Effect Of Proton Pump Inhibitor On Difficult-to-treat Rhinosinusitis With Laryngopharyngeal Reflux After Operation

Objective:Patients with Difficult-to-treat rhinosinusitis(DTRS)with laryngopharyngeal reflux(LPR)were given standardized oral administration of proton pump inhibitors(PPI)for 8 weeks after operation.The recovery of operation cavity,the improvement of symptoms and signs of laryngeal reflux and the changes of salivary pepsin concentration of reflux marker were compared to explore DTRS with LPR.Methods:Fifty patients with laryngopharyngeal reflux and Difficult-to-treat rhinosinusitis who underwent endoscop sinus surgery(ESS)were selected from December 1,2019 to April 1,2021 in the Department of Otolaryngology,Head and Neck Surgery,People’s Hospital of Henan University.Saliva samples were collected at four time points before operation: fasting in the morning,1 hour after lunch,1 hour after dinner,and when symptoms occurred.The concentration of pepsin was measured by enzyme-linked immunosorbent assay(ELISA).Collect the general data of patients,improve the laryngoscope,nasal endoscope and CT examination of paranasal sinuses;The preoperative general data,peripheral blood eosinophil count,Visual analogue scale(VAS)score of sinusitis symptoms,peripheral blood Ig E,Lund-Kennedy nasal endoscopy score,Lund-Mackay sinus CT score,Reflux symptom index(RSI)and Reflux finding score(RFS)were compared between the two groups.After operation,25 cases in the experimental group were treated with standardized PPI for 8 weeks plus routine perioperative treatment(nasal hormone before operation and regular follow-up after operation),and 25 cases were treated with routine perioperative treatment.The concentration of saliva pepsin in two groups of patients after PPI treatment at 8 weeks after operation was collected.Lund-Kennedy score,VAS score,RSI score and RFS score were collected at the 1st,3rd,6th and December follow-up.The Lund-Mackay scores were collected in the 12 th month after operation,and the changes of related symptom scores and objective examination results between the two groups compared with those before operation and the differences between the two groups were analyzed,so as to evaluate the short-term clinical effect of PPI treatment on DTRS with LPR one year after operation.Spearman correlation analysis evaluated the correlation between laryngopharyngeal reflux index(RSI and RFS scores)and sinusitis parameters(Lund-Kennedy and Lund-Mackay scores,VAS scores).All the data were statistically analyzed by SPSS25.0 software,with P<0.05 as the statistical test standard.Results:There were 25 cases in the experiment group,including 13 males and 12 females,with an average age of 43.0±11.8.The mean peripheral blood Ig E score was 172.78±82.26,the mean peripheral blood eosinophil count score was 0.43±0.25,Lund-Kennedy and Lund-Kennedy scores were 16.76±3.01,9.00±2.14,RFS and RSI scores were 9.36±1.80,14.32±4.52,respectively.There were 25 cases in the control group,including 12 males and 13 females,with an average age of 40.1±11.7,an average peripheral blood Ig E score of 159.68±74.60,an average peripheral blood eosinophil count score of 0.40±0.24,and Lund-Mackay and Lund-Kennedy scores of 17.24±3.72 and 9.08±2.31,respectively.According to the clinical symptoms,sinus CT and nasal endoscopy,there was no significant difference in age distribution,smoking history,Lund-Mackay score,Lund-Kennedy score,peripheral blood Ig E,peripheral blood eosinophil percentage,VAS score and saliva pepsin concentration between the experimental group and the control group(P>0.05).After one year’s continuous follow-up,it was found that the scores of RFS,RSI and VAS in the experimental group were significantly lower than those in the control group [(2.52±1.48)vs(3.64±1.65),P<0.05;(2.88±1.48)vs(4.68±1.65),P<0.05;(2.96±2.09)vs(5.80±3.10);P<0.05];Compared with the control group,the Lund-Kennedy score of the experimental group was lower[(1.08±0.76)vs(2.16±1.11),P<0.05];There was no significant difference in Lund-Mackay scores between the two groups[(0.92±0.95)vs(1.36±0.86),P>0.05];The concentration of pepsin in saliva of experimental group was significantly lower than that of control group[(51.35±10.39)vs(63.78±8.09);(58.14±11.43)vs(67.85±10.11);(60.66±12.20)vs(68.29±10.06),P<0.05],and there was no significant difference only one hour after dinner [(62.41±8.74)vs(64.52±7.94),P<0.05].Spearman correlation analysis showed that RSI was positively correlated with Lung-Kennedy score,Lung-Mackay score and VAS score(rs = 0.337,P = 0.017 < 0.05),(rs = 0.283,P = 0.046 < 0.05),(rs = 0.348,P=0.013 <0.05);RFS was positively correlated with Lung-Kennedy score,but had little correlation with Lung-Mackay score and VAS score(rs = 0.310,P = 0.028 < 0.05),(rs = 0.232,P = 0.104 > 0.05),(rs = 0.150,P = 0.05).Conclusions:1.The prognosis of some refractory sinusitis is closely related to throat reflux,so it is necessary to investigate throat reflux in patients with refractory sinusitis.2.PPI can improve the curative effect and quality of life for patients with refractory sinusitis with throat reflux after operation,and can be used as an individualized treatment for such patients.