페이지 2 페이지 7 LPR이있는사람들을가장자주치료하는전문의가이비인후과전문의 ( 귀, 코, 목의사 ) 입니다. 여러분의의료팀 ( 이비인후과전문의, 주치의, 위장전문의및외과의 ) 은귀하의문제를진단하고치료하기위해협력할것입니다. LPR 의징후및증상 LPR 이있는모든사람에게가

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페이지 8 질문? 여러분의질문은중요합니다. 질문이나문제가있으시면의사또는의료제공자에게전화하십시오. 병원직원도도움을드릴수있습니다. q UWMC 이비인후과 머리및목수술센터 206-598-4022 UWMC, 3 층 Box 356161 1959 N.E. Pacific St. Seattle, WA 98195 평일 8 a.m.

1 페이지 8 질문? 여러분의질문은중요합니다. 질문이나문제가있으시면의사또는의료제공자에게전화하십시오. 병원직원도도움을드릴수있습니다. q UWMC 이비인후과 머리및목수술센터 UWMC, 3 층 Box N.E. Pacific St. Seattle, WA 평일 8 a.m. ~ 5 p.m., 간호사음성메일라인으로전화하십시오 : 예약은 로전화하십시오. q HMC 이비인후과전문클리닉 ( 위치 : Ninth and Jefferson) Box Jefferson St. Seattle, WA Korean 환자교육이비인후과 머리및목수술센터 무증상역류 : 인후두역류질환 징후, 증상및치료법 이소책자는인후두역류 (LPR) 라고도불리는무증상 역류질환의징후, 증상및치료법을설명합니다. 역류는위액이식도 ( 삼키는관 ) 및목으로흐를때발생합니다. 이위액에는산및음식을분해하기위한특수효소가포함되어있습니다. 위에는산및소화효소에저항할수있는특수내막이있지만식도와목에는없습니다. 역류가발생할때위액은식도와목을손상시킬수있습니다. 인후두역류 (LPR) 는위액이후두또는목으로흐를때발생합니다. 이것은역류된위액이식도로만흐르는위식도역류질환 (GERD) 과는다릅니다. UWMC Otolaryngology Head and Neck Surgery Center University of Washington Medical Center Box N.E. Pacific St. Seattle, WA Korean /2004 Rev. 08/2010 Reprints on Health Online:

2 페이지 2 페이지 7 LPR이있는사람들을가장자주치료하는전문의가이비인후과전문의 ( 귀, 코, 목의사 ) 입니다. 여러분의의료팀 ( 이비인후과전문의, 주치의, 위장전문의및외과의 ) 은귀하의문제를진단하고치료하기위해협력할것입니다. LPR 의징후및증상 LPR 이있는모든사람에게가슴쓰림, 소화불량또는역류 ( 부분적으로소화된음식이위에서입으로돌아오는것 ) 감이있는것은아닙니다. 이것이 LPR 을무증상역류질환이라고부르는이유입니다. LPR 이있는사람중약 60%(100 명중 60 명 ) 는이러한증상을전혀가지지않습니다. 이것이 LPR 의진단을어렵게합니다. 그러나, 목과소리상자 ( 후두 ) 는위산에매우민감합니다. 소량의역류라도이들신체조직에손상과자극을야기할수있습니다. 그것은폐와호흡에도영향을미칠수있습니다. LPR 의증상 : 만성쉰소리 헛기침 만성기침 목이메는느낌 목통증또는삼킴곤란 코및목배액 목에음식걸림 질식사건 쉰소리는나오다안나오다할수도있으며, 낮에더심할수있습니다. 코와목의배액이많을수있으며, 또는점액또는점액질이너무많이쌓일수있습니다. 갑자기숨을쉴수없는느낌이들거나밤에숨이차서깰수있습니다. 가슴이쓰릴수도있습니다. 풀베드쐐기는또다른옵션입니다. 이것은침대길이를늘립니다. 풀베드쐐기는매트리스상점에서구입할수있습니다. 침대용등받이는중력을이용해위의내용물을위안에유지하여후두로역류하는것을방지합니다. 담배를피우는경우금연하십시오. 식후에눕지마십시오. 취침전 3 시간이내에는먹지마십시오. 저지방음식을섭취하십시오. 붉은육류와버터를제한하십시오. 튀긴음식, 초콜렛, 치즈및계란을피하십시오. 매운음식이나산성인음식및음료수를피하십시오. 녹양박하및박하를피하십시오. 카페인, 특히커피, 차및소다수 ( 특히콜라 ) 를피하십시오. 알코올음료를피하십시오. 과식하지마십시오. 과체중인경우체중을줄이십시오. 역류증상을겪고있을때는역류가악화될수있으므로굽히거나웅크리지마십시오. 대신, 무릎을굽혀몸을낮추십시오. 허리를굽히지마십시오. 허리둘레가느슨한옷을입으십시오. 힘을써서무거운물체를들지마십시오. 운동하기적어도 90 분전에식사하십시오. 스트레스를극복하는새로운방법을배우십시오.

3 페이지 6 페이지 3 수술 : 무증상역류질환이심하거나역류약을복용할수없는경우의사는위판막에대한수술을권고할수있습니다. 이수술을받은대부분의사람들은수년간무증상역류질환의고통에서완화됩니다. 치료기간 무증상역류질환이있는사람들은대부분어떤형식의치료를필요로합니다. 다른사람들은항상치료를필요로합니다. 일부사람들은수개월또는수년동안완전히회복된다음, 증상이돌아올수있습니다. 무증상역류질환을갖는것은고혈압을갖는것과같습니다. 치료한다고해서보통심각한의학적문제가야기되지는않습니다. 그러나치료하지않으면무증상역류질환이심각해질수있습니다. 장기적문제로는다음과같은것이있습니다 : 질식사건 천식, 기관지염또는기관의협착과같은호흡문제 음성변화 식도손상 역류를줄이기위한팁 의사가처방한대로약을복용하십시오. 조식및석식 30~45 분전에복용하십시오. 침대머리를 4~6 인치높이십시오. 베개는위부위에너무많은압력을가할것이므로베개를사용하지마십시오. 베개사용은목과등에통증을야기할수도있습니다. 그대신, 침대머리아래에블록, 벽돌또는책을놓아서침대전체가비스듬하도록하십시오. 머리를위한베개 1 개만사용하십시오. 이러한증상중하나라도있는경우, 특히흡연자인경우의사와상담하십시오. 후두를살펴보려면목구멍검사를받아야합니다. 그부위가부었거나빨갛게보이면무증상역류질환일수있습니다. 무증상역류질환검사 귀하에게무증상역류질환이있는지확인하기위해의사는여러가지검사를권장할수있습니다. 이들검사는귀하에게역류로인한손상이없는지확인할것입니다. 또한이들검사는의사가귀하에게가장적합한치료법을선택하는데도움이됩니다. ph/ 임피던스모니터링 이검사는완료하는데 24 시간이소요됩니다. 특수탐침을사용해목구멍에서위액의역류를측정합니다. 이것은아프지는않지만성가실수있습니다. 코를통해식도로작고부드럽고유연한튜브를집어넣습니다. 데이터수집을위해이튜브는허리에착용하는작은컴퓨터박스에 24 시간동안연결됩니다. 압력측정 이검사를위해작은튜브를코를통해식도로집어넣습니다. 그런다음귀하에게물을삼키게합니다. 이검사는삼키기의강도및타이밍을보여줍니다. 이검사는 30 분소요되며보통 ph/ 임피던스검사전에실시됩니다. 식도경검사 식도경검사에서는위산으로인한위벽손상을찾기위해식도경을식도에넣습니다.

4 페이지 4 페이지 5 식도경검사가후두전문의에의해수행되는경우, 그의사의진료실에서실시될것입니다. 귀하가의자에앉은상태에서식도경이코로들어갈것입니다. 진정제투여는필요하지않을것입니다. 식도경검사가다른의사에의해수행되는경우, 귀하는진정제를투여받고누워있게될것입니다. 식도경은입을통해들어갈것입니다. 바륨연하검사 바륨연하검사는 X- 레이를사용하는검사입니다. 기사는귀하가바륨이함유된흐릿한액체를삼킬때귀하식도의 X- 레이사진을찍을것입니다. 이검사는귀하의삼킴을점검하는것입니다. 이것은목구멍이좁아졌거나다른식으로비정상인지도나타낼것입니다. 기타상담 후두전문의는귀하의검사결과에대해다른의사와상담할수있습니다. 이들의사에는호흡기전문의 ( 폐를전문으로하는의사 ), 위장병전문의 ( 소화기계통을전문으로하는의사 ) 또는소화기수술전문의가포함될수있습니다. 무증상역류질환치료법 귀하의의사는최선의치료법에대해귀하와의논할것입니다. 무증상역류질환을가진대부분의사람들은무엇을언제먹을지를변경할필요가있습니다. 때때로약도필요합니다. LPR 의치료법에는다음과같은것이있습니다 : 역류를줄이기위한음식조절과같은생활습관변경. 보통위산을줄이는약도필요합니다. 음식및생활습관변경만으로는흔히역류를통제하기에충분하지않습니다. 이들약에는다음과같은것이있습니다 : - 비처방제산제 : Maalox, Gelusil, Gaviscon, Mylanta 및 Tums. 이러한약은하루 4번, 1 테이블스푼또는 2 정씩매식후 1시간및취침 1시간전에복용해야합니다. - 비처방 h 2 차단제 : Zantac75, Pepcid AC, Axid AR 및 Tagamet HB. 이들약은하루 2번또는증상이있을때복용해야합니다. - 처방 h 2 차단제 : Zantac ( 라니티덴 ), Pepcid ( 파모티딘 ), Axid ( 니자티딘 ) 및 Tagamet ( 시메티딘 ). 이약들은공복에복용해야합니다. 이약들은보통하루 2번또는취침시복용합니다. 식사하기 30~45분전또는식사하고 3시간후에복용합니다. - 처방양성자펌프억제제 : Prilosec ( 오메프라졸 ), Prevacid ( 란소프라졸 ), Protonix ( 판토프로졸 ), Nexium ( 에소메프로졸 ), Aciphex ( 라베프라졸 ) 및 Zegerid ( 오메프라졸및탄산수소나트륨 ). 이것들은위산을줄이기위해사용할수있는가장강한약입니다. 이약들은매일규칙적으로조식및 / 또는석식 30~45 분전에복용해야합니다. 의사는하루한번또는두번이약들을복용하도록처방할수있습니다.

Page 8 Patient Education Questions? Your questions are important. Call your doctor or health care provider if you have questions or concerns. Clinic staff are also available to help.

5 Page 8 Patient Education Questions? Your questions are important. Call your doctor or health care provider if you have questions or concerns. Clinic staff are also available to help. UWMC rd floor, UWMC Box N.E. Pacific St. Seattle, WA Weekdays, 8 a.m. to 5 p.m., call the Nurse s Voice Mail Line: For appointments, call HMC Otolaryngology Specialty Clinics at Ninth and Jefferson Box Jefferson St. Seattle, WA Silent Reflux: Laryngopharyngeal Reflux Disease Signs, symptoms, and treatments This booklet explains the signs, symptoms, and treatments for silent reflux disease, also called laryngopharyngeal reflux (LPR). Reflux occurs when stomach juice flows up into the esophagus (swallowing tube) and throat. This stomach juice contains acid and special enzymes to break down food. The stomach has a special lining that can resist the acid and digestive enzymes, but the esophagus and throat do not. Stomach juice can damage the esophagus and throat when reflux occurs. Laryngopharyngeal reflux (LPR) occurs when stomach juice flows into the voice box or throat. This is different than gastroesophageal reflux disease (GERD), when the refluxed stomach juice flows into the esophagus only. UWMC Otolaryngology Head and Neck Surgery Center Box N.E. Pacific St. Seattle, WA University of Washington Medical Center 04/2004 Rev. 08/2010 Reprints on Health Online:

6 Page 2 Page 7 The specialist who most often treats people with LPR is an otolaryngologist (ear, nose, and throat doctor). Your health care team your otolaryngologist, family doctor, gastrointestinal doctor, and surgeons will work together to diagnose and treat your problem. Signs and Symptoms of LPR A full bed wedge is another option. These Not all people with LPR have heartburn, should extend the length of your bed. They can indigestion, or the feeling of be bought at a foam shop. A bed wedge uses regurgitation (the return of partlydigested food from your stomach to gravity to keep your stomach contents in your stomach and prevent reflux to the voice box. your mouth). This is why we call it silent If you smoke, stop. reflux disease. About 60% of people (60 out of 100) with LPR never have these symptoms. This makes LPR hard to Do not lie down after eating. Do not eat within 3 hours of bedtime. diagnose. Eat a low-fat diet. Limit red meat and butter. Avoid fried foods, chocolate, cheese, and eggs. But, the throat and voice box (larynx) are very sensitive to stomach acid. Even small amounts of reflux can cause injury and irritation to these body tissues. It can also affect your lungs and breathing. The symptoms of LPR are: Chronic hoarseness Throat-clearing Chronic cough A feeling of a lump in your throat Throat pain or difficulty swallowing Nose and throat drainage Food sticking in your throat Choking episodes Hoarseness may come and go, and it may be worse during the day. You may have a lot of drainage from your nose and throat, or you may have too much mucus or phlegm build up. You may also have feelings of suddenly being unable to breathe, or you may wake up gasping at night. You may also have heartburn. Avoid spicy or acidic foods and drinks. Avoid spearmint and peppermint. Avoid caffeine, especially coffee, tea, and soda pop (especially cola). Avoid alcoholic drinks. Do not overeat. If you are overweight, lose weight. Avoid bending and stooping when you are having an episode of reflux, as this can make it worse. Instead, bend your knees to lower your body. Do not bend from the waist. Wear clothing that is loose around your waist. Avoid straining and lifting heavy objects. Eat at least 90 minutes before you exercise. Learn new ways of coping with stress.

7 Page 6 Page 3 Surgery: If you have severe silent reflux disease, or if you cannot take reflux medicine, your doctor may advise you to have surgery on your stomach valve. Most people who have this surgery have relief from silent reflux disease for many years. Length of Treatment People with silent reflux disease need some form of treatment most of the time. Other people need treatment all of the time. Some people recover completely for months or years, and then symptoms may return. Having silent reflux disease is a like having high blood pressure. With treatment, it does not usually cause a serious medical problem. But, without treatment, silent reflux disease can be serious. Some of the long-term problems are: Choking episodes Breathing problems such as asthma, bronchitis, or narrowing of the windpipe Voice changes Damage to your esophagus Tips for Reducing Reflux Take your medicines as prescribed by your doctor. Take them 30 to 45 minutes before your morning and evening meals. Raise the head of your bed 4 to 6 inches. Do not use pillows, as this will place too much pressure on your stomach area. Using pillows can also cause neck and back pain. Instead, place blocks, bricks, or old books under the head of your bed so that the entire bed is at an angle. Use only 1 pillow for your head. If you have any of these symptoms, talk with your doctor, especially if you smoke. You should have a throat exam to look at your voice box. If the area looks swollen or red, you may have silent reflux disease. Tests for Silent Reflux Disease Your doctor may recommend different tests to confirm that you have silent reflux disease. These tests will assure that you do not have any damage from the reflux. They will also help your doctor choose the best type of treatment for you. ph/impedance Monitoring This is a test that takes 24 hours to complete. A special probe is used to measure the reflux of gastric juice in your throat. It is not painful, but it can be annoying. You will have a small, soft, flexible tube placed into your esophagus through your nose. This tube will be connected to a small computer box that you wear around your waist for 24 hours to collect data. Manometry For this test, a small tube is placed through your nose and into your esophagus. You will then be asked to swallow water. The test will show the strength and timing of your swallowing. This test takes 30 minutes and usually is done before ph/impedance testing. Esophagoscopy In an esophagoscopy, a scope is placed in your esophagus to look for damage to the lining caused by stomach juice acid.

8 Page 4 Page 5 If your esophagoscopy is done by your laryngologist, it will be done in the doctor s office. You will sit in a chair and the scope will be placed in your nose. You will not need sedation. If your esophagoscopy is done by a different doctor, you will be sedated and lying down. The scope will go through your mouth. Medicines that lower stomach acid are also usually needed. Diet and lifestyle changes alone are often not enough to control the reflux. Some of these medicines are: - Non-prescription antacids: Maalox, Gelusil, Gaviscon, Mylanta, and Tums. These should be taken 4 times a day, 1 tablespoon or 2 tablets, 1 hour after each meal and before bedtime. Barium Swallow - Non-prescription h 2 blockers: Zantac75, Pepcid AC, Axid AR, and Tagamet HB. These medicines should be taken 2 times a day or when you have symptoms. A barium swallow is an exam that uses X-rays. The technologist will take X-ray images of your esophagus as you swallow a chalky liquid that contains barium. This test will check your swallowing. It will also show if your throat has any narrowing or is abnormal in any other way. Other Consults Your laryngologist may talk with other doctors about your test results. These doctors may include a pulmonologist (a doctor who specializes in lungs), a gastroenterologist (a doctor who specializes in the digestive system), or a surgeon who specializes in surgery of the digestive system. Treatment for Silent Reflux Disease Your doctor will talk with you about the best treatment for you. Most people with silent reflux disease need to change what and when they eat. Sometimes medicine is needed, as well. Treatment for LPR often includes: Lifestyle changes, such as changing your diet to reduce reflux. - Prescription h 2 blockers: Zantac (ranitidene), Pepcid (famotidine), Axid (nizatidine), and Tagamet (cimetidine). These medicines should be taken on an empty stomach. They are usually taken either 2 times a day or at bedtime. Take them 30 to 45 minutes before meals, or 3 hours after meals. - Prescription proton pump inhibitors: Prilosec (omeprazole), Prevacid (lansoprazole), Protonix (pantoprozole), Nexium (esomeprozole), Aciphex (rabeprazole), and Zegerid (omeprazole plus sodium bicarbonate). These are the strongest medicines available for reducing stomach acid. They must be taken regularly every day, 30 to 45 minutes before your morning and/or evening meal. Your doctor may prescribe them to be taken once or twice a day.

2 min 응용 말하기 01 I set my alarm for 7. 02 It goes off. 03 It doesn t go off. 04 I sleep in. 05 I make my bed. 06 I brush my teeth. 07 I take a shower.

2 min 응용 말하기 01 I set my alarm for 7. 02 It goes off. 03 It doesn t go off. 04 I sleep in. 05 I make my bed. 06 I brush my teeth. 07 I take a shower. 스피킹 매트릭스 특별 체험판 정답 및 스크립트 30초 영어 말하기 INPUT DAY 01 p.10~12 3 min 집중 훈련 01 I * wake up * at 7. 02 I * eat * an apple. 03 I * go * to school. 04 I * put on * my shoes. 05 I * wash * my hands. 06 I * leave