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Treatment Strategies for Voice Disorders Associated with Larygopharyngeal Reflux (LPR)

Treatment Strategies for Voice Disorders Associated with Larygopharyngeal Reflux (LPR). A Literature Review Kathleen Bell December 5, 2012. Introduction. Research of the Literature reveals confusion and controversy

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Treatment Strategies for Voice Disorders Associated with Larygopharyngeal Reflux (LPR)

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  1. Treatment Strategies for Voice Disorders Associated with Larygopharyngeal Reflux (LPR) A Literature Review Kathleen Bell December 5, 2012

  2. Introduction • Research of the Literature reveals confusion and controversy • “Interesting clinical paradox – Most underdiagnosed and overdiagnosed clinical entity in laryngology” (Bransky & Sulika)

  3. REFLUX- BACKFLOW OF GASTRIC CONTENT

  4. Two Esophageal Sphincters

  5. LPR VS GERD

  6. Reflux Finding Score (Belafsky et al, 2001

  7. The Reflux Symptom Index (Belasky et al, 2002)

  8. Laryngeal Findings(Lloyd, 2011)

  9. STANDARD ANTIREFLUX THERAPY • Phase 1 A. Dietary modification B. Life-style modification C. Medications – antacids • Phase 2 A. H2 blockers B. Proton pump inhibitors C. Prokinetic agents • Phase 3 A. Double dose PPI B. Surgery (fundoplication)

  10. Jamie Koufman pH water (8.8 & )

  11. Dietary & Herbal Adjunctive Therapies - Melatonin - D-Limonene - Iberogast - Gluten Free Diet

  12. PPI’s & Pharmaceuticals • Often double doses needed • Many patients unresponsive • Symptoms recurrent • Lifetime therapy • Prolonged use causes significant side-effects

  13. Body Modalities • Chiropractic Care • Accupuncture

  14. Voice Therapy & Psychological Therapy • Preventative Strategy • Component of comprehensive Therapeutic Strategy

  15. Most Important Studies & Authors • Jamie Koufman (1991)– “The Otolaryngologic Manifestations of Gastroesophageal Reflux Disease.” • Belafsky et al (2002) – “Symptoms and Findings of Laryngopharyngeal Reflux.” • Johntson et al (2003) – “Cell Biology of Laryngeal Epithelial Defenses in Health and Disease.” • Kahn et al (2006) – “Laryngopharyngeal Reflux – A Literature Review.” • Sataloff et al (2006) – Reflux Laryngitis and Related Disorders • Bransky & Sulica (2009) – Classics in Voice and Laryngology • Patrick (2011) – “Gastroesophageal Reflux Disease (GERD): A Review of Conventional and Alternative Treatments.”

  16. References – 50+!!! • Alcantara & Anderson (2008) • Amin et al (2001) • Aronson & Bless (2009) • Behlau & Oliveira (2009) • Belafsky et al (2001, 2002) • Boone et al (2010) • Bransky & Sulica (2009) • Cammarota et al (2003) • Chen, Xu, & Chen (2009) • Cuomo et al (2002) • Davies & Jahn (2004) • Dickman et al (2007). • Gainor et al (2011) • Halum et al (2005) • Hein, Tina (1999) • Hershcovici & Fass (2011) • Hopkins et al (2009). • Johnston et al (2003, 2004 ) • Kahn et al (2006) • Karkos et al (2007) • Kelchner et al (2005) • Koufman (2011) • Koufman &Johnston (2012) • Koufman et al (2002) • Koufman, Stern, & Bauer (2010) • Lloyd, Adam Thomas (2011) • McGuirt, William F. (2003) • Miskovitz & Betancourt (2005) • Mjönes et al (2005) • Møller & West (2000) • Moniniet al (2006) • Moss & Kelly (2007) • Murry et al (2006) • Nowak et al (2010) • Patrick, Lyn (2011) • Pitman (2010) • Rees & Belafsky (2008) • Ross et al (1998) • Sana et al (2011) • Sandage & Emerich (2002) • Sataloff, Robert T. (1991, 1998,2005, 2006,2010) • Sataloff et al (2006, 2012) • Sereg-Baharet al (2005) • Smoak & Koufman (2001) • Spencer (2006) • Syed & Bleach (2009) • Timmermans et al (2005) • Usai et al (2008) • Vashani et al (2010) • Watson et al (1997) • Wright et al (2005)

  17. Images Used • Slide 1 – funnyjokes.org • Slide 3 – babychoicbariatrics.com • Slide 4 – epgpatientdirect.org • Slide 10 – refluxcookbook.com • Slide 13 – http://en.wikipedia.org • Slide 13 – www.bennettclinic.com/chiropractic.jpg • http://www.w3.org/TR/xhtml1/DTD/xhtml1-strict.dtd

  18. Conclusions • Wealth of Research / Many Uncertainties • What is normal ? • Subtle changes = significant effects • Multidisciplinary team • Need for more specific controlled studies • Literature review integral to discovering what has been done, what needs to be done and whether or not you want to do it • Know the important publications: Journal of Singing, Journal of Voice, Laryngoscope, Otolaryngology, Head & Neck Surgery,

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