Posterior Laryngitis- Aetiology,Treatment and Health-Related Quality of Life

Abstract: Posterior laryngitis (PL) is defined as an inflammation involving the posterior part of the glottal region in conjunction with symptoms. The cause is multifactorial. The aims of the work presented in this thesis were to examine symptoms, physical signs, different aetiologies and health-related quality of life (HRQOL) in patients with PL and/or oesophageal dysmotility. In paper I, a group of patients diagnosed as having PL were examined, treated and followed, to determine whether follow-up is needed. Their current HRQOL was registered. In paper II, we investigated how many of the patients diagnosed with PL who had acid reflux in the proximal part of the oesophagus, altered motilin levels, and symptoms associated with functional gastrointestinal disease. Their HRQOL was registered before and after treatment. In paper III, patients with PL were scrutinized for the presence of gonadotropin-releasing hormone (GnRH) antibodies. In paper IV, patients with diabetes mellitus were examined to see whether blood levels of motilin were related to symptoms and signs of dysfunction in the oesophagus and stomach. Approximately 90% of the patients, investigated for reflux, were treated with proton pump inhibitors. Of the patients not investigated for reflux, 85% received acid-suppressing treatment. One-third of the investigated patients in paper II had objectively measured reflux. Patients with typical reflux symptoms had abnormal levels of motilin compared to those without these symptoms. Antibodies against GnRH and gastrointestinal symptoms were found to a greater extent in patients than in controls. There was a significant correlation between the percentage of simultaneous contractions in the oesophagus, and basic and peak plasma motilin values in patients with diabetes mellitus. HRQOL, especially in women, was low. Taken together, PL is associated with acid reflux in the proximal oesophagus, endocrine disturbances, functional gastrointestinal disease and reduced HRQOL. By improving follow-up, and optimising investigations and treatment, HRQOL can be improved.