reflux laryngitis
Introduction
Introduction to reflux laryngitis Reflux pharyngitis, also known as Laryngo-pharyngeal Reflux (LPR), is a disease that has been widely recognized by otolaryngologists in recent years. In fact, it is very common in clinical work. However, due to the former people The lack of understanding, the disease was misdiagnosed as ordinary chronic pharyngitis for a long time, not for the treatment of the cause, but the application of antibiotics and other drugs, resulting in no significant relief of symptoms, plagued many patients for a long time, seriously reduced the patient Quality of life. In recent years, as otolaryngologists have deepened their understanding of laryngeal reflux, it has been found that the incidence of laryngeal reflux in the population is very high, accounting for 10% of all patients in the otolaryngology clinic. 50% of patients with hoarseness. basic knowledge The proportion of illness: 0.001% Susceptible people: no special people Mode of infection: non-infectious Complications: laryngeal cancer secretory otitis media laryngeal stenosis
Cause
Cause of reflux laryngitis
Direct stimulation
The refluxing acid directly stimulates the throat mucosa to cause damage and discomfort. The protective substance in the normal laryngeal epithelium is absent in the laryngeal reflux patients, which together attenuate the mucosal defense mechanism. At the same time, the pharyngeal mucosa lacks the esophageal clearing ability and saliva neutralization, so it is more sensitive to reflux stimuli than the latter.
Lost reflection
The refluxing substance can stimulate the distal esophagus, causing vagal reflexes, causing chronic cough and clear sputum to cause damage to the vocal cord mucosa, and at the same time causing a relaxing reflex of the upper esophageal sphincter, causing the reflux to enter the throat causing damage.
Prevention
Reflux laryngitis prevention
1. Avoid overeating, excessive dinner or nightingale;
2. Do not rest immediately after a meal and should raise the bedside properly;
3. Quit smoking and alcohol, eat less spicy, coffee, and strong tea;
4. Avoid wearing the belt too tightly;
5. Reduce high fat and high sugar foods;
6. Reduce the intake of citrus, bayberry and other acidic fruits.
Complication
Reflux laryngitis complications Complications laryngeal cancer secretory otitis media laryngeal stenosis
Studies have shown that laryngeal reflux may be associated with laryngeal cancer, esophageal adenocarcinoma, secretory otitis media, laryngeal stenosis, laryngeal wheezing, chronic rhinosinusitis, obstructive sleep hypopnea syndrome, enamel injury, infant death syndrome, etc. Related.
Symptom
Reflux laryngitis symptoms common symptoms sore throat dyspnea bad breath cough hoarse pronunciation change
1. Sense of foreign body sensation or sensation of sputum;
2. Diccups and difficulty in pronunciation;
3. Chronic cough: mostly irritating dry cough;
There are also symptoms such as clearing, sore throat, difficulty breathing, bad breath, increased visceral secretions of the pharynx, and dry throat. The first three are considered to be particularly common.
Examine
Reflux laryngitis examination
Diagnosis of patients with hypopharyngeal reflux can be based on the patient's symptoms and an auxiliary examination.
At present, the commonly used clinical methods for the analysis of vocal tract in patients with hypopharyngeal reflux include:
Stroboscopic laryngoscope
Using physics to replace flat light with a stroboscopic light source, the high-speed vibrating vocal cords become visible slow motions, allowing us to observe microscopic lesions on the vocal cord mucosa. The stroboscopic laryngoscope helps the doctor to observe the morphological changes of the patient's larynx, and can also pass the vocal cord mucosal wave, the observation of the amplitude of the vocal cord vibration and other characteristics of the ordinary electronic laryngoscope.
Objective acoustic analysis
It includes indicators such as voice barrier index, phonetic map, spectral map, voice fatigue test, frequency perturbation and amplitude perturbation, noise test, etc., which can objectively evaluate the quality of the voice. Acoustic analysis can be used to initially analyze whether the pronunciation has pathological changes, whether to use the appropriate pronunciation characteristics to pronounce, and whether the sound contains more noise components.
Subjective acoustic analysis
At present, the internationally used subjective auditory sensory assessment and evaluation methods include the GRBAS classification proposed by Japanese scholars (listening subjective total hoarseness G, roughness R, breath B, no strength A, tension S grading evaluation) and American scholars CAPE-V classification.
Aerodynamic laryngeal function assessment
Commonly used measurement parameters are: pronunciation of glottal air flow, subglottic pressure, audible pressure threshold pressure value, audible airflow threshold airflow value, glottal air flow and other parameters. The application of aerodynamic analysis and acoustic examination can more objectively and comprehensively evaluate the laryngeal function.
Laryngeal electromyography, if necessary, laryngeal electromyography, etc.
Mucosal biopsy
It is currently believed that pepsin can be reactivated when the pH drops, and the damage of the laryngeal mucosa can be aggravated when an acid reflux event occurs. In patients with hypopharyngeal reflux, pepsin is elevated and carbonic anhydrase is reduced. The combination of the two will contribute to the diagnosis of laryngeal reflux.
In general, due to the lack of rigorous inclusion criteria and the corresponding multi-center large sample study, as well as the symptoms of laryngeal pharyngeal reflux and laryngoscope performance are weak, the rest of the diagnostic methods need further improvement, so At present, the diagnosis of laryngeal reflux is still more convincing by relying on a combination of the above methods.
Diagnosis
Diagnosis and diagnosis of reflux laryngitis
Identification of gastroesophageal reflux: Although laryngeal reflux often coexists with gastroesophageal reflux, it still tends to think that laryngeal reflux and gastroesophageal reflux are two different wholes. For example, laryngeal reflux often occurs during the day, standing or sitting, often with difficulty in pronunciation, hoarseness, clearing, pharyngeal foreign body sensation, long-term cough, excessive throat secretion, and poor swallowing. The mirror has a specific temporal region and vocal cord specific performance, and is associated with upper gastrointestinal sphincter dysfunction, and gastroesophageal reflux often occurs at night when lying down, with acid reflux, heartburn, chest pain, difficulty in swallowing, etc. as the main discomfort, visible gastroscopy Corresponding manifestations of esophagitis, gastroesophageal fistula, and Barrett's esophagus are mainly related to abnormal function of the lower esophageal sphincter.
