by Dr. Robert Bastian
CS joins Dr. Anthony Jahn in welcoming otolaryngologist Dr. Robert Bastian as a guest contributor to this issue and presenter at the Classical Singer Convention “It is my pleasure to problem. I remember one patient with between his stomach and esophagus. welcome Dr. Robert perimenopausal voice change, another Again, the lesion was unchanged.
Bastian, a nationally with small vocal nodules, and a third with a glottic sulcus. In each case misdiagnoses the actual explanation for his vocal fold and professional voice elsewhere had erroneously blamed acid lesion? Biopsy-proven human papilloma physician, who contributed reflux as the sole or primary explanation virus, HPV type 16. Frustration, career this month’s column. I for their problem. For these individuals, damage, and unnecessary expense can have learned a great deal from Dr. Bastian despite prolonged and aggressive attend an incorrect diagnosis.
over the years, and share his skepticism treatment for acid reflux, vocal limitations about the overuse of ‘acid reflux’ as a had remained unchanged.
reflux appears to be a real problem, once diagnosis. I invite all readers to attend his presentations at this year’s CS Convention underdiagnosis. A singer may really have “Avoid caffeine, alcohol,
in Chicago—you will learn a lot!” acid reflux yet not be diagnosed initially, spicy foods, mint, citrus,
only to find out later that this condition was central to his difficulty. Or, because carbonated beverages,
the singer does not directly experience the garlic, and chocolate,
“rain in the night” reflux events, he or she may decide not to follow the recommended particularly after 2 p.m.
acid may burble upward to the level These substances may make
brushed aside a physician recommendation acid reflux worse.”
to do a reflux trial only to discover more than a year later that this was indeed a not connect the voice disturbance to acid The most remarkable case I have seen primary issue for him. Frustration, career reflux because symptoms may be mild and illustrating the potential to “bark up the damage, and unnecessary expense can nonspecific and reflux can happen like a wrong tree” was that of a young opera follow underdiagnosis, too.
gentle nighttime rain that does not disturb singer with a rough, white patch on the sleep. Persons with acid reflux typically upper surface of one vocal fold. This small diagnosis right? With the caveat to notice at least some initial benefit within lesion was attributed to acid reflux yet had consider what follows only with input days of starting treatment.
persisted despite double-dose, twice-a- from your personal physician, why not There seems to be a growing problem, day medication and vigorous application master the core information about reflux however: even when the diagnosis is of all of the other lifestyle modifications. and its treatment, mix in a little common actually something else, acid reflux Eventually, he even underwent a surgical sense, and do an alternating DIY reflux may be invoked as the cause of a voice procedure to tighten the sphincter muscle trial? Then you can report the results to When Acid Reflux Treatment Takes You Down a Rabbit Trail Do you have a question on this topic or anything else health-related for Dr. Jahn? E-mail him at
we move to the strategy: Apply all of the tools described above (four behavior your physician to add additional data and Timing of meals
changes and three different medications) nuance to his or her diagnostic process. Eat the last meal or snack of the day simultaneously. Omit nothing for one An effective DIY trial begins with a fund no fewer than three hours before bed, week. During that week, as soon as you of knowledge and moves to a strategy for so that your stomach will be relatively awaken, “commune” with your throat. applying that knowledge. Here’s the basic empty when you fall asleep. This avoids Ask yourself if it feels dry or scratchy, information you need. “back-pressure” that might push stomach clear it, and assess your lowest to highest The first step is to know the symptom contents upward while you sleep.
pitches. If you are not sure whether the complex associated with acid reflux. This regimen has had any effect after a week’s may include a tendency to awaken in the Sleeping angle
trial, discontinue all seven “tools” for a Use four- to six-inch “blocks” of books, week while following the same morning throat that abates towards the end of the bricks, or boards between the floor and self-assessment. In week three, resume day; increased mucus and throat-clearing, head posts of your bed. During sleep, the the seven tools once again. Follow this especially early in the day; and difficulty slant in the bed frame allows gravity to weekly alternation, until you can make as a “morning singer” due to a lowered assist in keeping stomach acid where it a conclusion about the difference, if any, average pitch or a “heavy” morning belongs. Alternatively, use a foam wedge, between the two conditions.
voice. These symptoms may occur with available at “bed and bath” stores, under or without the more easily recognized your upper body.
enough to resolve all of the symptoms of that you should notice at least some small Second, know the tools used in treatment, Maintain your weight at an optimal change within that time. After all, many which encompass both behavior change level. Extra pounds increase pressure on who actually have acid reflux notice a and medication, as listed below.
considerable difference within days.
Food choices
A variety of medications, both your physician. Failure to notice any mint, citrus, carbonated beverages, garlic, prescription and over-the-counter, may difference between “on” and “off” weeks and chocolate, particularly after 2 p.m. prove helpful.
may not necessarily deter a physician who • Proton-pump inhibitor (PPI) has additional reasons to believe this is
acid reducers, such as OTC Prilosec or your diagnosis, but it is possible you may generic omeprazole. Prescription PPI’s contribute more robustly to your doctor’s also include Protonix, Prevacid, Aciphex, answer to this question and reduce the and Nexium. Take one of these 30-60 chance that you will tread the rabbit trail minutes before the last meal of the day to of over- or under-diagnosis.
decrease acidity of any nocturnal refluxate that reaches the level of your throat and Bastian Voice Institute in west suburban H2 Blocker acid reducers, such as Chicago after a successful career in
OTC Zantac, Pepcid, Axid, or Tagamet. academic otolaryngology. BVI is dedicated
You may double the dose if you use the exclusively to voice, swallowing, and airway
over-the-counter preparation. Take this disorders. Dr. Bastian is particularly
medication an hour after dinner and noted for including vocal phenomenology
preferably a couple of hours before bed in his diagnostic process, and when
as a second means of reducing stomach lesions are irreversible otherwise, for vocal
fold microsurgery in singers and other Liquid antacids, such as Gaviscon, performers. For more information visit
Mylanta, or Maalox. To neutralize acid,
take an antacid just before bed.


Type de prélevement Condition de prélèvement Condition de conservation Stabilité de l'échantillon du patient avant traitement avant traitement Tubes acceptés : Héparine 5ml, SEC 10 mL avec Gel 15-25°C impératif, pas de froid 2 h sur citrate, 4 h sur CTADM. COELIAQUE : AUTOANTICORPS ANTIENDOMYSIUM (IGA) Tubes acceptés : SEC 10 mL avec Gel Commentaire(s) : /! a

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