Inferior Turbinate Hypertrophy May Be Linked to Extraesophageal Reflux

GERD
mature adult man
Researchers examined the presence and severity of extraesophageal reflux disease in patients with inferior turbinate hypertrophy.

Patients with more severe extraesophageal reflux (EER) also exhibited higher grade inferior turbinate hypertrophy, suggesting a possible association, according to study findings published in JAMA Otolaryngology-Head & Neck Surgery.

Researchers conducted a prospective, multicenter, cohort study (ClinicalTrials.gov Identifier: NCT04581174) between October 2020 and October 2021 at 3 referral centers. Of 94 adults with EER enrolled in the study, 90 patients were included in the final analysis. The median age was 46 (IQR, 33-58) years, and 60% of patients were women.

Otolaryngologists performed nasal cavity endoscopies to assess the degree to which inferior turbinate hypertrophy obstructed total airway space according to the Camacho classification (grade 1: 0%-25%, grade 2: 26%-50%, grade 3: 51%-75%, and grade 4: 76%-100%).

Following nasal cavity endoscopy, the patients underwent 24-hour oropharyngeal pH monitoring using the Restech system to determine the severity of EER. To prevent medications interfering with test results, patients stopped taking proton pump inhibitors for 1 week, H2 blockers for 48 hours, and drugs containing calcium carbonate for 1 day prior to testing.

Researchers calculated a RYAN score based on the number of reflux episodes, the longest reflux episode duration, and the percentage of time below the pH thresholds of 5.5 for upright and 5.0 for supine positions. Patients with composite scores higher than 9.4 in the upright position and higher than 6.8 in the supine position received a diagnosis of pathological EER.

Primary outcomes included the presence of EER per the RYAN score, total number of EER events below pH 5.5, and total percentage of time below pH 5.5.

According to the Camacho classification, 41 patients scored grade 2 or lower for degree of inferior turbinate hypertrophy (group 1), while 49 patients scored grade 3 or higher (group 2). The researchers observed that an EER diagnosis based upon RYAN scoring occurred more frequently among patients in group 2 than group 1 (69.4% vs 34.1%).

Patients with more severe (group 2) vs less severe (group 1) inferior turbinate hypertrophy spent a higher median percentage of time below the pH threshold of 5.5 (11.2% [1.5%-15.8%] vs 2.1% [0.0%-9.4%], respectively). Patients in group 2 vs group 1 also experienced more total EER events (14 [4-26] vs. 6 [1-14], respectively).

EER did not affect location of inferior turbinate hypertrophy, with no observed difference between the left vs right nasal cavities or anterior vs posterior regions of the nasal cavity.

“In this cohort study, patients with a higher degree of [inferior turbinate hypertrophy] were more commonly diagnosed with more severe EER using 24-hour monitoring of oropharyngeal pH,” the study authors wrote. “A possible association between [inferior turbinate hypertrophy] and EER was reported.”

Study limitations include small sample size, subjectivity of Camacho staging for inferior turbinate hypertrophy, and the need to confirm the association between inferior turbinate hypertrophy and EER by analyzing the efficacy of antireflux medications and diet in reducing inferior turbinate hypertrophy.

Reference

Zeleník K, Javorská Z, Taimrová R, et al. Association between inferior turbinate hypertrophy and extraesophageal reflux. JAMA Otolaryngol Head Neck Surg. 2022;148(8):773-778. doi:10.1001/jamaoto.2022.1638