Dysphonia as an atypical presentation of gastro-oesophageal reflux

Refluxo laringofaringeano: estudo prospectivo correlacionando achados laringoscópicos precoces com a phmanometria de 24 horas de 2 canais

Introdução: Manifestações laríngeas do refluxo gastro-esofágico são problemas cada vez mais comuns. Estudos revelam alta associação com sensação de "globus", rouquidão crônica e com tosse crônica. Seu diagnóstico e tratamento diferem da clássica doença do refluxo gastro-esofágico. Os achados à endoscopia laríngea de hiperemia e edema de estruturas glóticas, espessamento do espaço interaritenóideo, granulomas, pólipos, edema de Reinke, estenose subglótica sugerem uma investigação diagnóstica completa através da pHmanometria de 24 horas, exame de maior sensibilidade e especificidade. Objetivo: correlacionar achados clínicos e laringoscópicos precoces sugestivos de refluxo gastro-esofágico com resultados da pHmanometria de 24 horas. Avaliar terapia medicamentosa e modificações dietéticas. Forma de estudo: Clínico prospectivo. Material e Método: pacientes adultos com queixas crônicas: tosse seca, "globus", sialorréia, disfonia, pigarro, halitose e engasgos. Foram excluídos pacientes com outras patologias de vias aéreas. Endoscopia laríngea descartava aqueles que apresentassem lesões laríngeas mais avançadas. Encaminhamento à pHmanometria e iniciado tratamento clínico. Resultados: 83,6% apresentaram refluxo patológico. Sintomas mais freqüentes: disfonia (72,5%), pigarro (60,8%), tosse (29,4%), "globus" (23,5%) e sialorréia (19,6%). Associação de sintomas: dois (67,4%); três (41,2%) e quatro (21,5%). 49 pacientes iniciaram tratamento com omeprazol (20 mg) e dieta: 83,7% cursaram com melhora dos sintomas após 6 meses. Em 95,9% dos pacientes tratados houve melhora laringoscópica. Conclusões: Houve uma correlação importante entre história clínica e endoscopia laríngea com achados à pHmanometria de 24 horas. Outros estudos poderão fortalecer a telescopia laríngea para o diagnóstico do refluxo laringofaríngeo e seu acompanhamento. É necessária abordagem multidisciplinar, além de um aumento do grau de suspeição do especialista.

Acoustic analysis in the diagnosis of voice disorders in children

The main aim of this study was to describe the changes in acoustic analysis in diagnosing voice disorders in children. The secondary goal was the attempt at differentiation of organic and functional disorders by means of acoustic analysis. The study included 112 children in treated due to laryngeal papilloma, gastro-esophageal reflux, atopic disease and noduli vocales. The following values have been determined: basic frequency F(o), jitter, shimmer, F(o) tremor and the harmonics to noise ratio (HNR). The study results confirmed that the HNR value was the most sensitive indicator of changes in the voice organ.

Voice disorders in patients with suspected laryngo-pharyngeal reflux disease

Many symptoms have been recognized in association with laryngo-pharyngeal reflux disease (LPRD), but reports of perceptual voice disorders in this condition have been lacking to date. Forty-nine patients with suspected LPRD were studied for five specific perceptual voice characteristics, and these characteristics were compared to the same characteristics in individuals who had never seen an Otolaryngologist for a voice disorder or throat problem (controls). Sixteen of the suspected LPRD patients also underwent 24-hour pH probe studies. All patients with suspected LPRD had significantly increased abnormal perceptual voice characteristics (musculoskeletal tension, hard glottal attack, glottal fry, restricted tone placement, and hoarseness) compared to the controls. Statistical objective differences between the two groups was demonstrated by the presence of increased shimmer in patients with suspected LPRD compared to controls. The differential diagnosis between functional voice disorders and LPRD may be complex, and perceptual parameters may overlap. Interdisciplinary evaluation is advocated.

Hoarseness and gastroesophageal reflux in children

The importance of a hoarse voice or voice change in children has not been stressed in the literature in the same way as it has been in adults. We present 21 children who had been suffering from chronic hoarseness for more than three months and had on fibre-optic laryngoscopy findings suggestive of gastroesophageal reflux. None of them had complained of gastroesophageal symptoms. Twenty-four hour pH monitoring revealed that 13 (62 per cent) of these children had gastroesophageal reflux, seven (33 per cent) having gastroesophageal reflux more than three times the upper limit of normal. The pH graphs highlighted frequent refluxes, ranging from 0.4 to 37.4 refluxes per hour (median of 7.3 refluxes/hour). The majority of these refluxes occurred when the child was awake as opposed to asleep, with a median of 14.8 refluxes/hour and 0.9 refluxes/hour respectively (p = 0.0009). The refluxes were classically of short duration. This study suggests that gastroesophageal reflux plays a direct role in the pathogenesis of chronic laryngitis and hoarseness in children.