Voice Problems among Laryngopharyngeal Reflux Patients Diagnosed with Oropharyngeal pH Monitoring

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.

The application of 24-hour pharyngeal pH-monitoring and Reflux Finding Score and Reflux Symptom Index questionnaires in the diagnostics of laryngopharyngeal reflux

“…The correlations were low -they did not exceed the value of 0.22 also in the case of analysing the individual elements of the scale. Such results are contradictory to those that can be found in the literature [17], in which the RSI scale was significantly correlated with the results of pH-monitoring, although the conclusions concerning the RFS scale are similar. The application of Spearman's correlation did not have any qualitative effect on the result.…”

“…Values of 13 and 7 were accepted as standard reference values for the RSI and RFS questionnaires, respectively, according to Belafsky's recommendation. In the case of pH monitoring, a Ryan Score greater than 9.4 in the vertical position or greater than 6.8 in the horizontal position was recognised as an indication of a health problem [14,17].…”

Nissen fundoplicationvsproton pump inhibitors for laryngopharyngeal reflux based on pH-monitoring and symptom-scale

“…Among these diagnostic methods, PPI trials and the RSI scale are subjective methods, which cannot provide direct pathophysiological evidence of LPR. The reflux finding score, which is based on laryngoscopic findings, also has poor reliability in detecting LPR[8,9]. Recent evidence has suggested no relationship between clinical findings of LPR, laryngoscopy, and the reflux finding score[26].…”

“…Laryngoscopic findings, such as erythema and edema, are also nonspecific signs of LPR[7]. The reflux finding score, a clinical severity rating scale based on laryngoscopic findings, has poor reliability in detecting LPR[8,9]. Monitoring of pH can directly detect increased esophageal or laryngopharyngeal acid exposure by a pH probe.…”

“…Therefore, it is regarded as the best evidence for diagnosis of LPR[10]. Some studies have documented LPR using a new pH sensor[9,11] and others have investigated the pH threshold for identifying patients with an abnormal pharyngeal pH environment[12,13]. However, few studies have shown the therapeutic outcome in patients with LPR who were diagnosed by oropharyngeal pH-monitoring.…”