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| FIGURE 1B. The area of the upper esophageal sphincter. The Killian's area is located between the inferior pharyngeal muscle above and the cricopharyngeal muscle below. |
The diagnostic work of patients presenting with symptoms of laryngo-esophageal reflux begins with the disease history and precise physical examination. Patients with laryngo-pharyngeal reflux present with symptoms related to the upper aero-digestive tract. (Table 1).
The most commonly reported symptom by patients is the pharyngeal globus or the sensation of "something stuck in the throat". Studies3-5 have shown that in 23 - 60% of patients presenting with pharyngeal globus, gastro-esophageal reflux is the etiological cause.
Other symptoms include constant throat clearing (caused by increased secretions and irritation of the laryngeal mucosa); voice hoarseness (caused by edema or inflammation of the vocal cords); chronic sore throat (often confused with chronic tonsillitis); cough; difficulty in swallowing (caused by dysfunction of the upper esophageal sphincter); bad breath; mouth burning; ear pain; (explained by the common sensory innervation of the esophagus and the external auditory canal by the 10th cranial nerve); food sticking in the throat; throat tightening; choking sensation; air swallowing; and water brash (hypersalivation). Laryngo-pharyngeal reflux should be suspected in patients presenting with any of these symptoms.
Although difficulty in swallowing can result from reflux, other causes should also be considered, especially when symptoms persist despite adequate reflux treatment.
Laryngoscopy and gastroscopy can be performed to confirm the diagnosis of reflux. Findings in these examinations confirm: arytenoid erythema, erythema in the interarytenoid area or the laryngeal surface of the epiglottis; the interarytenoid area as cobblestones; vocal cord edema; inflammatory lesions of the vocal cords, such as granuloma and ulcer; and filling of the hypopharynx with secretions (Figures 2, 3, 4a, 4b).
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| FIGURE 2. Endolaryngeal photograph, shows erythema of the arytenoids and a small polyp on the true left vocal cord. (a = true vocal cord, b = false vocal cord, c = arytenoid, d =interarytenoid area, e =aryepiglottic field) | ||
| FIGURE 1C. Lower esophageal sphincter | ||
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| FIGURE 4A. Endolaryngeal photograph, shows the left true vocal cord (arrow). (a = true vocal cord) | FIGURE 4B. Endolaryngeal photograph immediately after excision of the granuloma of the left vocal cord. (a = true vocal cord) | FIGURE 3. Endolaryngeal photograph, shows Reinke's edema of the true vocal cords. |