RU2716486C1 - Method for detecting and treating pharyngolaryngeal reflux - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, particularly to otorhinolaryngology. Symptoms are diagnosed in two stages. First stage involves an otorhinolaryngological examination involving an indirect laryngoscopy. If the patient has endoscopic signs of reflux-syndrome, such as hyperemia, thickening, maceration and folding of the interarytenoid space, the second stage is carried out – patient's examination. In case of interrogation, the following symptoms are detected: throat irritation, mucus sloughing down the pharynx posterior wall, lump in throat, mouth taste sour, heartburn or eructation, swallow discomfort, hoarse voice and cough, as well as data on how often patient lies after eating. That is followed by assessing the detected symptoms in scores: 0 points – absence of symptoms, 1 point – presence of symptoms 1 day a week, 2 points – presence of symptoms 2-3 days a week, 3 points – occurrence of symptoms 4 and more days a week. Obtained points are summed up and a single quantitative index is obtained, and if it is equal to or exceeds threshold of 5.5 points, conclusion is made on presence of pharyngolaryngeal reflux in patient. Efficiency of the prescribed therapy is controlled by comparing the total score before and after the treatment, determining the significance of the differences in the single quantitative index in the dynamics.

EFFECT: method provides more effective diagnosis of the reflux-induced pathology of the otolaryngs and correction of treatment ensured by using the high sensitivity and specificity indicators.

1 cl, 3 dwg, 2 ex

Description

The invention relates to medicine, namely to otorhinolaryngology, and may find application for the detection of pharyngolaryngeal reflux, including in pregnant women.

The development of pathology of ENT organs in some cases is associated with the throwing of gastric contents onto the mucous membranes of the upper respiratory tract, the so-called pharyngolaryngeal reflux (hereinafter - FLR).

Regular throwing of gastric contents into the larynxopharynx causes damage to the mucous membrane by its aggressive components, which leads to the development of chronic inflammatory changes. During pregnancy, the appearance and increase of FLR occurs due to a decrease in the tone of the esophageal sphincter under the influence of gestational hormones and an increase in intra-abdominal pressure as a result of fetal growth. In this case, the frequency of occurrence of pharyngolaryngeal reflux in pregnant women reaches 50 - 75%.

The most common symptoms of FLR are hoarseness (71%), cough (51%), as well as a lump in the throat (47%) and increased sputum production (42%).

The lack of timely treatment of FLR as a result of chronic nonspecific inflammation of the larynx can cause the formation of laryngeal granuloma, contact ulcers, hyperplastic Reinke laryngitis.

Esophagogastroduodenoscopy in the case of FLR also has low sensitivity, since the changes that cause FLR can be functional in nature and not be detected during endoscopy of the upper gastrointestinal tract.

A known method for the diagnosis of pharyngolaryngeal reflux, including daily impedance pH monitoring (see Chandra KM, Harding SM. Therapy Insight: treatment of gastroesophagealreflux in adults with chronic cough. Nature Clinical Practice Gastroenterology & Hepatology. 2007; 4 (11): 604- 613).

The disadvantages of the method is that it is expensive, has a number of contraindications, and its use during pregnancy to confirm pharyngolaryngeal reflux is impractical due to the invasive nature of the study.

There is also a known method for detecting pharyngolaryngeal reflux, including conducting surveys and analyzing the results obtained using the GerdQ questionnaire (see Delia Casa D., Missale G., Cestari R. GerdQ: tool for the diagnosis and management of gastroesophageal reflux disease in primary care. Recenti Prog Med. 2010; 101 (3): 115-117).

The GerdQ questionnaire is designed to diagnose and evaluate the effectiveness of treatment of patients with gastroesophageal reflux disease (hereinafter referred to as GERD). It is based on questions from well-known gastroenterology questionnaires: Gastrointestinal Symptom Rating Scale (GSRS), Reflux Disease Questionnaire (RDQ), and Gastro-oesophageal Reflux Disease Impact Scale (GIS). The questionnaire includes six indicators: heartburn and regurgitation, nausea and epigastric pain, sleep disturbance and taking additional medications.

When analyzing the results, each symptom of the scale is evaluated from 0 to 3 points, the presence of GERD is established with a total score of greater than or equal to 8 in accordance with the data of the application of this questionnaire (see Kaybysheva V.O., Kucheryavy Yu.A., Trukhmanov A.S. ., Storonova OA Konkov M.Yu., Mayev IV, Ivashkin VT The results of a multicenter observational study on the use of the international GerdQ questionnaire for the diagnosis of gastroesophageal reflux disease. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2013; 5; : 15-24).

The disadvantage of this method is that the use of this questionnaire does not allow to evaluate the symptoms of FLR.

The closest in technical essence to the claimed solution is a method for identifying and treating pharyngolaryngeal reflux, including conducting surveys and analyzing the results obtained on the basis of the GERD Screener questionnaire, which also contains questions for evaluating HRF, namely heartburn or belching, discomfort in the throat when swallowing, hoarseness voices and cough (see GD Fadeenko, I.E. Kushnir, M.O. Babak. “Epidemiological aspects of gastroesophageal reflux disease”, Suchasna gastroenterologiya, 2008; 5 (43): 12-16).

When implementing this method, fill out the questionnaire "Questionnaire for screening GERD". This questionnaire contains 12 questions that are typical for both a typical form of GERD (heartburn, acid regurgitation, dysphagia, belching) and atypical forms of the disease (cardiological manifestations, otorhinolaryngological manifestations: suffocation, hoarseness, cough and dental manifestations), as well as medication . At the same time, respondents indicate the frequency of occurrence of symptoms: never, occasionally, often, constantly. The question of the frequency of heartburn has other answers: daily, 1 time per week, 2 times or more in 1 week, 1 time or more in 1 month. Assessment of symptoms is carried out by analyzing each question, without defining a single numerical indicator.

The disadvantage of this method is that the method focuses on typical manifestations of GERD, contains only three questions that relate to otorhinolaryngological manifestations of GERD, which does not allow to assess the presence of FLR in a patient.

Moreover, various answers to questions, their inequality, do not allow to determine a single quantitative indicator in order to identify the studied disease and use this method as a tool for assessing the effectiveness of antireflux therapy. In addition, the method takes a fairly long time in its execution.

Thus, despite the variety of diagnostic methods for gastroesophageal reflux disease, there is currently no accurate non-invasive method that can detect pharyngolaryngeal reflux at the outpatient stage.

The technical result of the proposed solution is to increase the efficiency of diagnosis of reflux-induced pathology of ENT organs and treatment correction through the use of indicators of high sensitivity and specificity.

In order to achieve the indicated technical result in a method for detecting and treating pharyngolaryngeal reflux, comprising, by interrogating a patient, a group of clinical symptoms typical of typical and atypical forms of the disease, assessing their frequency and severity using a point scale, according to the invention, identifying the symptoms of the disease is carried out in two stages at the same time, at the first stage, an otorhinolaryngological examination is performed, including indirect laryngoscopy, and if the patient has endoscopic signs of reflux syndrome, such as hyperemia, thickening, maceration and folding of the mesenteric space, carry out the second stage - interviewing the patient with symptoms such as: sore throat, drainage of mucus along the back of the throat, lump in the throat, sour taste in the mouth, heartburn or belching, discomfort in the throat when swallowing, hoarseness of the voice and cough, as well as data on how often the patient lies after eating, then assess the symptoms identified in points: 0 points - no symptoms, 1 point - symptoms 1 day a week, 2 point - cash Chiyo symptoms 2-3

days a week, 3 points - the onset of symptoms 4 and more days a week; the scores obtained are summarized and a single quantitative indicator is obtained, and if it is equal to or exceeds the threshold of 5.5 points, a conclusion is made that the patient has pharyngolaryngeal reflux, and the effectiveness of the prescribed therapy is monitored by comparing the total score before and after treatment, determining the significance of the differences in a single quantitative indicator in dynamics.

Also, according to the invention, the presence of symptoms to the patient is assessed for the preceding survey of 7 days.

It is possible to suspect the formation of reflux-induced pathology of the larynxopharynx during endoscopic examination. The method of indirect laryngoscopy allows us to identify endoscopic signs characteristic of the casting of acidic contents into the larynx and to suggest the presence of FLR in the patient. The advantages of the method are its wide availability, simplicity and the absence of the need for anesthesia, which allows it to be used in pregnant women.

To determine the endoscopic signs characteristic of FLR and use them as diagnostic criteria, the diagnostic sensitivity of each symptom was calculated in the group of patients with exacerbation of chronic laryngitis and reflux syndrome, confirmed by the method of impedance-pH-metry.

As a result of the studies, three main endoscopic signs of FLR with the highest sensitivity were selected: hyperemia of the interchaloid space of the larynx (sensitivity 91.4%), swelling of the intercarpal space (sensitivity 86.1%), maceration and folding of the intercarpal space (sensitivity 89.3%) . Thus, the patient's identification of hyperemia, swelling, maceration, and folding of the interchaloid space of the larynx may indicate the presence of FLR.

The group of clinical symptoms was determined experimentally by interviewing patients with suspected presence of FLR. The data obtained were presented in the form of a questionnaire called the Index of Pharyngolaryngeal Reflux.

The questionnaire includes a group of symptoms from 9 indicators of the disease, selected empirically and sufficient for a preliminary diagnosis of FLR. The group consists of only 9 questions, which reduces the time it takes for the patient to fill out and simplifies the process of interpreting the data obtained by the researcher.

Answers to questions are evaluated at 0, 1, 2, 3 points, where 0 is the absence of symptoms, 1 is the presence of symptoms 1 day a week, 2 points are the presence of symptoms 2-3 days a week, 3 points are the occurrence of symptoms 4 or more days in Week. All answers are graded according to the same number of possible options, which, when determining a single indicator, does not distort the final result due to the equivalence of the numerical value of one or another answer.

In the proposed method, the patient is asked to evaluate the presence of clinical symptoms prior to the survey for 7 days, since, based on the study of available questionnaires, including groups of clinical symptoms, this period is considered the most reproducible in the patient's memory, which allows to obtain the most accurate information.

Based on the results of filling out the questionnaire, the points indicated for each question are summed up with the definition of a single quantitative indicator. Using a simple mathematical operation with the addition of points greatly facilitates the interpretation of the results of the study. Comparison of the amount of points before and after treatment allows you to evaluate the effectiveness of treatment measures and determine the significance of the differences in a single quantitative indicator in dynamics using generally accepted methods of statistical analysis.

The questionnaire was evaluated statistically by the ROC analysis, in which the ROC curve (Receiver operating characteristic or ROC curve) was constructed, with the calculation of the cut off value threshold value dividing patients according to the scores into patients and healthy. The indicator with the highest sensitivity and specificity was selected as the cutoff threshold. Based on the data obtained by the method of ROC analysis, the cutoff threshold is a point equal to 5.5. In this case, the positive sensitivity of 0.932 is excellent, and exceeding this threshold includes 93.2% of "patients" and 90.5% of "healthy" patients. If the total score is 5.5 or more, the patient is diagnosed with pharyngolaryngeal reflux.

The inventive method allows to evaluate the FLR in patients with typical complaints by comparing the results of filling out the questionnaire with the features of the endoscopic picture of the larynx.

The combination of two stages of disease detection, namely, a simultaneous comparison of laryngoscopic signs of FLR with the highest diagnostic sensitivity and symptoms typical of FLR, can improve the diagnosis of reflux-induced pathology of ENT organs and, based on the data obtained, adjust the prescribed therapy and more effectively carry out therapeutic measures.

From the above it follows that the introduced distinguishing features affect the specified technical result, are with him in a causal relationship.

The method is illustrated by drawings, where in FIG. 1. The questionnaire "Index of pharyngolaryngeal reflux"; in FIG. 2. summarized scores for the questionnaire and the corresponding indicators of sensitivity and specificity; in FIG. 3. shows the ROC curve and the area under the curve (AUC) of the “Pharyngolaryngeal Reflux Index” questionnaire.

The method is as follows.

The method is carried out in two stages. At the first stage, a routine otorhinolaryngological examination is performed, including indirect laryngoscopy. Indirect laryngoscopy is performed in a classical way: the patient is in a sitting position, the light source is located to the right of the patient at the level of the auricle, deviating from it 10-15 cm, the doctor is located opposite the patient.

The patient is asked to open his mouth and stick his tongue out. The doctor holds the tongue with his left hand through a gauze napkin, takes a laryngeal mirror with a diameter of 20 mm in his right hand. The mirror is fixed with a screw in the handle of the extension cord, and slightly heated above the flame of an alcohol lamp or a specially designed heater for mirrors.

Then, the laryngeal mirror is inserted into the oropharynx cavity with the mirror surface down to the back of the pharynx, pushing back the tongue of the soft palate back and up with the back surface of the mirror. The larynx is examined in three positions: with free breathing, phonation of the sounds “and” or “e” and with a deep breath. Indirect laryngoscopy reveals endoscopic signs of FLR, such as hyperemia, thickening, maceration, and folding of the mesenteric space.

The second stage, the patient with the presence of endoscopic signs of reflux syndrome and suspected presence of FLR, is offered to fill out a questionnaire "Index of pharyngolaryngeal reflux" (Fig. 1).

The data of the questionnaire include the following clinical symptoms: sore throat, mucus running down the back of the throat, lump in the throat or desire to clear the throat, discomfort in the throat when swallowing, coughing, hoarseness, sour taste in the mouth, heartburn or belching, as well as data how often the patient lies after eating.

After preliminary instruction, the patient makes it self-filling.

All complaints are evaluated in points for the week preceding the study, where 0 is the absence of symptoms, 1 is the presence of symptoms 1 day a week, 2 points are the presence of symptoms 2-3 days a week, 3 points are the occurrence of symptoms 4 or more days a week.

At the same time, in each paragraph of the questionnaire they put a mark on the numerical value of the points that most closely corresponds to the degree of complaints experienced.

The “Pharyngolaryngeal Reflux Index” questionnaire includes 9 clinical symptoms that are quite sufficient for the diagnosis of FLR, which is proved by performing ROC analysis, one of the goals of which was to select the ideal set of questions in the questionnaire.

The assessment of this questionnaire was carried out at the experimental stage by a statistical method by means of ROC analysis, which includes the construction of the ROC curve (Receiver operating characteristic or ROC curve). To assess the quality of the constructed ROC curve, the area under the curve (Area Under Curve or AUC) was calculated, which is bounded by the coordinate axes to the right and from the bottom and the points obtained from the top left (Fig. 3).

With AUC greater than or equal to 0.8, it is said that the model has high predictive power. The AUC for the curve constructed for the questionnaire from 9 questions presented is 0.980. In the process of work, the options for eliminating each of the questions were selected, but all the questions turned out to be important: their exclusion markedly reduced the AUC.

Thus, it has been experimentally proven that the use of the indicated questionnaire of 9 questions indicating specific clinical symptoms of the disease is the best quality indicator for further prognosis. In addition, the AUC for the presented set of questions is 0.980, which corresponds to the excellent quality of the model and indicates the high predictive power of the questionnaire proposed for identifying FLR.

The researcher determines a single quantitative indicator by a simple mathematical operation with the addition of points obtained by answering each of 9 questions. If the amount is equal to or exceeds the threshold of 5.5 points, then with a probability of 93.2% the patient has FLR (Fig. 2).

Based on the data obtained during an endoscopic examination of the larynx and according to the results of filling out the questionnaire “Index of pharyngolaryngeal reflux”, a conclusion is made about the presence or absence of pharyngolaryngeal reflux in a patient.

Based on the results obtained, therapeutic measures are carried out.

The data of the questionnaire make it possible to determine the effectiveness of treatment measures in points. The minimum value that the patient can score during the execution of the questionnaire is 0, and the maximum is 27 points, a value of 5.5 points is a threshold after which the patient has an FLR with a probability of 93.2%. The effectiveness of the prescribed therapy is monitored after 2 weeks against the background of the therapy by comparing the amount of points obtained by filling out the “Pharyngolaryngeal Reflux Index” questionnaire and determining the significance of the differences in a single quantitative indicator in dynamics. The decrease in the amount of points after treatment according to the results of filling out the questionnaire "Index of pharyngolaryngeal reflux" indicates the effectiveness of the therapy.

The method is illustrated by the following examples.

Example 1

Patient L., born in 1981, was admitted to the St. Petersburg Research Institute of Ear, Throat, Nose and Speech FBSU with complaints of paroxysmal cough, hoarseness.

From the anamnesis it is known that the above complaints have been disturbing for a long time (more than 3 years), I have been examined by a pulmonologist several times, pathology of the lower respiratory tract is excluded. During an ENT examination, hyperemia, folding of the mesenteric space, and injection of the posterior third of the vocal folds were determined.

During ENT examination, the mucous membrane of the nasal cavity is pink, moist, there is no pathological discharge, the nasal septum is not curved, and nasal breathing is free. The mucous membrane of the pharynx is pink, moist, palatine tonsils are pink, behind the arches, there are no deposits and lacunar plugs. AD / AS: external auditory canals free, eardrum gray, clear contours.

With indirect laryngoscopy, congestive hyperemia, thickening and folding of the mesenteric space, injection of the posterior third of the vocal folds are determined. The endoscopic picture of the larynx corresponds to chronic catarrhal laryngitis.

Since, according to the anamnesis and objective examination, no possible etiological factors for the development of chronic catarrhal laryngitis were identified, in order to identify the pathogenetic mechanism, the patient was asked to fill out a questionnaire “Pharyngolaryngeal Reflux Index”.

The questionnaire contained questions about the frequency of complaints such as: sore throat, drainage of mucus on the back of the throat, lump in the throat or desire to "clear the throat", discomfort in the throat when swallowing, coughing, hoarseness, sour taste in the mouth, heartburn or belching, as well as data on how often the patient lies after eating.

When analyzing the data obtained, it was revealed that the patient noted: 1. Sore throat more than 4 days in the previous week, which corresponds to 3 points. 2. Runoff of mucus along the back of the throat - more than 4 days in the previous week, which corresponds to 3 points. 3. A lump in the throat or a desire to “clear the throat” - more than 4 days in the previous week, which corresponds to 3 points. 4. Discomfort in the throat when swallowing - more than 4 days in the previous week, which corresponds to 3 points. 5. Cough - more than 4 days in the previous week, which corresponds to 3 points. 6. Hoarseness - more than 4 days in the previous week, which corresponds to 3 points. 7. Sour taste in the mouth - not a single day in the previous week. 8. Heartburn - 1 day for the previous week, which corresponds to 1 point. 9. Lying after eating more than 4 days a week, which corresponds to 3 points.

When summarizing all the points obtained according to the results of filling out the questionnaire "Index of pharyngolaringeal reflux" received 22 points.

Based on the statistical studies, it was found that if the total score according to the results of filling out the “Pharyngolaryngeal Reflux Index” questionnaire exceeds the threshold of 5.5 points, then with a probability of 93.2% the patient has FLR. Thus, the presence of a score of 22 in a patient indicates the development of FLR in the patient.

Comparing the data of an endoscopic examination of the larynx (the presence of congestive hyperemia, thickening and folding of the interchaloid space of the larynx) and a numerical indicator that exceeds the threshold of 5.5 points obtained by filling out the index “Pharyngolaryngeal Reflux Index”, it can be argued that the development of chronic catarrhal laryngitis in this patient associated with the presence of FLR.

The patient was prescribed antireflux therapy (proton pump inhibitors, alginates), and a gastroenterologist consultation was recommended. Against the background of the therapy, after 3 weeks, the patient noted the disappearance of cough, improved voice.

The data of the questionnaire make it possible to determine the severity of the effectiveness of treatment measures in points. Accordingly, a decrease in the amount of points according to the results of filling out the questionnaire “Index of pharyngolaringeal reflux” indicates the effectiveness of the treatment.

During the control filling of the questionnaire, 9 points were obtained, which is 13 points less than the previous result and indicates the correctly selected pathogenetic therapy of chronic inflammation in the larynx.

An additional examination by a gastroenterologist revealed a hiatal hernia, cardia insufficiency, and reflux esophagitis; according to the results of the daily impedance pH measurement, the patient confirmed pharyngolaryngeal reflux.

As a result of the application of the proposed method, the immediate causes of the development of inflammation in the larynx were identified, pathogenetic therapy was prescribed, as a result of which good results were obtained.

Example 2

Patient N., born in 1998 with a pregnancy of 23/24 weeks, turned to the St. Petersburg Research Institute of Ear, Throat, Nose and Speech with complaints of sore throat, sensation of a coma in the throat, occasional coughing, and was sick for 2 months. The patient repeatedly appealed for help to the clinic at the place of residence, antenatal clinic, received symptomatic cough treatment without significant effect. The patient was consulted by a pulmonologist, pathology of the lower respiratory tract is excluded.

An ENT examination revealed inflammatory changes in the posterior sections of the larynx according to the type of congestive hyperemia and pasty of the intercarpal space, arytenoid cartilage, and the folding of the intercarpal space.

The patient was asked to fill out the “Pharyngolaryngeal Reflux Index” questionnaire to detect FLR. It included questions about the frequency of perspiration in the throat, drainage of mucus on the back of the throat, coma in the throat or desire to “clear the throat”, discomfort in the throat when swallowing, coughing, hoarseness, sour taste in the mouth, heartburn or belching, as well as data on how often the patient lies after eating.

When analyzing the data obtained from the patient, it was revealed: 1. The patient noted a sore throat for more than 4 days in the previous week, which corresponds to 3 points. 2. Runoff of mucus along the back of the throat - 1 day for the previous week, which corresponds to 1 point. 3. A lump in the throat or a desire to “clear the throat” - more than 4 days in the previous week, which corresponds to 3 points. 4. Discomfort in the throat when swallowing - 1 day for the previous week, which corresponds to 1 point. 5. Cough - more than 4 days in the previous week, which corresponds to 3 points. 6. Hoarseness - 1 day for the previous week, which corresponds to 1 point. 7. Sour taste in the mouth - more than 4 days in the previous week, which corresponds to 3 points. 8. Heartburn - more than 4 days in the previous week, which corresponds to 3 points. 9. The patient lay after eating more than 4 days a week, which corresponds to 3 points.

When summarizing all the points obtained according to the results of filling out the questionnaire "Index of pharyngolaryngeal reflux", an index of 21 is obtained.

When assessing the diagnostic ability of the questionnaire, the indicator with the highest sensitivity and specificity was selected as the cutoff threshold. This point is an indicator of 5.5. In this case, exceeding this threshold includes 93.2% of "patients" and 90.5% of "healthy" patients. If the total score is 5.5 or more, the patient is diagnosed with pharyngolaryngeal reflux.

Thus, according to the results of filling out the “Pharyngolaryngeal Reflux Index” questionnaire, 21 points were obtained, which indicates the presence of FLR in the patient.

The patient was given recommendations on diet and diet, antireflux therapy (antacids) was prescribed. On examination after two weeks, the patient noted a decrease in sore throat, the disappearance of the sensation of a “coma in the throat” and cough.

An endoscopic examination of the larynx showed a decrease in the severity of inflammatory phenomena: the disappearance of pastiness of the interchaloid space, arytenoid cartilage, and a decrease in the folding of the interchaloid space.

When the control questionnaire “Index of pharyngolaryngeal reflux” was completed after 2 weeks against the background of antireflux therapy, the following data were received from the patient:

1. Sore throat, the patient noted 1 day for the previous week, which corresponds to 1 point. 2. Runoff of mucus along the back of the pharynx 1 day in the previous week, which corresponds to 1 point. 3. A lump in the throat or a desire to “clear the throat” 1 day for the previous week, which corresponds to 1 point. 4. Discomfort in the throat when swallowing, the patient did not observe a single day in the previous week, which corresponds to O points. 5. Cough 1 day for the previous week, which corresponds to 1 point. 6. Hoarseness not a single day in the previous week, which corresponds to 0 points. 7. The taste of sour in the mouth 1 day for the previous week, which corresponds to 1 point. 8. Heartburn for 2-3 days in the previous week, which corresponds to 2 points. 9. The patient did not lie after eating, which corresponds to 0 points.

When summarizing all the points according to the results of filling out the questionnaire after treatment with the “Pharyngolaryngeal Reflux Index”, a single quantitative indicator equal to 7 points was obtained, which exceeds the threshold of 5.5 and indicates that the patient has FLR, but its value decreases from 22 points (before treatment) to 7 points (after treatment) indicates the effectiveness of ongoing therapeutic measures.

The inventive method has the following advantages:

- has high sensitivity and specificity;

- allows you to detect FLR on an outpatient basis without costly invasive research methods (daily impedance pH meter);

- can be used in pregnant women;

- can be used to evaluate the effectiveness of ongoing therapy of FLR.

The inventive method is simple in execution for the doctor and the patient, does not require special equipment, takes a limited amount of time, which allows you to perform the study during normal admission during routine otorhinolaryngological examination of the patient.

Claims (2)

1. A method for identifying and treating pharyngolaryngeal reflux, comprising identifying a group of clinical symptoms characteristic of a typical and atypical form of the disease by interviewing a patient, assessing their frequency and severity using a point scale, characterized in that the detection of disease symptoms is carried out in two stages, wherein at the first stage, an otorhinolaryngological examination is performed, including indirect laryngoscopy, and if the patient has endoscopic signs of reflux syndrome, such as hyperemia, thickening, m aceration and folding of the interchaloid space, the second stage is performed - the patient is questioned with symptoms such as: sore throat, mucus running down the back of the throat, lump in the throat, sour taste in the mouth, heartburn or belching, discomfort in the throat when swallowing, hoarseness voices and cough, as well as data on how often the patient lies after eating, then assess the identified symptoms in points: 0 points - no symptoms, 1 point - the presence of symptoms 1 day per week, 2 points - the presence of symptoms for 2-3 days week, 3 points - occurrence symptoms of 4 or more days per week; the scores obtained are summarized and a single quantitative indicator is obtained, and if it is equal to or exceeds the threshold of 5.5 points, a conclusion is made that the patient has pharyngolaryngeal reflux, and the effectiveness of the prescribed therapy is monitored by comparing the total score before and after treatment, determining the significance of the differences in a single quantitative indicator in dynamics. 2. A method for identifying and treating pharyngolaryngeal reflux according to claim 1, characterized in that the presence of symptoms to the patient is assessed for the previous 7 days of the survey.

Images