Commonly referred to as “silent reflux,” laryngopharyngeal reflux (LPR) has long been difficult for physicians to diagnose because of its nonspecific symptoms. The traditional approach to assessing LPR symptoms relies on response to empiric treatment and symptom improvement using the reflux symptom index (RSI) or reflux finding score (RFS). Without clear criteria in place, these tools are highly subjective.
By: Craig H. Zalvan, MD, FACS
Chief of Otolaryngology and Medical Director
The Institute for Voice and Swallowing Disorders
CASE HISTORY & EVALUATION
66 year old male presents with diagnosis of GERD and asthma for chronic cough. He reports being well until 5 years ago when he had a severe URI, symptoms of which resolved, except for a chronic cough. Additional symptoms of ongoing waterbrash, throat clearing, and globus sensation; a tickle sensation in the throat followed by spasms of coughing associated with bouts of “wheezing,” described as a high pitch sound when breathing inward. He also reports his eyes tearing, rhinorrhea, and vocal strain with occasional bouts of nausea. Cold air and talking trigger coughing episodes.
Heartburn and regurgitation are easily identifiable symptoms of gastroesophageal reflux disease (GERD) and tend to be easier to treat with PPI therapy. However, symptoms of laryngopharyngeal reflux (LPR) or atypical reflux have become very prevalent in the population since they are difficult to spot and are often unresponsive to PPI therapy.
EXPANDING pH MEASUREMENT CAPABILITIES
The Dx–pH Measurement System is a revolutionary device that comfortably measures pH in the upper airway or esophagus. Prior to Restech’s introduction, it was difficult to detect reflux in the upper airway because previously available pH monitors were limited to measuring liquid reflux in the esophagus. Restech’s patented technology is the only commercial device available that is capable of measuring both liquid and aerosolized pH levels.
Your doctor will always be the best resource for strategies to tackle reflux. Have your symptoms been evaluated by a professional? Use our physician finder to locate a Restech provider near you.
In the meantime, here are some simple dietary and lifestyle modifications for reflux that can make a world of difference.
Restech’s pH system was the highlight of new research presented by Dr. Ezra Teitelbaum at the 2017 American College of Surgeons’session on Novel Endoscopic and Minimally Invasive Techniques for Esophageal Dysmotility and Reflux Disease. Dr. Teitelbaum (Assistant Professor of Surgery and Medical Education at Northwestern University) collaborated with Dr. Steven DeMeester (President and Executive Director of the Foundation for Research and Education in Esophageal and Foregut Disorders) on a study comparing the results of different pH monitoring tests in patients off antisecretory medications.
Are you using our NEW software yet?
Restech's new DataView software has a highly intuitive interface, saving you time while providing a precise and accurate reflux diagnosis. It is easy to use with its automatic calculations and color bands across the 5.0, 5.5, 6.0 & 6.5 pH thresholds.
1. SYMPTOMS DON’T TELL THE FULL STORY.
Empiric treatment with medication has long been the standard diagnostic tool for extraesophageal reflux. Presently, this approach is being challenged by new studies that suggest potential damage resulting from anti-reflux drugs. It is further complicated by a placebo effect mitigating symptoms while damaging acid persists. Given the multifactorial nature of laryngopharyngeal reflux, symptoms are not a reliable indication of how well reflux is being controlled.