Screening and diagnosis of laryngopharyngeal reflux in patients with laryngeal cancer stage I-II (T1-2N0M0)

Abstract

Topicality: The variety of manifestations of laryngopharyngeal reflux (LPR) in otolaryngological practice has made this problem relevant for the past decades. The development of LPR is associated with impaired function of the upper esophageal sphincter, which allows reflux to enter the larynx, pharynx, nasal cavity and middle ear cavity. In a number of studies, pathological reflux has been identified as one of the factors in the development of cancer of the upper respiratory and digestive tract. Aim of the study: to improve methods fors creening and diagnosis of laryngopharyngeal reflux in patients with laryngeal cancer stage I-II (T1-2N0M0). Materials and methods: The study group included 93 patients with stage I-II laryngeal cancer (T1-2N0M0). The control group was represented by 36 patients with reflux-associated benign neoplasms of the larynx. For preliminary diagnosis and objectification of complaints used the RSI test. To increase the accuracy of interpretation and objectification of laryngoscopic manifestations of LPR, the RFS scale was used. The daily pH-monitoring was carried out using an AG-1pH-M acidogastrograph with an electrode system. The severity of reflux was determined according to DeMeester criteria. According to the results of pH monitoring, clinical groups were formed. Results: When analyzing the results of the examination, the RSI index exceeded “9” in 41 (44.1%) patients. When tested on the RFS scale, the indicator “13 and higher” was recorded in 48 (51.6%) patients. All patients (41) with a positive RSI test received 24-hour pH monitoring. According to 24-hour pH-monitoring, the presence of LPR was verified in 33 (80.1%) patients with a positive RSI test. The study group consisted of 33 (80.1%) patients with squamous cell carcinoma of the larynx T1-2N0M0. After 24-hour pH-monitoring, we obtained the data: mild LPR was observed in 6 (18.2%) patients, moderate severity of LPR in 18 (54.5%) and severe LPR in 9 (27.3%). In patients with laryngeal cancer T1-2N0M0, which is associated with LPR, the DeMeester criterion exceeded 14.72. Conclusions: Comparison of pH-monitoring data and visual-analogue scales reaches 80.1% of compliance in patients with laryngeal cancer T1-2N0M0, which is associated with LPR. According to 24-hour pH-monitoring, the presence of LPR was verified in 33 (35.5%) of the examined patients with squamous cell carcinoma of the larynx. Using the modified The Reflux Symptom Index and The Reflux Finding Score scales is a highly reliable method for screening the diagnosis of laryngopharyngeal reflux in patients with laryngeal cancer.