Correlation between chronic rhinosinusitis and laryngopharyngeal reflux

Abstract

Background: Chronic rhinosinusitis (CRS) is a major Ear, Nose and Throat disease and there are higher numbers of refractory cases poorly responding to medical and surgical treatment. Laryngopharyngeal reflux (LPR) is said to be the important cause for same. Aims and Objectives: This study aims to study the incidence of LPR in patients of refractory CRS. This study also aims to study the impact of proton pump inhibitors (PPI) (effective treatment of LPR) given as adjuvant therapy along with functional endoscopic sinus surgery (FESS) in patients with refractory CRS. Materials and Methods: A total of 40 patients of refractory CRS taken up for the study were evaluated for signs and symptoms of LPR. They were then divided into two groups of 20 each -study group and control group. All the patients in both groups were evaluated for signs and symptoms of CRS. All these patients underwent FESS. Post-surgery patients in the study group were given intranasal steroids (INS) along with PPI (tablet pantoprazole) whereas in control group were put on INS without PPI. The patients were followed monthly for 3 months for improvement in signs and symptoms of CRS and patient's relief and comfortability levels. Results: 45% of patients of refractory CRS had LPR with the posterior larynx being mainly involved. The major signs and symptoms of CRS were nasal obstruction, nasal discharge, and nasal polyps. There was more improvement in nasal obstruction, nasal discharge, and post-nasal discharge in patients of study group with PPI as compared to control group without PPI. There was better relief of symptoms in patients given PPI as compared to control group and this improvement was more marked at 3 rd post-operative visit after 3 months. Conclusion: There is a strong association between refractory CRS and LPR. PPI are an effective drug for refractory CRS when given as adjuvant therapy along with FESS.

Association Between Chronic Rhinosinusitis and Reflux Diseases in Adults: A Systematic Review and Meta-Analysis

“…For instance, several reports have demonstrated the ability of gastric acid to reach up to the larynx and nasopharynx. 39,40 Multiple studies have assessed the prevalence of acid reflux among CRS patients, particularly those with refractory medical treatment, 10,26,41 surgical treatment, 27,33,42 or medical and surgical treatment. 40 However, the findings showed high variability among the studies, with some reporting a prevalence above 75% and others as low as 12%.…”

“…34 Furthermore, in Nanda et al's study, greater improvement was observed in patients who took PPI following FESS than in those who did not, especially after 3 months. 33…”

“…34 Furthermore, in Nanda et al's study, greater improvement was observed in patients who took PPI following FESS than in those who did not, especially after 3 months. 33 Based on the available evidence regarding the association between reflux diseases and refractory CRS, 4 studies specifically examined the outcomes of FESS in cases with or without comorbid GERD/LPR. The majority of these studies assessed surgical outcomes using disease-specific QOL questionnaires, while only one used a visual analog scale (Chambers et al), which is a non-specific method for assessing post-operative QOL in CRS patients.…”

The Impact of Laryngopharyngeal Reflux on Patient-reported Measures of Chronic Rhinosinusitis

“…For example, Nanda et al found that treating patients with refractory CRS and LPR using proton pump inhibitors (PPI) in conjunction with functional endoscopic sinus surgery (FESS), constituted effective management of post-nasal drip and nasal congestion symptoms. 22,23…”

“…For example, Nanda et al found that treating patients with refractory CRS and LPR using proton pump inhibitors (PPI) in conjunction with functional endoscopic sinus surgery (FESS), constituted effective management of post-nasal drip and nasal congestion symptoms. 22,23 The goal of this study is to investigate the co-existence of sinonasal and proximal reflux symptoms using the Sinonasal Outcomes Test (SNOT-22) and the Reflux Symptoms Index (RSI) as assessment tools. These psychometric questionnaires are routinely administered to patients with isolated CRS and LPR, respectively.…”