PMID- 11089989
OWN - NLM
STAT- MEDLINE
DCOM- 20001221
LR  - 20220310
IS  - 0003-4894 (Print)
IS  - 0003-4894 (Linking)
VI  - 109
IP  - 11
DP  - 2000 Nov
TI  - Laryngopharyngeal sensory deficits in patients with laryngopharyngeal reflux and 
      dysphagia.
PG  - 1000-6
AB  - There are no reliable means of quantifying the edema that results from acid 
      exposure to the posterior larynx in patients with laryngopharyngeal reflux (LPR). 
      However, it is possible to quantify laryngopharyngeal sensitivity in these 
      patients by endoscopic administration of air pulses to the laryngeal mucosa in 
      order to elicit the laryngeal adductor reflex. The purpose of this study was to 
      determine whether patients with LPR have sensory deficits in the laryngopharynx, 
      and whether treatment of these patients with a proton pump inhibitor (PPI) 
      results in resolution of sensory deficits. Flexible endoscopic evaluation of 
      swallowing with sensory testing was prospectively performed in 54 patients with 
      dysphagia without neurologic disease and in 25 healthy controls. The 
      laryngopharyngeal sensory level, posterior laryngeal edema, and LPR were 
      assessed. We defined LPR as passage of food material from the esophageal inlet 
      retrograde into the hypopharynx. Patients with LPR were placed on 3 months of 
      omeprazole or lansoprazole and then retested. Patients without LPR were placed on 
      H2 blockers for 3 months and then retested. In the dysphagia group, 48 of 54 
      patients (89%) had edema of the posterior larynx, and 42 of 54 (78%) had 
      laryngopharyngeal sensory deficits. We noted LPR in 38 of 54 (70%). In the 
      control group, 1 of 25 subjects (4%) had edema, sensory deficits, and LPR. The 
      differences in incidence of edema, sensory deficits, and LPR between the 
      dysphagia group and the control group were significant (p < .001, chi2 test). 
      Twenty-three patients with LPR placed on a PPI returned for follow-up, with 
      improvement in laryngeal edema in 14 of the 21 (67%) who had pretreatment edema 
      and resolution of sensory deficits in 15 of the 19 (79%) who had pretreatment 
      deficits. In the non-LPR, non-PPI group, 11 of 16 patients returned for 
      follow-up, with improvement in laryngeal edema in none of the 11 and improvement 
      in sensory deficits in 1 of the 11 (9.1%). The differences in improvement in 
      laryngeal edema and sensory deficits between the LPR, PPI group, and the non-LPR, 
      non-PPI group were significant (p < .01, Fisher's exact test). We conclude that 
      patients with dysphagia and edema of the posterior larynx as a result of LPR have 
      sensory deficits in the laryngopharynx. Treatment of these patients with a PPI 
      appears to result in resolution of laryngopharyngeal edema and improvement of 
      sensory deficits, both subjectively and objectively.
FAU - Aviv, J E
AU  - Aviv JE
AD  - Department of Otolaryngology-Head and Neck Surgery, New York-Presbyterian 
      Hospital and College of Physicians and Surgeons, Columbia University, New York, 
      New York 10032, USA.
FAU - Liu, H
AU  - Liu H
FAU - Parides, M
AU  - Parides M
FAU - Kaplan, S T
AU  - Kaplan ST
FAU - Close, L G
AU  - Close LG
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Ann Otol Rhinol Laryngol
JT  - The Annals of otology, rhinology, and laryngology
JID - 0407300
RN  - 0 (2-Pyridinylmethylsulfinylbenzimidazoles)
RN  - 0 (Anti-Ulcer Agents)
RN  - 0 (Proton Pump Inhibitors)
RN  - 0K5C5T2QPG (Lansoprazole)
RN  - KG60484QX9 (Omeprazole)
SB  - IM
MH  - 2-Pyridinylmethylsulfinylbenzimidazoles
MH  - Adult
MH  - Aged
MH  - Anti-Ulcer Agents/pharmacology/therapeutic use
MH  - Deglutition Disorders/*complications/*diagnosis
MH  - Female
MH  - Follow-Up Studies
MH  - Gastroesophageal Reflux/*complications/drug therapy
MH  - Humans
MH  - Hypopharynx/*physiopathology
MH  - Lansoprazole
MH  - Laryngeal Edema/complications/diagnosis
MH  - Laryngoscopy
MH  - Male
MH  - Middle Aged
MH  - Omeprazole/analogs & derivatives/pharmacology/therapeutic use
MH  - Pharyngeal Diseases/*complications/diagnosis/*physiopathology
MH  - Prospective Studies
MH  - Proton Pump Inhibitors
MH  - *Sensation Disorders/complications/physiopathology/therapy
MH  - Severity of Illness Index
EDAT- 2000/11/23 11:00
MHDA- 2001/02/28 10:01
CRDT- 2000/11/23 11:00
PHST- 2000/11/23 11:00 [pubmed]
PHST- 2001/02/28 10:01 [medline]
PHST- 2000/11/23 11:00 [entrez]
AID - 10.1177/000348940010901103 [doi]
PST - ppublish
SO  - Ann Otol Rhinol Laryngol. 2000 Nov;109(11):1000-6. doi: 
      10.1177/000348940010901103.