Dymek Andrzej, Dymek Lucyna, Starczewska-Dymek Liwia, Bożek Andrzej, Dymek Tomasz, Nowak Krzysztof
Centrum Medyczne Lucyna Andrzej Dymek NZOZ s.c. Strzelce Opolskie.
Otolaryngol Pol. 2012 Jan-Feb;66(1):33-8. doi: 10.1016/S0030-6657(12)70746-1.
INTRODUCTION: In 2006 The Global Consensus Group in Montreal pointed out that chronic laryngitis is highly associated with gastroesophageal reflux disease (GERD). AIM OF THE STUDY: To evaluate the frequency of LPR in a selected group of patients with chronic hoarseness. We were also interested in assessment of the relationship between Reflux Symptoms Index (RSI) scores, Ryan scores from the pharyngeal pH monitoring and the morphological changes in the larynx according to Reflux Findings Score (RFS). In addition, we wanted to assess the frequency of various clinical symptoms included in the RSI questionnaire among patients with LPR. MATERIALS AND METHODS: 42 patients from an outpatient ENT clinic with chronic hoarseness and RSI ≥ 13. All subjects underwent pharyngeal pH monitoring with the Dx-pH System Restech ™ and laryngoscopy. RESULTS: Among 42 patients with chronic hoarseness, LPR was confirmed in 35 patients (83.33%). In 7 subjects pharyngeal pH monitoring was normal. Among all patients with confirmed LPR, only 5 out of 8 elements of RFS laryngoscopic changes were observed. The most frequent inflammatory changes noticed included erythema of the arytenoids and interarytenoid regions (posterior laryngitis). These findings were found in 30 out of 35 patients with LPR. Median value of RFS in patients with LPR was 4.45, which is lower than the cut off value of 7 necessary for recognition of LPR. There is statistically significant positive correlation between Ryan scores and the RFS scale results (correlation coefficient 0.91, p<0.001). CONCLUSIONS: Pharyngeal pH monitoring confirmed LPR in 83.33% selected group of patients with chronic hoarseness and RSI ≥ 13. Isolated erythema of arytenoid and interarytenoid region was the most frequent inflammatory abnormality found in the larynx. RFS values below 7 do not exclude the diagnosis of LPR. We can use RFS scales as a prognostic test of severity of LPR - due to statistically significant positive correlation between Ryan score and RFS values. The use of RSI scale revealed that the most frequent symptom among patient with LPR was throat clearing followed by hoarseness.
引言：2006年，蒙特利尔全球共识小组指出，慢性喉炎与胃食管反流病（GERD）高度相关。 研究目的：评估一组选定的慢性声音嘶哑患者中喉咽反流（LPR）的发生率。我们还对评估反流症状指数（RSI）评分、咽pH监测的瑞安评分与根据反流发现评分（RFS）得出的喉部形态学变化之间的关系感兴趣。此外，我们想评估LPR患者中RSI问卷所包含的各种临床症状的发生率。 材料与方法：42例来自门诊耳鼻喉科诊所的慢性声音嘶哑且RSI≥13的患者。所有受试者均使用Dx-pH System Restech™进行咽pH监测和喉镜检查。 结果：在42例慢性声音嘶哑患者中，35例（83.33%）确诊为LPR。7例受试者的咽pH监测结果正常。在所有确诊为LPR的患者中，RFS喉镜检查变化的8项指标中仅观察到5项。最常见的炎症变化包括杓状软骨和杓间区红斑（喉后部炎症）。在35例LPR患者中有30例出现这些表现。LPR患者的RFS中位数为4.45，低于识别LPR所需的临界值7。瑞安评分与RFS量表结果之间存在统计学显著正相关（相关系数0.91，p<0.001）。 结论：咽pH监测在83.33%选定的慢性声音嘶哑且RSI≥13的患者中确诊为LPR。杓状软骨和杓间区孤立性红斑是喉部最常见的炎症异常。RFS值低于7并不能排除LPR的诊断。由于瑞安评分与RFS值之间存在统计学显著正相关，我们可以将RFS量表用作LPR严重程度的预后测试。使用RSI量表显示，LPR患者中最常见的症状是清嗓，其次是声音嘶哑。
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