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Pharyngeal pH and Impedance Monitoring

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Manual of Diagnostic and Therapeutic Techniques for Disorders of Deglutition

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Abstract

Gastroesophageal reflux disease is increasingly associated with ear, nose, and throat symptoms, including laryngitis. Recent studies have assessed the increasing role of pharyngeal pH and impedance in the diagnosis of patients with laryngopharyngeal reflux and other disorders thought to be due to supraesophageal reflux of gastric and duodenal ­contents. Gastroenterology and otolaryngology specialty societies have released various guidelines in recent years addressing diagnostic and therapeutic approaches to these prevalent and often difficult to treat ­conditions. Further outcome studies are needed to assess the role of ­pharyngeal impedance and pH monitoring in this group of patients and to determine who might symptomatically benefit from medical or surgical intervention.

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References

  1. Locke III GR, Talley NJ, Fett SL, Zinsmeister AR, Melton III LJ. Prevalence and clinical spectrum of gastroesophageal reflux: a population-based study in Olmsted County, Minnesota. Gastroenterology. 1997;112(5):1448–56.

    Article  PubMed  Google Scholar 

  2. el-Serag HB, Sonnenberg A. Comorbid occurrence of laryngeal or pulmonary disease with esophagitis in United States military veterans. Gastroenterology. 1997;113(3): 755–60.

    Article  PubMed  CAS  Google Scholar 

  3. Vaezi MF, Hicks DM, Abelson TI, Richter JE. Laryngeal signs and symptoms and gastroesophageal reflux disease (GERD): a critical assessment of cause and effect association. Clin Gastroenterol Hepatol. 2003;1(5):333–44.

    Article  PubMed  Google Scholar 

  4. Gaynor EB. Otolaryngologic manifestations of gastroesophageal reflux. Am J Gastroenterol. 1991;86(7):801–8.

    PubMed  CAS  Google Scholar 

  5. Graser A. Gastroesophageal reflux and laryngeal symptoms. Aliment Pharmacol Ther. 1994;8:265–72.

    Google Scholar 

  6. Koufman J, Sataloff RT, Toohill R. Laryngopharyngeal reflux: consensus conference report. J Voice. 1996;10(3):215–6.

    Article  PubMed  CAS  Google Scholar 

  7. Koufman JA. The otolaryngologic manifestations of gastroesophageal reflux disease (GERD): a clinical investigation of 225 patients using ambulatory 24-hour pH monitoring and an experimental investigation of the role of acid and pepsin in the development of laryngeal injury. Laryngoscope. 1991;101(4 Pt 2 Suppl 53):1–78.

    Google Scholar 

  8. Koufman JA, Wallace CW, et al. Reflux laryngitis and its sequela. J Voice. 1988;2:78–9.

    Article  Google Scholar 

  9. Richter JE. Typical and atypical presentations of gastroesophageal reflux disease. The role of esophageal testing in diagnosis and management. Gastroenterol Clin North Am. 1996;25(1):75–102.

    Article  PubMed  CAS  Google Scholar 

  10. Toohill RJ, Kuhn JC. Role of refluxed acid in pathogenesis of laryngeal disorders. Am J Med. 1997;103(5A):100S–6S.

    Article  PubMed  CAS  Google Scholar 

  11. Pandolfino JE, Richter JE, Ours T, Guardino JM, Chapman J, Kahrilas PJ. Ambulatory esophageal pH monitoring using a wireless system. Am J Gastroenterol. 2003;98(4): 740–9.

    Article  PubMed  Google Scholar 

  12. Sun G, Muddana S, Slaughter JC, et al. A new pH catheter for laryngopharyngeal reflux: normal values. Laryngoscope. 2009;119(8):1639–43.

    Article  PubMed  Google Scholar 

  13. Hong SK, Vaezi MF. Gastroesophageal reflux monitoring: pH (catheter and capsule) and impedance. Gastrointest Endosc Clin N Am. 2009;19(1):1–22; v.

    Google Scholar 

  14. Wiener GJ, Tsukashima R, Kelly C, et al. Oropharyngeal pH monitoring for the detection of liquid and aerosolized supraesophageal gastric reflux. J Voice. 2009;23(4): 498–504.

    Article  PubMed  Google Scholar 

  15. Ahmed T, Vaezi MF. The role of pH monitoring in extraesophageal gastroesophageal reflux disease. Gastrointest Endosc Clin N Am. 2005;15(2):319–31.

    Article  PubMed  Google Scholar 

  16. Merati AL, Lim HJ, Ulualp SO, Toohill RJ. Meta-analysis of upper probe measurements in normal subjects and patients with laryngopharyngeal reflux. Ann Otol Rhinol Laryngol. 2005;114(3):177–82.

    PubMed  Google Scholar 

  17. Shaker R, Milbrath M, Ren J, et al. Esophagopharyngeal distribution of refluxed gastric acid in patients with reflux laryngitis. Gastroenterology. 1995;109(5): 1575–82.

    Article  PubMed  CAS  Google Scholar 

  18. Ylitalo R, Lindestad PA, Ramel S. Symptoms, laryngeal findings, and 24-hour pH monitoring in patients with suspected gastroesophago-pharyngeal reflux. Laryngoscope. 2001;111(10):1735–41.

    Article  PubMed  CAS  Google Scholar 

  19. Oelschlager BK, Eubanks TR, Maronian N, et al. Laryngoscopy and pharyngeal pH are complementary in the diagnosis of gastroesophageal-laryngeal reflux. J Gastrointest Surg. 2002;6(2):189–94.

    Article  PubMed  Google Scholar 

  20. Hirano I, Richter JE. ACG practice guidelines: esophageal reflux testing. Am J Gastroenterol. 2007;102(3):668–85.

    Article  PubMed  Google Scholar 

  21. Wo JM, Jabbar A, Winstead W, Goudy S, Cacchione R, Allen JW. Hypopharyngeal pH monitoring artifact in detection of laryngopharyngeal reflux. Dig Dis Sci. 2002; 47(11):2579–85.

    Article  PubMed  CAS  Google Scholar 

  22. Noordzij JP, Khidr A, Desper E, Meek RB, Reibel JF, Levine PA. Correlation of pH probe-measured laryngopharyngeal reflux with symptoms and signs of reflux laryngitis. Laryngoscope. 2002;112(12):2192–5.

    Article  PubMed  Google Scholar 

  23. Ulualp SO, Toohill RJ, Shaker R. Outcomes of acid suppressive therapy in patients with posterior laryngitis. Otolaryngol Head Neck Surg. 2001;124(1):16–22.

    Article  PubMed  CAS  Google Scholar 

  24. Vaezi MF, Richter JE, Stasney CR, et al. Treatment of chronic posterior laryngitis with esomeprazole. Laryngoscope. 2006;116(2):254–60.

    Article  PubMed  CAS  Google Scholar 

  25. Eubanks TR, Omelanczuk PE, Maronian N, Hillel A, Pope CE 2nd, Pellegrini CA. Pharyngeal pH monitoring in 222 patients with suspected laryngeal reflux. J Gastrointest Surg. 2001;5(2):183–90; discussion 190–1.

    Google Scholar 

  26. Maldonado A, Diederich L, Castell DO, Gideon RM, Katz PO. Laryngopharyngeal reflux identified using a new catheter design: defining normal values and excluding artifacts. Laryngoscope. 2003;113(2):349–55.

    Article  PubMed  Google Scholar 

  27. Shaker R, Bardan E, Gu C, Kern M, Torrico L, Toohill R. Intrapharyngeal distribution of gastric acid refluxate. Laryngoscope. 2003;113(7):1182–91.

    Article  PubMed  Google Scholar 

  28. Oelschlager BK, Eubanks TR, Oleynikov D, Pope C, Pellegrini CA. Symptomatic and physiologic outcomes after operative treatment for extraesophageal reflux. Surg Endosc. 2002;16(7):1032–6.

    Article  PubMed  CAS  Google Scholar 

  29. Swoger J, Ponsky J, Hicks D, et al. Surgical fundoplication in laryngopharyngeal reflux unresponsive to aggressive acid suppression: a controlled study. Clin Gastroenterol Hepatol. 2006;4(4):433.e431–41.

    Google Scholar 

  30. Aslam M, Bajaj S, Easterling C, et al. Performance and optimal technique for pharyngeal impedance recording: a simulated pharyngeal reflux study. Am J Gastroenterol. 2007; 102(1):33–9.

    Article  PubMed  Google Scholar 

  31. Ulualp SO, Toohill RJ, Hoffmann R, Shaker R. Pharyngeal pH monitoring in patients with posterior laryngitis. Otolaryngol Head Neck Surg. 1999;120(5):672–7.

    Article  PubMed  CAS  Google Scholar 

  32. Sifrim D, Dupont L, Blondeau K, Zhang X, Tack J, Janssens J. Weakly acidic reflux in patients with chronic unexplained cough during 24 hour pressure, pH, and impedance monitoring. Gut. 2005;54(4):449–54.

    Article  PubMed  CAS  Google Scholar 

  33. Kawamura O, Aslam M, Rittmann T, Hofmann C, Shaker R. Physical and pH properties of gastroesophagopharyngeal refluxate: a 24-hour simultaneous ambulatory impedance and pH monitoring study. Am J Gastroenterol. 2004;99(6):1000–10.

    Article  PubMed  Google Scholar 

  34. Ciriza-de-Los-Rios C, Canga-Rodriguez-Valcarcel F. High-resolution manometry and impedance-pH/manometry: novel techniques for the advancement of knowledge on esophageal function and their clinical role. Rev Esp Enferm Dig. 2009; 101(12): 861–9.

    Article  PubMed  CAS  Google Scholar 

  35. Bredenoord AJ, Weusten BL, Smout AJ. Symptom association analysis in ambulatory gastro-oesophageal reflux monitoring. Gut. 2005;54(12):1810–7.

    Article  PubMed  CAS  Google Scholar 

  36. Kawamura O, Bajaj S, Aslam M, Hofmann C, Rittmann T, Shaker R. Impedance signature of pharyngeal gaseous reflux. Eur J Gastroenterol Hepatol. 2007;19(1):65–71.

    Article  PubMed  Google Scholar 

  37. Kahrilas PJ, Shaheen NJ, Vaezi MF. American Gastroenterological Association Institute technical review on the management of gastroesophageal reflux disease. Gastroenterology. 2008;135(4):1392–413; 1413 e1391–5.

    Google Scholar 

  38. Koufman JA, Aviv JE, Casiano RR, Shaw GY. Laryngopharyngeal reflux: position statement of the committee on speech, voice, and swallowing disorders of the American Academy of Otolaryngology-Head and Neck Surgery. Otolaryngol Head Neck Surg. 2002;127(1):32–5.

    Article  PubMed  Google Scholar 

  39. Belafsky PC, Postma GN, Daniel E, Koufman JA. Transnasal esophagoscopy. Otolaryngol Head Neck Surg. 2001;125(6):588–9.

    Article  PubMed  CAS  Google Scholar 

  40. Ossakow SJ, Elta G, Colturi T, Bogdasarian R, Nostrant TT. Esophageal reflux and dysmotility as the basis for persistent cervical symptoms. Ann Otol Rhinol Laryngol. 1987;96(4):387–92.

    PubMed  CAS  Google Scholar 

  41. Wiener GJ, Koufman JA, Wu WC, Cooper JB, Richter JE, Castell DO. Chronic hoarseness secondary to gastroesophageal reflux disease: documentation with 24-h ambulatory pH monitoring. Am J Gastroenterol. 1989;84(12):1503–8.

    PubMed  CAS  Google Scholar 

  42. Wilson JA, White A, von Haacke NP, et al. Gastroesophageal reflux and posterior laryngitis. Ann Otol Rhinol Laryngol. 1989;98(6):405–10.

    PubMed  CAS  Google Scholar 

  43. Katz PO. Ambulatory esophageal and hypopharyngeal pH monitoring in patients with hoarseness. Am J Gastroenterol. 1990;85(1):38–40.

    PubMed  CAS  Google Scholar 

  44. Woo P, Noordzij P, Ross JA. Association of esophageal reflux and globus symptom: comparison of laryngoscopy and 24-hour pH manometry. Otolaryngol Head Neck Surg. 1996;115(6):502–7.

    Article  PubMed  CAS  Google Scholar 

  45. Metz DC, Childs ML, Ruiz C, Weinstein GS. Pilot study of the oral omeprazole test for reflux laryngitis. Otolaryngol Head Neck Surg. 1997;116(1):41–6.

    Article  PubMed  CAS  Google Scholar 

  46. Vaezi MF, Schroeder PL, Richter JE. Reproducibility of proximal probe pH parameters in 24-hour ambulatory esophageal pH monitoring. Am J Gastroenterol. 1997; 92(5):825–9.

    PubMed  CAS  Google Scholar 

  47. Chen MY, Ott DJ, Casolo BJ, Moghazy KM, Koufman JA. Correlation of laryngeal and pharyngeal carcinomas and 24-hour pH monitoring of the esophagus and pharynx. Otolaryngol Head Neck Surg. 1998;119(5):460–2.

    PubMed  CAS  Google Scholar 

  48. Havas T, Huang S, Levy M, et al. Posterior pharyngolaryngitis: double-blind randomised placebo-controlled trial of proton pump inhibitor therapy. J Otolaryngol. 1999;3:243.

    Google Scholar 

  49. Smit CF, Copper MP, van Leeuwen JA, Schoots IG, Stanojcic LD. Effect of cigarette smoking on gastropharyngeal and gastroesophageal reflux. Ann Otol Rhinol Laryngol. 2001;110(2):190–3.

    PubMed  CAS  Google Scholar 

  50. Park W, Hicks DM, Khandwala F, et al. Laryngopharyngeal reflux: prospective cohort study evaluating optimal dose of proton-pump inhibitor therapy and pretherapy predictors of response. Laryngoscope. 2005;115(7):1230–8.

    Article  PubMed  CAS  Google Scholar 

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Author information

Authors and Affiliations

  1. Division of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, Nashville, TN, USA

    Robert T. Kavitt MD

  2. Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, TN, USA

    Michael F. Vaezi MD, PhD, MSc (Epi)

Authors
  1. Robert T. Kavitt MD
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  2. Michael F. Vaezi MD, PhD, MSc (Epi)
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Corresponding author

Correspondence to Michael F. Vaezi MD, PhD, MSc (Epi) .

Editor information

Editors and Affiliations

  1. Div. Gastroenterology & Hepatology, Medical College of Wisconsin, West Wisconsin Avenue 9200, Milwaukee, 53226, Wisconsin, USA

    Reza Shaker

  2. , Dpt of Communication Sciences & Disorder, University of Wisconsin-Milwaukee, East Hartford Ave 2400, Milwaukee, 53201, Wisconsin, USA

    Caryn Easterling

  3. , Dpt Otolaryngology/Head & Neck Surg., UC Davis Medical Center, Stockton Blvd. 2521, Sacramento, 95817, California, USA

    Peter C. Belafsky

  4. Ctr for Voice, Airway & Swallowing Disor, Department of Otolaryngology, Georgia Health Sciences University, 15th Street 1120, Augusta, 30912, Georgia, USA

    Gregory N. Postma

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Kavitt, R.T., Vaezi, M.F. (2013). Pharyngeal pH and Impedance Monitoring. In: Shaker, R., Easterling, C., Belafsky, P., Postma, G. (eds) Manual of Diagnostic and Therapeutic Techniques for Disorders of Deglutition. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-3779-6_11

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  • DOI: https://doi.org/10.1007/978-1-4614-3779-6_11

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