Reflux and Voice Disorders: Have We Established Causality?

Schneider, G; Vaezi, Michael F.; Francis, David O.

doi:10.1007/s40136-016-0121-5

Cited by 28 publications

(22 citation statements)

References 70 publications

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“…LPRD refers to reflux of gastric contents into the laryngopharynx of sufficient severity presumed to cause a constellation of symptoms including throat-clearing, cough, globus sensation, and hoarseness. 8 Because a reliable, validated gold standard for LPRD does not exist, patient-reported symptoms are often used as a surrogate for LPRD diagnosis. For the potential diagnosis of LPRD, the RSI is the most commonly accepted patient-reported outcome measure (PROM).…”

Section: Discussionmentioning

confidence: 99%

“…The RSI assesses nine symptoms that span both voice and traditional gastroesophageal reflux symptoms and includes items such as heartburn, cough, globus, and voice dysfunction . Although LPRD is a physiologically plausible explanation for dysphonia, randomized controlled trials assessing the utility of antireflux therapy to improve voice outcomes have demonstrated mixed results . Moreover, studies have demonstrated that non‐LPRD cases of dysphonia demonstrate elevated RSI scores and that voice therapy may improve RSI scores in LPRD patients when used both with and without a PPI .…”

Section: Introductionmentioning

confidence: 99%

“…5,6 Although LPRD is a physiologically plausible explanation for dysphonia, randomized controlled trials assessing the utility of antireflux therapy to improve voice outcomes have demonstrated mixed results. [7][8][9] Moreover, studies have demonstrated that non-LPRD cases of dysphonia demonstrate elevated RSI scores and that voice therapy may improve RSI scores in LPRD patients when used both with and without a PPI. 3,10,11 In this study, we seek to 1) investigate the symptom burden, as measured by the RSI and 10-item Voice Handicap Index (VHI-10), among patients with MTD not responsive to PPIs, and 2) measure the change in symptom burden following voice therapy.…”

Section: Introductionmentioning

confidence: 99%

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Voice therapy associated with a decrease in the reflux symptoms index in patients with voice complaints

et al. 2018

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Objectives/Hypothesis: Patients with muscle tension dysphonia often demonstrate an elevation in Reflux Symptom Index (RSI) and 10-item Voice Handicap Index (VHI-10) scores, and may be erroneously diagnosed with laryngopharyngeal reflux disease. In this study we assessed the effects of voice therapy on RSI and VHI-10 scores in patients with voice complaints not responsive to antireflux medications. Study Design: Retrospective cohort study. Methods: A study of patients was conducted at a single tertiary-care center over 1 year (January 2012–January 2013). Patients were included if they had dysphonia not responsive to proton pump inhibition, did not have neurologic or neoplastic disease, and participated in at least three voice-therapy sessions in the absence of antireflux therapy. Primary analysis assessed change in RSI scores between the initial and follow-up visits with a laryngologist. Results: A total of 18 patients were included (mean age = 49.9 ± 14.5 years, 89% female, 83% with a primary complaint of dysphonia). From initial to follow-up visit, the median RSI score (18.5 [interquartile range {IQR}, 9.5–22.8] vs. 10.5 [IQR, 4.5–14]; P = .02) and median VHI-10 score (25.5 [IQR, 11.3–30.0] vs. 13.5 [IQR, 9.5–20.8]; P = .03) significantly decreased. A significant inverse correlation was found between the number of voice therapy sessions/month and change in RSI score (r = −0.4; P = .05). Conclusions: In this study of patients with muscle tension dysphonia or vocal hyperfunction not responsive to antireflux therapy, RSI and VHI-10 scores improved following voice therapy. Results suggest that self-reported symptoms typically attributed to laryngopharyngeal reflux disease may actually be secondary to inefficient voice use patterns or anxiety about dysphonia that are responsive to voice therapy.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Voice therapy associated with a decrease in the reflux symptoms index in patients with voice complaints

et al. 2018

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“…The first insight that can be found in literature, concerning the possible involvement of ENT anatomical structures in the reflux pathology, goes back to 1903; in fact, Coffin speculated "gas reflux from the stomach" as well as the "hyper-acidity" could be considered responsible for hoarseness and back rhinorrhea [1][2][3][4]. Starting from the '80s, besides the relatively "old" knowledge of GED, a new concept arose; it proposed LPR could have been caused by "acid vapors" action, coming from the stomach.…”

Section: Introductionmentioning

confidence: 99%

“…Starting from the '80s, besides the relatively "old" knowledge of GED, a new concept arose; it proposed LPR could have been caused by "acid vapors" action, coming from the stomach. Those vapors, after being in contact with the esophageal mucosa and having passed through the Upper Esophageal Sphincter (UES), reach the upper respiratory tract: larynx, laryngopharynx, and finally the nose sinus area [3,5,18] and the middle ear through the auditory tubes [1,6,7].…”

Section: Introductionmentioning

confidence: 99%

Clinical-Diagnostic Correlations in Laryngopharyngeal Reflux (LPR). The Role of Peptesttm

Gelardi¹,

Eplite²,

Mezzina³

et al. 2017

IJOAOT

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LaryngoPharyngeal Reflux (LPR) is a term recently described, classified among the "extra-esophageal disorders", caused by another pathology called "Gastro-Esophageal Disease" (GED). Pepsin has been recognized as the true marker and the responsible factor of mucosal damage.The clinical-instrumental diagnosis of LPR is mainly based upon video laryngoscopy exam, pH-measuring, pH-impedance measuring, using "score" questionnaires, designed to establish the presence of specific symptoms (Reflux Symptom Index -RSI) and endoscopic signs (Reflux Finding Score -RFS). The evidence of the role of pepsin associated to the LPR helped to develop new technologies, able to detect the presence of that enzyme within the saliva; this device is called Peptest TMThe aim of the present study was to correlate the qualitativequantitative values of salivary pepsin (using Peptest TM ) with symptoms and signs obtained from RSI and RFS. The final goal is to validate this enzyme immunoassay method using LPR diagnostic tools.Seventy-five patients were recruited (41 females, 34 males) aged between 12 and 71 years old, (average age 45 years). All patients performed anamnesis, including food habits analysis, RSI evaluation, rhinofibrolaryngoscopy exam with RFS calculation and Peptest TM.Highly comparable results were obtained in all of the 75 patients undergoing double detection of Peptest TM , with LFD measure (T band intensity) and pepsin concentration (ng/ml).Statistically significant correlation concerning symptoms and saliva pepsin concentration was demonstrated as well as the relationship between objective signs and saliva pepsin concentration. The PeptestTM could become the "Gold standard" in all cases LPR pathology suspicion and may allow revealing the symptoms of that pathology at its early onset, avoiding dealing with more invasive methods and helping to adopt the correct therapeutic follow-up as soon as possible.

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Association of Singing With the Development of Pediatric Voice Disorders

James

Ong

2019

JAMA Otolaryngol Head Neck Surg

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To the Editor We thank Clarós et al 1 for their study investigating the association between singing in a children's choir and the development of voice disorders. The authors reported a significantly greater number of voice disorders in nonsingers compared with singers, thus emphasizing the importance of introducing conscientious voice care in nonsinging children. However, we have identified several notable limitations in this study.First, the presence of laryngopharyngeal reflux disease was formally examined in singing children, but not in the nonsinging group. Only the presence of reflux symptoms in the latter was mentioned haphazardly. The significance of this should not be understated because previous studies have demonstrated the association of reflux symptoms with voice disorders 2 and dysphonia, 3 ie, the primary and secondary outcomes of the study respectively. Both groups should have been formally examined for reflux symptoms and disease. Failure to do so would mean an unfair comparison between the 2 groups, which could potentially invalidate the findings of this study.In addition, the authors remarked that instances of vocal trauma could result from shouting during team sports or playing with other children. 1 They further postulated that this could be owing to the possibility that there are lower levels of vocal care awareness among nonsinging participants. However, the study importantly also noted that singing children had higher levels of participation in team sports than nonsinging children but still reported lower levels of vocal trauma. Any assumption that singing children who also participate in team sports would shout any differently cannot be made. The contradictory nature of this analysis thus implies that there is no clear correlation between participation in team sports and the development of vocal trauma, or that the risk is greater for nonsinging children.We would also like to draw attention to the subjective nature of this study, in particular the fact that parents who were responsible for signing up their children for choir, were also accountable for reporting the presence of voice symptoms. The possibility that parents of singing children were more susceptible to hypersensitivity in detection of voice symptoms ought not to be discounted. More objective measures of detecting voice quality and symptoms should be taken into consideration to minimize bias.Nevertheless, Clarós and colleagues 1 have made important contributions to our understanding of how vocal training and choral participation may decrease the risk of development of voice disorders among prepubescent children. Further work is necessary to strengthen the nature of this association.

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Reflux and Voice Disorders: Have We Established Causality?

Cited by 28 publications

References 70 publications

Voice therapy associated with a decrease in the reflux symptoms index in patients with voice complaints

Voice therapy associated with a decrease in the reflux symptoms index in patients with voice complaints

Clinical-Diagnostic Correlations in Laryngopharyngeal Reflux (LPR). The Role of Peptesttm

Association of Singing With the Development of Pediatric Voice Disorders

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