Different Characteristics of Oropharyngeal pH Changes in Different Laryngeal Diseases

Abstract

Objectives To evaluate the different characteristics of oropharyngeal pH changes in patients with different laryngeal diseases. Methods A retrospective analysis was performed. The clinical data of 262 patients were summarized. The patients were divided into 4 groups. Group 1 included 123 patients with suspected laryngopharyngeal reflux disease (LPRD). Group 2 included 45 patients with vocal cord polyps. Group 3 included 40 patients with vocal cord leukoplakia. Group 4 included 54 patients with laryngeal carcinoma. Their reflux symptom indexes (RSIs), reflux finding scores (RFSs), and Dx-pH monitoring results were compared. Results In total, 235 patients had abnormal RSI/RFS, 90 patients had abnormal Ryan scores. The rate of abnormal RSI/RFS of Group 1 was significantly higher than that of Group 4 (P = .001). Significant differences of the rates of abnormal Ryan scores existed between Groups 2 and 4 (P = .021) and Groups 3 and 4 (P = .027). There were obvious differences in upright Ryan scores between Groups 1 and 2 (P = .013), Groups 1 and 3 (P = .002), Groups 2 and 4 (P = .046), and Groups 3 and 4 (P = .009). There were significant differences in time percentage of oropharyngeal pH of upright 5.5∼6.5 and supine 5.0∼6.5 between Groups 1 and 3 as well as Groups 1 and 4 (upright: Groups 1 and 3: P = .017; Groups 1 and 4: P = .019. Supine: Groups 1 and 3: P = .018; Groups 1 and 4: P = .023). Conclusions There were different oropharyngeal pH characteristics in patients with different laryngeal diseases, which indicated laryngopharyngeal reflux may play different roles in different diseases through various patterns. Patients with vocal cord polyps, vocal cord leukoplakia, and laryngeal carcinoma had more and different patterns of oropharyngeal pH change than patients with LPRD. Patients with vocal cord polyps and vocal cord leukoplakia had more severe acid oropharyngeal pH change episodes than patients with laryngeal carcinoma.

Laryngopharyngeal Reflux and Benign Vocal Fold Lesions: A Systematic Review and Meta‐analysis

“…Following full‐text reviews of 35 studies, 26 were excluded because of the reasons listed in Figure 1. Accordingly, 9 studies were obtained for subsequent Meta‐analysis 23‐31 …”

“…Accordingly, in this Meta‐analysis we only included studies with objectively diagnosed LPR via 24‐hour pharyngeal pH monitoring. Among the studies included in the current Meta‐analysis, only 4 of them were analyzed in the previous systematic review, 23‐26 and an additional 5 studies with LPR diagnosed via the 24‐hour pharyngeal pH monitoring were further included 27‐31 . In addition, there are also several other methodological advantages of the current study.…”

“…Accordingly, 9 studies were obtained for subsequent Meta-analysis. [23][24][25][26][27][28][29][30][31]…”

Clinical Update Findings about pH-Impedance Monitoring Features in Laryngopharyngeal Reflux Patients

“…Oropharyngeal pH monitoring (Restech Dx–pH monitoring) was specifically developed for the diagnosis of LPR [ 48 ]. As for HEMII-pH studies, there are several diagnostic criteria in the literature [ 37 ]m but many authors agreed to consider a positive Ryan score (upright score ≥ 9.41 or supine score ≥ 6.8) for the presence of LPR [ 46 , 48 , 49 , 56 , 57 ]. Ryan score is calculated according to three components: the percent time pH < 5.5 upright or <5.0 supine; the number of episodes in which the pH dropped below threshold; and the duration of the longest episode.…”

“…According to the potential associations between LPR and many otolaryngological disorders, including suppurative otitis media [ 64 , 65 ], recalcitrant chronic rhinosinusitis [ 66 ], some benign lesions of the vocal folds [ 56 , 67 , 68 ], nonfunctional laryngeal disorders [ 69 ], vocal fold granuloma [ 70 ], Eustachian tube dysfunction [ 71 ], eye dryness [ 72 ], or chronic nasal obstruction [ 73 , 74 ], the usefulness of pH study in otolaryngology is an important issue. The identification of LPR as contributing factor of the above-mentioned otolaryngological conditions may lead to better therapeutic regimen and control of the clinical courses of the diseases.…”