Clinical Studies Of The Laryngopharyngeal Reflux Disease And Nasal Diseases

Objective:1 To research one year inpatient laryngopharyngeal reflux related disease incidence in Bethune International Peace Hospital.2 To observe the relevance between nasal symptom patient and laryngopharyngeal reflux disease.3 Retrospective study the relevance between the chronic nasal-sinusitis with nasal polyps who received FESS operation but recovered badly with reflux disease and the pathological type of nasal polyps.Methods:1 One year clinical investigation for laryngopharyngeal reflux disease was performed for hospitalized patients in our department,from July 2013 to July 2014. Including tumor of the upper respiratory tract, obstructive sleep apnea hypoventilation syndrome(OSAHS), chronic rhino- sinusitis with or without nasal polyps, nasal septum deviated, chronic tonsillitis, adenoid hypertrophy, styloid syndrome, fungal sinusitis, chronic otitis media, vocal benign diseases. All patients were taught to fill the reflux symptom index scale score(RSI).2 Thirty patients of laryngopharyngeal reflux disease were diagnosed in ENT outpatients in January 2013 to August 2014 in our hospital. Including 14 male and 16 female, aged 12-62 years, mean 33.5 years. All patients were nasal symptoms as chief complaint, have had no effect for the normal treatment of nasal-sinusitis for three months, All patients filled the RSI and the nasal symptoms of visual analog scale(VAS) score, nasal endoscopy and sinus CT scan imaging studies. All patients’ RSI≥13 points, Nasal endoscopy and CT imaging to exclude sinus sinusitis, tuberculosis, At the same time exclude ANCA ﹢and other diseases. The results were analyzed with SPSS21.0 statistical software.3 A retrospective study was performed for 64 cases of chronic nasal sinusitis with nasal polyps from January 2011 to December 2014 in our department, All patients have received full house FESS by the same rhinologist. All patients received preoperative routine use of antibiotics and steroid nasal spray for two weeks, All full house FESS was performed according by the front-to-back way, the nasal packing was removed 48 hours after operation and routine use of antibiotics for 1 week, hormone nasal spray for all patients from 1 month to 2 months postoperatively, nasal rinse twice daily, from 1 to 3month, the first endoscopic dressing time is two weeks postoperation by the same physician. Endoscopic clean up nasal dressing 1 time, after 1month later until after the 3months untill 6months. Review the patients that clinical improvement and delayed healing more than in 3months that sinus still edema and vesicles and exclude patients with allergies and other factors, patients were filled RSI by telephone or fill out when outpatient review. Patients with more than 13 points for the inclusion criteria, total 22 cases. The results of analysis of pathological and histological type of polyps in patients with normal and pathological classification were compared.Results:1 The annual inpatients research shows, the RSI positive patients with tumor of the upper respiratory tract are 22/80(27.5%); the RSI positive patients with OSAHS are 21/92 cases(22.8%); the RSI positive patients with chronic rhino- sinusitis with or without nasal polyps are 41/207 cases(19.8%); the RSI positive patients with nasal septum deviation are 12/94(12.7%); the RSI positive patients with chronic tonsillitis merger adenoidal are 25/228(10.9%); the RSI positive patients with styloid syndrome are 3/6(33.3%); the RSI positive patients with fungal sinusitis are 3/36(8.3%); the RSI positive patients with chronic suppurative otitis media are 3/55(5.5%); the RSI positive patients with vocal benign disease are 47/151(31.1%). Nasal dieasese approximately 16.61%, the largest number is chronic rhino-sinusitis. ENT with laryngopharyngeal reflux disease inpatients accounted for approximately 18.5% of the annual proportion.2 Laryngopharyngeal reflux symptom score at four time points, the first visit, after treatment 15 days, 45 days, 75 days four times repeated measures analysis of variance, Using Greenhouse-Geisser correction, statistic F= 128.974, P=0.000(P<0.05), believes there is a significant difference in the total score of the whole four time points, Repeated measures further do pairwise comparisons, any two P =0.000, can be considered both a difference between any two of the four time points. Seen by the standardized regression coefficients, excessive sputum or postnasal drip greatest impact, that is caused by the total score of the main symptoms of excessive sputum or postnasal drip. As the duration of treatment, the symptoms become less and less, even if the same symptoms, regression coefficient tends to decrease, indicating that the improvement in symptoms. The VAS total scores at four time points: the first visit, after treatment 15 days, 45 days, 75 days four times repeated measures analysis of variance, Using Greenhouse-Geisser correction, statistic F=44.352, P=0.000(P<0.05), believes there is a difference in the total score of the whole four time points, Repeated measures further do pairwise comparisons, any two P=0.000, can be considered both a difference between any two of the four time points. Seen by the standardized regression coefficients, hyposmia is the greatest impact, that is caused by the total score of the main symptoms of hyposmia. VAS total score of each variable associated with RSI: When first diagnosed RSI total score only associated with sneezing, r=0.463; after treatment 15 days RSI total score with headache and dizziness associated, The closest relationship with the headache, r=0.521; after treatment 45 days RSI total score with a runny nose and headache associated, the closest relationship with the runny nose, r=0.488. After treatment 75 days RSI is associated with the total score only sneezing, r=0.561. Spearman correlation analysis excessive sputum or postnasal drip and RSI Total score: With the increase in the number of days of treatment, the degree of correlation is growing.3 Among 64 inpatients, 22 chronic rhino-sinusitis with nasal polyps who have had delayed healing achieved clinical improvement. The reason was considered relevant to the laryngopharyngeal reflux disease after exclusion of other factors. Nasal polyps biopsy was genotyped, including 3 glandular type, accounting for 14.2%; 6 vascular type, accounting for 28.5%; 8 fibrosis type, accounting for 36.7%; 5 mixed type, accounting for 21.4%, which are more fibrosis. Comparing with normal recovery inpatients with chronic rhino-sinusitis and nasal polyps, the polypoid tissue type did not show significant difference. However the merger laryngopharyngeal reflux disease in17 patients with nasal polyps associated with an increase in eosinophils, compared with the number of patients with normal recovery.Conclusion:1 Annual inpatients research shows that patients in ENT especially throat and nasal disease should take into account the existence of the laryngopharyngeal reflux disease.2 Laryngopharyngeal reflux disease and nasal disease was significantly associated, nasal symptoms are chief complaint of the patient must exclude the laryngopharyngeal reflux disease first.3 Chronic rhino-sinusitis and nasal polyps in patients with postoperative recovery delayed and clinical healing,those who are associated with laryngopharyngeal reflux disease partly.