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| |  Reflux-Associated Laryngitis, Laryngopharyngeal Reflux Symptoms Often Misdiagnosed as Respiratory Issues: Presented at AAO-HNSF By Kristina Rebelo SAN DIEGO -- October 9, 2009 -- Reflux-associated laryngitis and laryngopharyngeal reflux (LPR), common but oftentimes missed conditions, should be within differential diagnoses in patients with pharyngeal and laryngeal symptoms not associated with upper-respiratory disease in the presence or in the absence of gastro-oesophageal reflux disease (GERD). Said M. Said Al-Jaaf, MD, College of Medicine, Hawler Medical University, Rizgary Teaching Hospital, Kurdistan, Iraq, presented a prospective study during a poster presentation here on October 4 at the American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) Annual Meeting 2009. This study documented some of the common presenting symptoms of LPR in 132 patients over 2 years (2006-2008) in the Kurdistan Region of Iraq. “As a clinical entity with many symptoms, LPR is not a rare condition in the Kurdistan Region of Iraq, but unfortunately, treating physicians can miss this condition and file the symptoms under other diseases,” Dr. Al-Jaaf told DocGuide. “LPR is particularly daunting to diagnose when there are nonsignificant, vague respiratory symptoms of unknown etiology -- nonpulmonary causes.” Patients were evaluated using a special questionnaire that asked them to describe the following symptoms: persistent chronic cough; globus sensation, globus hystericus; throat clearing; voice changes; regurgitation; heartburn; symptoms of peptic ulcer disease; and other nonspecific respiratory symptoms. Together these symptoms, plus laryngoscopic findings and pre-and post-antireflux therapy, were all recorded; esophagogastroduodenoscopy had been previously recorded at presentation. The study found that the primary pathophysiologic mechanisms of LPR in their study population at presentation were respiratory with persistent irritative cough (92%); scratchy throat (85%); globus pharynges (83%); and cricopharyngeal spasm (57%). Endoscopic findings revealed gastroduodenitis (5%); nonspecific gastritis (9%); duodenal ulcer (2%); and there were normal findings in 62.7%. Laryngoscopic findings were primarily posterior commissure (82%); vocal cord oedema (74%); laryngeal erythema (77%); and subglottic oedema (24%). One of the limitations in the study, according to Dr. Said Al-Jaaf, was that the follow-up of the patients was only for the study period. He recommends that patients be seen periodically, at least twice per year if symptomatic. “Management of LPR should be multidisciplinary; it should be teamwork,” said Dr. Said Al-Jaaf. “There should be a strategic plan with patients being followed not only by an otolaryngologist, but a gastroenterologist as well. Laryngoscopic finding were of value in the diagnosis of the changes in laryngeal mucosa pre- and post-medical treatment; I suggest this be kept in mind.”
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