Laryngopharyngeal Symptoms and Gastroesophageal Reflux Disease

The incidence of gastroesophageal reflux disease (GERD) in patients with laryngopharyngeal symptoms is greater than expect. A prospective study was performed to investigate the incidence of gastroesophageal reflux disease (GERD) and laryngopharyngeal reflux (LPR) in patients with laryngopharyngeal symptoms. Laryngologic evaluation with nasopharyngeal and laryngeal endoscopy and gastroenterologic evaluation with esophagogastroduodenoscopy including measurement of pH value were performed in 46 patients. Therapeutic intervention included general antireflux precautions and antireflux medication, and eradication of Helicobacter pylori in selected cases. Posterior laryngitis was present in 33 patients. GERD was present in 25 patients, hiatus hernia in 4 patients, H pylori-positive gastritis in 11 patients, and Barrett's metaplasia in 2 patients. Increasing evidence shows that GERD may cause laryngopharyngeal symptoms. Otherwise laryngopharyngeal symptoms can be predictors of GERD. Medical antireflux treatment is also effective for laryngopharyngeal symptoms.     

Reflux and vocal disorders in singers with bulimia

Dysphonia associated with bulimia has been described in the literature associated with vocal fold edema and polypoid changes. Laryngopharyngeal reflux (LPR) has been documented to cause reflux vocal fold pathology including edema and polypoid changes. We studied eight singers with bulimia and documented vocal fold pathology, including edema, posterior commissure hypertrophy, ventricular obliteration, and telangiectasia. Reflux was demonstrated in all eight. The results of this study showed that LPR may be a contributing factor to vocal disorders in singers with bulimia.     

Symptoms of Extraesophageal Reflux in a Community-Dwelling Sample

OBJECTIVES: Extraesophageal reflux disease (EERD) is linked with serious and varied health concerns. The authors' goal was to determine the prevalence of EERD and the effect on health-related quality of life in adults within a large community-based sample. STUDY DESIGN: Survey study conducted in a community setting. METHODS: In the Madison, Wisconsin area, 1845 adult subjects were surveyed. Main outcome measures were frequently of GERD and laryngeal symptoms, the Medical Outcomes Trust Short Form 12 (SF-12), Voice Handicap Index (VHI), and Quality of Life in Reflux and Dyspepsia (QOLRAD) questionnaires. RESULTS: More than 66% of subjects reported either GERD or laryngeal symptoms, and 26% reported both GERD and laryngeal symptoms (which reflect symptoms commonly reported for EERD). In addition, 39% of our sample took medicine for heartburn. Forty-four percent of subjects with both GERD and laryngeal symptoms reported occasional breathing difficulties, and 38% of these subjects reported a voice disorder. Significant reductions in perceived quality of general health, digestive health, and voice-related quality of life were found in subjects with both GERD and laryngeal symptoms, in comparison with subjects manifesting each symptom group alone, or in subjects with no symptoms. CONCLUSIONS: The presence of GERD and laryngeal symptoms, and their concurrence, was identified in a substantial number of subjects. The GERD and laryngeal symptoms surveyed represent those most commonly reported for EERD. Because EERD has been linked with tissue damage and reductions in health-related quality of life, it is important to identify these persons and provide treatment before progression of the condition.     

Acoustic Analysis Findings in Objective Laryngopharyngeal Reflux Patients

OBJECTIVE: The aim of this study was to identify the effects of objective laryngopharyngeal reflux (LPR) on the acoustic parameters of patients by comparing their voice samples with that of control subjects. STUDY DESIGN: Prospective study in two tertiary reference hospitals. METHODS: 48 consecutive patients with symptoms related to LPR and 64 control subjects were included in the study. Suspected LPR patients underwent a 24-hour ambulatory pH monitoring, and 25 (52%) of them were shown to have objective LPR. Acoustical evaluation results of objective LPR patients were compared with that of symptomatic LPR patients and control subjects. RESULTS: All frequency perturbation values obtained from objective and symptomatic LPR patients were higher than the control subjects (P<0.01). Mean fundamental frequency, amplitude perturbation measures, and noise-to-harmonics ratio were not significantly different between groups. CONCLUSION: LPR patients have significantly different frequency perturbation values than control subjects.     

Reliability of Speech-Language Pathologist and Otolaryngologist Ratings of Laryngeal Signs of Reflux in an Asymptomatic Population Using the Reflux Finding Score

OBJECTIVE: To determine inter- and intrajudge agreement in rating signs of laryngopharyngeal reflux (LPR) under "ideal" conditions: Experienced coworkers in a practice devoted to voice-disordered patients, raters trained in the items on a standardized scale, raters from both speech-language pathology (SLP) and otolaryngology, and raters of asymptomatic participants. STUDY DESIGN: Prospective study using a scale to rate videolaryngoscopic examinations. METHODS: Two SLPs and two otolaryngologists used the Reflux Finding Scale (RFS) to independently rate videotapes of endoscopic examinations for 30 participants asymptomatic of reflux. RESULTS: Thirteen (43%) were assigned a total score >7, indicative of LPR, by at least one rater. Intraclass correlation coefficients showed a significant lack of agreement in total scores provided by the otolaryngologists and by all raters combined. One otolaryngologist and the two SLPs demonstrated good interrater agreement in total scores. McNamar's statistic and Poisson regression modeling showed differences in rater agreement for many individual items. Repeated ratings of four participants showed no significant differences, indicating good intrarater reliability. CONCLUSIONS: Level of rater agreement regarding the presence and the severity of physical findings attributed to LPR within and between otolaryngologists and SLPs differed. Given the role each profession plays in the diagnosis and treatment of LPR and related voice disturbances, higher levels of interprofessional agreement are desired. Results support the need for greater consensus among professionals regarding the discreet features of physical findings associated with LPR, a fuller understanding of normal variants, and greater emphasis on interrater reliability when rating physical findings.     

The Validity and Reliability of the Reflux Finding Score

Laryngopharyngeal reflux (LPR) disease is common. The incidence of newly diagnosed cases has increased substantially due to awareness and development of new diagnostic measurements. The reflux finding score (RFS) and reflux symptom index (RSI) are believed to be useful in the assessment process, including after the initiation of therapy. However, many authors have suggested concerns about the reliability and validity of the RFS.ObjectiveTo evaluate the validity and reliability of the RFS.MethodsNinety-two patients diagnosed with LPR who had undergone 24-hour pH-Impedance tests were included. All patients underwent stroboscopy and 24-Hour pH-Impedance monitoring within thirty days. Fifty-nine patients filled out a RSI prior to stroboscopic exam. The RFS was determined by four blinded observers: one otolaryngology resident, two laryngology fellows, and one laryngologist. Stroboscopic images were reviewed again one year later to assess intrarater reliability. RFS and RSI were correlated with 24-hour pH Impedance testing.ResultsThe Kappa value between reviewers was 0.479. The percent agreement of the four observers for total RFS was 74.04%.The percent agreement between reviewers for subglottic edema was 78.77%; for ventricular obliteration was 65.55%; for erythema/hyperemia was 69.62%, for vocal fold edema was 68.32%; for diffuse laryngeal edema was 66.86%, for posterior commissure hypertrophy was 73.54%; for granuloma/granulation was 96.80%; for thick endolaryngeal mucus was 72.81%. The intrarater reliability of the four observers for total RFS was 67.5% with an intrarater reliability range of 50%–90%. The intrarater reliability for subglottic edema was 85% with a range of 70%–100%; for ventricular obliteration was 77.50% with a range of 70%–90%; for erythema/hyperemia was 65.00% with a range of 50%–90%; for vocal fold edema was 52.50% with a range of 30%–70%; for diffuse laryngeal edema was 62.50% with a range of 20%–80%; for posterior commissure hypertrophy was 52.50% with a range of 10%–80%; for granuloma/granulation was 100%; for thick endolaryngeal mucus was 55.00% with a range of 10%–90%. There was no correlation between RFS and any parameter of the 24-Hr pH-Impedance Test. RSI had a significant correlation with number of upright events (r value of 0.271, R² of 0.0733 and P-value of 0.037), total symptoms experienced (r value of 0.0.267, R² of 0.0715 and P-value of 0.041), and symptom correlation score (r value of -0.297, R² of 0.0884 and P-value of 0.022).ConclusionMany authors have expressed concerns about the reliability and validity of the RFS. In our study we found a fair/substantial interrater reliability, and a modest intra-rater reliability. We found no correlation between the RFS and 24-Hr pH Impedance testing. This study suggests that the concerns about the validity and reliability of the RFS may be warranted. This widely used clinical score should be interpreted with caution and further research and refinement should be considered.     

一种检测十二指肠胃返流光纤传感器的研制

设计了可检测十二指肠胃返流的光纤传感器,该传感器由470 nm的信号光、595 nm参考光和光纤束构成,主要检测十二指肠返流物中的胆红素在470 nm与595 nm的吸光度,本文还对影响传感器检测的因素,诸如波长、pH、胃液中悬浮颗粒造成的散射作用以及其他的因素,做了详细评价.传感器可以达到10 mg/dl优良的动态响应范围,离体实验结果表明,该传感器可以作为临床动态检测手段.