Figure 1 Figure 2
Laryngopharyngeal reflux (LPR) disease is common and it presenting symptoms differ in many aspects as compared to gastroesophageal reflux disease (GERD). The typical findings include redness and oedematous mucosa over the arytenoids (Figure 1) and posterior commissure area (Figure 2) with or without true vocal folds/subglottic involvement. Optimal treatment of LPR is crucial for successful subglottic stenosis management especially when definitive surgery is contemplated.
Figure 3 shows intraoperative clinical findings of LPR in a patient with subglottic stenosis. Thickened pale mucosa over interarytenoid and medial aspect of arytenoid complex mucosa were characteristiic. Gentle palpation demonstrate its soft consistency as compared to scar which is firm.
Figure 4 (a) Figure 4 (b)
Figure 4 (a & b) shows hyperplastic and oedematous posterior commissure
and arytenoid mucosa with corrugated/wavy appearance.
Figure 5 shows the early stage of vocal fold nodules in the presence of laryngopharyngeal reflux disease. Voive therapy and optimal management
of reflux are indicated.
Figure 6 (a) shows a markedly oedematous and prolapsing inter-arytenoid mucosa in severe LPR.
Figure 6 (b)
Figure 6 (b) shows severe oedema involving the arytenoids mucosa,
ariepiglottic folds, and pharyngoepiglottic folds bilaterally.
Figure 7 shows subcordal oedema and evolving narrowing
of subglottis secondary to prolonged acidic laryngitis.
Figure 8 is a close-up view of subcordal laryngitis (arrows) seen during suspension laryngoscopy in a patient planned for a laser procedure of another laryngeal lesion.
Figure 9 shows stringy mucous (arrows) as a feature of LPR.
Figure 10 (a) Figure 10 (b)
Subglottic stenosis complicating untreated longstanding LPR as seen during endoscopic assessment under GA. [Figure 10 (a) - at rest] and [Figure 10 (b) - upon retraction of false vocal folds]
Watch video of LPR @ YouTube
1.Belafsky PC, Postma GN, Koufman JA. Symptoms and findings of laryngopharyngeal reflux. Ear Nose Throat J. 2002 Sep. 81(9 Suppl 2):10-3
2.Belafsky PC, Postma GN, Koufman JA. Validity and reliability of the reflux symptom index (RSI). J Voice. 2002; 16:274-277.
3.Belafsky PC. Abnormal endoscopic pharyngeal and laryngeal findings attributable to reflux. Am J Med. 2003 Aug. 115(Suppl 3A):90S-96S.
Left-sided benign granuloma arising from vocal process region which develops insidiously in untreated severe laryngopharyngeal reflux disease. Note arytenoid mucosa erythema and posterior commissure mucosal hypertrophy.
Endoscopic appearance during phonation. Note supraglottic squeeze indicating muscle tension element. and false cord oedema.
i.Fasting at least 4 hours prior to test.
ii.Not presently taking any antibiotic.
Interpretation of results:
< 50 DPM Definitely negative for H.pylori
50 - 199 DPM Borderline positive for H.pylori
> 200 DPM Definitely positive for H.pylori
(DPM - Disintegrations per minute)
All results are read within two standard deviations with a specificity of 100% and a confidence interval of 99%