Summary
Objectives
Laryngopharyngeal reflux (LPR) is a pervasive disorder that may cause hoarseness,
throat clearing, and other symptoms. These symptoms are particularly problematic in
professional voice users. Proton pump inhibitors (PPIs) are the mainstay of current
medical management for LPR but may be insufficient in managing some patients' symptoms.
Laparoscopic Nissen fundoplication (LNF) is well established for treatment of gastroesophageal
reflux disease with a high success rate, but its role in the treatment of LPR remains
uncertain. This study was designed to investigate the effectiveness of anti-reflux
surgery in managing disease refractory to medical reflux therapy (twice of more per
day PPIs).
Study Design
Retrospective medical record review.
Methods
This study examined 25 professional voice users, age ranging from 14 to 75 years,
diagnosed with refractory LPR treated twice daily or more with PPIs. Reflux finding
scores (RFS) were graded by blinded raters and compared for initial, preoperative,
postoperative, and final visits. Twenty-four-hour pH-impedance study scores were obtained
pre- and postoperatively.
Results
Sixty percent of patients were on no-reflux medications postoperatively and an additional
24% were on less medication. RFS was not significantly different between pre- and
postoperative evaluations with good inter- and intrarater reliability; postoperative
examinations occurred on less or no pharmaceutical reflux treatment. Twenty-four-hour
pH-impedance testing revealed significant reductions in reflux and a nearly significant
reduction in total acid. Ninety percent of positive symptom indices preoperatively
were negative postoperatively. Seventy-six percent of patients on BID dosing of PPIs
and 86% of those receiving super-high-dose PPI administration who underwent LNF were
satisfied with the results for their LPR disease.
Conclusion
LNF should be considered as a treatment option for professional voice users with LPR
with symptoms refractory to standard or super-high-dose medical management. LNF may
decrease or eliminate the need for postoperative PPI usage. The RFS may not be sensitive
enough to monitor changes in LPR severity. Patients, especially those on super-high-dose
medication administration, are satisfied with the improvement in LPR symptoms after
anti-reflux surgery.
Key Words
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Article info
Publication history
Published online: March 13, 2014
Accepted:
December 13,
2013
Footnotes
Financial Disclosure: There are no relevant financial conflicts to disclose.
Identification
Copyright
© 2014 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
