Association Between Inferior Turbinate Hypertrophy and Extraesophageal Reflux

Abstract

To the authors' knowledge, no prior studies have examined the association between inferior turbinate hypertrophy (ITH) and extraesophageal reflux (EER). If EER were a cause or cofactor of ITH, antireflux treatment can be considered prior to surgical intervention. OBJECTIVE To evaluate EER presence and severity in patients with different degrees of ITH. DESIGN, SETTING, AND PARTICIPANTSProspective multicentric cohort study conducted at 3 referral centers treating patients with EER and certified for 24-hour monitoring of oropharyngeal pH. The monitoring was performed between October 2020 and October 2021. A total of 94 adult patients with EER symptoms were recruited, 90 of whom were analyzed.INTERVENTIONS Nasal endoscopy was performed to determine the degree of ITH, according to the Camacho classification. Presence and severity of EER were examined using 24-hour monitoring of oropharyngeal pH.MAIN OUTCOMES AND MEASURES Primary outcomes were presence of EER according to RYAN Score, total percentage of time below pH 5.5, and total numbers of EER events below pH 5.5. RESULTSOf the 90 analyzed patients (median [IQR] age, 46 [33-58] years; 36 [40%] male patients), 41 had a maximum of second-degree ITH (group 1), and 49 patients had at least third-degree ITH (group 2), according to the Camacho classification. On the basis of the RYAN Score, EER was diagnosed more often in group 2 (69.4%) than in group 1 (34.1%; difference, 35.3% [95% CI, 13.5%-56.9%]). Moreover, compared with group 1, group 2 exhibited higher median total percentage of time below pH 5.5 (median [IQR], group 1: 2.1% [0.0%-9.4%], group 2: 11.2% [1.5%-15.8%]; difference, 9.1% [95% CI, 4.1%-11.8%]) and higher median total number of EER events (median [IQR], group 1: 6 [1-14] events, group 2: 14 [4-26] events; difference, 8 [95% CI, 2-15] events). Patients with proven EER demonstrated no difference in the degree of ITH between the right and left nasal cavity (Cohen g, −0.17 [95% CI, −0.50 to 0.30]), or between the anterior and posterior parts of the nasal cavity (Cohen g, −0.21 [95% CI, −0.50 to 0.17]). CONCLUSIONS AND RELEVANCEIn this cohort study, patients with a higher degree of ITH had more severe EER. A possible association between severe ITH and EER was demonstrated.

Endoscopic Picture in Chronic Rhinosinusitis Associated with Gerd

“…In 2020, Lechien et al supplemented the endoscopic picture of the larynx under the influence of laryngopharyngeal reflux by describing changes on the pharyngeal side [5]. In 2022, Zeleník et al identified a relationship between hypertrophy of the Inferior Turbinate and extraesophageal reflux [6]. The aim of our study is to determine the characteristics of the endoscopic picture of the nose and nasopharynx in chronic rhinosinusitis associated with symptoms of gastroesophageal acid reflux disease.…”

Mulberry Posterior Inferior Nasal Turbinate Is Associated with a Lower Pharyngeal pH Environment

“…24 Only a few studies have addressed the relationship between EER and mucosal hypertrophy of the inferior nasal turbinate. 25,26 However, no prior research has objectively examined the possible effect of acidic pH environment on mulberry posterior inferior nasal turbinate formation. Therefore, this prospective study is aimed to investigate whether mulberry formation of the posterior inferior nasal turbinate is associated with acidic pH events monitored by 24-h oropharyngeal pH monitoring.…”

“…Only a few studies have addressed the relationship between EER and mucosal hypertrophy of the inferior nasal turbinate 25,26 . However, no prior research has objectively examined the possible effect of acidic pH environment on mulberry posterior inferior nasal turbinate formation.…”

A Parallel Line of Inquiry Related to Inferior Turbinate Hypertrophy and Extraesophageal Reflux

“…To the Editor Zeleník and colleagues have reported a possible association between inferior turbinate hypertrophy and extraesophageal reflux (EER). They also highlight previously reported associations of EER with chronic rhinosinusitis and chronic otitis media.…”

“…The authors comment on the challenges of measuring pepsin and/or pH in the nasal cavity. Improvements in technique will benefit each line of inquiry and investigators should consider following the parallel progress.…”