The significance of laryngopharyngeal reflux in benign vocal mucosal lesions.

ABSTRACT

OBJECTIVE: To determine the significance of laryngopharyngeal reflux (LPR) in benign vocal mucosal lesions. STUDY DESIGN AND SETTING: A case-control study at the tertiary referral medical center. SUBJECTS AND METHODS: From April 2003 to December 2006, we studied 110 patients with benign vocal mucosal lesions who had undergone 24-hour ambulatory double pH monitoring. The control group included 200 patients who had undergone ambulatory 24-hour double-probe pH monitoring due to laryngopharyngeal reflux-related symptoms without specific findings of benign vocal mucosal lesions. Reflux symptom index and reflux finding score were measured. We compared the prevalence of pathologic laryngopharyngeal reflux and various parameters of the pH monitoring such as total reflux number, fraction time of pH below 4 in various positions, and DeMeester scores. RESULTS: The prevalence of pathologic laryngopharyngeal reflux was 65 percent in the control group, 66 percent in vocal nodule group, 75 percent in the vocal polyp group, and 90 percent in the Reinke's edema group. Patients with Reinke's edema had a significantly higher prevalence of pathologic laryngopharyngeal reflux than controls (P = 0.016). LPR was associated with a significantly increased risk of Reinke's edema (odds ratio 4.846, 95% confidence interval 1.093 approximately 21.492). Total reflux number and DeMeester scores in the Reinke's edema group and fraction time of pH below 4 in the supine position in the vocal polyp group were significantly higher than those in the control group. CONCLUSION: Laryngopharyngeal reflux might play a role as an etiologic factor in Reinke's edema and vocal polyps.