Laryngopharyngeal Reflux (LPR)

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Impact of laryngopharyngeal reflux on subjective and objective voice assessments: a prospective study

Impact of laryngopharyngeal reflux on subjective and objective voice assessments: a prospective study

Laryngopharyngeal reflux (LPR) is the back flow of gastric contents into the laryngopharynx where it comes in contact with the tissues of the upper aerodi- gestive tract [1]. It concerns 4 to 10 % of patients who seek Ear Nose Throat (ENT) consultation and 1 % of patients in primary care practice [2–4]. The most common symptoms reported are globus sensation (88 %), throat clearing (82 %), and voice disorders such as hoarseness (79 %) [5, 6]. Heartburn accounts for less than 40 % of cases, whereas esophagitis concerns only 25 % of LPR patients [7, 8]. The major etiologic factor for hoarseness of more than 3 months duration is LPR, with a prevalence of 55 to 79 % in hoarse pa- tients [9–11]. In comparison with healthy subjects, LPR patients often reported abnormal subjective voice characteristics such as musculoskeletal tension, hard glottal attack, glottal fry, vocal forcing, forcing sensa- tions, clamping, vocal fatigue, prolonged voice warm- up time, and restricted tone placement [12–14]. LPR signs include posterior commissure hypertrophy (89 %), vocal fold edema (79 %), hyperemia (79 %), and diffuse laryngeal edema (76 %) 5 . This clinical entity considerably affects patients’ quality of life by reducing the speaker’s communicative effectiveness [2, 15]. Specifically, LPR is related to 50 to 78 % of the popula- tion with voice complaints and 91 % of voice disorders in the elderly [16–18]. Based on these voice disorders, many authors have used acoustic parameters as out- comes of medical treatment efficacy in LPR patients or in LPR patients with hoarseness, but results are mixed and controversial among studies [19–21]. Undoubt- edly, some observe improvements of some acoustic parameters values [20, 21], and others refute these results [22, 23]. These varied results do not help the understanding of the pathophysiological mechanisms underlying hoarseness in LPR patients. Specifically, some authors suggested that vocal fold edema may be the main sign responsible for irregular vocal fold vibration leading to hoarseness [13], whereas other suspected mechanisms include dryness, keratosis, thickening of the epithelium, ulcerative lesions and alterations of the Reinke space [24].
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Laryngopharyngeal reflux- diagnosis and management at a tertiary care centre

Laryngopharyngeal reflux- diagnosis and management at a tertiary care centre

Laryngopharyngeal reflux (LPR) represents a controversial subject in terms of both diagnosis and treatment. The recent trends show an increased interest in understanding and managing patients of LPR. The initial description of this condition dates back to atleast four decades. 1-6 It has become one of the most common conditions presenting in an otorhinolaryngology outpatient department which is diagnosed in approximately 10% of these patients. 7,8 These patients usually present with vague symptoms such as dry cough, frequent clearing of throat, foreign body sensation in
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THE EFFECT OF LARYNGOPHARYNGEAL REFLUX ON ACOUSTIC PARAMETERS IN FUNCTIONAL DYSPHONIA PATIENTS

THE EFFECT OF LARYNGOPHARYNGEAL REFLUX ON ACOUSTIC PARAMETERS IN FUNCTIONAL DYSPHONIA PATIENTS

[22] referred to multidisciplinary voice clinics (3). Many factors may contribute to the development of a functional voice disorders one of which may be laryngopharyngeal reflux (LPR). LPR is the backflow of stomach contents above the upper esophageal sphincter, into the pharynx, larynx, and upper aerodigestive system (4). So, the most common signs of LPR are posterior laryngeal edema and erythema, obliteration of the laryngeal ventricles, and interarytenoid hypertrophy. In up to 92% of cases, the most common organic symptoms of LPR are roughness/hoarseness (5) but LPR is also associated with the development of functional voice disorders like muscle tension dysphonia (6).
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Effect of Proton Pump inhibitors on laryngopharyngeal reflux disease: A Prospective study

Effect of Proton Pump inhibitors on laryngopharyngeal reflux disease: A Prospective study

The term Laryngopharyngeal Reflux (LPR) was coined by James and is accepted by the American Academy of Otolaryngology: Head and Neck surgery. [1] Laryngopharyngeal reflux disease (LPRD) was first described by von Leden and Moore, in the 1960, but it did not come to the forefront of otolaryngology practice until Koufman’s landmark thesis on the subject in 1991. [1,2] Laryngopharyngeal reflux disease is an extraesophageal variant of gastroesophageal reflux disease that affects the larynx and pharynx. [3,4] The other terms used for this in otorhinolaryngology practice are ‘extra esophageal reflux’, ‘chronic laryngitis’ and ‘supra esophageal complication of gastroesophageal reflux’. [4] Recent studies in this field evidently proves that laryngopharyngeal reflux represents a complex spectrum of abnormalities and it is therefore important to understand the basic scientific concepts relevant to this disease and also the appropriate clinical care of patients with laryngopharyngeal reflux.
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High-resolution manometry in patients with and without globus pharyngeus and/or symptoms of laryngopharyngeal reflux

High-resolution manometry in patients with and without globus pharyngeus and/or symptoms of laryngopharyngeal reflux

Wiener et al. placed probes into the esophagus and on the top of the upper esophageal sphincter (UES) to detect pH over a course of 24 h using double- probe pH testing. They found that patients with glo- bus pharyngeus had laryngopharyngeal acid reflux. In 1989, they once again used the similar methods to monitor pH over 24 h in 32 patients with globus pharyngeus. However, this time they reported that the symptoms and the acid reflux times of these pa- tients were all different from gastroesophageal reflux disease (GERD), and esophagitis was hardly found. Since then, research on globus pharyngeus has been extensively performed [4]. Although the results were not completely consistent, laryngopharyngeal reflux (LPR) was officially adopted by the American Acad- emy of Otolaryngology-Head and Neck Surgery in 2002 [5]. However, whether there was a close rela- tionship between globus pharyngeus and laryngophar- yngeal reflux and/or gastroesophageal reflux still left some doctors feeling confused. One study showed that abnormal laryngopharyngeal or esophageal reflux was not indicated by pH-impedance monitoring in some patients with suspected LPR refractory to pro- ton pump inhibitors (PPIs) treatments. The results proved that LPR is unlikely in these patients [6]. It can be induced that globus pharyngeus patients with non-LPR (G-NR) also account for a certain propor- tion. At present, there is no report about the etiolo- gies and influence factors of these patients. This study was performed to clarify the related factors of the symptoms of globus pharyngeus refractory to PPIs treatments and to learn more about G-NR so as to improve the curative effect.
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Original Article Anti-reflux effects of pantoprazole combined with mosapride and domperidone in the treatment of obstructive sleep apnea hypopnea syndrome and laryngopharyngeal reflux disease

Original Article Anti-reflux effects of pantoprazole combined with mosapride and domperidone in the treatment of obstructive sleep apnea hypopnea syndrome and laryngopharyngeal reflux disease

Abstract: Objective: To explore the anti-reflux effects of pantoprazole combined with mosapride and domperidone in the treatment of obstructive sleep apnea hypopnea syndrome (OSAHS) and laryngopharyngeal reflux disease (LPRD). Methods: A total of 92 patients with OSAHS and LPRD were divided into the control group (n=45, treated with pantoprazole combined with mosapride and domperidone) and the observation group (n=47, pantoprazole monotherapy) according to random number tables. All patients took the medications for 8 weeks. Pulmonary func- tion parameters and sleep quality indexes before and after treatment were compared. The results of reflux symptom index (RSI), reflux finding score (RFS) and arterial blood gas (ABG) analysis before treatment and after 8 weeks of treatment were also compared. Results: The observation group had significantly higher total rate of effective treat- ment than the control group (95.74% vs. 71.11%, P=0.001). The observation group also had significantly higher vital capacity (VC), ratio of forced vital capacity compared to predicted values (FVC%), ratio of diffusing capacity divided by the alveolar volume compared to predicted values (DLCO/VA%), ratio of forced expiratory volume in one second compared to predicted values (FEV1%), total lung capacity (TLC) than the control group 8 weeks after treatment (all P<0.01). The observation group had significantly lower proportion of stage I sleep, apnea hypopnea index (AHI), and arousal index (AI) than the control group (all P<0.001). The proportion of stage III sleep for the observation group was significantly higher than that for the control group (P<0.001), and there was no statistically significant differ- ence in the proportion of stage II sleep between the two groups (P>0.05). The proportion of patients whose RSI was above 13 and RFS above 7 in both groups decreased significantly after 8 weeks of treatment (both P<0.05), and the drop was more noticeable in the observation group (P<0.001). Both groups showed improvements in the results of ABG analysis after treatment (both P<0.05), but there was no statistically significant difference between the two groups (P>0.05). Conclusions: Pantoprazole combined with mosapride and domperidone can significantly improve lung function, sleep quality and acid reflux symptoms for patients with OSAHS and LPRD.
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Role of Laryngopharyngeal Reflux in Eustachian Tube Dysfunction in Adults

Role of Laryngopharyngeal Reflux in Eustachian Tube Dysfunction in Adults

We have here studied the relationship between Eustachian tube dysfunction and laryngopharyngeal reflux, evaluating also the results of medical therapy in patients with such problems. Based on clinical, endoscopic and cytological investigations, we found that acid laryngopharyngeal reflux was the basis of audiological symptoms and chronic dysfunction of the Eustachian tube.

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Does laryngopharyngeal reflux disease impair nasal mucociliary transport? A case control prospective study

Does laryngopharyngeal reflux disease impair nasal mucociliary transport? A case control prospective study

Background: Laryngopharyngeal reflux disease (LPRD) is the retrograde reflux of gastro duodenal contents above the level of upper oesophageal sphincter into larynx and pharynx. LPRD can lead to upper respiratory pathology by direct contact of nasal and nasopharyngeal mucosa with the regurgitated gastric acid. Refluxate can damage the cilia, thereby prolonging the mucociliary clearance time (MCT) and consequently affecting the innate defence mechanism of upper airway. Our objective was to analyse the relationship between MCT and LPRD in patients without any nasal pathology.
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Expression of CAIII and Hsp70 Is Increased the Mucous Membrane of the Posterior Commissure in Laryngopharyngeal Reflux Disease

Expression of CAIII and Hsp70 Is Increased the Mucous Membrane of the Posterior Commissure in Laryngopharyngeal Reflux Disease

8. Belafsky PC, Rees CJ. Laryngopharyngeal reflux: the value of oto- laryngology examination. Curr Gastroenterol Rep 2008;10:278-82. 9. Johnston N, Knight J, Dettmar PW, Lively MO, Koufman J. Pepsin and carbonic anhydrase isoenzyme III as diagnostic markers for la- ryngopharyngeal reflux disease. Laryngoscope 2004;114:2129-34. 10. Beere HM, Green DR. Stress management - heat shock protein-70

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Aerodynamic Analysis Of Voice In Persons With Laryngopharyngeal Reflux

Aerodynamic Analysis Of Voice In Persons With Laryngopharyngeal Reflux

Objectives of the study: The individuals with laryngopharyngeal reflux are prone for aspiration of refluxed contents and so there is a need for aerodynamic evaluation in these individuals. Hence, the present study investigated the aerodynamic characteristics in individuals with Laryngopharyngeal reflux. Study design: Prospective control group design. Method: Thirty laryngopharyngeal reflux subjects and 30 normal subjects participated in the study. Aerodynamic parameters such as vital capacity, mean air flow rate, maximum phonation duration and phonation quotient were measured using Aero Phone Instrument ((Model 6800). Independent t test was employed for statistical inference. Results: The results revealed that the vital capacity and maximum phonation duration values were lower for laryngopharyngeal reflux subjects when compared to normal controls. No significant differences were observed for mean air flow rate and phonation quotient. Conclusions: The results revealed that the laryngopharyngeal reflux individuals showed significant deviations in aerodynamic parameters when compared to normal individuals. Thus study confirms aerodynamic abnormalities in laryngopharyngeal reflux subjects.
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Role of proton Pump Inhibitors in the Management of Laryngopharyngeal Reflux

Role of proton Pump Inhibitors in the Management of Laryngopharyngeal Reflux

Results: The mean age group was 43.5 years. Foreign body sensation in the throat and frequent clearing of throat were most common presenting symptoms and Erythema of the arytenoids along with posterior commisure hypertrophy and ventricular obliteration were the common finding in videolaryngoscopy in patients of Laryngopharyngeal reflux. There was a significant improvement in the reflux symptom index and reflux finding score following treatment with proton pump inhibitors.

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Prevalence of Helicobacter pylori infection and influence of laryngopharyngeal reflux in patients with laryngeal pathologies

Prevalence of Helicobacter pylori infection and influence of laryngopharyngeal reflux in patients with laryngeal pathologies

Helicobacter pylori discovered in 1982 by Barry Marshall and Robin Warren is a gram negative spiral shaped microaerophilic bacteria known to colonise the gastric epithelial cell surface. Whether the bacteria can colonise the upper aerodigestive tract in areas like the oral cavity, pharynx and larynx is still being studied. This prospective study was undertaken to study if the bacteria was present in the laryngeal pathological tissue. Also the association of laryngopharyngeal reflux and laryngeal pathologies was studied along with its association in patients in whom H. pylori was detected. Helicobacter pylori is a common coloniser of human gastric mucosa. It reaches the stomach which is its primary reservoir via the oral cavity. The transmission can be either oro-oral or faeco-oral. Whether the bacteria can colonise in the upper aerodigestive tract involving oral cavity, pharynx and larynx are still under debate. Mapestone et al (3) demonstrated the presence of H. pylori in the dental plaque and saliva of patients with proven gastric colonisation by means of nested PCR. Kusano et al (2) have demonstrated the presence of coccoid forms of Helicobacter pylori in the tonsillectomy specimens of patients with Ig A nephropathy by means of immunofluorescence and immunoelectron microscopy, however they could not culture the bacteria .
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Laryngopharyngeal reflux & vocal quality in senior population:  "mr /ms  gluttony"

Laryngopharyngeal reflux & vocal quality in senior population: "mr /ms gluttony"

Health education instruments have, at core, a preventative basis, for they are, in essence, health promotion tools – strategic vehicles of promotion of health-inducing behaviours. The instrument described – “Mr./Ms. Gluttony” – stems form the need to develop versatile and pedagogic health education tools that communicate through the universal language of pictures represented by pictograms. Our object here is that of leading the patient to learn coping strategies and to promote vocal health in senior citizens. As mentioned earlier, the available literature on this issue is scarce, almost inexistent. In developing “Mr./Ms. Gluttony”, we have attempted to show the importance of learning tools in the area of speech therapy, specifically of vocal health, bringing to the senior population and to their informal caregivers information on healthy vs deleterious eating habits regarding the development o LPR. The “Mr./Ms. Gluttony” instrument was built around the character of a human being. Its anatomical design was set so as to emphasize the presence of an allegoric oesophageal tube, which pictorial content intends to suggest a symbolic representation of LPR. The instrument is particularly tailored to seniors (individuals aged 65 years old or older) with or without voice-related disorders associated with LPR. In the course of a speech therapy session, “Mr./Ms. Gluttony” can also be used in varied clinical contexts as assessment tool when the therapist wishes to gauge the patient’s knowledge or awareness on LPR. The use of playful activities involves strong pedagogic abilities and is a valuable resource within clinical practice, for it motivates senior patients’ engagement and instigates in them understanding and adherence to healthy habits. The use of pictograms is an added value to the construction of learning instruments developed with this specific population in mind – not only due to its didactic character, but also because it bridges linguist barriers, allowing senior patients to bypass any literacy shortcomings that would otherwise frustrate their knowledge acquisition.“Mr./Ms. Gluttony” presents, however, as spatial limitation, its unlikely portability, due to its large dimension. Such limitation can nonetheless be said to be offset when considering that “Mr./Ms. Gluttony” shows an elementary pertinence as a therapeutic intervention tool: it is adaptable to the gender and age of the subject, allowing for a unencumbered and playful interaction, adjustable to each individual patient.
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Laryngopharyngeal reflux in chronic obstructive pulmonary disease - a multi-centre study

Laryngopharyngeal reflux in chronic obstructive pulmonary disease - a multi-centre study

the upper esophageal sphincter and usually occurs during daytime in the upright position, while GERD occurs when gastric contents pass the lower esophageal sphincter and takes place more often in the supine position at night-time or during sleep [16]. LPR may be a contributing factor in patients with symptomatic COPD however, there are only a few studies analyzing the impact of LPR in patients with COPD [13, 17, 18]. In a large longitudinal study of COPD patients, self- reported GERD or use of PPIs was associated with a 20– 60% increased risk of moderate-severe exacerbations and hospitalized exacerbations during 3 years of follow up [19]. Yet, this study was based on a subjective, self- reported history of a physician’s diagnosis of GERD and studies based on objective evaluations by laryngeal- pharyngeal pH monitoring in a large COPD cohort are still missing. Here, we investigated the prevalence of LPR and explored its association with clinically relevant outcomes of COPD.
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Clinical significance of laryngopharyngeal reflux in patients with chronic obstructive pulmonary disease

Clinical significance of laryngopharyngeal reflux in patients with chronic obstructive pulmonary disease

The present study had some limitations. First, as menti- oned earlier, it had weak statistical power due to the small number of patients and had a lack of generalizability due to the preponderance of male subjects. We tried to exclude patients with alleged reflux-related gastrointestinal disease and those who had used proton pump inhibitors. A high prevalence of GERD and prevalent use of proton pump inhibitors led us to restrict the enrolled numbers of study subjects. As a result, statistical power was not achieved for some parameters. Second, a therapeutic trial with proton pump inhibitors and follow-up laryngeal examination were not performed in this study. Thus, the clinical significance of each RFS finding cannot be discussed. Third, RSI and RFS could have limited sensitivity and specificity for diagnosing the LPR. The innate weakness in diagnosing LPR is that there is no diagnostic method of gold standard yet. Although double probe pH monitoring could be used for suspicious patients, poor cooperation of the patients from discomfort during the test and lack of strong correla- tion with the LPR symptom limit the wide appliance of the double probe pH monitoring. In this study, diagnostic definition of LPR was based on RSI and RFS, because those parameters were validated in terms of the correlation and response to treatment.
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Management of laryngopharyngeal reflux with proton pump inhibitors

Management of laryngopharyngeal reflux with proton pump inhibitors

Even though dual-channel pharyngo-oesophageal 24-h pH monitoring is considered the diagnostic gold standard for LPR by some (Noordzij et al 2001; Habermann et al 2002) the role of pH testing in the diagnosis of LPR remains controversial (Vaezi et al 2003). Proximal oesophageal and hypopharyngeal pH testing are not widely available and are considered less useful by both community and academic gastroenterologists (Ahmed et al 2006), and there is a lack of consensus on how much refl ux in the hypopharynx is normal. Most studies show that hypopharyngeal pH-monitoring is not a predictor of response to acid inhibitory therapy as response to therapy is no more likely in individuals with abnormal hypopharyngeal acid refl ux compared to individuals with no acid refl ux (El-Serag et al 2001; Noordzij et al 2001; Vaezi et al 2003; Williams et al 2004; Vaezi et al 2006; Wo et al 2006). Finally it should be taken into account that oesopha- geal pH-monitoring is not even a perfect gold standard test for GERD. Contrary to this view, Haberman et al (2002) found that patients with a positive pH monitoring had signifi cant improvement in all symptoms, whereas in patients with a negative pH monitoring no statistically signifi cant change was seen after open label pantoprazole. From this result, the authors argued that empirical acid inhibitory therapy serves to select patients with refl ux-related problems from those without detectable refl ux. This conclusion may be seriously fl awed, though. The decrease in symptom scores was the same for both groups and the apparent difference in statistical outcomes was related to a small number of patients (n = 7) in the negative pH monitoring group.
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Combination drug therapy for laryngopharyngeal reflex

Combination drug therapy for laryngopharyngeal reflex

Background: We sought to evaluate the combination of high-dose prebreakfast proton pump inhibitors (PPIs) (40 mg pantoprazole) and a bedtime high-dose ranitidine (300 mg) dosing as a surrogate and rational regimen for LPR. Methods: 60 subjects that presented to ENT and HNS OPD with symptoms of laryngopharyngeal reflux (LPR) were prospectively evaluated and underwent a comprehensive otolaryngological examination. All subjects were treated sequentially and outcomes recorded using reflux finding score (RFS) and reflux symptom index (RSI).
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Laryngopharengeal Reflux in Gastroesophageal Reflux Disease: Does “Silent Laryngopharengeal Reflux” Really Exist?

Laryngopharengeal Reflux in Gastroesophageal Reflux Disease: Does “Silent Laryngopharengeal Reflux” Really Exist?

Gastroesophageal reflux disease (GERD) is diagnosed clinically or histologically due to abnormal exposure of the oesophagus to gastric contents [1]. Extraesophageal manifestations are the complicated GERD primarily in- volving the neighboring organs [2]. Laryngopharyngeal reflux (LPR) is common, but its diagnosis may be diffi- cult, for its symptoms are nonspecific and its laryngoscopic signs are not always correlated with symptom sever- ity [3]. Little gastric content can induce laryngitis as laryngeal tissue is more vulnerable to such injury than oe- sophageal one [4]. There is neither pathognomonic symptom nor sign for LPR, but both reflux symptoms index (RSI) and reflux finding score (RFS) were validated for its diagnosis [5].
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Imbalance towards Th1 predominance is associated with acceleration of lupus like autoimmune syndrome in MRL mice

Imbalance towards Th1 predominance is associated with acceleration of lupus like autoimmune syndrome in MRL mice

Mice. MRL- lpr/lpr mice were originally obtained from the Jackson Laboratory in 1978 and were maintained at Centre de Service des Animaux de Laboratoire (Orléans, France). In 1988, offspring of a single pair of long-lived male and female MRL- lpr/lpr founder mice were bred by brother-sister mating. At the sixth generation, a subline with a prolonged survival, referred to as MRL- lpr/lpr.ll , was obtained (4). MRL- 1 / 1 mice were purchased from Olac Laboratory, Oxon, UK. MRL. Yaa mice bearing the Yaa gene were developed by trans- ferring the Yaa gene from BXSB mice into MRL- 1 / 1 mice by back- cross procedure as described (2). All lines of MRL mice have been kept under the same condition and only male mice were used for the present study. Mice were bled from the retroorbital plexus, and re- sulting sera were stored at 2 20 8 C until use.
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Title: ENHANCEMENT IN LICENSE NUMBER PLATE SYSTEM USING K-NEIGHBOR NEAREST ALGORTHM

Title: ENHANCEMENT IN LICENSE NUMBER PLATE SYSTEM USING K-NEIGHBOR NEAREST ALGORTHM

Abstract— Image processing system treat images as two dimensional signals and set of signals processing methods are applied to them. LPR is also one of the applications of image processing. Till now, all the LPR systems have been developed using neural networks. In this paper we proposed to implement the system using Gabor filter, OCR and Vision Assistant to make the system faster and more efficient. To recognize number plate first of all add templates from A-z and 0-9 and add them into mat file. After that read the image and convert that image into grey scale. Now the next step is to find out threshold value of the image. After finding T-value convert that image into binary. In this work, we also use median filter & Gabor filter in which we made cell in which different-different subplot based on pixel value.
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