Does laryngopharyngeal reflux disease impair nasal mucociliary transport? A case control prospective study
Keywords:Laryngopharyngeal reflux, Mucociliary clearance, Mucociliary transport, Nasal mucosa, Rhinosinusitis
Background: Laryngopharyngeal reflux disease (LPRD) is the retrograde reflux of gastro duodenal contents above the level of upper oesophageal sphincter into larynx and pharynx. LPRD can lead to upper respiratory pathology by direct contact of nasal and nasopharyngeal mucosa with the regurgitated gastric acid. Refluxate can damage the cilia, thereby prolonging the mucociliary clearance time (MCT) and consequently affecting the innate defence mechanism of upper airway. Our objective was to analyse the relationship between MCT and LPRD in patients without any nasal pathology.
Methods: This study was a prospective case control study, with 45 patients each in the study and reference group. Study group included patients with symptoms of LPRD who fulfilled the reflux symptom index (RSI) score of more than 13 points. The reference group included subjects without LPRD, with RSI less than 13. In both groups, conditions causing impaired MCT like allergic rhinitis, sinusitis, rhinitis and history of smoking were excluded. Chronic sinusitis cases were excluded in both groups using sino-nasal outcome test -22 scoring system. Nasal MCT was measured in all these participants using the Saccharin test. Duration more than 20 minutes was taken as prolonged mucociliary clearance time.
Results: MCT was prolonged in 62% of subjects (28 out of 45) in the study group whereas, in the reference population MCT was normal.
Conclusions: LPRD is a contributing factor for impaired nasal mucociliary transport.
Koufman JA. The otolaryngologic manifestations of gastroesophageal reflux disease (GERD): a clinical investigation of 225 patients using ambulatory 24‐hour pH monitoring and an experimental investigation of the role of acid and pepsin in the development of laryngeal injury. Laryngoscope. 1991;101:1-78.
Ford CN. Evaluation and management of laryngopharyngeal reflux. JAMA. 2005;294:1534-40.
Schipper NG, Verhoef JC, Merkus FW. The nasal mucociliary clearance: relevance to nasal drug delivery. Pharm Res. 1991;8:807-14.
Pandya VK, Tiwari RS. Nasal mucociliary clearance in health and disease. Indian J Otolaryngol Head Neck Surg. 2006;58:332-4.
Corbo GM, Foresi A, Bonfitto P, Mugnano A, Agabiti N, Cole PJ. Measurement of nasal mucociliary clearance. Arch Dis Child. 1989;64:546-50.
Harding SM, Richter JE. The role of gastroesophageal reflux in chronic cough and asthma. Chest. 1997;111:1389-402.
Holma B, Lindegren M, Andersen JM. pH effects on ciliomotility and morphology of respiratory mucosa. Arch Environ Health. 1977;32:216-26.
Belafsky PC, Postma GN, Koufman JA. Validity and reliability of the reflux symptom index (RSI). J Voice. 2002;16:274-7.
Habib AR, Quon BS, Buxton JA, Alsaleh S, Singer J, Manji J, et al. The Sino‐Nasal Outcome Test–22 as a tool to identify chronic rhinosinusitis in adults with cystic fibrosis. Int Forum Allergy Rhino. 2015;5:1111-7.
Deborah S, Prathibha KM. Measurement of nasal mucociliary clearance. Clin Res Pulmonol. 2014;2:1019.
Lipan MJ, Reidenberg JS, Laitman JT. Anatomy of reflux: a growing health problem affecting structures of the head and neck. Anat Rec B New Anat. 2006;289:261-70.
Koufman JA, Aviv JE, Casiano RR, Shaw GY. Laryngopharyngeal reflux: position statement of the committee on speech, voice, and swallowing disorders of the American Academy of Otolaryngology-Head and Neck Surgery. Otolaryngol Head Neck Surg. 2002;127:32-5.
Keleş B, Oztürk K, Günel E, Arbağ H, Ozer B. Pharyngeal reflux in children with chronic otitis media with effusion. Acta Otolaryngol. 2004;124:1178-81.
Jecker P, Orloff LA, Wohlfeil M, Mann WJ. Gastroesophageal reflux disease (GERD), extraesophageal reflux (EER) and recurrent chronic rhinosinusitis. Eur Arch Otorhinolaryngol. 2006;263:664-7.
Ulualp SO, Toohill RJ, Hoffmann R, Shaker R. Possible relationship of gastroesophagopharyngeal acid reflux with pathogenesis of chronic sinusitis. Am J Rhinol. 1999;13:197-202.
DiBaise JK, Olusola BF, Huerter JV, Quigley EM. Role of GERD in chronic resistant sinusitis: a prospective, open label, pilot trial. Am J Gastroenterol. 2002;97(4):843-50.
Wong IW, Rees G, Greiff L, Myers JC, Jamieson GG, Wormald PJ. Gastroesophageal reflux disease and chronic sinusitis: In search of an esophageal nasal reflex. Am J Rhinol Allergy. 2010;24:255-59.
Özdek A, Çirak MY, Samįm E, Bayiz Ü, Safak MA, Turet S. A possible role of Helicobacter pylori in chronic rhinosinusitis: a preliminary report. Laryngoscope. 2003;113:679-82.
Contencin P, Narcy P. Nasopharyngeal pH monitoring in infants and children with chronic rhinopharyngitis. Int J Ped Otorhinolaryngol. 1991;22:249-56.
Bothwell MR, Parsons DS, Talbot A, Barbero GJ, Wilder B. Outcome of reflux therapy on pediatric chronic sinusitis. Otolaryngol Head Neck Surg. 1999;121:255-62.
Phipps CD, Wood WE, Gibson WS, Cochran WJ. Gastroesophageal reflux contributing to chronic sinus disease in children: a prospective analysis. Arch Otolaryngol Head Neck Surg. 2000;126:831-6
DelGaudio JM. Direct nasopharyngeal reflux of gastric acid is a contributing factor in refractory chronic rhinosinusitis. Laryngoscope. 2005;115:946-57.
Chambers DW, Davis WE, Cook PR, Nishioka GJ, Rudman DT. Long‐term outcome analysis of functional endoscopic sinus surgery: correlation of symptoms with endoscopic examination findings and potential prognostic variables. Laryngoscope. 1997;107:504-10.
Delehaye E, Dore MP, Bozzo C, Mameli L, Delitala G, Meloni F. Correlation between nasal mucociliary clearance time and gastroesophageal reflux disease: our experience on 50 patients. Auris Nasus Larynx. 2009;36:157-61
Ozmen S, Yücel OT, Sinici I, Ozmen OA, Süslü AE, Oğretmenoğlu O, et al. Nasal pepsin assay and pH monitoring in chronic rhinosinusitis. Laryngoscope. 2008;118:890-4.
Durmus R, Naiboglu B, Tek A, Sezikli M, Cetinkaya ZA, Toros SZ, et al. Does reflux have an effect on nasal mucociliary transport? Acta Otolaryngol. 2010;130:1053-7.
Wong IW, Omari TI, Myers JC, Rees G, Nair SB, Jamieson GG, Wormald PJ. Nasopharyngeal pH monitoring in chronic sinusitis patients using a novel four channel probe. Laryngoscope. 2004;114:1582-5.