咽喉反流伴阻塞性睡眠呼吸暂停低通气综合征患者的治疗及其咽喉反流体征评分、症状指数特点

目的 分析咽喉反流病(LPRD)伴阻塞性睡眠呼吸暂停综合征(OSAS)患者的咽喉反流体征评分(RFS)和咽喉反流症状指数(RSI)特点,探讨临床治疗效果。 方法 抽取100例LPRD患者,将其中合并有OSAS的患者作为观察组(n=39),其余作为对照组(n=61),观察两组RFS、RSI及呼吸暂停低通气指数(AHI)、血氧饱和度(SaO₂)、反流总数、总反流时间;比较治疗2个月后RSI、RFS评分。 结果 观察组RFS和RSI评分总分显著高于对照组,RFS体征差异均有统计学意义(P<0.05),咽喉反流伴OSAS患者声门下水肿、喉室消失、杓会厌襞红斑/充血、喉黏膜水肿、后联合肥厚或肿胀评分显著高于单纯的咽喉反流患者(P<0.05),RSI评分中咽喉反流伴OSAS患者呼吸困难、烧心胸痛胃酸反流评分显著高于单纯的咽喉反流患者(P<0.05);治疗后,观察组RSI评分总分高于对照组(P均<0.05),对照组在呼吸困难、烧心胸痛胃酸反流方面明显优于观察组(P<0.05)。治疗前后,两组AHI、SaO₂、反流总数比较均差异有统计学意义(P<0.05)。治疗后,观察组AHI、SaO₂均明显改善,与治疗前比较差异有统计学意义(P<0.05),两组反流总数、总反流时间改善显著,对照组优于观察组(P<0.05)。 结论 伴OSAS会加重LPRD患者咽喉反流相关症状,可能是LPRD患者治疗效果和症状改善较差的原因。     

喉咽反流维持治疗初探

目的 探讨喉咽反流的维持治疗方法。方法 将2019年7～11月就诊于合肥市第一人民医院耳鼻咽喉科门诊的反复发作的喉咽反流患者70例分成两组,观察组采用腹式呼吸屏气训练+耳穴按摩治疗,对照组采用雷贝拉唑、磷酸铝、莫沙比利治疗。疗程8周,每两周对症状及体征进行评分。结果 两组患者经过8周治疗,症状体征均有改善,评分无统计学差异,但对照组症状改善较治疗组快。结论 采用腹式呼吸屏气训练+耳穴按摩能显著改善反流症状及体征,对喉咽反流治疗安全有效,可作为喉咽反流维持治疗的主要方法。     

两种方法诊断咽喉反流患者的嗓音特征及治疗前后变化

目的　用pH监测和反流症状指数量表（reflux symptom index,RSI）联合反流体征评分量表（ref lux finding score,RFS）分别诊断咽喉反流,了解质子泵抑制剂治疗前后两种不同方法诊断咽喉反流患者嗓音学参数的变化,以期将嗓音改变作为咽喉反流疾病诊断和疗效判断的辅助指标之一。方法　2012年8月～2013年8月在北京大学 第三医院耳鼻咽喉科就诊,应用24小时多通道腔内阻抗及pH监测诊断为咽喉反流的患者26例,作为pH组;通过RSI、RFS诊断为咽喉反流的患者26例为量表组,无任何咽喉部不适的志愿者52名为对照组,对所有研究对象应用MDVP软件进行嗓音学参数检查;对实验组患者进行埃索美拉唑20 mg,2次/d,口服治疗,治疗1个月后复查嗓音学参数,分析治疗前、后患者嗓音学参数的差异。结果　咽喉反流患者与正常对照组之间比较,质子泵抑制剂治疗前频率微扰、振幅微扰、噪谐比均有显著性差异（P 均<0.05）;基频、最长发音时间无显著性差异;治疗后上述各嗓音声学参数与对照组之间比较均无显著性差异（P 均>0.05）;结论　咽喉反流患者存在嗓音声学参数的异常,质子泵抑制剂治疗后明显好转,某些嗓音学参数有可能作为咽喉反流疗效评估的客观指标之一。     

药物联合治疗咽喉反流的临床评价

目的 探讨联合用药咽喉反流(laryngopharyngeal reflux,LPR)治疗的临床效果.方法 以反流症状指数量表(reflux symptom index,RSI)评分>13分和(或)反流检查计分量表(reflux findingscore,RFS)评分>7分定为阳性,为LPR疑似患者58例,其中RSI评分阳性51例次,RSF评分全部阳性.按照视觉模拟量表对自身症状主观评价后分为轻、中、重三度.58例患者按随机数字表法分为综合治疗组(口服奥美拉唑和多潘立酮,含服甘桔冰梅片)和对照组(口服奥美拉唑).连续治疗3个月后评价疗效.结果 治疗前后根据视觉模拟量表评分显示,综合治疗组30例显效19例,有效8例,总有效率90.0%;对照组28例显效10例,有效9例,总有效率67.9%;综合治疗组疗效优于对照组(X~2=4.33,P<0.05).纤维喉镜检查显示综合治疗组30例中有效24例(80%),无效6例(20%),总有效率80.0%;对照组28例中有效15例(53.6%),无效13例(46.4%),总有效率53.6%;综合治疗组疗效优于对照组(X~2=4.59,P<0.05).患者咽喉部主要症状缓解时间比较,综合治疗组较对照组所需时间短,差异均有统计学意义(P值均<0.01).结论 奥美拉唑联合多潘立酮和甘桔冰梅片治疗LPR比单用奥美拉唑可能有更好的疗效.     

玄贝温胆汤联合半夏泻心汤加减治疗反流性咽喉病的临床观察

目的 探讨玄贝温胆汤联合半夏泻心汤加减治疗反流性咽喉病的临床疗效观察。方法 选取2018年6月～2019年6月160例我院收治的反流性咽喉病的患者为研究对象,平均分为观察组和对照组各80例,对照组实施玄贝温胆汤治疗,而观察组采用玄贝温胆汤联合半夏泻心汤加减治疗,分析两组患者的临床疗效。结果 患者经过玄贝温胆汤联合半夏泻心汤加减治疗后,观察组的治疗有效率98.75%高于对照组92.50%,有明显统计学差异（P<0.05）;反流性咽喉病患者治疗后不良反应分析显示,不良反应率6.25%,观察组的乏力、口干、腹泻、头晕与对照组比较差异均有统计学意义（P<0.05）;经过RSI及RFS测定,两组患者治疗前后的发声障碍、痰过多、咳嗽、咽异物感、声带充血、声带水肿比较,组间和组内比较差异均有统计学意义（P<0.05）;经过SF-36健康量表测定,两组患者的生理功能、躯体疼痛、社会功能、情感职能、精神健康比较有明显差异,比较差异均有统计学意义（P<0.05）。结论 玄贝温胆汤联合半夏泻心汤治疗反流性咽喉病的疗效较好,优于单用玄贝温胆汤,不良反应少经济成本低廉,对患者有效治疗及预...     

埃索美拉唑治疗咽喉反流的疗效评估

目的:探讨质子泵抑制剂埃索美拉唑治疗咽喉反流的疗效.方法:2009-06-2010-03期间门诊患者按反流症状指数(RSI)量表、反流检查计分(RFS)量表,以RSI>13分和RFS>7分筛选主诉为咽喉反流相关症状的患者,ELESA法检测唾液中存在的胃蛋白酶,确诊为咽喉反流者纳入研究对象,按要求完成8周正规埃索美拉唑治疗方案;完成8周疗程后再次RSI、RFS量表评分,ELESA法检测唾液中的胃蛋白酶.结果:经8周治疗后,24例患者症状明显好转,2例症状改善不明显.治疗前后RSI量表症状评分呈正态分布,经配对t检验,治疗前后RSI量表症状得分明显下降,差异有统计学意义(t=8.152,P<0.01);所有患者体征均改善.治疗前后RFS量表体征评分呈正态分布,经配对t检验,治疗前后RFS量表体征得分明显下降,差异有统计学意义(t=9.704,P<0.01);21例患者唾液中胃蛋白酶浓度下降,5例上升,治疗前后浓度差异比较,呈非正态分布,采用两样本相关非参数检验,差异有统计学意义(Z=-3.213,P(0.01).结论:26例咽喉反流患者经每日2次的埃索美拉唑治疗,大部分患者咽喉反流症状和体征得到改善,唾液中胃蛋白酶含量显著下降.     

声带息肉手术联合抗酸治疗反流性咽喉疾病合并声带息肉的预后影响

目的探讨声带息肉手术联合抗酸治疗对咽喉反流病(LPR)合并声带息肉预后的影响,为LPR合并声带息肉的治疗提供理论基础。方法本探究研究对象选择2014年10月-2016年10月期间于我院行声带息肉手术治疗的100例LPR合并声带息肉患者,将声带息肉手术术后未进行抗酸治疗治疗的46例患者设为对照组,术后采用抗酸治疗的54例患者设为观察组。分别比较治疗前后相关声学参数、反流症状指数(RSI)、反流检查计分(RFS)以及嗓音障碍指数(VHI-10)。结果两组治疗前后振幅微扰(Shimmer)、频率微扰(Jitter)、最长声时(MPT)、谐噪比(HNR)、声门噪声能量(NNE)差异显著,治疗后观察组NNE、MPT与对照组差异显著,有统计学意义(P0.05);治疗前后RSI13、RFS7人数比例差异显著,观察组治疗后RSI13、RFS7人数比例差显著低于对照组(32.61%vs55.55%),观察组咽喉反流治疗有效率显著高于对照组(67.39%vs44.45%),有统计学意义(P0.05);两组治疗前后VHI-10差异显著,治疗后观察组显著低于对照组[(5.43±1.32)vs(14.32±2.31)]。结论声带息肉手术联合抗酸治疗咽喉反流病合并声带息肉能够显著改善患者的反流症状,降低嗓音障碍对生活质量造成的影响,提高嗓音质量。     

窄带成像技术在咽喉反流诊断中的优势应用

目的 探讨窄带成像技术(NBI)在咽喉反流(LPR)诊断中的作用.方法 根据我国2015年咽喉反流性疾病诊断与治疗专家共识的标准招募39例咽喉反流阳性患者(LPR组)和19例阴性对照,参与者均完成反流症状指数评分量表(RSI)和反流体征评分量表(RFS)评分及NBI下的电子喉镜检查.结果 39例LPR患者中2例失访.与...     

咽喉反流与学龄前儿童分泌性中耳炎的相关性分析

目的　分析咽喉反流与学龄前儿童分泌性中耳炎的相关性,为儿童分泌性中耳炎的诊治提供更多思路和方法。方法　选取分泌性中耳炎合并咽喉反流的患儿为研究对象。通过反流症状指数评分量表（reflux symptom index,RSI）>13分及反流体征评分量表（reflux fingding score,RFS）≥7分诊断疑似咽喉反流。以病史结合耳内镜、声导抗检查确诊分泌性中耳炎。对患儿同时进行抗反流治疗,随访半年,观察疗效。结果　分泌性中耳炎合并咽喉反流的患儿病例资料完整者18例,其中男12例,女6例,年龄3~6岁。1例手术,17例保守治疗。治疗前、治疗1个月、治疗2个月后的RSI评分及各项症状评分,差异有统计学意义。治疗前RSI评分和RFS评分无相关性（r =0.043,P =0.865）。治疗后1个月72%患儿中耳炎症状治愈,RSI>13分的患儿症状缓解率与用药时间呈负相关（r =－0.871,P =0.00）;RSI≤13分的患儿症状缓解率与用药时间无相关性（r =－0.676,P =0.21）。治疗前的RFS评分与用药时间呈负相关（r =0.608,P =0.01）。随访半年,1例中耳炎复发,再次抗反流治疗后治愈。结论　咽喉反流与儿童分泌性中耳炎有相关性。咽喉反流相关性中耳炎患儿病史长,病情反复,常规治疗无效或频繁发作。结合抗反流治疗可改善患儿的中耳炎症状并减少复发。     

中西医结合治疗胃食管反流性咽喉炎

目的 探讨胃食管反流性咽喉炎的治疗方法 .方法 根据胃食管反流性咽喉炎的症状、体征、间接喉镜、胃镜检查确诊病例50例,给予法莫替丁、甲氧氯普胺(胃复安)、乌干胶囊、山参花茶、联合治疗3个月以上,进行治疗前后疗效对比观察.结果 50例患者中45例反酸、嗳气、声嘶、咽异物感、慢性咳嗽、清嗓子、咽喉分泌物多等症状基本消失或有明显减轻.间断喉镜检查咽喉部病变基本消失或明显减轻.治疗后复查胃镜,胃黏膜充血、水肿、糜烂基本消失.结论 对反流性咽喉炎给予制酸-抗反流-保胃-利咽喉"四位一体"的中西医结合治疗具有良好的疗效.     

中西医结合治疗儿童慢性鼻窦炎临床疗效观察

目的 观察中西医结合治疗儿童慢性鼻窦炎的临床疗效。方法 随机选择儿童慢性鼻窦炎120例,分别用中西医结合作为治疗组,单纯西药作为对照组,统计疗效。结果 中西医结合治疗组总有效率为86.7%,对照组总有效率为68.3%,差异有统计学意义。结论 中西医结合治疗儿童慢性鼻窦炎临床疗效显著。     

Change of acoustic parameters before and after treatment in laryngopharyngeal reflux patients

OBJECTIVES: To evaluate the usefulness of acoustic parameters as an indicator of laryngopharyngeal reflux (LPR) treatment efficacy. STUDY DESIGN: A prospective case series analysis. MATERIALS AND METHODS: From January to September 2005, we prospectively analyzed 40 patients who were diagnosed with laryngopharyngeal reflux by 24-hour ambulatory double-probe pH monitoring. Laryngopharyngeal reflux patients were treated medically and voice analysis was conducted three times: before treatment, 1 to 2 months after treatment, and 3 to 4 months after treatment. Jitter, shimmer, and harmonic-to-noise ratio (HNR) were analyzed as the acoustic parameters. Pre- and posttreatment reflux symptom index and reflux finding score were documented. RESULTS: Jitter, shimmer, and HNR had improved significantly at 1 to 2 months after treatment and were maintained at 3 to 4 months after treatment. Jitter was significantly correlated with reflux symptom index. CONCLUSION: Acoustic parameters can be used as indicators of treatment efficacy for laryngopharyngeal reflux disease.     

Evaluation of laryngopharyngeal reflux in patients with suspected laryngopharyngeal reflux, chronic otitis media and laryngeal disorders

We investigated the prevalence of laryngopharyngeal reflux in patients with signs and symptoms of reflux, chronic otitis media and benign and malignant vocal cord lesions. Three groups of patients in Ankara Ataturk Education and Research Hospital ENT–Head and Neck Surgery Clinics were compared between 2005 and 2006. The first group had patients with signs and symptoms of reflux, the second group consisted of patients with chronic otitis media, and in the third group had patients with laryngeal pathology, i.e. vocal cord lesions. The results of pH monitoring of all the three groups of patients were analyzed for laryngopharyngeal reflux. In the evaluation, two different criteria, based on reflux number and time spent in reflux, were used. It was investigated whether there was a difference in terms of reflux among these three groups. Also, the effects of reflux in etiopathogenesis of chronic otitis media and vocal cord lesions are discussed. A total of 84 patients were studied, with 22 patients with signs and symptoms of reflux in Group 1, 42 patients with chronic otitis media in Group 2, and 20 patients with vocal cord lesions in Group 3. No statistical difference could be detected among the groups in terms of the two criteria mentioned above. The frequency of laryngopharyngeal reflux in patients with chronic otitis media and vocal cord lesions was found to be as high as than in the patients with signs and symptoms of reflux. During the treatment of chronic otitis media and laryngeal disorders, we advise reflux work-up, and in case if there is reflux, we recommend reflux treatment in addition to treatment of primary disease.     

中西医结合治疗放射性咽粘膜反应内镜下疗效观察对照研究

应用中西医结合（中药增液消毒汤、中西药配制润咽消炎合剂体位灌注咽部吞服法、西药）治疗放射性咽粘膜反应，自觉症状及内镜下观察咽胶粘膜疗效明显高于对照组（P＜0.01）。     

中西医结合治疗大前庭导水管综合征听力下降的疗效分析

目的探讨中西医结合治疗以突发听力下降为主要表现的大前庭导水管综合征临床疗效。方法本研究纳入以突发听力下降为主要表现的大庭导水管综合征患者55例(71耳),随机分为实验组41耳和对照组30耳。实验组予中药健脾利水辨证施治结合银杏叶提取物滴剂(金纳多)治疗,对照组口服甲泼尼龙片结合银杏叶提取物滴剂;两组均连续治疗3周。比较两组平均听力阈值、各频率的听阈变化情况及临床疗效。结果两组患者治疗后各频率听阈较治疗前均显著提升(P<0.05);实验组显效23耳、有效4耳、无效14耳,临床有效率为65.85%;对照组显效7耳、有效9耳、无效14耳,临床有效率为53.33%。实验组的临床有效率与对照组无显著性差异(P>0.05)。但两组患者的临床显效率存在显著性差异(P<0.05),实验组的显效率(56.09%)高于对照组(23.33%)。结论以中药健脾利水辩证结合西医治疗大前庭导水管综合征患者突发听力下降可一定程度上恢复听力水平,且临床显效率高于单纯的糖皮质激素治疗,从安全性角度考虑,建议对此类患者选择中西医结合治疗方案。     

Correlation of pH probe-measured laryngopharyngeal reflux with symptoms and signs of reflux laryngitis

OBJECTIVES/HYPOTHESIS: Laryngitis secondary to gastric acid reflux is a prevalent, yet incompletely understood, otolaryngological disorder. Further characterization of the relationship between symptoms and signs and reflux severity is needed. STUDY DESIGN: Prospective clinical trial. METHODS: Forty-two consecutive, nonsmoking patients with one or more reflux laryngitis symptoms were recruited to complete a symptom questionnaire, videostrobolaryngoscopy, and 24-hour, dual-sensor pH probe testing. Twenty-nine patients had more than four episodes of laryngopharyngeal reflux, and the remaining 13 served as control subjects. Symptom scores were produced by multiplying the severity by the frequency for the following: hoarseness, throat pain, "lump-in-throat" sensation, throat clearing, cough, excessive phlegm, dysphagia, odynophagia, and heartburn. Endoscopic laryngeal signs included erythema and edema of the vocal folds and arytenoids, and interarytenoid irregularity. RESULTS: Symptom scores varied significantly, with throat clearing being greater than the rest. None of the symptoms, except heartburn, correlated with reflux (laryngopharyngeal and esophageal) severity. Patients with worse laryngopharyngeal reflux were found to have worse esophageal reflux. Endoscopic laryngeal signs were rated as mild, on average, and did not correlate with laryngopharyngeal reflux severity. The number of laryngopharyngeal reflux episodes (per 24 h) ranged from 0 to 40 (mean number, 10.6 episodes). CONCLUSIONS: Throat clearing was the most intense symptom in the present group of patients with proven reflux laryngitis. Dual-sensor pH probe testing could not predict the severity of patient's reflux laryngitis symptoms or signs. Only the heartburn symptom correlated with laryngopharyngeal and esophageal reflux.     

喉部痰液胃蛋白酶浓度检测对喉咽反流诊断及疗效判定的价值

目的:探讨喉部痰液胃蛋白酶检测对喉咽反流(LPR)诊断及其疗效判定的价值.方法:对2010-06-2010-07期间以咽干、咽喉部异物感、频繁清嗓、慢性咳嗽、发声易倦等症状就诊的36例患者进行3个月质子泵抑制剂诊断性治疗.治疗前后评估反流症状指数(RSI)、反流检查计分(RFS)及喉部痰液胃蛋白酶浓度.诊断性治疗有效者...     

Management of laryngopharyngeal reflux in Brazil: a national survey

IntroductionStudies assessing the management of laryngopharyngeal reflux by otolaryngologists have reported an important heterogeneity regarding the definition, diagnosis, and treatment, which leads to discrepancies in the management of the patient. Information about the current knowledge and practices of Brazilian otolaryngologists in laryngopharyngeal reflux is lacking.ObjectiveTo investigate the trends in management of laryngopharyngeal reflux disease among Brazilian otolaryngologists.MethodsA survey was sent by email to the members of the Brazilian Association of Otolaryngology-Head Neck Surgery. This survey has initially been conducted by the laryngopharyngeal reflux study group of young otolaryngologists of the International Federation of Otolaryngological Societies.ResultsAccording to the survey responders, the prevalence of laryngopharyngeal reflux was estimated to be 26.8% of patients consulting in otolaryngology and the most common symptoms were globus sensation, throat clearing, cough and stomach acid reflux. Nasal obstruction, Eustachian tube dysfunction, acute and chronic otitis media, vocal fold nodules and hemorrhage were considered not associated with laryngopharyngeal reflux by the majority of responders. About 2/3 of Brazilian otolaryngologists based the diagnosis of laryngopharyngeal reflux on the assessment of both symptoms and findings and a positive response to empiric therapeutic trials. Proton pump inhibitor utilized once or twice daily, was the most commonly used therapeutic scheme. Only 21.4% of Brazilian otolaryngologists have heard about nonacid and mixed laryngopharyngeal reflux and the awareness about the usefulness of multichannel intraluminal impedance pH monitoring (MII-pH) was minimal; 30.5% of responders did not consider themselves as well-informed about laryngopharyngeal reflux.ConclusionAlthough the laryngopharyngeal reflux-related symptoms, main diagnostic and treatment approaches referred by Brazilian otolaryngologists are consistent with the literature, the survey identified some limitations, such as the insufficient awareness of the role of laryngopharyngeal reflux in many otolaryngological conditions and of the possibility of non-acid or mixed reflux in refractory cases. Future studies are needed to establish international recommendations for the management of laryngopharyngeal reflux disease.     

慢性咽炎患者喉咽反流分析

目的 探讨慢性咽炎与喉咽反流(laryngopharyngeal reflux,LPR)发生的关系.方法 对112例慢性咽炎患者行24小时双探头(食管和咽部)pH值监测,将检查出的62例LPR患者随机分为两组,实验组:应用抑制胃酸药和清热解毒的咽炎药治疗;对照组:单用清热解毒的咽炎药,对两组咽部症状缓解及病变改善情况进行统计学比较.结果 慢性咽炎的体征多样化,实验组35例,有效率94.29%(33例),对照组27例,有效率77.78%(21例),P＜0.05.结论 LPR是导致慢性咽炎的重要病因,使用抑酸剂可明显改善喉咽反流,从而达到治疗慢性咽炎的目的.     

Characteristics of upright versus supine reflux pattern in patients with laryngopharyngeal reflux

IntroductionMany laryngeal-related problems have been attributed to laryngopharyngeal reflux including dysphonia, frequent throat clearing, chronic cough, and globus sensation. However, there is still controversy regarding diagnosis and clinical presentation of this disorder.ObjectiveThe main objective of this study is to describe laryngopharyngeal reflux characteristics of different reflux position patterns in laryngopharyngeal reflux patients diagnosed with oropharyngeal pH monitoring.MethodsA retrospective chart review was conducted for 161 laryngopharyngeal reflux patients diagnosed with 24 h oro-pharyngeal pH monitoring. Study subjects were categorized into upright and supine laryngopharyngeal reflux groups based on the pH results. The two groups were compared regarding the clinical presentation and pH characteristics.ResultsSignificant higher rates of upright laryngopharyngeal reflux position than supine laryngopharyngeal reflux position (P < 0.0001) were reported among the study group. Reflux symptoms index results were significantly higher in the upright larybgopharyngeal reflux group compared to the supine laryngopharyngeal reflux group. 24 h oropharyngeal pH measurements composite Ryan score was significantly higher in the upright group compared to the supine group (P < 0.0001). No significant difference was found between the upright and supine laryngopharyngeal reflux groups regarding the frequency of clinical presentation or voice handicap index ratings.ConclusionLaryngopharyngeal reflux was found to be more prevalent occurring in the upright position among the study group. Reflux-related characteristics including pH parameters were more evident in the upright laryngopharyngeal reflux position.