Zusammenfassung
Hintergrund
Der laryngopharyngeale Reflux (LPR) kann Ursache zahlreicher Erkrankungen sein, mit denen der HNO-Arzt täglich konfrontiert wird. Da sich der LPR vom gastroösophagealen Reflux (GÖR) unterscheidet, muss vor Therapiebeginn die Langzeit-pH-Messung direkt am Kehlkopf erfolgen. Dies ist durch ein neues Messsystem möglich.
Methode
Mit dem pH-RESPONSE® wurde der pH-Wert 24 h hinter dem Larynx und im distalen Ösophagusdrittel bei 20 Patienten gemessen und an beiden Messpunkten miteinander verglichen. Ferner wurde der De-Meester-Index als Maß für den GÖR bestimmt.
Ergebnisse
Das Messsystem wurde von 19/20 Patienten gut toleriert. Die Zahl der Refluxereignisse am Larynx betrug1/3 derer im Ösophagus und die durchschnittliche Dauer des pH-Wertes unter 4 am Larynx betrug im Schnitt 30 min.
Schlussfolgerung
Das beschriebene System gestattet eine leicht durchzuführende Diagnostik des LPR und die Messung des pH-Wertes am Kehlkopf sollte zum Standard beim Verdacht auf das Vorliegen eines LPR werden.
Abstract
Background
Laryngopharyngeal reflux disease (LPRD) can have various causes. Because LPRD differs from gastroesophageal reflux disease (GERD), the pH monitoring has to be performed directly next to the entrance of the larynx. This is now possible using a new system called pH-RESPONSE
Methods
The ambulatory pH was monitored using the double probe pH-RESPONSE™ in 20 patients with suspected LPRD. The number of refluxes, the number of long refluxes and the period in which the pH was below 4 were compared at the level of the larynx with the data from the esophageal electrode. The DeMeester score was also determined.
Results
The system was well tolerated by 19/20 patients. In 12 patients a GERD could be proved and ten also had LPRD. Surprisingly, these patients had no typical signs such as heart burn. The number of refluxes measured in the esophagus was a third that of the larynx. The average time of pH below 4 was 30 min.
Conclusion
The pH-RESPONSE™ easily allows ambulatory 24 -h double probe pH monitoring to diagnose LPRD. Because large differences were found between data form the esophagus from the level of the larynx, 24-h double probe pH monitoring should be a standard procedure before starting any therapy for LPRD.
This is a preview of subscription content, log in via an institution to check access.
Literatur
Belafsky PC, Postma GN, Koufman JA (2001) The validity and reliability of the reflux finding score (RFS). Laryngoscope 111: 1313–1317
Bouchard S, Lallier M, Yazbeck S, Bensoussan A (1999) The otolaryngologic manifestations of gastroesophageal reflux: when is a pH study indicated?J Pediatr Surg 34: 1053–1056
Bove M, Ruth M, Cange L, Mansson I (2000) 24-H pharyngeal pH monitoring in healthy volunteers: a normative study. Scan J Gastroenterol 35: 234–241
Harding SM, Richter JE, Guzzo MR, Schan CA, Alexander RW, Bradley LA (1996) Asthma and gastroesophageal reflux: acid suppressive therapy improves asthma outcome. Am J Med 100: 395–405
Hickson C, Simpson CB, Falcon R (2001) Laryngeal pseudosulcus as a predictor of laryngopharyngeal reflux. Laryngoscope 111: 1742–1745
Johnson L, DeMeester TR (1974) Twenty-four-hour pH monitoring of the distal esophagus. A quantitative measure of gastroesophageal reflux. Am J Gastroenterol 62: 325–332
Johnson PE, Koufman JA, Nowak LJ, Belafsky PC, Postma GN (2001) Ambulatory 24-hour double-probe pH monitoring: the importance of manometry. Laryngoscope 111: 1970–1975
Kuhn J, Toohill RJ, Ulualp SO et al. (1998) Pharyngeal acid reflux events in patients with vocal cord nodules. Laryngoscope 108: 1146–1149
Koufman J, Sataloff RT, Toohill R (1996) Laryngopharyngeal reflux: consensus conference report. J Voice 10: 215–216
Koufman JA, Burke AJ (1997) The etiology and pathogenesis of laryngeal carcinoma. Otolaryngol Clin North Am 30: 1-19
Loehrl TA, Smith TL, Darling RJ et al. (2002) Autonomic dysfunction, vasomotor rhinitis, and extraesophageal manifestations of gastroesophageal reflux. Otolaryngol Head Neck Surg 126: 382–387
Loughlin CJ, Koufman JA (1996) Paroxysmal laryngospasm secondary to gastroesophageal reflux. Laryngoscope 106: 1502–1505
Ludviksdottir D, Bjornsson E, Janson C, Boman G (1996) Habitual coughing and its associations with asthma, anxiety, and gastroesophageal reflux. Chest 109: 1262–1268
Maceri DR, Zim S (2001) Laryngospasm: an atypical manifestation of severe gastroesophageal reflux disease (GERD). Laryngoscope 111: 1976–1979
Pahn J, Schlottmann A, Witt G, Wilke W (2000) Diagnostik und Therapie der Laryngitis gastrica. HNO 48: 527–523
Schade G, Hess M (2002) Klinisches Vorgehen bei der Reflux-Laryngitis. HNO 50: 172–176
Senior BA, Khan M, Schwimmer C, Rosenthal L, Benninger M (2001) Gastroesophageal reflux and obstructive sleep apnea. Laryngoscope 111: 2144–2146
Schlottmann A, Wilke W, Pahn J (1999) 24-Stunden-pH-Metrie des Hypopharynx. HNO 47: 112–116
Ulualp SO, Toohill RJ, Hoffmann R, Shaker R (1999) Possible relationship of gastroesophagopharyngeal acid reflux with pathogenesis of chronic sinusitis. Am J Rhinol 13: 197–202
Woo P, Noordzij P, Ross JA (1996) Association of esophageal reflux and globus symptom: comparison of laryngoscopy and 24-hour pH manometry. Otolaryngol Head Neck Surg 115: 502–507
Ylitalo R, Lindestad PA, Ramel S (2001) Symptoms, laryngeal findings, and 24-hour pH monitoring in patients with suspected gastroesophago-pharyngeal reflux. Laryngoscope 111: 1735–1741
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Jecker, P., Schuon, R. & Mann, W.J. Zur Notwendigkeit der zweikanaligen 24-h-pH-Metrie in der Diagnostik des laryngopharyngealen Reflux. HNO 51, 704–709 (2003). https://doi.org/10.1007/s00106-002-0801-y
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00106-002-0801-y