[The role of laryngopharyngeal reflux in the pathogenesis of Reinke's edema]

Extraesophageal signs of gastroesophageal reflux disease: otorhinolaryngologist’s view

The data on association between various pathologies of the ENT organs and gastroesophageal reflux disease (GERD) is analysed in the article. The variety of extraesophageal signs of GERD in children and adults is given, what is advisable to inform physicians of different specialties about the possibilities of antireflux therapy. These options are expanded with the emergence of a unique new drug, Alfasoxx. Its bioadhesive formula is based on hyaluronic acid and chondroitin sulphate thereby protecting the esophageal mucosa. Alfasoxx acts on the surface of the esophageal mucosa without penetrating into the systemic bloodstream and it also has a low allergenic potential, which has been confirmed by numerous studies. With its healing and repairing effect on erosive lesions of the esophageal epithelium, Alfasoxx in combination with proton pump inhibitors is more effective in achieving regression of clinical manifestations of the disease and improving patients quality of life (according to SF-36 questionnaire) compared to proton pump inhibitors monotherapy.

Management of Laryngopharyngeal Reflux in Asia

OBJECTIVES

This study was conducted to investigate the current practices of Asian otolaryngologists for laryngopharyngeal reflux (LPR).

METHODS

An online survey about LPR was sent to 2,000 members of Asian otolaryngological societies, and a subgroup analysis was performed between Western and Eastern Asian otolaryngologists. The survey was conducted by the Laryngopharyngeal Reflux Study Group of Young Otolaryngologists of the International Federation of Oto-rhino-laryngological Societies.

RESULTS

Among approximately 1,600 Asian otolaryngologists, 146 completed the survey (62 from Western Asian countries, 84 from Eastern Asian countries). A substantial majority (73.3%) of the otolaryngologists considered LPR and gastroesophageal reflux disease to be different diseases. The symptoms thought to be closely related to LPR were coughing after lying down, throat clearing, and globus sensation. The findings thought to be closely related to LPR were posterior commissure granulations and hypertrophy, arytenoids, and laryngeal erythema. The respondents indicated that they mostly diagnosed LPR (70%) after an empirical therapeutic trial of proton pump inhibitors (PPIs). Although multichannel intraluminal impedance-pH (MII-pH) monitoring is a useful tool for diagnosing nonacid or mixed LPR, 78% of Asian otolaryngologists never or very rarely used MII-pH. Eastern Asian otolaryngologists more frequently used once-daily PPIs (64.3% vs. 45.2%, P=0.021), whereas Western Asian otolaryngologists preferred to use twice-daily PPIs (58.1% vs. 39.3%, P=0.025). The poor dietary habits of patients were considered to be the main reason for therapeutic failure by Asian otolaryngologists (53.8%). Only 48.6% of Asian otolaryngologists considered themselves to be adequately knowledgeable and skilled regarding LPR.

CONCLUSION

Significant differences exist between Western and Eastern Asian otolaryngologists in the diagnosis and treatment of LPR. Future consensus statements are needed to establish diagnostic criteria and therapeutic regimens.

Reinke's edema: a proposal for a classification based on morphological characteristics

PURPOSE

Reinke's edema is a benign laryngeal condition characterized by swelling of the superficial layer of the lamina propria of the vocal fold. The aim of this work is to propose a new classification of Reinke's edema based on its morphological characteristics.

METHODS

Our classification is a synthesis of the classifications available in the literature and is based on morphological characteristics such as the involvement of one or two vocal folds and the presence or absence of polypoid lesions regardless of the observation method.

RESULTS

We indicate four types of Reinke's edema: type 1: Reinke's edema of one vocal fold; type 2: Reinke's edema of both vocal folds; type 3: Reinke's edema of one vocal fold with associated polypoid lesion, not necessarily the same fold of the edema; type 4: Reinke's edema of both vocal folds with associated polypoid lesion on one or both folds.

CONCLUSION

Our proposed classification for Reinke's edema represents a synthesis of the classifications available in the literature and is characterized by a simple categorization based on morphological characteristics commonly visible through laryngoscopy.