Your Visit with an ENT Specialist

. Posted in GERD AND LPRD

After your ENT doctor takes a detailed medical history, he or she will perform a head and neck examination with a focus on the nose and the throat. If your doctor thinks that you may have LPRD, he or she may perform a throat examination using a small mirror. The doctor may also use an instrument called a flexible fiber-optic laryngoscope. This is a thin, flexible fiber lens that allows the doctor to look at your voice box and throat.

Before the laryngoscope exam, your nose is sprayed with a decongestant mixed with a mild anesthetic, or the two may be given as separate sprays. The otolaryngologist (ENT doctor) will use the laryngoscope to evaluate your nose, throat, and voice box. If the area is swollen, inflamed, and/or red - especially around your voice box - you might have LPRD. Very often, patients who suffer from LPRD show swelling behind the vocal cords at the top of the esophagus,
called postglottic swelling. The ENT is also looking for the following features:

■ Red, irritated, and/or swollen arytenoids (structures at the back of the vocal cords that make them move) and/or interarytenoid space (the space between the arytenoids)

■ Red, irritated larynx (vocal cords)

■ Small laryngeal ulcers

■ Swelling of the vocal folds

■ Granulomas or polyps on the vocal cords or in the larynx

■ Evidence of a hiatal-hernia-like secretions coming up from the esophagus

■ Significant laryngeal pathology of any type

A second type of examination is called a videostroboscopy. This is a video examination of the larynx using a rigid endoscope with an intermittent (strobe) xenon light source that is activated by vocal fold movement. The video examination allows enlarged, slow-motion visualization of the vocal cords. This technology is also available for use in the doctor’s office and begins with a topical spray anesthesia. The definitive diagnosis of LPRD is made by demonstrating that there is acid reflux into the back of the throat. To do this, two pH sensors are used, and the patient is monitored over a 24-hour period. A small tube is passed through the nose into the esophagus to monitor the amount and type of reflux during a typical day. The patient is then free to leave the office, returning the next day. One of the biggest advantages of this type of testing is that it allows the monitoring of the patient’s system while he or she goes through a typical daily routine. In some cases, barium studies (X-ray test) are used. This procedure is almost always done if a patient complains of difficulty with swallowing, because it will clearly show if there are any scars or abnormal growths in the esophagus or if there is any inflammation of the esophagus caused by refluxed acid. A study called an esophagealgastroduodenal (EGD) endoscopy can be used to evaluate the esophagus, stomach, and small intestine for related conditions. Although barium esophagoscopy is
less sensitive in diagnosing LPRD, it is often used after treatment has failed.

Last, some physicians take a biopsy - either by using a brush to gather cells (called a brush biopsy) or by actually taking a piece of tissue - as a means for identifying changes in the lining of the throat that correspond to chronic irritation due to reflux. Some children have nonacidic reflux, which is not picked up by a pH probe or biopsy, and new studies are under way to determine whether a different type of probe can be used to identify this condition.

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