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BACKGROUNDLaryngopharyngeal reflux disease can present with a varied symptomatology because of the involvement of multiple sub-sites of the upper aero-digestive tract. It is a very common disease to be encountered in routine practice by both medical and ENT personnel. Its association with multiple pathologies including malignancy warrants an early diagnosis and management. The lack of cost effective and non-invasive tests constitutes a major hurdle in its early management.OBJECTIVES1. To define the “at risk” population, prone to developing laryngopharyngeal reflux. 2. To formulate major and minor risk factors for the clinical diagnosis of patients with laryngopharyngeal reflux. 3. To evaluate the efficacy of lifestyle management alone as a treatment option. 4. To formulate a treatment protocol for the management of patients and to prevent recurrence.STUDY DESIGNWe performed a prospective analysis of 234 patients diagnosed with laryngopharyngeal reflux. Patients were randomized into study and control groups based on the treatment protocol, using a computer generated randomization table and were single blinded to the type of therapy received. A complete analysis of the possible risk factors, symptoms, and signs was performed with statistical analysis.RESULTS AND CONCLUSIONThe data has helped us define the “at risk” population and formulate the criteria to diagnose cases of laryngopharyngeal reflux, clinically. The results emphasize the non-requirement of invasive or costly investigations for all patients and indicate the probable protocol to be followed prior to considering further investigation. The role of long term proton pump inhibitor treatment along with lifestyle modification in the initial phase of treatment, as mentioned in the literature, was re-confirmed by our study. However, in addition to the initial treatment, the study establishes the need for continuing lifestyle modification further for at least six months after the cessation of proton pump inhibitor therapy to prevent early recurrence of symptoms.

To evaluate the role of video head impulse test in the diagnosis of peripheral vestibular disorders, we performed an observational study in the outpatient department in a tertiary setup in which the clinical head impulse test and the video head impulse test were performed on 45 patients with clinically suspected peripheral vestibular disorders, and their results were correlated. To analyse our results, each ear was counted individually and hence, among 45 patients, 12 out of 90 ears showed abnormal clinical head impulse test for lateral semicircular canals and 27 out of 90 ears showed abnormal video head impulse test for lateral semicircular canals. This gave us an additional diagnostic accuracy of 21.1% on using video head impulse test for the lateral semicircular canals as compared to the clinical head impulse test. Video head impulse test is a physiological, quick and well tolerated test for assessing the vestibular function, and the only practical test for assessing the vertical semicircular canal function. Video head impulse test provides valuable information in localising the site of lesion as it assesses the semicircular canals individually. Video head impulse is merely not an objectification and registration system for the clinical head impulse test as it provides additional information such as vestibulo-ocular reflex gain, and occurrence of covert refixation saccades which cannot be picked up by naked eyes.

Objectives: Determine the effect of L-N-acetylcysteine (LNAC) on gentamicin (GM) initiated vestibulotoxicity. Methods: Wistar rats were divided into 4 groups: Group A (n = 7) had intratympanic (IT) GM (20 mg in 40 µL); group B (n = 6) had IT GM and intraperitoneal (IP) LNAC (350 mg/kg) at 24 hours and 1 hour before GM administration; group C (n = 6) had IT GM and IT LNAC (5 mg in 40 µL); and group D (n = 6) had only IT saline (40 µL). Rats were tested by ABR and cervical vestibular evoked myogenic potentials (VEMP) pretreatment, and at 1 week and 1 month posttreatment. Morphological analysis of the inner ears was performed at 1 month. Main outcome measures were the mean change in VEMP P1 latency at sound stimulation from 80 to 110 dB SPL, and hair cell count in the saccule. Results: Rats treated with IT LNAC exhibited the least change in mean VEMP latencies, although the intergroup differences were not statistically significant except for 80 dB stimulation at 1 week posttreatment. IP and IT LNAC resulted in preservation of the VEMP response in all rats, whereas 42% of rats not receiving LNAC had absent responses. Morphological analysis of the saccule revealed lower mean hair cell counts in rats not receiving LNAC. Conclusions: Systemic and IT administration of LNAC of rats treated with GM resulted in minimal variations in VEMP latencies and greater preservation of vestibular hair cells. The protective effect of LNAC in GM-initiated vestibulotoxicity is promising and warrants further research.

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