Investigation of the potential relationship between gastroesophageal reflux disease and laryngopharyngeal reflux disease in symptomatology - a prospective study based on a multidisciplinary outpatient.

OBJECTIVE: To investigate the relationship between laryngopharyngeal reflux disease (LPRD) and gastroesophageal reflux disease (GERD). METHODS: Gastroesophageal Reflux Disease Questionnaire (GERD-Q) and Reflux Symptom Index (RSI) scale were administered to patients attending the gastroenterology outpatient clinic at the Sixth Medical Center of the PLA General Hospital from 7 April 2021 to 10 June 2021. Patients with GERD-Q score >7 were indicated GERD, and patients with RSI >13 were indicated LPRD. The analysis of patients with pure GERD (independent GERD, iG), patients with LPRD and GERD (LPRD & GERD, L&G), patients with simple LPRD (independent LPRD, iL) and the percentage of normal group (GERDQ-negative and RSI-negative, N). RESULTS: 3060 GERD-Q and RSI questionnaires were distributed, and 2974 complete questionnaires were returned. Among them, 274 (9.20%) iL, 334 (11.23%) iG and 151 (5.10%) L&G patients and 2215 (74.48%) N patients. The positive rate of GERD in this sample was 16.31%, of which 31.13% had coexisting LPRD, and the positive rate of LPRD was 14.29%, of which 35.53% had coexisting GERD. Among patients with LPRD, the positive rate of concomitant GERD (χ2 = 4.157, p = 0.041) and RSI score (Z = -6.823, p = 0.000) was significantly higher in patients with the presence of respiratory symptoms than in those without respiratory symptoms. CONCLUSION: LPRD can exist alone or in conjunction with GERD. Patients with both LPRD and GERD had the most severe reflux symptoms. The need to focus on the risk of those initially screened only with GERD developing LPRD. Respiratory symptoms play an important role in reflux disease.

Thyroarytenoid botulinum toxin injection for refractory laryngeal contact granuloma.

BACKGROUND: Although there are many treatments for laryngeal contact granuloma (LCG), some patients still fail treatment. Botulinum toxin A injection vocal cords may be a salvage therapy. OBJECTIVES: To study the efficacy of thyroarytenoid botulinum toxin A injection for the treatment of refractory LCG. MATERIAL AND METHODS: From May 2021 to March 2022, 23 male patients with refractory idiopathic LCG were treated by injection of botulinum toxin A into the thyroarytenoid muscle via the thyrohyoid membrane approach. Inspiratory-phase laryngoscopy images were collected before treatment and 3 months after injection treatment. The lesion size was evaluated with the Farwell granuloma endoscopic grading system and Image J software. RESULTS: The average age of 23 patients was 49 years. The dose of botulinum toxin injection ranged from 2.5 to 5 units. Three months after injection, 17 patients were cured, 2 patients showed marked improvement, and 4 patients did not experience any effect. The total efficacy rate was 82.61% (19/23), and no serious complications occurred. Almost all patients experienced hoarseness within one week after injection; they gradually recovered after one month, and their voice returned to baseline at 3 months. CONCLUSIONS: Thyroarytenoid botulinum toxin injection is an effective method for resolving refractory LCG.

Does hypopharyngeal-esophageal multichannel intraluminal impedance-pH monitoring for the diagnosis of laryngopharyngeal reflux have to be 24 h?

PURPOSE: To investigate the diagnostic value of combined multi-timepoint salivary pepsin testing (MTPSPT) and hypopharyngeal-esophageal multichannel intraluminal impedance-pH monitoring (HEMII-pH) for laryngopharyngeal reflux (LPR) and whether an appropriate reduction in the duration of HEMII-pH would affect the accuracy of diagnosis of LPR. METHODS: Recruited patients were studied with both MTPSPT and HEMII-pH. The diagnosis of LPR was based on the occurrence of > 1 reflux event and/or positive results on any of the MTPSPT. The diagnostic value of combined diagnosis was studied through combining a breakdown of the 24-h HEMII-pH finding and the results of the MTPSPT. The diagnostic value was expressed in terms of sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). RESULTS: Based on 24-h HEMII-pH and MTPSPT, the positive rate of LPR was 83.33% and 74.69%, respectively. According to the combined diagnosis, the positive rate of LPR was 90.74%. The sensitivity and specificity of the combined diagnosis both were 89.51% and 100%, when the HEMII-pH intervals were 7 a.m.-6 p.m. and 7 a.m.-7 p.m., respectively. However, when the monitoring time was extended to 8 p.m. and bedtime, the sensitivity, specificity, PPV and NPV of the combined diagnosis both were 100%. CONCLUSIONS: The combination of MTPSPT and HEMII-pH increased the sensitivity and accuracy of diagnosis of LPR. For patients with positive MTPSPT results, the duration of HEMII-pH can be appropriately shortened to reduce patient sufferings.

Comparison of PPI and combined treatment in the treatment of recurrent laryngeal contact granuloma.

OBJECTIVE: To compare the therapeutic effect of PPI and combined treatment in the treatment of patients with recurrent laryngeal contact granuloma. METHODS: The clinical data of 299 patients with recurrent laryngeal contact granuloma treated with PPI or combined treatment (PPI with glucocorticoid injection into granuloma by the thyroglossal approach) from February 2013 to June 2019 were analyzed retrospectively. Patients were divided into two subgroups: PPI and combined treatment. The cure rates, recurrence rates and cure time of the two subgroups were compared and analyzed separately. Than we can get the optimal treatment of the two treatment in the treatment of recurrent patients. RESULTS: In recurrent patients, the cure rate (81.20%) and recurrence rate (3%) of combined treatment were superior to those of PPI (57.58%) and recurrence rate (12.12%); (P < 0.05). The cure time of PPI was longer than that of combination therapy (P < 0.001). CONCLUSION: The therapeutic effect of combined treatment is better than that of PPI in patients with recurrence. At the same time, combined treatment is an effective treatment for recurrent granuloma and can be used as a first-line treatment for recurrent laryngeal contact granuloma.

Li Maneuver for geotropic horizontal canal benign paroxysmal positional vertigo (HC-BPPV) -A better choice.

PURPOSE: This study aimed to retrospectively evaluate the efficacy of Li Maneuver as a repositioning maneuver for geotropic HC-BPPV, compared with Gufon Maneuver. METHODS: Data of geotropic HC-BPPV patients treated at our department between January 2009 and January 2020 was retrospectively collected and analyzed. Enrolled cases were divided into Gufoni Group and Li Group. Follow-up results were recorded on the first, third, and seventh day after the first therapeutic maneuver. RESULTS: A total of 254 cases were enrolled, with 87 cases in Gufoni Group, and 167 cases in Li Group. The cure rate at the first, third, and seventh days of follow-up was 62.22%, 77.01%, and 90.80% respectively for Gufoni Group, while for Li Group the number was 60.48%, 72.46%, and 89.22% respectively. Statistical analysis showed no significant difference. CONCLUSIONS: Li Maneuver for geotropic HC-BPPV was as effective as Gufoni Maneuver but much simpler and faster. By introducing Li Maneuver, we may help physicians to treat geotropic HC-BPPV patients more willingly, which would decrease the chance of delayed treatment and ease the burden of the health-care system.

Short-term outcome of transcutaneous glucocorticoid injection for laryngeal contact granuloma in females.

OBJECTIVE: To evaluate the short-term efficacy of transcutaneous glucocorticoid injection for laryngeal contact granuloma in females. METHODS: A total of 14 female patients with laryngeal contact granuloma treated in our outpatient department from November 2017 to January 2020 were included in the study. Inspiratory-phase laryngoscopy images were collected before treatment and 1 month after each injection, and the lesion size was measured and evaluated with ImageJ software. RESULTS: Two patients achieved complete remission after one injection, with a percent reduction of 100%. After two injections, 4 patients achieved complete remission, with a percent reduction ranging from 96% to 100%. After 3 injections, 4 patients achieved complete remission (including one patient with bilateral lesions), and the percent reduction ranged from 95% to 100%. Three patients achieved incomplete remission, with a percent reduction of 46%, 55%, and 81%, respectively. In one case, there was no remission, and the granuloma increased in size after treatment. CONCLUSION: In women with laryngeal contact granuloma, transcutaneous glucocorticoid injection therapy can quickly resolve the granuloma in a short period.

The role of nonacid reflux in laryngopharyngeal reflux diseases.

OBJECTIVE: To analyze the role of nonacid reflux in laryngopharyngeal reflux diseases (LPRD). METHODS: From January 2014 to April 2019, 344 patients associated with LPRD underwent 24-h multichannel intraluminal impedance-pH monitoring, and their reflux symptom index (RSI) and reflux finding score (RFS) were recorded. The numbers of acid, weakly acidic and alkaline reflux events in the laryngopharynx were counted, and the consistency analysis of the results with the results of the RSI and RFS was conducted. RESULTS: Among the 344 patients, nonacid reflux events accounted for 74.1% (1367/1845) of the all reflux events. There were 111 patients with ≥ 3 acid reflux events, 218 patients with ≥ 3 any kinds of reflux events, and 257 patients with positive results of RSI or RFS. Taking the results of the RSI and or RFS as a reference, the sensitivity, specificity and consistency test Kappa value for the diagnosis of LPRD according to the existence of ≥ 3 acid reflux events were 41.2%, 94.2% and 0.228, respectively. With the existence of three or more all kinds of reflux events as the standard, the sensitivity, specificity and consistency test Kappa value were 76.7%, 74.7% and 0.449, respectively. CONCLUSION: The nonacid reflux events account for the highest proportion of laryngopharyngeal reflux events, and the consistency of the results of RSI and or RFS with all reflux events is higher than that with only acid reflux events, that indicates nonacid reflux may play an important role in LPRD.

An epidemiological survey of laryngopharyngeal reflux disease at the otorhinolaryngology-head and neck surgery clinics in China.

PURPOSE: Using the Reflux Symptom Index (RSI), this nationwide study aimed to investigate the incidence, diagnostic status, risk factors, and common symptoms of adult laryngopharyngeal reflux disease (LPRD) at otorhinolaryngology-head and neck surgery (OHNS) clinics in China. METHODS: This multicenter cross-sectional survey began at the different institutions ranged from July to October 2017, and the duration was 12 months. A total of 90,440 eligible patients were finally enrolled from 72 medical institutions in China. All these patients completed the questionnaire based on RSI. In this study, LPRD was defined as RSI > 13. RESULTS: There were 9182 with LPRD among the 90,440 eligible participants (10.15%). However, only 1294 had a history of LPRD diagnosis among those with LPRD (14.09%). There were regional differences in the frequency of LPRD (P < 0.001). The proportions of patients with LPRD in males (vs. females), middle- and old-aged patients (vs. young), with current smoking history (vs. no smoking), and current drinking history (vs. no drinking) were significantly higher (all P < 0.001). Middle and old age, current smoking, and drinking history were independent predictors of LPRD (all P < 0.001, OR 1.240, 1.261, and 1.481, respectively). "Sensations of something stuck in throat or a lump in throat", "clearing throat", and "excess throat mucus or postnasal drip" were the most frequent clinical symptoms in patients with LPRD. CONCLUSIONS: LPRD has a high incidence at the OHNS clinics in China. However, the diagnostic status of this disease is not optimistic. Older age, smoking, and drinking history were risk factors for LPRD.

Congenital malformation of the oval window: experience of radiologic diagnosis and surgical technique.

The aim of this study was to introduce and discuss the method of preoperative radiological diagnosis to the congenital absence or atresia of the oval window (OW), and the method of surgical treatment. From July 2010 through August 2014, patients with normal external canal and tympanic membrane but conductive hearing loss underwent high resolution CT scan (HRCT). The multi-planar reformation (MPR), a post-processing protocol, was used. The patients with diagnosis of OW atresia and malformed stapes preoperatively underwent surgical treatment. The vestibular drilled-out and promontory drilled-out technique was used to reconstruct the ossicular chain. In the preoperative radiological diagnosis, six patients (ears) were noted to have congenital absence or atresia of the oval window with malformed facial nerve (class 4) and two patients (ears) were found to have footplate fixation (class 2). In the surgical treatment of eight ears, the malformed structure was identified and the ossicular chain reconstruction was made in six ears. The coronal HRCT CT imaging and the MPR post-processing technique can provide us practical and definite information for surgical treatment, especially in the discrimination of OW atresia and the fixed stapedal footplate. The promontory drill-out technique, fenestration in the bottom of the basal turn, provides us a new method in the hearing reconstruction when the area of OW was fully covered by malformed facial nerve. This technique was first reported in the literature.

[Short and long term effect of quick repositioning maneuver for patients with benign paroxysmal positional vertigo induced in the straight head-hanging test].

OBJECTIVE: To investigate the clinical characteristics, short and long term effect of quick repositioning maneuver along the sagittal plane for patients with benign paroxysmal positional vertigo who were induced vertigo in the straight head-hanging test. METHODS: The clinical data of 38 patients affected by benign paroxysmal positional vertigo who were induced vertigo in the straight head-hanging test from July 2009 to July 2014 in the Department of Otolaryngology Head and Neck Surgery of Navy General Hospital were retrospectively analyzed. After diagnosis, the patients were underwent quick repositioning maneuver along the sagittal plane. RESULTS: Of the 38 cases studied, 15 patients (39.5%) were males and 23 patients (60.5%) were females. The age of the patients ranged from 33 to 71 years with a mean of 55 ± 12 years. The median duration between symptoms and diagnosis was 8 days. The total improvement was 33 cases (86.8%) in patients with superior semicircular canal BPPV when they were re-evaluated at 1 week and 32 cases (84.2%) at 3 months time. CONCLUSIONS: Quick repositioning maneuver along the sagittal plane is an effective, easy alternative for treatment of the patients with benign paroxysmal positional vertigo induced vertigo in the straight head-hanging test. It is not necessary to identify the directions of the nystagmus.

Is the grading system of the severity of the OSAHS used presently rational or not?: from the view of incidence of hypertension in different severity groups.

The grading system of the severity of obstructive sleep apnea hypopnea syndrome (OSAHS) used presently showed that the severe OSAHS had an extensive range of apnea hypopnea index (AHI) (≥ 30, even over 100). So this grading system is not rational. From Jan 1999 to June 2011, there were 2,618 patients complaining of snoring took the polysomnography. The patients were divided into 11 groups according to their AHI. Frequencies of OSAHS with hypertension in each group were tested using crosstabs. The incidence of hypertension was increased as the increasing of AHI. Crosstab analysis showed that there were four cutoff points of AHI (5, 30, 50, 100). There was a significant difference in the incidence of hypertension between the groups of AHI more than the cutoff point and AHI less than the cutoff point. So from the view of hypertension in each group, we recommend that the AHI <5 should be considered as normal or simple snorer, AHI = 5-30 as mild degree of OSAHS, AHI = 30-50 as moderate degree of OSAHS, AHI = 50-100 as severe degree of OSAHS, and AHI ≥ 100 as profound degree of OSAHS.

Salivary pepsin testing for laryngopharyngeal reflux: will it change our management?

PURPOSE OF REVIEW: This review focus on the clinical value of salivary and laryngopharyngeal tissue pepsin measurement in the diagnosis and treatment of laryngopharyngeal reflux (LPR). RECENT FINDINGS: A growing body of research suggests that salivary pepsin detection provides a noninvasive method for the identifying LPR occurrence. Pepsin detection testing is still variable, and an optimal method that balances utility with accuracy has not been agreed. Timing and number of test samples recommended also remains controversial, however literature indicates that increasing the number of tests over a day increases pepsin detection rate. It remains unclear whether detection of pepsin alone can be used to confirm LPR diagnosis. Pepsin positivity is correlated with improved response to proton pump inhibitor (PPI) therapy, and therefore may play a role in guiding therapeutic choices. Detection of pepsin in laryngeal tissue has the same clinical value as detection in saliva and requires further investigation to determine utility. SUMMARY: As a noninvasive method for the diagnosis of LPR, the detection of salivary pepsin in the oropharynx shows potential clinical value, however the exact method of detection and diagnostic values are unclear. Salivary or tissue-based pepsin detection may be helpful in predicting therapeutic effects of PPI and providing personalized treatment options. The detection threshold of salivary pepsin may be different in different countries and regions. Timing and number of samples needed for detection is still controversial.

Reliability and Validity of GRBASzero in Clinical Environments.

PURPOSE: This study aimed to evaluate the reliability and validity of GRBASzero in a real clinical setting. METHODS: The reliability and validity of GRBASzero were assessed using two independent datasets. Dataset 1 included 283 outpatients who underwent both GRBASzero assessment and human expert evaluation. Dataset 2 from the Perceptual Voice Qualities Database comprised 287 voice samples that underwent evaluation by GRBASzero and were subsequently compared with GRBAS (Grade, Roughness, Breathiness, Asthenicity, Strain) ratings provided by human experts. The reliability of GRBASzero was assessed using Fleiss Kappa, while the validity of GRBASzero was examined using the intraclass correlation coefficient. RESULTS: In dataset 1, the test-retest reliability of GRBASzero was poor, with the consistency of features A and S approaching random allocation. Consistency analysis with human experts showed a poor agreement for all features except for B. In dataset 2, there was also a poor agreement between GRBASzero and human experts. CONCLUSION: The reliability and validity of GRBASzero in a real clinical environment are poor and do not meet the requirements for clinical testing, indicating the need for further optimization and improvement.

[Diagnosis and treatment of subglottic mass（report of 5 cases）].

Subglottic masses is very rare. The clinical data of five cases of subglottic mass in our hospital from 2017 to 2022 were summarized, and their clinical manifestations, auxiliary examination findings, treatment plan and pathological features were analyzed. Among the 5 patients, 1 case was subglottic pleomorphic adenoma, 1 case was subglottic granuloma, 1 case was subglottic breast cancer metastasis, 1 case was subglottic primary adenoid cystic carcinoma, and 1 case was immunoglobulin G4-related disease. No recurrence was observed in the patients so far. Subglottic mass is easy to be missed. Therefore, when the lesion is suspected in this area, the examination of ear, nose and throat should be carried out systematically to detect the lesion early and improve the prognosis.

The Consistency Between Symptom Scales and Multi-time Point Salivary Pepsin Test for Diagnosing Laryngopharyngeal Reflux Disease.

OBJECTIVE: To investigate the screening diagnostic value of reflux symptom index (RSI) and reflux symptom score (RSS) for laryngopharyngeal reflux disease (LPRD). METHODS: Fifty-two patients hospitalized in the Department of Otolaryngology-Head and Neck Surgery at The Sixth Medical Center of PLA General Hospital between October 2022 and April 2023 were enrolled in the study. These patients completed the RSS, RSI scales, as well as underwent the multi-time point salivary pepsin test (MTPSPT). Cohen's kappa test and receiver operating characteristic analysis were utilized to assess and compare the diagnostic values of the RSI and RSS. RESULTS: A total of 52 patients, comprising 37 males and 15 females, with a mean age of 44 ± 12 years, were enrolled in the study. The Kappa values between RSS, RSI, and MTPSPT were found to be 0.403 (P < 0.05) and 0.192 (P < 0.05), respectively. When considering MTPSPT as the diagnostic criterion, the sensitivity and specificity of RSS were determined to be 76.70% and 76.90%, respectively, while those of RSI were 41.10% and 42.30%. Additionally, the negative predictive values for RSS and RSI stood at 77.70% and 64.70%, respectively, and their positive predictive values were 94.20% and 57.10%. Furthermore, the area under the curves (AUC) for RSS and RSI were calculated to be 0.677 (95% confidence interval [CI]: 0.464-0.742) and 0.609 (95% CI: 0.533-0.800), respectively. CONCLUSIONS: RSS had a better concordance with multi-time point salivary pepsin test results and AUC values when screening for LPRD.

A Study of the Diagnostic Value of the Sign and Symptom Questionnaires for Laryngopharyngeal Reflux Disease.

OBJECTIVE: To investigate the diagnostic value of symptom questionnaires, sign questionnaires, and the combination of 2 questionnaires for laryngopharyngeal reflux disease (LPRD). STUDY DESIGN: Prospective, single-centered. SETTING: Seventy-seven patients who were hospitalized in the Department of Otolaryngology-Head and Neck Surgery from October 2022 to April 2023 were included. METHODS: Included patients completed the RSS, RSI, RSA, and RFS questionnaires and underwent 24-hour hypopharyngeal-esophageal multichannel intraluminal impedance-pH monitoring (HEMII-pH). The RSS, RSI, RSA, RFS, RSS+RSA, RSS+RFS, RSI+RSA, RSI+RFS, and RSI+RFS diagnostic value were compared using Cohen's k test and receiver operating characteristic analysis. RESULTS: Based on the 24 hours HEMII-pH results, 52 patients had LPRD, and 25 patients did not have LPRD. The Kappa values of RSS, RSI, RSA, RFS, RSS+RSA,2 RSS+RFS, RSI+RSA, and RSI+RFS with the 24 hours HEMII-pH monitoring results were 0.565, 0.442, 0.318, 0.431, 0.517, 0.631, 0.451, and 0.461, respectively. The RSS+RFS questionnaire had the highest AUC of 0.836 (95% confidence interval [CI] 0.762-0.909) and the RSA questionnaire had the lowest AUC (AUC = 0.665, 95% CI 0.560-0.790). The sensitivity of RSS was the highest (98%), the specificities of RSS+RFS and RSI+RFS were the highest (96%), and the specificity of RSS was the lowest (52%). RSS+RFS had a sensitivity of 75%, second only to RSS and RFS (76%). CONCLUSION: Among the 8 methods, the RSS combined with the RFS had the highest concordance with 24 hours HEMII-pH monitoring results and AUC values when screening for LPRD.

The Time-Point Distribution Characteristics of Laryngopharyngeal Reflux in Elderly Patients.

OBJECTIVE: To identify the characteristics of the time-point distribution of the occurrence of hypopharyngeal-proximal reflux episodes (HREs) in elderly and younger patients with laryngopharyngeal reflux (LPR). STUDY DESIGN: Retrospective cohort study. SETTING: Analysis of data from patients with LPR-related symptoms and 24-hour hypopharyngeal-esophageal multichannel intraluminal impedance-pH (24-hour HEMII-pH) monitoring from February 2017 to September 2022 at Sixth Medical Center of PLA General Hospital. METHODS: Patients were divided into 2 age groups: the elderly group (>60 years) and the younger group (≤60 years). The time series of HREs and meals within 24 hours were analyzed based on HEMII-pH. RESULTS: A total of 305 patients were included (126 elderly patients). In younger patients, except for nonacid-gas HREs, the incidence of the remaining types of HREs tended to increase within 2 hours after meals, especially after dinner. The incidence of all types of HREs pre- and postmeal was not significantly different in the elderly group (χ2 = 0.080, P = .777). The incidence of nighttime HREs in elderly patients was statistically higher than in younger patients (6.23% vs 3.96%, P = .030), particularly acid-/nonacid-liquid HREs. CONCLUSION: HREs tend to increase within 2 hours after meals in younger LPR patients, except for nonacid-gas HREs. In elderly LPR patients, the incidence of all types of HREs pre- and postmeal were not significantly different, and nighttime fluid HREs was more prone to occur than in younger patients.

Tumoral Calcinosis in the Larynx.

Tumoral calcinosis is a rare benign disease defined as calcium salt deposits in the periarticular soft tissue region. Tumoral calcinosis is rare in the neck and larynx. In this case, we described a 58-year-old man who had numerous calcified nodules in the larynx.

Can pepsin immunohistochemical staining of laryngeal lesions accurately diagnose non-acid laryngeal reflux?

BACKGROUND: Non-acid reflux is the most common form of laryngopharyngeal reflux (LPR). However, the damage caused by non-acid reflux to the laryngeal mucosa is weaker than that caused by acid reflux. AIMS: To evaluate whether pepsin immunohistochemical (IHC) staining of laryngeal lesions can accurately diagnose acidic and non-acidic LPR. MATERIALS AND METHODS: Hypopharyngeal-esophageal multichannel intraluminal impedance-pH monitoring was performed, and the patients were divided into acid reflux and non-acid reflux groups. Pathological sections of laryngeal lesions were examined using pepsin IHC staining, which was positive when pepsin was detected in the cytoplasm. RESULTS: The study included 136 patients, with 58 in the acid reflux group, 43 in the non-acid reflux group, and 35 in the without reflux group. There were no significant differences in the positive rate of pepsin IHC staining between the non-acid and acid reflux groups (p = .421). The sensitivity of pepsin IHC staining for the diagnosis of acid and non-acid reflux was 94.8% and 90.7%, respectively. CONCLUSIONS: The sensitivity of pepsin IHC staining for laryngeal lesions in the diagnosis of non-acidic LPR is satisfactory. SIGNIFICANCE: Pepsin IHC staining is suitable for LPR screening of patients with laryngeal lesions as it is economical, non-invasive, and highly sensitive.