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OTORINOLARINGOLOGIA

A Journal on Otorhinolaryngology, Head and Neck Surgery,
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Otorinolaringologia 1999 September;49(3):109-18

Copyright © 2000 EDIZIONI MINERVA MEDICA

language: Italian

Proximal esophageal and lung scintigraphy in patients with posterior laryngitis

Bestetti A., Carola F., Carnevale-Ricci P. M.*, Sambataro G.*, Tarolo G. L.

Ospedale S. Paolo - Milano Università degli Studi - Milano Cattedra di Medicina Nucleare * Cattedra Otorinolaringoiatria


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Background. Posterior laryngitis and gastroesophageal reflux disease seem to be associated in about 50-60% of patients. Clinically, these patients only report symptoms as dry cough, odynophagia and hoarseness, and frequent respiratory infections secondary to gastropulmonary micro-aspiration. Aim: to assess gastroesophageal reflux (GER) and the eventual involvement of respiratory tract by scintigraphic methods in patients with posterior laryngitis.
Methods. 130 patients (87 F, 43 M, mean age±SD 49±16 yr, range 15-76) complaining of dry cough, odynophagia and hoarseness, and with posterior laryngitis, and 20 healthy subjects (13 F, 7 M, mean age±SD 53±13 yr, range 19-74) have been studied. After an overnight fast all patients underwent gastroesophageal scintigraphy, using 300 ml of orange juice labelled with 99mTc-sulfur colloid. At 24 hours pulmonary scan was performed acquiring planar images (anterior and posterior) in the supine position.
Results. 72% of patients (94/130) had GER: 18/94 (19%) had distal (GER-pd) and 76/94 (81%) had proximal reflux (GER-pp); 19 patients had pulmonary activity and proximal reflux. Number, duration of reflux episodies and percent of esophageal acid exposure were significantly higher (p<0.0001) in patients GER-pp compared to patients GER-pd; 36 patients did not show reflux and had associated co-factors or pathologies, that may account for cervical symptoms. Symptoms percent, esophageal motility parameters were not significantly different among all the patients. Patients with GER-pp had gastric emptying time longer than healthy subjects.
Conclusions. The majority of patients with posterior laryngitis had proximal reflux. Proximal esophageal acid exposure seems to be a trigger to gastropulmonary micro-aspiration in posterior laryngitis. Symptoms as dry cough, odynophagia and hoarseness are unreliable indicators of the presence or absence of gastroesophageal reflux and of upper respiratory disorders.

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