Double probe pH-monitoring findings in patients with benign lesions of the true vocal folds: comparison with typical GERD and the effect of smoking

Abstract

We conducted a pH-monitoring study to determine the prevalence of pathologic gastroesophageal reflux (GER+) and laryngopharyngeal reflux (LPR+) in patients with resected benign true vocal fold lesions (TVFLs) and positive reflux finding score (RFS). We compared our findings with those of patients with typical GER disease (GERD) symptoms and normal laryngoscopy. In the group of patients with TVFLs, we compared the pH-monitoring findings of smokers with those of non-smokers. Seventy-two [females 32, mean (SD) age 49.3 (13.1) years] patients with resected TVFLs (polyps: 32, nodules: 20, Reinke's edema: 12, granulomas: 4, leukoplakia: 4) and 24 [females 14, mean (SD) age 42.2 (13.4) years] patients with typical GERD symptoms, who served as controls for the hypopharyngeal measurements, underwent 24-h double probe, hypopharyngeal and distal esophageal, ambulatory pH monitoring. Thirty-eight (52.8%) patients with TVFLs had GER+ and 52 (72.2%) had LPR+. More laryngopharyngeal reflux episodes (LPREs) were detected in patients with TVFLs compared to those with GERD (P < 0.001). With respect to the specific TVFLs, 12 (37.5%) patients with polyps had GER+ and 24 (75%) had LPR+, 6 (30%) patients with nodules had GER+ and 12 (60%) had LPR+, 6 (50%) patients with Reinke's edema had GER+ and 8 (66.7%) had LPR+ and all the patients with granuloma or leucoplakia had both GER+ and LPR+. Twenty (55.6%) of the 36 smokers and 32 (88.9%) of the 36 non-smokers with TVFLs had LPR+ (P = 0.003), while GER+ was recorded in 16 (44.4%) smokers and 22 (61.1%) non-smokers (P = 0.238). Smokers had significantly less LPREs (P < 0.001). In conclusion, 24-h double probe pH monitoring may detect GER+ and/or LPR+ in a substantial proportion of patients with resected TVFLs and positive RFS. Our study suggests that LPR+ is more prevalent in patients with TVFLs compared with typical GERD patients and that non-smokers with TVFLs are more likely to have LPR+ than smokers with TVFLs.

Association between laryngopharyngeal reflux and benign vocal folds lesions: A systematic review.

“…In the study of Kuhn et al, LPR was identified in 64% of nodule patients and 18% of control subjects . This relationship between LPR and nodules has been supported by Beltis et al, who assessed the prevalence of LPR in patients with nodules compared to patients suffering from GERD . According to pH monitoring findings that differentiated distal reflux alone (GERD) from those who had proximal reflux (LPR), these authors reported a nodule rate of 60% in patients with LPR, double the rate of nodules in the GERD group.…”

“…Five studies investigated the relationship between LPR and nodules using an objective approach to LPR diagnosis . In 1998 and 1999, respectively, Kuhn et al and Ulualp et al reported a significantly higher prevalence of pharyngeal acid reflux events in patients with nodules in comparison with healthy subjects .…”

Disfoni Hastalarında Laringostroboskopik Değerlendirme

“…Mevcut bulgular m z n sigara kullan m ndan bams z olarak incelenmi olmas na ra men özellikle reinke ödemindeki da l m n de i memi olmas n n temel nedenlerinden birinin, sigaraya ba l reinke ödemi olu umunun y llar süren bir döngüde olu tu unu ve ilerleyen dekadlarda anlaml fark olu turabilecek bir örnekleme ula abileceimiz oldu unu dü ünmekteyiz. Bununla birlikte laringofaringeal reflü-nün de benign kord vokal lezyonlarn n olu umunda rol oynad fakat sigaran n sinerjistik bir etkiyle de il kendi ba na bir faktör oldu u da literatürde bildirilmi tir (8).…”

Use Videostrobokymography to Quantitatively Analyze the Vibratory Characteristics Before and After Conservative Medical Treatment of Vocal Fold Leukoplakia

“…1,2 Now, this leukoplakia of vocal fold is considered to be a premalignant lesion. Although many efforts have been contributed to treat the disease, results are still not satisfactory.…”