Esophageal dynamic and laryngopharyngeal reflux play a role in pathogenesis of vocal cord polyps

Abstract

Through monitoring esophageal dynamic change, and detection of laryngopharyngeal reflux(LPR) and gastroesophageal reflux events,to discuss the relationship of vocal cord polyps with laryngopharyngeal reflux. Thirty-two patients with vocal cord polyps were diagnosed by electronic laryngoscopy in Nanfang Hospital between October 2011 to May 2012. This study applied high-resolution esophageal manometry (HRM) and ambulatory 24-hour multichannel intraluminal impedance-pH monitoring (MII-pH) to obtain the upper esophageal sphincter(UES) and lower esophageal sphincter pressure, characteristics of sectional esophageal motility; laryngopharyngeal reflux (LPR)and gastroesophageal reflux events, as well as the reflux properties of substances. Sixteen healthy volunteers were recruited as normal controls. UES relaxation duration, duration of UES relaxation time, UES relaxation recovery time and mean length of LES were all shorter than those of the control group (t were 2.244, 2.624, 2.310 and -2.397, P < 0.05). There were 40.6% (13/32) LPR and 50.0% (16/32) gastroesophageal reflux found in vocal polyp patients. Median number (M [P25; P75]) of laryngopharyngeal acid reflux events were 0.5[0.0;3.5] and 0.0[0.0;0.0] in vocal polyp group and the controls, median mean time of laryngopharyngeal acid exposure 0.1[0.0;1.7] and 0.0[0.0;0.0] min, median clearance time of laryngopharyngeal acid were 3.5[0.0;53.5] and 0.0[0.0;0.0] s, median scores of DeMeester were 14.8[1.6;31.3] and 1.8[1.1;4.1] and median frequency of total liquid reflux episodes were 46.5[25.3;69.0] and 32.5[20.0;36.3], respectively. The median numbers of laryngopharyngeal acid reflux events, time of acid exposure, time of acid clearance, DeMeester scores and frequency of total liquid reflux episodes were increased or higher in vocal polyp group than those in the controls (z were 2.481, 2.767, 2.767, 2.344 and 1.980, P < 0.05). There are upper esophageal sphincter and Lower esophageal sphincter dismotility in vocal polyp patients with LPR. LPR events were dominated by acid reflux in upright position.Esophageal dynamic disfunction and LPR should be considered in the study of the pathogenesis of vocal cords polyps.