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Ear, Nose & Throat Journal 99(8)
2.

In the regions of both sides of false vocal folds, there
was no significant difference between negative group
and control group (P ¼ .61 and .97 for right and left
sides);
3. In the regions of both sides of arytenoids, there was
neither significant difference between positive group
and negative group (P ¼ .56 and .16 for right and left
side), nor between negative group and control group
(P ¼ .21 and .16 for right and left sides);
4. In other comparisons, there were significant differences
(P < .05).

Discussion
Figure 6. Comparison of the average hue values in the left side of
larynx of different groups. Region 1, left arytenoid; 2, interarytenoid;
3, left false vocal fold; 4, left vocal fold.
Table 2. Results of the ANOVA Analysis Between the Positive,
Negative, and Control Groups in the 7 Laryngeal Regions.
Region
Right true vocal fold

Left true vocal fold

Right false vocal fold

Left false vocal fold

Right arytenoid

Left arytenoid

Interarytenoid

Positive
Negative
Control
Positive
Negative
Control
Positive
Negative
Control
Positive
Negative
Control
Positive
Negative
Control
Positive
Negative
Control
Positive
Negative
Control

Positive

Negative

Control

-
0.34
0.00a
-
0.13
0.00a
-
0.00a
0.00a
-
0.00a
0.00a
-
0.56
0.00a
-
0.16
0.00a
-
0.60
0.00a

0.34
-
0.00a
0.13
-
0.01a
0.00a
-
0.61
0.00a
-
0.97
0.56
-
0.21
0.16
-
0.16
0.60
-
0.04a

0.00a
0.00a
-
0.00a
0.01a
-
0.00a
0.61
-
0.00a
0.97
-
0.00
0.21
-
0.00a
0.16
-
0.00a
0.04a
-

Abbreviation: ANOVA, analysis of variance.
a
P < 0.05.

mean values of hue of the 7 regions, the right side and the left
side of larynx, respectively.
Then, we applied the analysis of variance analysis to find if
there was significant difference between different groups
within each region (shown in Table 2). From these, we could
see that:
1. In the regions of both sides of the true vocal folds and
interarytenoid, there was no significant difference
between positive group and negative group (P ¼ .34
and .13 for right and left sides, P ¼ .60 for
interarytenoid);

Jacob et al reported in 1991 that posterior laryngitis without
ulceration could be associated with gastropharyngeal reflux as
documented by pH monitoring.6 In a prospective study, Kamel
et al reported the elimination of symptoms and signs of chronic
posterior laryngitis during treatment with omeprazole.11 Hanson et al reported that the color value of the posterior laryngeal
structures and vocal folds in the patients who were treated for
reflux laryngitis were significantly changed.12 However, the
mechanism of how acid reflux affects different regions in larynx has not been elucidated clearly.
In our previous study, we demonstrated that there might be
correlations between laryngopharyngeal reflux disorder
(LPRD) and the hue value of laryngoscopic images, where hue
values of patients with LPRD tend to be lower. Furthermore,
we found that different regions of larynx have different hue
values. The regions of both arytenoids and the interarytenoid
regions are closer to the inlet of esophagus. The hue value of
these 2 regions are almost the highest of the 7 regions, except
for the true vocal fold and false vocal fold regions.7,12,13 It was
hypothesized that this phenomenon was correlated with the
presence of air in the reflux was predominantly during upright
position and the pattern of reflux out of the upper esophageal
sphincter (UES) was spilling, spurting, and spraying.14,15
Based on Figures 4 through 6 and Table 2, there were
significant differences between hue values in every region
when comparing the positive group and the control group.
When comparing the negative and the control group, there
was no significant difference in both sides of arytenoid
regions and false vocal folds. Additionally, there was no
significant difference when we compared positive with negative groups in both sides of vocal folds, arytenoids, and
interarytenoid region.
Comparing to the control group, the negative group has no
significant different hue value in both sides of vocal folds,
arytenoids, and interarytenoid region with the positive group.
Indicating the same level of inflammation of these regions
between the 2 groups. Suggesting that these regions may be
affected by acid or pepsin already in the negative group. As
previously stated, the negative group was comprised of patients
with some symptoms of LPRD and RSI > 13, but were negative
in MII-24 h pH monitoring. So, we hypothesized that this group
might be presenting a developing stage of LPRD. We should

```

ENT - September 2020

The Creation of a Sustainable Otolaryngology Department in Malawi Nathan Douglas Vandjelovic, Eric Masao Sugihara, Wakisa Mulwafu, and David Nathan Madgy
Hazardous Grilling Due to Wire Brushes Nima A. Vahidi, Brenna A. Keane, Paul J. Whalen, and Anita Jeyakumar
Guns n’ Noses: Endoscopic Removal of an Air-Gun Pellet Retained in the Frontal Sinus Dylan A. Levy, Andrew Y. Lee, Waleed M. Abuzeid, and Nadeem A. Akbar
Vitamin D Status in Egyptian Children With Allergic Rhinitis Khaled Saad, Abobakr Abdelmoghny, Mohamed Diab Aboul-Khair, Yasser Farouk Abdel-Raheem, Eman Fathalla Gad, Ahmed El-Sayed Hammour, Bahaa Hawary, Asmaa M. Zahran, Mohamd A. Alblihed, and Amira Elhoufey
Pediatric Epistaxis and Its Correlation Between Air Pollutants in Beijing From 2014 to 2017 Ying-Xia Lu, Jie-Qiong Liang, Qing-Long Gu, Chong Pang, and Chun-Lei Huang
Otomycosis With Tympanic Membrane Perforation: A Review of the Literature Petros Koltsidopoulos and Charalampos Skoulakis
Simultaneous Bilateral Same-Day Endoscopic Myringoplasty Using Tragal Cartilage From One Ear Baklaci Deniz, Kuzucu Ihsan, Guler Ismail, Kum Rauf Oguzhan, and Ozcan Muge
A Preliminary Report on the Investigation of Prestin as a Biomarker for Idiopathic Sudden Sensorineural Hearing Loss Changling Sun, Xiaolin Xuan, Zhi Zhou, Yuan Yuan, and Fei Xue
A Retrospective Study to Identify the Relationship Between the Dimension of Osseous External Auditory Canal and Chronic Otitis Media Yi-Fang Lee, Pei-Yin Wei, Chia-Huei Chu, Wen-Huei Liao, An-Suey Shiao, and Mao-Che Wang
Investigation of the Effectiveness of Surgical Treatment on Respiratory Functions in Patients With Obstructive Sleep Apnea Syndrome Burak Kersin, Murat Karaman, Engin Aynacı, and Ahmet Keles
Changing Trends of Color of Different Laryngeal Regions in Laryngopharyngeal Reflux Disease Chen Du, Paige Thayer, Yan Yan, Qingsong Liu, Li Wang, and Jack Jiang
ENT - September 2020 - Intro
ENT - September 2020 - Cover1
ENT - September 2020 - Cover2
ENT - September 2020 - 489
ENT - September 2020 - 490
ENT - September 2020 - 491
ENT - September 2020 - 492
ENT - September 2020 - 493
ENT - September 2020 - 494
ENT - September 2020 - 495
ENT - September 2020 - 496
ENT - September 2020 - 497
ENT - September 2020 - 498
ENT - September 2020 - 499
ENT - September 2020 - 500
ENT - September 2020 - The Creation of a Sustainable Otolaryngology Department in Malawi Nathan Douglas Vandjelovic, Eric Masao Sugihara, Wakisa Mulwafu, and David Nathan Madgy
ENT - September 2020 - 502
ENT - September 2020 - Hazardous Grilling Due to Wire Brushes Nima A. Vahidi, Brenna A. Keane, Paul J. Whalen, and Anita Jeyakumar
ENT - September 2020 - 504
ENT - September 2020 - Guns n’ Noses: Endoscopic Removal of an Air-Gun Pellet Retained in the Frontal Sinus Dylan A. Levy, Andrew Y. Lee, Waleed M. Abuzeid, and Nadeem A. Akbar
ENT - September 2020 - 506
ENT - September 2020 - 507
ENT - September 2020 - Vitamin D Status in Egyptian Children With Allergic Rhinitis Khaled Saad, Abobakr Abdelmoghny, Mohamed Diab Aboul-Khair, Yasser Farouk Abdel-Raheem, Eman Fathalla Gad, Ahmed El-Sayed Hammour, Bahaa Hawary, Asmaa M. Zahran, Mohamd A. Alblihed, and Amira Elhoufey
ENT - September 2020 - 509
ENT - September 2020 - 510
ENT - September 2020 - 511
ENT - September 2020 - 512
ENT - September 2020 - Pediatric Epistaxis and Its Correlation Between Air Pollutants in Beijing From 2014 to 2017 Ying-Xia Lu, Jie-Qiong Liang, Qing-Long Gu, Chong Pang, and Chun-Lei Huang
ENT - September 2020 - 514
ENT - September 2020 - 515
ENT - September 2020 - 516
ENT - September 2020 - 517
ENT - September 2020 - Otomycosis With Tympanic Membrane Perforation: A Review of the Literature Petros Koltsidopoulos and Charalampos Skoulakis
ENT - September 2020 - 519
ENT - September 2020 - 520
ENT - September 2020 - 521
ENT - September 2020 - Simultaneous Bilateral Same-Day Endoscopic Myringoplasty Using Tragal Cartilage From One Ear Baklaci Deniz, Kuzucu Ihsan, Guler Ismail, Kum Rauf Oguzhan, and Ozcan Muge
ENT - September 2020 - 523
ENT - September 2020 - 524
ENT - September 2020 - 525
ENT - September 2020 - 526
ENT - September 2020 - 527
ENT - September 2020 - A Preliminary Report on the Investigation of Prestin as a Biomarker for Idiopathic Sudden Sensorineural Hearing Loss Changling Sun, Xiaolin Xuan, Zhi Zhou, Yuan Yuan, and Fei Xue
ENT - September 2020 - 529
ENT - September 2020 - 530
ENT - September 2020 - 531
ENT - September 2020 - A Retrospective Study to Identify the Relationship Between the Dimension of Osseous External Auditory Canal and Chronic Otitis Media Yi-Fang Lee, Pei-Yin Wei, Chia-Huei Chu, Wen-Huei Liao, An-Suey Shiao, and Mao-Che Wang
ENT - September 2020 - 533
ENT - September 2020 - 534
ENT - September 2020 - 535
ENT - September 2020 - 536
ENT - September 2020 - Investigation of the Effectiveness of Surgical Treatment on Respiratory Functions in Patients With Obstructive Sleep Apnea Syndrome Burak Kersin, Murat Karaman, Engin Aynacı, and Ahmet Keles
ENT - September 2020 - 538
ENT - September 2020 - 539
ENT - September 2020 - 540
ENT - September 2020 - 541
ENT - September 2020 - 542
ENT - September 2020 - Changing Trends of Color of Different Laryngeal Regions in Laryngopharyngeal Reflux Disease Chen Du, Paige Thayer, Yan Yan, Qingsong Liu, Li Wang, and Jack Jiang
ENT - September 2020 - 544
ENT - September 2020 - 545
ENT - September 2020 - 546
ENT - September 2020 - 547
ENT - September 2020 - 548
ENT - September 2020 - 549
ENT - September 2020 - 550
ENT - September 2020 - 551
ENT - September 2020 - 552
ENT - September 2020 - Cover3
ENT - September 2020 - Cover4
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