• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.14 no.1
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• pp.26-29
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• 2003

Background and Objectives : Gastric acid reflux has been suggested to have an association with sleep apnea(SA). This study's aim is to evaluate the relationship between reflux laryngitis and SA through the fact that the treatment of reflux laryngitis may impact the snoring and SA related symptoms in selective individuals. Methods : Population consist of 24 males and 10 female aged 34 to 66 years(mean age 50 years) confirmed by Reflux Finding Score(RFS) of PC Belafsky. Thirty four patients with reflux laryngitis and associated symptoms of SA were treated with proton pump inhibitor(Rabeprazole sodium 10mg/day) for 60 days. The degree of snoring and apnea related symptoms were evaluated using questionnaires, and palatine tonsillar hypertropy(PTH) and RFS were compared preoperatively and postoperatively. Results : After antireflux treatment for 60 days, the snoring(p=0.039), daytime sleepiness(p=0.002), and concentration(p=0.011) were significantly improved(p<0.05) and RFS was significantly decreased(p=0.000), but morning headache(p=0.057) and sleep apnea(p=0.083) were not significantly improved(p>0.05) and PTH was not significantly decreased(p=0.328). Conclusion : Treatment of reflux laryngitis significantly impacted the snoring, daytime sleepiness, and concentration in selective individuals. These results suggest some close relationship between reflux laryngitis and SA, and the treatment of reflux laryngitis may be some effective in those with both disorders.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.14 no.2
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• pp.98-103
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• 2003

Background and Objectives : Although many studies have examined the effect of drinking on voice change, its cause and degree remain unclear. Since voice change occurs more frequently the day following drinking, rather than immediately afterwards, we examined whether the voice change was correlated with reflux laryngitis due to gastroesophageal motor disturbances. Subjects and Methods : For this study, 10 patients were selected who had neither voice change nor symptoms of reflux laryngitis at baseline (male : female=5 : 5, mean age=28 years old) They were subjected to psychoacoustic, acoustic, and aerodynamic tests and video stroboscopy at 4:00 P.M. the day before drinking (test 1), at 8:00 A.M. (test 2) and 4:00 P.M. (test 3) on the following day. On the day of drinking, the subjects had to drink more than their usual amount of Soju(Korean liquor) and were not allowed to talk much. The stroboscopy findings were quantified using the PC Belafsky score. Results : The laryngeal response to gastric reflux after drinking was compared between tests 1 and 2. In both tests, laryngeal edema and injection were observed on video stroboscopy. The psychoacoustic test detected more severe hoarseness in test 2 than in test 1. In addition, the acoustic test detected a mild increase in both jitter and shimmer. However, the differences between tests 2 and 3, which were performed when there was reduced or no gastric reflux, were not significant. Conclusions : Drinking may cause gastric reflux, which produces reversible voice change by irritating the vocal cords and larynx. Therefore, reflux laryngitis should be suspected in a patient whose voice changes markedly after drinking.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.11 no.2
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• pp.161-166
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• 2000

Background and Objectives : Vocal fold hemorrhage occur by blood accumulation in Reinke's space by vocal trauma. It is mostly asymptomatic, but in some cases it may cause severe dysphonia. It is often seen in patients who use their voice professionally. However, recent changes of life style affected the phonation in general population. We studied to know what are the causes and what are the major factors to affect the vocal fold hemorrhages. Materials and Methods : 19 subjects were evaluated by using of questionaire and laryngoscopic examinations. We evaluated the factors to lead the change in voice directly, underlying causes, occupations and laryngeal findings. Results : The direct causes of the vocal fold hemorrhages were clearing throat, talking, coughing and singing. Reflux laryngitis and upper respiratory infection were the underlying diseases. Vocal fold hemorrhages were developed during the menstruation in 5 patients. Accompanying functional voice disorders were seen in 13 patients, such as, vocal fold nodule, nodule with varix, vocal polyp, Reinke's edema. Patients with reflux laryngitis had the habits of clearing throat as the direct cause of the vocal fold hemorrhages and had hyperkinetic functional voice disorders. Voice abuse was the direct cause of the vocal fold hemorrhages in patients who was in the period of the menstruation. The most common site of the hemorrhage was at the membranous portion of the vocal folds. Conclusions : Authors thought the forceful laryngeal activity was the cause of the vocal fold hemorrhages. And reflux laryngitis and menstruation was the risk factors of the vocal fold hemorrhages.

• Korean Journal of Bronchoesophagology
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• v.9 no.1
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• pp.67-74
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• 2003

Larygopharyngeal reflux(LPR) is one form of the Gastroesophageal Reflux Diseases(GERD). It is known to cause various kinds of otolaryngologic symptoms such as hoarseness, globus sensation in throat, chronic throat clearing, and chronic cough, Disease entities diagnosed by otolaryngologists as posterior laryngitis, globus pharyngeus and reflux laryngitis should be suspected as LPR-related diseases. The nizatidine(AXID), as a Histamine H2-receptor antagonist, reduces gastric acid secretion and improves gastric motility function. Objectives : The effect of nizatidine using 150mg b.i.d was evaluated for symptom relief and improvement of laryngoscopic findings in patients with LPR. Materials and Methods : In 30 multicenter, observational trial performed nationalwidely in Korea. 308 patients with LPR symptom were observed to evaluate their symptoms and larygnoscopic findings after 4weeks, 8weeks, 12weeks of treatment with nizatidine. Results : The symptoms of LPR including globus sensation, chronic throat clearing and hoarseness, are reduced significantly after 4 weeks, 8weeks, and 12weeks of treatment(p<0.05). The laryngoscopic findings including diffuse erythema, edema and granulation are improved after nizatidine treatment(p<0.05). and the efficacy of nizatidine on LPR-related sympoms after 4 weeks is 88.6%, and those of after 8 weeks and 12weeks were 92.6%, and 99.1% in ITT(Intent To Treatment) group(p<0.05). And PPA(Per Protocol Analysis)group showed 93.7%, 97.3%, and 99.1% of efficacy after 4, 8, and 12 weeks of nizatidine treatment(p<0.05). Conclusion : These results indicate that in patient with LPR, nizatidine 150mg b.i.d treatment very effectively reduces LPR symptoms and improves laryngoscopic findings as well as reduces gastric acid secretion and improves gastric motility function.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.9 no.2
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• pp.115-127
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• 1998

Laryngopharyngeal reflux(LPR) is one firm of the gastroesophageal reflux diseases(GERD). It is known to cause various kinds of otolaryngologic symptoms such as hoarseness, foreign body sensation in throat, chronic throat clearing, chronic cough, etc. Disease entities diagnosed by otolaryngologists as posterior laryngitis, globus pharyngeus should be suspected as LPR-related diseases. In this multi-center trial, we tried to evaluate the effect of cisapride(10mg tid) on LPR-related symptoms as the part I study(CIS-KOR-051) in 19 centers, and as the part II study(CIS-KOR-052) comparative evaluation of effect between cisapride(10mg tid) and ranitidine(150mg bid) on LPR-related symptoms in 4 centers. In part I study, efficacy of cisapride on LPR-related symptoms after 4 weeks was 53.5% and that of after 8weeks was 77.9% in per protocol(PPA) analysis group. In part II study, efficacy of the cisapride was much better than that of ranitidine not only from 8 weeks trial(p<0.001) but also from 4 weeks trial(p<0.021) in PPA group. In the multiple logistic regression analysis among the parameters which affect the efficacy of the treatment, cisapride prescribed group showed 10 times greater than that of ranitidine prescribed group(p<0.0001, Odds ratio : 10) in PPA group. LPR was proved by 24Hr double probe pHmetry in 13 patients out of 19 patients tested(68.4%). Thus these results indicated that inducing the improvement of motility functions could affect the amelioration of the LPR-related symptoms much better than reducing acid secretion from the stomach. And maybe it suggests that LPR-related symptoms mainly developed by the reduced motility functions of the esophagus and/or delayed gastric emptying.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.11 no.1
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• pp.87-97
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• 2000

One week survey to investigate the prevalence rate and clinical characteristics of laryngopharyngeal reflux symptoms in Korea. The subject(n=7,704 patients) was newly enrolled patients at the out patient clinic in 90 ENT departments of resident training hospitals and 11 local clinics, which were voluntarily participated in the study 1) Twenty five percent of all enrolled patients has LPR-related symptoms or clinical findings from the examination by ENT specialists. 2) Among e name of LPR-related diagnosis, globus syndrome was e most common, and follows by reflux laryngitis, and chronic laryngitis. 3) Women was more prevalent than men, and it is common in 5th, 6th, and 7th decades, which seems to be related with aging process. 4) Most popular symtoms of LPR. were globus sensation, conic throat clearing, and hoarseness of unknown origin. 5) Aggravating factors of LPR-related symptoms were tiredness, mental stress, drink alcohol, cigarettes smoking, spicy food, and drinking coffee. 6) LPR-related symptoms were more common in professional voice users. 7) In past medical history, diseases of stomach and tonsillitis were most common.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.27 no.2
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• pp.78-83
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• 2016

Laryngopharyngeal reflux (LPR) disease is an extraoesophageal variant of gastro-esophageal reflux disease that can affect the larynx and pharynx. LPR is associated with symptoms of laryngeal irritation such as throat clearing, coughing, and hoarseness. The main diagnostic methods currently used are laryngoscopy and pH monitoring. The most common laryngoscopic signs are redness and swelling of the throat. However, these findings are not specific of LPR and may be related to other causes or can even be found in healthy individuals. Furthermore, the role of pH monitoring in the diagnosis of LPR is controversial. A therapeutic trial with proton pump inhibitors (PPIs) has been suggested to be cost-effective and useful for the diagnosis of LPR. However, the recommendations of PPI therapy for patients with a suspicion of LPR are based on the results of uncontrolled studies, and high placebo response rates suggest a much more complex and multifactorial pathophysiology of LPR than simple acid reflux. Laryngoscopy and pH monitoring have failed as reliable tests for the diagnosis of LPR. Empirical therapy with PPIs is widely accepted as a diagnostic test and for the treatment of LPR. However, further research is needed to develop a definitive diagnostic test for LPR.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.18 no.2
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• pp.96-101
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• 2007

Laryngopharyngeal reflux (LPR) is the retrograde movement of gastric contents into the larynx, pharynx, and upper aero-digestive tract. LPR differs from gastroesophageal reflux in that it is often not associated with heartburn and regurgitation symptoms. Otolaryngological manifestations of acid reflux include a wide range of pharyngeal and laryngeal symptoms. Belafsky et al. developed a useful self-administered tool, the reflux symptom index (RSI), for assessing the degree of LPR symptoms. Patients are asked to use a 0 to 5 point scale to grade the following symptoms: 1) hoarseness or voice problems; 2) throat clearing; 3) excess throat mucus or postnasal drip ; 4) difficulty swallowing; 5) coughing after eating or lying down; 6) breathing difficulties ; 7) troublesome or annoying cough; 8) sensation of something sticking or a lump in the throat; 9) heartburn, chest pain, indigestion or stomach acid coming up. A RSI score greater than 13 is considered abnormal. As there is no validated instrument to document the physical findings and severity of LPR, Belafsky et al. developed an eight-item clinical severity scale for judging laryngoscopic finding, the reflux finding score (RFS). They rated eight LPR-associated findings on a scale from 0 to 4 : subglottic edema, ventricular obliteration, erythema/hyperemia, vocal-fold edema, diffuse laryngeal edema, posterior commissure hypertrophy, granuloma/granulation tissue, and thick endolaryngeal mucus. A RFS score of greater than 7 was found to suggest LPR-associated laryngitis. Although both indices (RSI and RFS) are widely used, there is some controversy about their validity (sensitivity and specificity) and reliability (intra-rater and inter-rater) in LPR diagnosis and treatment. We discuss the validity and reliability of RSI and RFS with literature review.

• Korean Journal of Bronchoesophagology
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• v.9 no.1
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• pp.83-86
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• 2003

Background and Objectives : Paradoxical vocal cord movement is a series of paroxysmal adduction of the anterior two-thirds of the vocal cords during respiration or during phonation. The choking, stridor, and wheezing in this condition occur primarily on inhalation, rather than on exhalation. The two pathognomonic diagnostic criterias that need to be assessed during an acute presentation are laryngoscopy with direct visualization of paradoxical adduction of the vocal cords and pulmonary function testing. Materials and Methods : A retrospective review of 3 patients who were referred to otolaryngologist from pulmonology department, and were confirmed by typical laryngoscopic findings with paradoxical adduction of the vocal cords was conducted. Results The patients were misdiagnosed as exercised-induced asthma, and unresponsive to corticosteroid and bronchodilators. Improvement was achieved only by diagnosis with paradoxial vocal cord movement. Biofeed back therapy, voice therapy, treatment for reflux laryngitis improved symptoms. Conclusion The etiology of paradoxical vocal cord movement is unknown. It may be functional or emotional. The functional factors that were proposed are neurologic deficit and gastroesophageal reflux. Management methods of this condition consist of psychological counselling, voice therapy, and antireflux medication.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.20 no.2
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• pp.141-147
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• 2009

Background and Objectives: Although laryngopharyngeal reflux disease (LPRD) is a widely recognized disease in the field of otolaryngology, controversies still exist regarding the diagnosis and treatment for it. The purpose of this survey was to find out current trends in diagnosis and management of LPRD among Korean otolaryngologists. Materials and Method: Questionnaires were obtained from 26 Korean otolaryngology specialists by electronic balloting, and 46 members of the Korean Society of Head and Neck Surgery (KSHNS) bye-mail. Survey participants were asked about their preferences in diagnostic policy, duration/dosage of antireflux treatment, and their familiarity to the reflux symptom index (RST) and the reflux finding scores (RFS). Results: The majority of the survey participants (64%) preferred empiric therapy trial with proton pump inhibitors (PPIs) based on patients' symptoms and their laryngeal findings. PPIs alone (27%) or PPIs with prokinetics (32%) were usually prescribed as a first line treatment mostly with once daily schedule in the morning before meal and for less than 4 months of duration (86%). More than 90% of participants were aware of the RSI and RFS, but less than 50% of them were actually using those items in the clinics. Conclusion: Most of Korean otolaryngologists who participated in this survey answered that they prefer starting empirical treatments with proton pump inhibitors mainly based on the patient's symptoms and their laryngeal findings.