Upper esophageal pH monitoring: Transnasal placement of the Bravo wireless capsule system

Laryngopharyngeal reflux (LPR) is a common entity and is known to be associated with many common aerodigestive disorders. The diagnosis of LPR based on symptoms or laryngeal findings alone is unreliable. Upper esophageal pH monitoring enables the otolaryngologist to objectively confirm the presence of LPR and to gauge the response and effectiveness of medical therapy. In this article, we present the technique for transnasal placement of a wireless pH monitoring capsule for the diagnosis of LPR. This technique can be performed by otolaryngologists in the office. It is safe and can be done under local anesthesia, in conjunction with transnasal esophagoscopy. The main advantage is that, unlike single- or double-probe pH monitoring devices, wireless capsule monitoring does not interfere with patients’ daily activities and diet, giving a more accurate measurement of reflux episodes in the upper esophagus. The technique has a low potential for complications, and monitoring can be performed for 24- and 48-hour periods.