). The polysomnographic parameters similarly improved with the use of the twin-block and monoblock devices. The significant reduction in TMD symptoms was observed. Conclusion: The use of the monoblock device increased the retropalatal airway volume. This volume increase may be attributed to the fact that the design of the monoblock device allows less mandibular movement than does that of the twinblock device. Indicates the potential benefits of MADS treatment in alleviating TMD-related issues. Clinical significance: Monoblock MADs have improved effects on respiratory parameters and upper airway dimensions in patients with OSA and mild to moderate TMD. [ABSTRACT FROM AUTHOR]

Lower esophageal sphincter (LES) pathophysiology has been established in gastroesophageal reflux disease (GERD); however, less is understood regarding the role the upper esophageal sphincter (UES) plays in preventing laryngopharynphageal reflux. Sustained UES basal pressure prevents reflux into the pharynx while allowing relaxation during ingestion. We investigate whether GERD influences UES function via HRM and pH Impedance testing. A retrospective analysis of 318 patients who underwent high‐resolution manometry with trans‐nasally placed manometric catheter and 24‐h multichannel intraluminal impedance pH monitoring. One hundred and forty‐seven patients met Lyon consensus criteria for GERD based on acid exposure time >6%. The most common chief concern was heartburn or reflux, present in 59% of these patients. Upper esophageal sphincter basal and residual pressures were not significantly different between patients with GERD when compared to those without GERD, including a subanalysis of patients with extraesophageal symptoms. The LES basal and residual pressures, DCI and MNBI are statistically lower in patients with pathologic GERD. HRM and pH Impedance testing demonstrates no difference in UES basal and residual pressures based on pH diagnosis of GERD. We redemonstrate the association with hypotonic LES, diminished DCI and MNBI with GERD. [ABSTRACT FROM AUTHOR]

The intranasal route enables direct delivery of multiple substances from the nose to the brain, through olfactory and trigeminal pathways, bypassing the blood–brain barrier and avoiding systemic absorption. Despite the potential of this route, the various administration approaches make data reproducibility and interpretation challenging, emphasizing the necessity to establish a consistent methodology. Considering this, the aim of our study was to assess and compare the distribution of two dye volumes (30 µl and 50 µl) in the nasal cavity of rat cadavers. We employed three distinct methods of intranasal delivery: nose drops, by pipette tip, or cannula inserted into the nasal cavity. The results indicated that for both volumes, using the nose drops and the pipette tip methods, the dye dispersion occurred mainly in the vestibule, respiratory and olfactory regions, without reaching the olfactory bulbs. Using the cannula method, the deposition predominantly occurred in the respiratory and olfactory regions, with the dye reaching 66.7% and 100% of the olfactory bulbs, respectively, to low and high volume. Furthermore, the results demonstrated differences between the two volumes, in the pharynx, larynx, trachea, septal window, and incisive papilla, where an increased dye presence was observed with the 50 µl instillation across all three methods. According to our results, the intranasal delivery with a cannula was the most effective method for dye deposition in the olfactory region. However, further studies in live animals will be necessary to determine and refine the administration method that consistently allows specific deposition in the olfactory system. [ABSTRACT FROM AUTHOR]

Background: Modification of foods or liquids is commonly administered as part of dysphagia treatment. However, no consensus exists on the parameters for defining texture‐modified food for patients with dysphagia. Objectives: The aim of this study was to evaluate the effect of food/liquid material on swallowing physiology in patients with dysphagia and to discuss the optimal food choice for direct swallowing therapy. Materials and Methods: A total of 140 patients underwent a videofluoroscopic swallowing study using three test foods/liquids: 3 mL of mildly thick liquid (Thick liquid), jelly made of agar and polysaccharide [ABSTRACT FROM AUTHOR]

Objective: In pharyngeal dysphagia, poor pharyngeal contraction and upper esophageal sphincter (UES) dysfunction result in post‐swallow saliva residue (SR). This study aimed to clarify the relationship between swallowing pressure and SR in the valleculae and piriform sinuses on flexible endoscopic evaluation of swallowing (FEES). Methods: Pharyngeal dysphagia patients with Wallenberg syndrome were included. Amounts of post‐swallow SR in the valleculae and piriform sinuses were classified into four grades using SR scores based on FEES. The Hyodo score was also calculated to evaluate swallowing function. High‐resolution manometric data in the nasopharyngeal, oropharyngeal, hypopharyngeal, oro‐hypopharyngeal, and UES zones on swallowing were obtained for comparison with SR and Hyodo scores. Results: Of the 31 recruited, data from 26 patients who successfully underwent FEES and manometry were analyzed. Vallecular SR scores were strongly negatively correlated with a maximum pressure of the oropharynx (r = −0.52, p = 0.006), distal contractile integrals (DCI) of the oropharynx (r = −0.52, p = 0.007), and DCI of the oro‐hypopharynx (r = −0.55, p = 0.004). Hyodo scores for parameters 1 and 4 (corresponding to salivary pooling and pharyngeal clearance, respectively) were strongly negatively correlated with a maximum hypopharyngeal pressure (r = −0.57, p = 0.002) and strongly positively correlated with peristaltic velocity (r = 0.53, p = 0.007), respectively. SR scores and Hyodo scores related to SR were not correlated with pressure data of the UES. Conclusion: Manometric analysis of our SR scoring method using FEES revealed that a higher amount of SR in the valleculae, but not in the piriform sinuses, is associated with weaker pharyngeal pressure in pharyngeal dysphagia, especially at the oropharyngeal level. Level of Evidence: 4 Laryngoscope, 134:3519–3526, 2024 [ABSTRACT FROM AUTHOR]

Earthworms have a complex digestive system consisting of the mouth, pharynx, esophagus, crop, gizzard, and intestine which work together to pass the soil out. The gut soil and associated microbial load in earthworms' gut hinder the outcome of many experiments like in-vitro regeneration, histology, immunohistochemistry, molecular expression and toxicological studies. Currently, the available gut cleaning techniques are time-consuming and costly. The tissue paper method takes 4-7 days; the agar-agar method takes around 3-5 days to clean the gut. Therefore, refined techniques are needed to reduce the gut cleaning process in a cost-effective and at the same time in a minimum number of days. Bisacodyl is a medication used to treat constipation and it acts as a laxative drug that increases peristatic movement of the gut. It can also be used to cleanse the intestines before a bowel examination or surgery. The present study aims to enhance the gut-cleaning process in earthworm, Eudrilus eugeniae , using the drug bisacodyl. Briefly, the earthworm is exposed to different concentrations (1 mg, 2 mg, 4 mg, 6 mg, 8 mg and 10 mg) of bisacodyl and analyzed for its excretion rate. We observed that 4 mg is more efficient and aids in cleaning the earthworm's gut within two days. A lower bisacodyl concentration is inefficient in cleaning the gut in a shorter duration while at higher bisacodyl concentrations, worm experienced autotomy. Since the drug was active for only 45 mins, the worm became normal one hour after withdrawal from the experiment. Other than E. eugeniae , for Perionyx excavatus we observed 4 mg bisacodyl drug is efficient and aids in cleaning its gut within two days. Overall, the designed protocol is efficient for gut cleaning in a shorter duration in a cost-effective manner. [ABSTRACT FROM AUTHOR]

Objective: Hemangioma is a common benign tumor in the head and neck. The therapeutic effect by conventional treatment was not very satisfactory. The purpose of this study is to explore the surgical strategy of low-temperature plasma radiofrequency in the treatment of hemangioma located in the nasal cavity, pharynx, and larynx. Methods: The clinical data of 29 cases with hemangioma in nasal cavity, pharynx, and larynx treated by low-temperature plasma radiofrequency ablation were retrospectively analyzed. The strategy of ablation before resection was performed for 16 cases of nasal capillary hemangioma. The other 13 cases of cavernous hemangioma in the pharynx and larynx were treated by the strategy of direct ablation. Results: All 29 patients underwent a successful operation with minimal intraoperative bleeding and no postoperative bleeding complications. There was no nasal septum perforation, dyspnea, dysphagia, dysphonia, or other complications. The patients were followed up for more than 3 years without recurrence. Conclusion: Low-temperature plasma radiofrequency is a practical, minimally invasive, and accurate method for treating hemangiomas in the nasal cavity, pharynx, and larynx. For capillary hemangiomas, the strategy of ablation before resection may be an effective way to reduce bleeding, and for cavernous hemangiomas, the strategy of direct ablation is a simple and efficient method. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the effects of nasal septum deviation on the pharyngeal airway and craniocervical posture measurements using cone beam computed tomography (CBCT). This retrospective study analyzed the CBCTs of 25 patients with and without nasal septum deviation. Various parameters defining the pharyngeal airway and craniocervical and facial skeletal morphology were measured and compared between the groups after confirming intra-examiner reliability. Compared to the control group, the group with nasal septum deviation had a statistically significantly shorter nasopharyngeal length (p < 0.001), longer vertical airway length (p < 0.002), and larger cervical column curvature angle (p < 0.006). Children with a nasal septum deviation of 4 mm or more on their CBCT scan are susceptible to unfavorable pharyngeal airway and craniocervical postural changes. [ABSTRACT FROM AUTHOR]

The present study reports tongue configuration data recorded with ultrasound for two sets of consonant sequences uttered by five native Catalan speakers. Articulatory data for the onset cluster pairs [kl]-[ɣl] and [kɾ]-[ɣɾ], and also for [l#k]-[l#ɣ] and [r#k]-[r#ɣ], analyzed in the first part of the investigation revealed that, as a general rule, the (shorter) velar approximant is less constricted than the (longer) voiceless velar stop at the velar and palatal zones while exhibiting a more retracted tongue body at the pharynx. These manner of articulation-dependent differences may extend into the preceding liquid. Data for [k#l]-[kl] and [k#r]-[kɾ] dealt with in the second part of the study show that the velar is articulated with more tongue body retraction for [k#l] vs. [kl] and for [k#r] vs. [kɾ], and with a higher tongue dorsum for [k#l] vs. [kl] and the reverse for [k#r] vs. [kɾ]. Therefore, clusters are produced with a more extreme lingual configuration across a word boundary than in syllable-onset position, which at least in part may be predicted by segmental factors for the [k#r]-[kɾ] pair. These articulatory data are compared with duration data for all sequence pairs. [ABSTRACT FROM AUTHOR]

Forestier syndrome, also known as Diffuse Idiopathic Skeletal Hyperostosis (DISH), is characterized by typical findings of ossification and calcification primarily of the anterior longitudinal ligament, which result in osteophyte formation. This is a rare condition and is rarely associated with systemic diseases such as diabetes mellitus and obesity. It occurs mostly in the fifth and sixth decades of life and predominantly in males. This report describes a case of a 68-year-old man with DISH syndrome, who experienced a difficult airway and a serious complication during intubation. [ABSTRACT FROM AUTHOR]

Overlooked connections among various neurological functions can potentially yield valuable clinical assessment tools. In this paper, several such connections are explored, including relationships between vibration sense and balance, visual midline and temporomandibular joint function, and temporosphenoidal line indicators and temporalis muscle contraction. Here I present several additional 'clinical tricks' that better isolate the segments and tissues I am assessing. [ABSTRACT FROM AUTHOR]

With the increasing awareness of the "united airway disease" theory, more horses, not only sport horses but also pleasure horses, undergo detailed examinations of the respiratory tract. Using endoscopy, equine asthma (EA) is most commonly diagnosed in the lower airway, while pharyngeal lymphoid hyperplasia (PLH) is common in the upper airway. Grading EA as mild–moderate (MEA) and severe (SEA), this study aims to compare the co-occurrence and investigate the possible relationship between the clinical symptoms and endoscopic signs of MEA/SEA and PLH in pleasure horses. In this retrospective study, 80 out of 93 pleasure horses suspected of EA were enrolled and underwent a standardized protocol for a complete airway examination, including resting endoscopy with mucus accumulation assessment and cytology. The obtained results were scored and analyzed. In the studied pleasure horses, PLH co-occurred more frequently in horses with EA than without (p < 0.0001) and more in horses with SEA than with MEA (p = 0.025). However, when EA and PLH co-occurred, the severity of the clinical symptoms of EA did not increase (p > 0.05). In both EA and PLH, the amount of tracheal and nasopharyngeal mucus increased with the severity of the disease; however, it was positively correlated (ρ = 0.33; p = 0.02) only in SEA horses. In conclusion, it is likely that EA is often accompanied by PLH; however, PLH did not play a role in increasing the severity of EA's clinical symptoms. The role of the severity of accumulated mucus in the lower and upper airways when EA/PLH co-occur requires further research to confirm the morphological and functional unity of the respiratory tract, aligning with the concept of "united airways disease". [ABSTRACT FROM AUTHOR]

Objective : To determine the sensitivity and specificity of velar notching seen on nasopharyngoscopy for levator veli palatini (LVP) muscle discontinuity and anterior positioning. Design : Nasopharyngoscopy and MRI of the velopharynx were performed on patients with VPI as part of their routine clinical care. Two speech-language pathologists independently evaluated nasopharyngoscopy studies for the presence or absence of velar notching. MRI was used to evaluate LVP muscle cohesiveness and position relative to the posterior hard palate. To determine the accuracy of velar notching for detecting LVP muscle discontinuity, sensitivity, specificity, and positive predictive value (PPV) were calculated. Setting : A craniofacial clinic at a large metropolitan hospital. Participants: Thirty-seven patients who presented with hypernasality and/or audible nasal emission on speech evaluation and completed nasopharyngoscopy and velopharyngeal MRI study as part of their preoperative clinical evaluation. Results : Among patients with partial or total LVP dehiscence on MRI, presence of a notch accurately identified discontinuity in the LVP 43% (95% CI 22-66%) of the time. In contrast, the absence of a notch accurately indicated LVP continuity 81% (95% CI 54-96%) of the time. The PPV for the presence of notching to identify a discontinuous LVP was 78% (95% CI 49-91%). The distance from the posterior edge of the hard palate to the LVP, known as effective velar length, was similar in patients with and without notching (median 9.8 mm vs 10.5 mm, P = 1.00). Conclusion : The observation of a velar notch on nasopharyngoscopy is not an accurate predictor of LVP muscle dehiscence or anterior positioning. [ABSTRACT FROM AUTHOR]

Background: A pathological communication between the trachea and oesophagus – a tracheoesophageal fistula – may be congenital or acquired, benign or malignant, necessitating a multidisciplinary approach. Conservative attempts at closure of this abnormal connection are ineffective; the interposition of healthy vascular tissue offers the least chance of recurrence. Methods: Outcomes of an islanded fasciocutaneous internal mammary artery perforator flap applied for tracheoesophageal fistula management were assessed in four radiated patients with laryngeal carcinoma using retrospective records. Results: Four male patients, with an average age of 60.75 years, underwent tracheoesophageal fistula closure between September 2017 and February 2021. A left-sided second internal mammary artery perforator flap was used in all cases, with an average dimension of 10.5 × 4.5 cm. There were no complications of tracheoesophageal leak, flap issues or donor site morbidity on follow up. Conclusion: Recent advances in angiosomal territory mapping and microvascular dissection techniques, combined with an understanding of tracheoesophageal fistula pathology, have changed management perspectives in these difficult-to-treat patients. [ABSTRACT FROM AUTHOR]

This study was the first attempt to visualize pulmonary retention of nanocarriers (NCs) with the use of the P2 probe, a new water-initiated aggregation-caused fluorescent-quenching (ACQ) dye, for the development of NCs with long-lasting retention in the respiratory system (RS). Flash nanoprecipitation was used to fabricate mucopenetrating NCs (MP/NCs) and mucoadhesive NCs (MA/NCs). Both NCs were labeled with the P2 probe, and their distribution and retention in RS were visualized after intratracheal administration to rats. MP/NCs and MA/NCs had a mean diameter below 200 nm and ζ-potential of 0 and 48 mV, respectively. MA/NCs showed three times stronger interactions with mucin than MP/NCs, resulting in significantly lower diffusiveness in mucus. The P2 probe exhibited an ACQ effect with negligible rekindling in simulated lung fluid, and the spectroscopic data suggested applicability to reliable imaging of insufflated NCs. In confocal laser scanning microscopic and in vivo imaging system images of the rat RS, MA/NCs were locally deposited in the respiratory tract and transported toward the pharynx by mucocilliary clearance (MCC). In contrast, MP/NCs diffused in the respiratory mucus were less subject to the influence of MCC. Based on the results from the bioimaging study using the P2 probe, MP/NCs could offer enhanced pulmonary retention of drugs compared with MA/NCs. [ABSTRACT FROM AUTHOR]

Pharyngeal muscle changes occur in patients with Parkinson's disease and related disorders (PRD); however, the association between the structural alterations in the pharynx and the symptoms of dysphagia remains unclear. We assessed structural changes and contractile forces by measuring pharyngeal wall thickness and width. We aimed to define the pharyngeal measurements and determine their value as diagnostic tools for dysphagia. The pharyngeal wall thickness (PWT), pharyngeal width at rest (PWR), and shortest pharyngeal width at swallowing (PWS) were measured using lateral neck roentgenograms and videofluoroscopic swallowing study. We compared the PWR and PWT between the PRD and control groups using an independent t-test. The Kendall correlation test was performed on the radiological data of the pharynx (PWT, PWR and PWS), dysphagia scales (Penetration–Aspiration scale [PAS] and Dysphagia Outcome and Severity Scale [DOSS]), and Hoehn and Yahr scale (HY scale). The PWT was smaller and the PWR greater in the PRD than in the control group (p < 0.05). The dysphagia scales (PAS and DOSS) were correlated with the radiological data (PWT and PWS) and the HY scale (p < 0.05). The HY scale score also correlated with the PWT (p < 0.05). The optimal cutoff points of the PWT and PWR for predicting aspiration were 4.05 and 16.05 mm in the PRD group, respectively. Using the PWT, PWR and PWS, muscle atrophy and contractile strength of the pharynx can be estimated. The combination of the PWT and PWR can be a simple indicator for predicting swallowing disorders at the bedside. [ABSTRACT FROM AUTHOR]

Swallowing disorders, or dysphagia, can lead to bolus aspiration in the airway, causing serious adverse health effects. Current clinical interventions for dysphagia are mainly empirical and often based on symptoms rather than etiology, of which a thorough understanding is still lacking. However, it is challenging to study the swallowing process that involves sequential structural motions and is inaccessible to standard visualization instruments. This study proposed an in vitro method to visualize swallowing hydrodynamics and identify the fundamental mechanisms underlying overflow aspirations. An anatomically accurate pharynx–epiglottis model was developed from patient-specific CT images of 623 µm isotropic resolution. A compliant half-pharynx cast was prepared to incorporate dynamic structures and visualize the flow dynamics in the mid-sagittal plane. Three locations of frequent overflow aspiration were identified: the epiglottis base, cuneiform tubular recesses, and the interarytenoid notch. Water had a consistently higher aspiration risk than a 1% w/v methylcellulose (MC) solution. The contracting–relaxing pharynx and flapping epiglottis spread the liquid film, causing a delayed esophageal entry and increased vallecular residual, which was more pronounced with the MC solution. Dispensing the liquid too slowly resulted in water aspiration, whereas this was not observed with the MC solution. An incomplete epiglottis inversion, such as horizontal or down-tilt 45°, aggravated the aspiration risks of water. This study suggests that it is practical to use anatomically accurate respiratory–digestive models to study the swallowing process by incorporating varying physiological details. [ABSTRACT FROM AUTHOR]

IntroductionIn resource-limited settings, obstructive sleep apnea (OSA) often goes undiagnosed as polysomnography (PSG) is expensive, time-consuming, and not readily available. Imaging studies of upper airway have been tried as alternatives to PSG to screen for OSA. However, racial differences in upper airway anatomy preclude generalizability of such studies. We sought to test the hypothesis that ultrasonography (USG), an inexpensive, readily available tool to study soft tissue structures of the upper airway, would have predictive value for OSA in South Asian people.MethodsAdult patients with sleep-related complaints suspicious for OSA were taken for overnight PSG. After the PSG, consecutive patients with and without OSA were studied with submental ultrasonography to measure tongue base thickness (TBT) and lateral pharyngeal wall thickness (LPWT).ResultsAmong 50 patients with OSA and 25 controls, mean age was 43.9 ± 11.4 years, and 39 were men. Patients with OSA had higher TBT (6.77 ± 0.63 cm vs 6.34 ± 0.54 cm, P value = 0.004) and higher LPWT (2.47 ± 0.60 cm vs 2.12 ± 0.26 cm, P value = 0.006) compared to patients without OSA. On multivariate analysis, TBT, LPWT, and neck circumference were identified as independent factors associated with OSA. These variables could identify patients with severe OSA with a sensitivity of 72% and a specificity of 76%.ConclusionPatients with OSA have higher tongue base thickness and lateral pharyngeal wall thickness proportionate to the severity of the disease, independent of BMI and neck circumference. These findings suggest that sub-mental ultrasonography may be useful to identify patients with severe OSA in resource-limited settings.

Objectives: This study aims to review the current role of various ultrasonographic methods in the evaluation of the upper airway in patients with obstructive sleep apnea. Methods: A literature review was performed on the medical databases: Pubmed, Web of Science, Scopus and Embase. After analyzing the available studies, six of them were selected for data extraction. Results: All selected studies demonstrated that it is possible to use ultrasonography as a method of evaluating the upper airway. Studies with gray-scale ultrasound concluded that the lateral pharyngeal wall and tongue are thicker in patients with obstructive sleep apnea compared to non-apneic patients. Moreover, studies with tissue characterization ultrasound, nowadays called quantitative ultrasound, have identified unique features in obstructive sleep apnea patients: standardized backscatter ultrasonography demonstrated that this particular sound wave analysis is associated with the severity of obstructive sleep apnea. Ultrasonography with elastography shows that the electrical stimulus generated in the hypoglossal nerve results in greater stiffness on the side of the tongue that is stimulated; whereas studies show conflicting results regarding the evaluation of baseline tongue stiffness in obstructive sleep apnea patients compared to non-apneic subjects. Conclusion: There is feasibility of different methods of ultrasonographic evaluation of the upper airway, with emphasis on ultrasonographic methods of tissue characterization, such as elastography, which proved to be a promising method of evaluating the mechanical properties of the muscles involved in the pathogenesis of obstructive sleep apnea and which require further studies for a better elucidation of its applicability.

Summary Managing equine patients that require prolonged periods of nasogastric intubation can be difficult and may require the use of repeated intubation or use of an in‐dwelling nasogastric tube. Both approaches present potential risks for complications from nasal, pharyngeal and oesophageal trauma. Diagnosis and treatment of cranial oesophageal lesions can be particularly challenging due to the anatomy of this region. [ABSTRACT FROM AUTHOR]