Laryngopharyngeal reflux and autonomic nerve dysfunction: what about stress?
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LETTER TO THE EDITOR
Laryngopharyngeal reflux and autonomic nerve dysfunction: what about stress? Jerome R. Lechien1,2,3 · Raghu Nandhan Sampath Kumar1,4 · Carlos Miguel Chiesa‑Estomba1,5 Received: 10 July 2019 / Accepted: 13 July 2019 © Springer-Verlag GmbH Germany, part of Springer Nature 2019
Keywords Laryngopharyngeal · Reflux · Laryngitis · Nerve · Stress · Autonomic · Vagus Dear Editor, We have carefully read the paper of Wang et al. who studied the association between laryngopharyngeal reflux (LPR) and autonomic nerve dysfunction [1]. In their study, Wang et al. identified autonomic nerve dysfunction through 5-min short-range heart rate variability and they correlated some of these impairments with symptoms (Reflux Symptom Index, RSI) and findings (Reflux Finding Score, RFS). We compliment the authors for this study that covers an important and often neglected area. Deteriorated vagal nerve function is an important point in the pathogenesis of gastroeosophageal reflux disease (GERD) [2] but is less studied in LPR. Many points can be addressed in regard to the methodology of the study of Wang et al.
This comment refers to the article available at https://doi. org/10.1007/s00405-019-05482-w. * Jerome R. Lechien [email protected] 1
Laryngopharyngeal Reflux Study Group of Young Otolaryngologists of International Federation of Otorhinolaryngological Societies (YO-IFOS), Paris, France
2
Department of Anatomy and Experimental Oncology, Mons School of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium
3
Department of Otorhinolaryngology and Head and Neck Surgery, CHU Saint-Pierre, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium
4
Department of Otology, Neurotology and Skullbase Surgery, Madras ENT Research Foundation, Tamil Nadu, Chennai, India
5
Department of Otorhinolaryngology, Head and Neck Surgery, Hospital Universitario Donostia, San Sebastián, Spain
First, the authors have used RSI and RFS for the assessment of symptoms and findings associated with LPR. However, these two scores are currently criticized for their lack of reliability [3, 4] and the lack of consideration of many extra-laryngeal symptoms and findings [4, 5]. Precisely, RSI does not consider many digestive symptoms, i.e., nausea, indigestion, flatus, regurgitations, burp, etc., which are, however, associated with LPR. Indeed, a recent study found that LPR patients had a higher proportion of digestive complaints in comparison with healthy individuals irrespective to the occurrence of GERD [6]. In that respect, the consideration of the digestive symptoms would make particular sense in the present study because they may develop in a context of vagus nerve dysfunction and remain a good indicator of parasympathetic dysfunction [7]. Similarly, RFS does not consider extra-laryngeal findings, which can be associated with LPR according to many clinical studies [4, 8, 9]. In addition, the authors did not specify the method used for
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