Atypical Clinical Presentation of Laryngopharyngeal Reflux: A 5-Year Case Series

Abstract

Background: Laryngopharyngeal reflux (LPR) is a common disease in otolaryngology characterized by an inflammatory reaction of the mucosa of the upper aerodigestive tract caused by digestive refluxate enzymes. LPR has been identified as the etiological or favoring factor of laryngeal, oral, sinonasal, or otological diseases. In this case series, we reported the atypical clinical presentation of LPR in patients presenting in our clinic with reflux. Methods: A retrospective medical chart review of 351 patients with LPR treated in the European Reflux Clinic in Brussels, Poitiers and Paris was performed. In order to be included, patients had to report an atypical clinical presentation of LPR, consisting of symptoms or findings that are not described in the reflux symptom score and reflux sign assessment. The LPR diagnosis was confirmed with a 24 h hypopharyngeal-esophageal impedance pH study, and patients were treated with a combination of diet, proton pump inhibitors, and alginates. The atypical symptoms or findings had to be resolved from pre- to posttreatment. Results: From 2017 to 2021, 21 patients with atypical LPR were treated in our center. The clinical presentation consisted of recurrent aphthosis or burning mouth (N = 9), recurrent burps and abdominal disorders (N = 2), posterior nasal obstruction (N = 2), recurrent acute suppurative otitis media (N = 2), severe vocal fold dysplasia (N = 2), and recurrent acute rhinopharyngitis (N = 1), tearing (N = 1), aspirations (N = 1), or tracheobronchitis (N = 1). Abnormal upper aerodigestive tract reflux events were identified in all of these patients. Atypical clinical findings resolved and did not recur after an adequate antireflux treatment. Conclusion: LPR may present with various clinical presentations, including mouth, eye, tracheobronchial, nasal, or laryngeal findings, which may all regress with adequate treatment. Future studies are needed to better specify the relationship between LPR and these atypical findings through analyses identifying gastroduodenal enzymes in the inflamed tissue.

Validity and Reliability of the Reflux Sign Assessment‐10 (RSA‐10)

“…The RSA-10 is subdivided into oral cavity, pharyngeal, and laryngeal subscores. Given that LPRD has recently been associated with atypical signs in some cases, 14,15 RSA-10 allows for the inclusion of additional signs, such as rhinopharyngeal erythema, 15 mulberry inferior turbinate, 14 or nasal crusts. 15 The total RSA-10 score ranges from 0 to 40.…”

Clinical Update Findings about pH-Impedance Monitoring Features in Laryngopharyngeal Reflux Patients

“…According to the potential associations between LPR and many otolaryngological disorders, including suppurative otitis media [ 64 , 65 ], recalcitrant chronic rhinosinusitis [ 66 ], some benign lesions of the vocal folds [ 56 , 67 , 68 ], nonfunctional laryngeal disorders [ 69 ], vocal fold granuloma [ 70 ], Eustachian tube dysfunction [ 71 ], eye dryness [ 72 ], or chronic nasal obstruction [ 73 , 74 ], the usefulness of pH study in otolaryngology is an important issue. The identification of LPR as contributing factor of the above-mentioned otolaryngological conditions may lead to better therapeutic regimen and control of the clinical courses of the diseases.…”

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.…”