Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, Ostrava, Czech Republic.
Department of Craniofacial Surgery, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic.
JAMA Otolaryngol Head Neck Surg. 2022 Aug 1;148(8):773-778. doi: 10.1001/jamaoto.2022.1638.
To the authors' knowledge, no prior studies have examined the association between inferior turbinate hypertrophy (ITH) and extraesophageal reflux (EER). If EER were a cause or cofactor of ITH, antireflux treatment can be considered prior to surgical intervention.
To evaluate EER presence and severity in patients with different degrees of ITH.
DESIGN, SETTING, AND PARTICIPANTS: Prospective multicentric cohort study conducted at 3 referral centers treating patients with EER and certified for 24-hour monitoring of oropharyngeal pH. The monitoring was performed between October 2020 and October 2021. A total of 94 adult patients with EER symptoms were recruited, 90 of whom were analyzed.
Nasal endoscopy was performed to determine the degree of ITH, according to the Camacho classification. Presence and severity of EER were examined using 24-hour monitoring of oropharyngeal pH.
Primary outcomes were presence of EER according to RYAN Score, total percentage of time below pH 5.5, and total numbers of EER events below pH 5.5.
Of the 90 analyzed patients (median [IQR] age, 46 [33-58] years; 36 [40%] male patients), 41 had a maximum of second-degree ITH (group 1), and 49 patients had at least third-degree ITH (group 2), according to the Camacho classification. On the basis of the RYAN Score, EER was diagnosed more often in group 2 (69.4%) than in group 1 (34.1%; difference, 35.3% [95% CI, 13.5%-56.9%]). Moreover, compared with group 1, group 2 exhibited higher median total percentage of time below pH 5.5 (median [IQR], group 1: 2.1% [0.0%-9.4%], group 2: 11.2% [1.5%-15.8%]; difference, 9.1% [95% CI, 4.1%-11.8%]) and higher median total number of EER events (median [IQR], group 1: 6 [1-14] events, group 2: 14 [4-26] events; difference, 8 [95% CI, 2-15] events). Patients with proven EER demonstrated no difference in the degree of ITH between the right and left nasal cavity (Cohen g, -0.17 [95% CI, -0.50 to 0.30]), or between the anterior and posterior parts of the nasal cavity (Cohen g, -0.21 [95% CI, -0.50 to 0.17]).
In this cohort study, patients with a higher degree of ITH had more severe EER. A possible association between severe ITH and EER was demonstrated.
据作者所知，尚无研究探讨下鼻甲肥大（ITH）与食管外反流（EER）之间的关系。如果 EER 是 ITH 的病因或促成因素，那么可以考虑在手术干预之前进行抗反流治疗。
评估不同程度 ITH 患者的 EER 存在和严重程度。
设计、地点和参与者：这是一项在 3 个转诊中心进行的前瞻性多中心队列研究，这些中心专门治疗 EER 患者，并通过 24 小时监测口咽 pH 值进行认证。监测于 2020 年 10 月至 2021 年 10 月进行。共招募了 94 名有 EER 症状的成年患者，其中 90 名进行了分析。
进行鼻内镜检查以根据 Camacho 分类确定 ITH 的程度。使用 24 小时监测口咽 pH 值来检查 EER 的存在和严重程度。
主要结局是根据 RYAN 评分判断 EER 的存在、总 pH 值<5.5 的时间百分比和总 pH 值<5.5 的 EER 事件数。
在 90 名接受分析的患者中（中位数[IQR]年龄为 46[33-58]岁；36[40%]为男性患者），根据 Camacho 分类，41 名患者最大程度地患有二级 ITH（第 1 组），49 名患者患有至少三级 ITH（第 2 组）。根据 RYAN 评分，第 2 组（69.4%）比第 1 组（34.1%）更常诊断出 EER（差异为 35.3%[95%CI，13.5%-56.9%]）。此外，与第 1 组相比，第 2 组的总 pH 值<5.5 的中位时间百分比更高（中位数[IQR]，第 1 组：2.1%[0.0%-9.4%]，第 2 组：11.2%[1.5%-15.8%]；差异为 9.1%[95%CI，4.1%-11.8%]），总 EER 事件数也更高（中位数[IQR]，第 1 组：6[1-14]次，第 2 组：14[4-26]次；差异为 8[95%CI，2-15]次）。在 EER 得到证实的患者中，右侧和左侧鼻腔之间的 ITH 程度没有差异（Cohen g，-0.17[95%CI，-0.50 至 0.30]），或鼻腔前后部分之间的 ITH 程度也没有差异（Cohen g，-0.21[95%CI，-0.50 至 0.17]）。
在这项队列研究中，ITH 程度较高的患者 EER 更严重。证明了严重 ITH 与 EER 之间可能存在关联。
