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.

Substernal goiter and laryngopharyngeal reflux

ABSTRACT Objective This study aims to compare the prevalence of laryngopharyngeal reflux signs between two groups of patients undergoing thyroidectomy for voluminous goiter: substernal goiters and voluminous cervical goiter without thoracic extension. Subjects and methods A retrospective case-control study was performed with data retrieved of the charts of the patients submitted to thyroidectomies occurred at a tertiary care center (Head and Neck Surgery Department, University of São Paulo Medical School) between 2010 and 2014. The selected thyroidectomies were allocated in two groups for study: patients with substernal goiters and patients with voluminous cervical goiter without thoracic extension. Cervical goiters were selected by ultrasonography mensuration. Clinical criterion was used to define substernal goiter. Results The average thyroid volume in patients with substernal goiter was significantly greater than the average volume in patients with only cervical goiter (p < 0.001). The prevalence of signs of reflux laryngitis at laryngoscopy was significantly greater in substernal goiter patients (p = 0.036). Moreover, substernal goiter was considered as the unique independent variable for high reflux laryngitis signs at laryngoscopy (OR = 2.75; CI95%: 1.05-7.20; p = 0.039) when compared to only cervical goiter patients. Conclusion This study shows a significant association between substernal goiters and signs of laryngopharyngeal reflux at preoperative laryngoscopy. Therefore, when compared with voluminous cervical goiters, the substernal goiters increase the chance of reflux laryngitis signs in patients.

Reflux finding score: análisis de la concordancia inter-observador / Reflux finding score: analysis of the interobserver concordance / Reflux finding score: análise de concordância interobservador

Introducción: el reflujo laringofaríngeo (RLF) es una manifestación extradigestiva del Reflujo Gastroesofágico (RGE). Actualmente, el algoritmo diagnóstico usado en la mayoría de los Servicios de Otorrinolaringologìa (ORL) consiste en identificar los síntomas sugestivos de reflujo laringofaríngeo y realizar una fibronasolaringoscopia flexible para determinar si existen cambios estructurales identificables en la laringe o en los tejidos vecinos. Se ha desarrollado una escala subjetiva para cuantificar la severidad de los cambios inflamatorios de la laringe, identificando los hallazgos laringoscópicos asociados con reflujo laringofaríngeo. Los mismos son clasificados por el índice de hallazgos de reflujo “Reflux Finding Score” (RFS), desarrollado por Belafky y cols. El puntaje máximo es de 26 y un puntaje de 7 o mayor a 7 es considerado altamente sospechoso de RLF. Objetivos: Determinar el índice Kappa de Resultados Interobservador usando el RFS en pacientes con RLF en el Servicio de Otorrinolaringología del Sanatorio Allende. Determinar las características de los pacientes con diagnóstico de RLF según: Sexo, edad, síntomas presentes y tratamiento indicado en pacientes que consultaron ambulatoriamente en el Servicio de ORL del Sanatorio Allende sucursal Nueva Córdoba. Material y método: Se determinó el índice Kappa de Resultados entre observadores usando el RFS en paciente con RLF entre 2 médicos del staff de Servicio de ORL del Sanatorio Allende, se analizó frecuencia de sexo, edad, síntomas, conducta médica. Conclusión: El índice Kappa del RFS para cada uno de los 8 ìtems del RFS es leve, medido como < 0,2.

Introduction: the Laryngopharyngeal Reflux (LPR) is recognized as an extra-digestive manifestation of gastroesophageal reflux (GERD). At present, the diagnostic algorithm used in most of the otorhinolaryngology (ORL) services involves identifying suggestive symptoms of laryngopharyngeal reflux and carrying out a flexible fibronasolaryngoscopy to determine if there are identifiable structural changes in the larynx or neighboring tissues. A subjective scale has been developed to quantify the severity of inflammatory changes in the larynx by identifying endoscopic findings related to laryngopharyngeal reflux. These subjective findings for patients with LPR are classified using the “Reflux Finding Score” (RFS) developed by Belafsky et al.The maximum score is 26 and a score of 7 or greater is considered to indicate that LPR is highly likely. Objetive: To determine the Kappa Coefficient of the interobserver agreement using the RFS in patients with LPR in the Otorhinolaryngology Service of the Allende Hospital. To determine the characteristics of patients with LPR diagnosis according to: Gender, age, manifested symptoms and treatment indicated in patients that were treated as an outpatient in the ORL Service of the Allende Hospital, Nueva Córdoba’s branch. Material and method: The Kappa Coefficient was determined by the interobserver agreement using the RFS in patients with LPR between two Staff doctors of the ORL Service of the Allende Hospital; it was investigated the sex frequency, age, symptoms and medical behavior. Conclusions: The Kappa Coefficient of LPR for each of the eight items of LPR is poor, valued as < 0.2.

Introdução: o refluxo laringofaríngeo (RFL) é uma manifestação extra-digestiva do refluxo gastroesofágico (RGE). Atualmente o algoritmo diagnóstico usado pela maioria dos Serviços de Otorrinolaringología (ORL) consistem em identificar os sintomas sugestivos do RFL e realizar uma fibronasolaringoscopia flexível para determinar se existem mudanças estruturais identificáveis na laringe ou nos tecidos vizinhos. Existe uma escala subjetiva para quantificar a severidade das alterações inflamatórias na laringe, identificando os achados laringoscópicos que têm relação com o RFL. Eles são classificados pelo índice de achados de refluxo “Reflux Finding Score” (RFS), desenvolvido por Belafky e cols. A pontuação maxima é de 26 e uma pontuação de 7 ou maior é considerado quase sugestivo de RFL. Objetivos: Determinar o índice Kappa dos resultados interobservador usando o RFS em pacientes com RFL no Serviço de Otorrinolaringologia do Sanatorio Allende. Determinar as características dos pacientes com diagnóstico de RFL Segundo: Sexo, idade, sintomas presentes e tratamento indicado em pacientes que fizeram consultas externas no Serviço de ORL do Sanatorio Allende em Nueva Córdoba. Material e método: Determinou-se o índice Kappa dos resultados entre observadores usando o RFS em pacientes com RFL entre 2 médicos do staff do Serviço de ORL do Sanatorio Allende. Analizou-se a frequência entre o sexo, a idade, os sintomas, as doenças associadas e a terapeútica médica. Conclusões: O índice Kappa do RFS para cada item do RFS é insuficiente, medida como < 0,2.

Laryngopharyngeal Reflux and Proton Pump Inhibitors.

Laryngopharyngeal reflux (LPR) refers to the backflow of stomach contents into the throat that is into the hypopharynx.LPR is different from classical GERD. Although PPIs appear to be effective, higher doses for a longer duration are necessary as compared with esophageal GERD disease. In this study we focused on clinical characteristics and role of proton pump inhibitors in Laryngopharyngeal Reflux. Material and Methods: The prospective observational study was done in LPR patients in the Department of ENT and HNS of SKIMS Medical College and Government Medical College Srinagar for a period of 2 years from 2010 to 2012 .Sixty cases were enrolled in the study. LPR was diagnosed on the basis of RFS and RSI. Role of PPI was assessed by the changes of RSI and RFS with Proton pump inhibitors. Results: Total number of patients included in the study were 60, 42 (70%) cases were females, 18 (30%) were males. Frequent clearing of throat was the most common symptom. Mean RSI of all patients was 25.25 before treatment. Significant change in RSI occurred after first 10 weeks of therapy and no further significant change occurred in the next 10 weeks. Most common laryngeal finding was erythema/hyperaemia; Mean RFS of the patients was 13 before treatment with proton pump inhibitors. There was slight response after 10 weeks of therapy in physical findings and significant response after 20 weeks. Conclusion: LPR is a common condition presenting in ENT settings, the symptoms and signs may be complex. PPI are treatment of choice and should be continued for about 5 months because clinical symptoms take about two month to resolve while signs take about 5 months to resolve.