[Treatment of laryngeal pathology associated with gastroesophageal reflux disease]. / Lechenie patologii gortani, assotsiirovannoi s gastroezofageal'noi reflyuksnoi bolezn'yu.

OBJECTIVE: To increase the effectiveness of the treatment of laryngeal pathology associated with gastroesophageal reflux disease (GERD), to determine the indications for the appointment of anti-inflammatory therapy to these patients. MATERIAL AND METHODS: 120 patients were examined and treated, 58 of them men and 62 women, aged 30 to 82 years with GERD-associated laryngeal pathology. Three groups of patients were formed, comparable in age and gender, in accordance with the type of pachydermia in interarytenoid region; type 1 (40 patients) - pachydermia did not go beyond the middle of the interarytenoid cartilage (according to G.F. Ivanchenko), less than 3 mm, without signs of perifocal inflammation; type 2 (40 patients) - pachydermia of large size, extending beyond the middle of the interarytenoid cartilage with a spread to the entire interarytenoid region (according to G.F. Ivanchenko), often in combination with hyperkeratosis or epithelial dysplasia; type 3 (30 patients) - pachydermia of large size in combination with severe perifocal inflammation. All patients received antireflux therapy. Each group is divided into two subgroups: patients who did not receive anti-inflammatory therapy, and patients who received anti-inflammatory therapy, the basis of which was inhalation with degassed alkaline mineral water, as well as according to indications acetylcysteine, benzyldimethylammonium chloride 0.01% or hydroxymethylquinoxalindioxide, with severe swelling of the mucous membrane - budesonide. All patients completed the questionnaire "Reflux Symptoms Scale" before and after treatment. RESULTS: In group 2 patients (with type 2 pachydermia), the effectiveness of anti-inflammatory therapy was 75%. Of the 20 patients in this group, after inhaled therapy, 4 patients had pachydermia in interarytenoid region disappeared, 11 patients had type 1 pachydermia visualized, 5 (25%) patients had no pronounced dynamics. In group 3 patients (with type 3 pachydermia), the effectiveness of inhaled treatment was 100%, out of 15 patients after inhaled therapy, type 2 pachydermia was diagnosed in 8 patients, type 1 pachydermia - in 7 patients. In 4 patients, complex therapy led to the complete disappearance of reflux-associated laryngeal granulomas without surgical treatment. The effectiveness of inhaled therapy in relation to patient complaints after a month was 87%, while the effectiveness of treatment of patients without inhalation was 45%. CONCLUSIONS: Indications for the appointment of inhaled anti-inflammatory therapy in patients with reflux-associated pathology of the larynx are the presence of complaints of hoarseness, dryness, tickling, lump in the throat and chronic cough, endolaryngoscopic signs of exacerbation of chronic inflammation of the mucous membrane of the posterior larynx.

[Screening for laryngeal disease in patients with gastroesophageal reflux disease]. / Skrining zabolevanii gortani u patsientov s gastroezofageal'noi reflyuksnoi bolezn'yu.

OBJECTIVE: To improve the diagnosis of laryngeal disease in patients with gastroesophageal reflux disease (GERD). MATERIAL AND METHODS: 171 patients (89 (52%) men, 82 (48%) women) with non-erosive (39 (23%) people) and erosive (132 (77%) people) forms of GERD were examined. None of the patients made active complaints about the condition of the larynx and pharynx. The examination included a questionnaire, examination by an otorhinolaryngologist, and videoendolaryngoscopy. RESULTS: The survey revealed the presence of symptoms of otorhinolaryngological pathology in 74% of patients. Videolaryngoscopy revealed no laryngeal pathology in 55 (32%) patients, and signs of GERD-associated laryngitis were detected in 116 (68%) patients. The most common pathology was pachydermia in interarytenoid region - in 89 people, laryngeal granuloma was detected in 7 patients, leukoplakia - in 2 patients, chronic edematous polypous laryngitis - in 2 patients, benign laryngeal formations - in 9 patients. In patients with GERD (erosive and non-erosive forms), an asymptomatic course of chronic laryngitis associated with this pathology was observed in 44% of cases. In 52% of patients, pachydermia in interarytenoid region was diagnosed, of which every second had pronounced hyperplasia and folding of the mucous membrane in interarytenoid region, which must be differentiated from laryngeal cancer (in this case, patients should be under the dynamic supervision of an otorhinolaryngologist). Other precancerous formations of the larynx (granulomas and leukoplakia) were found in 5% of patients. Benign neoplasms of the larynx (polyps and cysts) were also detected in 5% of cases. CONCLUSIONS: Despite the high frequency of detection of otorhinolaryngological diseases in the examined patients with gastroesophageal reflux disease, none of the patients presented complaints related to the pathology of the larynx, which indicates the need for active detection of this pathology in this category of patients by questioning, questioning, as well as examination by an otorhinolaryngologist.