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Objective: To improve the diagnosis of laryngeal disease in patients with gastroesophageal reflux disease (GERD)., Material and Methods: 171 patients (89 (52%) men, 82 (48%) women) with non-erosive (39 (23%) people) and erosive (132 (77%) people) forms of GERD were examined. None of the patients made active complaints about the condition of the larynx and pharynx. The examination included a questionnaire, examination by an otorhinolaryngologist, and videoendolaryngoscopy., Results: The survey revealed the presence of symptoms of otorhinolaryngological pathology in 74% of patients. Videolaryngoscopy revealed no laryngeal pathology in 55 (32%) patients, and signs of GERD-associated laryngitis were detected in 116 (68%) patients. The most common pathology was pachydermia in interarytenoid region - in 89 people, laryngeal granuloma was detected in 7 patients, leukoplakia - in 2 patients, chronic edematous polypous laryngitis - in 2 patients, benign laryngeal formations - in 9 patients. In patients with GERD (erosive and non-erosive forms), an asymptomatic course of chronic laryngitis associated with this pathology was observed in 44% of cases. In 52% of patients, pachydermia in interarytenoid region was diagnosed, of which every second had pronounced hyperplasia and folding of the mucous membrane in interarytenoid region, which must be differentiated from laryngeal cancer (in this case, patients should be under the dynamic supervision of an otorhinolaryngologist). Other precancerous formations of the larynx (granulomas and leukoplakia) were found in 5% of patients. Benign neoplasms of the larynx (polyps and cysts) were also detected in 5% of cases., Conclusions: Despite the high frequency of detection of otorhinolaryngological diseases in the examined patients with gastroesophageal reflux disease, none of the patients presented complaints related to the pathology of the larynx, which indicates the need for active detection of this pathology in this category of patients by questioning, questioning, as well as examination by an otorhinolaryngologist.

Aim: To investigate the frequency of extraesophageal syndromes in elderly patients with gastroesophageal reflux disease (GERD)., Materials and Methods: This cross-sectional study was conducted to compare the clinical manifestations of GERD in 1100 patients aged 60 to 75 years and in 453 patients aged 36 to 60 years. A control group consisted of 154 elderly patients without GERD and 178 mature-aged patients without this condition. GERD was diagnosed via analysis of its symptoms, esophagogastroduodenoscopy, and 24-hour pH monitoring on the basis of the Montreal consensus guidelines. Extraesophageal syndromes were detected actively using the current methods accepted to treat lung, heart, and ENT diseases and a simultaneous gastroesophageal examination., Results: Chronic cough, asthma, chronic laryngitis, cardialgias and cardiac arrhythmias were much more common in elderly patients with GERD than in those without this condition and prevalent in patients with erosive esophagitis and Barrett's esophagus as compared with those with non-erosive reflux disease. The mature-aged patients were recorded to have similar but less pronounced trends. The authors proposed an algorithm for the management of patients with extraesophageal manifestations of GERD, the important aspect of which was two-month acid-suppressive therapy used as both diagnostic testing and empirical treatment for this pathology., Conclusion: The extraesophageal manifestations of GERD in elderly patients are a serious clinical problem calling for considerable attention.

Introduction: The 24-hours pH-monitoring is the "gold standard" to verify the presence of pathologic reflux and confirmation of GERD. But there is lack of data whether it is helpful to verify the link between extraesophageal manifestations with GERD., Aim: To evaluate the utility of proximal 24-hours pH monitoring for diagnosing ENR manifestations of GERD., Methods: Ninety one GERD patients were enrolled to the study. The allergic, infectious and toxic etiology of comorbid diseases were exclusion criteria. Dual-probe 24-hours pH studies were performed to all of the patients. Distal probe was placed 5 cm above esophago-gastric junction, the proximal one--at the upper 1/3 of esophagus over upper esophageal sphincter. The presence of high gastroesophageal reflux (HGR) was diagnosed when at least one episode of drop of pH < 4 for 20 sec at proximal probe during the study occurred. The evaluation of sensitivity and specificity of the method was calculated by the standard protocol., Results: Comorbid ENR pathology (GERD + CP) was found in 59 patients. Presence of HGR was found in 76.27% of patients of GERD + CP group and in 43.75% of controls (p = 0.0026). Number of HGR was higher in GERD + CP group: M +/- s: 12.51 +/- 18.56 compared to 2.84 +/- 7.11 accordingly, p = 0.0003. Mean pH values were lower in the main group: 6.32 +/- 0.52 compared to 6.58 +/- 0.42 in controls, p = 0.011. Acid exposure time was greater in the main group: 3.19 +/- 6.76 min, compared to 2.42 +/- 10.02 min in controls, p = 0.003. The correlation was found between each of the studied pH-metric parameters and presence of ENR pathology in GERD patients. The results of calculated diagnostic efficacy of the 24-hrs pH monitoring for evaluating the link between GERD and comorbid pathology were as follows: Diagnostic sensitivity--76.27% (95% Confidence Interval's limits (CI): 0.6403-0.8531); Diagnostic specificity: 56.25% (95% CI [0.3933-0.7183]); likelihood ratio for a positive test result 1.743 (95% CI [1.148-2.648]); likelihood ratio for a negative test result 0.422 (95% CI [0.243-0.731])., Conclusion: There is correlation between parameters of 24-hours pH-monitoring in the proximal esophagus and comorbid ENR pathology in GERD patients. High gastroesophageal reflux is more common in GERD patients with comorbid ENR pathology than in GERD patients without ENR diseases. Detection of high gastroesophageal reflux with placing the distal probe in the upper esophagus may be helpful for the diagnosing of extraesophageal manifestations of GERD.

The increased number of ecological problems in Russia has stimulated the development of methodological approaches to studying a human chemical load under the conditions of an industrial town. The data on mortality in children under 3 years of age, who lived in a developed industrial town, have been analyzed. Comparison of data on ambient air purity and those on the incidence of respiratory disease has established a correlation between environment pollution and the likelihood of diseases in children under the influence of harmful factors.

Incidence rate of chronic ENT diseases was compared in workers of tobacco and pharmaceutical industries. Using representative samples of workers employed in both industries exposed to industrial dust hazards, the rate and structure of chronic ENT pathology were compared. Damage to the upper airways (UA) consists in dystrophic changes in ENT mucosa (subatrophic isolated and combined forms). Chronic combined UA lesions in workers of the tobacco factories occur more frequently than in workers of pharmaceutical factories. It is necessary to conduct ENT examinations in applicants for jobs in factories with industrial dust hazards to detect basic diseases, especially in those with nasal septal defects and related respiratory problems.

Screening for chronic hyperplastic laryngitis (CHL) has been performed among 70,000 workers and peasants of the Moscow Region. CHL was detected in 355 examinees (0.47%). The data were analysed for 166 CHL patients (age 31-50, 87 males, 29 females). 8 patients had laryngostenosis but tracheostoma was indicated only one of them. Malignant transformation occurred in 3 patients. Laryngeal lesions were symmetric in 36 patients, unilateral with separate inflammatory infiltrates clinically similar to tumors were seen in 45 patients. Local forms of CHL may look as separate small nodules, contact lesions in the region of vocal processes of the arytenoid cartilages, and diffuse inflammatory edema of the vocal cords. In rare cases inflammatory tumor-like laryngeal lesions in CHL depend on local flock of lymphoid elements--lymphoid hyperplasias. A cytological study in CHL is effective in identification of the signs of dystrophy, keratinization and epithelial cell atypia as well as the presence of microflora.