Diagnosis of Laryngopharyngeal Reflux Disease in Patients with Voice Disorders Using Combined Multi-channel Intraluminal Impedance and pH Monitoring (MII-pH)


Authors: J. Vydrová 1;  P. Brandtl 2;  J. Dubová 1;  O. Bendová 1;  F. Šram 1;  R. Domagalská 1
Authors‘ workplace: Hlasové a sluchové centrum , Praha, Medical Healthcom, s. r. o., Praha 1;  Centrum pro diagnostiku gastroenterologických chorob, Praha 2
Published in: Otorinolaryng. a Foniat. /Prague/, 62, 2013, No. 4, pp. 191-197.
Category: Original Papers

Overview

The penetration of duodenogastric contents, i.e. refluxed fluid, above the upper esophageal sphincter (UES) is often responsible for voice disorders and other symptoms in ENT. In the last decade, the method of combined multichannel intraluminal impedance and pH monitoring (MII-pH) was developed for reflux diagnosis but has not yet been sufficiently tested on patients with voice disorders. The aim of this work was to find out on the sensitivity and usefulness of this method for diagnosing laryngopharyngeal reflux disease (LPRD) in voice disorders.

Methods:
111 patients with voice disorders were selected based on pathological findings on laryngeal mucosa diagnosed through laryngeal stroboscopy (Reflux Finding Score over 7) and Reflux Symptom Index value over 13. These patients underwent 24 hours MII-pH monitoring in order to determine the extent and pH of the reflux episodes.

Results:
Episodes of acidic or weakly acidic reflux through the upper esophageal sphincter (UES) were detected in 94% of the patients. In 98% subjects these episodes reached the Z2 sensor located 2 cm distal from the upper edge of the esophageal sphincter. In 100% of the subjects the refluxate reached the Z3 sensor located 4 cm distally from the upper edge of the esophageal sphincter. The pH of the reflux episodes reaching the UES was weekly acidic in 20% patients, both acidic and weakly acidic in 71% acidic in only 3% patients. The De Meester score was abnormal in only 38% of patients.

Discussion and conclusion:
The sensitivity of the combined MII-pH was found to be highly superior to the traditional methods. Single channel pH metry (de Meester score) would have neglected reflux findings in 62% and the double-channel pH metry in 20% of patients, thereby reducing the chance of LPRD being correctly diagnosed and treated. The MII-pH is considered to be a highly useful method for detecting LPRD in patients with voice disorders.

Keywords:
voice disorders, laryngopharyngeal reflux, Multichannel intraluminal impedance, gastroenterology


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Audiology Paediatric ENT ENT (Otorhinolaryngology)
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