The Journal of Laryngology & Otology

Main Article

Impact of different pH thresholds for 24-hour dual probe pH monitoring in patients with suspected laryngopharyngeal reflux

O Reichela1 c1 and W J Issinga2

a1 Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig Maximilians University Munich, Germany

a2 Department of Otorhinolaryngology, The Freeman Hospital, Newcastle Upon Tyne, UK

Abstract

Objectives: The gold standard test for laryngopharyngeal reflux is 24-hour pH monitoring, which determines the reflux area index with a pH threshold of less than four (i.e. the reflux area index four). However, refluxed pepsin is able to cause laryngeal injury at pH levels above five.

Study design: Prospective study.

Materials and methods: In order to establish normative values for a reflux area index with a pH threshold of less than five (i.e. the reflux area index five), 29 healthy volunteers underwent pH monitoring. In 45 patients with suspected laryngopharyngeal reflux, reflux area index four and reflux area index five were determined by pH study.

Results: In healthy volunteers, the reflux area index five was 72.6 (95th percentile). In 29 of 44 patients, laryngopharyngeal reflux was diagnosed due to a reflux area index four of greater than 6.3. However, the reflux area index five revealed laryngopharyngeal reflux in six more patients.

Conclusions: For exact analysis of pH monitoring results, two pH thresholds (less than four and less than five) must be considered. Further studies with a larger number of healthy volunteers are necessary in order to reveal normative values for the reflux area index five parameter.

(Accepted February 20 2007)

(Online publication May 23 2007)

Correspondence:

c1 Address for correspondence: Dr Oliver Reichel, Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig Maximilians University Munich, Klinikum Grosshadern, Marchionini-Strasse 15, 81377 Munich, Germany. Fax: +49 89 70 95 68 69 E-mail: entdoc@gmx.net

Footnotes

Dr O Reichel takes responsibility for the integrity of the content of the paper.

Competing interests: None declared