He underwent a bilateral endoscopic intranasal ethmoidectomy in late 1993 for chronic nasal polyposis and chronic ethmoiditis. Three months later, endoscopic evaluation of the nose revealed it to be clear. In spring, he again had seasonal symptomatology, relieved by ranitidine. There is often a dilemma concerning symptomatology in the throat, especially in patients with postnasal discharge, throat clearing, throat irritation, and chronic coughing. It is assumed that these symptoms are related to chronic vasomotor rhinitis and sinus disease, yet treatment with topical steroids, decongestants, antibiotics and surgical intervention fail to relieve the patient of the pharyngeal and tracheobronchial complaints.
Symptoms continue until gastroesophageal reflux is diagnosed and treated.
Recently, upper aerodigestive tract manifestations of gastroesophageal reflux have been recognized extensively. This condition usually is very subtle and the majority of patients do not have distal esophageal symptomatology. It has been suggested that laryngeal and pharyngeal cancer may be related to gastroesophageal reflux, especially in non-smoking patients with these cancers. In 50 percent of patients, a detailed study by an inquisitive radiologist will pick up spontaneous gastroesophageal reflux on an esophagram. Yet in the other 50 percent of patients, this subtle condition will not be diagnosed through laboratory investigation, esophagram or a 24-hour pH probe monitoring.