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Lukaschyk J, Abel J, Brockmann-Bauser M, Clausen JF, Reiter R, Wessel J, Rohlfs AK. The Relation Between Endoscopic and Subjective Laryngopharyngeal Reflux Signs, Vocal Tract Discomfort, Voice Handicap, and Voice Disorder Type: Same Yet Different? J Voice 2024:S0892-1997(23)00381-8. [PMID: 38182496 DOI: 10.1016/j.jvoice.2023.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 11/19/2023] [Accepted: 11/20/2023] [Indexed: 01/07/2024]
Abstract
OBJECTIVES This study aimed to investigate the relation between subjective voice-related symptoms and endoscopic findings in patients with different etiology of voice disorder and vocally healthy subjects with and without laryngopharyngeal reflux (LPR). STUDY DESIGN Retrospective cross-sectional study. METHODS The study involved 149 participants (106 female, 43 male) including 125 with various voice disorders (functional, structural, and neurogenic) and 24 vocally healthy individuals. For self-rating the German versions of the Voice Handicap Index (VHI), Vocal Tract Discomfort (VTD) Scale, and Reflux Symptom Index (RSI) were applied, while endoscopic evaluations utilized the Reflux Finding Score (RFS) and Reflux Sign Assessment (RSA). Statistical analyses incorporated ANOVA with Bonferroni posthoc tests to identify group variations. Correlations between VTD Scale, VHI, RSI, RFS, and RSA were evaluated using Pearson's correlation coefficient. To examine test sensitivity and specificity for the VTD Scale and RSA, we performed a receiver operating characteristics analysis. Youden's-Index was applied to determine the cut-off-value with best discriminatory abilities. The diagnosis of LPR was assumed when the criteria of RFS > 7 AND RSI > 13 was met. RESULTS Significant differences for all voice diagnosis groups and vocally healthy individuals for RFS and all three self-rating questionnaires were found. Moreover, there was significant correlation between VTD Scale and VHI and RSI as well as RSI and RFS, which was moderate, negative in the group of persons with LPR. However, there was no significant difference for RSA results between the vocally healthy or any diagnosis group. CONCLUSION Thus, the RFS may be more suitable to predict reflux and voice-related symptoms. The VTD Scale is a useful instrument in screening voice disorders but also LPR and can therefore be used as a tool for decision-making when transferring to a specialist.
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Affiliation(s)
- Julia Lukaschyk
- ENT, Phoniatrics and Pedaudiology - Klosterstern, Hamburg, Germany.
| | - Jakob Abel
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Meike Brockmann-Bauser
- Department of Phoniatrics and Speech Pathology, Clinic for Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jacob Friedrich Clausen
- Department of Otorhinolaryngology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Rudolf Reiter
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Hospital, Ulm, Germany
| | - Julian Wessel
- ENT, Phoniatrics and Pedaudiology - Klosterstern, Hamburg, Germany
| | - Anna-Katharina Rohlfs
- ENT, Phoniatrics and Pedaudiology - Klosterstern, Hamburg, Germany; Department of Otorhinolaryngology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Lin Y, Peng S. Current Treatment of Laryngopharyngeal Reflux. EAR, NOSE & THROAT JOURNAL 2023:1455613231180031. [PMID: 37296536 DOI: 10.1177/01455613231180031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023] Open
Abstract
Objectives: Laryngopharyngeal reflux (LPR) is a complex syndrome characterized by the reflux of gastroduodenal contents into the pharynx or larynx, resulting in a range of symptoms, including chronic cough, throat clearing, pain, dysphagia, hoarseness, and dysphonia. Despite the lack of a gold standard for diagnosis or treatment, various strategies have been proposed to manage LPR. However, the effectiveness of these treatments is compromised by the lack of a uniform treatment protocol, which places a burden on patients, physicians, and the healthcare system. This study aims to systematically review the treatments of LPR and provide updated and useful clinical information to clinical physicians. Methods: The literature with an emphasis on LPR and related keywords is searched and reviewed in PubMed. Results: Treatment of LPR includes health education, lifestyle modification, dietary changes, medications, and surgery, as well as the emergence of a novel treatment method involving external upper esophageal sphincter compression devices. Conclusions: Currently, medication is the main treatment, supplemented with lifestyle and dietary changes, but there is still a lack of effective means for patients with drug-resistant or intolerant LPR. More high-quality and rigorous trials must continue to be conducted to determine the best treatment options and find novel treatments. Taking into account the complexity of LPR, this study proposes a simple algorithm to help clinicians with the initial management of this disease.
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Affiliation(s)
- Yang Lin
- School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, People's Republic of China
| | - Shunlin Peng
- School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, People's Republic of China
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Runggaldier D, van Schie B, Marti S, Bohlender JE. [Current possibilities and challenges in the treatment of laryngopharyngeal reflux]. HNO 2023; 71:294-303. [PMID: 36795120 PMCID: PMC10125953 DOI: 10.1007/s00106-023-01280-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2023] [Indexed: 02/17/2023]
Abstract
Laryngopharyngeal reflux (LPR) is characterized by backflow of gastric or gastroduodenal content and gases into the upper aerodigestive tract, which can damage the mucus membranes of the larynx and pharynx. It is associated with a variety of symptoms such as retrosternal burning and acid regurgitation, or other unspecific symptoms such as hoarseness, globus sensation, chronic cough, or mucus hypersecretion. Due to the lack of data and the heterogeneity of studies, diagnosis of LPR is problematic and challenging, as recently discussed. Moreover, the different therapeutic approaches are also discussed controversially in the face of the poor evidence base, and include pharmacologic and conservative dietary measures. Hence, in the following review, the available options for treatment of LPR are critically discussed and summarized for daily clinical use.
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Affiliation(s)
- Daniel Runggaldier
- Klinik für Otorhinolaryngologie, Head and Neck Surgery, Abt. für Phoniatrie und klinische Logopädie, Universitätsspital Zürich, Frauenklinikstrasse 24, 8091, Zürich, Schweiz. .,Universität Zürich, Rämistrasse 71, 8006, Zürich, Schweiz.
| | - Bram van Schie
- Klinik für Otorhinolaryngologie, Head and Neck Surgery, Abt. für Phoniatrie und klinische Logopädie, Universitätsspital Zürich, Frauenklinikstrasse 24, 8091, Zürich, Schweiz.,Universität Zürich, Rämistrasse 71, 8006, Zürich, Schweiz
| | - Silvan Marti
- Klinik für Otorhinolaryngologie, Head and Neck Surgery, Abt. für Phoniatrie und klinische Logopädie, Universitätsspital Zürich, Frauenklinikstrasse 24, 8091, Zürich, Schweiz.,Universität Zürich, Rämistrasse 71, 8006, Zürich, Schweiz
| | - Jörg E Bohlender
- Klinik für Otorhinolaryngologie, Head and Neck Surgery, Abt. für Phoniatrie und klinische Logopädie, Universitätsspital Zürich, Frauenklinikstrasse 24, 8091, Zürich, Schweiz.,Universität Zürich, Rämistrasse 71, 8006, Zürich, Schweiz
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4
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Gao J, Luo R, Ruan B, Liu Z, Long R, Jiang C, Cheng S, Wang Y, Su L, Li P. [Consistency analysis of pepsin immunohistochemistry and pepsin test box in the diagnosis of laryngopharyngeal reflux]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2023; 37:97-102;106. [PMID: 36756822 PMCID: PMC10208864 DOI: 10.13201/j.issn.2096-7993.2023.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Indexed: 02/10/2023]
Abstract
Objective:To analyze the consistency of pepsin assay kit, pepsin IHC, reflux symptom index(RSI) and reflux finding score(RFS) in the diagnosis of laryngopharyngeal reflux disease(LPRD). Methods:The clinical data of 61 inpatients with laryngeal diseases who were admitted to the Department of Otolaryngology, the First Affiliated Hospital of Kunming Medical University from May 2020 to December 2021 were retrospectively analyzed. The RSI and RFS scores, the Formwitz score of pepsin immunohistochemistry, and the results of pepsin detection kit were recorded. ICC group correlation coefficient and Kappa consistency analysis was used for three detection methods. Results:Among 61 patients, 30 cases were positive and 31 cases were negative for the pepsin test kit, with a positive rate of 49.18%. The positive rate of pepsin immunohistochemistry was 45.90%(28/61), and the diagnostic agreement rate between the two was 70.49%. The consistency between them was high(κ=0.409). The positive rate of RSI and RFS in diagnosing LPRD was 62.30%(38/61), and the consistency rate was 73.77% with pepsin detection kit. The consistency between them was high(κ=0.486). Taking pepsin IHC as the reference standard, the sensitivity, specificity, positive predictive value and negative predictive value of pepsin detection kit were 71.43%(20/28), 69.70%(23/33), 66.67%(20/30) and 74.19%(23/31), respectively. Using RSI and RFS scales as reference criteria, the sensitivity, specificity, positive predictive value and negative predictive value of pepsin detection kit were 89.29%(25/28), 60.61%(20/33), 65.79%(25/38) and 86.96%(20/23), respectively. Analysis of correlation coefficient within ICC group: ICC value was 0.628, 95% confidence interval(0.497-0.741), the three methods have good consistency. Conclusion:The RSI and RFS scale scores were in good agreement with the pepsin test kit, and the pepsin test kit was also in good agreement with pepsin immunohistochemistry. As a non-invasive diagnostic technique, the pepsin test kit can be widely used in the diagnosis of pharyngeal reflux in combination with pepsin immunohistochemistry and RSI and RFS scale.
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Affiliation(s)
- Jingyu Gao
- Department of Otolaryngology,First Affiliated Hospital of Kunming Medical University,Kunming,650032,China
| | - Renjing Luo
- Department of Otolaryngology,First Affiliated Hospital of Kunming Medical University,Kunming,650032,China
| | - Biao Ruan
- Department of Otolaryngology,First Affiliated Hospital of Kunming Medical University,Kunming,650032,China
| | - Zhuohui Liu
- Department of Otolaryngology,First Affiliated Hospital of Kunming Medical University,Kunming,650032,China
| | - Ruiqing Long
- Department of Otolaryngology,First Affiliated Hospital of Kunming Medical University,Kunming,650032,China
| | - Chaowu Jiang
- Department of Otolaryngology,First Affiliated Hospital of Kunming Medical University,Kunming,650032,China
| | - Sheng Cheng
- Department of Otolaryngology,First Affiliated Hospital of Kunming Medical University,Kunming,650032,China
| | - Yan Wang
- Department of Otolaryngology,First Affiliated Hospital of Kunming Medical University,Kunming,650032,China
| | - Lu Su
- Department of Otolaryngology,Kunming Yan'an Hospital
| | - Peng Li
- Department of General Surgery,Kunming Yan'an Hospital
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[Transcultural German translation of the reflux symptom score-12 questionnaire]. HNO 2022; 70:886-890. [PMID: 36239757 PMCID: PMC9691492 DOI: 10.1007/s00106-022-01233-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2022] [Indexed: 11/30/2022]
Abstract
Bei der Diagnostik des laryngopharyngealen Refluxes (LPR) spielen neben einer anamnestischen und klinischen bzw. apparativen Beurteilung auch Fragebögen zur detaillierten Erfassung der Symptomatik eine wesentliche Rolle. Neben dem Reflux Symptom Index (RSI), dem bekanntesten LPR-Symptomfragebogen, wurde kürzlich auch ein neuer Fragebogen, „Reflux Symptom Score“ (RSS), sowie eine kürzere Version, der Reflux Symptom Score 12 (RSS-12), veröffentlicht. Letzterer ist allerdings nur in englischer, französischer und portugiesischer Sprache verfügbar, ermöglicht jedoch eine wesentlich genauere Differenzierung der Symptomatik unter Einbeziehung von Symptomstärke, Häufigkeit des Auftretens von Beschwerden sowie der refluxbezogenen Beeinträchtigung der Lebensqualität. Das Ziel dieser Arbeit ist daher, eine entsprechende transkulturelle deutschsprachige Übersetzung des RSS-12 (aktuell nun als G‑RSS-12 bezeichnet) mit Verständlichkeitstestung vorzustellen, um den klinischen und wissenschaftlichen Einsatz dieses Fragebogens auch im deutschsprachigen Raum zu ermöglichen.
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Liu CP, Jiang AY, Chen F, Wu J, Wang SY, Cao L, Liao T, Zheng YQ. Predictive Value of Laryngeal Mucosa Pepsin in Therapeutic Response of Laryngopharyngeal Reflux. J Voice 2022:S0892-1997(22)00146-1. [PMID: 35760633 DOI: 10.1016/j.jvoice.2022.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 05/19/2022] [Accepted: 05/20/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVES/HYPOTHESIS To investigate the predictive capability of pepsin level in the laryngeal mucosa to the therapeutic effect of proton-pump inhibitors in patients with suspected laryngopharyngeal reflux (LPR), so as to verify whether it can be referred to as a biomarker of LPR. STUDY DESIGN Prospective case study. METHODS Sixty patients with clinical empiric LPR were enrolled, with an reflux symptom index (RSI) ≥ 13 and an reflux finding score (RFS) > 7 as screening criteria. Biopsy specimens from the interarytenoid mucosa were obtained under topical anesthesia for pepsin immunohistochemical staining. Two parameters were observed in these patients with different pepsin levels after the administration of esomeprazole for 12 weeks: the RSI and the RFS. RESULTS Among the 60 cases, 35 cases were negative or weakly positive for pepsin (Pepsin(-) group), and 25 cases were moderately positive or strongly positive for pepsin (Pepsin(+) group). After therapy, the RSI significantly decreased from 17.00 (15.00, 19.00) to 6.00 (5.00, 11.00) in the Pepsin(+) group (Z = -4.38, P < 0.01), but no difference was found in the RFS (T = 1.48, P > 0.05). No significant difference was observed in the RSI (T = 2.01, P > 0.05) or the RFS (T = 2.01, P > 0.05) in the Pepsin(-) group either before or after therapy. An improvement in the RSI ≥ 50% was taken as the standard of effective therapy. The effective rate in the Pepsin(+) group was 72.0% (18/25), while it was 14.3% (5/35) in the Pepsin(-) group. There was a significant difference in the effective rate between the two groups (χ2 = 20.55, P < 0.01). CONCLUSIONS Proton-pump inhibitors exhibited better effects in patients with higher pepsin levels in the laryngeal mucosa. Laryngeal mucosa pepsin may serve as an ideal indicator to screen patients suitable for proton-pump inhibitor therapy and a reliable biomarker to identify patients with LPR.
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Affiliation(s)
- Cai-Peng Liu
- Department of Otorhinolaryngology Head and Neck Surgery, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, China
| | - Ai-Yun Jiang
- Department of Otorhinolaryngology Head and Neck Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Fang Chen
- Department of Otorhinolaryngology Head and Neck Surgery, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, China
| | - Jian Wu
- Department of Otorhinolaryngology Head and Neck Surgery, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, China
| | - Shu-Yue Wang
- Department of Otorhinolaryngology Head and Neck Surgery, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, China
| | - Lei Cao
- Department of Otorhinolaryngology Head and Neck Surgery, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, China
| | - Tao Liao
- Department of Otorhinolaryngology Head and Neck Surgery, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, China
| | - Yi-Qing Zheng
- Department of Otorhinolaryngology Head and Neck Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China; Department of Otorhinolaryngology Head and Neck Surgery, Sun Yat-sen Memorial Hospital of Sun Yatsen University, Guangzhou, China.
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