喉再训练疗法改善疑似喉咽反流病患者的咽喉症状。
Laryngeal Recalibration Therapy Improves Laryngopharyngeal Symptoms in Patients With Suspected Laryngopharyngeal Reflux Disease.
机构信息
Department of Otolaryngology, University of California San Diego, La Jolla, California, USA.
Department of Medicine, Division of Gastroenterology and Hepatology, University of California San Diego, La Jolla, California, USA.
出版信息
Am J Gastroenterol. 2024 Nov 1;119(11):2198-2205. doi: 10.14309/ajg.0000000000002839. Epub 2024 Apr 24.
INTRODUCTION
Laryngopharyngeal symptoms such as cough, throat clearing, voice change, paradoxic vocal fold movement, or laryngospasm are hyper-responsive behaviors resulting from local irritation (e.g., refluxate) and heightened sympathetic tone. Laryngeal recalibration therapy (LRT) guided by a speech-language pathologist (SLP) provides mechanical desensitization and cognitive recalibration to suppress hyper-responsive laryngeal patterns. The aim of this study was to assess symptom response to LRT among patients with chronic laryngopharyngeal symptoms undergoing evaluation of gastroesophageal reflux disease (GERD).
METHODS
Adults with chronic laryngopharyngeal symptoms referred for evaluation of GERD to a single center were prospectively followed. Inclusion criteria included ≥2 SLP-directed LRT sessions. Data from endoscopy, ambulatory reflux monitoring, and patient-reported outcomes were collected when available. The primary outcome was symptom response.
RESULTS
Sixty-five participants completed LRT: mean age 55.4 years (SD 17.2), 46 (71%) female, mean body mass index 25.6 kg/m 2 (6.8), and mean of 3.7 (1.9) LRT sessions. Overall, 55 participants (85%) met criteria for symptom response. Specifically, symptom response was similar between those with isolated laryngopharyngeal symptoms (13/15, 87%) and concomitant laryngopharyngeal/esophageal symptoms (42/50, 84%). Among participants who underwent reflux monitoring, symptom response was similar between those with proven, inconclusive for, and no GERD (18/21 [86%], 8/9 [89%], 10/13 [77%]).
DISCUSSION
Eighty-five percent of patients with chronic laryngopharyngeal symptoms referred for GERD evaluation who underwent LRT-experienced laryngeal symptom response. Rates of symptom response were maintained across patients with or without proven GERD and patients with or without concomitant esophageal reflux symptoms. SLP-directed LRT is an effective approach to incorporate into multidisciplinary management of chronic laryngopharyngeal symptoms/laryngopharyngeal reflux disease.
简介
咳嗽、清嗓、声音改变、声门反常运动或喉痉挛等喉咽症状是由于局部刺激（例如反流物）和交感神经张力增加而导致的过度反应行为。由言语语言病理学家（SLP）指导的喉再训练疗法（LRT）提供机械脱敏和认知再校准，以抑制过度反应性的喉模式。本研究的目的是评估接受胃食管反流病（GERD）评估的慢性喉咽症状患者对 LRT 的症状反应。
方法
前瞻性地随访因 GERD 评估而到单中心就诊的慢性喉咽症状成人患者。纳入标准包括≥2 次 SLP 指导的 LRT 疗程。当有可用数据时，收集内镜检查、动态反流监测和患者报告的结果数据。主要结局是症状反应。
结果
65 名参与者完成了 LRT：平均年龄 55.4 岁（标准差 17.2），46 名（71%）女性，平均体重指数 25.6kg/m 2 （6.8），LRT 疗程平均为 3.7（1.9）次。总体而言，55 名参与者（85%）符合症状反应标准。具体而言，孤立性喉咽症状（13/15，87%）和同时存在喉咽/食管症状（42/50，84%）的患者之间的症状反应相似。在接受反流监测的参与者中，在有明确证据、不确定证据和无 GERD 的患者之间，症状反应相似（18/21 [86%]，8/9 [89%]，10/13 [77%]）。
讨论
85%因 GERD 评估而接受 LRT 的慢性喉咽症状患者经历了喉症状反应。在有明确或无 GERD 以及有或无同时存在的食管反流症状的患者中，症状反应的发生率保持不变。SLP 指导的 LRT 是一种有效的方法，可纳入慢性喉咽症状/喉咽反流病的多学科管理中。
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