Comparison of Reflux Symptom Score versus Reflux Symptom Index in screening laryngopharyngeal reflux

Abstract

ObjectivesTo compare the screening value of the Reflux Symptom Score (RSS) and the Reflux Symptom Index (RSI) for laryngopharyngeal reflux (LPR).MethodsAll included patients attending the Department of Otolaryngology at the Sixth Medical Center of the PLA General Hospital from February 2022 to August 2022, completed the RSS and the RSI and underwent 24‐hour hypopharyngeal‐esophageal multichannel intraluminal impedance‐pH (24 h HEMII‐pH) monitoring. The results of 24 h HEMII‐pH were used as a diagnostic criterion for LPR, consistency between two questionnaires (RSS, RSI) and 24 h HEMII‐pH was compared by the weighted Cohen's kappa statistic and the screening value of RSS and RSI for LPR was compared by receiver operating characteristics analysis.ResultsA total of 77 patients, 58 males, and 19 females, were included. The Kappa values of between RSS, RSI, and 24 h HEMII‐pH were 0.663 (p < 0.001) and 0.213 (p < 0.05), respectively. The sensitivity of RSS and RSI were 92.8% and 48.2%, respectively, the specificity was 71.4% and 80.9%. The negative predictive value and positive predictive value of RSI were 36.9%, 87.1%, and that of RSS were 78.9%, 89.6%. The area under curve of the RSS (0.783; 95% CI = 0.53, 0.75) is significantly higher than RSI (0.633; 95% CI = 0.72, 0.90).ConclusionThe RSS has a higher consistency and better screening value for LPR compared to RSI. In addition, the RSS includes more reflux symptoms, which may reduce the number of missed diagnoses in patients with LPR to some extent.Level of Evidence3 Laryngoscope, 133:2104–2109, 2023

A Study of the Diagnostic Value of the Sign and Symptom Questionnaires for Laryngopharyngeal Reflux Disease

“…While the RSI investigates nine common symptoms in patients, the RSS questionnaire incorporates uncommon laryngeal symptoms and respiratory and gastrointestinal‐related symptoms. Our previous study showed that the RSS questionnaire had a higher kappa value than the RSI 8 . In this study, the RSS questionnaire still showed a high kappa value and AUC value.…”

“…Twenty‐four hours of HEMII‐pH monitoring was performed on each included patient. The HEMII‐pH procedures have been described in previous the publication 8 . A proximal reflux event was defined as an episode in which reflux reached the 2 impedance sensors in the hypopharynx and a diagnosis of LPRD was made when more than 1 proximal reflux event occurred 11 .…”

“…The HEMII-pH procedures have been described in previous the publication. 8 A proximal reflux event was defined as an episode in which reflux reached the 2 impedance sensors in the hypopharynx and a diagnosis of LPRD was made when more than 1 proximal reflux event occurred. 11 According to the 24 hours HEMII-pH results, patients were divided into a positive LPRD group (LPRD) and a negative LPRD group (N-LPRD).…”

“…To reduce the underdiagnosis rate and improve the accuracy of the scales for screening, Lechien developed the RSS and RSA questionnaires in recent years, which have been gradually validated and applied in several countries. A study showed that the RSS was more consistent with 24 hours HEMII‐pH monitoring results than the RSI 8 . Despite the subjective nature of the questionnaires, they remain essential screening tools for LPRD in the clinic.…”

“…A study showed that the RSS was more consistent with 24 hours HEMII-pH monitoring results than the RSI. 8 Despite the subjective nature of the questionnaires, they remain essential screening tools for LPRD in the clinic. The study found that RSI does not correlate with RFS 9 and that the severity reflected by RSI does not account for changes in the signs.…”