Pharyngeal acid reflux events in patients with vocal cord nodules

Joan Kuhn, Robert J. Toohill, Seckin O. Ulualp, Judith Kulpa, Candy Hofmann, Ronald Arndorfer, Reza Shaker

Research output: Contribution to journalArticle

106 Citations (Scopus)

Abstract

Objective: Gastroesophageal reflux has been implicated in the pathogenesis of vocal cord nodules. However, a cause-and-effect relationship has not been established. Because documentation of pharyngeal acid reflux events makes this correlation more plausible, the aim of the present study was to determine the frequency of pharyngeal acid reflux events in patients with vocal cord nodules. Methods: Eleven patients with vocal cord nodules (mean age, 42 ± 6 years) and eleven healthy volunteers (mean age, 45 ± 6 years) were studied. Patients underwent barium esophagram and ambulatory 24- hour simultaneous three-site pharyngoesophageal pH monitoring. Controls only had ambulatory 24-hour simultaneous three-site pH monitoring. In the ambulatory pH monitoring studies, pH was recorded from the manometrically determined sites of pharynx (2 cm above upper esophageal sphincter), proximal esophagus (10 cm distal to pharyngeal site), and distal esophagus (5 cm above the lower esophageal sphincter). Pharyngeal acid reflux event was deemed acceptable if all three sites recorded a decrease in pH below 4 which was not related to meal or drinking. Results: Pharyngeal acid reflux events occurred in seven of 11 patients with vocal cord nodules (1-4 episodes) and two of 11 controls (1-2 episodes) (P < .05). In both groups all pharyngeal acid reflux events occurred in upright position and were not associated with belching or coughing. Barium studies documented hiatal hernia in two patients and gastroesophageal reflux in five of 11 patients. However, none of the esophageal reflux events reached the pharynx on barium esophagram. Conclusions: Prevalence of pharyngeal acid reflux events is significantly higher in patients with vocal cord nodules compared with normal controls and suggests a contributory role for gastroesophagopharyngeal acid reflux in the pathogenesis of some vocal cord nodules.

Original languageEnglish (US)
Pages (from-to)1146-1149
Number of pages4
JournalLaryngoscope
Volume108
Issue number8 I
DOIs
StatePublished - Aug 1998

Fingerprint

Vocal Cords
Acids
Barium
Gastroesophageal Reflux
Pharynx
Esophagus
Eructation
Upper Esophageal Sphincter
Ambulatory Monitoring
Lower Esophageal Sphincter
Hiatal Hernia
Documentation
Drinking
Meals
Healthy Volunteers

Keywords

  • Gastroesophageal reflux
  • Vocal nodules

ASJC Scopus subject areas

  • Otorhinolaryngology

Cite this

Kuhn, J., Toohill, R. J., Ulualp, S. O., Kulpa, J., Hofmann, C., Arndorfer, R., & Shaker, R. (1998). Pharyngeal acid reflux events in patients with vocal cord nodules. Laryngoscope, 108(8 I), 1146-1149. https://doi.org/10.1097/00005537-199808000-00008

Pharyngeal acid reflux events in patients with vocal cord nodules. / Kuhn, Joan; Toohill, Robert J.; Ulualp, Seckin O.; Kulpa, Judith; Hofmann, Candy; Arndorfer, Ronald; Shaker, Reza.

In: Laryngoscope, Vol. 108, No. 8 I, 08.1998, p. 1146-1149.

Research output: Contribution to journalArticle

Kuhn, J, Toohill, RJ, Ulualp, SO, Kulpa, J, Hofmann, C, Arndorfer, R & Shaker, R 1998, 'Pharyngeal acid reflux events in patients with vocal cord nodules', Laryngoscope, vol. 108, no. 8 I, pp. 1146-1149. https://doi.org/10.1097/00005537-199808000-00008
Kuhn J, Toohill RJ, Ulualp SO, Kulpa J, Hofmann C, Arndorfer R et al. Pharyngeal acid reflux events in patients with vocal cord nodules. Laryngoscope. 1998 Aug;108(8 I):1146-1149. https://doi.org/10.1097/00005537-199808000-00008
Kuhn, Joan ; Toohill, Robert J. ; Ulualp, Seckin O. ; Kulpa, Judith ; Hofmann, Candy ; Arndorfer, Ronald ; Shaker, Reza. / Pharyngeal acid reflux events in patients with vocal cord nodules. In: Laryngoscope. 1998 ; Vol. 108, No. 8 I. pp. 1146-1149.
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AB - Objective: Gastroesophageal reflux has been implicated in the pathogenesis of vocal cord nodules. However, a cause-and-effect relationship has not been established. Because documentation of pharyngeal acid reflux events makes this correlation more plausible, the aim of the present study was to determine the frequency of pharyngeal acid reflux events in patients with vocal cord nodules. Methods: Eleven patients with vocal cord nodules (mean age, 42 ± 6 years) and eleven healthy volunteers (mean age, 45 ± 6 years) were studied. Patients underwent barium esophagram and ambulatory 24- hour simultaneous three-site pharyngoesophageal pH monitoring. Controls only had ambulatory 24-hour simultaneous three-site pH monitoring. In the ambulatory pH monitoring studies, pH was recorded from the manometrically determined sites of pharynx (2 cm above upper esophageal sphincter), proximal esophagus (10 cm distal to pharyngeal site), and distal esophagus (5 cm above the lower esophageal sphincter). Pharyngeal acid reflux event was deemed acceptable if all three sites recorded a decrease in pH below 4 which was not related to meal or drinking. Results: Pharyngeal acid reflux events occurred in seven of 11 patients with vocal cord nodules (1-4 episodes) and two of 11 controls (1-2 episodes) (P < .05). In both groups all pharyngeal acid reflux events occurred in upright position and were not associated with belching or coughing. Barium studies documented hiatal hernia in two patients and gastroesophageal reflux in five of 11 patients. However, none of the esophageal reflux events reached the pharynx on barium esophagram. Conclusions: Prevalence of pharyngeal acid reflux events is significantly higher in patients with vocal cord nodules compared with normal controls and suggests a contributory role for gastroesophagopharyngeal acid reflux in the pathogenesis of some vocal cord nodules.

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