Heterotopic gastric mucosal patch of the esophagus is associated with higher prevalence of laryngopharyngeal reflux symptoms

Laryngopharyngeal reflux (LPR) is common in clinical practice. Heterotopic gastric mucosal patch of the proximal esophagus (HGMP) is reported to cause LPR symptoms. This study assessed the prevalence of LPR symptoms and correlation with the size of HGMP. Four hundred and sixty-two patients undergoing endoscopy were carefully questioned regarding LPR symptoms experienced in the previous 12 weeks. The size of the HGMP was assessed and documented during endoscopy. Clinicopathological classifications were assigned (types I–V) accordingly. HGMP [median one patch (range 1–3), median size 15 mm [3–35] was detected in 26 (19 HGM type I and 7 HGM type II] patients giving a prevalence of 5.6%. Among the indications, there were significantly more LPR symptoms as referral indications among patients with HGMP. There were no significant differences in the endoscopic findings. On specific enquiries, significantly more HGMP patients had experienced any LPR symptoms (73.1 vs. 25.9%, p < 0.001) specifically chronic cough (p = 0.002), throat discomfort/hoarseness (p < 0.001), globus sensation (p = 0.004), regurgitation (p < 0.001). HGMP patients also had more heartburn (p = 0.001). Larger HGMP (≥15 mm) was only associated with more chronic cough (p = 0.022). In conclusion, patients with HGMP have significantly more LPR symptoms. However, most were mild and detected through specific enquiries. Interestingly, the size of HGMP did not significantly affect the prevalence of LPR symptoms.     

Incidence and treatment results of laryngopharyngeal reflux in chronic obstructive pulmonary disease

Laryngopharyngeal reflux (LPR) is defined as the movement of gastric content towards the larynx and the pharynx and it may cause respiratory symptoms or difficulty in their control. We aimed to find the frequency of LPR in chronic obstructive pulmonary disease (COPD) patients and to investigate its effect on COPD symptoms and the results of its treatment. At baseline 30 (20 male, 10 female, mean age: 65 ± 10 years) COPD patients completed LPR and COPD symptom questionnaires and 13 (44%) were diagnosed with LPR based on laryngeal examination. Patients with LPR were given 2 months of PPI treatment, after which LPR and COPD symptom questionnaires, laryngeal examinations and pulmonary function tests were repeated. Following the treatment, significant improvements in COPD symptom index, LPR symptom index and laryngeal examination findings were observed in patients with LPR (P < 0.01, P < 0.01, P < 0.0001, respectively). Treatment of LPR resulted in a significant improvement in the symptoms of COPD.     

Laryngopharyngeal reflux in chronic rhinosinusitis patients and the role of endoscopic sinus surgery

ObjectivesLatest literature proposes laryngopharyngeal reflux (LPR) as the underlying contributory factor for chronic inflammation in both upper and lower airways. In this study, we investigated LPR symptoms and signs of CRS patients and the various factors on their LPR symptoms and signs. We also evaluated the effect of the LPR symptoms and signs of CRS patients after endoscopic sinus surgery (ESS).MethodsWe performed a retrospective analysis from 91 patients who underwent primary ESS. They were assessed for LPR symptoms with Reflux Symptom Index (RSI) and Reflux Finding Scores (RFS) before ESS. Sino-Nasal Outcome Test (SNOT)-22, Lund–Mackay (LM) scoring system, and Lund-Kennedy (LK) scoring system were evaluated for CRS severity. They had to fulfill SNOT-22, RSI, and RFS at 6 months after surgery.ResultsNasal polyps, smoking, asthma, allergy, LM scores and LK scores didn't have significant correlations with preoperative RSI and RFS (P > .05 for all). RSI had significant correlations with SNOT-22 preoperatively and postoperatively (P < .05 for all). RFS had a significant correlation with postoperative SNOT-22 (P = 0.034). RSI and RFS decreased significantly more after ESS (P < 0.001 for both). Smoking had a significant effect on the postoperative RFS (P = 0.003). Non-smoker showed significantly lower scores of postoperative RFS (P = .0.003).ConclusionOur study suggests that subjective CRS symptoms were related with subjective LPR symptoms and ESS was effective in reducing signs and symptoms of LPR in CRS patients. Especially, smoking was associated with less improvement of laryngoscopic findings after ESS.     

Observations of increased gastroesophageal reflux symptomology in an anhydrous ammonia exposed population

ObjectiveThis case series describes a cohort of patients exposed to anhydrous ammonia vapors with clinical findings of laryngopharyngeal reflux (LPR). The study characterizes the identification of LPR as a consequence of vapor inhalation and the utility of PPI therapy in LPR secondary to inhalational ammonia exposure.MethodsThis is a case series of 15 patients exposed to anhydrous ammonia from a single chemical spill who experienced LPR several months after exposure. Symptoms of LPR were assessed at their initial consultation and by phone at least 30 days after treatment with low-dose PPI or diet modification. At this visit, patients underwent complete head and neck examination and flexible direct laryngoscopy.Results15 patients were available for analysis before and after treatment. 93.3 % experienced at least three cardinal symptoms of LPR. 66 % of these patients had at least one LPR finding on flexible laryngoscopy. 73 % were treated with daily standard dose PPI, and 82 % of these patients experienced reduction of symptoms after 30 days of PPI treatment. Four of 15 patients were not taking the PPI as prescribed, and only one of these patients had resolution of LPR symptoms.ConclusionWe conclude that there is an association between anhydrous ammonia exposure and the development of LPR symptoms. In this study, treatment with PPIs was successful in reducing symptoms for most patients, and patients who did not receive PPIs experienced symptoms for a longer time.     

Therapeutic Effect of Multilevel Surgery on Laryngopharyngeal Reflux in Obstructive Sleep Apnea Patients: Impact on the Reflux Symptom Index and Reflux Finding Score

Objectives.Our previous study found that multilevel obstructive sleep apnea (OSA) surgery mitigated laryngopharyngeal reflux (LPR) symptoms in terms of the reflux symptom index (RSI), but no studies have investigated the impact of OSA surgery on laryngoscopic parameters. The aim of this study was to examine the clinical outcome of LPR improvement following OSA surgery, with a focus on both the RSI and the reflux finding score (RFS).Methods.Prospectively collected data from 28 patients who underwent multilevel OSA surgery from 2017 to 2021 were retrospectively analyzed. Patients were asked to complete the RSI questionnaire and underwent a laryngoscopic examination to evaluate the RFS before and after surgery. Age, height, weight, body mass index (BMI), and polysomnography data before and after surgery were also reviewed.Results.After surgery, the total RSI and RFS decreased significantly from 11.96±8.40 to 7.68±6.82 (P=0.003) and from 6.57±3.49 to 3.21±1.87 (P<0.001). The positive rates of RSI and RFS decreased from 28.6% to 17.9% and 32.1% to 0%, respectively. Significant improvements were found in the RSI subdomains of throat clearing, throat mucus, breathing difficulty, troublesome cough, and heartburn sensation, while all RFS subdomains except granuloma improved significantly. In subgroup analyses, no significant differences were found between subgroups based on age, OSA severity, or BMI.Conclusion.OSA surgery has the potential to alleviate both LPR symptoms and laryngoscopic results. Additional research integrating more objective techniques and novel treatment strategies is required to better comprehend the clinical impact of OSA surgery on LPR.     

Silent reflux: Ex juvantibus criteria for diagnosis and treatment of laryngeal disorders

Conclusions. Some primary laryngeal pathologies with specific clinical presentation may be related to silent laryngeal reflux. An ex adjuvantibus proton pump inhibitor (PPI) treatment may be helpful for showing evidence of such a hidden laryngeal disorder. Objective. To assess the validity of PPI as an ex adjuvantibus criterion for diagnosis and treatment of suspected reflux-associated laryngitis. Patients and methods. Sixty patients with clinical suspicion of laryngo-pharyngeal reflux (LPR) were identified on the grounds of laryngeal symptoms (dysphonia, cough, globus sensation, increased throat clearing, bad taste, and laryngeal spasm), laryngeal features (arytenoid edema/erythema, partial or total vocal fold erythema, and posterior glottic edema) with or without gastro-esophageal reflux disorder (GERD). They were consequently subdivided in three groups: type I, with LPR symptoms and features without GERD; type II with LPR symptoms and features with GERD; and type III with LPR features only. Types I and III were randomly treated with omeprazole (group A) or with immunostimulating vaccine (group B) for 3 months. Pre- and post-treatment laryngeal features and symptoms in all groups were evaluated by laryngo-stroboscopy and analyzed for statistical correlation. Results. All omeprazole-treated patients showed improvement of laryngeal features and symptoms. With PPI treatment, a more significant improvement was noticed with respect to nonspecific immunostimulant therapy. Also, patients without LPR symptoms showed improvement of laryngeal features.     

Double probe pH-monitoring findings in patients with benign lesions of the true vocal folds: comparison with typical GERD and the effect of smoking

We conducted a pH-monitoring study to determine the prevalence of pathologic gastroesophageal reflux (GER+) and laryngopharyngeal reflux (LPR+) in patients with resected benign true vocal fold lesions (TVFLs) and positive reflux finding score (RFS). We compared our findings with those of patients with typical GER disease (GERD) symptoms and normal laryngoscopy. In the group of patients with TVFLs, we compared the pH-monitoring findings of smokers with those of non-smokers. Seventy-two [females 32, mean (SD) age 49.3 (13.1) years] patients with resected TVFLs (polyps: 32, nodules: 20, Reinke’s edema: 12, granulomas: 4, leukoplakia: 4) and 24 [females 14, mean (SD) age 42.2 (13.4) years] patients with typical GERD symptoms, who served as controls for the hypopharyngeal measurements, underwent 24-h double probe, hypopharyngeal and distal esophageal, ambulatory pH monitoring. Thirty-eight (52.8%) patients with TVFLs had GER+ and 52 (72.2%) had LPR+. More laryngopharyngeal reflux episodes (LPREs) were detected in patients with TVFLs compared to those with GERD (P < 0.001). With respect to the specific TVFLs, 12 (37.5%) patients with polyps had GER+ and 24 (75%) had LPR+, 6 (30%) patients with nodules had GER+ and 12 (60%) had LPR+, 6 (50%) patients with Reinke’s edema had GER+ and 8 (66.7%) had LPR+ and all the patients with granuloma or leucoplakia had both GER+ and LPR+. Twenty (55.6%) of the 36 smokers and 32 (88.9%) of the 36 non-smokers with TVFLs had LPR+ (P = 0.003), while GER+ was recorded in 16 (44.4%) smokers and 22 (61.1%) non-smokers (P = 0.238). Smokers had significantly less LPREs (P < 0.001). In conclusion, 24-h double probe pH monitoring may detect GER+ and/or LPR+ in a substantial proportion of patients with resected TVFLs and positive RFS. Our study suggests that LPR+ is more prevalent in patients with TVFLs compared with typical GERD patients and that non-smokers with TVFLs are more likely to have LPR+ than smokers with TVFLs.     

Hoarseness and laryngopharyngeal reflux: a cause and effect relationship or coincidence?

The role of laryngopharyngeal reflux (LPR) on hoarseness is widely assumed and accepted. Few articles present objective information on the subject. One of the main problems in establishing a relationship is our lack of knowledge of what is normal. We compared patients with chronic hoarseness and healthy controls to establish three goals: (1) to demonstrate the presence of additional symptoms and signs of LPR in patients with hoarseness; (2) to find the prevalence of LPR by utilizing 24 h double-probe in patients with hoarseness and compare it with that of the control group; (3) to contribute data to establish prevalence of LPR in healthy population. Forty-three patients with hoarseness and 20 healthy volunteers were enrolled in the study. All the patients in the study group had hoarseness of more than 3 months duration. The subjects recieved videolaryngoscopic evaluation and 24 h double-probe pH monitoring, and the results were compared. In the study group, 27 patients (62.8%) out of 43 had LPR episodes, compared to 6 (30%) of 20 healthy volunteers. Mean number of LPR episodes recorded by the pharyngeal probe was 7.0 [standard deviation (SD): 8.8] in 24 h, and this was significantly higher than that of the healthy controls [0.9/24 h (SD: 1.9)] (P = 0.003). Mean number of LPR episodes of the study group in upright position was 5.8 (SD: 7,0) and in supine position was 1.2 (SD: 3.3). These numbers were also significantly higher from the controls (P = 0.005 and P = 0.014 respectively). The results of this study show that: (1) most common additional symptoms were heartburn and chronic throat clearing and most common finding is pachydermia; (2) LPR incidence in patients with chronic hoarseness is significantly higher than the LPR incidence in healthy controls; (3) LPR is present in healthy people. However, the severity of LPR seems to be the causative factor rather than its presence.     

Risk factors for laryngopharyngeal reflux

The aim of this study was to evaluate the demographic and clinicopathologic characteristics of gastroesophageal reflux disease (GERD) with and without laryngopharyngeal reflux (LPR) to determine the risk factors for the occurrence of LPR in patients with GERD. This is a retrospective study of GERD patients with and without LPR. From the outpatient computer program of our hospital we randomly enrolled 45 GERD patients with LPR into the first group and another 45 GERD patients without LPR to the second group. Medical records of the patients in both groups were examined. All patients underwent upper gastrointestinal system endoscopy. LPR was confirmed by laryngoscopy, and LPR-related laryngoscopy scoring. Non-erosive GERD (NERD), erosive GERD (ERD) and Barrett’s esophagus (BE) were diagnosed by endoscopy and histopathology. Various clinical parameters including status of Helicobacter pylori (H. pylori) infection, topography of gastritis were analyzed. For therapy, lansoprazole in a dosage of 30 mg BID for at least 8 weeks were given to all patients in both groups. GERD patients with and without LPR were compared according to demographic, clinic, endoscopic and histopathological parameters. The results revealed that patients with LPR were younger than the patients without LPR (38.7 ± 10.2 years and 43.8 ± 11.5 years; p = 0.08); however, there was no statistical significance. Patients without LPR showed no gender predilection (55% male) while LPR patients showed male preponderance (71% male). In LPR group, 11 patients (24%) had NERD, while 28 (62%) and 6 (13%) patients had ERD and BE, respectively. Twenty-seven (60%) patients without LPR were diagnosed as NERD, 15 patients (33%) without LPR had ERD and only 3 patients (6.6%) showed the histological findings of BE. The patients in LPR group had higher body mass index. Hiatal hernia was more frequent in the patients with LPR (53%) than in the patients without LPR (24%) (p = 0.005). LPR patients had longer duration of reflux symptoms than the patients without LPR (p = 0.04). H. pylori status was not different in both groups but the patients without LPR had more corpus gastritis than the patients with LPR. Eight weeks of lansoprazole treatment was successful in 71% of patients with LPR, and 86% of patients without LPR. We concluded that male gender, hiatal hernia, longer duration of symptoms, high BMI, having ERD and BE seems as risk factors for the occurrence of LPR in patients with GERD. H. pylori status did not have any effect on the development of LPR. Corpus dominant gastritis may have a protective role against the development of LPR. Proton pump inhibitor therapy is less effective in patients with LPR.     

Characteristics of laryngopharyngeal reflux in patients with chronic otitis media

Objective

To summarize the characteristics of laryngopharyngeal reflux (LPR) in patients with chronic otitis media.

The value of a liquid alginate suspension (Gaviscon Advance) in the management of laryngopharyngeal reflux

Laryngopharyngeal reflux (LPR) refers to the backflow of stomach contents into the laryngopharynx. Increasing evidence has demonstrated that LPR is a contributing factor in some cases of hoarseness, vocal fatigue, voice breaks, cough and globus and chronic throat clearing. However, several randomised placebo-controlled trials of proton pump inhibitors in the treatment of LPR have been reported with the majority showing no significant benefit in patient symptom scores over placebo. The aim of this pilot clinical study was to investigate whether any improvement in LPR-related symptoms, using the Reflux Symptom Index (RSI), and clinical findings, using the Reflux Finding Score (RFS), could be achieved with treatment with a liquid alginate suspension compared to control (no treatment). Patients presenting with the symptoms of LPR to the Otorhinolaryngology Outpatient Department at the Queen’s Medical Centre, Nottingham, UK were considered eligible if they had an RSI of greater than 10 and an RFS greater than 5 based on a fibreoptic examination of the larynx. A total of 49 patients were randomised into the open, parallel group study; 24 patients were randomised to receive 10 ml liquid alginate suspension (Gaviscon^® Advance) four times daily after meals and at bedtime, and 25 patients into the control group (no treatment). Patients were assessed pre-treatment and at 2, 4 and 6 months post treatment. Mean (SD) RSI and RFS pre-treatment scores were 23.9 (7.0) and 10.4 (3.6) for the treatment group and 24.6 (7.4) and 10.3 (3.3) for the control group, respectively. Significant differences between treatment and control were observed for RSI at the 2-month (11.2 (7.0) vs. 16.8 (6.4), P = 0.005) and 6-month (11.2 (8.1) vs. 18.3 (9.4), P = 0.008) assessments and for RFS at the 6-month (7.1 (2.8) vs. 9.5 (3.4), P = 0.005) assessment. Significant improvement in symptom scores and clinical findings were achieved with liquid alginate suspension (Gaviscon^® Advance) compared to control and further evaluation for the management of patients presenting with LPR is warranted.     

Prevalence of pH-documented laryngopharyngeal reflux in Chinese patients with clinically suspected reflux laryngitis

PURPOSE: Laryngopharyngeal reflux (LPR) is one of the main factors behind different laryngeal pathology according to the Western literature. Literature reported that the prevalence of gastroesophageal reflux disease (GERD) in Chinese population was considerably lower than that in Western countries. To date, however, there is no study to evaluate the prevalence of pH-documented LPR in the Chinese ethnicity. MATERIALS AND METHODS: We thus recruited 28 consecutive Chinese patients with reflux symptoms including globus, throat discomfort, throat clearing, chronic cough, or burping lasting more than 1 month in the preceding 1 year, together with stroboscopic evidence suggestive of reflux laryngitis according to the reflux finding score in our study. All patients underwent thorough head and neck examination and transnasal endoscopic assessment. The prevalence of pH-documented LPR and GERD was then documented using ambulatory 24-hour pH biprobe study. RESULTS: Six (21%) of the 28 patients had pH-documented LPR. Four (14%) of the 28 patients had GERD with 3 of them having concomitant LPR. Only burping was associated with pH-documented LPR (P < .05). No relationship was observed between pH-documented LPR and other factors, including age, sex, other reflux symptoms except burping, and the reflux finding score. CONCLUSION: Chinese patients do have and present with symptoms of extraesophageal reflux, and we observed a lower prevalence of pH-documented LPR in Chinese patients with clinically suspected reflux laryngitis compared with white patients.     

Laryngopharyngeal reflux might play a role on chronic nonspecific pharyngitis

Chronic nonspecific pharyngitis is one of the most common reasons for visits to otorhinolaryngology physicians. The underlying conditions are still unknown. The aim of this study was to investigate the role of laryngopharyngeal reflux in chronic nonspecific pharyngitis patients based on the patient’s history and clinical examination. Fifty consecutive patients with symptoms of chronic nonspecific pharyngitis and control group of 30 healthy persons were evaluated prospectively. 14C-urea breath test was used to exclude Helicobacter pylori infection of gastric mucosa. All the patients and the controls were assessed by blinded same laryngologist with the use of the reflux finding score (RFS) and reflux symptoms index (RSI). Also chronic nonspecific pharyngitis patients with laryngopharyngeal reflux (LPR) were evaluated prospectively before and 6 months after b.i.d treatment with proton pump inhibitors. The RSI of the nonspecific pharyngitis group was found significantly higher than the control group (P < 0.01). The RFS of nonspecific pharyngitis was found significantly higher than the control group (P < 0.01). The reflux finding score ≥7 has been accepted as LPR; the reflux incidence was significantly higher in the nonspecific pharyngitis group than the control group (P < 0.01). Posttreatment RSI of nonspecific pharyngitis patients group revealed a statistically significant decrease when compared with the pretreatment RSI (P < 0.01). Posttreatment RFS of nonspecific pharyngitis patients also revealed a significant decrease when compared with the pretreatment RFS (P < 0.01). We suggest that LPR may be related to the pathogenesis of chronic nonspecific pharyngitis.     

The effect of obstructive sleep apnea surgery on laryngopharyngeal reflux with obstructive sleep apnea

Abstract

Background: Obstructive sleep apnea (OSA) may play a role in the occurrence of laryngopharyngeal reflux (LPR). OSA surgery also may have a significant curative effect on LPR with OSA.

Objectives: To analyze the role of OSA in LPR and the effect of OSA surgery on LPR with OSA.

Methods: Forty-five OSA patients with LPR symptoms were enrolled and were divided into the LPR positive group (RSI > 13) and the LPR suspicious group (1?≤?RSI ≤ 13) based on reflux symptom index (RSI). All the patients underwent OSA surgery. The RSI scores at three different time points postoperatively were compared with that preoperatively.

Results: In the LPR positive and LPR suspicious group, the result revealed that there were significant differences in RSI score between one month, three months, six months after surgery and before surgery (p?<?.001 for all). Moreover, in the LPR positive group, there was a significant difference in RSI score among one month, three months and six months after surgery (p?=?.01).

Conclusions and significance: The effect of OSA on LPR exists and OSA surgery can improve the symptoms of LPR with OSA obviously. For some LPR patients with OSA, the combination therapy of OSA and LPR is needed.     

Association of laryngopharyngeal manifestations and gatroesophageal reflux

The aim of this study was to investigate the prevalence of gastroesophageal reflux disease (GERD) in patients with laryngopharyngeal symptoms, the relationship between laryngopharyngeal reflux (LPR) and Helicobacter Pylori infection and treatment response to proton pump inhibitors. Forty-five patients with suspected gastroesophageal reflux diseases related symptoms (sore throat, throat burning, throat clearing, globus sensation, cough, halitozis, dysphonia, dysphagia, postnasal dripping, vocal fatigue, and sputum) were included in this study. For pre-therapeutic and post-therapeutic comparison, symptoms and laryngological findings were graded on a 4-point scale. The patients underwent upper gastrointestinal system endoscopy. During endoscopy, antral biopsies from the stomach were obtained to detect H. Pylori. Antireflux medication with proton pump inhibitors (PPI) and H. Pylori eradication therapy if present were prescribed to the patients. The improvement in symptoms and laryngological findings were evaluated after treatment. By means of esophagogastroduodenoscopy (EGD), reflux was detected in only 11% of patients. But there can be reflux patients other than the detected ones. Although, H. Pylori was present in 62% of patients, no correlation was found between H. Pylori positivity and symptoms. All patients responded well to antireflux treatment and H. Pylori eradication therapy. Laryngopharyngeal symptoms and findings can be predictors of gastroesophageal diseases when response to reflux treatment is taken into account.     

Prevalence of laryngopharyngeal reflux in a population with gastroesophageal reflux

OBJECTIVE: Laryngopharyngeal reflux (LPR) is a syndrome associated with a constellation of symptoms usually treated by ENT surgeons. It is believed to be caused by the retrograde flow of stomach contents into the laryngopharynx, this being a supra-esophageal manifestation of gastroesophageal reflux disease (GERD). It has been cited that LPR and GERD can be considered separate entities. Our hypothesis was that LPR is a supra-esophageal manifestation of GERD and therefore that patients with GERD should have a degree of symptoms suggestive of LPR because of the reflux of the gastric contents. We examined a population of patients with both upper gastrointestinal endoscopy and symptom-proven GERD and, using a questionnaire, looked at their existing symptoms to help assess the prevalence of LPR. We also looked at whether, with more severe GERD (suggestive of increased gastric content reflux), the degree of symptoms suggestive of LPR would be increased, as would be expected. METHODS: A population of patients with endoscopically proven GERD were recruited and divided into groups depending on the severity of their reflux disease. A questionnaire was then administered that examined both LPR and GERD scoring criteria. The relationship between GERD and LPR was then analyzed. RESULTS: We recruited 1,383 subjects with GERD; those with severe GERD had significantly higher LPR scores compared with those with mild (P < .01), moderate (P < .05), or inactive disease (P < .001). CONCLUSIONS: The condition of LPR is likely to represent a supra-esophageal manifestation of GERD. This study examined a large number of patients with endoscopically proven GERD and has demonstrated a correlation between the severity of GERD and the prevalence of LPR. LPR and GERD are common and interlinked conditions. The subsequent prevalence of LPR in the population with GERD is therefore likely to be dramatically underestimated.     

Silent reflux: ex juvantibus criteria for diagnosis and treatment of laryngeal disorders

CONCLUSIONS: Some primary laryngeal pathologies with specific clinical presentation may be related to silent laryngeal reflux. An ex adjuvantibus proton pump inhibitor (PPI) treatment may be helpful for showing evidence of such a hidden laryngeal disorder. OBJECTIVE: To assess the validity of PPI as an ex adjuvantibus criterion for diagnosis and treatment of suspected reflux-associated laryngitis. PATIENTS AND METHODS: Sixty patients with clinical suspicion of laryngo-pharyngeal reflux (LPR) were identified on the grounds of laryngeal symptoms (dysphonia, cough, globus sensation, increased throat clearing, bad taste, and laryngeal spasm), laryngeal features (arytenoid edema/erythema, partial or total vocal fold erythema, and posterior glottic edema) with or without gastro-esophageal reflux disorder (GERD). They were consequently subdivided in three groups: type I, with LPR symptoms and features without GERD; type II with LPR symptoms and features with GERD; and type III with LPR features only. Types I and III were randomly treated with omeprazole (group A) or with immunostimulating vaccine (group B) for 3 months. Pre- and post-treatment laryngeal features and symptoms in all groups were evaluated by laryngo-stroboscopy and analyzed for statistical correlation. RESULTS: All omeprazole-treated patients showed improvement of laryngeal features and symptoms. With PPI treatment, a more significant improvement was noticed with respect to nonspecific immunostimulant therapy. Also, patients without LPR symptoms showed improvement of laryngeal features.     

Narrow band imaging might contribute to the diagnosis of laryngopharyngeal reflux

PurposeLaryngopharyngeal reflux (LPR) accounts for 4–10% of outpatient visits. The standard domestic LPR diagnostic tools are the reflux finding score (RFS) and reflux symptom index (RSI). Narrow band imaging (NBI) can identify previously unknown characteristic microvessel features. Our aim was to explore the role of NBI in LPR diagnosis.Materials and methodsWe recruited 56 LPR outpatients and 41 symptom-negative controls. All individuals received RSI and RFS scores and underwent 24-hour multichannel intraluminal impedance-PH (MII-pH) monitoring and endoscopic NBI before and after treatment. The positivity rates in the study and control groups, before and after treatment, and using NBI and the conventional method were evaluated.ResultsFifty-one LPR and six control patients had sparse light brownish dots or tufted light brownish dots in the postcricoid region. The RSI and RFS positivity rates were 31.3% and 87.1%, respectively. NBI is as effective as the RFS (P < 0.05), and has poor consistency with the RSI (P < 0.05). Fifty-three LPR patients underwent posttreatment laryngoscopy. The positivity rate decreased to 17.0% (P < 0.05).ConclusionNBI has good value for LPR diagnosis.     

Diagnosis and treatment of laryngopharyngeal reflux

BACKGROUND: During the last decades an increased prevalence of reflux disease can be observed. Otolaryngologists play an increasing role in the treatment of patients suffering from laryngopharyngeal reflux (LPR). Typical symptoms for LPR are globus sensation, dysphagia, throat clearing, chronic cough and hoarseness. The most frequent laryngoscopic finding in patients suffering from LPR is a posterior commissure hypertrophy. LPR is confirmed by laryngoscopy, LPR-related laryngoscopy scoring, 24-hour dual-probe pH-monitoring, and by empiric trial with proton pump inhibitors (PPI). For therapy PPI-medication in a dosage of 40 mg BID for at least 3 months is successful in many patients. Additional lifestyle modifications can also have a positive effect. When medical management fails, further diagnostic procedures should be initiated. CONCLUSION: In patients suffering from unspecific laryngeal and respiratory symptoms LPR is an important differential diagnosis.