ACID ESOPHAGO-PHARYNGEAL REFLUX AS THE CAUSE OF HOARSENESS

Background: Gastroesophageal reflux has been implicated in otolaryngol ogic problems, particularly chronic hoarseness that cannot be attribut ed to other causes. Patients and Methods: To study this relationship b etween gastroesophageal reflux and chronic hoarseness we used 24-h dua l-site ambulatory pH-recordings in 68 patients with chronic hoarseness and laryngeal lesions suggestive of acid irritation. Results: Thirty- eight patients (56%) had evidence of at least one esophago-pharyngeal reflux episode. The mean number of esophago-pharyngeal episodes was 6. 7 +/- 12 within 24 hours (range: 1-34 episodes). The mean duration of these episodes was 201 +/- 28 seconds (range: 6 seconds - 19.6 minutes ). Most patients with esophago-pharyngeal reflux had no evidence of pa thologic gastroesophageal reflux. Only 28.9% of the patients with esop hago-pharyngeal reflux episodes also had pathologic gastroesophageal r eflux, whereas 23.3% of the patients without esophago-pharyngeal reflu x had no gastroesophageal reflux disease. The esophago-pharyngeal refl ux occurred mainly in the upright position. Conclusions: Occult esopha go-pharyngeal reflux, predominantly in the upright position, appears t o be common and severe in patients with chronic hoarseness. Gastroesop hageal reflux may be an important factor in the pathogenesis of chroni c hoarseness. The causative mechanisms are not clear.