Study on the time-point distribution characteristics of the occurrence of laryngopharyngeal reflux / 中华耳鼻咽喉头颈外科杂志

Objective: To investigate the characteristics of the time-point distribution of the occurrence of laryngopharyngeal reflux (LPR) by 24-hour multichannel intraluminal impedance-pH monitoring (24 h MII-pH) and to provide guidance for the development of individualized anti-reflux strategies for LPR patients. Methods: We conducted a retrospective analysis of 24 h MII-pH data from 408 patients [339 males and 69 females, aged 23-84 (55.08±11.08) years] attending the Department of Otorhinolaryngology Head and Neck Surgery at the Sixth Medical Center of the PLA General Hospital from January 2013 to March 2020. The number of gas acid/weak-acid reflux, mixed gas-liquid acid/weak-acid reflux, liquid acid/weak-acid reflux and alkaline reflux events at different time points were recorded and statistically analyzed through SPSS 26.0 software. Results: A total of 408 patients were included. Based on the 24 h MII-pH, the total positive rate of LPR was 77.45% (316/408). The type of positive gaseous weak-acid reflux was significantly higher than the remaining types of LPR (χ2=297.12,P<0.001). Except the gaseous weak-acid reflux, the occurrence of the remaining types of LPR showed a tendency to increase after meals, especially after dinner. Liquid acid reflux events occurred mainly between after dinner and the following morning, and 47.11% (57/121) of them occurred within 3 h after dinner. There was a significant positive association between Reflux Symptom Index scores and gaseous weak-acid reflux(r=0.127,P<0.01), liquid acid reflux(r=0.205,P<0.01) and liquid weak-acid reflux(r=0.103,P<0.05)events. Conclusions: With the exception of gaseous weak-acid reflux events, the occurrence of the remaining types of LPR events has a tendency to increase after meals, especially after dinner. Gaseous weak-acid reflux events accounts for the largest proportion of all types of LPR events, but the pathogenic mechanisms of gaseous weak-acid reflux are needed to further investigate.

Comparison of clinical characteristics of patients with different types of laryngopharyngeal reflux disease / 中华耳鼻咽喉头颈外科杂志

Objective: To compare the clinical characteristics of patients with different type of laryngopharyngeal reflux disease in order to study the effect of non-acid reflux on laryngopharyngeal reflux disease. Methods: From January 2015 to January 2020, 349 inpatients or outpatients suspected of having laryngopharyngeal reflux underwent 24-hour multichannel intraluminal impedance pH monitoring (MII-pH). There were 303 male and 46 female patients, with an average age of 56.03 years old ranged from 25 to 81 years old. The reflux symptom index (RSI)and reflux findings score(RFS)were recorded before MII-pH monitoring. The number of acid reflux events and non-acid reflux events in hypopharynx were counted. It was defined mainly acid reflux type when the ratio of acid reflux to all reflux events was greater than 50%, mainly non-acid reflux type when the ratio of non-acid reflux to all reflux events was greater than 50%. The clinical characteristics of patients with different type of reflux were compared. SPSS 19.0 software was used for statistical analysis, and multiple independent samples were compared between groups. The quantitative data were analyzed by multivariate analysis of variance, and the counting data were analyzed by chi-square test, the difference was statistically significant when P<0.05. Results: The 24-hour MII-pH showed that there were 90 patients with no reflux events, 51 patients with mainly acid reflux type, 198 patients with mainly non-acid reflux type and 10 patients with equal acid reflux events and non-acid reflux events. Statistics showed that the RSI(10.72±4.40), RFS(7.70±2.73) and the average number of reflux events(0) in the group without reflux events were significantly lower than those in patients with mainly acid reflux type (RSI 13.16±6.62,RFS 10.08±3.03,average number of reflux events 5.33±3.15,P<0.05) and mainly non-acid reflux type(RSI 13.25±5.54,RFS 8.81±2.54,average number of reflux events 7.93±5.26, P<0.05). There was no significant difference in RSI between the mainly non-acid reflux type group and the mainly acid reflux type group, but the RFS of the mainly non-acid reflux type group was significantly lower than that of the mainly acid reflux type group. The average number of reflux events in the mainly non-acid reflux group was significantly higher than that in the mainly acid reflux type group (P<0.05). Conclusion: The results show that non-acid reflux plays a certain role in laryngopharyngeal reflux disease, but the effect of acid reflux is greater.

Functional recovery of laryngeal reconstruction with the anterior cervical turnover myocutaneous flap after partial laryngectomy / 第二军医大学学报

Objective To evaluate the laryngeal function recovery following laryngeal defect reconstruction with anterior cervical turnover myocutaneous flap after partial laryngectomies. Methods The swallowing, respiration and phonation functions of 43 patients, who received vertical partial laryngectomy, extended vertical partial laryngectomy, expanded frontovertical partial laryngectomy or subtotal laryngectomy, and laryngeal reconstruction with turnover myocutaneous flap between 2008 and 2010, were retrospectively analyzed. Thirty-two patients had glottic carcinoma (15 phase II, 16 phase IV, 1 phase IV) and 11 had transglottic carcinoma (15 phase II, 6 phase III). The aspiration rate and decannulation rate were recorded. The swallowing function score, respiration function score, and voice parameters were analyzed and compared before and after operation. Results Six months after operation all the cases had normal swallowing and respiration functions, with no aspiration and with a decannulation rate of 100%. The swallowing function scores were similar before and after operation ([7 = 903. 1, P = 0. 559), and the respiratory function was significantly improved after operation (17 = 713. 5, P = 0. 012). All the caseshad normal voice. Six months after operation, the voice quality (such as Jitter, Shimmer and normalized noise energy [NNE]) were significantlybetter than that before theoperation (P12 months after operation was significantly better than that at 6 months after operation (P<0. 05). Conclusion Anterior cervical turnover myocutaneous flap for reconstruction of laryngeal defects following partial laryngectomiescan achieve high decannulation rate and better phonation recovery, showing a satisfactory restoration of laryngeal function.