Nasopharyngeal pH monitoring in chronic sinusitis patients using a novel four channel probe.

OBJECTIVE: To determine the prevalence of acid reflux into the nasopharynx in patients with chronic sinusitis. STUDY DESIGN: Prospective study of patients presenting to a specialist rhinology practice with chronic sinusitis. METHODS: Forty patients with chronic sinusitis underwent ambulatory 24 hour pH testing. The mean age of the patients was 56.3 years (25 Female, 15 Male). The studies were performed using a specially developed bifurcated 4 channel pH probe, incorporating 2 circumferential sensors positioned at the naso- and hypo-pharynx, and 2 unidirectional sensors positioned at the proximal and distal esophagus. RESULTS: The circumferential band sensors yielded a stable recording largely free of artefact allowing meaningful recordings to be obtained from thirty-seven patients. Twelve patients (32.4%) were diagnosed with gastroesophageal reflux. A total of 809 reflux episodes were recorded. Of these, 596 (73.7%) reached the distal esophagus, with 187 (23.1%) and 24 (3.0%) reaching the proximal esophagus and hypopharynx respectively. Only 2 episodes (0.2%) were recorded in the nasopharynx. This occurred in 2 of 37 patients (5%). CONCLUSIONS: Acid reflux into the nasopharynx is a rare event in patients with chronic sinusitis even though a significant proportion (32.4%) have abnormal 24 hour pH studies. It is likely that alternative mechanisms other than direct acid contact are involved in the pathogenesis of chronic sinusitis.