Sinusitis and chronic progressive exercise-induced cough and dyspnea.

We present the case of a 47-year-old man with exercise-induced dyspnea, cough, chest tightness, and recalcitrant chronic rhinosinusitis. Evaluation revealed IgE sensitization to grass, tree, and weed pollen, no evidence of obstruction on spirometry, and a negative methacholine challenge. Diagnostic considerations included allergic and nonallergic rhinitis, asthma, aspirin-exacerbated respiratory disease, vocal cord dysfunction, extra-esophageal manifestations of acid reflux, and vasculitits. Further evaluation with sinus imaging, laryngoscopy, ambulatory pharyngeal pH testing, upper endoscopy, and bronchoscopy led to a diagnosis. Key issues surrounding the diagnostic and therapeutic approaches to this patient's condition are reviewed.

[1]  Timothy L. Smith,et al.  Treatment of Postnasal Drip with Proton Pump Inhibitors: A Prospective, Randomized, Placebo-Controlled Study , 2007, American journal of rhinology.

[2]  M. Ichimiya,et al.  Detection of Helicobacter pylori in Nasal and Maxillary Sinus Specimens From Patients With Chronic Sinusitis , 2003, The Laryngoscope.

[3]  M. Bloomston,et al.  Laparoscopic Nissen fundoplication offers High Patient Satisfaction with Relief of Extraesophageal Symptoms of Gastroesophageal Reflux Disease , 2006, The American surgeon.

[4]  R. Midilli,et al.  The effect of laparoscopic Nissen fundoplication on laryngeal findings and voice quality , 2007, Surgical Endoscopy.

[5]  J. Tack,et al.  Paroxysmal Laryngospasm: A Typical but Underrecognized Supraesophageal Manifestation of Gastroesophageal Reflux? , 2004, Digestive Diseases and Sciences.

[6]  M. A. Şafak,et al.  A Possible Role of Helicobacter pylori in Chronic Rhinosinusitis: A Preliminary Report , 2003, The Laryngoscope.

[7]  J. Koufman,et al.  Validity and reliability of the reflux symptom index (RSI). , 2002, Journal of voice : official journal of the Voice Foundation.

[8]  J. Ponsky,et al.  Surgical fundoplication in laryngopharyngeal reflux unresponsive to aggressive acid suppression: a controlled study. , 2006, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[9]  A. Merati,et al.  Nissen Fundoplication Surgery for Extraesophageal Manifestations of Gastroesophageal Reflux (EER) , 2002, The Laryngoscope.

[10]  M. Vaezi,et al.  CON: Treatment with PPIs Should NOT Be Preceded by pH Monitoring in Patients Suspected of Laryngeal Reflux , 2006, The American Journal of Gastroenterology.

[11]  J. Freeman,et al.  Role of Gastroesophageal Reflux Disease in Patients with Cervical Symptoms , 1995, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[12]  J. Richter,et al.  Laryngeal signs and symptoms and gastroesophageal reflux disease (GERD): a critical assessment of cause and effect association. , 2003, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[13]  J. Myers,et al.  Nasopharyngeal pH Monitoring in Chronic Sinusitis Patients Using a Novel Four Channel Probe , 2004, The Laryngoscope.

[14]  E. Weaver.  Association between gastroesophageal reflux and sinusitis, otitis media, and laryngeal malignancy: a systematic review of the evidence. , 2003, The American journal of medicine.

[15]  G. Friedrich,et al.  Effect of Pantoprazole on the Course of Reflux-Associated Laryngitis: a Placebo-Controlled Double-Blind Crossover Study , 2003, Scandinavian journal of gastroenterology.

[16]  L. Way,et al.  Effect of Laparoscopic fundoplication on gastroesophageal reflux disease-induced respiratory symptoms , 2000, Journal of Gastrointestinal Surgery.

[17]  R. Poe,et al.  Chronic cough and gastroesophageal reflux disease: experience with specific therapy for diagnosis and treatment. , 2003, Chest.

[18]  Third Expert Panel on theDiagnosis,et al.  Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma , 1997 .

[19]  A. Park,et al.  Laparoscopic Nissen Fundoplication Effectively Relieves Symptoms in Patients with Laryngopharyngeal Reflux , 2007, Journal of Gastrointestinal Surgery.

[20]  M. Anvari,et al.  Does laparoscopic fundoplication provide long-term control of gastroesophageal reflux related cough? , 2004, Surgical Endoscopy And Other Interventional Techniques.

[21]  S. Ashley,et al.  Endoscopic Treatment for Atypical Manifestations of Gastroesophageal Reflux Disease , 2006, The American Journal of Gastroenterology.

[22]  C. T. French,et al.  Chronic cough due to gastroesophageal reflux disease: efficacy of antireflux surgery. , 2002, Surgical endoscopy.

[23]  P. Levine,et al.  Evaluation of Omeprazole in the Treatment of Reflux Laryngitis: A Prospective, Placebo‐Controlled, Randomized, Double‐Blind Study , 2001, The Laryngoscope.

[24]  D. Weldon.  Gastroesophageal reflux disease and sinusitis: their role in patients with chronic cough. , 2006, Allergy and asthma proceedings.

[25]  C. Ko,et al.  Laparoscopic Nissen Fundoplication Improves Quality of Life in Patients with Atypical Symptoms of Gastroesophageal Reflux , 2003, The American surgeon.

[26]  D. Oleynikov,et al.  Symptomatic and physiologic outcomes after operative treatment for extraesophageal reflux , 2002, Surgical Endoscopy.

[27]  C. Pellegrini,et al.  Long-term outcomes of laparoscopic antireflux surgery for gastroesophageal reflux disease (GERD)-related airway disorder , 2006, Surgical Endoscopy And Other Interventional Techniques.

[28]  J. Leggit.  Vocal cord dysfunction. , 2004, American family physician.

[29]  H. El‐Serag,et al.  Lansoprazole treatment of patients with chronic idiopathic laryngitis: a placebo-controlled trial , 2001, American Journal of Gastroenterology.

[30]  J. DelGaudio.  Direct Nasopharyngeal Reflux of Gastric Acid is a Contributing Factor in Refractory Chronic Rhinosinusitis , 2005, The Laryngoscope.

[31]  N. Fuleihan,et al.  Effect of aggressive therapy on laryngeal symptoms and voice characteristics in patients with gastroesophageal reflux. , 2001, Acta oto-laryngologica.

[32]  M. Spyrou,et al.  Laparoscopic antireflux surgery and its effect on cough in patients with gastroesophageal reflux disease , 2002, Journal of Gastrointestinal Surgery.

[33]  J. Koufman,et al.  Laryngopharyngeal Reflux: Position Statement of the Committee on Speech, Voice, and Swallowing Disorders of the American Academy of Otolaryngology-Head and Neck Surgery , 2002, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[34]  M. Anvari,et al.  Gastro-oesophageal reflux related cough and its response to laparoscopic fundoplication , 1998, Thorax.

[35]  K. Woessner,et al.  The clinical effectiveness of aspirin desensitization in chronic rhinosinusitis , 2008, Current allergy and asthma reports.

[36]  L. Boulet,et al.  Diagnosis and management of cough executive summary: ACCP evidence-based clinical practice guidelines. , 2006, Chest.

[37]  M. Trudeau,et al.  Paradoxical vocal cord dysfunction in juveniles. , 2000, Archives of otolaryngology--head & neck surgery.

[38]  Harold H. Kim,et al.  A Study of the Link between Gastric Reflux and Chronic Sinusitis in Adults , 2006, Ear, nose, & throat journal.

[39]  C. Ford.  Treatment of Chronic Posterior Laryngitis With Esomeprazole , 2006, The Laryngoscope.

[40]  D. Maceri,et al.  Laryngospasm: An Atypical Manifestation of Severe Gastroesophageal Reflux Disease (GERD) , 2001, The Laryngoscope.

[41]  J. Koufman,et al.  Fundoplication for laryngopharyngeal reflux disease. , 2004, Journal of the American College of Surgeons.

[42]  M. Anvari,et al.  Preoperative symptom evaluation and esophageal acid infusion predict response to laparoscopic Nissen fundoplication in gastroesophageal reflux patients who present with cough , 2002, Surgical Endoscopy.

[43]  M. Benninger,et al.  The Medical Management of Rhinosinusitis , 1997, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[44]  J. Koufman,et al.  The Validity and Reliability of the Reflux Finding Score (RFS) , 2001, The Laryngoscope.

[45]  D. Steward,et al.  Proton Pump Inhibitor Therapy for Chronic Laryngo-Pharyngitis: A Randomized Placebo-Control Trial , 2004, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[46]  J. Wilson,et al.  Lump in the throat , 2007, Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery.

[47]  C. Qua,et al.  Gastro‐oesophageal reflux disease in chronic laryngitis: prevalence and response to acid‐suppressive therapy , 2006, Alimentary pharmacology & therapeutics.