Akaki CM, Velázquez RSL

Language: Spanish
References: 8
Page: 124-133
PDF size: 384.31 Kb.

ABSTRACT

Background The laryngopharynx reflux is a frequent concern in the Otolaryngology consultation, unfortunately it is common to over diagnose it and getting throw it without enough clinical evidence. One of the most useful tools for evaluating laryngeal signs of pathology is the indirect laryngoscopy with a rigid 70^° endoscopic lens, that provides a sharp image, with the advantage of a faster diagnosis and quicker test free of risks from other endoscopic studies.
Objectives To analyze the instrument called rigid 70^° laryngoscope lens by doing indirect laryngoscopies, measuring the concordance between two national experts in laryngeal pathology, taking as a diagnostic measure a visual scale that is already known and used for the diagnosis of laryngopharynx reflux.
Material and method We digitally recorded 30 laryngoscopies of patients with and without suggestive laryngopharynx reflux symptoms. Each observer analyzed and qualified separately each parameter with the visual scale proposed by Belafsky (2001), then we compared the average of each observer and calculate the statistical inter observer concordance in each clinical parameter with the Kappa coefficient.
Results We found a very far discordance in most of the parameters and only one concordance in the parameter ulcer/granuloma; so, this instrument is a simple and quick method with few collateral symptoms but it can not be a repeatable method measuring hyperemia, vocal cord edema, diffuse larynx edema, ventricular obliteration, posterior commissure hypertrophy, thick endolarynx secretion or pseudo-sulcus.
Conclusion The indirect laryngoscopy with a rigid 70^° endoscopic lens is not a method with an internal validity enough for the correct identification and interpretation of the suggestive signs of laryngopharynx reflux.

REFERENCES

1. Hanson DG, Jiang JJ. Diagnosis and management of chronic laryngitis associated with reflux. Am J Med 2000;108:112S-119S.

2. Ylitalo R, Ramel S. Extra esophageal reflux in patients with contact granuloma: a prospective controlled study. Ann Otol Rhinol Laryngol 2002;111:441-446.

3. Hickson C, Simpson CB, Falcon R. Laryngeal seudosulcus as a predictor of laryngopharyngeal reflux. Laryngoscope 2001;111:1742-1745.

4. Lundy DS, Casiano RR, Sullivan PA, et al. Incidence of abnormal laryngeal findings in asymptomatic singing students. Otolaryngol Head Neck Surg 1999;121:69-77.

5. Hickson C, Simpson CB, Falcon R. Laryngeal pseudosulcus as a predictor of laryngopharyngeal reflux. Laryngoscope 2001;111:1742-1745.

6. Vaezi MF. Laryngitis and gastro esophageal reflux disease: increasing prevalence or poor diagnostic tests? Am J Gastroenterology 2004;99:786-788.

7. Belafsky PC, Postma GN, Koufman JA. The validity and reliability of the Reflux Finding Score (RFS). Laryngoscope 2001;111:1313-1317.

8. Wolfsen HC, Hemminger LL, Achem SR, Loeb DS, et al. Complications of endoscopy of the upper gastrointestinal tract: a single-center experience, 2004;79:1264- 1267.