The utility of oropharyngeal pHmetry in the diagnosis and treatment of laryngopharyngeal reflux
DOI:
https://doi.org/10.34631/sporl.2197Keywords:
pharyngolaryngeal reflux, oropharyngeal pHmetry, reflux protocol, reflux diagnosis, reflux treatment, acid refluxAbstract
Introduction: Laryngopharyngeal reflux is a chronic illness with variable and unspecific symptoms, representing up to 10% of otolaryngology appointments. Its diagnosis and treatment are controversial, with high rates of treatment failure. Oropharyngeal pHmetry is an objective diagnosis method that measures both liquid and gaseous pH variations in the oropharynx, having previously demonstrated a higher diagnosis value than esophageal pHmetry.Methods: Prospective observational study. Thirty patients who were observed in otolaryngology appointments between May 2022 and May 2023 were referred to the study (observed by an otolaryngologist who suspected of laryngopharyngeal reflux and referred the patients). Patients fulfilled Reflux Symptom Index and Voice-Handicap Index-10, were submitted to flexible nasofibrolaryngoscopy with posterior fulfillment of the Reflux Finding Score and oropharyngeal pHmetry. Posteriorly, underwent treatment of 3 months with protein pump inhibitors (esomeprazol 40mg twice daily). Response to treatment was defined as an improvement of at least 5 points in the reflux symptom index. Based on the obtained results and literature review, we propose a protocol of diagnostic and treatment approach for laryngopharyngeal reflux.
Results: 28 patients were included in the study, 75% female, aged µ=53,5 years and body mass index µ=28.6. Regarding pHmetry, 63% had acid reflux (15% slight, 37% moderate e 11% severe), 26% had non-acid reflux and 11% had normal pHmetry. After 3 months of proton-pump inhibitors 50% of patients had no significant improvement in their symptoms. Oropharyngeal pHmetry predicted treatment response in 26 out of 28 patients (93%). The correlation of acid events with symptom events had a significant correlation with proton-pump inhibitor response (p<0.01), as well as Ryan score positivity (p<0.01). In patients responsive to treatment, the average of reflux symptom index improvement was 13,7 points. Reflux Symptom Index, Reflux Finding Score and Body Mass Index had a statistically significant correlation with the severity of acid reflux (slight, moderate or severe) but not with the type of reflux (acid vs non-acid).
Conclusions: This study demonstrates that oropharyngeal pHmetry is an effective method for differentiating acid and non-acid Laryngopharyngeal reflux, effectively predicting proton-pump inhibitor treatment response, being useful from the moment of diagnosis or in treatment adjustment for proton-pump inhibitor refractory patients.
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