Laryngopharyngeal reflux- diagnosis and management at a tertiary care centre

Afshan Fathima; Vivekanand A.; M. D. Prakash

doi:10.18203/issn.2454-5929.ijohns20193879

Authors

Afshan Fathima Department of ENT, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
Vivekanand A. Department of ENT, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
M. D. Prakash Department of ENT, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India

DOI:

https://doi.org/10.18203/issn.2454-5929.ijohns20193879

Keywords:

Laryngopharyngeal reflux, Reflux symptom index, Reflux finding score

Abstract

Background: Laryngopharyngeal reflux (LPR) disease is a clinical entity due to the retrograde flow of gastric contents into the pharynx. It can be considered as an extraesophageal syndrome of gastroesophageal reflux disease (GERD). The objective of the present study is to study the clinical profile of LPR and their response to treatment.

Methods: 100 consecutive patients attending the outpatient department of ENT, presenting with a clinical profile of LPR were selected in the present study. The patients’ symptoms were evaluated based on the reflux symptom index (RSI) and was followed by an endoscopic examination of larynx and a scoring was made based on reflux finding score (RFS). An RSI score of ≥13 and RFS of >7 were considered for starting patients on LPR treatment. The patients were then put on treatment and followed up for 3 months.

Results: In our study population the most common symptom was foreign body sensation in throat (52%). The most common sign noted on endoscopic examination of larynx was hyperemia/erythema of laryngeal tissue particularly bilateral arytenoids. Majority of our patients responded well to combination of pantoprazole (40 mg) and domperidon (30 mg) for 4 weeks. This was evaluated in terms of reduction in the RSI and RFS scores.

Conclusions: LPR is more commonly encountered clinical entity and the otorhinolaryngologist should bear it in mind while treating patients for chronic complaints of throat pain, change in voice etc. Appropriate diagnosis and management of LPR can prevent unwarranted use of antibiotics and surgeries in these patients.

Metrics

Metrics Loading ...

References

Leden HV, Moore P. Contact ulcer of the larynx. Experimental observations. Arch Otolaryngol. 1960;72:746-52.

Pesce G, Caligaris F. Posterior laryngitis in the pathology of the digestive system. Arch Ital Laringol. 1966;74:77-92.

Cherry J, Margulies S I. Contact ulcer of the larynx. Laryngoscope. 1968;78:1937-40.

Delahunty JE, Cherry J. Experimentally produced vocal cord granulomas. Laryngoscope. 1968;78:1941-7.

Hallewell JD, Cole TB. Isolated head and neck symptoms due to hiatus hernia. Arch Otolaryngol. 1970;92:499-501.

Cherry J, Spiegel CI, Margulies SI, Donner M. Pharyngeal localization of symptoms of gastroesophageal reflux. Ann Otol Rhinol Laryngol. 1970;79:912-4.

Dale O T, Alhamarneh O, Young K, Mohan S. Laryngeal sensory testing in the assessment of patients with laryngopharyngeal reflux. J Laryngol Otol. 2010;124:330-2.

Bove M J, Rosen C. Diagnosis and management of laryngopharyngeal reflux disease. Curr Opin Otolaryngol Head Neck Surg. 2006;14:116-23.

Koufman JA. The otolaryngologic manifestations of gastroesophageal reflux disease (GERD): a clinical investigations of 225 patients using ambulatory 24-h pH monitoring and an experimental investigation of the role of acid and pepsin in the development of laryngeal injury. Laryngoscope. 1991;101:1-78.

Adhami T, Goldblum JR, Ricter J, Goldblum J, Vaezi M. The role of gastric and duodenal agents in laryngeal injury; an experimental canine model. Am J Gastroenterol. 2004;99:2098-106.

Kollarik M, Ru F, Undem BJ. Acid-sensitive vagal sensory pathways and cough. Pulm Pharmacol Ther. 2007;20:402-11.

Belafsky PC, Postma GN, Koufman JA. Validity and reliability of the reflux finding score (RFS). Laryngoscope. 2001;111:1313-7.

Castell DO, Wu WC, Ott D J. Gastroesophageal reflux disease, pathogenesis, diagnosis, therapy. Mt. Kisko, NY: Futura; 1985: 1-324.

Locke GR, Talley NJ, Fett SL, Zinsmeister AR, Melton LJ. Prevalence and clinical spectrum of gastroesophageal reflux: A population based study in Olmsted County, Minnesota. Gastroenterol. 1997;112(5):1448-56.

Alam KH, Vlastarakos PV. Diagnosis and management of laryngo-pharyngeal reflux. Indian J Otolaryngol Head Neck Surg. 2014;66(3):227-31.

Koufman JA, Amin MR, Panetti M. Prevalence of reflux in 113 consecutive patients with laryngeal and voice disorders. Otolaryngol Head Neck Surg. 2000;123(4):385-8.