Complex Diagnosis of Clinical Forms of Laryngitis Caused by Laryngopharyngeal Reflux Disease (LPRD)

INTRODUCTION: Regurgitation of acidic gastric content to pharynx and larynx, coexisting with gastroesophageal reflux disease, is referred to as laryngopharyngeal reflux disease (LPRD). The symptomatology of LPRD is wide and includes many nonspecific symptoms, which makes differential diagnosis difficult. OBJECTIVE: The aim of the study is the confirmation of LPRD as a cause of laryngitis classified in reflux finding score (RFS). METHODS: In the assessment of dysphonia severity, reflux symptom index (RSI) was used as well as acoustic examination of voice. The assessment of morphological changes in larynx included high-speed digital imaging (HSDI) technique with high speed and high resolution mode, as well as RFS. In the objective assessment of LPRD causes, barofunction of upper esophageal sphincter (UES) and 24-hour pH-metry of air exhaled expressed in Ryan score were used. RESULTS: According to RSI, patients reported symptoms classified as LPRD. HSDI revealed the most frequent edema and hyperemia of the intraarytenoid area, arytenoids and vocal folds edema. Pathological values of acoustic parameters and numerous nonharmonic components in spectrography were observed. Barofunction of UES and pH of air exhaled showed decreases in analyzed parameters. Statistical analysis revealed a significant correlation between RSI, RFS and Ryan score as well as between RSI, RFS and resting UES pressure. CONCLUSIONS: Application of 24-h pH-metry of air exhaled confirmed the existence of an irritating factor causing LPRD. Decrease of UES pressure revealed predisposition to regurgitation of gastric content and gases to the larynx. Hyperemia and edema of the intraarytenoid area and vocal folds were the most common clinical forms of LPRD.