Proximal pharyngeal reflux correlates with increasing severity of lingual tonsil hypertrophy

Objective To determine if degree of lingual tonsil hypertrophy(LTH) correlates with pharyngeal reflux. Design Prospective. Methods Patients with flexible laryngoscopic evidence of LTH were included. Degree of LTH was graded mild, moderate, or severe by two otolaryngologists blinded to pH study results. Threesensor pH study results were correlated to LTH grade. Results Nineteen patients were included (five with mild LTH, eight with moderate LTH, and six with severe LTH). Nasopharyngeal reflux (NPR) events <pH4 were found in four of six severe LTH patients but no mild or moderate LTH patients (P = 0.006). All severe LTH patients had NPR events <pH5, compared with only 4 of 11 mild or moderate LTH patients (P = 0.017). Atthe UES, 4 of 6 severe LTH patients had pathologic reflux, compared with 4 of 13 mild or moderate (P = 0.025). Interobserver reliability calculated by Cohen's kappa was excellent (0.92). Conclusions Our study shows a continuum of increasing pharyngeal reflux with higher LTH severity. Severe LTH may be a reliable physical sign of pharyngeal reflux, especially NPR. © 2008 American Academy of Otolaryngology-Head and Neck Surgery Foundation. All rights reserved.

[1]  P. Strollo Indications for treatment of obstructive sleep apnea in adults. , 2003, Clinics in chest medicine.

[2]  R. Dantas,et al.  Effect of gastroesophageal reflux on hypertrophy of the base of the tongue , 2000, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[3]  J. Haze,et al.  Obstructive sleep apnea. , 1987, Cranio : the journal of craniomandibular practice.

[4]  R. Dantas,et al.  Severe Hypertrophy of the Base of the Tongue in Adults , 2004, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[5]  P. Kahrilas,et al.  Proximal esophageal pH-metry in patients with 'reflux laryngitis'. , 1991, Gastroenterology.

[6]  C. R. Stasney,et al.  The proximal probe in esophageal pH monitoring: development of a normative database. , 2000, Journal of voice : official journal of the Voice Foundation.

[7]  Jo Shapiro,et al.  The Reliability of the Assessment of Endoscopic Laryngeal Findings Associated With Laryngopharyngeal Reflux Disease , 2002, The Laryngoscope.

[8]  R. Rogers,et al.  Obstructive sleep apnea. , 1996, The New England journal of medicine.

[9]  J. Katz,et al.  Respiratory complications of gastroesophageal reflux disease. , 1996, Primary care.

[10]  Justin C. Wise,et al.  Gastroesophageal reflux and laryngopharyngeal reflux in patients with sleep-disordered breathing , 2005, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[11]  Justin C. Wise,et al.  Association of Nasopharyngeal and Laryngopharyngeal Reflux with Postnasal Drip Symptomatology in Patients with and without Rhinosinusitis , 2006, American journal of rhinology.

[12]  J. Koufman The Otolaryngologic Manifestations of Gastroesophageal Reflux Disease (GERD): A Clinical Investigation of 225 Patients Using Ambulatory 24‐Hour pH Monitoring and an Experimental Investigation of the Role of Acid and Pepsin in the Development of Laryngeal Injury , 1991, The Laryngoscope.

[13]  J. Koufman,et al.  Laryngopharyngeal reflux: consensus conference report. , 1996, Journal of voice : official journal of the Voice Foundation.

[14]  E. Quigley,et al.  Can Symptoms Predict Esophageal Motor Function or Acid Exposure in Gastroesophageal Reflux Disease?: A Comparison of Esophageal Manometric and Twenty-four-hour pH Parameters in Typical and Extraesophageal Gastroesophageal Reflux Disease , 2001, Journal of clinical gastroenterology.

[15]  E. Reardon,et al.  Lingual tonsillectomy: A treatment for inflammatory lesions of the lingual tonsil , 1984, The Laryngoscope.

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

[17]  G. Rasp,et al.  Efficacy of once-daily esomeprazole treatment in patients with laryngopharyngeal reflux evaluated by 24-hour pH monitoring , 2007, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

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

[19]  J. Koufman,et al.  Prevalence of Reflux in 113 Consecutive Patients with Laryngeal and Voice Disorders , 2000, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[20]  J. Elia LINGUAL TONSILLITIS , 1959, Annals of the New York Academy of Sciences.

[21]  A. Schantz,et al.  Papillary hyperplasia of the lingual tonsil. Report of a case. , 1972, Archives of otolaryngology.

[22]  Fuat Özgen,et al.  Lingual Tonsil Hypertrophy Producing Obstructive Sleep Apnea , 1996, The Laryngoscope.

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

[24]  W. Issing,et al.  Association of Laryngopharyngeal Symptoms With Gastroesophageal Reflux Disease , 2002, The Laryngoscope.

[25]  Í. Yorulmaz,et al.  Gastroesophageal Reflux Disease: Symptoms Versus pH Monitoring Results , 2003, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.