Diagnosis of laryngopharyngeal Reflux by Impedance with esophageal pHmetry in children with chronic dysphonia

Abstract

Laryngopharyngeal Reflux (LPR) is the retrograde flow of gastric or duodenal contents into the pharynx and larynx, causing inflammation in the upper aerodigestive tract. Traditionally, a pH monitoring study with an acid reflux index was used. The use of multichannel intraluminal impedance testing with pH monitoring (MII-pH) confirms a causal relationship between suspicious symptoms and LPR. Objectives: To evaluate LPR diagnosed by MII-pH in the pediatric population consulting due to chronic dysphonia and laryngoscopic findings suggestive of LPR, in addition, to measure the concordance between MII-pH and traditional pH monitoring. Patients and Method: Descriptive, prospective study of patients consulting at the Gastroenterology or Otorhinolaryngology polyclinic due to chronic dysphonia, whose nasofibrolaryngoscopy (NFL) was suggestive of LPR. The patients were hospitalized for a 24-hour MII-pH. Patients with a congenital or acquired morbid history were excluded. Pathological LPR was considered if there were 3 or more acid reflux episodes at the proximal level in MII-pH. The frequency of traditional pH monitoring and altered MII-pH and the concordance between both methods were evaluated. Results: 12 patients were recruited, 10 men, 6 to 15 years old. On 9/12, pathological LPR was confirmed by MII-pH, of which 2/9 had traditional pH measurements in normal ranges and 7/9 altered pH measurements. In 3 patients, LPR was ruled out by normal proximal MII-pH. The concordance between MII-pH and traditional pH monitoring was acceptable (kappa 0.4). Conclusions: 75% of the patients with dysphonia and suggestive NFL showed objective evidence of pathological LPR. Since only with the clinical evaluation, NFL and conventional pH monitoring it is not possible to diagnose LPR, we recommend perform MII-pH for greater diagnostic certainty, avoiding unnecessary treatment, and with unwanted effects in 25% of cases.