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Narrow Band Imaging for lingual tonsil hypertrophy and inflammation, in laryngo-pharyngeal reflux disease

  • Laryngology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Purpose

The objective of this study is to analyse the relationship between the endoscopic signs of laryngo-pharyngeal reflux, the lingual tonsil hypertrophy (LTH) and its inflammation, adopting Narrow Band Imaging (NBI) technology.

Methods

We enrolled, as cases, patients with clinical diagnosis of laryngopharyngeal reflux disease (LPRD), a Reflux Symptom Index (RSI) ≥ 13, and a Reflux Finding Score (RFS) ≥ 7. Controls were enrolled among patients who underwent the same transnasal endoscopy, equipped with NBI, with a RSI < 13 and a RFS < 7. Nasopharynx, Lingual Tonsils (LT), Hypopharynx and Larynx were evaluated by two experienced otolaryngologists, who calculated the Reflux Finding Scale (RFS) score and focused their attention on the base of the tongue, observing its surface with NBI technology.

Results

82 patients with diagnosis of laryngopharyngeal reflux were enrolled as cases. Mean RFS was 11.7 (SD = 2.9). As controls, we enrolled 80 patients. Mean RFS was 2.7 (SD = 1.63). We found that RFS positivity was associated with a significant increase in LT dimension (2.5 vs 1.1, p < 0.001), with a higher LT crypt inflammation grading (1.8 vs 0.09, p < 0.001) and with a higher Roman Cobblestone pattern grading (1.48 vs 0.11, p < 0.001). A significant correlation between the crypt inflammation and the hyperemia subscore of RFS was present (r = 0.696, p < 0.0001), while it was not possible to find a correlation between crypt inflammation and either diffuse laryngeal edema (r = 0.166, p = 0.135) and posterior commissure hypertrophy (r = 0.089, p = 0.427).

Conclusions

NBI allowed us to identify endoscopically the presence of enlarged lingual tonsil, crypt inflammation and superficial mucosal changes, in patients affected by LPRD.

Level of evidence

2 (prospective, case–control study).

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Acknowledgements

Jacopo Galli: substantial contributions to conception and design, acquisition of data, analysis and interpretation of data; involved in drafting the manuscript and revising it critically for important intellectual content; gave final approval of this manuscript version to be published. Stefano Settimi: acquisition of data, analysis and interpretation of data; involved in drafting the manuscript and revising it critically for important intellectual content. Giampiero Salonna: acquisition of data, analysis and interpretation of data. Dario Mele: acquisition of data, analysis and interpretation of data. Eugenio De Corso: acquisition of data, analysis and interpretation of data; involved in drafting the manuscript and revising it critically for important intellectual content. Gaetano Paludetti: substantial contributions to conception and design; involved in drafting the manuscript and revising it critically for important intellectual content; gave final approval of this manuscript version to be published.

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Authors and Affiliations

  1. Institute of Otolaryngology, Head and Neck Surgery, School of Medicine and Surgery, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy

    Jacopo Galli, Stefano Settimi, Giampiero Salonna, Dario Antonio Mele & Gaetano Paludetti

  2. Institute of Otolaryngology, Head and Neck Surgery, Fondazione Policlinico Universitario “A.Gemelli” – IRCCS, Rome, Italy

    Eugenio De Corso

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  1. Jacopo Galli
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Correspondence to Stefano Settimi.

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Galli, J., Settimi, S., Salonna, G. et al. Narrow Band Imaging for lingual tonsil hypertrophy and inflammation, in laryngo-pharyngeal reflux disease. Eur Arch Otorhinolaryngol 277, 819–825 (2020). https://doi.org/10.1007/s00405-019-05765-2

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  • DOI: https://doi.org/10.1007/s00405-019-05765-2

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