Narrow Band Imaging for lingual tonsil hypertrophy and inflammation, in laryngo-pharyngeal reflux disease

Eur Arch Otorhinolaryngol. 2020 Mar;277(3):819-825. doi: 10.1007/s00405-019-05765-2. Epub 2019 Dec 19.


Purpose: The objective of this study is to analyse the relationship between the endoscopic signs of laryngo-pharyngeal reflux, the lingual tonsil hypertrophy (LTH) and its inflammation, adopting Narrow Band Imaging (NBI) technology.

Methods: We enrolled, as cases, patients with clinical diagnosis of laryngopharyngeal reflux disease (LPRD), a Reflux Symptom Index (RSI) ≥ 13, and a Reflux Finding Score (RFS) ≥ 7. Controls were enrolled among patients who underwent the same transnasal endoscopy, equipped with NBI, with a RSI < 13 and a RFS < 7. Nasopharynx, Lingual Tonsils (LT), Hypopharynx and Larynx were evaluated by two experienced otolaryngologists, who calculated the Reflux Finding Scale (RFS) score and focused their attention on the base of the tongue, observing its surface with NBI technology.

Results: 82 patients with diagnosis of laryngopharyngeal reflux were enrolled as cases. Mean RFS was 11.7 (SD = 2.9). As controls, we enrolled 80 patients. Mean RFS was 2.7 (SD = 1.63). We found that RFS positivity was associated with a significant increase in LT dimension (2.5 vs 1.1, p < 0.001), with a higher LT crypt inflammation grading (1.8 vs 0.09, p < 0.001) and with a higher Roman Cobblestone pattern grading (1.48 vs 0.11, p < 0.001). A significant correlation between the crypt inflammation and the hyperemia subscore of RFS was present (r = 0.696, p < 0.0001), while it was not possible to find a correlation between crypt inflammation and either diffuse laryngeal edema (r = 0.166, p = 0.135) and posterior commissure hypertrophy (r = 0.089, p = 0.427).

Conclusions: NBI allowed us to identify endoscopically the presence of enlarged lingual tonsil, crypt inflammation and superficial mucosal changes, in patients affected by LPRD.

Level of evidence: 2 (prospective, case-control study).

Keywords: Crypt inflammation; Laryngopharyngeal reflux; Lingual tonsil hypertrophy; Reflux finding score.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Aged
  • Case-Control Studies
  • Endoscopy
  • Female
  • Humans
  • Hypertrophy
  • Inflammation / diagnostic imaging*
  • Inflammation / pathology
  • Laryngopharyngeal Reflux / diagnostic imaging*
  • Laryngopharyngeal Reflux / pathology
  • Male
  • Middle Aged
  • Narrow Band Imaging / methods*
  • Palatine Tonsil / diagnostic imaging*
  • Palatine Tonsil / pathology
  • Prospective Studies
  • Tongue / diagnostic imaging*
  • Tongue / pathology