Middle-Ear Pressure Normalised Before the Ear Symptom Score Did: Eight Weeks of Serial Tympanometry, Reflux Symptom Index, Reflux Finding Score and Eustachian Tube Dysfunction Questionnaire-7 in an Adult with Laryngopharyngeal Reflux

Abstract

Background: Laryngopharyngeal reflux may inflame the mucosa around the pharyngeal orifice of the Eustachian tube, yet few reports follow both domains on one timetable.

Objective: This report scores both domains on the same three-visit schedule to establish whether they recover together.

Methods: A 34-year-old man presented with three to four weeks of bilateral ear fullness and tinnitus and no heartburn. Fibreoptic laryngoscopy showed mucoid secretion around the torus tubarius, arytenoid erythema and thick endolaryngeal mucus. Saline irrigation, lansoprazole, alginate, oral acetylcysteine and dietary advice were given for eight weeks, and the Reflux Symptom Index, Reflux Finding Score, ETDQ-7 and tympanometry were scored at three visits.

Results: At presentation the Reflux Symptom Index was 24, the Reflux Finding Score 11 and the ETDQ-7 28; tympanometric peak pressure was −185 and −165 daPa, with normal static compliance and canal volumes. All five measures improved, but only four were ever abnormal and they did not cross their boundaries together. By week 4 both peak pressures had crossed the −100 daPa boundary (−95 and −85 daPa), while the ETDQ-7 stayed above its threshold at 16 and the Reflux Symptom Index sat exactly on its own at 13. Only by week 8 was the patient's own ear score within range.

Conclusion: Middle-ear pressure crossed its conventional boundary before the patient-reported ear score did, in an order the visit schedule fixes but a magnitude it does not. Five interventions began on the same day, so no improvement can be attributed to treatment, and no audiogram was taken.