Chronic hoarseness secondary to gastroesophageal reflux disease: documentation with 24-h ambulatory pH monitoring.

TLDR

Gastroesophageal reflux is linked to chronic hoarseness and other otolaryngologic problems, yet the underlying mechanisms remain unclear. The study aimed to investigate the association between GER and chronic hoarseness by monitoring 33 patients with laryngeal lesions using 24‑hour intraesophageal or dual pharyngoesophageal pH monitoring. The authors employed 24‑hour ambulatory intraesophageal or dual pharyngoesophageal pH monitoring to assess acid exposure in these patients. Seventy‑eight percent of patients exhibited severe GER, mainly in the upright position, with many showing occult reflux despite normal standard tests, demonstrating that the 24‑hour pH monitor is useful for detecting this treatable condition.

Abstract

Gastroesophageal reflux (GER) has been implicated in otolaryngologic problems, particularly chronic hoarseness that cannot be attributed to other causes. To study this relationship, we used 24-h ambulatory intraesophageal or dual pharyngoesophageal pH monitoring in 33 patients with chronic hoarseness and laryngeal lesions suggestive of acid irritation. Twenty-six of the patients (78.8%) had pH evidence of severe GER, being at least three times greater than the upper limit of normal. In contrast to 19 patients with proven esophagitis, this GER was worse in the upright position. Of 15 patients with both pharyngeal and esophageal probes, three had esophagopharyngeal reflux, and two had atypical unexplained pharyngeal decreases in pH to below 4.0. Less than half of the 33 patients had the typical symptoms of GER, and standard esophageal tests usually yielded normal findings. Occult GER, predominantly in the upright position, appears to be common and severe in patients with chronic hoarseness, who have laryngeal lesions suggestive of GER. The causative mechanisms are not clear. The 24-h esophageal pH monitor is useful in screening this potentially treatable problem.