Risk factors for the development of reflux disease include increased gastric acid production, prolonged gastric emptying, restricted oesophageal clearance, reduced saliva secretion, increased intraabdominal pressure and sphincter insufficiency. Above all, acid, pepsin, bile salts and other gastroduodenal proteins cause mucosal irritation. Particularly, the combination of acid and pepsin tends to lead to mucosal damage, whereas the laryngopharyngeal mucosa is much more sensitive than the oesophageal mucosa due to a lack of defence mechanisms. 1,2 Gastro-oesophageal reflux (GER) and laryngopharyngeal reflux (LPR) are two different clinical entities, and a fundamental distinction needs to be made. GER often occurs at night and has classic reflux symptoms such as heartburn, acid regurgitation and retrosternal pain.In contrast, LPR occurs mostly during daytime and causes non-specific symptoms such as hoarseness, globus sensation, chronic throat clearing and increased mucus. 3 Nevertheless, GER and LPR can occur simultaneously and cause similar symptoms. 4 A correlation between various clinical pictures and GER has already been established. 5 These include reflux oesophagitis, oesophageal strictures, Barrett oesophagus and Barrett carcinoma. However, data for LPR are less clear.Various medical conditions seen on a daily basis such as chronic laryngopharyngitis, chronic sinusitis, bronchial asthma, pulmonary fibrosis and recurrent otitis media are associated with LPR. 6 Today, oesophago-gastro-duodenoscopy and impedance pH monitoring are the gold standard to assess GER. 5 In contrast, LPR is often diagnosed by clinical signs and symptoms and/or a trial of proton pump inhibitor (PPI) therapy. A few validated methods already exist to detect and quantify LPR, namely the reflux symptom index (RSI), the reflux finding score (RFS) and oropharyngeal pH monitoring (PHM). The latter was first described in 2009 and has been validated by various research groups. [7][8][9] Meanwhile, its reliability and reproducibility was proven to be high for extraoesophageal reflux assessment. [10][11][12]

Background: Laryngopharyngeal reflux (LPR) is a prevalent disorder. The aim of the present retrospective cohort study was to evaluate oropharyngeal pH-monitoring using a novel scoring system for LPR. Methods: In a total of 180 consecutive patients with possible LPR, reflux symptom index (RSI), reflux finding score (RFS), oropharyngeal pH-monitoring and transnasal esophagoscopy were carried out for further investigation. Results: In our series, 99 (55%) patients had severe LPR, 29 (16%) cases presented with moderate and 23 (13%) with mild severity, 9 (5%) subjects revealed neutral values, and 7 (4%) individuals were alkaline, while 13 (7%) patients had no LPR. In detecting LPR, the sensitivity, specificity and accuracy of oropharyngeal pH-monitoring was 95%, 93% and 94%, respectively. Conclusion: Oropharyngeal pH-monitoring is a reliable tool in the assessment of LPR, but the pH graphs have to be precisely analyzed and interpreted in context with other validated diagnostic tests.