Prevalence and Clinical Findings of Nasopharyngeal Reflux in Patients With Idiopathic Nasal Symptoms: A Preliminary Study

Importance Recent studies suggested that laryngopharyngeal reflux disease may be associated with chronic nasal symptoms. Objective To investigate the prevalence and the pre- to posttreatment clinical findings of nasopharyngeal reflux disease (NRD) in patients with idiopathic chronic nasal complaints without allergy or chronic rhinosinusitis. Design Prospective uncontrolled preliminary study. Setting University Hospital. Participants Patients with chronic idiopathic nasal complaints, without rhinosinusitis, allergic rhinitis, or other common sinonasal diseases. Intervention From July 2022 to November 2024, patients underwent a 24 hour nasopharyngeal pH-testing (Dx-pH system) for detecting NRD. Patients with NRD were treated with alginates or antacids for 3 months. Main Outcomes Laryngopharyngeal and nasal symptoms and findings were evaluated from pre- to posttreatment with reflux symptom score (RSS), Sinonasal Outcome Test-22 (SNOT-22), and reflux sign assessment (RSA). Results Thirty-three patients (15 females; mean age 50.1 ± 16.4 years) were evaluated. NRD was identified in 26 patients (78.8%) with a mean of 85.6 ± 64.3 reflux events, predominantly alkaline (pH > 6.0). Endoscopic findings included mulberry inferior turbinate (72.2%), crusts (38.9%), and dry nasal mucosa (27.8%). Posttreatment analysis revealed a significant reduction in RSS from 141.4 ± 100.9 to 95.2 ± 82.6 ( P = .015). While baseline SNOT-22 scores showed nonsignificant reduction posttreatment (46.2 ± 19.1 vs 36.0 ± 31.0), nasal RSA decreased significantly ( P = .023). Nasal dryness was positively associated with the total upright reflux time (pH < 6.5; r s = .575; P = .016) and the number of acid reflux events ( r s = .523; P = .026), while the RSA pharynx was associated with the supine reflux time ( r s = .573; P = .016). Conclusion Nasopharyngeal reflux, predominantly alkaline, shows high prevalence (78.8%) with characteristic endoscopic findings. Anti-reflux treatment significantly improves reflux symptoms and nasal scores, though overall sinonasal quality of life shows modest change.