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

Abstract

Purpose: The diagnosis of laryngopharyngeal reflux (LPR) is commonly based on non-specific symptoms and findings and a positive response to an empirical therapeutic trial. The therapeutic response is, however, unpredictable, and many patients need pH-impedance monitoring to confirm the diagnosis. Methods: A review of the recent literature was conducted in PubMED, Scopus, and Embase about the pH-study features of LPR patients. A summary of last evidence was proposed. Results: The awareness of otolaryngologists about indications and interpretation of pH-impedance monitoring is low. The hypopharyngeal-esophageal multichannel intraluminal impedance-pH monitoring (HEMII-pH) is the most reliable examination determining the type and composition of hypopharyngeal reflux events (HRE) and the LPR features. The use of HEMII-pH is important to confirm the diagnosis in selected patients because non-specificity of symptoms and findings. There are no international consensus guidelines for the LPR diagnosis at the HEMII-pH. However, most studies supported the occurrence of >1 acid/weakly acid/nonacid HRE as diagnostic threshold. HREs are more frequently gaseous, weakly/nonacid compared with reflux events of gastroesophageal reflux. HREs occurred as daytime and upright, which does not support the value of double proton pump inhibitors or bedtime alginate. Oropharyngeal pH-monitoring is another approach reporting different sensitivity and specificity outcomes from HEMII-pH. The use of Ryan score for the LPR diagnosis at the oropharyngeal pH monitoring may be controversial regarding the low consideration of alkaline HREs. Conclusions: The awareness of otolaryngologists about HEMII-pH indication, features, and interpretation is an important issue regarding the high prevalence of LPR in outpatients consulting in otolaryngology. The HEMII-pH findings may indicate a more personalized treatment considering type and occurrence time of HREs.

Post‐thyroidectomy voice and swallowing disorders and association with laryngopharyngeal reflux: A scoping review

“…LPR is considered as a silent reflux, without significant correlation between pharyngeal reflux events and symptoms at the HEMII‐pH. 29 In other words, the inflammatory reaction of laryngopharyngeal mucosa required a few weeks of backflow of gastroduodenal content into the upper aerodigestive tract, 30 , 31 which supports that LPR symptoms develop a few weeks after the surgery. In most studies, authors assessed LPR symptoms and findings at least 6 weeks postthyroidectomy, which seems adequate.…”

“…The importance of HEMII‐pH is strengthened by the nonspecificity of LPR symptoms and findings (e.g., globus sensation, throat clearing, dysphagia, dysphonia), which may be commonly found in patients with laryngeal nerve injury without reflux. Scerrino et al 15 used esophageal pH‐monitoring to investigate esophageal proximal events, but, in practice, we know that many esophageal reflux episodes do not reach pharynx because UES tonicity 29 . From an epidemiological standpoint, the nonspecificity of LPR‐symptoms and findings may support the careful exclusion of comorbidities that may be associated with laryngopharyngeal symptoms 1 .…”

“…To date, the HEMII‐pH is commonly accepted as the best diagnostic tool for LPR, identifying acid, weakly acid, or nonacid hypopharyngeal reflux events. 29 The importance of HEMII‐pH is strengthened by the nonspecificity of LPR symptoms and findings (e.g., globus sensation, throat clearing, dysphagia, dysphonia), which may be commonly found in patients with laryngeal nerve injury without reflux. Scerrino et al 15 used esophageal pH‐monitoring to investigate esophageal proximal events, but, in practice, we know that many esophageal reflux episodes do not reach pharynx because UES tonicity.…”

Treating and Managing Laryngopharyngeal Reflux Disease in the Over 65s: Evidence to Date

“… 52 The low efficacy of PPIs is related to the high prevalence of weakly acid and non-acid (alkaline) LPR, which require treatment with alginate or magaldrate. 53 , 54 …”

“…52 The low efficacy of PPIs is related to the high prevalence of weakly acid and non-acid (alkaline) LPR, which require treatment with alginate or magaldrate. 53,54 According to data in the the literature, elderly LPR patients report different therapeutic responses from younger patients. [44][45][46] Lee et al reported significantly more responders to PPI therapy, defined as those whose RSI score improved by more than 50%, in both the 18-39-year-old group (86%) and the 40-59-year-old group (75%), compared with the >60-year-old group (57%).…”