Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_1015_Библиотеки_им_академика_М_И_Перельмана

distal oesophagus of patients with LPR and in con­trols determines an increase in the tone of the upper oesophageal sphincter (Gerhardt et al. 1978).

1989; Koufman 1991) at the same time as laryngeal

Acoustic voice analysis and laryngoscopic inves­tigation can also be found in the work of Vashani et al. (2010), who evaluated the effectiveness of voice therapy in a group of 32 patients with GORD and

The association between hoarseness and LPR was studied by Ozturk et al. (2006) in a sample of 43 subjects presenting with hoarseness for over 3 months and 20 control subjects. All subjects underwent vid­eolaryngoscopic evaluation and 24-h double-probe pH monitoring. The results obtained by comparing data from the two methods in the two populations showed that in the study group 27 of 43 patients

Abnormal laryngeal findings that can be correlated to reflux were identified in a sample of 65 asymp­tomatic singing students who underwent videostro­boscopic evaluation. Five students (8.3%) exhibited benign vocal fold lesions (two with nodules and three with cysts) and 44 students (73.4%) exhibited pos­terior erythema, suggesting possible reflux (Lundy et al. 1999). This correlation was considered useful to plan preventive measures in young singing profes­sionals with high vocal demands.

What is more interesting is the association between functional dysphonia and LPR. The correlation between the two entities has been investigated by several authors. Karkos et al. (2007) studied 23 sub­jects with dysphonia for over 3 months, by comparing them with eight healthy volunteers. Of the initial sample 22 dysphonic patients and six healthy subjects completed the protocol that included a 24-h dual­probe pH-metry. Of all the parameters studied, the longest duration (in seconds) of reflux episodes in the supine position and the time fraction in which the pH was below 4 in the supine position were significantly longer in dysphonic patients than in control subjects (P \ 0.05). This led the authors to conclude that there is a correlation between LPR and the two parameters, although many more parameters may determine functional dysphonia, including ‘‘medical’’ and psy­chological causes.

1.42–2.30), 1.40 (95% CI, 1.18–1.67) and 2.45 (95% CI, 1.97–3.04), respectively. Multivariate analysis correlated regurgitation in a consistent way with the cumulative duration of singing activity (P = 0.04) and weekly singing performances (P = 0.005). The authors concluded by reporting a greater prevalence of reflux symptoms in opera choristers versus control subjects. They also underlined the need for further investigation to clarify whether GOR in this popula­tion is stress-related and may be considered as a professional disease. As to the relation with stress, Marchese et al. (2008) described the case of a 49-year-old professional soprano with a 6-year history of regurgitation and pyrosis in association with an increased time to achieve adequate vocal warm-up, restricted vocal tone placement, and decreased pitch range. After the diagnosis of posterior laryngitis and negative oesophagogastroduodenoscopy findings, a functional study with oesophageal manometry and pharyngeal pH monitoring was conducted. Oesopha­geal manometry documented lower oesophageal sphincter incompetence and isolated episodes of upper oesophageal sphincter hypertonia. Pharyngeal pH monitoring (the patient was asked to perform her normal singing and vocal warm-up activity) reported, during singing, 69 episodes of pharyngeal reflux equivalent to 10% of the total reflux time, which is 10 times higher than that previously described as the upper limit (0.9%) in healthy volunteers. This finding suggested a correlation between pharyngeal acid exposure and singing, thereby indicating that such a condition may be considered related to this profes­sional activity. The authors agreed that further data are required to support this conclusion.