title: Silent reflux: ex juvantibus criteria for diagnosis and treatment of laryngeal disorders.
abstract: CONCLUSIONS
  Some primary laryngeal pathologies with specific clinical presentation may be related to silent laryngeal reflux. An ex adjuvantibus proton pump inhibitor (PPI) treatment may be helpful for showing evidence of such a hidden laryngeal disorder.
  
  
  OBJECTIVE
  To assess the validity of PPI as an ex adjuvantibus criterion for diagnosis and treatment of suspected reflux-associated laryngitis.
  
  
  METHODS
  Sixty patients with clinical suspicion of laryngo-pharyngeal reflux (LPR) were identified on the grounds of laryngeal symptoms (dysphonia, cough, globus sensation, increased throat clearing, bad taste, and laryngeal spasm), laryngeal features (arytenoid edema/erythema, partial or total vocal fold erythema, and posterior glottic edema) with or without gastro-esophageal reflux disorder (GERD). They were consequently subdivided in three groups: type I, with LPR symptoms and features without GERD; type II with LPR symptoms and features with GERD; and type III with LPR features only. Types I and III were randomly treated with omeprazole (group A) or with immunostimulating vaccine (group B) for 3 months. Pre- and post-treatment laryngeal features and symptoms in all groups were evaluated by laryngo-stroboscopy and analyzed for statistical correlation.
  
  
  RESULTS
  All omeprazole-treated patients showed improvement of laryngeal features and symptoms. With PPI treatment, a more significant improvement was noticed with respect to nonspecific immunostimulant therapy. Also, patients without LPR symptoms showed improvement of laryngeal features.
authors.affiliation: Department of Neurology and Otorhinolaryngology, University La Sapienza II Medical School, Rome, Italy.
authors.forename: Simonetta
authors.initials: S
authors.lastname: Monini
authors.forename: Arianna
authors.initials: A
authors.lastname: Di Stadio
authors.forename: Annarita
authors.initials: A
authors.lastname: Vestri
authors.forename: Maurizio
authors.initials: M
authors.lastname: Barbara
mesh_terms: D000276:Adjuvants, Immunologic / Q000627:therapeutic use; D000284:Administration, Oral; D000286:Administration, Sublingual; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000897:Anti-Ulcer Agents / Q000627:therapeutic use*; D001419:Bacteria; D002457:Cell Extracts / Q000627:therapeutic use; D003937:Diagnosis, Differential; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D006801:Humans; D007818:Laryngeal Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D007828:Laryngoscopy; D008297:Male; D008875:Middle Aged; D009853:Omeprazole / Q000627:therapeutic use*; D054328:Proton Pump Inhibitors; D014612:Vaccines / Q000627:therapeutic use; D000095983:Bacterial Lysates
chemical_list: D000276:Adjuvants, Immunologic; D000897:Anti-Ulcer Agents; D002457:Cell Extracts; D009853:Omeprazole; D054328:Proton Pump Inhibitors; D014612:Vaccines; C030259:Broncho-Vaxom; D000095983:Bacterial Lysates