Correlation Between Allergic Rhinitis And

Lryngopharingeal Reflux

Oleh :
Arief Wiratama (30101507388)
Aditya Reza Prianugraha
(30101407113)

Pembimbing :
dr. Afif Zjauhari, Sp.THT-KL
 Journal Identity
• Correlation between Allergic Rhinitis and
Title Laryngopharyngeal Reflux
• Sami Alharethy , Abdulsalam Baqays, Tamer A. Mesallam
,Falah Syouri,
Authors
Mawaheb Al Wedami, Turki Aldrees, and Alhanouf
AlQabbani

Published
• 22 March 2018

Publisher
• BioMed Research International
 Background
Non specific
Laryngopharyngeal
clinical
reflux (LPR)
presentations

However, there is a gap in

the literature regarding the
Symptoms may be correlation of
associated with allergies laryngopharyngeal reflux
(allergic rhinitis and laryngitis) with allergic
rhinitis/laryngitis
Objectives 126
• to explore the Pasients

Patients and Methods

correlation between
allergic rhinitis and
laryngopharingeal 24-hour oropharyngeal
reflux pH monitoring system

LPR (+) LPR (-)

Allergic
Rhinitis +/-
SFAR
1 LPR (+) > LPR (-)
in SFAR scores (𝑝<0.0001).

Result
2 The Ryan score ↔ SFAR total score
significantly correlated
& its symptomatology-related items
(ranged between 0.35 and 0.5)
1
LPR increases patients’self-
rating of allergic manifestations

CONCLUTION
There is an association between
2
laryngopharyngeal reflux and allergic
rhinitis/laryngitis
 interest in exploring gastric reflux ↑

INTRODUCTION
Asher W. (1935)  GERD

heartburn and acidic regurgitation

Otolaryngologist found  no specific

symptoms arising from the upper
aerodigestive tract related with GERD
LPR the diagnosis of
• Hoarseness the LPR is a
• Throat clearing and complex

I N TO D U C T I O N
• globus pharyngeus process because
ambiguous
symptoms
GERD
• Heartburn
• acidic regurgitation occur at
• esophagitisas detected Night and
by endoscopy or pH frequently in
monitoring systems the supine
positionin
the awareness of LPR ↑
• Sore throat
•

I N T R O D U C TO N
Globus sensation
Allergic • Throat clearing
Rhinitis • Dysphonia
an inflammatory • Nasal pruritus
process that occurs • sneezing
in the nasal mucosa • Rhinorrhea
that is stimulated by • Post nasal drip
exposure to • Nasal congestion
allergens
 LPR ↔ AR/AL

INTRODUCTION
Lack of available source to the relationship between
these two conditions.

This Research

to explore the associations between the

LPR and AR/AL.
 PAT I E N T S A N D
Filled up 24-hour

METHODS
126 oropharyn
SFAR geal pH
Patients
questionare monitoring
Presented to the
clinic with to assess their To detect the
symptoms allergic rhinitis presence of
suggestive of status LPR
LPR
24-Hour Oropharyngeal pH
Monitoring
• patients maintain their usual daily activity

PAT I E N T S A N D
• recorded meal times and recumbent position times

METHODS
in a diary

Ph 5 Ph 5.5
On upright On supine
position position
Ryan score

• Number of reflux

PAT I E N T S A N D
episodes Score :

METHODS
• Duration of the longest ≥ 9,41 (upright
reflux episodes position)
• The percentage of time ≥ 6,80 (supine
below the predeterminant position)
pH threshold
SFAR Rating

PAT I E N T S A N D
Patients complete the questionaire

METHODS
Total Score ≥ 7  Rhinitis
Allergic
 Statiscal Analysis
Analysis

PAT I E N T S A N D
Nonparametric AR (+) in LPR (+)
statistical

METHODS
AR (+) in LPR (-)

Spearman’s The correlation

correlation between Ph results
coefficient
and SFAR results
Analysis Mann–Whitney SFAR rating in
test

PAT I E N T S A N D
LPR (+)

METHODS
SFAR rating in
LPR (-)
Chi Square test to examine the difference
between the negative and
positive LPR groups
regarding the frequency
distribution of AR diagnosis
⁕The level of significance was set as 𝑝 < 0.05. use SPSS
Version 22
RESULT
 70
Females A mean age :
126 39,4 ± 21,2
Patients
56 males years

R E S U LT
Groups LPR positive LPR negative p
(𝑛 = 63) (𝑛 = 63)

AR positive 54(85%) 30(48%) 0,002

𝑛(%)
AR negative 9 (15%) 33 (52%)
𝑛(%)
Comparison between the positive and negative LPR
groups regarding SFAR score results.

R E S U LT
 Correlation
between the SFAR
score (item and
total scores) and
Ryan score

R E S U LT
 • There was
significantly higher
frequency of positive
LPR (+) > LPR (-) AR diagnosis
in SFAR scores (𝑝<0.0001). reported in the
positive LPR group

R E S U LT
compared to the
negative LPR group

• There was a significant

The Ryan score ↔ positive correlation
between the pH Ryan
SFAR total score score and the total
SFAR score
 Microscopic structure Larynx is an crucial structure
intercorelating

Exacerbation in one part can effected another part respiratory system

RA have similar affected on

86% asthmatic population have
laryngeal mucosa (Keller,1920
nasal symptom (Keller,1920)
and holland et al, 1999)

- Edema
To explore associations - Excessive mucous secretion
betweeen AR/AL and LPR - congestion
 Methods More
objective Biopsi for detected DIS in
spesific and
oropharingeal mucosa
sensitive
Amin et al,
- More invasive
2009 - Time comsuming
- expensive

Methods - Clinical history

subjektif - Pharyngolaryngoscopy
- Endoscopy of upper gastrointestinal tract
 DIAGNOSTIC FOR LPR
(Instrumental methods)

Diagnostic for
LPR

A 24-hour Oropharyngeal DIS (dilatation Intercellular

PH Monitoring System Space) in oropharingeal
(Ayazi,2009) mucosa (Amin et al, 2009)
DIAGNOSTIC FOR LPR reflux reflux
(non instrumental) symptoms finding
index (RSI) score
(RFS)

Belafsky, 2001
more sensitivity and
specificity
(Musser et al.2011 and Can’t be used as the main
Mesallam et al. 2010) instrument for
LPR diagnosis.
 - Dysfonia
LPR - Frequent throat clearing
- Globus sensation
(Krouse and Altman,2010)

Misdirection Of
Clinician And Scientists
AR/LA for diagnostic
Randhawa et al, Correlation dysphonia
15 people
2010 and allergic

DYSPHONIA ALLERGIC
- RSI - Skin Prick Test (SPT)
• Smaller study - RSF - NO (Nitrous Oxide)
population
• non objective
LPR diagnostic
method There were no significant differences
between allergy and LPR

• may mask the accurancy of conclusion

 126 Patients

Rhinitis Alergy LPR

24-hour oropharyngeal pH
SFAR questionare
monitoring

Significant positive correlation between Ryan score and

both item number 1 &5 in SFAR questionnaire

Total SFAR score were significantly > LPR (+) compare to LPR (-)
 SFAR

CORRELATION
WITH CLINICAL
ALERGIC RHINITIS
Ryan Score
(LPR)
 Eren,et No difference between (+) and (-) RA group
al, 2014 regarding reflux symptoms and score

diversity of results found in the current study and previously

studies because:
Other studies used a more
In this study
objective

- objective diagnostic LPR - allergic conditions (skin

(pH monitoring) prick test)
- subjective allergy - subjective testing for LPR
test (SFAR). (RSI and RFS).
 This study, AR (+) significant > in LPR (+) compare
LPR(-)

Support to the hypothesis of a relationship between LPR and AR/LA

based clinical presentation

Limitation of this study

Still debate the accuracy and
Absence of an objective there is no consensus about the
test for allergy (SPT) validity of SPT
 CONCLUSSION

LPR and allergic

rhinitis/
Laryngitis are LPR can be a
associate cofactor in
increasing patients’
self-perception of
allergic problems.
THANK YOU
 Lampiran
SFAR (RA = >7)
Standardized questionnaire for SFAR assessment
1. In the past 12 months, have you had a problem apart from cold or flu with (please tick appropriate cases(s)) :
Sneezing No □ Yes □
Runny nose No □ Yes □
Blocked nose No □ Yes □
If YES (at least one nose problem):
2. In the past 12 months, has this nose problem been accompanied by itchy-watery eyes?
No □ Yes □
3. In which of the past 12 months (or in which season) did this nose problem occur?
Jan □ Feb □ Mar □ Apr □ May □
June □ July □ Aug □ Sept □ Oct □
Nov □ Dec □
(or alternatively)
Winter □ Spring □ Summer □ Autumn □
4. What trigger factors provoke or increase your nose problem?
House dust □
House dust mites □
Pollens □
Animal (cat, dogs…) □
Others (please specify) ___________________________________________________
5. Do you think to be allergic?
No □ Yes □
6. Have you already been tested for allergy (SPT, IgE)?
No □ Yes □
If YES:
6a. What was the result?
Positive □ Negative □
7. Has a doctor already diagnosed that you suffer/suffered from asthma, eczema or allergic rhinitis?
No □ Yes □
8. Is any member of your family suffering from asthma, eczema or allergic rhinitis?
No □ Yes □
YES: Who and what disease? (please tick appropriate cases(s)):
Father Asthma □ Eczema □ Allergic rhinitis □
Mother Asthma □ Eczema □ Allergic rhinitis □
Siblings Asthma □ Eczema □ Allergic rhinitis □
Ryan Score for LPR
pH normal: 7,2
LPR: supine= 5
upright= 5,2
RSI
REFLUX FINDING SCORE
RSI