Does laryngopharyngeal reflux disease impair nasal mucociliary transport? A case control prospective study

Abstract

Background: Laryngopharyngeal reflux disease (LPRD) is the retrograde reflux of gastro duodenal contents above the level of upper oesophageal sphincter into larynx and pharynx. LPRD can lead to upper respiratory pathology by direct contact of nasal and nasopharyngeal mucosa with the regurgitated gastric acid. Refluxate can damage the cilia, thereby prolonging the mucociliary clearance time (MCT) and consequently affecting the innate defence mechanism of upper airway. Our objective was to analyse the relationship between MCT and LPRD in patients without any nasal pathology. Methods: This study was a prospective case control study, with 45 patients each in the study and reference group. Study group included patients with symptoms of LPRD who fulfilled the reflux symptom index (RSI) score of more than 13 points. The reference group included subjects without LPRD, with RSI less than 13. In both groups, conditions causing impaired MCT like allergic rhinitis, sinusitis, rhinitis and history of smoking were excluded. Chronic sinusitis cases were excluded in both groups using sino-nasal outcome test -22 scoring system. Nasal MCT was measured in all these participants using the Saccharin test. Duration more than 20 minutes was taken as prolonged mucociliary clearance time. Results: MCT was prolonged in 62% of subjects (28 out of 45) in the study group whereas, in the reference population MCT was normal. Conclusions: LPRD is a contributing factor for impaired nasal mucociliary transport.