ENT - September 2020 - 543

Clinical Study

Changing Trends of Color of Different
Laryngeal Regions in Laryngopharyngeal
Reflux Disease

Ear, Nose & Throat Journal
2020, Vol. 99(8) 543-547
ª The Author(s) 2019
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DOI: 10.1177/0145561319854745
journals.sagepub.com/home/ear

Chen Du, MD1, Paige Thayer, BS2, Yan Yan, MD1 , Qingsong Liu, MD1,
Li Wang, MD1, and Jack Jiang, MD, PhD2

Abstract
Introduction: In our previous study, we demonstrated that there might be correlations between laryngopharyngeal
reflux disorder and the hue value of laryngoscopic images. And we found that different regions of larynx have different hue values.
It was hypothesized that the degree of inflammation varies between different laryngeal regions, due to an acid reflux pattern.
Objective: The objective of this study was to compare the changing trends of hue values of different laryngeal regions in patients
with laryngopharyngeal reflux (LPR) disease. Methods: Ninety-seven patients, including 20 pH-positive, 19 pH-negative were
tested for LPR through multichannel intraluminal impedance 24-hour pH monitoring, and 58 controls with reflux symptom index
less than 13. Laryngoscopic images of all patients were obtained. The hue values of 7 areas of interest, including both sides of the
true vocal folds, the false vocal folds, the arytenoids, and the interarytenoid space, were quantified using a hue calculation. The
analysis of variance analysis was applied to find if there was significant difference between different groups within each region.
Results: (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; (2) in the regions of both sides of false vocal folds, there was no significant difference between
negative group and control group; (3) in the regions of both sides of arytenoids, there was neither significant difference between
positive group and negative group nor between negative group and control group; (4) in other comparisons, there were significant
differences. Conclusion: Hue values of separate laryngeal regions are different. In negative group, the hue values of interarytenoid region are similar with positive group, and the sensitivity to the acid are different from different regions. The sensitivity
in the true vocal folds may be present.
Keywords
laryngitis, laryngopharyngeal reflux, color analysis

Introduction
Laryngopharyngeal reflux (LPR) is a common condition in
otolaryngologic diseases and it afflicts nearly 50% of all
patients with laryngeal or voice disorders.1 Additionally,
almost 15% of patients in outpatient otolaryngology clinics
have chronic LPR.2-4 Hoarseness, throat clearing, choking sensation, dysphagia, dysphonia, globus, and laryngospasms also
are suspected to be associated with LPR.5
In the 1990s, Jacob et al6 reported that posterior laryngitis
could be associated with evidence of gastropharyngeal reflux,
suggesting that acid reflux may affect the posterior structure of
the larynx. However, the mechanisms on how the acid affects
the laryngopharynx are still unknown. In a previous study, we
used the hue value of laryngoscopic images as a tool to diagnose LPR and hue value was demonstrated to be a valid quantitative parameter of inflammation.7,8 Moreover, we found that
the hue values of 7 different laryngeal regions were not same.
Two false vocal folds and the interarytenoid region tend to have

lower hue values, while others do not. This indicates that the
degree of inflammation varies between different laryngeal
regions. This may be associated with acid reflux pattern.
This study was designed to compare the changing trends of
hue values of different laryngeal regions. To perform this, we
applied the objective 24-hour multichannel intraluminal

1

Department of Otolaryngology, Peking University Third Hospital, Beijing,
People's Republic of China
2
Division of Otolaryngology-Head and Neck Surgery, Department of Surgery,
University of Wisconsin School of Medicine and Public Health, Madison,
WI, USA
Received: April 7, 2019; revised: May 5, 2019; accepted: May 10, 2019
Corresponding Author:
Yan Yan, MD, Department of Otolaryngology, Peking University Third
Hospital, 49 North Garden Rd, Haidian District Beijing, People's Republic of
China.
Email: yanyan_ent@bjmu.edu.cn
https://www.sagepub.com/journals-permissions https://www.doi.org/10.1177/0145561319854745 http://journals.sagepub.com/home/ear https://www.orcid.org/0000-0002-7924-8070 https://www.orcid.org/0000-0002-7924-8070
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