Dysphonia and laryngopharyngeal reflux.
The correlation between laryngo-pharyngeal reflux and dysphonia has been evaluated in patients without significant laryngoscopic findings and without vocal misuse. Studies were performed, using a validated questionnaire on typical reflux symptoms as well as instrumental means, e.g. videolaryngoscopy, multi-electrode 24-hr oesophageal pH monitoring, vocal acoustic analysis, gastro-oesophagoscopy, on 62 patients (51 male, 11 female) with dysphonia for > or = 3 months, selected from 350) consecutive patients presenting with voice disorders. Standard criteria were: absence of laryngeal neoformation (benign or malignant) and correct use of voice. Anti-reflux treatment was prescribed in all selected patients. A group of 62 selected patients without laryngo-pharyngeal disease were studied as controls. Mean values of the harmonic to noise ratio and maximum phonation time were pathological in all patients with dysphonia and significantly correlated (p = 0) with the entity of the larynx alteration. The 24-hour pH monitoring revealed gastro-oesophageal reflux in all cases with a clear prevalence of episodes in the upright, compared to supine, position. From a multiple regression analysis of pH-metric values, considered important in predicting maximum phonation time and harmonic to noise ratio alteration. the significant predictors (p < 0.01) were those parameters indicating the existence of a laryngo-pharyngeal reflux disease: in an upright position, the prevalence of the number of refluxes and of time of pH < 4. In conclusion, the association between electro-acoustic reliefs and laryngoscopic data, as well as an alteration in maximum phonation time and harmonic to noise ratio in patients with pH-metric indicative parameters of laryngo-pharyngeal reflux disease led to the hypothesis of a possible correlation between entity and duration of the reflux and dysfunction of the arytenoid muscles, upon which chronic vocal fatigue, with consequent laryngeal compensatory stress, depends.
Department of Otorhinolaryngology, University "Federico 11", Naples, Italy.
U
U
Cesari
J
J
Galli
F
F
Ricciardiello
M
M
Cavaliere
V
V
Galli
D000328:Adult; D005260:Female; D005764:Gastroesophageal Reflux / Q000453:epidemiology* / Q000503:physiopathology*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007828:Laryngoscopy / Q000379:methods; D007830:Larynx / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D010614:Pharynx / Q000503:physiopathology*; D015995:Prevalence; D012720:Severity of Illness Index; D014832:Voice Disorders / Q000175:diagnosis* / Q000453:epidemiology*