Association of Sinonasal Factors With Chronic Laryngitis in Korean Adults

Abstract

IMPORTANCE Allergic laryngitis is underdiagnosed owing to overlapping clinical manifestations that arise from other causes of laryngitis. Sinonasal conditions associated with chronic laryngitis, including allergic laryngitis, have not been reported using population-based epidemiologic data. OBJECTIVE To estimate the association of the prevalence of chronic laryngitis with various sinonasal symptoms and endoscopic findings, and to identify which of the sinonasal factors are particularly associated with allergic cause of chronic laryngitis. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional, population-based study of 11 283 participants 18 years and older who had undergone laryngoscopic and nasal endoscopic examination used data from 2010 through 2012 in the fifth edition of the Korea National Health and Nutrition Examination Survey, a nationwide survey of South Korea. Participants were extracted by stratified, multistage, clustered sampling to comprise a nationally representative sample. Data were analyzed in September 2017. EXPOSURES Sociodemographic characteristics, smoking status, alcohol use, questionnaires for voice change and sinonasal symptoms, and nasal endoscopic examinations before and after shrinkage of the nasal mucosa. MAIN OUTCOMES AND MEASURES Chronic laryngitis diagnosed by laryngoscopic examination, and allergic cause of laryngitis determined by specific serum immunoglobulin E tests. RESULTS Of the 11 283 participants included in the study, the mean (SD) age was 50.1 (16.6) years, and 6365 (56.4%) were women. In total, 343 participants (3.0%) were diagnosed with chronic laryngitis through results of laryngoscopic examination. Chronic laryngitis was associated with a higher rate of rhinitis symptoms (odds ratio [OR], 1.54; 95% CI, 1.21-1.96), anterior/posterior nasal drip (OR, 2.03; 95% CI, 1.38-2.98), nasal congestion (OR, 1.49; 95% CI, 0.99-2.25), endoscopic findings of pale mucosa (OR, 1.74; 95% CI, 1.33-2.28), mucous or puslike discharge (OR, 1.53; 95% CI, 1.08-2.18), and puslike discharge in the middle meatus (OR, 1.85; 95% CI, 1.19-2.88), especially in female participants and participants older than 50 years. Subgroup analysis revealed that all participants with allergic laryngitis showed sensitization to Dermatophagoides farinae, and the allergic laryngitis group (n = 9) had a higher presence of rhinitis symptoms (n = 5; 56%) than did the nonallergic laryngitis group (n = 1 of 12; 8%) among participants younger than 50 years (risk difference, 47%; 95% CI, 4%-78%). CONCLUSIONS AND RELEVANCE The association of various sinonasal factors with chronic laryngitis were prominent in female participants, as well as those 50 years and older. Nevertheless, the presence of rhinitis symptoms in patients with chronic laryngitis was associated with allergic cause of laryngitis solely in participants younger than 50 years. In young adults, presence of rhinitis symptoms might aid in considering allergic laryngitis.

Features of inhalant allergy on nasal endoscopy: a systematic review and meta-analysis

“…Abstract screening was performed on 410 records. Full-text analysis was performed on 133 articles (2 full-text's were unable to be located) resulting in 15 (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24) studies being included (Figure 1).…”

“…A median of 187 participants were recruited per study (minimum 40, maximum 1322). Of the 15 included studies, 11 included a strictly pediatric population (<18 years) (10)(11)(12)(13)(14)16,17,19,(22)(23)(24) , 2 included a strictly adult population (≥18 years) (15,20) , 1 included a mixed pediatric and adult population (18) , and 1 did not mention if inclusion was restricted by age (21) .…”

“…All articles were original with cross-sectional study designs (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)24) , with the exception of two studies, 1 was a conference abstract with a cross-sectional design (23) , and the other an original article with a self-controlled case series design (10) .…”

“…Of the 15 included studies, 10 used SPT as their only reference standard (11)(12)(13)(14)(15)(16)(17)(22)(23)(24) , 1 used specific IgE serology as their only reference standard (20) , 3 used either SPT or specific IgE serology (18,19,21) , and 1 used SPT 'in season' as their reference standard (and had their same population 'out of season' as the control group as the study had a self-controlled case series design) (10) .…”

“…For the nasal endoscopy procedure, 8 studies stated that local anesthetic or decongestant was applied prior to endoscopy (11)(12)(13)16,(18)(19)(20)(21) , 1 stated that no local anesthetic or decongestant was used (22) , and 6 did not specify if local anesthetic or decongestant was used (10,14,15,17,23,24) . It was reported that endoscopy only took place during the allergy season in 4 studies (10,15,16,21) and not specified in the remaining 11 studies (11)(12)(13)(14)(17)(18)(19)(20)(22)(23)(24) .…”