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The Inclusion of Voice Assessments to Aid Diagnostic and Surgical Decision Making for Patients With Laryngopharyngeal Reflux

  • Swapna Chandran
    Correspondence
    Address correspondence and reprint requests to Swapna Chandran, Department of Otolaryngology – HNS and Communicative Disorders, University of Louisville School of Medicine, 529 S. Jackson Street, ENT Suite, Louisville, KY 40202.
    Affiliations
    Department of Otolaryngology – HNS and Communicative Disorders, University of Louisville, School of Medicine, Louisville, Kentucky
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  • Asim Mohiuddin
    Affiliations
    University of Louisville, School of Medicine, Louisville, Kentucky
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  • Elizabeth Cash
    Affiliations
    Department of Otolaryngology – HNS and Communicative Disorders, University of Louisville, School of Medicine, Louisville, Kentucky

    UofL Healthcare – Brown Cancer Center, Louisville, Kentucky
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  • Christina Albert
    Affiliations
    Department of Otolaryngology – HNS and Communicative Disorders, University of Louisville, School of Medicine, Louisville, Kentucky
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  • Farid Kehdy
    Affiliations
    Division of General Surgery, Department of Surgery, University of Louisville, School of Medicine, Louisville, Kentucky
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      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

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      REFERENCES

        • Koufman JA
        • Aviv JE
        • Casiano RR
        • et al.
        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
        • Fusconi M
        • De Virgilio A
        • Conte M
        • et al.
        The importance of the number of reflux episodes in the diagnosis of laryngopharyngeal reflux disease.
        Otolaryngol Head Neck Surg. 2013; 148: 261-266
        • Hicks DM
        • Ours T.M.
        • Abelson T.I.
        • et al.
        The prevalence of hypopharynx findings associated with gastroesophageal reflux in normal volunteers.
        J Voice. 2002; 16: 564-579
        • Rosen CA
        • Lee AS
        • Osborne J
        • et al.
        Development and validation of the voice handicap index-10.
        Laryngoscope. 2004; 114: 1549-1556
        • Belafsky PC
        • Postma GN
        • Koufman JA
        Validity and reliability of the reflux symptom index (RSI).
        J Voice. 2002; 16: 274-277
        • Postma GN
        • Halum SL
        Laryngeal and pharyngeal complications of gastroesophageal reflux disease.
        GI Motility online. 2006;
        • Kim YS
        • Kim N
        • Kim GH
        Sex and gender differences in gastroesophageal reflux disease.
        J Neurogastroenterol Motil. 2016; 22: 575-588
        • Lechien JR
        • Carroll TL
        • Bobin F
        • et al.
        Influence of age and sex on clinical and therapeutic features of laryngopharyngeal reflux.
        Otolaryngol Head Neck Surg. 2022; 166: 468-476
        • Shim YK
        • Kim N
        • Park YH
        • et al.
        Effects of age on esophageal motility: use of high-resolution esophageal impedance manometry.
        J Neurogastroenterol Motil. 2017; 23: 481
        • Kuo B
        • Castell DO
        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
        • Dean BB
        • Gano AD
        • Knight K
        • et al.
        Effectiveness of proton pump inhibitors in nonerosive reflux disease.
        Clin Gastroenterol Hepatol. 2004; 2: 656-664
        • Qadeer MA
        • Phillips CO
        • Lopez AR
        • et al.
        Proton pump inhibitor therapy for suspected GERD-related chronic laryngitis: a meta-analysis of randomized controlled trials.
        Am J Gastroenterol. 2006; 101: 2646-2654
        • Catania RA
        • Kavic SM
        • Roth JS
        • et al.
        Laparoscopic Nissen fundoplication effectively relieves symptoms in patients with laryngopharyngeal reflux.
        J Gastrointest Surg. 2007; 11 (Discussion 1587-8): 1579-1587
        • Van Der Westhuizen L
        • Von SJ
        • Wilkerson BJ
        • et al.
        Impact of Nissen fundoplication on laryngopharyngeal reflux symptoms.
        The American Surgeon. 2011; 77: 878-882