Peak nasal inspiratory airflow measurements for assessing laryngopharyngeal reflux treatment

Ceylan, Seyit Mehmet; Kanmaz, Mahmut Alper; Disikirik, Ilyas; Karadeniz, Pınar Günel

doi:10.1111/coa.13737

Cited by 4 publications

(4 citation statements)

References 23 publications

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“…Furthermore, pepsin has been identified in the secretion of otitis media in several studies [ 6 , 25 , 26 ]. According to nasal obstruction, two recent studies supported that LPR may lead to edema of the nasal mucosa, including the posterior part of the inferior turbinate, as observed in this study [ 27 , 28 ]. Interestingly, Magliulo et al found pepsin in the tears [ 29 ], which may support the occurrence of a relationship between laryngopharyngeal reflux and tear disorders through the injury of the nasal mucosa of the inferior meatus.…”

Section: Discussionsupporting

confidence: 85%

Atypical Clinical Presentation of Laryngopharyngeal Reflux: A 5-Year Case Series

Lechien

Hans

Bobin

et al. 2021

JCM

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Background: Laryngopharyngeal reflux (LPR) is a common disease in otolaryngology characterized by an inflammatory reaction of the mucosa of the upper aerodigestive tract caused by digestive refluxate enzymes. LPR has been identified as the etiological or favoring factor of laryngeal, oral, sinonasal, or otological diseases. In this case series, we reported the atypical clinical presentation of LPR in patients presenting in our clinic with reflux. Methods: A retrospective medical chart review of 351 patients with LPR treated in the European Reflux Clinic in Brussels, Poitiers and Paris was performed. In order to be included, patients had to report an atypical clinical presentation of LPR, consisting of symptoms or findings that are not described in the reflux symptom score and reflux sign assessment. The LPR diagnosis was confirmed with a 24 h hypopharyngeal-esophageal impedance pH study, and patients were treated with a combination of diet, proton pump inhibitors, and alginates. The atypical symptoms or findings had to be resolved from pre- to posttreatment. Results: From 2017 to 2021, 21 patients with atypical LPR were treated in our center. The clinical presentation consisted of recurrent aphthosis or burning mouth (N = 9), recurrent burps and abdominal disorders (N = 2), posterior nasal obstruction (N = 2), recurrent acute suppurative otitis media (N = 2), severe vocal fold dysplasia (N = 2), and recurrent acute rhinopharyngitis (N = 1), tearing (N = 1), aspirations (N = 1), or tracheobronchitis (N = 1). Abnormal upper aerodigestive tract reflux events were identified in all of these patients. Atypical clinical findings resolved and did not recur after an adequate antireflux treatment. Conclusion: LPR may present with various clinical presentations, including mouth, eye, tracheobronchial, nasal, or laryngeal findings, which may all regress with adequate treatment. Future studies are needed to better specify the relationship between LPR and these atypical findings through analyses identifying gastroduodenal enzymes in the inflamed tissue.

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Section: Discussionsupporting

confidence: 85%

Atypical Clinical Presentation of Laryngopharyngeal Reflux: A 5-Year Case Series

Lechien

Hans

Bobin

et al. 2021

JCM

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“…Furthermore, pepsin has been identified in secretion of otitis media in several studies [6,26,27]. According to nasal obstruction, two recent studies supported that LPR may lead to edema of the nasal mucosa, including the posterior part of the inferior turbinate as observed in this study [28,29]. Interestingly, XX et al found pepsin in the tears [30], which may support the occurrence of a relationship between laryngopharyngeal reflux and tear disorders through the injury of the nasal mucosa of the inferior meatus.…”

Section: Discussionsupporting

confidence: 75%

Atypical Clinical Presentation of Laryngopharyngeal Reflux: A 5-year Case-Series

Lechien¹,

Hans²,

Bobin³

et al. 2021

Preprint

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Background: Laryngopharyngeal reflux (LPR) is a common disease in otolaryngology characterized by an inflammatory reaction of the mucosa of the upper aerodigestive tract caused by digestive refluxate enzymes. LPR has been identified as etiological or favoring factor of laryngeal, oral, sinonasal or otological diseases. In this case-series, we reported atypical clinical presentation of LPR in patients presenting in our clinic with reflux. Methods: A retrospective medical chart review of 351 patients with LPR treated in the European Reflux Clinic in Brussels, Poitiers and Paris was performed. In order to be included, patients had to report atypical clinical presentation of LPR, consisting of symptoms or findings that are not described in reflux symptom score and reflux sign assessment. The LPR diagnosis was confirmed with 24-hour hypopharyngeal-esophageal impedance pH-study and patients were treated with a combination of diet, proton pump inhibitors and alginates. The atypical symptoms or findings had to be resolved from pre- to posttreatment Results: From 2017 to 2021, 21 patients with atypical LPR were treated in our center. The clinical presentation consisted of recurrent aphthosis or burning mouth (N=9), recurrent burps and abdominal disorders (N=2), posterior nasal obstruction (N=2), recurrent acute suppurative otitis media (N=2), severe vocal fold dysplasia (N=2), and recurrent acute rhinopharyngitis (N=1), tearing (N=1), aspirations (N=1) or tracheobronchitis (N=1). Abnormal upper aerodigestive tract reflux events were identified in all of these patients. Atypical clinical findings resolved and did not recur after an adequate anti-reflux treatment. Conclusion: LPR may present with various clinical presentations including mouth, eye, tracheobronchial, nasal or laryngeal findings, which may all regress with an adequate treatment. Future studies are needed to better specify the relationship between LPR and these atypical findings through analyses identifying gastroduodenal enzyme in the enflamed tissue.

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“…Another promising diagnostic tool is the detection of pepsin on saliva. The presence of pepsin not only in saliva, but in the tears and nasal mucosa is an interesting finding and may be related to nasopharyngeal inflammation 25,26 . Regarding the LPR assessment, the RSI and the Reflux Finding Score (RFS) are the most popular clinical tools, the first evaluating symptoms and the second evaluating endoscopic findings suggestive of LPR.…”

Section: Discussionmentioning

confidence: 99%

“…The presence of pepsin not only in saliva, but in the tears and nasal mucosa is an interesting finding and may be related to nasopharyngeal inflammation. 25,26 Regarding the LPR assessment, the RSI and the Reflux Finding Score (RFS) are the most popular clinical tools, the first evaluating symptoms and the second evaluating endoscopic findings suggestive of LPR. It is worth noting the RSI questionnaire, in addition to being validated with 24-hour dual-probe esophageal pH monitoring, has been widely used in the clinical diagnosis of LPR in recent years, in conjunction with laryngoscopy findings and the RFS.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Laryngopharyngeal Reflux and Obstructive Sleep Apnea: A Population‐Based Study

et al. 2022

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Objectives/Hypothesis: To evaluate the presence of laryngopharyngeal reflux (LPR) and the potential association between presence of LPR symptoms and obstructive sleep apnea (OSA) in a representative sample from a population-based study.Study Design: Cross-sectional study.Methods: Participants of the follow-up of the Epidemiological Sleep Study were evaluated. Sleep was assessed through questionnaires and polysomnography. The presence of LPR was based on the questionnaire Reflux Score Index (RSI), and scores higher than 13 were suggestive of LPR. A general linear model test was used for comparison of continuous data and Pearson's chi-square test was used to compare categorical variables. Predictors of LPR were obtained by regression analysis.Results: 701 were enrolled (54.8% female, 45.2% male; mean age, 50.2 AE 13.3 years). The mean apnea-hypopnea index score was 17 AE 18.3 events/hr, and the mean RSI score was 7.0 AE 8.1. LPR was found in 17% of the volunteers, whereas OSA was present in 38.5% of the sample. Specifically, in those patients with OSA, the prevalence of LPR was 45.4%; however, there was no statistically significant association between LPR and the presence of OSA. The severity of OSA was not associated with RSI score. The presence of LPR was associated with older age, smoking, excessive daytime sleepiness and worse quality of life and sleep scores questionnaires.Conclusions: Age, smoking, but not body mass index, were associated with LPR. There was not statistically significant association of LPR with OSA. Individuals with symptoms of LPR had greater drowsiness and worse quality of life and sleep.

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Peak nasal inspiratory airflow measurements for assessing laryngopharyngeal reflux treatment

Cited by 4 publications

References 23 publications

Atypical Clinical Presentation of Laryngopharyngeal Reflux: A 5-Year Case Series

Atypical Clinical Presentation of Laryngopharyngeal Reflux: A 5-Year Case Series

Atypical Clinical Presentation of Laryngopharyngeal Reflux: A 5-year Case-Series

Assessment of Laryngopharyngeal Reflux and Obstructive Sleep Apnea: A Population‐Based Study

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