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

Brown, Hannah J.; Kuhar, Hannah N.; Plitt, Max A.; Husain, Inna; Batra, Pete S.; Tajudeen, Bobby A.

doi:10.1177/0003489420921424

Cited by 18 publications

(31 citation statements)

References 49 publications

(69 reference statements)

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“…The included studies were published between 1999 and 2020, reporting data on a total of 22,361 patients (16,514 with rhinitis, 522 with NSD, and 5325 with CRS), with a mean age of 39.1 years (33.9 years for rhinitis, 34.0 years for NSD, and 49.3 years for CRS). Of the 103 studies, 29 reported on CRS (2 specifically excluded chronic rhinosinusitus with nasal polyps [CRSwNP], 33,34 3 did not specify CRSwNP or CRS without nasal polyps [CRSsNP], 1,15,35 and 3 specifically focused on CRSwNP, 36–38 whereas the remaining 21 studies reported varying percentages of patients with nasal polyps), 64 on rhinitis (only 3 studies included patients with NAR 39–41 ), and the remaining 10 on NSD. Studies varied in their inclusion, exclusion, and diagnostic criteria.…”

Section: Resultsmentioning

confidence: 99%

Rhinologic disease and its impact on sleep: a systematic review

Fried

Yuen

et al. 2020

Int Forum Allergy Rhinol

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Background Rhinologic disease can be responsible for systemic symptoms affecting mood, cognition, and sleep. It is unclear whether sleep disturbance in specific rhinologic disorders (chronic rhinosinusitis [CRS], rhinitis, and nasal septal deviation [NSD]) is an obstructive phenomenon or due to other mechanisms. In this review we examine the impact of CRS, rhinitis, and NSD on objective and subjective sleep outcome metrics and draw comparisons to normal controls and patients with known obstructive sleep apnea (OSA). Methods A systematic review of 4 databases (PubMed, Scopus, Cochrane Library, and Web of Science) was performed. Studies reporting on objective (apnea‐hypopnea index [AHI], respiratory disturbance index [RDI], oxygen nadir) and subjective (Epworth Sleepiness Scale [EpSS], Pittsburgh Sleep Quality Index [PSQI], Fatigue Severity Scale [FSS]) sleep parameters and disease‐specific patient‐reported outcome measures (PROMs; 22‐item Sino‐Nasal Outcome Test [SNOT‐22], Rhinoconjunctivitis Quality of Life Questionnaire [RQLQ], Nasal Obstruction Symptom Evaluation [NOSE]) were included. Results The database search yielded 1414 unique articles, of which 103 were included for analysis. Baseline PROMs were at the high end of normal to abnormal for all 3 conditions: EpSS: CRS (9.8 ± 4.0), rhinitis (9.7 ± 4.3), and NSD (8.9 ± 4.6); and PSQI: CRS (11.0 ± 4.5), rhinitis (6.1 ± 3.7), and NSD (8.6 ± 3.5). Objective measures demonstrated a mild to moderate OSA in the studied diseases: AHI: CRS (10.4 ± 11.5), rhinitis (8.6 ± 8.8), and NSD (13.0 ± 6.9). There were significant differences when compared with reported norms in all measured outcomes (p < 0.001). Conclusion Sleep quality is impacted by rhinologic (CRS, rhinitis, NSD) disease. There is likely a mild obstructive component contributing to poor sleep, but other contributing factors may be involved.

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Section: Resultsmentioning

confidence: 99%

Rhinologic disease and its impact on sleep: a systematic review

Fried

Yuen

et al. 2020

Int Forum Allergy Rhinol

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“…The most prevalent symptoms associated with LPR are globus sensation, throat clearing, hoarseness, excess throat mucus or postnasal drip [2,12,45]. These symptoms, which are commonly observed in primary care medicine, are nonspecific and may be associated with active laryngopharyngeal allergy [2], rhinitis [46], chronic rhinosinusitis [47], smoking [48], alcohol abuse [49], and benign laryngopharyngeal infections [50]. In other words, it is difficult to base the LPR diagnosis only on laryngopharyngeal symptoms without objective examination or exclusion of these confounding factors.…”

Section: Symptomsmentioning

confidence: 99%

Management of Laryngopharyngeal Reflux: A Practical Algorithm Management for Primary care Physicians

Lechien¹,

Saussez²,

Muls³

et al. 2020

Preprint

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Laryngopharyngeal reflux (LPR) is a prevalent disease in the general population and may have acute or chronic clinical presentation. LPR may be misdiagnosed in primary care medicine regarding the lack of gastroesophageal reflux disease symptoms and the lack of findings at the gastrointestinal endoscopy. Depending on the physician field of expertise and experience, LPR may be clinically over- or under-diagnosed. The management of LPR is possible in primary care medicine but primary care physician has to consider some red flags that requires to address the patient to otolaryngologist or gastroenterologist. The use of patient-reported outcome questionnaire such as reflux symptom score-12 and the consideration of some oral and pharyngeal findings visualized through the mouth opening may help the primary care physician to evaluate the LPR findings at the diagnosis time and throughout treatment. In this review, we provide a practical algorithm of management of LPR for primary care physician or other specialists that cannot perform fiberoptic examination. In this algorithm, physician has to exclude some confounding conditions such as allergy or other causes of pharyngolaryngitis and red flags. Physician may prescribe an empirical treatment based on diet and behavioral changes with or without medication, depending on the complaint severity of the patient. In case of prescription of medication, proton pump inhibitors and alginate have to be considered in association to protect the upper aerodigestive tract mucosa from acid, weakly acid and alkaline pharyngeal reflux events.

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“…Thus, the frequent observation of these symptoms may lead to a potential overestimation of their prevalence in LPR, which is known to be prevalent in otolaryngology [ 1 ]. Interestingly, the high prevalence of these symptoms led some authors to use the reflux symptom index (RSI) [ 19 ] as a clinical tool for the assessment of symptoms and for therapeutic outcomes in some of these conditions [ 20 , 21 , 22 ].…”

Section: Discussionmentioning

confidence: 99%

Do Otolaryngologists Over- or Underestimate Laryngopharyngeal Reflux Symptoms and Findings in Clinical Practice? A Comparison Study between the True Prevalence and the Otolaryngologist-Estimated Prevalence of Symptoms and Findings

Lechien

2022

JCM

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Purpose: To investigate the prevalence of symptoms and signs of laryngopharyngeal reflux (LPR) and to compare them with the otolaryngologist-estimated prevalence of the most common LPR-related symptoms and signs. Methods: The prevalence of LPR symptoms and signs was determined through the clinical data of 403 patients with a positive LPR diagnosis on hypopharyngeal–esophageal multichannel intraluminal impedance pH monitoring. The otolaryngologist-estimated prevalence was assessed through an international survey investigating the thoughts of 824 otolaryngologists toward LPR symptom and sign prevalence. The determination of potential over- or underestimation of LPR symptoms and findings was investigated through a data comparison between the ‘true’ prevalence and the ‘estimated prevalence’ of symptoms and findings by otolaryngologists. Results: The prevalence of breathing difficulties, coated tongue, and ventricular band inflammation was adequately evaluated by otolaryngologists. The prevalence of hoarseness, throat pain, odynophagia, dysphagia, throat clearing, globus sensation, excess throat mucus, tongue burning, heartburn, regurgitations, halitosis, cough after eating or lying down, and troublesome cough was overestimated by otolaryngologists (p < 0.01), while the prevalence of chest pain was underestimated as an LPR symptom. Most laryngeal signs, e.g., arytenoid/laryngeal erythema, inter-arytenoid granulation, posterior commissure hypertrophy, retrocricoid edema/erythema, and endolaryngeal sticky mucus, were overestimated (p < 0.01). The occurrence of anterior pillar erythema and tongue tonsil hypertrophy was underestimated by participants. Conclusion: Most laryngopharyngeal reflux symptoms and laryngeal signs were overestimated by otolaryngologists, while some non-laryngeal findings were underestimated. Future studies are needed to better understand the reasons for this phenomenon and to improve the awareness of otolaryngologists toward the most and least prevalent reflux symptoms and signs.

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

Cited by 18 publications

References 49 publications

Rhinologic disease and its impact on sleep: a systematic review

Rhinologic disease and its impact on sleep: a systematic review

Management of Laryngopharyngeal Reflux: A Practical Algorithm Management for Primary care Physicians

Do Otolaryngologists Over- or Underestimate Laryngopharyngeal Reflux Symptoms and Findings in Clinical Practice? A Comparison Study between the True Prevalence and the Otolaryngologist-Estimated Prevalence of Symptoms and Findings

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