Laryngeal Reflux Research Articles

Watchful waiting in laryngo-tracheobronchial amyloid: A case report.

We report the long term follow up of a now 66-year-old male with laryngo-tracheobronchial amyloidosis. The patient initially presented with dysphonia and dyspnoea. He was diagnosed with laryngeal reflux and asthma. Seven years later, the patient underwent cross sectional thoracic imaging showing diffuse thickening of the distal trachea and proximal main bronchi. The patient's FEV1 and FVC remained stable over 13 years and no intervention was required.

Common laryngopharyngeal reflux: A review

Abstract Clinically, gastroesophageal reflux disease (GERD) or gastroesophageal reflux disease (GORD) is a chronic upper gastrointestinal disease characterized by persistent and regular flow of stomach content up into the esophagus, resulting in symptoms and/or complications. Further, if acid reflux symptoms are more apparent in the larynx or pharynx, then the disorder may be called laryngopharyngeal reflux disorder (LPRD). The reflux of such acid to soft tissues beyond the esophagus will cause damage, which may turn into a relatively serious condition, especially for those with laryngeal reflux. Traditionally, obesity has been known as a primary risk factor for GERD or LPRD and related complications. Many studies have reported the association between obesity, hiatus hernia, and various motility dysfunctions of the upper gastrointestinal tract in patients with LPRD. Somehow obesity predisposes to these conditions, or whether they merely coexist with LPRD remains to be elucidated and dissents exist. Previous studies often recommend longer treatment and higher doses of proton pump inhibitors (PPI) for general gastroesophageal reflux because the presence of gastric acid in the pharynx and larynx can damage the vocal cords. Patients with laryngopharyngeal reflux can feel the symptoms while sitting at rest, and those with GERD feel the symptoms when lying down. The stomach contents, including pepsin and gastric acid, are the culprits that cause major damage to the tissues. Bile salts from the gallbladder further worsen the injury. A high-risk population includes people with obesity and/or obstructive sleep apnea.

New progress in diagnosis and treatment of congenital laryngomalacia in infants

Congenital laryngomalacia is the most common disease causing laryngeal stridor in infants. The pathogenesis has not yet been clearly concluded. It may be related to abnormal development of laryngeal cartilage anatomical structure, neuromuscular dysfunction, gastroesophageal and laryngeal reflux disease, etc. The typical manifestations of the disease are inspiratory laryngeal stridor and feeding difficulties, which can be divided into mild, moderate and severe according to the severity of symptoms. The diagnosis is mainly based on clinical symptoms, signs and endoscopy, among which endoscopy is an important diagnostic basis. The treatment of laryngomalacia depends on the severity of symptoms. Mild and some moderate congenital laryngomalacia children can be relieved by conservative treatment, and severe and some moderate congenital laryngomalacia children should be treated by surgery. Supraglottic plasty is the main surgical method, which can effectively improve the symptoms of laryngeal stridor, dyspnea, feeding difficulties and growth retardation in most children, and the surgical effect is good.

Efficacy of Anti-Reflux Medications on Improvement of Symptoms of Reflux Laryngitis

Abstract Objectives/Hypothesis reflux laryngitis is an inflammatory condition of the upper airway tract tissues due to the effect of gastric or duodenal content reflux, which provokes morphological changes in the upper aero digestive tract. Reflux laryngitis related symptoms affect up to 50% of patients in the Division of Laryngology. The purpose of this systematic review to shed light on the current therapeutic strategies used for the management of reflux laryngitis in order to determine the efficacy on improvement of symptoms. Methods the included studies published between 2003 and 2018. Regarding the type of included studies. All patients who suffer from reflux laryngitis in otorhinolaryngology clinics in included studies and treated by proton pump inhibitors or H2 blockers or prokinetics were added. Reviewed papers should include degree of improvement of any of the following symptoms: hoarseness, cough, Globus sensation, sore throat, dysphonic attacks, throat clearing non-productive cough, dysphagia, excessive throat mucus, etc. When using antireflux medications. Results The demographic characteristics and clinical data in all 15 studies are shown in the following tables: #Studies were arranged according to publication year. This table showed that; the included studies published between 2003 and 2018. The search identified 49 relevant papers, of which 15 studies met the inclusion criteria, accounting for 990 patients. The main therapeutic scheme consisted of once or twice daily PPIs for a duration ranged from 4 to 24 wk. The most used PPIs were omeprazole, esomeprazole, rabeprazole, lansoprazole and pantoprazole with a success rate ranging from 18% to 87%. Other composite treatments have been prescribed including PPIs, prokinetics, and H2 Receptor antagonists. Conclusions LPRD is more common in the age group of 31-40 years and proton pump inhibitors and prokinetics are highly effective in controlling laryngeal reflux symptom index and laryngeal reflux finding score.

Can pepsin immunohistochemical staining of laryngeal lesions accurately diagnose non-acid laryngeal reflux?

Background Non-acid reflux is the most common form of laryngopharyngeal reflux (LPR). However, the damage caused by non-acid reflux to the laryngeal mucosa is weaker than that caused by acid reflux. Aims To evaluate whether pepsin immunohistochemical (IHC) staining of laryngeal lesions can accurately diagnose acidic and non-acidic LPR. Materials and Methods Hypopharyngeal-esophageal multichannel intraluminal impedance-pH monitoring was performed, and the patients were divided into acid reflux and non-acid reflux groups. Pathological sections of laryngeal lesions were examined using pepsin IHC staining, which was positive when pepsin was detected in the cytoplasm. Results The study included 136 patients, with 58 in the acid reflux group, 43 in the non-acid reflux group, and 35 in the without reflux group. There were no significant differences in the positive rate of pepsin IHC staining between the non-acid and acid reflux groups (p = .421). The sensitivity of pepsin IHC staining for the diagnosis of acid and non-acid reflux was 94.8% and 90.7%, respectively. Conclusions The sensitivity of pepsin IHC staining for laryngeal lesions in the diagnosis of non-acidic LPR is satisfactory. Significance Pepsin IHC staining is suitable for LPR screening of patients with laryngeal lesions as it is economical, non-invasive, and highly sensitive.

Proton pump inhibitors as treatment of laryngeal disorders among patients with gastroesophageal reflux disease: a single-arm (pre and post) quasi-experimental study

BackgroundLaryngopharyngeal reflux is a silent cause of laryngeal disorders which was documented in the last decade by many studies. This study aimed to evaluate the prevalence of laryngeal reflux in GERD cases and to evaluate the effect of GERD treatment on these laryngeal disorders.MethodologyIn this single-arm (pre and post) quasi-experimental study, eighty patients with GERD were examined for laryngeal disorders by rigid laryngoscopy and assessed by the Reflux Finding Score (RFS). Complaints of patients were evaluated using the 9-item Reflux Symptom Index (RSI) questionnaire. Patients received medical treatment of GERD in the form of proton pump inhibitors (PPIs) only, and they were reassessed after 3 months for improvement in their symptoms and signs using RSI and RFS systems to compare patient complaints and findings in the laryngeal endoscopy pre- and post-treatment.ResultsAmong 80 confirmed GERD cases, 70 (87.5%) suffered from laryngeal disorders. Throat clearing and postnasal drip were the most prevalent symptoms, and ventricular obliteration and erythema, vocal fold and diffuse laryngeal edema, and posterior commissure hypertrophy were the most detected signs. Significant improvement in both symptoms and signs after 3 months of PPI therapy was clearly observed. The resistance rate among our studied patients was reported to be 22.4%.ConclusionGERD can be considered as an inducer or cause of laryngeal disorders, with a significant direct proportional relationship between the severity of GERD and both the RSI and RFS. PPI greatly improves laryngeal disorders among GERD patients with a high response rate (77.6%).

Clinical Evaluation of Laryngopharyngeal Reflux and its Response to Proton Pump Inhibitors.

To clinically evaluate the patients of laryngopharyngeal reflux(LPR) and their response to Proton Pump Inhibitors(PPIs) using laryngeal Reflux Symptom Index (RSI) and Reflux Finding Score (RFS). This prospective observational study was conducted on 128 patients attending the ENT-OPD of VSSIMSAR,Burla,India,who had persistent laryngeal symptoms for more than 2 months.Data was collected using standardized RSI and RFS after taking detailed history and laryngoscopic examination.Patients who were diagnosed of LPR on the basis of their RSI & RFS were subjected to treatment with PPI-Pantoprazole & were called back for follow up at 2nd, 4th and 6th months.Pre and post treatment RSI& RFS were compared using appropriate statistical tests and results with p-value< 0.01 were considered statistically significant. The overall effect of PPIs on all symptoms & signs of LPR,included in RSI and RFS respectively,is statistically significant except on swallowing (not statistically significant at p<0.01) showing a careful usage of RSI & RFS while diagnosing LPR clinically.Study also elucidated that PPI are effective in relieving symptoms of LPR patients.Evaluating Pearson correlation coefficient,the value of R=0.3717;R2=0.1382 shows low positive correlation between the RSI & RFS.RSI & RFS are related to each other and any change in the RSI will affect the value of RFI and vice versa. From this study we conclude that LPR is prevalent in age of 28-37 years & has female preponderance.PPIs are effective in treating LPR.Though RSI and RFS are effective and valid parameters for managing LPR cases but have to be used cautiously while interpreting the results.

The role of continuous 48 h oropharyngeal pH monitoring in the diagnosis of laryngopharyngeal reflux disease

Objective: To investigate the daily variation of LPR and the significance of 48-hour oropharyngeal pH monitoring in the diagnosis of LPRD. Methods: 72 subjects with suspected LPRD who were treated in our department from June 2018 to June 2021 were included. All patients were hospitalized to complete continuous 48-hour oropharyngeal Dx-pH monitoring. The consistency of Ryan index and W index and the correlation of various reflux parameters between the first and second 24-hour were compared. SPSS 24.0 was used for statistical analysis. Results: All 72 subjects successfully completed 48-hour oropharyngeal Dx-pH monitoring. Ryan index was positive in 11 cases (15.2%) in the first 24-hour, in 17 cases (23.6%) in the second 24-hour, in 5 cases (6.9%) both first and second, and in 23 cases (31.9%) in either 24-hour, Kappa=0.211 (P=0.064), 18 cases (25%) had inconsistent results of the first 24-hour and the second 24-hour, and there was no significant difference in the positive rate between the first and second (P=0.234). The number of positive cases in 48-hour monitoring increased by 109.1% compared with 24-hour monitoring.For W index, 49 cases (68.1%) were positive in the first 24-hourf 53 cases (73.6%) were positive in the second 24-hour, 42 cases (58.3%) were positive both first and second, and 58 cases (80.6%) were positive in either 24-hour, Kappa=0.477 (P<0.001), 16 cases (22.2%) had inconsistent results of the first and second, and there was no significant difference in the positive rate between the first and second (P=0.804). The number of positive cases in 48-hour monitoring increased by 18.4% compared with 24-hour monitoring. There was no significant difference in all the reflux parameters of first and second (P>0.05). The correlation comparison showed that the correlation of various reflux parameters in the upright position was lower than that in the supine position. Conclusion: Laryngeal reflux has daily variability. Extending the monitoring time of Dx-pH to 48-hour can help reduce the missed diagnosis caused by daily variability; the use of W index can reduce the influence of daily variability on the diagnostic results of LPRD.

Expression of pepsin in nasopharyngeal carcinoma and its correlation with quality of life after radiotherapy

Objective: By analyzing the expression of pepsin in nasopharyngeal carcinoma (NPC) tissues, to investigate the correlation between laryngeal reflux (LPR) and NPC, as well as the effect of LPR on the quality of life of patients with NPC after radiotherapy. Methods: A total of 133 patients with NPC who underwent radiotherapy at the Department of Otorhinolaryngology of the Affiliated Hospital of Guizhou Medical University and the Affiliated Cancer Hospital of Guizhou Medical University from 2005 to 2019 were enrolled consecutively, including 90 males and 43 females, aged (44.32±7.47) years old. At the same period, 58 patients with chronic nasopharyngitis who underwent nasopharyngeal biopsy were selected as the control group. Immunohistochemical method was used to detect the expression of pepsin in nasopharyngeal specimens of the two groups. In addition, 188 normal individuals were selected as the normal group in the same period. NPC patients before and within 6 months after radiotherapy were inverstigated by the General Information Questionnaire and the Quality of Life Scale, and the pepsin levels in saliva of NPC patients before and after radiotherapy and the individuals in normal group were measured. SPSS 21.0 software was used for statistical analysis. Results: Pepsin expression in 133 specimens of NPC patients was strongly positive in 24 cases (18.05%), positive in 21 cases (15.79%), weakly positive in 69 cases (51.88%), and negative in 19 cases (14.29%). The specimens of control group had 10 cases of weakly positive (17.24%), 48 cases of negative (82.76%), but no strong positive or positive pepsin expression. The rate of positive pepsin expression in the NPC group was higher than that in the control group, with a statistically significant (χ2=83.15, P<0.001). The pepsin content in the saliva of NPC patients after radiotherapy ((30.31±7.82) ng/ml) was higher than that before radiotherapy ((20.47±8.21) ng/ml) and the normal group (5.11±2.13) ng/ml), and the pepsin content in saliva before radiotherapy was higher than that in the normal group, and all differences were statistically significant (all P<0.05). After radiotherapy, the five functional domains of quality of life and overall quality of life of NPC patients decreased, while the related symptom scores increased (all P<0.05). Multiple linear regression analysis showed that pepsin content in saliva was the influential factor of five functional domains of quality of life, related symptoms and overall quality of life in NPC patients after radiotherapy (all P<0.05). Conclusion: The positive rate of pepsin expression in NPC tissues is high, and the pepsin in saliva before and after radiotherapy of NPC patients is significantly higher than that in normal, suggesting that LPR may be involved in the process of NPC and affect the quality of life after radiotherapy in NPC patients.

Effect of Proton Pump Inhibitors, Mucolytics and Steroids on Voice Outcomes After Laryngomicrosurgery

Background and Objectives Proton pump inhibitors (PPIs), mucolytics, and steroids were commonly recommended after phonomicrosurgery to prevent worsening of vocal fold (VF) scar formation and subglottal swelling. However, there is no consensus about whether laryngeal reflux and thick discharge are associated with the voice outcomes following phonomicrosurgery in benign VF lesions. The purpose of this study is to examine voice outcomes of use of PPIs, mucolytics,and steroids after phonomicrosurgery.Materials and Method This randomized controlled study is performed with patients undergoing laryngomicroscopic surgery for VF polyp and cyst. Participants were randomly assigned to 1) no medication, 2) PPIs, 3) PPIs+mucolytics, and 4) PPIs+mucolytics+steroids for 2 months postoperatively. Grade, roughness, breathiness, asthenia, and strain (GRBAS) scale, stroboscopic examination, aerodynamic assessment, acoustic analysis, and Voice Handicap Index-10 (VHI-10) were performed pre- and post-operatively at 2 months. Parameters were compared among four groups.Results Among 85 patients, a total of 50 patients were included. The VHI-10, perceptual and acoustic parameters improved in all groups after surgery. However, there was no significant difference in those parameters among all groups.Conclusion PPIs, mucolytics, and steroids did not significantly influence voice outcomes after phonomicrosurgery in patients with benign VF lesions.

The risk of laryngitis with herpes zoster infection: A nested case-control study using data from the Korean National Sample Cohort.

BackgroundWhether herpes zoster infection (HZI) affects laryngitis incidence remains unknown.ObjectiveThe purpose of this population-based retrospective study was to analyze the relationship between laryngitis and HZI using data from the Korean Health Insurance Review and Assessment Service—National Sample Cohort.MethodsThis study analyzed 1,197,093 medical claim codes from 2018. Patients with HZI (ICD-10: B02) were retrospectively identified. Laryngeal diseases were defined by ICD-10 codes for five subgroups: 1) malignant disease, 2) benign disease, 3) vocal cord palsy, 4) inflammatory disease, and 5) reflux disease.ResultsAmong the Korean population older than 20 years, 12,809 experienced HZI. Subjects with HZI were more likely to be older (mean age: 51.54 years vs. 48.06 years, p <0.0001). The proportion of subjects with laryngeal disease was higher in those with HZI than in those without HZI (55.55% vs. 41.37%, p <0.0001). Laryngeal disease was significantly associated with HZI in multiple regression analysis (odds ratio (OR) = 1.77, 95% confidence interval: 1.71–1.84) after adjusting for age, sex, hypertension, diabetes, dyslipidemia, ischemic heart disease, cerebral stroke, and depression. Among laryngeal disease subgroups, inflammatory disease (OR = 1.05; 95% CI: 1.01–1.09) and reflux (OR = 1.20; 95% CI: 1.15–1.25) were associated with HZI.ConclusionsHZI is independently associated with laryngitis. Results of this study have implications for etiological investigations and prevention strategies for laryngitis.

Potential Therapeutic Effect of Continuous Positive Airway Pressure on Laryngopharyngeal Reflux in Obstructive Sleep Apnea Patients

To investigate the potential therapeutic effect of continuous positive airway pressure (CPAP) treatment on laryngopharyngeal reflux in obstructive sleep apnea (OSA) patients, we performed a retrospective analysis of data prospectively collected from patients who underwent CPAP therapy after being diagnosed with moderate to severe OSA between January 2019 and May 2020. Subjects were asked to complete the reflux symptom index (RSI) questionnaire before and after CPAP. Additionally, a laryngoscopic examination was performed to evaluate objective endoscopic findings and determine reflux finding score (RFS). A total of 46 patients were included in the analysis. Overall, significant decreases in mean RSI score (10.85 ± 6.40 vs. 8.80 ± 7.99, p < 0.001) and RFS (7.41 ± 3.32 vs. 4.65 ± 2.12, p < 0.001) were observed after CPAP treatment. Within subdomains of the RSI, throat clearing, postnasal drip, breathing difficulty, troublesome cough, and foreign body sensation were significantly improved by CPAP treatment. All subdomains of RFS, with the exception of posterior commissure hypertrophy and granuloma, showed significant differences after CPAP treatment. There were no differences between subgroups according to body mass index or severity of OSA. CPAP treatment in OSA potentially reduces laryngeal reflux symptoms and improves laryngeal examination findings.

Proton pump inhibitors for the treatment of laryngopharyngeal reflux disease: A protocol for systematic review and meta-analysis.

Background:Laryngopharyngeal Reflux disease refers to abnormal reflux of gastric contents through the esophagus into the throat, which irritates and damages the pharyngeal mucosa, and causes corresponding symptoms. Proton Pump Inhibitors are an important class of gastric acid secretion inhibitors after H2 receptor blockers, which can be used clinically to treat peptic ulcer, abnormal gastric acid secretion and other related diseases. The common clinical drugs include omeprazole, lansoprazole, rabeprazole and so on. Clinical practice has shown that Proton Pump Inhibitors have a good therapeutic effect on Laryngopharyngeal Reflux disease, but evidence of evidence-based medicine is lacking. The purpose of this protocol is to systematically evaluate the efficacy and safety of Proton Pump Inhibitors in the treatment of Laryngopharyngeal Reflux disease and to improve the evidence-based basis for the clinical application of Proton Pump Inhibitors in the treatment of Laryngopharyngeal Reflux disease.Methods:English computer retrieval database (PubMed, Embase, Web of Science, the Cochrane Library) and Chinese computer retrieval database (Wanfang Database, VIP Information Chinese Journal Service Platform, Chinese Biomedical Database) . In addition, Baidu Scholar and Google Scholar were manually searched for randomized controlled clinical studies on the treatment of laryngeal reflux disease with Proton Pump Inhibitors from the establishment of the database to July 2020. Two researchers independently extracted and evaluated the data of the included studies, and meta-analysis was conducted on the included literatures with RevMan5.3 software without language restrictions.Results:In this study, the efficacy and safety of Proton Pump Inhibitors in the treatment of Laryngopharyngeal Reflux disease are evaluated by the overall response rate, clinical symptom remission rate and other indicators.Conclusions:This study will provide reliable evidence-based evidence for the clinical application of Proton Pump Inhibitors in the treatment of Laryngopharyngeal Reflux disease.OSF Registration number: DOI 10.17605 / OSF.IO / NY6SC

Laryngeal signs and pH-multichannel intraluminal impedance in infants and children: The missing ring: LPR and MII-pH in children

Objectiveto investigate the reliability of laryngeal reflux finding score (RFS) and symptom index (RSI) in assessing gastroesophageal reflux (GER) in children and infants. Methodspatients with laryngeal or respiratory symptoms, who underwent laryngoscopy and esophageal pH-impedance (MII-pH) were recruited. RSI and RFS were correlated to MII-pH results. A RSI>13, RFS>7, acid exposure index>7%, total reflux episodes>100/24 h in infants or>70/24 h in children, or a positive symptom index or association probability, were considered pathological. Analysis considering age (</>12 months) was performed. Sensitivity, specificity, positive (PPV) and negative predictive values (NPV) of the laryngeal scores were calculated. Results197 children (median 53 months, 61 infants) were enrolled. MII-pH was pathological in 5/10 patients with RFS>7, and in 17/31 with RSI>13. RFS>7 had 3.9% sensitivity, 93% specificity, a PPV of 50 and a NPV of 34 in predicting GER disease. RFS was inversely associated to weakly acidic and proximal GER. RSI>13 had 13% sensitivity, 83% specificity, and a PPV and NPV similar to RFS. RSI was significantly associated with the number of acid reflux episodes, and, in infants, with bolus exposure index. ConclusionsRSI and RFS aren't accurate in predicting GER in infants and children. Acid reflux relates to laryngeal symptoms, but neither acid, nor proximal and weakly acidic GER relate to laryngeal alterations.

Relationship between laryngopharyngeal reflux and calcification of arytenoid cartilage in male patients with idiopathic laryngeal contact granuloma

Objective:To investigate the relationship between laryngopharyngeal reflux and arytenoid cartilage calcification in male idiopathic laryngeal contact granuloma. Method:The clinical data of 92 male patients with idiopathic laryngeal contact granuloma who had the thin laryngeal CT scan images and laryngeal reflux symptom index（RSI） scale data before treatment were analyzed retrospectively. The effect of laryngopharyngeal reflux on the calcification of arytenoid cartilage in laryngeal contact granuloma patients was analyzed by Chi-square statistics with SPSS 16.0 software. Result:Among the 92 patients, 44 patients with RSI>13（47.83%） and 48 patients with RSI≤13（52.17%）. Unilateral granuloma was found in 87 cases（94.57%） and bilateral granuloma in 5 cases（5.43%）. A total of 97 sides of the diseased side, there were 87 sides of arytenoid cartilage with calcification（89.69%） and 10 sides without calcification（10.31%）. Among the patients with RSI>13, there were 45 sides of arytenoid cartilage with calcification（45/46, 97.83%） and one side without calcification（1/46, 2.17%）, and in the patients with RSI≤13, there were 42 sides of arytenoid cartilage with calcification（42/51, 82.35%） and 9 sides without calcification（9/51, 17.65%）. The calcification rate of arytenoid cartilage in patients with RSI>13 group was significantly higher than that in RSI≤13 group（χ²=4.701, P=0.030）. Conclusion:The calcification rate of arytenoid cartilage in male idiopathic laryngeal contact granuloma patients with laryngopharyngeal reflux is higher than that in patients without laryngopharyngeal reflux. Laryngopharyngeal reflux may aggravate or promote the inflammatory reaction of granuloma and accelerate the calcification of arytenoid cartilage.

The influence of age on the score of reflux symptom index scale and reflux finding score scale in the diagnosis of pharyngeal and laryngeal reflux

Objective:The aim of this study is to determine the accuracy of RSI and RFS in the diagnosis of hypopharyngeal reflux （LPR）, the scores of RSI and RFS were compared in different age groups. To explore the RSI and RFS scoring thresholds for diagnosis of LPR in different age groups. Method:From January 2017 to March 2019, 258 patients with suspected LPR in our hospital outpatient clinic completed the RSI and RFS scales. According to their age, 258 patients with RSI>13 and RFS>7 were selected. They were divided into group A （18-<40 years, n=86）, group B （40-<60 years, n=107） and group C （≥60 years, n=65）. The diagnosis was confirmed by 24 h pH-metry. The diagnostic rate, RSI and RFS scores were compared among the three groups. ROC curve was used to analyze the optimal thresholds for the diagnosis of LPR by RSI and RFS scores. Result:Among the three groups, group C had the highest diagnostic rate（93.85%）. There was no significant difference in RFS score among the three groups （P>0.05）, RSI score was significantly different （P<0.05）, RSI score of group A and group B was higher than that of group C （P<0.05）. According to ROC analysis, the best RSI cutoffs for diagnosing LPR in group C was 11, and the area under the ROC curve was 0.866. Conclusion:The RSI score is a good criterion for the diagnosis of LPR. The diagnostic threshold of RSI in elderly patients is different from that in young patients. For elderly patients, the diagnostic threshold for the recommended RSI score is 11.

Treatment of Laryngeal Contact Granuloma: Surgical Therapy or Conservative Treatment

Objective: Despite the fact that there are many treatment alternatives, laryngeal contact granuloma has a high tendency of persistence, spontaneous disappearance without treatment, and recurrence. A comparison of the effects of conservative treatment and surgical therapy on laryngeal contact granuloma was made in a retrospective review. Methods: A total of 124 patients with laryngeal contact granuloma were divided into 2 groups according to treatment: simple surgical excision (n = 36) and conservative treatment (n = 84). Additionally, the reflux finding score (RFS) and the reflux symptom index (RSI) were utilized to assess the disease. Results: A total of 124 patients, with a median age of 48.5 years, ranging from 9 to 74 years, were recruited (107 male, 17 female). According to the diagnostic criteria for laryngeal reflux (RSI >13 or RFS >7), there were 67 cases, accounting for 54.03% of the total. Surgery was effective in 15 patients (15/36, 41.67%), and conservative treatment was effective in 62 patients (62/84, 73.81%). The 2 groups had statistically significant differences. Conclusions: Conservative treatment, which is a comprehensive anti-reflux therapy, is better than surgical therapy and plays an important role in the treatment of laryngeal contact granuloma.

Laryngeal Disorders in Egyptian Patients with Gastroesophageal Reflux Disease

AbstractBackground: Gastroesophageal reflux disease (GERD) is chronic illness caused by reflux of gastric acidic contents back up into the esophagus causing wide range of symptoms. Laryngeal reflux is caused by A mechanism which seem identical to GERD some researchers think there is correlation between the prevalence of the two diseases.Aim of Study: The study aimed to evaluate the prevalence of laryngeal reflux in cases of gastroesophageal reflux disease.Methods: In this Prospective study evaluation of the prevalence of Laryngeal reflux symptom in cases of GERD was done in 200 patients by applying Reflux Finding Score (RFS) and Reflux Symptoms Index (RSI). They were divided into two groups Group-I; included 100 patients with Lartngeal reflux symptoms, Group-II; included 100 patients without Laryngeal reflux symptoms and this group was subdivided by laryngoscopic finding into Group-IIA; Laryngeal reflux free and Group-IIB; silent laryngeal reflux according to RFS.Results: GERD was found in all 200 (100%) patients included in the study Group I included 100 patients all of them had symptoms and signs of Laryngeal reflux, Group II included 100 patients didn't have symptoms of Laryngeal reflux of them 92 (92%) patients (Group IIA) were found to be free of Laryngeal reflux signs and 8 (8%) patients (Group IIB) were found to have signs of laryngeal reflux (silent laryngeal reflux).Conclusion: Manifest Laryngeal reflux was found in 100 (50%) of GERD patients, silent Laryngeal reflux was found in 8 (8%) of GERD patients not complaining of Laryngeal reflux symptoms.

Application of reflux symptom index in diagnosis of allergic patients with laryngopharyngeal reflux

Objective:To explore the diagnostic value and optimal diagnostic threshold of reflux symptom index(RSI) in allergic patients with laryngopharyngeal reflux. Method: All the adult allergic patients with respiratory tract symptoms completed the RSI with the consent of the patients. A total of 150 patients with RSI＞13 were screened out. The LPR patients were confirmed by 24 h pH-metry of pharyngo-laryngoesophageal (allergic group). The same number of non allergic laryngeal reflux patients were selected as control group (non allergic group). The ratio of RSI＞13 to LPR was calculated. The total score of RSI and each score were compared between the allergic group and the non allergic group. ROC curve was used to analyze the highly suspicious RSI score thresholds for patients with reflux laryngitis. Result:Only 53(35.33%) of 150 patients with RSI＞13 were diagnosed as LPR after 24 h pH-metry test in allergic patients. Among the 9 symptoms of RSI, the scores of 6 symptoms in allergic group were significantly higher than those in non allergic group(P<0.05). The average RSI score of allergic group was 23.57±3.17. The average RSI score of non allergic group was 17.57±2.64. The total score of allergic group was higher than that of non allergic group(P<0.05). According to the RSI score ROC curve of allergic group, the area under 95% confidence interval curve was 0.815. RSI had certain diagnostic accuracy for allergic patients with LPR. The best critical value of RSI score for allergic patients with LPR was 18, the sensitivity was 94.3%, and the specificity was 56.7%. Conclusion:RSI can be used to screen allergic patients with LPR, diagnostic score threshold RSI＞18 points, has a certain diagnostic accuracy.

Application of dysphonia severity index in laryngeal reflux related voice diseases

Objective:To discuss the validity and reliability of dysphonia severity index in evaluating the effect of diagnosis and treatment of laryngeal reflux related voice diseases. Method:54 cases of voice disease patients accompanied by laryngopharyngeal reflux from January 2016 to June 2017 in department of otorhinolaryngology of our hospital were divided into two groups according to treatment type. 32 cases in the operation group received laser surgery and standard acid suppression therapy for 6 weeks, and 22 patients in the non-operation group received standard acid suppression therapy for 6 weeks. 24 h multichannel impedance pH (MCII-pH) monitoring was carried out. The indexes of reflux symptom, reflux finding score, subjective auditory perception and objective acoustic parameters of voice were measured before and after treatment, and the dysphonia severity index was calculated and analyzed. Result:There was no significant difference in age, sex and course of disease between the two groups (P> 0.05).Compared with pre-treatment, RSI, RFS, Jitter, Shimmer, G and R in two groups decreased significantly after treatment, and MPT, DSI increased significantly (P<0.05). Before treatment, RSI, RFS, Jitter, Shimmer, G and R in the operation group were significantly higher than those in the non-operation group, and MPT, DSI were lower (P<0.05). There were no significant differences in the parameters between the two groups after treatment (P> 0.05). DSI was negatively correlated with GRBAS scoring parameters, Jitter and Shimmer, and positively correlated with RSI, RFS, and MPT (P<0.01). DSI is related to the location of the lesion (P<0.05) The incidence of anxiety was 27.27% in patients with moderate and severe sudden sensorineural hearing loss, and the incidence of depression was 25.25%. The scores of anxiety and depression were statistically significant (P<0.05). The multivariate logistic regression analysis showed that the status of anxiety and depression was accompanied by symptoms and other diseases (P<0.05). There was a significant difference between the effective group, the significant efficacy group and the cured group (P<0.05). The difference between the scores before and after treatment was compared. Differences in the ineffective group compared with the other three groups, and the cured group compared with the other three groups of anxiety, depression were statistically significant. Conclusion:DSI can be used as an objective evaluation index for the diagnosis and treatment of laryngeal reflux related voice diseases, and it is accurate and reliable.