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Laryngorhinootologie 2018; 97(04): 238-245
DOI: 10.1055/s-0044-100794
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Laryngopharyngealer Reflux

Laryngopharyngeal Reflux
Rudolf Reiter
1   Univ.-Klinik Ulm Sektion Phoniatrie und Pädaudiologie der Universitätsklinik für Hals-, Nasen-, Ohrenheilkunde, Kopf- und Halschirurgie
,
Adrienne Heyduck
1   Univ.-Klinik Ulm Sektion Phoniatrie und Pädaudiologie der Universitätsklinik für Hals-, Nasen-, Ohrenheilkunde, Kopf- und Halschirurgie
,
Thomas Seufferlein
2   Universitätsklinik Ulm, Universitätsklinik für Hals-, Nasen-, Ohrenheilkunde, Kopf- und Halschirurgie
,
Thomas Hoffmann
3   Universitätsklinikum Ulm Zentrum für Innere Medizin, Klinik für Innere Medizin I
,
Anja Pickhard
4   Technische Universität München Hals-Nasen-Ohrenklinik
› Author Affiliations
Further Information

Publication History

10/23/2017

01/09/2018

Publication Date:
10 April 2018 (online)

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Zusammenfassung

Die Prävalenz von laryngopharyngealem Reflux (LPR) wird in der Allgemeinbevölkerung mit bis zu 31 % angegeben. Bei Patienten mit Stimmproblemen bzw. Kehlkopferkrankungen tritt ein LPR bei ca. 50 % der Patienten als Begleiterscheinung auf. Typische refluxbedingte Erkrankungen am Larynx sind eine chronische Laryngitis und das Kontaktgranulom. Nicht abschließend geklärt ist die Rolle des LPR bei der Genese des Stimmlippenkarzinoms. Für die Diagnose des LPR gibt es noch keine evidenzbasierten Daten, er kann jedoch üblicherweise klinisch aus der Kombination typischer Symptome (Heiserkeit, chronischer Hustenreiz/Räuspern, Globusgefühl/Dysphagie) und dem charakteristischen laryngoskopischen Bild (ein Schleimhauterythem bzw. eine Schleimhauthyperplasie mit Fältelung der Interarytenoidregion und ein Stimmlippenödem) gestellt werden. Gelegentlich wird eine LPR zusätzlich durch eine pharyngeale 24h-pH-Metrie-Untersuchung gesichert. Die Therapie des LPR umfasst mehrere Bereiche, wie z.B. diätetische Maßnahmen, die medikamentöse Therapie mit Protonenpumpeninhibitoren (PPIs) und ggf. eine chirurgische Intervention. Bei symptomatischen Patienten erfolgt oft eine Therapie mit PPIs, bei der der HNO-Arzt im engen Dialog mit dem Gastroenterologen steht.

Abstract

The prevalence of laryngopharyngeal reflux (LPR) is around 31 % in the general population. Patients with a dysphonia or other laryngeal diseases are accompanied up to 50 % by an LPR. Typical reflux associated diseases of the larynx are a chronical laryngitis and a contact granuloma. The role of LPR is still not clarified in the development of a glottic carcinoma. There still doesn’t exist evidence based data for the diagnosis of a LPR. Therefore LPR is usually clinically diagnosed by a combination of typical symptoms like hoarseness, chronic coughing, relapsing throat clearing, globus pharyngis and dysphagia as well as through the laryngoscopic characteristics like mucosal erythema, mucosal hyperplasia with plication of the interarytenoid region and an edema of the vocal cords. Occasionally the LPR can be ensured with the additional method of the pharyngeal 24-hour pH-monitoring. The therapy of the LPR is a multimodal for example dietary arrangements, medication with proton pump inhibitors and where indicated a surgical intervention. The treatment of a symptomatic patient is administered by proton pump inhibitors in a close dialog with the ENT practitioner and the gastroenterologist.

Schlüsselwörter

Reflux - Larynx - Laryngopharyngealer Reflux - LPR - PPIs

Key words

reflux - larynx - laryngopharyngeal reflux - LPR - PPIs
 

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