Role Of Laryngopharyngeal Reflux Research Articles

The role of laryngopharyngeal reflux in the development of nasopharyngeal manifestations of GERD in preschoolers

Purpose. To study the level of vitamin D and the levels of antimicrobial peptides in the blood of children suffering from gastroesophageal reflux disease with nasopharyngeal symptoms, to find out how they depend on the composition of refluxate in LFR and how they affect microbial colonization in the nasopharynx.
 Materials and methods. The clinical study was conducted on the basis of the ENT and the Gastroenterology Departments of the Municipal Non-Commercial Enterprise “City Children's Hospital no. 5" of Zaporizhia City Council. By clinical examination and pH monitoring in the esophagus, the following groups of children 3 to 6 years were established: the 1st group of 22 children with gastroesophageal reflux disease with nasopharyngeal signs, the 2nd group of 22 children with gastroesophageal reflux disease without nasopharyngeal signs. Children were assigned to 1st group on the basis of the presence of clinical manifestations that indicated like a high GER. For children with nasopharyngeal manifestations of GERD, there are not only complaints specific to GERD, as well as symptoms that may indicate LFR: cough after eating and morning hoarseness, redness of the larynx and swelling of the vocal cords.The control group (the 3rd group) consisted of 22 children without pathology from the gastrointestinal tract and ENT systems. The children were tested for the levels of 25(ОН)D3, 1,25(ОН)2D, vitamin D binding protein (DBP), α­defensins 1–3 and cathelicidins. Microbial contamination of the mucous membrane of the nasopharyngeal zone was carried out. As far as the distribution differed from normal one (p<0.05), the data are presented as median and inter-quartile ranges Me (Q25; Q75). The results were processed in Microsoft Excelfor Windows 4.0 and Statistica 6.0.
 Results. Vitamin D deficiency was revealed in all children of the 1st group (with GERD with LFR). Also, the level of 25(OH)D3 was statistically significantly lower than in children with GERD without LFR and in children of the control group. So, in children of the 1st group, the level 25(ОН)D3 was equel to 13.3 (11.6; 14.9) ng / ml, while in the children of 2nd group it was equal to 21.6 (20.3; 22.9) ng / ml at p < 0.0001 and in children of the control group it was equal to 24.6 (22.8; 28.2) ng / ml at p < 0.0001. The study of the level of antimicrobial peptides showed their significant decrease in children with LFR: the level of α­defensins 1–3 was equel to 2535.0 (1950.0; 3120.0) pg / ml and cathelicidins was equel to 17.9 (5.8; 33.3) ng / ml, which showed a significant statistical difference at p <0.01 compared to other groups. It was noted that in children with acidic and mixed LFR, the level of cathelicidins is lower than in children with alkaline reflux. Thus, in most children with LFR, Haemophilus influenza was detected in nasopharyngeal cultures. Haemophilus influenza in the nose was sown only in children with mixed and acid reflux (30.0% and 80.0%, respectively). This is not typical of children with alkaline reflux. Also, more than two microorganisms were found in half of children with mixed and acid reflux, which was also not registered in children with alkaline reflux (p = 0.05). It was determined that in children with nasopharyngeal manifestations of GERD with Haemophilus influenza in the throat and nose at the same time higher parameters of the total number of acid reflux (180.0 (91.0; 310.0)), the number of prolonged acid reflux (8.0 (4.0; 12.0)) and the percentage of acid reflux per day (20.0 (11.0; 37.6)), which is significant at р˂0,05 than in children when the pathogen was detected only in the throat and in children who do not detected this microorganism Thus, the data obtained confirm that pathological manifestations from the ENT organs are a consequence of the LFR due to GERD.
 Conclusions. Our study indicates the aggressive effect of acid reflux on the nasopharyngeal mucosa in children suffering from gastroesophageal reflux disease with LFR. Thus, the lack of anti-inflammatory action of cathelicidins due to their increased utilization and reduced formation in conditions of vitamin D deficiency, leads to significant colonization by gram-negative flora, which can contribute to severe disease.

Prethyroidectomy voice and swallowing disorders and the possible role of laryngopharyngeal reflux disease

Objectives The aim of the study was to evaluate voice and swallowing function before thyroid surgery and to explore the possible role of thyroid enlargement and laryngopharyngeal reflux (LPR). Methods We conducted a prospective study of patients who underwent hemi- or total thyroidectomy (n = 118) and compared the results with patients of laparoscopic cholecystectomy (n = 110). All subjects underwent videolaryngostroboscopy, filled in subjective evaluations of voice, swallowing and reflux complaints. Acoustic voice analysis (AVA), maximum phonation time (MPT) and perceptual voice evaluation were conducted. Results We found no difference in voice quality between study and control group, neither in subjective complaints nor in AVA or perceptual evaluation. We did find indicative signs of minor laryngeal changes in thyroid group. Swallowing Impairment Score (SIS) revealed worse swallowing function in thyroid patients (p = 0.0006). Comparison of Reflux Symptom Index (RSI) scores revealed that thyroid group patients have higher values compared to control group (p = 0.006). Nevertheless, Reflux Finding Score (RFS) showed identical scores in both groups (p = 0.220). In thyroid group there was a strong positive correlation between RSI and SIS (ρ = 0.641), but no correlation between RFS and SIS (ρ = −0.002). In addition, we found a weak positive correlation between thyroid weight and RFS (ρ = 0.379). Conclusions Changes in laryngeal area caused by thyroid disorders do not lead to subjective but indicate slight objective disturbances in voice quality. We detected a decline in swallowing quality within thyroid patients. Higher RSI scores and a positive correlation between RFS and thyroid weight, indicate a possible role of thyroid gland in LPR.

Association of Dry Eye with Laryngopharyngeal Reflux in Clinical Practice

ABSTRACT Background Dry eye disease (DED) is a common disorder, accounting for up to 35% of the general population. Therefore, we hypothesized that laryngopharyngeal reflux (LPR), inducing refluxate rising into airways, may involve the ocular surface and may either induce or worsen DED. Aim To investigate the prevalence and relevance of suspected LPR in DED patients and subjects with refractive problems (RP) without DED, they were defined as non-dry eye group (NEG) in clinical practice. Methods This retrospective study included consecutive patients evaluated because of dry eye-like symptoms at eight tertiary ophthalmological clinics. Parameters included reflux symptom index (RSI), ocular surface disease index (OSDI), symptom assessment in dry eye (SANDE) for frequency and severity, Schirmer test, tear break-up time (BUT), and Oxford grading. Results The study included 245 subjects (72.5% females; mean age 56.3 years), 152 DED patients, and 93 sex- and age-matched NEG subjects. Pathological RSI (score>13) was detected in 80 subjects (32.6%); 68 (85%) with DED and 12 (15%) CG (OR = 8; p < .0001). In NEG, pathological RSI was associated with higher SANDE (Frequency and Severity), OSDI, and Schirmer scores (OR = 16.36; 14.51; 12.54; and 7.22, respectively. In DED patients, pathological RSI was associated with higher OSDI values (OR = 8.75). Conclusion Patients with DED are at eight times higher risk for having pathological RSI than NEG patients. Moreover, pathological RSI was associated with more severe ocular symptoms both in DED and non-DED patients. The role of LPR in definite DED patients remains to be clarified, but this condition deserves to be investigated in managing patients with DED symptoms.

Role of laryngopharyngeal reflux (LPR) in complications after tonsillectomy in adult patients

Background Tonsillectomy and tonsillectomy with adenoidectomy are among the most common surgical procedures in otolaryngology practice, but the complications, especially the postoperative bleeding, are seriously troubling surgeons. Some authors had identified that gastroesophageal reflux and LPR are both risk factors for complications in tonsillectomy of children patients. Aims/Objectives Therefore, we designed this prospective study to assess the role of LPR in the development of complications following tonsillectomy in adult patients. We want to provide a basis for future clinical practice. Material and Methods We recruited a totally of 150 adult patients (18–60 years old) who had an indication of tonsillectomy because of recurrent tonsillitis and divided them into two groups, the laryngopharyngeal reflux (LPR) group and the control group identified by the results of Reflux Symptom Index (RSI) and Reflux Finding Score (RFS). The complications that were observed and evaluated were pain, hemorrhage, fever, infection, and pulmonary problems. Result All the patients complained of pain after surgery. The duration of the pain in the LPR group was much longer than that of the control group. In the LPR group, patients had a similar pain level on the first day after surgery. However, on the 7th day and 14th day after surgery, the pain level was obviously higher than that of the control group. We found that the body temperature mildly rose on the 1st day after surgery and gradually fell to normal level in both groups. No cases had bleeding within 24 h after surgery. There were nine cases of bleeding in the LPR group, while only one case of bleeding occurred in the control group. There were no cases of infection or pulmonary complications in either group. Conclusions and significance LPR is closely related to the complications followed by tonsillectomy and we also suggest that high dosages of proton pump inhibitors (PPI), alkaline water, and alginates should be proscribed to the patients with LPR during the perioperative period.

Clinical and morphological aspects of the LPR-associated cancer of the larynx

Introduction: Squamous cell carcinomas of the head and neck, including laryngeal cancer, rank sixth in prevalence according to world statistics from developed countries. The role of laryngopharyngeal reflux as one of the risk factors for the development of laryngeal cancer remains controversial and needs further study. Objective: To analyze and compare clinical manifestations and morphological data in patients with laryngeal cancer T1-2N0M0 with LPR. Materials and methods: 87 patients with laryngeal cancer of the I-II stage T1-2N0M0. For the purpose of screening diagnostics of LPR, modified visualanalogue scales RSI and RFS were used,24-hour pH-monitoring was performed. To conduct a histopathological study, samples of surgical material were selected from 8 patients with laryngeal cancer of the I-II stage T1-2N0M0 with LPR; 8 patients with laryngeal cancer – without LPR and 8 patients with benign neoplasms of the larynx with LPR. Results: When analyzing the results of the examination, the RSI index exceeded “9” in 39 (44.8%) patients. According to 24-hour pH monitoring, the presence of LPR was diagnosed in 32 (36.8%) examined patients with morphologically verified squamous cell carcinoma of the larynx, which made up the study group. In 6 (75.0%) patients from the comparison group, areas covered by stratified squamous epithelium were determined within the mucous membrane, in 5 (62.5%) patients, transition zones containing both stratified squamous and single-layered multilayer ciliated were determined epithelium. The nature and intensity of lymphohistiocytic infiltration was more expressed in patients with associated LPR.

The role of Helicobacter Pylori and laryngopharyngeal reflux in recurrent tonsillitis

ObjectivesTo detect Helicobacter Pylori [HP] in tonsillar tissue of recurrent tonsillitis cases and assess the possible role of Laryngopharyngeal reflux [LPR] in tonsillar HP infection. MethodsA prospective study was done on the cited subject in a sample size of 50 paediatric patients [Age group: 6–18 years] suffering from recurrent tonsillitis. LPR was diagnosed by Reflux Symptom index [RSI] and Reflux Finding score [RFS]. A score of more than 7 and 13 was regarded as significant for RFS and RSI respectively. Patients with both scores significant were regarded to be suffering from LPR. Tonsillar specimen after tonsillectomy were subjected to urease test, histopathology [ Modified Giemsa Staining] and culture to detect HP. A minimum of two positive tests of the mentioned three were taken as gold standard to diagnose colonization of HP. Tabulated data was statistically analysed. ResultsWe recorded an incidence of 9% [18 cases] for LPR in recurrent tonsillitis. No case of HP colonization of tonsils was detected in this case series, even in patients of LPR. ConclusionWe conclude that tonsils are not an extra gastric reservoir of HP. In addition, there is no aetiological relationship between recurrent tonsillitis and HP. And lastly, LPR is not a significant factor for colonization of tonsils by HP.

Involvement of Laryngopharyngeal Reflux in Select Nonfunctional Laryngeal Diseases: A Systematic Review.

To investigate the existing published evidence supporting the role of laryngopharyngeal reflux (LPR) in the development of the select nonfunctional laryngeal diseases of laryngotracheal stenosis, granuloma, leukoplakia, and laryngeal infections. PubMed, Cochrane Library, and Scopus. A systematic review was performed by 3 independent investigators for studies providing information about the prevalence and role of LPR in the development of laryngotracheal stenosis, granuloma, leukoplakia, and laryngeal infections. Diagnostic criteria and clinical outcome evaluation of included studies were analyzed with PRISMA criteria. Of the 64 relevant publications, 27 clinical and 4 basic science studies were included. Ten studies used objective reliable examinations for LPR diagnosis (eg, dual- or triple-probe or oropharyngeal pH monitoring, multichannel intraluminal impedance-pH monitoring, or pepsin detection). According to the bias analysis and the results of studies, the association between LPR and laryngotracheal stenosis, leukoplakia, laryngeal papillomatosis, or vocal fold granuloma remains poorly demonstrated. There is a notable heterogeneity among included studies regarding their inclusion criteria, diagnostic methods, and clinical outcome evaluation. Although some experimental findings support the involvement of bile salts and other gastroduodenal proteins active in alkaline pH, no included clinical studies assessed the role of nonacid and mixed reflux through multichannel intraluminal impedance-pH monitoring. The involvement of LPR in the development of leukoplakia, laryngotracheal stenosis, vocal fold granuloma, and laryngeal papillomatosis is currently not demonstrated. The potential relationship between LPR and these select nonfunctional laryngeal diseases must be confirmed through future clinical and experimental studies considering acid, nonacid, and mixed LPR.

Association between laryngopharyngeal reflux and benign vocal folds lesions: A systematic review.

To investigate the role of laryngopharyngeal reflux (LPR) in the development of benign lesions of the vocal folds (BLVF). PubMed, Cochrane Library, and Scopus were searched by three independent investigators for articles published between January 1990 and November 2018 providing substantial information about the role of LPR in the development of nodules, polyps, cysts, Reinke's edema, and sulcus vocalis. Inclusion, exclusion, diagnostic criteria and clinical outcome evaluation of included studies were analyzed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. Of the 155 relevant publications, 42 studies were included. Thirty-five were clinical studies and seven were experimental research studying the impact of reflux on vocal fold tissue. Only seven clinical studies utilized objective LPR diagnoses (pH monitoring), suggesting an association between LPR and the development of nodules, polyps, and Reinke's edema. These studies were characterized by a substantial heterogeneity due to discrepancies in inclusion/exclusion criteria, diagnostic methods, and clinical outcome evaluation. The few basic science studies on this topic support that LPR creates an environment that may predispose to BLVF through changes in defense mechanisms of the vocal folds, cell-to-cell dehiscence, inflammatory reaction of the vocal folds, and reaction to phonotrauma. Caustic mucosal injury from LPR could cause increased susceptibility of the vocal fold mucosa to injury and subsequent formation of nodules, polyps, or Reinke's edema. However, the heterogeneity and the low number of high-quality studies limit the ability to draw definitive conclusions. Future clinical and experimental studies are needed to better identify the role of reflux in development of BLVF. Laryngoscope, 129:E329-E341, 2019.

Laryngopharyngeal Reflux

The prevalence of laryngopharyngeal reflux (LPR) is around 31 % in the general population. Patients with a dysphonia or other laryngeal diseases are accompanied up to 50 % by an LPR. Typical reflux associated diseases of the larynx are a chronical laryngitis and a contact granuloma. The role of LPR is still not clarified in the development of a glottic carcinoma. There still doesn't exist evidence based data for the diagnosis of a LPR. Therefore LPR is usually clinically diagnosed by a combination of typical symptoms like hoarseness, chronic coughing, relapsing throat clearing, globus pharyngis and dysphagia as well as through the laryngoscopic characteristics like mucosal erythema, mucosal hyperplasia with plication of the interarytenoid region and an edema of the vocal cords. Occasionally the LPR can be ensured with the additional method of the pharyngeal 24-hour pH-monitoring. The therapy of the LPR is a multimodal for example dietary arrangements, medication with proton pump inhibitors and where indicated a surgical intervention. The treatment of a symptomatic patient is administered by proton pump inhibitors in a close dialog with the ENT practitioner and the gastroenterologist.

The Role of Reflux in Childhood Otorhinolaryngological Disorders

This article seeks to review the current literature on the role of laryngopharyngeal reflux in the development of various disorders of the ear, nose and throat in infants and children including otitis media, chronic rhinosinusitis and airway disorders. The aim is to guide the otolaryngology clinician in investigation and management of reflux and to identify priorities for future research in this area. Many otolaryngological disorders coexist with reflux more often than might be expected by chance, but evidence of causality is weak. Although many otolaryngologists are convinced that treatment of reflux can make a significant difference to the clinical course of many upper airway disorders, the evidence to support this is lacking. In part, this is due to inadequate tools for describing the symptoms and endoscopic signs of laryngopharyngeal reflux and the lack of a sensitive, specific and reliable objective test. Further research demonstrating simple associations between otolaryngological diseases and reflux is unlikely to be of much value. Instead, researchers should concentrate their efforts on studies to develop and validate better means of recording symptoms and signs of laryngopharyngeal reflux and investigating the clinical utility of salivary pepsin, oropharyngeal pH monitoring and multichannel intraluminal impedance.

Role of Laryngopharyngeal Reflux in Complications of Tonsillectomy in Pediatric Patients.

Tonsillectomy and tonsillectomy with adenoidectomy are among the most common surgical procedures in otolaryngology practice. Gastroesophageal reflux was identified as a risk factor for complications in tonsillectomy. This prospective study was designed to assess the role of reflux in the development of complications following tonsillectomy in pediatric patients. Children (n=60) who underwent tonsillectomy with adenoidectomy were divided into two groups, i.e., the laryngopharyngeal reflux (LPR) group and control group. Patients with LPR were identified by reflux symptom index and reflux finding score. Pain, hemorrhage, fever, nausea, vomiting, fever, dehydration, infection, and pulmonary problems were evaluated post operatively. The mean lengths of hospital stay were 2.11days in the reflux group and 1.05days in the control group. The difference was statistically significant. Visual analogue scores of both groups were similar on day 1 but it was significantly higher on day 7 and 14 in LPR group. Nausea and vomiting rates were 11.1 and 9.5% for the patients in the LPR group and the controls, respectively. The difference between the two groups was not significant. The mean fever was 37.6°C in the reflux group and 37.3°C in the controls, which were not significantly different. 19% of the controls and 22% of the LPR group patients were readmitted. This difference was not statistically significant. There were two cases of bleeding in the reflux group, while no bleeding occurred in the control group. This difference was significant statistically. LPR is a risk factor for complications following tonsillectomy.

The Effect of Singing on Laryngopharyngeal Reflux

Objective: While there has been widespread conjecture regarding the role of laryngopharyngeal reflux in singing, there remains no objective data demonstrating that voice use causes increased reflux. We attempted to objectively analyze pharyngeal pH changes during singing to better understand how it is affected by singing. Method: Eight singers underwent 24-hour pharyngeal pH probe testing with the Restech Dx-pH measurement systemTM, one hour of which was spent singing. The mean pH and number of pH drops were recorded. A one-tailed t test was used to compare the mean pH of the time singing with the 2 control values. Results: The mean pH for the control time was 6.8347, for the control time without the time supine was 6.9164, and for the time singing was 7.0286. We were thus able to reject the null hypothesis that singing decreases laryngeal pH ( P = .035). There was an increase in mean pH during the time singing as compared with the 2 control groups. Conclusion: While singers may have increased reflux complaints, our data suggest that the singing itself does not cause an increase in acid exposure to the laryngopharynx.

The Role of Laryngopharyngeal Reflux as a Risk Factor in Laryngeal Cancer: A Preliminary Report

ObjectivesTo evaluate the significance of laryngopharyngeal reflux (LPR) as a risk factor in laryngeal cancer.MethodsWe performed a case-control study with 29 consecutive laryngeal cancer patients who had undergone 24-hour ambulatory double pH monitoring from 2003 to 2006. The control group included 300 patients who had undergone 24-hour ambulatory double pH monitoring due to LPR-related symptoms. We analyzed the prevalence of LPR and numerous parameters from the 24-hour ambulatory double pH monitoring in the laryngeal cancer patient and control groups. Pathologic LPR is defined when more than three episodes of LPR occur in 24 hours.ResultsThe prevalence of pathologic LPR was significantly higher in the laryngeal cancer group than the control group (P=0.049). The reflux number of the upper probe was significantly higher in the laryngeal cancer group (P<0.001). However the effects of pathologic LPR on laryngeal cancer risk were diluted after adjusting for smoking and alcohol consumption in the multivariable logistic regression.ConclusionThe pathologic LPR might be a possible risk factor in the development of laryngeal cancer. A further study should be necessary to verify the exact role of LPR in laryngeal cancer.

Current knowledge, controversies and future directions in hyperfunctional voice disorders

Taking the preceding five papers in this special issue of the International Journal of Speech-Language Pathology as a starting point, this paper synthesizes key aspects of hyperfunctional voice disorders (HFVD). Aetiological and contributing factors, defining features, prevention, assessment and intervention are canvassed, while controversial issues and future directions in research and clinical practice are discussed. Despite disagreements and inconsistencies in terminology surrounding HFVD, there is broad agreement that musculoskeletal tension is the hallmark of these voice disorders. There is also reasonable consensus that the pathogenesis and persistence of HFVD are associated with multiple and overlapping factors, some of which are likely to interact in as yet unknown ways. In addition to dysregulated laryngeal muscle functioning, key processes in the psychosocial and sensory domains are canvassed as likely contributors to HFVD. Vocal fatigue is considered as an intriguing relative of HFVD, the role of laryngopharyngeal reflux is debated and the proposition that particular individuals are psychologically and/or physiologically predisposed to HFVD is discussed. New directions in assessment highlight the use of client-centred measures to consider insider perspectives of psychological factors, vocal effort and vocal fatigue. Emerging psychosocial and physical-manipulative interventions are emphasized and the future educational needs of voice care professionals are considered.

Hoarseness in children: The role of laryngopharyngeal reflux

The role of laryngopharyngeal reflux (LPR) in hoarseness in children is not well studied. The purpose of this study was to determine the prevalence of LPR in hoarse children. Retrospective chart review identified 337 children with hoarseness over a 3-year period. mode of presentation, associated symptoms, endoscopic findings, laboratory testing, and therapeutic interventions and their outcomes. Mean age at presentation was 7.2+/-4.3 years with a male:female ratio of 1.7:1. Of the 295/337 (88%) children who underwent endoscopy, 107/295 (36%) had LPR changes alone, 86/295 (29%) had vocal fold nodules, 63/295 (20%) had both LPR and vocal fold nodules; and 22/295 (7%) had a finding other than LPR or nodules. Of the children diagnosed with LPR by endoscopy (with or without nodules), 93/170 (55%) underwent at least one additional test for reflux with 69/93 (74%) having a positive test. Of the children diagnosed with LPR by endoscopy, neither cough nor throat clearing was identified in 82/170 (48%) of children. At the first follow-up visit, an average of 3 months from initial presentation, 50% of 169 children who were treated for reflux had improved or resolved. By the second follow-up visit, 4.5 months later, 68% of those children had improved or resolved. LPR appears to be a very common cause of hoarseness in children, and is an increasingly important symptom in identifying children with LPR. Treatment of LPR often results in improvement of hoarseness.

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.

Adult laryngotracheal stenosis: etiology and surgical management.

The most common causes of laryngotracheal stenosis have changed over the last 100 years, with external trauma and infection being supplanted by iatrogenic trauma from intubation and tracheotomy. Modern-day surgeons continue to struggle with the prevention and the treatment of this difficult problem, and the purpose of this review is to examine new causes, diagnostic methods, and treatments in laryngotracheal stenosis. Recent publications have focused on the topics of idiopathic subglottic stenosis; percutaneous dilational tracheotomy, with the possibility of this technique increasing the incidence of stenosis; the role of laryngopharyngeal reflux; and the use of primary resection with anastomosis as a curative treatment. Although promising work has been reported in the treatment of laryngotracheal stenosis, notably with primary resection and anastomosis, many questions remain to be answered, especially in the causes of this potentially life-threatening disease.

The role of laryngopharyngeal reflux in head and neck cancer patients

Objective. Laryngopharyngeal reflux may play a role in the aetiology of squamous cell cancer of the head and neck and contribute to complications in head and neck cancer patients after surgery or during radiotherapy. Patients and methods. To investigate the incidence of laryngopharyngeal and gastrooesophageal reflux in patients with head and neck cancer, ambulatory 24-h double-probe pH monitoring was performed in 24 untreated patients with laryngeal or pharyngeal squamous cell carcinoma. In addition, 10 patients who had been irradiated in the head and neck area were analysed for reflux to study the effect of radiotherapy on reflux. Results. Only four of the 24 head and neck cancer patients (17%) had neither pathological laryngopharyngeal nor gastro-oesophageal reflux. Oesophageal acid exposure was abnormal in five patients and acid exposure at the level of the upper oesophageal sphincter was abnormal in four patients. Eleven patients had pathological reflux in both areas. Irradiated patients did not differ from the untreated patients considering the incidence of pathological laryngopharyngeal or gastrooesophageal reflux. Conclusion. The data obtained in this study indicate that reflux is a common event in head and neck cancer patients.