ENT - September 2020 - 546

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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

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