Laryngopharyngeal reflux as a potential cause of persistent local neck symptoms after total thyroidectomy
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HEAD AND NECK
Laryngopharyngeal reflux as a potential cause of persistent local neck symptoms after total thyroidectomy Calogero Cipolla1 · Ina Macaione1 · Salvatore Vieni1 · Mario Latteri1 · Angela Vullo2 · Giuseppa Graceffa1 · Eugenio Fiorentino1 Received: 4 May 2020 / Accepted: 16 July 2020 © The Author(s) 2020
Abstract Purpose Local neck symptoms (LNS) may be related to goiter, but are also reported by patients suffering from laryngeal– pharyngeal reflux (LPR). The aim of this study was to investigate whether LPR could play a role in the persistence of some LNS after total thyroidectomy (TT). Methods A consecutive case series of 160 patients with multinodular goiter (MNG) candidate for TT were included in this study. Each patient was closely studied for both the thyroid pathology and reflux disease before and 6 months after surgery to assess the persistence of LNS after surgery. Results Only throat discomfort showed a significant improvement (p = 0.031) after surgery. On the other hand, swallowing and voice disorders persisted after surgery in 82.3% and 77.3% of patients, respectively (p = 0.250 and p = 0.062), such as the correlated reflux laryngopharyngitis (p = 0.5). Conclusions LPR can be considered a predisposing factor or an important concurrent causa to the persistence of LNS after TT, in particular for swallowing disorders and voice disorders. In patients with non-toxic MNG who complain of local neck symptoms, the investigation of a possible coexistence of a reflux disease is appropriate before surgery. Patients should be informed about the possibility that some symptoms can persist even after removal of the goiter. Keywords Local neck symptoms · Thyroidectomy · Nodular goiter · Laryngopharyngeal reflux
Introduction Non-toxic MNG affects 25–33% of the population in endemic areas [1] and LNS such as voice disorders, swallowing and throat discomfort are present in a range of 13–50% of these patients [2, 3]. However, the relationship between LNS and mechanical effects of MNG or its removal is not clear. In fact, swallowing disorders, voice disorders and throat discomfort may be related to goiter, but they are also reported by patients suffering from LPR [4, 5]. Reflux laryngopharyngitis is a fairly frequent finding caused by LPR, and is considered one of the atypical clinical * Eugenio Fiorentino [email protected] 1
Department of Surgical Oncological and Oral Sciences, University of Palermo, Via del Vespro 129, 90127 Palermo, Italy
Istituto Zooprofilattico Sperimentale della Sicilia, Via G. Marinuzzi 3, 90129 Palermo, Italy
2
presentations of gastroesophageal reflux affecting the larynx and pharynx, more often in the absence of gastrointestinal symptoms [6]. LPR prevalence is about 50% in patients with throat disorders [6, 7], it gives rise to swallowing and voice disorders and throat discomfort but catheter or capsule-based pH and impedance monitoring are unreliable to diagnose it [8, 9]. A highly significant correlation between symptoms and reflux laryngopharyngitis has b
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