From the Guidelines
Yes, LPR can contribute to chronic sinusitis, as evidenced by studies showing a high incidence of nasopharyngeal reflux in patients with chronic sinusitis 1. LPR occurs when stomach acid flows upward into the throat and potentially into the nasal passages, causing inflammation of the sinus tissues. This inflammation can lead to mucus buildup, blockage of sinus drainage pathways, and create an environment conducive to bacterial growth and infection. Some key points to consider include:
- A study using 24-hour monitoring with dual-pH probes found that 63% of children with chronic sinusitis showed gastroesophageal reflux, and 32% demonstrated nasopharyngeal reflux 1.
- Treatment of GERD in children and adults has been shown to result in significant improvement in sinusitis symptoms, with 79% of patients improving their sinusitis symptoms after treatment of GERD 1.
- Medical treatment of GERD, such as proton pump inhibitors (PPIs) like omeprazole 20-40mg daily or pantoprazole 40mg daily for 2-3 months, combined with lifestyle modifications, can help reduce acid production and alleviate symptoms.
- For the sinusitis component, saline nasal irrigation twice daily and possibly intranasal corticosteroids like fluticasone 1-2 sprays per nostril daily may be needed to reduce inflammation and infection susceptibility in the sinuses. The connection between LPR and chronic sinusitis exists because acid can damage the protective mucous membranes throughout the upper airway, compromising their barrier function and allowing for increased inflammation and infection susceptibility in the sinuses, as suggested by the high incidence of nasopharyngeal reflux in patients with chronic sinusitis 1.
From the Research
LPR and Chronic Sinusitis
- Laryngopharyngeal reflux (LPR) may play a significant role in patients with chronic and recurrent sinusitis 2
- The relationship between LPR and chronic sinusitis is not fully understood, but it is believed that LPR may contribute to the development of chronic sinusitis
- Studies have shown that patients with LPR are more likely to experience chronic sinusitis symptoms, such as nasal congestion and discharge 3
Diagnosis and Treatment of LPR
- Diagnosis of LPR can be challenging, and diagnostic tools such as pH probe, multichannel intraluminal impedance, and manometry are required for adequate diagnosis 2
- Treatment of LPR typically involves lifestyle modification and acid-suppressive agents, such as proton pump inhibitors (PPIs) 4, 5
- Aggressive acid suppression with twice-daily PPIs for at least 4 months may be warranted for treatment of LPR 4
Evidence for LPR Contribution to Chronic Sinusitis
- While there is evidence to suggest that LPR may contribute to chronic sinusitis, the relationship between the two conditions is not fully understood 2, 3
- Further studies are needed to determine the exact mechanisms by which LPR may contribute to chronic sinusitis
- Empiric treatment of suspected LPR with PPIs has been shown to be effective in some studies, but the evidence is not consistent across all studies 6