The Hypopharyngeal Reflux in Double-pH/Z Does Not Correlate with the Reflux Finding Score in Patients with Laryngopharyngeal Reflux

Česká verze

Authors: Tatiana Haličková ¹ ; L. Nosáková ²; R. Michalová ³
Authors place of work: Klinika ORL a chirurgie hlavy a krku, Ústredná vojenská nemocnica SNP – FN, Ružomberok ¹; Interná klinika – gastroenterologická, Jesseniova lekárska fakulta UK, Univerzitná nemocnica Martin ²; I. Interná klinika, Jesseniova lekárska fakulta UK, Univerzitná nemocnica Martin ³
Published in the journal: Otorinolaryngol Foniatr, 67, 2018, No. 2, pp. 60-66.
Category: Původní práce

Summary

Introduction:

Laryngopharyngeal reflux (LPR) is defined as retrograde gastric fluid flow above the upper esophageal sphincter in upper and lower respiratory tract, pharynx and oral cavity. Diagnosis of laryngopharyngeal reflux significantly limits nonspecific clinical manifestations and its problematic capture by pH metric measurements. In clinical practice, the Reflux Finding Score (RFS) is traditionally used using flexible laryngoscopy to assess the rate of changes in larynx and vocal cords caused by LPR and Reflux Symptom Index (RSI), a questionnaire focusing on the patient‘s subjective troubles due to reflux. Two-channel pH metry with impedance currently allows for the most accurate detection of LPR episodes in the hypopharyngeal region.

Aims and Methods:

Analysis of 24-hour two-channel pH measurements in symptomatic patients with positive RFS (RFS> 7) in terms of number of LPR episodes. Our hypothesis predicted a positive relationship between LPR and total RFS. We prospectively examined 36 patients with chronic laryngopharyngeal symptoms, the diagnosis of which has not led to a clear identification of the cause of the difficulties. We performed a flexible laryngoscopy with RFS determination and a 24 hour two-channel pH metry with impedance. In patients with positive RFS and at least one LPR episode on a 24 hour two-channel pH metry with impedance, we evaluated the relationship between LPR and total RFS.

Results:

Statistically we evaluated 17 patients. Average RFS was 9.88 ± 0.39. LPR episodes were divided into groups according to the pH drop in the proximal pH sensor (pH <6, 5.5, 5, 4.5, 4). We found that the number of LPR episodes with a marked decrease in pH in the hypopharynx is low and predominates LPR with a lower pH decrease in the hypopharynx. We did not confirm a statistically significant correlation between LPR and RFS, irrespective of the pH decrease in the hypopharynx. We did not confirm a significant relationship even if we evaluated only those who had a positive RSI (RSI> 13) (n = 12) at the same time, even if we evaluated only patients who had pseudosulcus vocalis (n = 12).

Conclusion:

We have not confirmed the direct relationship between LPR episodes and total RFS in patients with laryngopharyngeal reflux. It was not present regardless of the pH decrease in the hypopharynx. Increasing the inclusion criteria also did not produce a positive correlation. The 24-hour impedance pH metry probably does not reflect all aspects of the LPR effect on the vocal / larynx area.

Keywords:

laryngopharyngeal reflux, pH metry, impedance, Reflux Symptom Index, Reflux Finding Score, pseudosulcus vocalis

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