Laryngopharyngeal reflux (LPR) is commonly treated with empiric acid suppression. More evidence points to pepsin in the pathophysiology of LPR. Previous studies have evaluated esophageal impedance in patients who had previously failed high dose proton pump inhibitor (PPI) using older catheters without proximal esophageal (just under the upper esophageal sphincter) and pharyngeal impedance sensors. The aim of this study was to compare what traditional diagnostic tools, used for esophageal reflux, would detect and diagnose compared with what a combined hypopharyngeal-esophageal MII catheter with dual pH (HEMII-pH) can detect in the esophagus and pharynx in patients with suspected LPR.
Forty-two subjects with presumed LPR were referred for HEMII-pH testing. The number of distal and proximal esophageal impedance events, number of pharyngeal impedance events, symptom correlation, and event acidity were recorded. Previous normative values (>1 pharyngeal impedance events every 24 hours) were used to designate what was pathological LPR on HEMII-pH.
Forty-two total subjects had pharyngeal impedance sensor data recorded. Twelve (28.6%) of the subjects were tested while taking high-dose PPI therapy. The mean number of proximal esophageal events was 23.3. The mean number of pharyngeal impedance events was 10. Thirty-four subjects (81%) tested positive for pharyngeal reflux. All patients who tested positive using traditional proximal impedance criteria also tested positive using pharyngeal criteria. Of patients who tested negative using traditional criteria, 72% were positive based on pharyngeal criteria.
HEMII-pH catheters should be considered in patients with LPR symptoms. Traditional criteria used for diagnosing esophageal reflux may not translate into LPR.
Level of Evidence
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- Changing patterns in reflux care: 10-year comparison of ABEA members.Ann Otol Rhinol Laryngol. 2015; 124: 940-946
- Esophageal ph-impedance monitoring in patients with therapy-resistant reflux symptoms: “on” or “off” proton pump inhibitor?.Am J Gastroenterol. 2008; 103: 2446-2453
- Pepsin detection in patients with laryngopharyngeal reflux before and after fundoplication.Surg Endosc. 2011; 25: 3870-3876
- Safety of long-term PPI therapy.Best Pract Res Clin Gastroenterol. 2013; 27: 443-454
- Hoarseness: is it really laryngopharyngeal reflux?.Laryngoscope. 2008; 118: 363-366
- Reflux symptom index and reflux finding score in otolaryngologic practice.J Voice. 2012; 26: e123-e127
- Twenty-four-hour ambulatory simultaneous impedance and pH monitoring: a multicenter report of normal values from 60 healthy volunteers.Am J Gastroenterol. 2004; 99: 1037-1043
- Validity and reliability of the Reflux Symptom Index (RSI).J Voice. 2002; 16: 274-277
- The validity and reliability of the Reflux Finding Score (RFS).Laryngoscope. 2001; 111: 1313-1317
- Meta-analysis of upper probe measurements in normal subjects and patients with laryngopharyngeal reflux.Ann Otol Rhinol Laryngol. 2005; 114: 177-182
- The reliability of the assessment of endoscopic laryngeal findings associated with laryngopharyngeal reflux disease.Laryngoscope. 2002; 112: 1019-1024
- Dual pH with multichannel intraluminal impedance testing in the evaluation of subjective laryngopharyngeal reflux symptoms.Otolaryngol Head Neck Surg. 2016; 155: 1014-1020
- First agreement analysis and day-to-day comparison of pharyngeal pH monitoring with pH/impedance monitoring in patients with suspected laryngopharyngeal reflux.J Gastrointest Surg. 2012; 16: 1096-1101
- The effect of antireflux surgery on laryngeal symptoms, findings and voice parameters.Eur Arch Otorhinolaryngol. 2015; 272: 3375-3383
- Antireflux surgery in patients with chronic cough and abnormal proximal exposure as measured by hypopharyngeal multichannel intraluminal impedance.JAMA Surg. 2013; 148: 608-615
- Normal values of pharyngeal and esophageal 24-hour pH impedance in individuals on and off therapy and interobserver reproducibility.Clin Gastroenterol Hepatol. 2013; 11: 366-372
- Omeprazole does not reduce gastroesophageal reflux: new insights using multichannel intraluminal impedance technology.J Gastrointest Surg. 2004; 8: 888-896
- How much pharyngeal exposure is “normal”? Normative data for laryngopharyngeal reflux events using Hypopharyngeal Multichannel Intraluminal Impedance (HMII).J Gastrointest Surg. 2012; 16: 16-25
- ACG practice guidelines: esophageal reflux testing.Am J Gastroenterol. 2007; 102: 668-685
- pH impedance and high-resolution manometry in laryngopharyngeal reflux disease high-dose proton pump inhibitor failures.Laryngoscope. 2012; 122: 2473-2481
- Pepsin as a marker of extraesophageal reflux.Ann Otol Rhinol Laryngol. 2010; 119: 203
- Pepsin as a causal agent of inflammation during nonacidic reflux.Otolaryngol Head Neck Surg. 2009; 141: 559-563
- Nissen fundoplication for laryngopharyngeal reflux after patient selection using dual pH, full column impedance testing: a pilot study.Ann Otol Rhinol Laryngol. 2016; 125: 722-728
- Injection augmentation for chronic cough.J Voice. 2015; 29: 763-767
- Symptom overlap between laryngopharyngeal reflux and glottic insufficiency in vocal fold atrophy patients.Ann Otol Rhinol Laryngol. 2014; 123: 265-270
Published online: August 03, 2018
Accepted: March 13, 2018
© 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.