Mulberry Posterior Inferior Nasal Turbinate Is Associated with a Lower Pharyngeal pH Environment

Abstract

ObjectivesMulberry‐like changes of the posterior inferior nasal turbinate (MPINT) can lead to nasal obstruction. Extraesophageal reflux (EER) characterized by lower pH causes mucosal inflammation and therefore can contribute to sinonasal pathologies. No prior studies have objectively examined the possible association between acidic pH and MPINT formation. Therefore, this study is aimed to investigate the 24‐h pharyngeal pH value in patients with MPINT.Study designProspective case–control multi‐center study.MethodsFifty‐five patients with chronic EER symptoms were included in the study. They filled in questionnaires aimed at reflux and sinonasal symptoms (RSI®, SNOT‐22) and underwent video endoscopy evaluating the laryngeal findings (RFS®) and the presence or absence of the MPINT. And, 24‐h oropharyngeal pH monitoring was used to detect the acidic pH environment in the pharynx.ResultsOut of the 55 analyzed patients, 38 had the MPINT (group 1), and in 17 patients, the MPINT was absent (group 2). Based on the pathological RYAN Score, in 29 (52.7%) patients, severe acidic pH drops were detected. In group 1, the acidic pH drops were diagnosed significantly more often (68.4%) compared with those in group 2 (p = 0.001). Moreover, in group 1, a significantly higher median total percentage of time spent below pH 5.5 (p = 0.005), as well as a higher median number of events lasting more than 5 min (p = 0.006), and higher median total number of events with pH drops (p = 0.017) were observed.ConclusionIn this study, the MPINT was significantly more often present in patients with acidic pH events detected by 24‐h oropharyngeal pH monitoring. Acidic pH in the pharynx might lead to MPINT formation.Level of Evidence3 Laryngoscope, 2023

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

“…RSA-10 also proposed the possibility to include atypical signs associated with LPRD. Because LPRD may be atypical and involved in nasal or tear disorders, for example, 14,15,31,32 the practitioners may include atypical items to evaluate their changes over time.…”

“…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.…”

Personalized Treatments Based on Laryngopharyngeal Reflux Patient Profiles: A Narrative Review

“…In clinical practice, oropharyngeal pH monitoring could be an interesting diagnostic approach for the detection of nasopharyngeal reflux events. Indeed, the gastric content of pharyngeal reflux events may reach the sinonasal mucosa, Eustachian tube, and tears, which is associated with dry eyes, otitis media, Eustachian tube dysfunction, dry nasal mucosa, nasal crusts, or mulberry turbinate (Figure 4) [87][88][89][90]. Because there is no nasopharyngealhypopharyngeal-esophageal impedance-pH monitoring probe available in the market, the placement of oropharyngeal-pH monitoring sensors in the nasopharynx may be used to confirm nasopharyngeal reflux disease in such patients [91].…”