Discussion
The most common complications/adverse effects of HEMII-pH consist of nose pain, runny nose, nose bleeding, throat pain/discomfort, chest pain, cough, headache and dysphagia [4]. Catheter displacement is known to be a potential problem that may impair the test accuracy [5]. The pH probe movements usually depend on the body position, bolus size and composition and talking [5]. During swallowing, the pH probe began by ascending 0.5-2.0 cm then returned to the baseline position. A study found that, for 48 swallows, the ascending oscillation was followed by a descending oscillation of up to 2.0 cm before returning to baseline; the pH probe movements could account for the variation in results and reproducibility of simultaneous esophageal pH-monitoring. In this paper, we reported two rare complications of HEMII-pH characterized by probe movements related to retrograde esophageal peristaltic events (belching and vomiting). Regarding the features of the first patient, hiatal hernia could be a favoring factor. To the best of our knowledge, this kind of complication was never reported. Otolaryngologist who performed in-office HEMII-pH testing has to be aware about the risk of folded probe or probe node in patients with vomiting events or belching. The removal of the probe has to be cautious in patients with a clinical suspicion of probe movements regarding the theoretical risk of nasal traumatism.