The Significance of Laryngopharyngeal Reflux in Benign Vocal Mucosal Lesions

2009 ◽  
Vol 141 (3) ◽  
pp. 369-373 ◽  
Author(s):  
Jae Ho Chung ◽  
Kyung Tae ◽  
Yong Seop Lee ◽  
Jin Hyeok Jeong ◽  
Seok Hyun Cho ◽  
...  
Keyword(s):  
Laryngopharyngeal Reflux ◽  
Ph Monitoring ◽  
Medical Center ◽  
Control Group ◽  
Etiologic Factor ◽  
Vocal Polyp ◽  
Total Reflux ◽  
Increased Risk ◽  
Reinke’S Edema ◽  
Mucosal Lesions

OBJECTIVE: To determine the significance of laryngopharyngeal reflux (LPR) in benign vocal mucosal lesions. STUDY DESIGN AND SETTING: A case-control study at the tertiary referral medical center. SUBJECTS AND METHODS: From April 2003 to December 2006, we studied 110 patients with benign vocal mucosal lesions who had undergone 24-hour ambulatory double pH monitoring. The control group included 200 patients who had undergone ambulatory 24-hour double-probe pH monitoring due to laryngopharyngeal reflux-related symptoms without specific findings of benign vocal mucosal lesions. Reflux symptom index and reflux finding score were measured. We compared the prevalence of pathologic laryngopharyngeal reflux and various parameters of the pH monitoring such as total reflux number, fraction time of pH below 4 in various positions, and DeMeester scores. RESULTS: The prevalence of pathologic laryngopharyngeal reflux was 65 percent in the control group, 66 percent in vocal nodule group, 75 percent in the vocal polyp group, and 90 percent in the Reinke's edema group. Patients with Reinke's edema had a significantly higher prevalence of pathologic laryngopharyngeal reflux than controls ( P = 0.016). LPR was associated with a significantly increased risk of Reinke's edema (odds ratio: 4.846, 95% confidence interval 1.093∼21.492). Total reflux number and DeMeester scores in the Reinke's edema group and fraction time of pH below 4 in the supine position in the vocal polyp group were significantly higher than those in the control group. CONCLUSION: Laryngopharyngeal reflux might play a role as an etiologic factor in Reinke's edema and vocal polyps.

Does laryngopharyngeal reflux affect healing and recovery after tonsillectomy?

2007 ◽  
Vol 122 (6) ◽  
pp. 603-608 ◽  
Author(s):  
S Elwany ◽  
Y A Nour ◽  
E A Magdy
Keyword(s):  
Wound Healing ◽  
Laryngopharyngeal Reflux ◽  
Ph Monitoring ◽  
Control Group ◽  
Study Group ◽  
Pain Scores ◽  
Blinded Study ◽  
Group A ◽  
Group B ◽  
Control Group Group

AbstractIntroduction:Laryngopharyngeal reflux is increasingly being implicated in several otolaryngological disorders.Aims:To study a potential correlation between pre-operative laryngopharyngeal reflux and wound healing and recovery after tonsillectomy, based on subjective and objective findings.Materials and methods:A prospective, blinded study was undertaken, including 60 patients scheduled for tonsillectomy, divided into two equal groups: a study group (group A) with pre-operative laryngopharyngeal reflux documented using ambulatory 24-hour pH monitoring; and a control group (group B) without laryngopharyngeal reflux.Results:Group A had significantly higher pain scores on the seventh and 14th post-operative days (p = 0.022 and p = 0.000, respectively) and took a significantly longer time to return to normal eating (p = 0.013), compared with group B. Group A also showed significantly slower healing on the seventh and 14th post-operative days, as estimated by assessing the grade of post-operative slough formation (p = 0.016 and p = 0.029, respectively). A significant correlation between the number of pharyngeal reflux episodes and the degree of post-operative slough was also found.Conclusions:Laryngopharyngeal reflux can significantly decrease wound healing following tonsillectomy. Therefore, pre-operative recognition and management of this condition is desirable in order to eliminate its negative post-operative effect.

scholarly journals Laryngopharyngeal pH Monitoring in Patients With Idiopathic Pulmonary Fibrosis

2021 ◽  
Vol 12 ◽  
Author(s):  
Yiliang Su ◽  
Li Shen ◽  
Fen Zhang ◽  
Xing Jiang ◽  
Xiaofeng Jin ◽  
...  
Keyword(s):  
Idiopathic Pulmonary Fibrosis ◽  
Pulmonary Fibrosis ◽  
Supine Position ◽  
Ph Value ◽  
Laryngopharyngeal Reflux ◽  
Ph Monitoring ◽  
Upright Position ◽  
Index Score ◽  
Control Group ◽  
Healthy Individuals

Background: Patients with idiopathic pulmonary fibrosis (IPF) often have irritating persistent dry cough. Possible correlations between dry cough and laryngopharyngeal reflux (LPR) remain unclear.Methods: 44 patients with IPF and 30 healthy individuals underwent 24 h laryngopharyngeal pH monitoring. Ryan index score was calculated. Patients’ demographic and clinical data were collected.Results: 44 patients with IPF and 30 healthy individuals were included. The proportions of men and smokers were significantly higher in IPF group than control group (All p < 0.01). The average laryngopharyngeal pH value for 24 h was similar in the IPF (7.11 ± 0.08) group and control group (7.09 ± 0.06). According to the percentage duration of pH < 6.5, pH6.5–7.5, and pH > 7.5 in the overall measure duration, the patients were classified into three pH groups. In entire pH monitoring duration, the proportion of pH > 7.5 group in IPF patients was higher than control group; at upright position, the proportion of pH > 7.5 group in IPF patients was higher than control group; at supine position, the proportion of pH < 6.5 group in IPF patients was higher than control group (All p < 0.01). Seven patients had Ryan index score>9.41 at upright position. All patients had Ryan index score<6.79 at supine position. Four patients showed significantly higher and one patient had significantly lower average pH at coughing than the overall average pH (All p < 0.05).Conclusions: Patients with IPF may have LPR. Basic and acidic LPR may likely occur at upright and supine position, respectively. Ryan index may not accurately reflect LPR in patients with IPF.

scholarly journals Changing Trends of Color of Different Laryngeal Regions in Laryngopharyngeal Reflux Disease

2019 ◽  
Vol 99 (8) ◽  
pp. 543-547
Author(s):  
Chen Du ◽  
Paige Thayer ◽  
Yan Yan ◽  
Qingsong Liu ◽  
Li Wang ◽  
...  
Keyword(s):  
Laryngopharyngeal Reflux ◽  
Ph Monitoring ◽  
Vocal Folds ◽  
Control Group ◽  
Negative Group ◽  
Positive Group ◽  
Changing Trends ◽  
Significant Difference ◽  
False Vocal ◽  
And Control

Introduction: In our previous study, we demonstrated that there might be correlations between laryngopharyngeal reflux disorder and the hue value of laryngoscopic images. And we found that different regions of larynx have different hue values. It was hypothesized that the degree of inflammation varies between different laryngeal regions, due to an acid reflux pattern. Objective: The objective of this study was to compare the changing trends of hue values of different laryngeal regions in patients with laryngopharyngeal reflux (LPR) disease. Methods: Ninety-seven patients, including 20 pH-positive, 19 pH-negative were tested for LPR through multichannel intraluminal impedance 24-hour pH monitoring, and 58 controls with reflux symptom index less than 13. Laryngoscopic images of all patients were obtained. The hue values of 7 areas of interest, including both sides of the true vocal folds, the false vocal folds, the arytenoids, and the interarytenoid space, were quantified using a hue calculation. The analysis of variance analysis was applied to find if there was significant difference between different groups within each region. Results: (1) In the regions of both sides of the true vocal folds and interarytenoid, there was no significant difference between positive group and negative group; (2) in the regions of both sides of false vocal folds, there was no significant difference between negative group and control group; (3) in the regions of both sides of arytenoids, there was neither significant difference between positive group and negative group nor between negative group and control group; (4) in other comparisons, there were significant differences. Conclusion: Hue values of separate laryngeal regions are different. In negative group, the hue values of interarytenoid region are similar with positive group, and the sensitivity to the acid are different from different regions. The sensitivity in the true vocal folds may be present.

scholarly journals The Relationship Between Gastroesophageal Reflux Disease and Laryngopharyngeal Reflux Based on pH Monitoring

2020 ◽  
pp. 014556132097191
Author(s):  
Yun Wu ◽  
Junyao Wang ◽  
Qing Huang ◽  
Tao Peng ◽  
Lili Zhao ◽  
...  
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Reflux Disease ◽  
Esophageal Manometry ◽  
Laryngopharyngeal Reflux ◽  
Ph Monitoring ◽  
Reflux Time ◽  
Total Reflux ◽  
Significant Difference ◽  
The Relationship

Objectives: Many studies on the relationship between gastroesophageal reflux disease (GERD) and laryngopharyngeal reflux (LPR) were based on symptoms, but there are few research on it using reflux monitoring. This study was designed to investigate the relationship between GERD and LPR based on pH monitoring. Methods: All patients were scheduled for esophageal manometry and pH monitoring sequentially. They were stratified into 4 groups as no reflux disease, isolated GERD, isolated LPR (iLPR), and GERD combined with LPR (GERD&LPR) according to pH monitoring. Results: The incidence of LPR in GERD was 46.3%, while the probability of combining GERD in LPR was 52.7%. The reflux profile in the laryngopharynx showed a significant difference in the total reflux time (17.82 ± 18.4 vs 9.62 ± 9.58, P = .023) and the percentage of total reflux time (1.31% ± 1.37% vs 0.71% ± .0.73%, P = .023) between the GERD&LPR and iLPR groups. Conclusion: Laryngopharyngeal reflux can be combined with GERD or it can exist as an independent diagnosis. In patients with GERD&LPR, the total reflux time and the percentage of reflux time in the laryngopharynx are higher than those in the iLPR group. Reflux episodes in the laryngopharynx of patients with GERD&LPR may be derived from GERD.

scholarly journals Laryngopharyngeal pH monitoring in patients with interstitial lung diseases

2019 ◽  
Author(s):  
Yiliang Su ◽  
Li Shen ◽  
Fen Zhang ◽  
Xing Jiang ◽  
Xiaofeng Jin ◽  
...  
Keyword(s):  
Clinical Data ◽  
Supine Position ◽  
Lung Diseases ◽  
Laryngopharyngeal Reflux ◽  
Ph Monitoring ◽  
Interstitial Lung Diseases ◽  
Upright Position ◽  
Index Score ◽  
Control Group ◽  
Healthy Individuals

Abstract Background Patients with interstitial lung diseases (ILDs) often have irritating persistent dry cough. Possible correlations between dry cough and laryngopharyngeal reflux (LPR) remain unclear. Methods 44 patients with ILDs and 30 healthy individuals underwent 24-hour laryngopharyngeal pH monitoring. Ryan index score was calculated. Patients’ demographic and clinical data were collected. Results 44 patients (23 cases of IPF and 21 cases of CTD-ILD) and 30 healthy individuals were included. The proportions of men and smokers were significantly higher in IPF group than in CTD-ILD group and control group (All P<0.01). Other demographic and clinical data were similar in IPF and CTD-ILD group. According to the percentage duration of pH<6.5, pH6.5-7.5, and pH>7.5 in the overall measure duration, the patients were classified into three pH groups. In entire pH monitoring duration, the proportion of pH>7.5 group in ILD patients was higher than control group; at upright position, the proportion of pH>7.5 group in ILD patients was higher than control group; at supine position, the proportion of pH<6.5 group in ILD patients was higher than control group (All P<0.01). Seven patients had Ryan index score>9.41 at upright position. All patients had Ryan index score<6.79 at supine position. Four patients showed significantly higher and one patient had significantly lower average pH at coughing than the overall average pH (All P<0.05). Conclusions Patients with ILDs may have LPR. Basic and acidic LPR may likely occur at upright and supine position, respectively. Ryan index may not accurately reflect LPR in patients with ILDs.

scholarly journals Extended-Spectrum Beta-Lactamase Bacteria From Urine Isolates in Children

2015 ◽  
Vol 20 (5) ◽  
pp. 373-377
Author(s):  
Lisa A. Degnan ◽  
Aaron M. Milstone ◽  
Marie Diener-West ◽  
Carlton K. K. Lee
Keyword(s):  
Risk Factors ◽  
Medical Center ◽  
Empiric Antibiotic Therapy ◽  
Control Group ◽  
Beta Lactamase ◽  
Gram Negative ◽  
Extended Spectrum Beta Lactamase ◽  
Extended Spectrum ◽  
Increased Risk ◽  
Urinary Isolates

OBJECTIVES: Multidrug-resistant Gram-negative bacteria, including extended-spectrum beta-lactamase (ESBL)–producing organisms, are a growing problem. The primary objective of this study was to describe the proportion of children with ESBL-producing urinary isolates at a tertiary medical center as well as these organisms' susceptibility patterns. The secondary objective was to identify the risk factors for acquiring ESBL urinary pathogens. METHODS: This retrospective study evaluated a cohort of children with ESBL urinary isolates, admitted to a tertiary children's hospital during a 6-year period. The proportion of patients with an ESBL-producing urinary isolate among all patients who grew a Gram-negative isolate is described together with the organism's susceptibility pattern. Patients with non-ESBL Gram-negative urinary organisms were used as a control group for identifying patient risk factors for ESBL. RESULTS: A total of 7.8% (29 of 370) of patients in our cohort grew Gram-negative urinary isolates with an ESBL strain. Most of the ESBL organisms isolated were sensitive to carbapenems (100% of ESBL organisms susceptible to ertapenem and 93.8% susceptible to meropenem) and amikacin (92.3% of ESBL organisms susceptible). Patients with longer hospitalization, recent antibiotic use, and recent intensive care unit admission were found to be at increased risk for ESBL organisms in the urine. CONCLUSIONS: When selecting empiric antibiotic therapy for suspected urinary tract infection in children, it may be prudent to consider the risk factors identified for acquiring an ESBL urinary pathogen.

Changes in Pharyngeal Baseline Impedance in Patients With Laryngopharyngeal Reflux

2020 ◽  
Vol 163 (3) ◽  
pp. 563-568
Author(s):  
Jeon Gang Doo ◽  
Su Il Kim ◽  
Jung Min Park ◽  
Oh Eun Kwon ◽  
Young Chan Lee ◽  
...  
Keyword(s):  
Laryngopharyngeal Reflux ◽  
Ph Monitoring ◽  
Medical Center ◽  
Tertiary Care ◽  
Case Series ◽  
Healthy Controls ◽  
Retrospective Case ◽  
Tertiary Care Medical Center ◽  
Intraluminal Impedance ◽  
Reflux Event

Objective Few studies have investigated pharyngeal intraluminal baseline impedance (BI) levels in patients with laryngopharyngeal reflux (LPR). The aim of this study was to compare intraluminal BI levels between patients with LPR and healthy controls. Study Design Retrospective case series. Setting Tertiary care medical center. Subjects and Methods We conducted a retrospective analysis of 24-hour multichannel intraluminal impedance (MII)–pH monitoring results from patients with suspected LPR complaining of reflux symptoms. Patients with suspected LPR were divided into 2 groups according to the 24-hour MII-pH monitoring (LPR group: patients with symptoms with reflux events ≥1, symptom but no reflux [SNR] group: patients with symptoms but no reflux event). Healthy controls were recruited and also underwent 24-hour MII-pH monitoring. We compared the esophageal and pharyngeal BI levels and ratios between 3 groups. Results Pharyngeal BI levels in the LPR group were significantly higher than in the healthy controls. In addition, the pharyngeal BI levels in the SNR group were significantly higher than in the healthy controls. All ratios of pharyngeal to distal esophageal BI levels in the LPR and SNR group were significantly higher than in the healthy controls. However, there were no significant differences in esophageal BI levels and ratios between the 3 groups. Conclusion We found that the pharyngeal BI levels were higher in patients with LPR than in healthy controls. In addition, the pharyngeal BI levels measured by 24-hour MII-pH monitoring in patients with LPR symptoms, but without a reflux episode, were higher than in the healthy controls.

Metabolic Correlates of Theophylline Therapy: A Concentration-Related Phenomenon

1994 ◽  
Vol 28 (2) ◽  
pp. 175-179 ◽  
Author(s):  
John M. Flack ◽  
Kenneth W. Ryder ◽  
Daniel Strickland ◽  
Robert Whang
Keyword(s):  
Medical Center ◽  
Control Group ◽  
Related Phenomenon ◽  
Theophylline Concentration ◽  
Serum Theophylline Concentration ◽  
Metabolic Disturbances ◽  
Serum Theophylline ◽  
Increased Risk ◽  
History Of ◽  
Adults And Children

OBJECTIVE: To determine the relationship of serum theophylline concentration with electrolyte and glucose abnormalities across a broad range of theophylline concentrations. DESIGN: Retrospective review of a computerized laboratory database between June 1, 1984 and June 1, 1986. SETTING: A midwestern university medical center. PATIENTS: Eight hundred sixty-nine patients with serum theophylline concentrations of >5.5 μmol/L and a random unmatched sample (control group) of 350 in- and outpatient adults and children with no history of reactive airways disease or theophylline exposure. RESULTS: Patients with measurable theophylline had a higher risk of hypokalemia, hyponatremia, hyperglycemia, hypophosphatemia, and hypomagnesemia compared with the unexposed control group. Unadjusted odds ratios (OR) were: (1) hypokalemia OR=4.2 (95 percent CI 2.2 to 7.9); (2) hyponatremia OR=5.4 (95 percent CI 2.0 to 12.9); (3) hypomagnesemia OR=1.6 (95 percent CI 1.0 to 2.5); (4) hyperglycemia OR=2.3 (95 percent CI 1.7 to 3.0); and (5) hypophosphatemia OR=2.7 (95 percent CI 1.2 to 5.3). A linear concentration—response relationship was documented between serum theophylline concentration and all metabolic disturbances. conclusions: Measurable theophylline was associated with increased risk for glucose and electrolyte abnormalities in a concentration-related fashion across a broad range of theophylline concentrations from 5.5 to ≥110 μmol/L.

scholarly journals Are frequent dental x-ray examinations associated with increased risk of vestibular schwannoma?

2012 ◽  
Vol 117 (Special_Suppl) ◽  
pp. 78-83 ◽  
Author(s):  
Yueh-Ying Han ◽  
Oren Berkowitz ◽  
Evelyn Talbott ◽  
Douglas Kondziolka ◽  
Maryann Donovan ◽  
...  
Keyword(s):  
Vestibular Schwannoma ◽  
Medical Center ◽  
Cell Phones ◽  
Control Group ◽  
X Rays ◽  
University Of Pittsburgh ◽  
X Ray ◽  
Increased Risk ◽  
History Of ◽  
Wireless Phones

Object The authors evaluated the potential role of environmental risk factors, including exposure to diagnostic or therapeutic radiation and to wireless phones that emit nonionizing radiation, in the etiology of vestibular schwannoma (VS). Methods A total of 343 patients with VSs who underwent Gamma Knife surgery performed between 1997 and 2007 were age and sex matched to 343 control patients from the outpatient degenerative spinal disorders service at the University of Pittsburgh Medical Center. The authors obtained information on previous exposure to medical radiation, use of wireless phone technologies, and other environmental factors thought to be associated with the development of a VS. Conditional multivariate logistic regression was used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs). Results After adjusting for race, education, cigarette smoking, alcohol consumption, occupational exposure to noise, use of cell phones, and family history of cancer, the authors identified only a single factor that was associated with a higher risk of VS: individuals exposed to dental x-rays once a year (aOR = 2.27, 95% CI = 1.01–5.09) or once every 2–5 years (aOR = 2.65, 95% CI = 1.20–5.85), compared with those exposed less than once every 5 years. Of interest, a history of exposure to radiation related to head or head-and-neck computed tomography was associated with a reduced risk of VS (aOR = 0.52, 95% CI = 0.30–0.90). No relationship was found between the use of cell phones or cordless phones and VS. Conclusions Patients with acoustic neuromas reported significantly more exposure to dental x-rays than a matched cohort control group. Reducing the frequency of dental x-ray examinations may decrease the potential risk of VS.

The comparison of an empiric proton pump inhibitor trial vs 24-hour double-probe Ph monitoring in laryngopharyngeal reflux

2003 ◽  
Vol 117 (5) ◽  
pp. 386-390 ◽  
Author(s):  
Cem Bilgen ◽  
Fatih Ögüt ◽  
Hatice Kesimli-Dinç ◽  
Tayfun Kirazli ◽  
Serhat Bor
Keyword(s):  
Proton Pump Inhibitor ◽  
Proton Pump ◽  
Laryngopharyngeal Reflux ◽  
Ph Monitoring ◽  
Control Group ◽  
Study Group ◽  
Double Probe ◽  
Alternative Method ◽  
Significant Difference ◽  
Physical Findings

Laryngopharyngeal reflux (LPR), which is defined as the backflow of gastric contents into the upper aerodigestive tract, is a relatively common disorder. However, its diagnosis still poses many problems. Twenty-four-hour double-probe pH monitoring is currently the diagnostic test of choice, but it has many disadvantages. Thus, an empiric trial of antireflux therapy has been suggested as an alternative method for diagnosis. The purpose of this article is to evaluate the validity of this alternative method in the management of LPR. The study group consisted of 36 patients with symptoms and physical findings suggesting LPR. The control subjects were 23 healthy adults. Twenty-four-hour double-probe pH monitoring was performed both in the study group and the control group, and the results were compared. In addition, the symptoms and physical findings in the study group was scored by the modified reflux symptom index (MRSI) and reflux finding score (RFS) at four intervals: before the start of therapy and at the second, fourth and sixth months of the therapy. The results of the 24-hour double-probe pH monitoring showed no significant difference between the study and the control groups (p>0.05). In the study group, the MRSI before the therapy was 13.6±4.4. This index improved significantly to 4.3±1.9 at the second month; to 1.5±0.6 at the fourth month, and to 0.5±0.2 at the sixth month of the therapy (p<0.05). The RFS before the start of the therapy was 14.8±3.8; and it improved significantly to 7.7±3.8 at the second month; to 4.5±2.3 at the fourth month, and to 1.4±0.9 at the sixth month of the therapy (p<0.05). The significant improvement in the MRSI and the RFS during the course of proton pump inhibitor therapy relates the patients’ symptoms and physical findings to LPR. This implies the validity of the method, not only in the treatment of LPR, but in the diagnosis of this disorder, as well. Unfortunately, 24-hour double-probe pH monitoring has failed to differentiate LPR patients from healthy individuals.

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