Instruments evaluating the clinical findings of laryngopharyngeal reflux: A systematic review

Abstract

Objectives To identify the instruments for evaluating the clinical findings (ICFs) of laryngopharyngeal reflux (LPR) designed for use with regard to diagnosis and treatment effectiveness. Methods The PubMed, Scopus, and Cochrane databases were used to search for subject headings following Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) recommendations. Three investigators retrieved relevant studies published between 1990 and 2018 describing the evolution of laryngopharyngeal findings throughout LPR treatment. Issues of clinical relevance, that is, LPR diagnosis, treatments, and signs assessed for diagnosis or as therapeutic outcomes, were assessed. The investigators also evaluated the psychometric properties (conceptual model, content validity, consistency, reliability, concordance, convergent validity, known‐groups validity, responsiveness to change, and interpretability) of the ICF. The risk of bias was assessed with the tool of the Clarity Group and Evidence Partners. Results The search identified 1,227 publications with a total of 4,735 LPR patients; of these studies, 53 met the inclusion criteria. Of these 53 studies, we identified 10 unvalidated and six validated ICFs. None of the validated ICFs included all the psychometric properties. The main identified deficiencies related to ICF psychometric validation included variable construct validity, disparate and uncertain reliabilities, and a lack of interpretability. The lack of consideration of certain LPR laryngeal and extralaryngeal signs is the main weakness of ICFs, biasing content, and construct validities. Conclusion The low specificity of LPR signs, the lack of consideration of many findings, and the absence of a gold standard for diagnosis constitute barriers to the further validation of these ICFs. Additional studies are needed to develop complete and reliable ICFs. Laryngoscope, 129:720–736, 2019

Association between laryngopharyngeal reflux and benign vocal folds lesions: A systematic review.

“…However, most of the included studies do not account for possible confounders, biasing potential LPR diagnosis and clouding any relationship between LPR and benign lesions. Smoking, alcohol abuse, chronic rhinosinusitis, and allergy may be associated with laryngopharyngitis findings and misdiagnosis of reflux …”

“…Smoking, alcohol abuse, chronic rhinosinusitis, and allergy may be associated with laryngopharyngitis findings and misdiagnosis of reflux. 1,15,47,48 Other potential bias includes lack of blinded analysis, and among the included studies that studied the association between BLVF and reflux through laryngoscopy exam findings,…”

“…The investigators analyzed trials for number of subjects, study design, inclusion and exclusion criteria, quality of trial, evidence level, symptoms, and signs used for LPR diagnosis. Previous studies have highlighted the ways in which other conditions such as allergy, dryness, and phonotrauma might mimic LPR, and included studies emphasizing approaches to LPR diagnosis, which helped to limit potential impact of confounding issues . Methods used for LPR diagnosis were carefully analyzed, and risk of bias was assessed using the Tool to Assess Risk of Bias in Cohort Studies developed by the Clarity Group and Evidence Partners…”

Evaluation of the Reflux Symptom Index and the Endolaryngeal Findings Scale after Treatment in Individuals with Laryngopharyngeal Reflux

“…This scale does not consider extra-laryngeal signs such as pharyngeal sticky mucus, pharyngeal wall erythema, and tongue tonsil hypertrophy, although many studies that reported that these signs may be associated with LPR. [33][34][35] Finally, we classified the RSI and the ERFS as reliable instruments for the post-treatment follow-up of individuals with LPR, with an emphasis on the RSI, which demonstrated better results.…”

A Multicentre Study in UK Voice Clinics Evaluating the Non-invasive Reflux Diagnostic Peptest in LPR Patients

“…This questionnaire needs to be prepared and validated in patient and control subjects. This area remains controversial and even using this battery of diagnostic tests is not considered to be accurate [27][28][29]. Recently, several studies have suggested that pepsin is a good biomarker for detecting LPR and that it can be considered as a reliable diagnostic marker [30][31][32][33][34][35][36][37]; this in turn has led to a valuable role for pepsin as a diagnostic test for both GERD and LPR [1,[38][39][40][41] especially as Peptest is a rapid and non-invasive diagnostic test and patient compliance has been demonstrated to be high.…”