Laryngopharyngeal Reflux Has Negative Effects on Taste and Smell Functions

Objective We evaluated the halimetric, olfactory, and taste functions of patients with laryngopharyngeal reflux (LPR). Study Design Prospective clinical study. Setting Multicenter tertiary care hospital. Methods Patients who were diagnosed with LPR for the first time on the basis of a Reflux Finding Score (RFS) >11 and a Reflux Symptom Index (RSI) >13 were enrolled in this study. A control group was selected from patients without a complaint of LPR. OralChroma was used for the halimetric measurement; Sniffin’ Sticks were used for the smelling test; Taste Strips were used for the taste test; and monosodium L-glutamate was used for the umami test. Results A total of 110 subjects were included, with a mean age of 36.8 ± 10 years (range, 19-57 years). The differences in odor threshold scores were significant between the groups ( P < .001), but no change was detected for the odor identification or discrimination scores between the groups. Bitter taste scores were significantly diminished in the reflux group compared with those in the control group ( P = .001), whereas no impairments were found in the other taste scores (sweet, salty, and sour). The reflux group had significantly higher umami taste scores than those of the control group for the posterior tongue and soft palate anatomic sites ( P < .001 and P < .001, respectively). Dimethyl sulfite levels were significantly higher in the reflux group than in the control ( P = .001). Conclusion Questioning patients who present with halitosis, taste, or smelling disorders is important to diagnose LPR.

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The role of magnesium supplement in laryngopharyngeal reflux disease

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20214899 ◽

2021 ◽

Vol 8 (1) ◽

pp. 47

Author(s):

Adhira Gobind

Keyword(s):

Reflux Disease ◽

Laryngopharyngeal Reflux ◽

Tertiary Care ◽

Treatment Protocol ◽

Care Hospital ◽

Reflux Symptom Index ◽

Symptom Index ◽

Regular Treatment ◽

Laryngopharyngeal Reflux Disease

Background: Laryngopharyngeal reflux disease (LPRD) is one of the most prevalent upper gastrointestinal disorder encountered in clinical practice and its optimal treatment is not standardized. The role of magnesium in the human body functions is often underestimated. Since magnesium (Mg) plays a major role in the regulation of smooth muscle contractionby relaxing the pyloric sphincter and enhancing gastric emptying, thereby decreasing the pressure on the LES, it was hypothesized that adding magnesium supplements along with the regular treatment for LPRD, can improve LPRD symptoms. Magnesium has a neutralizing action on the gastric acid and therefore, it may be pertinent to achieve optimal Mg intakes in patients with LPRD.Methods: This is a prospective study done over a period of 1 year conducted in a tertiary care hospital in central India in patients presenting with LPRD of the age group 18-65 years. Results: The study patients were divided into two groups-one treated with esmoprazole 40 mg capsules and alginate syrup and the other with esmoprazole capsules, alginate syrup and magnesium glycinate (250 mg) supplement. Both the groups showed appreciable improvement in their mean reflux symptom index (RSI) and reflux finding score (RFS) at 1 month and 3 months follow-up. Females showed a higher preponderance than males in the disease, symptoms and the mean RSI and RFS score.Conclusions: Addition of magnesium supplements along with the regular treatment for LPRD, can improve LPRD symptoms and should be considered in the treatment protocol of LPRD.

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Laryngopharyngeal Reflux: Symptoms, Signs, and Presence of Pepsin in Saliva - A Reliable Diagnostic Triad

International Archives of Otorhinolaryngology ◽

10.1055/s-0040-1709987 ◽

2020 ◽

Author(s):

Shilpa Divakaran ◽

Sivaa Rajendran ◽

Roshan Marie Thomas ◽

Jaise Jacob ◽

Mary Kurien

Keyword(s):

Positive Response ◽

Laryngopharyngeal Reflux ◽

Ph Monitoring ◽

Tertiary Care ◽

Acid Reflux ◽

Response To Treatment ◽

Care Hospital ◽

Reflux Symptom Index ◽

Symptom Index ◽

Chi Squared

Abstract Introduction Twenty-four-hour multichannel intraluminal impedance with double probe pH monitoring (MII-pH), though considered the most sensitive tool for the diagnosis of gastroesophageal reflux disease (GERD), is invasive, time consuming, not widely available, and unable to detect non-acid reflux. In contrast, the presence of pepsin in the saliva would act as a marker for reflux, considering that pepsin is only produced in the stomach. Objective To evaluate the predictive value of salivary pepsin in diagnosing laryngopharyngeal reflux (LPR) as suggested by the results of reflux symptom index (RSI > 13), reflux finding score (RFS > 7), and positive response to treatment with a 4-week course of proton-pump inhibitors. Methods This prospective study was done at a tertiary care hospital on 120 adult patients attending ENT OPD with clinical diagnosis of LPR. The presence of pepsin in their pharyngeal secretions and saliva using a lateral flow device, the Peptest, was compared with RSI, RFS, and with the response to medical treatment using the Chi-squared test. Results Salivary pepsin was found to be positive in 68% of the patients, with 87.5% of them showing positive response to treatment. Chi-squared analysis showed a significant association between positive salivary pepsin and RFS > 7, RSI >13, a combination of RFS > 7 and RSI > 13 as well as with response to treatment (p < 0.0001). Conclusion When considered along with the clinical indicators of RFS and RSI of more than 7 and 13, respectively, and/or with a response to treatment, a positive salivary pepsin test indicates statistically significant chance of presence of LPR.

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Cross sectional study of prevalence of LPRD at tertiary care hospital

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20190778 ◽

2019 ◽

Vol 5 (2) ◽

pp. 445

Author(s):

Raghvendra Singh Gaur ◽

Paromita Patra

Keyword(s):

Laryngopharyngeal Reflux ◽

Tertiary Care ◽

Treatment Protocol ◽

Stomach Contents ◽

Cross Sectional Study ◽

Care Hospital ◽

Sectional Study ◽

Reflux Symptom Index ◽

Symptom Index ◽

Cross Sectional

Background: Reflux means return or regurgitation of fluid. When symptoms arise due to reflux of stomach contents into the pharynx and larynx it is termed as laryngopharyngeal reflux disease (LPRD). GERD and LPRD are two different entities and the management principle of GERD doesn’t apply to LPRD. We designed a cross sectional study to evaluate the prevalence of laryngopharyngeal reflux among the patients visiting the ENT outpatient department over a duration of one year.Methods: Patients presenting with throat and voice symptoms for more than a month were included in the study. The reflux symptom index (RSI) put forward by Belafsky et al was used to assess the symptoms of reflux. A diagnosis of reflux was made if the patient had an RSI score >13. Results: A total of 2669 patients included in study period, out of which 1316 (49.3%) were males and 1353 (50.7%) were females. Out of the 2669, 1938 (72.6%) patients were found to have a RSI of >13. Out of the 1938 patients subjected to 70 laryngoscopy 1842 patients (95%) were found to have a RFS >7. Of the 1842 patients with RFS >7, 1234 were males (67%) and 608 were females (33%).Conclusions: In a developing country like India, where resources and man power are limited, symptoms of laryngopharyngeal reflux might often be overlooked. The diagnosis and treatment protocol for LPRD needs to be standardized through more long term studies in the manner it has been done for GERD.

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Shar Pei Larynx: Supraglottic and Postcricoid Mucosal Redundancy and Its Association With Medical Comorbidities

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489418810893 ◽

2018 ◽

Vol 128 (2) ◽

pp. 121-127 ◽

Cited By ~ 2

Author(s):

Yin Yiu ◽

Kathleen M. Tibbetts ◽

C. Blake Simpson ◽

Laura A. Matrka

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Laryngopharyngeal Reflux ◽

Tertiary Care ◽

Retrospective Chart Review ◽

Future Research ◽

Morbidly Obese ◽

Reflux Symptom Index ◽

Symptom Index ◽

Obstructive Sleep

Objectives: The aim of this study is to describe a clinical entity the authors term “Shar Pei larynx,” characterized by redundant supraglottic and postcricoid mucosa that the authors hypothesize coexists in patients with obstructive sleep apnea, laryngopharyngeal reflux, and obesity. By exploring this hypothesis, the authors hope to set the foundation for future research with the goal of identifying whether Shar Pei larynx is a marker for untreated sleep apnea or other diseases. Study Design: Retrospective chart review. Setting: Two tertiary care academic institutions. Methods: Data were collected from a 5-year period by querying for patients described to have “Shar Pei larynx” or “posterior supraglottic and/or postcricoid mucosal redundancy” on laryngoscopic findings. Relevant demographic and clinical characteristics were analyzed, with a focus on associations with obesity, sleep apnea, and laryngopharyngeal reflux. Results: Thirty-two patients were identified with physical findings consistent with Shar Pei larynx. Twenty-six patients (81.3%) were obese; 16 (50%) were morbidly obese. Twenty-two patients (68.8%) either had an existing diagnosis of obstructive sleep apnea or were diagnosed on polysomnography performed after initial evaluation. Sixteen patients (50%) had type 2 diabetes mellitus, and 87.5% of these patients were obese. Twenty-eight patients (87.5%) noted histories of reflux, with a median reflux symptom index of 27 of 45. Five patients underwent procedures to reduce mucosal redundancy related to Shar Pei larynx. Conclusions: This pilot study confirms that the majority of patients diagnosed with Shar Pei larynx also had diagnoses of obesity, obstructive sleep apnea, and reflux disease. The demonstrated association is strong enough to warrant further study.

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The Value of Routine pH Monitoring in the Diagnosis and Treatment of Laryngopharyngeal Reflux

Otolaryngology ◽

10.1177/0194599812436952 ◽

2012 ◽

Vol 146 (6) ◽

pp. 952-958 ◽

Cited By ~ 24

Author(s):

Michael Friedman ◽

Craig Hamilton ◽

Christian G. Samuelson ◽

Kanwar Kelley ◽

Renwick Taylor ◽

...

Keyword(s):

Predictive Value ◽

Laryngopharyngeal Reflux ◽

Ph Monitoring ◽

Linear Regression Analysis ◽

Tertiary Care ◽

Case Series ◽

Reflux Symptom ◽

Reflux Symptom Index ◽

Symptom Index ◽

Significant Difference

Objective. To assess the need for pH testing in diagnosing laryngopharyngeal reflux (LPR). Study Design. Case series with planned data collection. Setting. Tertiary care center. Subjects and Methods. On the basis of symptoms and/or abnormal endoscopic findings, more than 500 patients underwent 24-hour pharyngeal pH testing at a single center (using the Dx-pH probe) between January 2009 and June 2011. A total of 163 patients not on proton-pump inhibitors at the time of study and with complete data available for analysis (pH results, body mass index, smoking status, pretest reflux symptom index) were divided into 2 groups by positive (n = 70) and negative (n = 93) Ryan Score. The Reflux Symptom Index (RSI) was compared between groups and assessed overall against Ryan Score parameters at different pH thresholds. The diagnostic utility of an RSI ≥ 13 for prediction of Ryan Score was assessed. Results. No significant difference in RSI was seen between Ryan-positive (17.50 ± 11.47) and Ryan-negative (14.95 ± 11.43) patients ( P = .161). Overall, RSI correlated poorly with percentage time spent below pH thresholds 6.5, 6.0, 5.5, and 5.0 and upright and supine Ryan parameters at these thresholds (as determined by linear regression analysis). The sensitivity, specificity, positive predictive value, and negative predictive value of RSI ≥ 13 for Ryan positivity were 55.7%, 47.3%, 44.3%, and 58.7%, respectively. Conclusion. Our findings show that in our population of otolaryngology patients, the diagnosis of LPR cannot be reliably made on the basis of symptoms alone. Diagnosis, and in particular treatment decisions, should ideally be made on the basis of a combination of symptoms, signs, and confirmatory testing.

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Relationship between extralaryngeal endoscopic findings, proton pump inhibitor (PPI) response, and pH measures in suspected laryngopharyngeal reflux

Diseases of the Esophagus ◽

10.1093/dote/doy072 ◽

2018 ◽

Vol 32 (4) ◽

Cited By ~ 6

Author(s):

N Agrawal ◽

R Yadlapati ◽

N Shabeeb ◽

C PE Price ◽

A Lidder ◽

...

Keyword(s):

Proton Pump Inhibitor ◽

Proton Pump ◽

Laryngopharyngeal Reflux ◽

Care Center ◽

Tertiary Care ◽

Variable Response ◽

Reflux Symptom Index ◽

Symptom Index ◽

Endoscopic Findings

Summary Laryngopharyngeal reflux (LPR) is a clinical entity diagnosed by history laryngoscopic findings that has a variable response to empiric proton-pump inhibitor (PPI) therapy. While the reflux finding score (RFS), an endoscopic scoring scheme, has been advanced as a measure of LPR, it has not been externally validated against symptom severity in practice. Extralaryngeal pharyngeal endoscopic findings may have diagnostic utility but remain underexplored. This study assesses the correlation between extralaryngeal findings and (1) 24-hour oropharyngeal pH & (2) PPI response in patients with suspected LPR. Subjects presented to a tertiary care center with laryngeal symptoms ≥1 month and reflux symptom index (RSI) ≥13. Following baseline questionnaires, laryngoscopy, and a 24-hour oropharyngeal pH probe study, subjects were prescribed 8–12 week omeprazole trials. Baseline endoscopic findings were scored in a blinded fashion using the RFS and extralaryngeal score criteria, summatively the ‘ELS.’ PPI response was defined as ≥50% improvement in RSI. Thirty-three subjects with flexible endoscopic recordings completed baseline and follow-up questionnaires. The cohort's baseline mean RSI was 23.0 ± 7.2 with a ΔRSI = 9.8 after PPI therapy. The baseline RFS score averaged 5.3 ± 2.7. 45% of our subjects was found to be PPI responsive. The Cohen's kappa for the ELS but not the RFS was significant. There were no significant differences between the RFS (P = 0.10) or ELS (P = 0.07) for PPI responders & nonresponders. Oropharyngeal pH measures did not correlate with the RFS or ELS. In conclusion, endoscopic scores of laryngeal and extralaryngeal findings did not predict PPI response or oropharyngeal acid exposure in suspected LPR.

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A Prospective Randomized Clinical Trial of Combination Therapy with Proton Pump Inhibitors and Mucolytics in Patients with Laryngopharyngeal Reflux

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489420913592 ◽

2020 ◽

Vol 129 (8) ◽

pp. 781-787

Author(s):

Minsuk Chae ◽

Dong Hyuk Jang ◽

Ho Chan Kim ◽

Minsu Kwon

Keyword(s):

Combination Therapy ◽

Proton Pump Inhibitors ◽

Proton Pump ◽

Laryngopharyngeal Reflux ◽

Symptomatic Relief ◽

Control Group ◽

Reflux Symptom Index ◽

Symptom Index ◽

Significant Difference

Objectives: To identify whether combination therapy with mucolytics and proton pump inhibitors (PPIs) leads to faster and more effective symptomatic relief in patients with laryngopharyngeal reflux (LPR). Methods: Patients diagnosed as LPR with a reflux symptom index (RSI) ≥ 13 and a reflux finding score (RFS) ≥ 7 were enrolled in this prospective study. Patients were randomly allocated to control (PPI only) or experimental (PPI + mucolytics) groups and changes in RSI and RFS values were assessed at 1- and 3-month follow-up. Results: One hundred sixteen patients were randomly allocated into either the control group ( n = 59) or the experimental group ( n = 57). The RSI and RFS scores significantly decreased in both groups (all P < .001) after 1 month of treatment; however, there was no significant difference in RSI change between groups ( P = .223). After 3 months of treatment, there remained no significant difference in RSI change between groups ( P = .592). Conclusions: Combination therapy with mucolytics and PPI compared to PPI alone did not lead to faster or more effective symptomatic relief in LPR patients.

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Pengaruh suplementasi zinc terhadap perbaikan klinis penderita laryngopharyngeal reflux disease

Oto Rhino Laryngologica Indonesiana ◽

10.32637/orli.v44i2.94 ◽

2015 ◽

Vol 44 (2) ◽

pp. 131

Author(s):

Chrisma Pramana ◽

Muyassaroh Muyassaroh ◽

Dwi Antono

Keyword(s):

Clinical Improvement ◽

Reflux Disease ◽

Laryngopharyngeal Reflux ◽

Reflux Symptom ◽

Control Group ◽

Reflux Finding Score ◽

Reflux Symptom Index ◽

Symptom Index ◽

Post Test ◽

Laryngopharyngeal Reflux Disease

Latar Belakang: Laryngopharyngeal Reflux Disease (LPRD) menyebabkan kerusakan mukosa laring dan faring. Zinc adalah kelompok zat gizi mikro yang berperan dalam inhibisi terhadap sekresi asam lambung, pembentukan carbonic anhidrase, dan reepitelisasi. Tujuan: Mengetahui pengaruh suplementasi zinc pada perbaikan klinis penderita LPRD. Metode: Penelitian eksperimental dengan pre-post test randomized control trial pada penderita LPRD di klinik THT-KL RSUP Dr. Kariadi yang memenuhi kriteria penelitian. Kelompok kontrol diberikan omeprazol dan plasebo, sedangkankelompok perlakuan diberikan omeprazol dan zinc. Pemberian terapi dilakukan selama 4 minggu kemudian dianalisis skoring Reflux Symptom Index (RSI) dan Reflux Finding Score (RFS) sebelum terapi dan sesudah terapi pada kedua kelompok. Analisis data dengan uji Wilcoxon dan independent t test. Hasil: Sampel sebanyak 27 penderita, kelompok kontrol 13 orang, dan kelompok perlakuan 14 orang. Skor RSI sebelum terapi pada kelompok kontrol 22,92±6,982, sedangkan pada kelompok perlakuan19,57±6,136 (p=0,223). Skor RFS sebelum terapi pada kelompok kontrol 10,46±2,367, sedangkan pada kelompok perlakuan 10,86±2,983 (p=0,767). Skor RSI sesudah terapi pada kelompok kontrol 15,92±8,893, sedangkan pada kelompok perlakuan 9,07±6,294 (p=0,034). Skor RFS sesudah terapi pada kelompok kontrol 6,54±1,808, sedangkan pada kelompok perlakuan 4,54±2,240 (p=0,024). Kesimpulan: Suplementasi zinc berpengaruh pada perbaikan klinis penderita LPRD. Perbaikan klinis penderita LPRD yang diberikan suplementasi zinc lebih baik dibanding tanpa suplementasi zinc. Kata kunci: Reflux Symptom Index, Reflux Finding Score, zinc ABSTRACTBackground: Laryngopharyngeal Reflux Disease (LPRD) could cause mucosal damage on larynx and pharynx. Zinc is microsubstance which has a role as inhibiting factor to gastric acid, carbonic anhidrase establishment, and reepitelization. Objective: The study aimed to know the effect of zinc onLPRD patient’s clinical improvement. Methods: Experimental study with pre-post test randomized control trial on LPRD patients in ENT center RSUP Dr. Kariadi. Control group was prescribed omeprazole and placebo,while interventioned group was prescribed omeprazole and zinc. The treatment was conducted for 4 weeks, and Reflux Symptom Index (RSI) and Reflux Finding Score (RFS) were analyzed before and after treatment for both groups. Data were analyzed with Wilcoxon’s test and independent t-test. Result: The sample was 27 patients, consisted of 13 patients in control group and 14 patients in interventioned group. RSI score before theraphy on control group was 22,92±6,982, on interventioned group 19,57±6,136(p=0,223). RFS score on control group 10,46±2,367, on interventioned group 10,86±2,983 (p=0,767). RSI after theraphy on control group 15,92±8,89,3 while on interventioned group 9,07±6,294 (p=0,034). RFS score after theraphy on control group 6,54±1,808, while on interventioned group 4,54±2,240 (p=0,024). Conclusion: This study found that zinc supplementation had an effect on clinical improvement on patients with LPRD. Clinical improvement on LPRD patients who got zinc supplementation was found better than without zinc supplementation.Keywords: Reflux Symptom Index, Reflux Finding Score, Zinc

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The Impact of Laryngopharyngeal Reflux on Patient-reported Measures of Chronic Rhinosinusitis

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489420921424 ◽

2020 ◽

Vol 129 (9) ◽

pp. 886-893 ◽

Cited By ~ 2

Author(s):

Hannah J. Brown ◽

Hannah N. Kuhar ◽

Max A. Plitt ◽

Inna Husain ◽

Pete S. Batra ◽

...

Keyword(s):

Chronic Rhinosinusitis ◽

Laryngopharyngeal Reflux ◽

Care Center ◽

Tertiary Care ◽

Retrospective Chart Review ◽

Reflux Symptom Index ◽

Symptom Index ◽

Patient Reported ◽

The Impact ◽

Snot 22

Objective: This study explored the impact of laryngopharyngeal reflux (LPR) on quality-of-life outcomes captured by Sino-Nasal Outcome Test (SNOT-22) and Reflux Symptom Index (RSI) in patients with chronic rhinosinusitis (CRS) and patients with symptoms of LPR. Methods: In a retrospective chart review, SNOT-22 and RSI scores were analyzed in patients seen at a tertiary care center with CRS, LPR, or both CRS and LPR. SNOT-22 items were grouped into sleep, nasal, otologic, and emotional symptom subdomains. Results: A total of 138 patients (36 with CRS alone, 60 with LPR alone, and 42 with both CRS and LPR) were included. Compared to patients with CRS alone, those with CRS and LPR (CRS+LPR) had higher SNOT-22 total (50.54 ± 19.53 vs 35.31 ± 20.20, P < .001), sleep (19.61 ± 9.31 vs 14.42 ± 10.34, P < .022), nasal (17.38 ± 7.49 vs 11.11 ± 8.52, P < .001), otologic subdomains (9.17 ± 5.07 vs 5.53 ± 5.14, P < .002), and RSI (22.06 ± 9.42 vs 10.75 ± 8.43, P < .003). Patients with LPR alone had higher RSI compared to those with CRS (18.48 ± 9.77 vs 10.75 ± 8.43, P < .037). RSI and SNOT-22 scores were positively correlated irrespective of patient group (R = 0.289, P = .003). Conclusion: Compared to patients with CRS or LPR alone, those with CRS+LPR demonstrated higher RSI and total and subdomain SNOT-22 scores. Patients with LPR alone had elevated SNOT-22 despite absent endoscopic evidence of sinusitis.

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Evidence of Pepsin-Related Ocular Surface Damage and Dry Eye (PROD Syndrome) in Patients with Laryngopharyngeal Reflux

Life ◽

10.3390/life10090202 ◽

2020 ◽

Vol 10 (9) ◽

pp. 202

Author(s):

Rocco Plateroti ◽

Marta Sacchetti ◽

Giuseppe Magliulo ◽

Andrea Maria Plateroti ◽

Annalisa Pace ◽

...

Keyword(s):

Dry Eye ◽

Ocular Surface ◽

Laryngopharyngeal Reflux ◽

Surface Damage ◽

Control Group ◽

Reflux Symptom Index ◽

Symptom Index ◽

Body Sensation ◽

Ocular Discomfort ◽

Surface Changes

Background: patients with laryngopharyngeal reflux (LPR) showed detectable levels of tear pepsin that explain the nasolacrimal obstruction. The purpose of this study was to determine whether patients with LPR show ocular surface changes and to investigate the relationship between lacrimal pepsin concentration and ocular alterations. Methods: Fifty patients with positive endoscopic signs for LPR and an equal or higher score of 13 and 7 for Reflux Symptom Index and Reflux Finding Score were enrolled. Twenty healthy patients with no reflux disease and dry eye were included as the control group. After evaluation of ocular discomfort symptoms, the tear break-up time test, corneal staining, and tear sampling were performed. Tear pepsin levels were measured using Pep-testTM kit. Results: Patients with LPR showed ocular surface changes including epithelial damage (48%) and impairment of lacrimal function (72%). Tear pepsin levels were detectable in 32 out of 50 (64%) patients with LPR (mean ± SD: 55.4 ± 67.5 ng/mL) and in none of the control subjects. Most of the LPR patients complained of ocular discomfort symptoms, including itching (38%), redness (56%), or foreign body sensation (40%). Tear pepsin levels were significantly correlated with the severity of LPR disease and with ocular surface changes. Conclusions: A multidisciplinary approach, including ophthalmological evaluation, should be considered in order to improve the management of patients with LPR.

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