New York University Voice Center, Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, New York, U.S.A.
Laryngoscope. 2014 Jun;124(6):1420-4. doi: 10.1002/lary.24483. Epub 2013 Dec 9.
OBJECTIVES/HYPOTHESIS: To characterize the videoendoscopic laryngeal findings in patients with a prior established diagnosis of laryngopharyngeal reflux disease (LPR) as the sole etiology for their chief complaint of hoarseness. We hypothesized that many, if not all, of these patients would present with discrete laryngeal pathology, divergent from LPR.
Prospective, nonintervention.
Patients presenting to a tertiary laryngology practice with an established diagnosis of LPR as the sole etiology of their hoarseness were included. All subjects completed the Voice Handicap Index and Reflux Symptom Index, in addition to a questionnaire regarding their reflux diagnosis and prior treatment. Laryngoscopic examinations were reviewed by the laryngologist caring for the patients. Reliability of findings was assessed by interpretation of videoendoscopic findings by three outside laryngologists not involved in the care of the patients.
Laryngeal pathology distinct from LPR was identified in all 21 patients felt to be causative of the chief complaint of dysphonia. Specifically, the most common findings were benign mucosal lesions and vocal fold paresis (29% each), followed by muscle tension dysphonia (14%). Two patients were found to have vocal fold leukoplakia, of which one was confirmed to be a microinvasive carcinoma upon removal.
LPR may be overdiagnosed; other etiologies must be considered for patients with hoarseness who fail empiric LPR treatment.
目的/假设：描述先前被诊断为喉咽反流病（LPR）的患者的视频内镜下喉部表现，这些患者的主要抱怨是声音嘶哑，我们假设这些患者中的许多（如果不是全部）人都会出现离散的、与 LPR 不同的喉部病变。
前瞻性、非干预性。
将因 LPR 是唯一病因而出现声音嘶哑的患者纳入到一家三级喉科诊所。所有患者均完成嗓音障碍指数和反流症状指数评估，以及与反流诊断和既往治疗相关的问卷。由负责患者护理的喉镜医生对喉镜检查进行回顾。由三名未参与患者治疗的外部喉镜医生对视频内镜检查结果进行解读，以评估检查结果的可靠性。
所有被认为是导致主要抱怨声音嘶哑的 21 例患者都存在与 LPR 不同的喉部病变。具体而言，最常见的发现是良性黏膜病变和声带瘫痪（各占 29%），其次是肌肉紧张性发声障碍（14%）。两名患者发现有声带白斑，其中一名在切除后被确诊为微浸润性癌。
LPR 可能被过度诊断；对于经验性 LPR 治疗失败的声音嘶哑患者，必须考虑其他病因。
4 级。
