Comparison of Nasal Resistance and Flow in Laryngopharyngeal Reflux Patients and Controls

Background: The pathophysiology of laryngopharyngeal reflux (LPR) is not well understood. Respiration affects the status of upper and lower esophageal sphincters. Objective: We compared nasal airway resistance and flow during respiration in LPR patients and controls to detect a possible correlation. Methods: Total nasal resistance (TNR) and sum of flow (SF) of 25 LRP patients and 25 controls without LPR was measured with active anterior rhinomanometry. Gastrointestinal and otolaryngological symptoms, severity and duration were assessed according to visual analog scale. Patients were subjected to upper gastrointestinal endoscopy, nasendoscopy and flexible pharyngolaryngoscopy. Results: LPR patients had before decongestion statistically significant lower TNR (0. 15; p-value: 0.008) and higher SF (547; p-value: 0.004) and after decongestion TNR (0.10; p-value: 0.002) and SF (762; p-value: 0.003) at 75 Pascal compared to controls. Decongestion decreased non significantly (p-value: 0.66) TNR in controls (27.2%) less than in LPR group (28%). Stepwise logistic regression analysis revealed SF 450 increases likelihood of LPR 5 times (95% confidence interval: 1.6-19.2) compared to those having SF 450. Conclusion: Our results supports that relatively lower TNR and higher SF are associated with LPR. If this is con-firmed in larger group of LPR patients, it will contribute to better understanding of LPR pathophysiology. This may allow also partial explanation of CPAP anti reflux effect. Controlled reduction of TNR by nasal surgery might be needed to avoid disruption of this newly discovered anti reflux barrier.