Gastroesophageal reflux and laryngeal disease
C. W. Deveney, K. Benner and J. Cohen
Department of Surgery, Oregon Health Sciences University, Portland.
OBJECTIVE: We wanted to determine if surgical correction of
gastroesophageal reflux disease (GERD) would affect inflammatory laryngeal
lesions in a select group of patients with known GERD and chronic
inflammatory laryngeal lesions. DESIGN: Patients with persistent
inflammatory lesions in the larynx were referred for workup of GERD when
these lesions were not associated with smoking or drinking or when
cessation of smoking failed to ameliorate these lesions during a minimum
period of 6 months. Twenty-four-hour pH monitoring was used to confirm GERD
in 10 patients, while two patients had GERD confirmed radiologically, and
one patient had typical symptoms of esophagitis and incompetent lower
esophageal sphincter. Thus, 13 patients with chronic laryngeal inflammation
persistent after cessation of smoking had concomitant GERD. These patients
were all treated with Nissen fundoplication for GERD. SETTING: Patients
with chronic laryngitis were referred to an otolaryngologist at a tertiary
medical center. PATIENTS: Patients were consecutively selected as they
presented with chronic persistent laryngeal lesions and were found to have
GERD. INTERVENTIONS: Surgical correction of GERD with Nissen
fundoplication. MAIN OUTCOME MEASURES: Status of the larynx was assessed at
3-month intervals with fiberoptic laryngoscopy and symptoms (ie,
hoarseness, sore throat) were evaluated. RESULTS: Laryngeal inflammatory
lesions and voice changes (hoarseness and sore throat) promptly resolved in
eight (73%) of 11 patients. To date, these improvements have continued
after a mean follow-up of 11 months. CONCLUSIONS: Correction of GERD in a
selected subset of patients with laryngeal inflammatory lesions ameliorates
these lesions.
