Summary
Objective
Patients with suspected laryngopharyngeal reflux (LPR) present with a variety of symptoms,
such as cough, hoarseness, and globus sensation, and often do not have the classic
features associated with gastroesophageal reflux disease.
Study Design
To achieve greater clarity in the symptom presentation, response to treatment, and
the impact on vocal function among patients presenting with signs and symptoms consistent
with LPR, we prospectively evaluated initial assessments and outcomes after medication
or surgical management.
Methods
A sample of 109 patients completed self-report measures of reflux symptoms, voice
handicap, and underwent diagnostic workup by both laryngologist and foregut surgeon
to include laryngoscopy, esophagogastroduodenoscopy, manometry and pH monitoring.
Patients were then followed for at least 3 months, and outcomes of therapy were recorded.
Results
The most common indicators on initial workup were reflux symptom inventory score ≥
13 and at least one abnormality on manometry. Male patients were significantly more
likely to demonstrate esophagitis on biopsy, abnormal upper esophageal sphincter mean
pressure, and acid (vs nonacid) reflux. Older patients were more likely to have normal
esophageal distal contractile integral activity. Significantly higher voice handicap
ratings were observed among patients with a positive reflux indicator score in addition
to abnormal upper esophageal sphincter mean basal pressure and contractile front velocity.
Patients with acid versus nonacid reflux were equally as likely to report non-responsivity
to antisecretory medications. Among a subset of patients with 3-month follow-up data
(N = 39), reflux scores were significantly lower irrespective of treatment modality
(surgical vs pharmacological intervention).
Conclusion
Extensive comprehensive workup did not reveal a single predictive indicator for LPR.
Voice assessments may be more sensitive to upper esophageal symptomatology or dysfunction
compared to reflux assessments, which may be better indicators of inflammation. Our
collaborative data confirms the value of assessing vocal quality and impairment, especially
in the presence of equivocal reflux indicators, as together these measures may achieve
greater sensitivity to reflux issues and may aid in surgical decision making.
Key words
Level of Evidence
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of VoiceAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
REFERENCES
- Laryngopharyngeal reflux: position statement of the committee on speech, voice, and swallowing disorders of the American Academy of Otolaryngology-Head and Neck Surgery.Otolaryngol Head Neck Surg. 2002; 127: 32-35
- The importance of the number of reflux episodes in the diagnosis of laryngopharyngeal reflux disease.Otolaryngol Head Neck Surg. 2013; 148: 261-266
- The prevalence of hypopharynx findings associated with gastroesophageal reflux in normal volunteers.J Voice. 2002; 16: 564-579
- Development and validation of the voice handicap index-10.Laryngoscope. 2004; 114: 1549-1556
- Validity and reliability of the reflux symptom index (RSI).J Voice. 2002; 16: 274-277
- Laryngeal and pharyngeal complications of gastroesophageal reflux disease.GI Motility online. 2006;
- Sex and gender differences in gastroesophageal reflux disease.J Neurogastroenterol Motil. 2016; 22: 575-588
- Influence of age and sex on clinical and therapeutic features of laryngopharyngeal reflux.Otolaryngol Head Neck Surg. 2022; 166: 468-476
- Effects of age on esophageal motility: use of high-resolution esophageal impedance manometry.J Neurogastroenterol Motil. 2017; 23: 481
- Optimal dosing of omeprazole 40 mg daily: effects on gastric and esophageal pH and serum gastrin in healthy controls.Am J Gastroenterol. 1996; 91: 8
- Effectiveness of proton pump inhibitors in nonerosive reflux disease.Clin Gastroenterol Hepatol. 2004; 2: 656-664
- Proton pump inhibitor therapy for suspected GERD-related chronic laryngitis: a meta-analysis of randomized controlled trials.Am J Gastroenterol. 2006; 101: 2646-2654
- Laparoscopic Nissen fundoplication effectively relieves symptoms in patients with laryngopharyngeal reflux.J Gastrointest Surg. 2007; 11 (Discussion 1587-8): 1579-1587
- Impact of Nissen fundoplication on laryngopharyngeal reflux symptoms.The American Surgeon. 2011; 77: 878-882
Article info
Publication history
Published online: May 07, 2022
Accepted:
March 13,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2022 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
