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Sagandykova K, Papulova N, Azhenov T, Darbekova A, Aigozhina B, Lechien JR. Endoscopic Features of Chronic Rhinosinusitis in Patients with Gastroesophageal Reflux Disease. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1257. [PMID: 39202538 PMCID: PMC11356763 DOI: 10.3390/medicina60081257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 07/12/2024] [Accepted: 07/26/2024] [Indexed: 09/03/2024]
Abstract
Chronic rhinosinusitis (CRS) is a complex inflammatory condition affecting the nasal and paranasal sinus mucosa. Gastroesophageal reflux disease (GERD) has been implicated as a potential exacerbating factor in CRS, but the specific endoscopic features of nasopharyngeal pathology in this context remain poorly understood. Background and Objectives: Chronic rhinosinusitis is a multifactorial disease with various underlying etiologies, including inflammation, anatomical factors, and environmental triggers. While gastroesophageal reflux disease has been suggested as a potential contributor to chronic rhinosinusitis, the specific endoscopic features indicative of nasopharyngeal pathology in CRS patients with GERD symptoms have not been clearly elucidated. Our aim is to identify specific endoscopic features of nasopharyngeal pathology in patients with CRS associated with GERD symptoms and to propose a method for assessing the influence of gastroesophageal reflux disease on the mucosal layer of the nose and nasopharynx. Materials and Methods: We conducted a cross-sectional observational study involving 521 adult patients presenting with symptoms suggestive of CRS. From this cohort, 95 patients with the highest scores on the Reflux Symptom Index (RSI) and Reflux Symptom Score-12 (RSS-12) questionnaires were selected as the main group. Endoscopic examinations were performed to assess the nasal and nasopharyngeal mucosa. Results: Our study revealed significant alterations in the nasopharyngeal mucosa of patients with CRS associated with GERD symptoms. Increased vascularity of the nasopharyngeal mucosa was observed in 91 patients (95.7%), while hypertrophy was noted in 83 patients (87.4%). Mucus was present in the nasopharynx of 77 patients (81.1%), exhibiting varying characteristics of color and consistency. Asymmetric hypertrophy of the oropharyngeal mucosa was noted in 62 patients (65.3%). Conclusions: We propose a method for assessing the influence of gastroesophageal reflux disease on the mucosal layer of the nose and nasopharynx, which may aid in diagnostic and management decisions. Further research is warranted to explore the potential impact of GERD symptoms on the course and severity of CRS exacerbations.
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Affiliation(s)
- Kalamkas Sagandykova
- “University Medical Center” Corporate Fund, School of Medicine, Nazarbayev University (NUSOM), Astana 010000, Kazakhstan
- Department of Otorhinolaryngology, NpJSC “Astana Medical University”, Astana 010000, Kazakhstan; (N.P.); (T.A.); (B.A.)
| | - Nataliya Papulova
- Department of Otorhinolaryngology, NpJSC “Astana Medical University”, Astana 010000, Kazakhstan; (N.P.); (T.A.); (B.A.)
| | - Talapbek Azhenov
- Department of Otorhinolaryngology, NpJSC “Astana Medical University”, Astana 010000, Kazakhstan; (N.P.); (T.A.); (B.A.)
| | - Aliya Darbekova
- Medical Center Hospital of the President’s Affairs Administration of the Republic of Kazakhstan, Astana 010000, Kazakhstan;
| | - Bayan Aigozhina
- Department of Otorhinolaryngology, NpJSC “Astana Medical University”, Astana 010000, Kazakhstan; (N.P.); (T.A.); (B.A.)
| | - Jerome R. Lechien
- Laryngopharyngeal Reflux Study Group, Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), 13005 Paris, France;
- Department of Otolaryngology-Head and Neck Surgery, Foch Hospital, 78180 Paris, France
- School of Medicine, University Paris Saclay, 91190 Paris, France
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Lechien JR, Vaezi MF, Chan WW, Allen JE, Karkos PD, Saussez S, Altman KW, Amin MR, Ayad T, Barillari MR, Belafsky PC, Blumin JH, Johnston N, Bobin F, Broadhurst M, Ceccon FP, Calvo-Henriquez C, Eun YG, Chiesa-Estomba CM, Crevier-Buchman L, Clarke JO, Dapri G, Eckley CA, Finck C, Fisichella PM, Hamdan AL, Hans S, Huet K, Imamura R, Jobe BA, Hoppo T, Maron LP, Muls V, O'Rourke AK, Perazzo PS, Postma G, Prasad VMN, Remacle M, Sant'Anna GD, Sataloff RT, Savarino EV, Schindler A, Siupsinskiene N, Tseng PH, Zalvan CH, Zelenik K, Fraysse B, Bock JM, Akst LM, Carroll TL. The Dubai Definition and Diagnostic Criteria of Laryngopharyngeal Reflux: The IFOS Consensus. Laryngoscope 2024; 134:1614-1624. [PMID: 37929860 DOI: 10.1002/lary.31134] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 09/18/2023] [Accepted: 10/10/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE The objective of this work was to gather an international consensus group to propose a global definition and diagnostic approach of laryngopharyngeal reflux (LPR) to guide primary care and specialist physicians in the management of LPR. METHODS Forty-eight international experts (otolaryngologists, gastroenterologists, surgeons, and physiologists) were included in a modified Delphi process to revise 48 statements about definition, clinical presentation, and diagnostic approaches to LPR. Three voting rounds determined a consensus statement to be acceptable when 80% of experts agreed with a rating of at least 8/10. Votes were anonymous and the analyses of voting rounds were performed by an independent statistician. RESULTS After the third round, 79.2% of statements (N = 38/48) were approved. LPR was defined as a disease of the upper aerodigestive tract resulting from the direct and/or indirect effects of gastroduodenal content reflux, inducing morphological and/or neurological changes in the upper aerodigestive tract. LPR is associated with recognized non-specific laryngeal and extra-laryngeal symptoms and signs that can be evaluated with validated patient-reported outcome questionnaires and clinical instruments. The hypopharyngeal-esophageal multichannel intraluminal impedance-pH testing can suggest the diagnosis of LPR when there is >1 acid, weakly acid or nonacid hypopharyngeal reflux event in 24 h. CONCLUSION A global consensus definition for LPR is presented to improve detection and diagnosis of the disease for otolaryngologists, pulmonologists, gastroenterologists, surgeons, and primary care practitioners. The approved statements are offered to improve collaborative research by adopting common and validated diagnostic approaches to LPR. LEVEL OF EVIDENCE 5 Laryngoscope, 134:1614-1624, 2024.
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Affiliation(s)
- Jerome R Lechien
- Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Brussels, Belgium
- Department of Laryngology and Broncho-Esophagology (Anatomy Department), EpiCURA Hospital, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium
- Department of Otolaryngology-Head and Neck Surgery, Foch Hospital, Paris Saclay University, Research Committee of Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Paris, France
- Department of Otorhinolaryngology and Head and Neck Surgery, Polyclinic of Poitiers, Poitiers, France
| | - Michael F Vaezi
- Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Walter W Chan
- Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jacqueline E Allen
- Department of Otolaryngology, Head and Neck Surgery, University of Auckland, Auckland, New Zealand
| | - Petros D Karkos
- Department of Otorhinolaryngology and Head and Neck Surgery, Thessaloniki Medical School, Thessaloniki, Greece
| | - Sven Saussez
- Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Brussels, Belgium
- Department of Laryngology and Broncho-Esophagology (Anatomy Department), EpiCURA Hospital, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium
| | - Kenneth W Altman
- Department of Otolaryngology-Head and Neck Surgery, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Milan R Amin
- Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, New York, USA
| | - Tareck Ayad
- Department of Otolaryngology-Head Neck Surgery, Montreal Hospital, Montreal, Canada
| | - Maria R Barillari
- Division of Phoniatrics and Audiology, Department of Mental and Physical Health and Preventive Medicine, L. Vanvitelli University, Naples, Italy
| | - Peter C Belafsky
- Department of Otolaryngology, UC Davis Medical Center, Sacramento, California, USA
| | - Joel H Blumin
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Nikki Johnston
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Francois Bobin
- Department of Otorhinolaryngology and Head and Neck Surgery, Polyclinic of Poitiers, Poitiers, France
| | | | - Fabio P Ceccon
- Department of Otolaryngology-Head and Neck Surgery, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Christian Calvo-Henriquez
- Department of Otorhinolaryngology and Head and Neck Surgery, Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain
| | - Young-Gyu Eun
- Department of Otolaryngology Head & Neck Surgery, Department of Biomedical Science and Technology, Graduate School, Kyung Hee University, Kyung Hee University School of Medicine, Kyung Hee University Medical Center, Seoul, Republic of Korea
| | - Carlos M Chiesa-Estomba
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Universitario Donostia, San Sebastian, Spain
| | - Lise Crevier-Buchman
- Department of Otolaryngology-Head and Neck Surgery, Foch Hospital, Paris Saclay University, Research Committee of Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Paris, France
| | - John O Clarke
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University, Redwood City, California, USA
| | - Giovanni Dapri
- International School Reduced Scar Laparoscopy, Minimally Invasive General and Oncologic Surgery Center, Humanitas Gavazzeni University Hospital, Bergamo, Italy
| | - Claudia A Eckley
- Divisão de Otorrinolaringologia, Fleury Medicina e Saúde Laboratórios de Diagnóstico, São Paulo, Brazil
| | - Camille Finck
- Department of Otorhinolaryngology-Head and Neck Surgery, CHU de Liege, Liege, Belgium
| | | | - Abdul-Latif Hamdan
- Department of Otorhinolaryngology-Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Stephane Hans
- Department of Otolaryngology-Head and Neck Surgery, Foch Hospital, Paris Saclay University, Research Committee of Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Paris, France
| | - Kathy Huet
- Department of Metrology and Langage Science, University of Mons, Mons, Belgium
| | - Rui Imamura
- Department of Otorhinolaryngology, Clinical Hospital, University of São Paulo School of Medicine, Sao Paulo, Brazil
| | - Blair A Jobe
- Department of Surgery, Drexel University, Philadelphia, Pennsylvania, USA
| | - Toshitaka Hoppo
- Department of Surgery, Drexel University, Philadelphia, Pennsylvania, USA
| | - Lance P Maron
- Netcare Park Lane Hospital, Johannesburg, South Africa
| | - Vinciane Muls
- Department of gastroenterology, CHU Saint-Pierre, Brussels
| | - Ashli K O'Rourke
- Department of Otolaryngology, Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Paulo S Perazzo
- Department of Otolaryngology, School of Medicine, São Paulo Federal University, Sao Paulo, Brazil
| | - Gregory Postma
- Department of Otolaryngology, Head & Neck Surgery, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Vyas M N Prasad
- ENT Centre and Singapore Medical Specialist Centre, Singapore, Singapore
| | - Marc Remacle
- Department of Otolaryngology, Centre Hospitalier du Luxembourg, Luxembourg, Luxembourg
| | - Geraldo D Sant'Anna
- Disciplina de Otorrinolaringologia, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Robert T Sataloff
- Department of Otolaryngology - Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Edoardo V Savarino
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Antonio Schindler
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
| | - Nora Siupsinskiene
- Department of Otolaryngology, Academy of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
- Faculty of Health Sciences, Klaipeda university, Klaipeda, Lithuania
| | - Ping-Huei Tseng
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Craig H Zalvan
- Department of Otolaryngology-New York Medical College, School of Medicine, Valhalla, NY; Institute for Voice and Swallowing Disorders, Sleepy Hollow, NY, USA
| | - Karol Zelenik
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, Ostrava, Czech Republic
| | | | - Jonathan M Bock
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Lee M Akst
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Hospital, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Thomas L Carroll
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Brigham and Women's Hospital and Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
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Javorská Z, Zeleník K, Lukáčová K, Taimrová R, Vrtková A, Hránková V, Lubojacký J, Formánek M, Tedla M. Mulberry Posterior Inferior Nasal Turbinate Is Associated with a Lower Pharyngeal pH Environment. Laryngoscope 2024; 134:62-68. [PMID: 37246719 DOI: 10.1002/lary.30766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/24/2023] [Accepted: 05/13/2023] [Indexed: 05/30/2023]
Abstract
OBJECTIVES Mulberry-like changes of the posterior inferior nasal turbinate (MPINT) can lead to nasal obstruction. Extraesophageal reflux (EER) characterized by lower pH causes mucosal inflammation and therefore can contribute to sinonasal pathologies. No prior studies have objectively examined the possible association between acidic pH and MPINT formation. Therefore, this study is aimed to investigate the 24-h pharyngeal pH value in patients with MPINT. STUDY DESIGN Prospective case-control multi-center study. METHODS Fifty-five patients with chronic EER symptoms were included in the study. They filled in questionnaires aimed at reflux and sinonasal symptoms (RSI®, SNOT-22) and underwent video endoscopy evaluating the laryngeal findings (RFS®) and the presence or absence of the MPINT. And, 24-h oropharyngeal pH monitoring was used to detect the acidic pH environment in the pharynx. RESULTS Out of the 55 analyzed patients, 38 had the MPINT (group 1), and in 17 patients, the MPINT was absent (group 2). Based on the pathological RYAN Score, in 29 (52.7%) patients, severe acidic pH drops were detected. In group 1, the acidic pH drops were diagnosed significantly more often (68.4%) compared with those in group 2 (p = 0.001). Moreover, in group 1, a significantly higher median total percentage of time spent below pH 5.5 (p = 0.005), as well as a higher median number of events lasting more than 5 min (p = 0.006), and higher median total number of events with pH drops (p = 0.017) were observed. CONCLUSION In this study, the MPINT was significantly more often present in patients with acidic pH events detected by 24-h oropharyngeal pH monitoring. Acidic pH in the pharynx might lead to MPINT formation. LEVEL OF EVIDENCE 3 Laryngoscope, 134:62-68, 2024.
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Affiliation(s)
- Zuzana Javorská
- Department of Otolaryngology, Head and Neck Surgery, Comenius University, University Hospital, Bratislava, Slovakia
| | - Karol Zeleník
- 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
| | - Kristína Lukáčová
- Department of Otolaryngology, Head and Neck Surgery, Comenius University, University Hospital, Bratislava, Slovakia
| | | | - Adéla Vrtková
- Department of Applied Mathematics, Faculty of Electrical Engineering and Computer Science, VSB-Technical University of Ostrava, Ostrava, Czech Republic
- Department of Deputy Director for Science, Research and Education, University Hospital Ostrava, Ostrava, Czech Republic
| | - Viktória Hránková
- 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
| | - Jakub Lubojacký
- 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
| | - Martin Formánek
- 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
| | - Miroslav Tedla
- Department of Otolaryngology, Head and Neck Surgery, Comenius University, University Hospital, Bratislava, Slovakia
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