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Włodarczyk E, Jetka T, Miaśkiewicz B, Skarzynski PH, Skarzynski H. Validation and Reliability of Polish Version of the Reflux Symptoms Index and Reflux Finding Score. Healthcare (Basel) 2022; 10:healthcare10081411. [PMID: 36011068 PMCID: PMC9408310 DOI: 10.3390/healthcare10081411] [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] [Received: 05/23/2022] [Revised: 07/21/2022] [Accepted: 07/21/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: To confirm the credibility, consistency, and replicability of the Polish versions of the Reflux Symptoms Index (PL-RSI) and the Reflux Finding Score (PL-RFS). (2) Methods: The translation followed the WHO recommendations. The study group included 100 volunteers (age 15−87) with hoarseness and pharyngolaryngeal complaints. The control group comprised 55 healthy volunteers (age 20−75). Study participants completed the PL-RSI; then, two independent otolaryngologists completed the PL-RFS based on pharyngeal videostroboscopy. Questionnaires were repeated after 7 days, with no treatment before the second round. Additionally, patients underwent 24 h pH-metry. The control group had a single round of questionnaires followed by pH-metry. (3) Results: The PL-RSI is consistent, reliable (Cronbach’s alpha 0.77−0.83; test−retest reliability 0.83), and significantly correlated with other patient-filled tools (p < 0.001). The PL-RFS intra-rater reliability is 0.84−0.91, and inter-rater is 0.88. Both questionnaires strongly correlate with pH-metry (PL-RSI upright Ryan Score 0.35, PL-RFS—0.60). Both clearly distinguish (i) healthy from persons with voice disorders, but without acid LPR (p < 0.0001), and (ii) within patient group between subjects with and without acid LPR (p = 0.0002). (4) Conclusions: The PL-RSI and PL-RFS are reliable and can be recommended to Polish-speaking otolaryngologists. Our findings confirm the role of country-specific factors in RSI results and that practitioners should always use a proper control group.
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Affiliation(s)
- Elżbieta Włodarczyk
- Rehabilitation Clinic, World Hearing Center, Institute of Physiology and Pathology of Hearing, 05-830 Warsaw, Poland
- Correspondence:
| | - Tomasz Jetka
- World Hearing Center, Institute of Physiology and Pathology of Hearing, 05-830 Warsaw, Poland;
| | - Beata Miaśkiewicz
- Audiology and Phoniatric Department, World Hearing Center, Institute of Physiology and Pathology of Hearing, 05-830 Warsaw, Poland;
| | - Piotr Henryk Skarzynski
- Teleaudiology and Screening Department, World Hearing Center, Institute of Physiology and Pathology of Hearing, 05-830 Warsaw, Poland;
- Institute of Sensory Organs, 05-830 Warsaw, Poland
- Heart Failure and Cardiac Rehabilitation Department, Faculty of Medicine, Medical University of Warsaw, 03-242 Warsaw, Poland
| | - Henryk Skarzynski
- Otorhinolaryngology Surgery Clinic, World Hearing Center, Institute of Physiology and Pathology of Hearing, 05-830 Warsaw, Poland;
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Eckley CA, Tangerina R. Using RSI and RFS scores to differentiate between reflux-related and other causes of chronic laryngitis. Braz J Otorhinolaryngol 2021; 89:54-59. [PMID: 34840124 PMCID: PMC9874340 DOI: 10.1016/j.bjorl.2021.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/28/2021] [Accepted: 08/09/2021] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To establish if the Reflux Symptom Index (RFI) and the Reflux Finding Score (RFC) can help establish the differential diagnosis in patients with distinct causes of chronic laryngopharyngitis. METHODS A group of 102 adult patients with chronic laryngopharyngitis (Group A - 37 patients with allergic rhinitis; Group B - 22 patients with Obstructive Sleep Apnea (OSA); Group C - 43 patients with Laryngopharyngeal Reflux (LPR)) were prospectively studied. Chronic laryngitis was diagnosed based on suggestive symptoms and videolaryngoscopic signs (RSI ≥ 13 and RFS ≥ 7). Allergies were confirmed by a positive serum RAST, OSA was diagnosed with a positive polysomnography, and LPR with a positive impedance-PH study. Discriminant function analysis was used to determine if the combination of RSI and RFS scores could differentiate between groups. RESULTS Patients with respiratory allergies and those with LPR showed similar and significantly higher RSI scores when compared to that of patients with OSA (p < 0.001); Patients with OSA and those with LPR showed similar and significantly higher RFS scores when compared to that of patients with Respiratory Allergies (OSA vs. Allergies p < 0.001; LPR vs. Allergies p < 0.002). The combination of both scores held a higher probability of diagnosing OSA (72.73%) and Allergies (64.86%) than diagnosing LPR (51.16%). CONCLUSIONS RSI and RFS are not specific for reflux laryngitis and are more likely to induce a false diagnosis if not used with diligence.
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Lechien JR, Mouawad F, Bobin F, Bartaire E, Crevier-Buchman L, Saussez S. Review of management of laryngopharyngeal reflux disease. Eur Ann Otorhinolaryngol Head Neck Dis 2021; 138:257-267. [DOI: 10.1016/j.anorl.2020.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Wlodarczyk E, Domeracka-Kolodziej A, Miaskiewicz B, Skarzynski H, Skarzynski PH. A simple qualitative scale for diagnosis of laryngopharyngeal reflux: high correlations with pH measurements and disease severity. The usefulness of the Warsaw Scale in LPR diagnostics compared to other diagnostic tools. Eur Arch Otorhinolaryngol 2021; 278:4883-4892. [PMID: 34357461 PMCID: PMC8553686 DOI: 10.1007/s00405-021-06989-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 07/08/2021] [Indexed: 12/26/2022]
Abstract
Purpose Diagnosis and monitoring of laryngopharyngeal reflux (LPR) is a constant challenge in otolaryngological practice, chiefly because there are no specific symptoms characteristic of the disease. In this paper, we present the validation of a simple, 6-level qualitative scale to gauge the clinical findings of LPR. It has been previously published in Polish as the Warsaw Scale. Methods In the study, we enrolled 100 patients with voice problems who had registered in our clinic, and we performed an extended battery of diagnostic tests for LPR, together with 24-h pH monitoring. Results The Warsaw Scale significantly outperformed other instruments in both predicting LPR status and correlating with pH measurements. Moreover, the rating provided by the scale showed a strong association with patient-reported symptoms. Conclusion The data indicate that the Warsaw Scale could be used as an affordable, consistent, and effective diagnostic and monitoring tool for LPR.
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Affiliation(s)
- E Wlodarczyk
- World Hearing Center, Institute of Physiology and Pathology of Hearing, Warsaw/Kajetany, Poland
| | - A Domeracka-Kolodziej
- World Hearing Center, Institute of Physiology and Pathology of Hearing, Warsaw/Kajetany, Poland
| | - B Miaskiewicz
- World Hearing Center, Institute of Physiology and Pathology of Hearing, Warsaw/Kajetany, Poland
| | - H Skarzynski
- World Hearing Center, Institute of Physiology and Pathology of Hearing, Warsaw/Kajetany, Poland
- Institute of Sensory Organs, Kajetany, Poland
- Oto-Rhino-Laryngology Surgery Clinic, World Hearing Center, Institute of Physiology and Pathology of Hearing, Warsaw/Kajetany, Poland
| | - P H Skarzynski
- World Hearing Center, Institute of Physiology and Pathology of Hearing, Warsaw/Kajetany, Poland.
- Institute of Sensory Organs, Kajetany, Poland.
- Oto-Rhino-Laryngology Surgery Clinic, World Hearing Center, Institute of Physiology and Pathology of Hearing, Warsaw/Kajetany, Poland.
- Heart Failure and Cardiac Rehabilitation Department, Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland.
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Wang H, Fu Z, Xu P, Gu X, Chen X, Yu W. Proton pump inhibitor treatment improves pulmonary function in acute exacerbations of COPD patients with 24-hour Dx-pH monitoring-diagnosed laryngopharyngeal reflux. CLINICAL RESPIRATORY JOURNAL 2021; 15:558-567. [PMID: 33751792 DOI: 10.1111/crj.13347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 03/04/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Chronic obstructive pulmonary disease (COPD) patients have higher laryngopharyngeal reflux (LPR)-related symptom incidence. But LPR treatment is empirical. We aimed to determine the frequency of LPR, diagnosed by 24-hour Dx-pH monitoring, among acute exacerbations of COPD (AECOPD) patients with Reflux Symptom Index (RSI) ≥13 and investigate proton pump inhibitor (PPI) treatment effect on LPR, COPD symptoms, and pulmonary function. METHODS From January 2016 to September 2017, 102 AECOPD patients with RSI ≥13 were enrolled. COPD assessment test (CAT), mMRC dyspnea scale, pulmonary function tests, and 24-hour Dx-pH monitoring were performed. The Ryan score was evaluated by using the Dx-pH DataView Lite software, which identifies patients with abnormal pharyngeal pH environments. Associations among RSI, pulmonary function test results, and Ryan score parameters were evaluated. The abovementioned assessments were reperformed after treatment, and pre- and posttreatment data were compared. RESULTS Of the 102 eligible patients, 49 (48.04%) were diagnosed with LPR based on Ryan score. Percentage of the forced expiratory volume at 1 second (FEV1%) was significantly worse in Ryan-positive than in Ryan-negative AECOPD patients. There were significant negative correlations between FEV1% and Ryan score (r = -0.394, P < 0.001), FEV1% and % time below pH threshold (r = -0.371, P < 0.001) in upright position but not in supine position. There was no significant correlation between RSI and Ryan score parameters. There were significant improvements in RSI, mMRC, CAT, and FEV1% in Ryan-positive AECOPD patients after PPI and basic treatments. CONCLUSION Study results indicate unreliability of RSI threshold for LPR diagnosis. Combination of symptoms, endoscopic findings, and 24-hour Dx-pH monitoring is recommended for LPR diagnosis and PPI treatment decisions, especially in difficult-to-control or severe COPD patients.
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Affiliation(s)
- Huaying Wang
- Department of Respiratory and Critical Care Medicine, Affiliated People's Hospital to Ningbo University, Yinzhou People's Hospital, Ningbo City, P.R. China
| | - Zhongming Fu
- Department of Respiratory and Critical Care Medicine, Affiliated People's Hospital to Ningbo University, Yinzhou People's Hospital, Ningbo City, P.R. China
| | - Peihong Xu
- Department of Respiratory and Critical Care Medicine, Affiliated People's Hospital to Ningbo University, Yinzhou People's Hospital, Ningbo City, P.R. China
| | - Xiao Gu
- Department of Respiratory and Critical Care Medicine, Affiliated People's Hospital to Ningbo University, Yinzhou People's Hospital, Ningbo City, P.R. China
| | - Xiaofei Chen
- Department of Respiratory and Critical Care Medicine, Affiliated People's Hospital to Ningbo University, Yinzhou People's Hospital, Ningbo City, P.R. China
| | - Wanjun Yu
- Department of Respiratory and Critical Care Medicine, Affiliated People's Hospital to Ningbo University, Yinzhou People's Hospital, Ningbo City, P.R. China
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Lechien JR, Dapri G, Dequanter D, Rodriguez Ruiz A, Marechal MT, De Marrez LG, Saussez S, Fisichella PM. Surgical Treatment for Laryngopharyngeal Reflux Disease: A Systematic Review. JAMA Otolaryngol Head Neck Surg 2020; 145:655-666. [PMID: 31046069 DOI: 10.1001/jamaoto.2019.0315] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Importance Laryngopharyngeal reflux (LPR) is a prevalent disease that is usually treated with diet, lifestyle modifications, and proton pump inhibitor therapy. However, nearly 10% to 30% of patients do not achieve adequate acid suppression even with high doses of proton pump inhibitors. For these patients with resistant disease, fundoplication may be recommended but the success rate of fundoplication surgery on laryngopharyngeal symptoms and findings remains uncertain. Objective To determine whether fundoplication is associated with control of signs and symptoms in patients with LPR. Evidence Review A literature search was conducted on PubMed, Cochrane Library, and Scopus according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guideline to identify studies published between 1990 and 2018 about the efficacy of fundoplication on clinical outcomes of LPR. Three investigators screened publications for eligibility and exclusion based on predetermined criteria. Study design, patient characteristics, diagnostic method, exclusion criteria, treatment characteristics, follow-up, and quality of the outcome assessment were evaluated. Findings Of the 266 studies identified, 34 met the inclusion criteria, accounting for 2190 patients with LPR (1270 women and 920 men; mean [SD] age at the time of surgery, 49.3 [6.3] years). A weighted mean of 83.0% of patients (95% CI, 79.7%-86.3%) experienced improvement and a weighted mean of 67.0% of patients (95% CI, 64.1%-69.9%) experienced a disappearance of symptoms, but there is a high level of methodological heterogeneity among studies according to diagnostic method, exclusion criteria, and outcomes used to assess the efficacy of fundoplication. A pH study without impedance study was used in most studies but with various inclusion criteria. According to results of an a priori assessment, the clinical outcomes used were overall poor, excluding many symptoms and findings associated with LPR. Conclusion and Relevance The reported studies of fundoplication in LPR disease have important heterogeneity in method of diagnosis, exclusion criteria, symptoms, and signs assessed as therapeutic outcomes; therefore, this systematic review was nonconclusive regarding whether surgery for LPR disease is associated with effective control of sight and symptoms. Otolaryngologists, gastroenterologists, and surgeons must establish a diagnostic criterion standard, clear indications for surgery, and future clinical outcomes to precisely assess the effectiveness of treatment.
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Affiliation(s)
- Jérôme R Lechien
- Laboratory of Anatomy and Cell Biology, Faculty of Medicine, University of Mons Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium.,Laboratory of Phonetics, Faculty of Psychology, Research Institute for Language Sciences and Technology, University of Mons, Mons, Belgium.,Laryngopharyngeal Reflux Study Group of the Young Otolaryngologists of the International Federation of Oto-rhino-laryngological Societies, Paris, France.,Department of Otorhinolaryngology and Head and Neck Surgery, EpiCURA Hospital, Baudour, Belgium.,Department of Otorhinolaryngology and Head and Neck Surgery, CHU St-Pierre, CHU de Bruxelles, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Giovanni Dapri
- Laryngopharyngeal Reflux Study Group of the Young Otolaryngologists of the International Federation of Oto-rhino-laryngological Societies, Paris, France.,Department of Surgery, CHU St-Pierre, CHU de Bruxelles, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Didier Dequanter
- Laryngopharyngeal Reflux Study Group of the Young Otolaryngologists of the International Federation of Oto-rhino-laryngological Societies, Paris, France.,Department of Otorhinolaryngology and Head and Neck Surgery, CHU St-Pierre, CHU de Bruxelles, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Alexandra Rodriguez Ruiz
- Laryngopharyngeal Reflux Study Group of the Young Otolaryngologists of the International Federation of Oto-rhino-laryngological Societies, Paris, France.,Department of Otorhinolaryngology and Head and Neck Surgery, CHU St-Pierre, CHU de Bruxelles, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Marie-Thérèse Marechal
- Laryngopharyngeal Reflux Study Group of the Young Otolaryngologists of the International Federation of Oto-rhino-laryngological Societies, Paris, France.,Department of Surgery, CHU St-Pierre, CHU de Bruxelles, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Lisa G De Marrez
- Laboratory of Anatomy and Cell Biology, Faculty of Medicine, University of Mons Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium.,Laryngopharyngeal Reflux Study Group of the Young Otolaryngologists of the International Federation of Oto-rhino-laryngological Societies, Paris, France
| | - Sven Saussez
- Laboratory of Anatomy and Cell Biology, Faculty of Medicine, University of Mons Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium.,Laryngopharyngeal Reflux Study Group of the Young Otolaryngologists of the International Federation of Oto-rhino-laryngological Societies, Paris, France.,Department of Otorhinolaryngology and Head and Neck Surgery, EpiCURA Hospital, Baudour, Belgium.,Department of Otorhinolaryngology and Head and Neck Surgery, CHU St-Pierre, CHU de Bruxelles, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Piero Marco Fisichella
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Boston Veterans Affairs Healthcare System, Boston, Massachusetts
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Arslanoğlu A, Durgut O. Linguistic Adaptation, Reliability, and Validation of the Turkish Version of the Reflux Symptom Index. J Voice 2020; 36:146.e1-146.e4. [PMID: 32482495 DOI: 10.1016/j.jvoice.2020.04.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 04/21/2020] [Accepted: 04/22/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The reflux symptom index (RSI) has been designed to raise the clinical suspicion of laryngopharyngeal reflux (LPR) in patients presenting with ear, nose, and throat symptoms. OBJECTIVE To develop a Turkish version of the RSI (Tr-RSI) and to evaluate its internal consistency, reliability, and clinical validity METHODS: The RSI was translated into Turkish. A total of 44 asymptomatic control subjects without LPR and 62 patients with LPR were enrolled into this study. The patients were treated with diet and behavioral modifications combined with 20 mg of rabeprazole twice daily for 3 months. All individuals were asked to fill the Tr-RSI. Participants in the control group were asked to refill the Tr-RSI after 1 week, whereas those in the patient group after treatment. Test-retest reliability, validity, and internal consistency were computed. RESULTS The Cronbach's alpha value of Tr-RSI was 0.959, indicating excellent internal consistency. The single-measurement intra-class correlation coefficient absolute agreement was 0.948 (with 95% confidence interval of 0.907-0.971), indicating good test-retest reliability. The Tr-RSI scores for total and each item were significantly higher in the LPR patient group than in the control group (P < 0.001). In the LPR patient group, the posttreatment Tr-RSI scores for each item and total were significantly lower than the pretreatment scores (P < 0.001). CONCLUSION The Tr-RSI was successfully created. It can be used with strong internal consistency, high test-retest reliability, and optimal clinical validity.
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Affiliation(s)
- Ahmet Arslanoğlu
- Department of Otorhinolaryngology, Health Science University, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Osman Durgut
- Department of Otorhinolaryngology, Health Science University, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey.
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Hou C, Chen M, Chen T, Yang Y, Yang X, Lin Z, Zeng Y, Chen L, Liu C. Study on laryngopharyngeal and esophageal reflux characteristics using 24-h multichannel intraluminal impedance-pH monitoring in healthy volunteers. Eur Arch Otorhinolaryngol 2020; 277:2801-2811. [DOI: 10.1007/s00405-020-05969-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 04/07/2020] [Indexed: 12/12/2022]
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Eckley CA, Tangerina R. Validation of the Brazilian Portuguese Version of the Reflux Finding Score. J Voice 2020; 35:806.e1-806.e5. [PMID: 32057613 DOI: 10.1016/j.jvoice.2020.01.012] [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: 10/04/2019] [Revised: 01/15/2020] [Accepted: 01/16/2020] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Laryngopharyngeal reflux (LPR) poses a diagnostic challenge. Clinical diagnosis, based on suggestive symptoms and laryngoscopic signs of inflammation, should be acceptable, as long as diligent differential diagnosis is sought. In order to minimize subjectivity, a number of diagnostic instruments have been proposed, being the most common the Reflux Symptom Index and the Reflux Finding Score (RFS). The latter has been translated into several languages including Portuguese, but it still has not been properly validated in this language. OBJECTIVE To validate the Brazilian Portuguese version of the RFS. MATERIAL AND METHOD For validity and internal consistency, 172 adults were studied (106 with LPR and 66 healthy controls). Flexible transnasal laryngoscopy images were randomly examined twice by each of the two experienced otolaryngologists with a 72-hour interval. Strict exclusion criteria were applied to avoid other possible known causes of chronic laryngitis. For assessment of reproducibility and temporal stability, a random sample of 108 subjects (53 patients and 55 controls) were tested and retested. RESULTS A statistically significant difference was observed in the mean RFS between patients with LPR (10.26 ± 3.58) and controls (5.52 ± 1.34) (P < 0.001). The interclass correlation coefficient comparing test and retest for both raters was high (R1 = 0.956; R2 = 0.948). CONCLUSION The Brazilian Portuguese version of the RFS proved to be a reliable and reproducible instrument for the diagnosis of LPR with a sensitivity of 82.08%, a specificity of 93.94%, a positive predictive value of 95.60%, and a negative predictive value was 76.54%.
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Affiliation(s)
- Claudia Alessandra Eckley
- Head of the Otolaryngology Division of Fleury Medicina e Saúde Diagnostic Laboratories, São Paulo, SP, Brazil.
| | - Rodrigo Tangerina
- Attending Physician Otolaryngology Division, Fleury Medicina e Saúde Diagnostic Laboratories, São Paulo, SP, Brazil
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The application of 24-hour pharyngeal pH-monitoring and Reflux Finding Score and Reflux Symptom Index questionnaires in the diagnostics of laryngopharyngeal reflux. GASTROENTEROLOGY REVIEW 2019; 14:274-282. [PMID: 31988674 PMCID: PMC6983756 DOI: 10.5114/pg.2019.90253] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 03/14/2019] [Indexed: 11/17/2022]
Abstract
Introduction Twenty-four-hour oesophageal pH-monitoring is a gold standard in the diagnostics of gastroesophageal reflux (GERD); however, this examination does not always perform well in patients in whom laryngeal symptoms of reflux are observed. Aim To test the effectiveness of Reflux Symptom Index (RSI) and Reflux Finding Score (RFS) in confirming the occurrence of laryngopharyngeal reflux (LPR). Material and methods Eighty-two patients with symptoms suggesting the occurrence of LPR were studied. The mean age of the participants amounted to 48.79 ±12.02. The patients were asked to fill in the RSI. The pharynx was assessed using videolaryngostroboscopy and then the RSF was filled in. Next, 24-hour pharyngeal pH-monitoring was performed with the use of a Dx pH – Restech System device. All the statistical analyses were conducted with the use of the R computational environment. Results The authors attempted to determine the reference values of the RSI and RFS questionnaires for the Polish population. For a very general approximation, normality of the distributions of the results in the RSI and RFS questionnaire can be done and an approximation mean + 2 SD can be used as a reference value. Then, for RSI the recommended cut-off limit of LPR would fluctuate, depending on the study, between 8 and 17, whereas for RFS it would be between 8 and 14. Conclusions When used alone, RSI/RFS questionnaires do not allow an unambiguous diagnosis of LPR assessed by 24-hour pharyngeal pH-monitoring.
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Lechien JR, Muls V, Dapri G, Mouawad F, Eisendrath P, Schindler A, Nacci A, Barillari MR, Finck C, Saussez S, Akst LM, Sataloff RT. The management of suspected or confirmed laryngopharyngeal reflux patients with recalcitrant symptoms: A contemporary review. Clin Otolaryngol 2019; 44:784-800. [PMID: 31230417 DOI: 10.1111/coa.13395] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 05/14/2019] [Accepted: 06/13/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To summarise current knowledge about the prevalence, aetiology and management of recalcitrant laryngopharyngeal reflux (LPR) patients-those who do not respond to anti-reflux medical treatment. METHODS A literature search was conducted following the PRISMA guidelines to identify studies that reported success of anti-reflux medical treatment with emphasis on studies that attempted to be rigorous in defining a population of LPR patients and which subsequently explored the characteristics of non-responder patients (ie aetiology of resistance; differential diagnoses; management and treatment). Three investigators screened publications for eligibility from PubMED, Cochrane Library and Scopus and excluded studies based on predetermined criteria. Design, diagnostic method, exclusion criteria, treatment characteristics, follow-up and quality of outcome assessment were evaluated. RESULTS Of the 139 articles screened, 45 met the inclusion criteria. The definition of non-responder patients varied substantially from one study to another and often did not include laryngopharyngeal signs. The reported success rate of conventional therapeutic trials ranged from 17% to 87% and depended on diagnostic criteria, treatment scheme, definition of treatment failure and treatment outcomes that varied substantially between studies. The management of non-responders differed between studies with a few differential diagnoses reported. No study considered the profile of reflux (acidic, weakly acid, non-acid or mixed) or addressed personalised treatment with the addition of alginate or magaldrate, low acid diet, or other interventions that have emerging evidence of efficacy. CONCLUSION To date, there is no standardised management of LPR patients who do not respond to traditional treatment approached. A diagnostic and therapeutic algorithm is proposed to improve the management of these patients. Future studies will be necessary to confirm the efficacy of this algorithm through large cohort studies of non-responder LPR patients. LEVEL OF EVIDENCE 2a.
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Affiliation(s)
- Jerome R Lechien
- Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France.,Laboratory of Anatomy and Cell Biology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium.,Laboratory of Phonetics, Faculty of Psychology, Research Institute for Language sciences and Technology, University of Mons (UMons), Mons, Belgium.,Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Lille, Lille, France
| | - Vinciane Muls
- Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France.,Department of Gastroenterology and Endoscopy, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Giovanni Dapri
- Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France.,Department of Gastrointestinal Surgery, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - François Mouawad
- Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Lille, Lille, France
| | - Pierre Eisendrath
- Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France.,Department of Gastroenterology and Endoscopy, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Antonio Schindler
- Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France.,Department of Biomedical and clinical sciences, Phoniatric Unit, L. Sacco Hospital, University of Milan, Milan, Italy
| | - Andrea Nacci
- Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France.,ENT Audiology and Phoniatric Unit, University of Pisa, Pisa, Italy
| | - Maria R Barillari
- Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France.,Division of Phoniatrics and Audiology, Department of Mental and Physical Health and Preventive Medicine, University of L. Vanvitelli, Naples, Italy
| | - Camille Finck
- Laboratory of Phonetics, Faculty of Psychology, Research Institute for Language sciences and Technology, University of Mons (UMons), Mons, Belgium.,Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Liège, Université de Liège, Liège, Belgium
| | - Sven Saussez
- Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France.,Laboratory of Phonetics, Faculty of Psychology, Research Institute for Language sciences and Technology, University of Mons (UMons), Mons, Belgium
| | - Lee M Akst
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Hospital, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Robert T Sataloff
- Department of Otolaryngology, Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
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12
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Agrawal N, Yadlapati R, Shabeeb N, Price CP, Lidder A, Shintani-Smith S, Bové M, Pandolfino J, Tan B. Relationship between extralaryngeal endoscopic findings, proton pump inhibitor (PPI) response, and pH measures in suspected laryngopharyngeal reflux. Dis Esophagus 2019; 32:5067901. [PMID: 30101358 DOI: 10.1093/dote/doy072] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 04/23/2018] [Accepted: 07/16/2018] [Indexed: 12/11/2022]
Abstract
Laryngopharyngeal reflux (LPR) is a clinical entity diagnosed by history laryngoscopic findings that has a variable response to empiric proton-pump inhibitor (PPI) therapy. While the reflux finding score (RFS), an endoscopic scoring scheme, has been advanced as a measure of LPR, it has not been externally validated against symptom severity in practice. Extralaryngeal pharyngeal endoscopic findings may have diagnostic utility but remain underexplored. This study assesses the correlation between extralaryngeal findings and (1) 24-hour oropharyngeal pH & (2) PPI response in patients with suspected LPR. Subjects presented to a tertiary care center with laryngeal symptoms ≥1 month and reflux symptom index (RSI) ≥13. Following baseline questionnaires, laryngoscopy, and a 24-hour oropharyngeal pH probe study, subjects were prescribed 8-12 week omeprazole trials. Baseline endoscopic findings were scored in a blinded fashion using the RFS and extralaryngeal score criteria, summatively the 'ELS.' PPI response was defined as ≥50% improvement in RSI. Thirty-three subjects with flexible endoscopic recordings completed baseline and follow-up questionnaires. The cohort's baseline mean RSI was 23.0 ± 7.2 with a ΔRSI = 9.8 after PPI therapy. The baseline RFS score averaged 5.3 ± 2.7. 45% of our subjects was found to be PPI responsive. The Cohen's kappa for the ELS but not the RFS was significant. There were no significant differences between the RFS (P = 0.10) or ELS (P = 0.07) for PPI responders & nonresponders. Oropharyngeal pH measures did not correlate with the RFS or ELS. In conclusion, endoscopic scores of laryngeal and extralaryngeal findings did not predict PPI response or oropharyngeal acid exposure in suspected LPR.
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Affiliation(s)
- N Agrawal
- Department of Otolaryngology - Head and Neck Surgery
| | - R Yadlapati
- Division of Medicine - Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - N Shabeeb
- Indiana University School of Medicine, Indianapolis, Indiana
| | - C Pe Price
- Department of Otolaryngology - Head and Neck Surgery
| | - A Lidder
- University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | | | - M Bové
- Department of Otolaryngology - Head and Neck Surgery
| | - J Pandolfino
- Division of Medicine - Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - B Tan
- Department of Otolaryngology - Head and Neck Surgery
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13
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Lechien JR, Saussez S, Nacci A, Barillari MR, Rodriguez A, Le Bon SD, Crevier-Buchman L, Harmegnies B, Finck C, Akst LM. Association between laryngopharyngeal reflux and benign vocal folds lesions: A systematic review. Laryngoscope 2019; 129:E329-E341. [PMID: 30892725 DOI: 10.1002/lary.27932] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 01/14/2019] [Accepted: 02/25/2019] [Indexed: 01/05/2023]
Abstract
OBJECTIVES To investigate the role of laryngopharyngeal reflux (LPR) in the development of benign lesions of the vocal folds (BLVF). METHODS PubMed, Cochrane Library, and Scopus were searched by three independent investigators for articles published between January 1990 and November 2018 providing substantial information about the role of LPR in the development of nodules, polyps, cysts, Reinke's edema, and sulcus vocalis. Inclusion, exclusion, diagnostic criteria and clinical outcome evaluation of included studies were analyzed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. RESULTS Of the 155 relevant publications, 42 studies were included. Thirty-five were clinical studies and seven were experimental research studying the impact of reflux on vocal fold tissue. Only seven clinical studies utilized objective LPR diagnoses (pH monitoring), suggesting an association between LPR and the development of nodules, polyps, and Reinke's edema. These studies were characterized by a substantial heterogeneity due to discrepancies in inclusion/exclusion criteria, diagnostic methods, and clinical outcome evaluation. The few basic science studies on this topic support that LPR creates an environment that may predispose to BLVF through changes in defense mechanisms of the vocal folds, cell-to-cell dehiscence, inflammatory reaction of the vocal folds, and reaction to phonotrauma. CONCLUSIONS Caustic mucosal injury from LPR could cause increased susceptibility of the vocal fold mucosa to injury and subsequent formation of nodules, polyps, or Reinke's edema. However, the heterogeneity and the low number of high-quality studies limit the ability to draw definitive conclusions. Future clinical and experimental studies are needed to better identify the role of reflux in development of BLVF. Laryngoscope, 129:E329-E341, 2019.
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Affiliation(s)
- Jerome R Lechien
- Laryngopharyngeal Reflux Study Group of the Young Otorhinolaryngologists of International Federation of Otorhinolaryngological Societies (YO-IFOS), Marseille, France.,Laboratory of Anatomy and Cell Biology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium.,Laboratory of Phonetics, Faculty of Psychology, Research Institute for Language Sciences and Technology, University of Mons, Mons, Belgium.,Department of Otorhinolaryngology-Head and Neck Surgery, CHRU de Lille, Université de Lille, Lille, France.,Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Sven Saussez
- Laryngopharyngeal Reflux Study Group of the Young Otorhinolaryngologists of International Federation of Otorhinolaryngological Societies (YO-IFOS), Marseille, France.,Laboratory of Anatomy and Cell Biology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium.,Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Andrea Nacci
- Laryngopharyngeal Reflux Study Group of the Young Otorhinolaryngologists of International Federation of Otorhinolaryngological Societies (YO-IFOS), Marseille, France.,ENT Audiology and Phoniatric Unit, University of Pisa, Pisa, Italy
| | - Maria Rosaria Barillari
- Laryngopharyngeal Reflux Study Group of the Young Otorhinolaryngologists of International Federation of Otorhinolaryngological Societies (YO-IFOS), Marseille, France.,Division of Phoniatrics and Audiology, Department of Mental and Physical Health and Preventive Medicine, University of Luigi Vanvitelli, Naples, Italy
| | - Alexandra Rodriguez
- Laryngopharyngeal Reflux Study Group of the Young Otorhinolaryngologists of International Federation of Otorhinolaryngological Societies (YO-IFOS), Marseille, France.,Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Serge D Le Bon
- Laryngopharyngeal Reflux Study Group of the Young Otorhinolaryngologists of International Federation of Otorhinolaryngological Societies (YO-IFOS), Marseille, France.,Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Lise Crevier-Buchman
- Laryngopharyngeal Reflux Study Group of the Young Otorhinolaryngologists of International Federation of Otorhinolaryngological Societies (YO-IFOS), Marseille, France.,Department of Otorhinolaryngology-Head and Neck Surgery, Foch Hospital, Paris, France
| | - Bernard Harmegnies
- Laryngopharyngeal Reflux Study Group of the Young Otorhinolaryngologists of International Federation of Otorhinolaryngological Societies (YO-IFOS), Marseille, France.,Laboratory of Phonetics, Faculty of Psychology, Research Institute for Language Sciences and Technology, University of Mons, Mons, Belgium
| | - Camille Finck
- Laryngopharyngeal Reflux Study Group of the Young Otorhinolaryngologists of International Federation of Otorhinolaryngological Societies (YO-IFOS), Marseille, France.,Laboratory of Anatomy and Cell Biology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium.,Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Liège, Faculty of Medicine, University of Liège, Liège, Belgium
| | - Lee M Akst
- Laryngopharyngeal Reflux Study Group of the Young Otorhinolaryngologists of International Federation of Otorhinolaryngological Societies (YO-IFOS), Marseille, France.,Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Hospital, Johns Hopkins School of Medicine, Baltimore, Maryland, U.S.A
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14
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Lechien JR, Akst LM, Hamdan AL, Schindler A, Karkos PD, Barillari MR, Calvo-Henriquez C, Crevier-Buchman L, Finck C, Eun YG, Saussez S, Vaezi MF. Evaluation and Management of Laryngopharyngeal Reflux Disease: State of the Art Review. Otolaryngol Head Neck Surg 2019; 160:762-782. [PMID: 30744489 DOI: 10.1177/0194599819827488] [Citation(s) in RCA: 215] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To review the current literature about the epidemiology, clinical presentation, diagnosis, and treatment of laryngopharyngeal reflux (LPR). DATA SOURCES PubMed, Cochrane Library, and Scopus. METHODS A comprehensive review of the literature on LPR epidemiology, clinical presentation, diagnosis, and treatment was conducted. Using the PRISMA statement, 3 authors selected relevant publications to provide a critical analysis of the literature. CONCLUSIONS The important heterogeneity across studies in LPR diagnosis continues to make it difficult to summarize a single body of thought. Controversies persist concerning epidemiology, clinical presentation, diagnosis, and treatment. No recent epidemiologic study exists regarding prevalence and incidence with the use of objective diagnostic tools. There is no survey that evaluates the prevalence of symptoms and signs on a large number of patients with confirmed LPR. Regarding diagnosis, an increasing number of authors used multichannel intraluminal impedance-pH monitoring, although there is no consensus regarding standardization of the diagnostic criteria. The efficiency of proton pump inhibitor (PPI) therapy remains poorly demonstrated and misevaluated by incomplete clinical tools that do not take into consideration many symptoms and extralaryngeal findings. Despite the recent advances in knowledge about nonacid LPR, treatment protocols based on PPIs do not seem to have evolved. IMPLICATIONS FOR PRACTICE The development of multichannel intraluminal impedance-pH monitoring and pepsin and bile salt detection should be considered for the establishment of a multiparameter diagnostic approach. LPR treatment should evolve to a more personalized regimen, including diet, PPIs, alginate, and magaldrate according to individual patient characteristics. Multicenter international studies with a standardized protocol could improve scientific knowledge about LPR.
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Affiliation(s)
- Jerome R Lechien
- 1 Laryngopharyngeal Reflux Study Group of Young Otolaryngologists, International Federation of Oto-rhino-laryngological Societies, Paris, France.,2 Department of Anatomy and Experimental Oncology, Mons School of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium.,3 Laboratory of Phonetics, Faculty of Psychology, Research Institute for Language Sciences and Technology, University of Mons, Mons, Belgium.,4 Department of Otorhinolaryngology and Head and Neck Surgery, CHU Saint-Pierre, Faculty of Medicine, University Libre de Bruxelles, Brussels, Belgium
| | - Lee M Akst
- 5 Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Abdul Latif Hamdan
- 1 Laryngopharyngeal Reflux Study Group of Young Otolaryngologists, International Federation of Oto-rhino-laryngological Societies, Paris, France.,6 Department of Otorhinolaryngology and Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Antonio Schindler
- 1 Laryngopharyngeal Reflux Study Group of Young Otolaryngologists, International Federation of Oto-rhino-laryngological Societies, Paris, France.,7 Department of Biomedical and Clinical Sciences, Phoniatric Unit, L. Sacco Hospital, University of Milan, Milan, Italy
| | - Petros D Karkos
- 1 Laryngopharyngeal Reflux Study Group of Young Otolaryngologists, International Federation of Oto-rhino-laryngological Societies, Paris, France.,8 Department of Otorhinolaryngology and Head and Neck Surgery, Thessaloniki Medical School, Thessaloniki, Greece
| | - Maria Rosaria Barillari
- 1 Laryngopharyngeal Reflux Study Group of Young Otolaryngologists, International Federation of Oto-rhino-laryngological Societies, Paris, France.,9 Division of Phoniatrics and Audiology, Department of Mental and Physical Health and Preventive Medicine, University of Naples SUN, Naples, Italy
| | - Christian Calvo-Henriquez
- 1 Laryngopharyngeal Reflux Study Group of Young Otolaryngologists, International Federation of Oto-rhino-laryngological Societies, Paris, France.,10 Department of Otorhinolaryngology and Head and Neck Surgery, Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain
| | - Lise Crevier-Buchman
- 1 Laryngopharyngeal Reflux Study Group of Young Otolaryngologists, International Federation of Oto-rhino-laryngological Societies, Paris, France.,11 Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, Paris, France
| | - Camille Finck
- 1 Laryngopharyngeal Reflux Study Group of Young Otolaryngologists, International Federation of Oto-rhino-laryngological Societies, Paris, France.,2 Department of Anatomy and Experimental Oncology, Mons School of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium.,12 Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Liège, Faculty of Medicine, University of Liège, Liège, Belgium
| | - Young-Gyu Eun
- 1 Laryngopharyngeal Reflux Study Group of Young Otolaryngologists, International Federation of Oto-rhino-laryngological Societies, Paris, France.,13 Department of Otorhinolaryngology and Head and Neck Surgery, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Sven Saussez
- 1 Laryngopharyngeal Reflux Study Group of Young Otolaryngologists, International Federation of Oto-rhino-laryngological Societies, Paris, France.,2 Department of Anatomy and Experimental Oncology, Mons School of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium.,4 Department of Otorhinolaryngology and Head and Neck Surgery, CHU Saint-Pierre, Faculty of Medicine, University Libre de Bruxelles, Brussels, Belgium
| | - Michael F Vaezi
- 14 Division of Gastroenterology, Hepatology, Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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15
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Lechien JR, Saussez S, Schindler A, Karkos PD, Hamdan AL, Harmegnies B, De Marrez LG, Finck C, Journe F, Paesmans M, Vaezi MF. Clinical outcomes of laryngopharyngeal reflux treatment: A systematic review and meta-analysis. Laryngoscope 2018; 129:1174-1187. [PMID: 30597577 DOI: 10.1002/lary.27591] [Citation(s) in RCA: 101] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 09/06/2018] [Accepted: 09/10/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To investigate the therapeutic benefit of proton pump inhibitors (PPIs) over placebo in patients with laryngopharyngeal reflux (LPR) and to analyze the epidemiological factors of heterogeneity in the literature. METHODS An electronic literature search was conducted to identify articles published between 1990 and 2018 about clinical trials describing the efficiency of medical treatment(s) on LPR. First, a meta-analysis of placebo randomized controlled trials (RCTs) comparing PPIs versus placebo was conducted according to diet. The heterogeneity, response to PPIs, and evolution of clinical scores were analyzed for aggregate results. Second, a systematic review of diagnosis methods, clinical outcome of treatment, and therapeutic regimens was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. RESULTS The search identified 1,140 relevant publications, of which 72 studies met the inclusion criteria for a total of 5,781 patients. Ten RCTs were included in the meta-analysis. The combined relative risk was 1.31 in favor of PPIs and increased to 1.42 when patients did not receive diet recommendations. Randomized controlled trials were characterized by a significant heterogeneity due to discrepancies in clinical therapeutic outcomes, diagnosis methods (lack of gold standard diagnostic tools), and therapeutic scheme. The epidemiological analysis of all articles supports the existence of these discrepancies in the entire literature. In particular, many symptoms and signs commonly encountered in LPR are not assessed in the treatment effectiveness. The lack of diagnosis precision and variability of inclusion criteria particularly create bias in all reported and included articles. CONCLUSION This meta-analysis supports a mild superiority of PPIs over placebo and the importance of diet as additional treatment but demonstrates the heterogeneity between studies, limiting the elaboration of clear conclusions. International recommendations are proposed for the development of future trials. Laryngoscope, 129:1174-1187, 2019.
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Affiliation(s)
- Jerome R Lechien
- From the Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS).,the Laboratory of Anatomy and Cell Biology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology.,the Laboratory of Phonetics, Faculty of Psychology, Research Institute for Language Sciences and Technology, University of Mons (UMons), Mons
| | - Sven Saussez
- From the Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS).,the Laboratory of Anatomy and Cell Biology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology.,the Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Université Libre de Bruxelles
| | - Antonio Schindler
- From the Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS).,the Department of Biomedical and Clinical Sciences, Phoniatric Unit, L. Sacco Hospital, University of Milan, Milan, Italy
| | - Petros D Karkos
- From the Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS).,the Department of Otorhinolaryngology and Head and Neck Surgery, Thessaloniki Medical School, Thessaloniki, Greece
| | - Abdul Latif Hamdan
- From the Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS).,the Department of Otorhinolaryngology and Head and Neck Surgery, American University of Beirut-Medical Center, Beirut, Lebanon
| | - Bernard Harmegnies
- From the Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS).,the Laboratory of Phonetics, Faculty of Psychology, Research Institute for Language Sciences and Technology, University of Mons (UMons), Mons
| | - Lisa G De Marrez
- From the Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS).,the Laboratory of Anatomy and Cell Biology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology
| | - Camille Finck
- From the Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS).,the Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Liège, Faculty of Medicine, University of Liège, Liège, Belgium
| | - Fabrice Journe
- From the Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS).,the Laboratory of Anatomy and Cell Biology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology
| | - Marianne Paesmans
- the Information Management Unit, Institut Jules Bordet, Université Libre de Bruxelles, School of Medicine, Brussels
| | - Michael F Vaezi
- Division of Gastroenterology, Hepatology, Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
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Laryngopharyngeal reflux disease: clinical presentation, diagnosis and therapeutic challenges in 2018. Curr Opin Otolaryngol Head Neck Surg 2018; 26:392-402. [DOI: 10.1097/moo.0000000000000486] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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17
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Lechien JR, Schindler A, De Marrez LG, Hamdan AL, Karkos PD, Harmegnies B, Barillari MR, Finck C, Saussez S. Instruments evaluating the clinical findings of laryngopharyngeal reflux: A systematic review. Laryngoscope 2018; 129:720-736. [DOI: 10.1002/lary.27537] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 08/01/2018] [Accepted: 08/03/2018] [Indexed: 12/22/2022]
Affiliation(s)
- Jerome R. Lechien
- Laryngopharyngeal Reflux Study Group of Young Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS); Mons
- Department of Anatomy and Experimental Oncology; Mons School of Medicine, UMONS Research Institute for Health Sciences and Technology; Mons
- Laboratory of Phonetics, Faculty of Psychology, Research Institute for Language Sciences and Technology ; University of Mons (UMons); Mons
| | - Antonio Schindler
- Laryngopharyngeal Reflux Study Group of Young Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS); Mons
- Department of Otorhinolaryngology and Head and Neck Surgery, CHU Saint-Pierre, School of Medicine; Université Libre de Bruxelles; Brussels
| | - Lisa G. De Marrez
- Laryngopharyngeal Reflux Study Group of Young Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS); Mons
| | - Abdul Latif Hamdan
- Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Liège, Faculty of Medicine; University of Liège; Liège Belgium
| | - Petros D. Karkos
- Laryngopharyngeal Reflux Study Group of Young Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS); Mons
- Department of Biomedical and Clinical Sciences, Phoniatric Unit, L. Sacco Hospital; University of Milan; Milan
| | - Bernard Harmegnies
- Laryngopharyngeal Reflux Study Group of Young Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS); Mons
- Department of Anatomy and Experimental Oncology; Mons School of Medicine, UMONS Research Institute for Health Sciences and Technology; Mons
| | - Maria Rosaria Barillari
- Laryngopharyngeal Reflux Study Group of Young Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS); Mons
- Division of Phoniatrics and Audiology, Department of Mental and Physical Health and Preventive Medicine; University of Naples SUN; Naples Italy
- Department of Otorhinolaryngology and Head and Neck Surgery; Thessaloniki Medical School; Thessaloniki Greece
| | - Camille Finck
- Laryngopharyngeal Reflux Study Group of Young Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS); Mons
- Department of Anatomy and Experimental Oncology; Mons School of Medicine, UMONS Research Institute for Health Sciences and Technology; Mons
- Department of Otorhinolaryngology and Head and Neck Surgery; American University of Beirut-Medical Center; Beirut Lebanon
| | - Sven Saussez
- Laryngopharyngeal Reflux Study Group of Young Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS); Mons
- Laboratory of Phonetics, Faculty of Psychology, Research Institute for Language Sciences and Technology ; University of Mons (UMons); Mons
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The development of new clinical instruments in laryngopharyngeal reflux disease: The international project of young otolaryngologists of the International Federation of Oto-rhino-laryngological Societies. Eur Ann Otorhinolaryngol Head Neck Dis 2018; 135:S85-S91. [DOI: 10.1016/j.anorl.2018.05.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 05/18/2018] [Accepted: 05/22/2018] [Indexed: 12/27/2022]
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19
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Globus pharyngeus: a review of etiology, diagnostics, and treatment. Eur Arch Otorhinolaryngol 2018; 275:1945-1953. [DOI: 10.1007/s00405-018-5041-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 06/14/2018] [Indexed: 12/13/2022]
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20
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Correlation between Allergic Rhinitis and Laryngopharyngeal Reflux. BIOMED RESEARCH INTERNATIONAL 2018; 2018:2951928. [PMID: 29765981 PMCID: PMC5885348 DOI: 10.1155/2018/2951928] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 12/09/2017] [Accepted: 01/08/2018] [Indexed: 01/30/2023]
Abstract
Background and Objectives Laryngopharyngeal reflux (LPR) exhibits nonspecific clinical presentations, and these symptoms may be associated with other conditions such as allergies, including allergic rhinitis and laryngitis. However, there is a gap in the literature regarding the correlation of laryngopharyngeal reflux with allergic rhinitis/laryngitis. Hence, the aim of this study is to explore the correlation between these two conditions. Patients and Methods A total of 126 patients with suggestive manifestations of laryngopharyngeal reflux were included in this study. Patients were classified into LPR positive and negative groups based on the results of a 24-hour oropharyngeal pH monitoring system while allergic rhinitis status was assessed with the score for allergic rhinitis (SFAR). The results of the two groups were compared regarding the SFAR score. Correlation between the pH results and SFAR score was explored. Results The LPR positive group demonstrated significantly higher SFAR scores compared to the negative LPR group (p < 0.0001). In addition, the Ryan score was significantly correlated with the SFAR total score and its symptomatology-related items (r ranged between 0.35 and 0.5). Conclusion. It seems that laryngopharyngeal reflux increases patients' self-rating of allergic manifestations. It appears that there is an association between laryngopharyngeal reflux and allergic rhinitis/laryngitis.
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Image analysis of the interarytenoid area to detect laryngopharyngeal reflux disease. Am J Otolaryngol 2018; 39:228-229. [PMID: 29336901 DOI: 10.1016/j.amjoto.2018.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 01/03/2018] [Indexed: 11/22/2022]
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Järvenpää P, Laatikainen A, Roine RP, Sintonen H, Arkkila P, Aaltonen LM. Symptom relief and health-related quality of life in globus patients: a prospective study. LOGOP PHONIATR VOCO 2017; 44:67-72. [PMID: 29119844 DOI: 10.1080/14015439.2017.1397741] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Globus may be a persistent symptom impairing patients' quality of life. Diagnostics and treatment are controversial but some globus patients may benefit from reassurance and attention. We investigated how globus symptoms change during a short-term follow-up without any treatment after an examination by an ear, nose and throat (ENT) physician and further diagnostic procedures. We also surveyed whether patients with persistent globus suffer from simultaneous voice problems. The study comprised 30 consecutive globus patients referred to Helsinki University Hospital, Department of Otorhinolaryngology - Head and Neck Surgery. We performed an ENT examination and scored patients' videolaryngostroboscopies using the Reflux Finding Score (RFS). Patients filled in three questionnaires: the Reflux Symptom Index (RSI), the Deglutition Handicap Index (DHI) and the 15-Dimensional Measure of Health-Related Quality of Life (15-D HRQoL). Patients underwent transnasal esophagoscopy, high-resolution manometry, and 24-hour multichannel intraluminal impedance and pH monitoring. After a four-month follow-up, patients re-answered the same questionnaires and a speech and language pathologist (SLP) examined the patients. Baseline and follow-up questionnaires were available from 27 (90%) patients. According to the RSI (p = .001) and the DHI (p = .003), patients' symptoms diminished after four months. The 15-D showed improvement in one subscale measuring discomfort and symptoms (p = .023). The SLP examined 23 (77%) patients, finding functional voice problems in six (26%). The study showed that most globus patients felt their symptoms diminished without any treatment during four months. In some patients, coexisting voice problems may be associated with persistent globus.
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Affiliation(s)
- Pia Järvenpää
- a Department of Otorhinolaryngology - Head and Neck Surgery , University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Assi Laatikainen
- b City of Vantaa , Health Care and Social Services, Rehabilitation , Vantaa , Finland
| | - Risto P Roine
- c Department of Health and Social Management , University of Eastern Finland , Kuopio , Finland.,d Group Administration , University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Harri Sintonen
- e Department of Public Health , University of Helsinki , Helsinki , Finland
| | - Perttu Arkkila
- f Department of Gastroenterology , University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Leena-Maija Aaltonen
- a Department of Otorhinolaryngology - Head and Neck Surgery , University of Helsinki and Helsinki University Hospital , Helsinki , Finland
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Zhang C, Hu ZW, Yan C, Wu Q, Wu JM, Du X, Liu DG, Luo T, Li F, Wang ZG. Nissen fundoplication vs proton pump inhibitors for laryngopharyngeal reflux based on pH-monitoring and symptom-scale. World J Gastroenterol 2017; 23:3546-3555. [PMID: 28596691 PMCID: PMC5442091 DOI: 10.3748/wjg.v23.i19.3546] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 01/21/2017] [Accepted: 02/17/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To compare the outcomes between laparoscopic Nissen fundoplication (LNF) and proton pump inhibitors (PPIs) therapy in patients with laryngopharyngeal reflux (LPR) and type I hiatal hernia diagnosed by oropharyngeal pH-monitoring and symptom-scale assessment.
METHODS From February 2014 to January 2015, 70 patients who were diagnosed with LPR and type I hiatal hernia and referred for symptomatic assessment, oropharyngeal pH-monitoring, manometry, and gastrointestinal endoscopy were enrolled in this study. All of the patients met the inclusion criteria. All of the patients underwent LNF or PPIs administration, and completed a 2-year follow-up. Patients’ baseline characteristics and primary outcome measures, including comprehensive and single symptoms of LPR, PPIs independence, and satisfaction, and postoperative complications were assessed. The outcomes of LNF and PPIs therapy were analyzed and compared.
RESULTS There were 31 patients in the LNF group and 39 patients in the PPI group. Fifty-three patients (25 in the LNF group and 28 in the PPI group) completed reviews and follow-up. Oropharyngeal pH-monitoring parameters were all abnormal with high acid exposure, a large amount of reflux, and a high Ryan score, associated reflux symptom index (RSI) score. There was a significant improvement in the RSI and LPR symptom scores after the 2-year follow-up in both groups (P < 0.05), as well as typical symptoms of gastroesophageal reflux disease. Improvement in the RSI (P < 0.005) and symptom scores of cough (P = 0.032), mucus (P = 0.011), and throat clearing (P = 0.022) was significantly superior in the LNF group to that in the PPI group. After LNF and PPIs therapy, 13 and 53 patients achieved independence from PPIs therapy (LNF: 44.0% vs PPI: 7.14%, P < 0.001) during follow-up, respectively. Patients in the LNF group were more satisfied with their quality of life than those in the PPI group (LNF: 62.49 ± 28.68 vs PPI: 44.36 ± 32.77, P = 0.004). Body mass index was significantly lower in the LNF group than in the PPI group (LNF: 22.2 ± 3.1 kg/m2vs PPI: 25.1 ± 2.9 kg/m2, P = 0.001).
CONCLUSION Diagnosis of LPR should be assessed with oropharyngeal pH-monitoring, manometry, and the symptom-scale. LNF achieves better improvement than PPIs for LPR with type I hiatal hernia.
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Allen J, Belafsky PC. Gastroesophageal Reflux Disease, Globus, and Dysphagia. Dysphagia 2017. [DOI: 10.1007/174_2017_139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Francis DO, Patel DA, Sharda R, Hovis K, Sathe N, Penson DF, Feurer ID, McPheeters ML, Vaezi MF. Patient-Reported Outcome Measures Related to Laryngopharyngeal Reflux: A Systematic Review of Instrument Development and Validation. Otolaryngol Head Neck Surg 2016; 155:923-935. [PMID: 27554511 PMCID: PMC5639324 DOI: 10.1177/0194599816664330] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 06/22/2016] [Accepted: 07/25/2016] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Patient-reported outcome (PRO) measures are often used to diagnose laryngopharyngeal reflux (LPR) and monitor treatment outcomes in clinical and research settings. The present systematic review was designed to identify currently available LPR-related PRO measures and to evaluate each measure's instrument development, validation, and applicability. DATA SOURCES MEDLINE via PubMed interface, CINAHL, and Health and Psychosocial Instrument databases were searched with relevant vocabulary and key terms related to PRO measures and LPR. REVIEW METHODS Three investigators independently performed abstract review and full text review, applying a previously developed checklist to critically assess measurement properties of each study meeting inclusion criteria. RESULTS Of 4947 studies reviewed, 7 LPR-related PRO measures (publication years, 1991-2010) met criteria for extraction and analysis. Two focused on globus and throat symptoms. Remaining measures were designed to assess LPR symptoms and monitor treatment outcomes in patients. None met all checklist criteria. Only 2 of 7 used patient input to devise item content, and 2 of 7 assessed responsiveness to change. Thematic deficiencies in current LPR-related measures are inadequately demonstrated: content validity, construct validity, plan for interpretation, and literacy level assessment. CONCLUSION Laryngopharyngeal reflux is often diagnosed according to symptoms. Currently available LPR-related PRO measures used to symptomatically identify suspected LPR patients have disparate developmental rigor and important methodological deficiencies. Care should be exercised to understand the measurement characteristics and contextual relevance before applying these PRO measures for clinical, research, or quality initiatives.
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Affiliation(s)
- David O Francis
- Department of Otolaryngology, Bill Wilkerson Center, Nashville, Tennessee, USA
- Center for Surgical Quality and Outcomes Research, Nashville, Tennessee, USA
- Vanderbilt Evidence-Based Practice Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Dhyanesh A Patel
- Division of Gastroenterology and Hepatology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Rohit Sharda
- Division of Gastroenterology and Hepatology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kristen Hovis
- Department of Otolaryngology, Bill Wilkerson Center, Nashville, Tennessee, USA
| | - Nila Sathe
- Vanderbilt Evidence-Based Practice Center, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - David F Penson
- Center for Surgical Quality and Outcomes Research, Nashville, Tennessee, USA
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Geriatric Research and Education Coordination Center, Veteran's Administration Tennessee Valley Health System, Nashville, Tennessee, USA
| | - Irene D Feurer
- Center for Surgical Quality and Outcomes Research, Nashville, Tennessee, USA
- Departments of Surgery and Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Melissa L McPheeters
- Vanderbilt Evidence-Based Practice Center, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Center for Population Health Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Michael F Vaezi
- Division of Gastroenterology and Hepatology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Abstract
Gastro-oesophageal reflux is associated with a wide range of respiratory disorders, including asthma, isolated chronic cough, idiopathic pulmonary fibrosis, chronic obstructive pulmonary disease and cystic fibrosis. Reflux can be substantial and reach the proximal margins of the oesophagus in some individuals with specific pulmonary diseases, suggesting that this association is more than a coincidence. Proximal oesophageal reflux in particular has led to concern that microaspiration might have an important, possibly even causal, role in respiratory disease. Interestingly, reflux is not always accompanied by typical reflux symptoms, such as heartburn and/or regurgitation, leading many clinicians to empirically treat for possible gastro-oesophageal reflux. Indeed, costs associated with use of acid suppressants in pulmonary disease far outweigh those in typical GERD, despite little evidence of therapeutic benefit in clinical trials. This Review comprehensively examines the possible mechanisms that might link pulmonary disease and oesophageal reflux, highlighting the gaps in current knowledge and limitations of previous research, and helping to shed light on the frequent failure of antireflux treatments in pulmonary disease.
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Schneider GT, Vaezi MF, Francis DO. Reflux and Voice Disorders: Have We Established Causality? CURRENT OTORHINOLARYNGOLOGY REPORTS 2016; 4:157-167. [PMID: 28163985 DOI: 10.1007/s40136-016-0121-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
A trend of attributing abnormal voice changes to reflux has gained momentum among medical professionals over the last few decades. Evidence supporting the connection between reflux and voice and the use of anti-reflux medication in patients with dysphonia is conflicting and deserves careful examination. In the current health care environment, it is important that medical decisions be based on science rather than anecdote and practice patterns. The goal of this review is to investigate the evidence linking reflux and voice changes. Specifically, this association will be examined in the context of the Bradford-Hill criteria to determine what evidence exists for a causal relationship between this exposure (reflux) and outcome (voice change).
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Affiliation(s)
- G Todd Schneider
- Vanderbilt Voice Center, Department of Otolaryngology, Bill Wilkerson Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Michael F Vaezi
- Division of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, Nashville, TN, USA
| | - David O Francis
- Vanderbilt Voice Center, Department of Otolaryngology, Bill Wilkerson Center, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Surgical Quality and Outcomes Research, Center for Population Sciences, and Evidence-based Practice Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA
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Halitosis associated volatile sulphur compound levels in patients with laryngopharyngeal reflux. Eur Arch Otorhinolaryngol 2016; 273:1515-20. [DOI: 10.1007/s00405-016-3961-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 03/01/2016] [Indexed: 01/06/2023]
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Brook CD, Platt MP, Russell K, Grillone GA, Aliphas A, Noordzij JP. Time to competency, reliability of flexible transnasal laryngoscopy by training level: a pilot study. Otolaryngol Head Neck Surg 2015; 152:843-50. [PMID: 25788339 DOI: 10.1177/0194599815572792] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 01/23/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine the progression of flexible transnasal laryngoscopy reliability and competency in otolaryngology residency training. STUDY DESIGN Prospective case control study. SETTING Academic otolaryngology department. SUBJECTS Medical students, otolaryngology residents, and otolaryngology attending physicians. METHODS Fourteen otolaryngology residents from PGY-1 to PGY-5 and 3 attending otolaryngologists viewed 25 selected and digitally recorded flexible transnasal laryngoscopies. The evaluators were asked to rate 13 items relating to abnormalities in the oropharynx, hypopharynx, larynx, and subglottis. The level of concern and level of comfort with the diagnosis were assessed. Intraclass correlations were calculated for each topic and by level of training to determine reliability within each class and compare competency versus attending interpretations. RESULTS Intraclass correlation of residents compared to attending physicians demonstrated significant improvements by year for left and right vocal fold immobility, subglottic stenosis, laryngeal mass, left and right vocal cord abnormalities, and level of concern. Additionally, pooled vocal cord mobility and pooled results in categories with good attending reliability demonstrated stepwise improvement as well. For these categories, resident reliability was found to be statistically similar to attending physicians in all categories by PGY-3. There were no trends for base of tongue abnormalities, pharyngeal abnormalities, and pharyngeal and hypopharyngeal masses. CONCLUSIONS Resident competency for flexible transnasal laryngoscopy progresses during residency to reliability with attending otolaryngologists by the PGY-3 year over key facets of the examination.
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Affiliation(s)
| | - Michael P Platt
- Boston University School of Medicine, Boston, Massachusetts, USA
| | - Kimberly Russell
- Boston University School of Medicine, Boston, Massachusetts, USA
| | | | - Avner Aliphas
- Boston University School of Medicine, Boston, Massachusetts, USA
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Domeracka-Kołodziej A, Grabczak EM, Dąbrowska M, Arcimowicz M, Lachowska M, Osuch-Wójcikiewicz E, Niemczyk K. Comparison of voice quality in patients with GERD-related dysphonia or chronic cough. Otolaryngol Pol 2014; 68:220-6. [DOI: 10.1016/j.otpol.2013.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 10/02/2013] [Indexed: 10/26/2022]
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Mesallam TA, Malki KH, Farahat M, Bukhari M, Alharethy S. Voice problems among laryngopharyngeal reflux patients diagnosed with oropharyngeal pH monitoring. Folia Phoniatr Logop 2014; 65:280-7. [PMID: 24861352 DOI: 10.1159/000362835] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND AND OBJECTIVES There is a lack of consensus regarding the clinical presentation and diagnosis of laryngopharyngeal reflux (LPR). The aim of this study was to explore voice-related abnormalities in a group of LPR patients, diagnosed with a 24-hour oropharyngeal pH monitoring. PATIENTS AND METHODS Eighty-two patients with voice-related problems participated in the study. Diagnosis of LPR was made using a 24-hour oropharyngeal pH monitoring. Patients were divided accordingly into positive and negative pH groups. Comparisons between the two groups were done, including results of clinical presentation, Voice Handicap Index-10 (VHI-10), reflux symptom index (RSI), reflux finding score (RFS), and acoustic measurements. The correlation was conducted between Ryan scores and other variables including VHI-10, RSI, and RFS. RESULTS Significant differences were found between the two groups for RSI and VHI-10. No significant differences were found between the two groups regarding clinical presentation, RFS or acoustic measures. Significant positive correlations were found between the Ryan composite measurements and both severity ratings (VHI-10, RSI). CONCLUSION LPR clinical presentation appears to be non-specific in terms of symptoms and laryngeal findings. LPR appears to have an effect on the patients' self-perception of voice problems. Further studies are needed to clarify the effect of LPR on acoustic measurements.
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Affiliation(s)
- Tamer A Mesallam
- Department of Otolaryngology, Head and Neck Surgery, King Saud University, Riyadh, Saudi Arabia
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Wan Y, Yan Y, Ma F, Wang L, Lu P, Maytag A, Jiang JJ. LPR: how different diagnostic tools shape the outcomes of treatment. J Voice 2014; 28:362-8. [PMID: 24491501 DOI: 10.1016/j.jvoice.2013.12.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 12/06/2013] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To seek a deeper and more comprehensive understanding of two major diagnostic methods for laryngopharyngeal reflux by exploring whether and how differences exist before and after treatment between patients diagnosed by either Reflux Symptom Index (RSI) and Reflux Finding Score (RFS) or 24-hour pH monitoring. MATERIALS AND METHODS Two groups of patients who confirmed laryngopharyngeal reflux disease (LPRD) by either a combination of RSI and RFS (Questionnaire group, 35 patients) or 24-hour multichannel intraluminal impedance (MII) pH monitoring (pH Group, 23 patients) were recruited. All patients were prescribed esomeprazole 20 mg twice a day for 1 month. RSI, RFS, and acoustic parameters before and after treatment were compared between the two groups. Intrinsic correlations involving multiple parameters were investigated as well. RESULTS Except for excess throat mucus (P = 0.019) and subglottic edema (P = 0.042), most RSI and RFS items before treatment were not significantly different between the Questionnaire and pH Groups, and nearly all such items in both groups exhibited distinct remission after therapy (P < 0.05). Absolute value of remission in RSI after treatment was more prominent in pH Group than in the Questionnaire group (P = 0.007). Jitter (P = 0.252), shimmer (P = 0.815), and harmonics-to-noise ratio (P = 0.117) descended to normal value after treatment. Moderate to high levels of correlation were found between the patient's original status and the absolute value of remission in most items of RSI and RFS as well as voice parameters. CONCLUSION The 24-hour MII pH monitoring and a combination of RSI and RFS are quite competitive with each other in selecting LPRD patients. Although treatment worked out on nearly all the symptoms, laryngeal images and voice parameters, 24-hour MII pH seems to be more promising in a greater symptom relief. The extent of relief that can take place in most of the measurements is considerably determined by their initial status.
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Affiliation(s)
- Yichen Wan
- Department of Otolaryngology - Head and Neck Surgery, Peking University, Third Hospital, Beijing, People's Republic of China; Department of Otolaryngology- Head and Neck Surgery, Peking University, International Hospital, Beijing, People's Republic of China
| | - Yan Yan
- Department of Otolaryngology - Head and Neck Surgery, Peking University, Third Hospital, Beijing, People's Republic of China
| | - Furong Ma
- Department of Otolaryngology - Head and Neck Surgery, Peking University, Third Hospital, Beijing, People's Republic of China.
| | - Li Wang
- Department of Otolaryngology - Head and Neck Surgery, Peking University, Third Hospital, Beijing, People's Republic of China
| | - Peiquan Lu
- Department of Otolaryngology - Head and Neck Surgery, Peking University, Third Hospital, Beijing, People's Republic of China
| | - Allison Maytag
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Jack J Jiang
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Smith JA, Houghton LA. The oesophagus and cough: laryngo-pharyngeal reflux, microaspiration and vagal reflexes. COUGH 2013; 9:12. [PMID: 23590893 PMCID: PMC3640905 DOI: 10.1186/1745-9974-9-12] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Accepted: 03/17/2013] [Indexed: 12/25/2022]
Abstract
Gastro-oesophageal reflux disease is generally considered to be one of the commonest causes of chronic cough, however randomised controlled trials of proton pump inhibitors have often failed to support this notion. This article reviews the most recent studies investigating the mechanisms thought to link reflux and cough, namely laryngo-pharyngeal reflux, micro-aspiration and neuronal cross-organ sensitisation. How recent evidence might shed light on the failure of acid suppressing therapies and suggest new approaches to treating reflux related cough are also discussed.
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Affiliation(s)
- Jaclyn A Smith
- Respiratory and Allergy Centre, The University of Manchester, University Hospital of South Manchester, Manchester, UK.
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Abstract
Reflux disease has gained in importance over the last decade since we know that many of the symptoms and diseases of the upper aerodigestive tract might be associated with reflux. However, a distinction needs to be made between extraesophageal reflux (EER) and gastroesophageal reflux disease (GERD). There are several techniques available for the diagnosis of EER. Furthermore, there are various pH monitoring devices to determine acid contamination of the larynx and the pharynx. In addition, flexible transnasal esophagoscopy is a practicable technique for the rapid examination of reflux, its cause as well as the diagnosis of reflux-induced mucosal changes in the esophagus. The present article describes the instruments used for the diagnosis of reflux against the background of our own experience and the international literature.
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Abstract
BACKGROUND Extraesophageal reflux disease often requires diagnosis and treatment by a phoniatry or ear, nose and throat specialist. The disease needs to be differentiated from gastroesophageal reflux disease. OBJECTIVE A new oropharyngeal pH measuring system with a single channel probe has recently been introduced. The aim of this study was to compare oropharyngeal pH-metry with the existing diagnostic methods for extraesophageal reflux disease and to present initial results in our own patients. METHODS A literature search for oropharyngeal pH-metry was performed in the databases NHS EED, HTA, DARE, Clinical trials, Cochrane reviews and Medline/PubMed. A selective literature search was also carried out on the problem of extraesophageal reflux disease. RESULTS Evaluation scales, trial proton pump inhibitor therapy or pH-metry, for example, can be used to diagnose extraesophageal reflux disease. pH-metry can be performed using a classical two-channel pH-metry system; a new oropharyngeal pH measuring system has recently been introduced. This new method has been evaluated in initial studies for normative data and has been compared to two-channel pH-metry. Prospective randomised studies to diagnose extraesophageal reflux disease with the new oropharyngeal pH-metry method are still lacking. DISCUSSION Oropharyngeal pH-metry has some potential advantages compared to classical two-channel pH-metry; however, a lot of questions remain unanswered. These will be discussed and illustrated with the help of a number of own patient case reports.
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Friedman M, Hamilton C, Samuelson CG, Kelley K, Taylor R, Darling R, Taylor D, Fisher M, Maley A. The Value of Routine pH Monitoring in the Diagnosis and Treatment of Laryngopharyngeal Reflux. Otolaryngol Head Neck Surg 2012; 146:952-8. [DOI: 10.1177/0194599812436952] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Objective. To assess the need for pH testing in diagnosing laryngopharyngeal reflux (LPR). Study Design. Case series with planned data collection. Setting. Tertiary care center. Subjects and Methods. On the basis of symptoms and/or abnormal endoscopic findings, more than 500 patients underwent 24-hour pharyngeal pH testing at a single center (using the Dx-pH probe) between January 2009 and June 2011. A total of 163 patients not on proton-pump inhibitors at the time of study and with complete data available for analysis (pH results, body mass index, smoking status, pretest reflux symptom index) were divided into 2 groups by positive (n = 70) and negative (n = 93) Ryan Score. The Reflux Symptom Index (RSI) was compared between groups and assessed overall against Ryan Score parameters at different pH thresholds. The diagnostic utility of an RSI ≥ 13 for prediction of Ryan Score was assessed. Results. No significant difference in RSI was seen between Ryan-positive (17.50 ± 11.47) and Ryan-negative (14.95 ± 11.43) patients ( P = .161). Overall, RSI correlated poorly with percentage time spent below pH thresholds 6.5, 6.0, 5.5, and 5.0 and upright and supine Ryan parameters at these thresholds (as determined by linear regression analysis). The sensitivity, specificity, positive predictive value, and negative predictive value of RSI ≥ 13 for Ryan positivity were 55.7%, 47.3%, 44.3%, and 58.7%, respectively. Conclusion. Our findings show that in our population of otolaryngology patients, the diagnosis of LPR cannot be reliably made on the basis of symptoms alone. Diagnosis, and in particular treatment decisions, should ideally be made on the basis of a combination of symptoms, signs, and confirmatory testing.
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Affiliation(s)
- Michael Friedman
- Rush University Medical Center, Chicago, Illinois, USA
- Advanced Center for Specialty Care, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA
| | - Craig Hamilton
- Advanced Center for Specialty Care, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA
| | - Christian G. Samuelson
- Advanced Center for Specialty Care, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA
| | - Kanwar Kelley
- Advanced Center for Specialty Care, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA
| | - Renwick Taylor
- Advanced Center for Specialty Care, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA
| | - Robert Darling
- Advanced Center for Specialty Care, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA
| | - David Taylor
- Advanced Center for Specialty Care, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA
| | - Michelle Fisher
- Advanced Center for Specialty Care, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA
| | - Alexander Maley
- Rush University Medical Center, Chicago, Illinois, USA
- Advanced Center for Specialty Care, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA
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Printza A, Kyrgidis A, Oikonomidou E, Triaridis S. Assessing Laryngopharyngeal Reflux Symptoms with the Reflux Symptom Index. Otolaryngol Head Neck Surg 2011; 145:974-80. [DOI: 10.1177/0194599811425142] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Objective. To validate the Reflux Symptom Index (RSI) in Greek patients and estimate the prevalence of laryngopharyngeal reflux (LPR) symptoms in the Greek population. Study Design. Prospective, controlled validation study. Setting. Tertiary referral hospital and primary care. Subjects and Methods. For validation purposes, the instrument was administered to 53 patients with confirmed LPR. Sex- and age-matched controls with no LPR or gastroesophageal reflux disease (GERD) symptoms presenting in a primary care setting composed the control group. Reliability and construct validity were statistically appraised. Using the RSI, the authors estimated the prevalence of LPR in a randomly selected sample of the Greek adult population. Results. The mean (SD) RSI score of the 172 sex- and age-matched controls was 3.2 (3.5). The mean (SD) RSI score of the 53 confirmed LPR patients was 19.9 (6.8). Cronbach α was 0.865. Factor analysis verified that the RSI instrument consists of 2 principal factors. To estimate the prevalence of LPR, a representative sample of the Greek adult population (188 subjects) completed the RSI questionnaire: 36.3% were male, and 29.6% were smokers. Mean (SD) age was 53.4 (17.7) years. The instrument was able to discriminate 16 patients with LPR symptoms with a mean (SD) score of 18.91 (6.39). Conclusion. The authors evaluated the internal consistency, reliability, and construct validity of the RSI for the Greek population. Factor analysis of the Greek translation of the RSI demonstrated that it can be a reliable tool in the diagnostic approach of LPR patients. Using the RSI, the authors recorded that the prevalence of LPR in a representative sample of the Greek population is 8.5%.
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Affiliation(s)
- Athanasia Printza
- Second Department of Otolaryngology Head & Neck Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Athanassios Kyrgidis
- First Department of Otolaryngology Head & Neck Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Stefanos Triaridis
- First Department of Otolaryngology Head & Neck Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Gastroesophageal Reflux Disease, Globus, and Dysphagia. Dysphagia 2011. [DOI: 10.1007/174_2011_340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Musser J, Kelchner L, Neils-Strunjas J, Montrose M. Patient Compliance during 24-Hour Dual pH Probe Monitoring for Extraesophageal Reflux. ISRN OTOLARYNGOLOGY 2011; 2011:703936. [PMID: 23724257 PMCID: PMC3658825 DOI: 10.5402/2011/703936] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2011] [Accepted: 09/28/2011] [Indexed: 12/18/2022]
Abstract
Objective. During ambulatory 24-hour dual pH probe monitoring for suspected extraesophageal reflux (EER), patients are responsible for indicating relevant study events. Study interpretation relies on patient accuracy and compliance to test instructions. This study sought to explore patient compliance during pH probe monitoring and evaluated the utility of a Post-Evaluation Questionnaire as a clinical tool. Participants and Methods. Participants were prospectively studied during 24-hour dual pH probe monitoring. Participants used both a food diary and monitor settings to indicate relevant study events. Following pH testing, participants completed a Post-Evaluation Questionnaire regarding test experiences. Results. Eighty-two participants completed the study. Means and standard deviations were calculated for individual responses on the Post-Evaluation Questionnaire. Means indicate high participant accuracy for study events, and adherence to typical activities and diet over the testing period. Factor analysis was performed on the Post-Evaluation Questionnaire items and identified two factors: “typical experiences” and “times forgot.” Cronbach's alpha demonstrated acceptable reliability levels for questions related to “typical experiences,” but poor reliability for “times forgot” questions. Conclusions. Assessment of participant compliance during pH probe testing can quickly and easily be completed through a Post-Evaluation Questionnaire. Participant compliance can be assessed for improved study interpretation.
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Affiliation(s)
- Joy Musser
- Department of Communication Sciences and Disorders, University of Cincinnati, P.O. Box 670394, Cincinnati, OH 45267, USA
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