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A Simulated Reflux Model

Jong-Lyel Roh, MD, PhD; Yeo-Hoon Yoon, MD

Arch Otolaryngol Head Neck Surg. 2006;132:995-1000.

Objective  To evaluate the effects of acid and pepsin on the healing of traumatized vocal folds in a simulated reflux model. Gastroesophageal reflux is related to various laryngeal manifestations. However, there is a lack of established reflux animal models that would ensure longer observation periods.

Design  A prospective randomized animal study.

Interventions  Forty-two rabbits underwent a stripping procedure of the unilateral glottis and catheter insertion under transoral endoscopic guidance. The animals were randomly assigned to a control group (n = 21; isotonic sodium chloride was used) or a reflux group (n = 21, acid and pepsin were used). They received intrapharyngeal catheter irrigation with 3 mL of isotonic sodium chloride or a solution of acid with a pH of 3 and pepsin, 0.3 mg/mL, twice daily for 4 or 8 weeks after surgery.

Main Outcome Measures  Gross and histologic findings of the preinjured glottides of the 2 groups were compared.

Results  The catheter extrusion rate was significantly low (6%), and any catheter problems were immediately solved by reinsertion or reconnection. The extent of glottic scarring and frequency of granulation formation were higher in the reflux group compared with the control group (P<.05). Histologic inflammation scores and collagen deposition were significantly greater in the reflux group compared with the control group (P<.05).

Conclusions  Our data suggest that glottic wound healing is significantly affected by acid and pepsin. Antireflux treatment can be advocated to minimize further injury caused by gastroesophageal reflux in patients who undergo laryngeal surgery.

Author Affiliations: Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (Dr Roh); and Department of Otolaryngology–Head and Neck Surgery, Cancer Research Institute, Chungnam National University College of Medicine, Daejeon, South Korea (Dr Yoon).