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. 2022 Aug 1;148(8):773-778.
doi: 10.1001/jamaoto.2022.1638.

Association Between Inferior Turbinate Hypertrophy and Extraesophageal Reflux

Karol Zeleník  1   2 , Zuzana Javorská  3 , Renata Taimrová  4 , Adéla Vrtková  5 , Viktória Hránková  1   2 , Miroslav Tedla  3 , Kristína Lukácová  3 , Jakub Lubojacký  1   2 , Martin Formánek  1   2 , Pavel Komínek  1   2
Affiliations

Association Between Inferior Turbinate Hypertrophy and Extraesophageal Reflux

Karol Zeleník et al. JAMA Otolaryngol Head Neck Surg. .

Abstract

Importance: To the authors' knowledge, no prior studies have examined the association between inferior turbinate hypertrophy (ITH) and extraesophageal reflux (EER). If EER were a cause or cofactor of ITH, antireflux treatment can be considered prior to surgical intervention.

Objective: To evaluate EER presence and severity in patients with different degrees of ITH.

Design, setting, and participants: Prospective multicentric cohort study conducted at 3 referral centers treating patients with EER and certified for 24-hour monitoring of oropharyngeal pH. The monitoring was performed between October 2020 and October 2021. A total of 94 adult patients with EER symptoms were recruited, 90 of whom were analyzed.

Interventions: Nasal endoscopy was performed to determine the degree of ITH, according to the Camacho classification. Presence and severity of EER were examined using 24-hour monitoring of oropharyngeal pH.

Main outcomes and measures: Primary outcomes were presence of EER according to RYAN Score, total percentage of time below pH 5.5, and total numbers of EER events below pH 5.5.

Results: Of the 90 analyzed patients (median [IQR] age, 46 [33-58] years; 36 [40%] male patients), 41 had a maximum of second-degree ITH (group 1), and 49 patients had at least third-degree ITH (group 2), according to the Camacho classification. On the basis of the RYAN Score, EER was diagnosed more often in group 2 (69.4%) than in group 1 (34.1%; difference, 35.3% [95% CI, 13.5%-56.9%]). Moreover, compared with group 1, group 2 exhibited higher median total percentage of time below pH 5.5 (median [IQR], group 1: 2.1% [0.0%-9.4%], group 2: 11.2% [1.5%-15.8%]; difference, 9.1% [95% CI, 4.1%-11.8%]) and higher median total number of EER events (median [IQR], group 1: 6 [1-14] events, group 2: 14 [4-26] events; difference, 8 [95% CI, 2-15] events). Patients with proven EER demonstrated no difference in the degree of ITH between the right and left nasal cavity (Cohen g, -0.17 [95% CI, -0.50 to 0.30]), or between the anterior and posterior parts of the nasal cavity (Cohen g, -0.21 [95% CI, -0.50 to 0.17]).

Conclusions and relevance: In this cohort study, patients with a higher degree of ITH had more severe EER. A possible association between severe ITH and EER was demonstrated.

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Conflict of interest statement

Conflict of Interest Disclosures: None reported.

Comment in

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