Post treatment improvement of laryngopharyngeal reflux diagnosed using a novel algorithm: A cohort study
Keywords:
laryngopharyngeal reflux, reflux symptom index, reflux finding score, acoustic voice analysis, pH indicatorAbstract
Purpose: to compare pre and post treatment measurements in patients with laryngopharyngeal reflux diagnosed, to patients gastroesophageal reflux disorder and without symptoms of laryngopharyngeal reflux using combined algorithm.
Methods: This prospective cohort study involving 384 patients was conducted. We used the following algorithm: the reflux symptom index (RSI) questionnaire score of >13; videolaryngastroboscopy with the assessment of the reflux finding score (RFS)>7; pH-strips of mucus from the laryngopharynx; acoustic analysis of the voice of singers with voice disorders. Patients with LPR and GERD were treated with proton pump inhibitors (PPIs) at a dose of 20 mg twice a day, and recommendations for lifestyle and dietary changes were given for a month. Patients were monitored for a period of six months.
Results: After treatment, RSI and RFS results in patients with LPR and GERD significantly improved from 19.9±6.4 & 9.1±1.7 and 18.7±5.3 & 10.10±2.4 respectively (p˂0.001). In patients without the symptoms of LPR, the laryngopharyngeal medium pH ranged from min 5.5 to max 7.5, and in cases of suspected LPR and GERD, it ranged from min 5 to max 8 and min and 4.5 to max 8.5 respectively. The acoustic voice analysis scores changed after therapy, p-value˂0.05.
Conclusion: The lack of a gold standard and the inaccessibility of diagnostic methods make LPR diagnosis a very complex task. However, using the proposed diagnostic algorithm, the post treatment scores were improved. More studies are needed to validate the algorithm for early diagnosis of LPR.
References
Lechien JR, Crevier-Buchman L, Distinguin L, et al. Is Diet Sufficient as Laryngopharyngeal Reflux Treatment? A Cross-Over Observational Study. Laryngoscope. 2022 Oct;132(10):1916–23. doi:10.1002/lary.29890
Brown J, Shermetaro C. Laryngopharyngeal Reflux. In Treasure Island (FL); 2022.
Lechien JR, Mouawad F, Barillari MR, et al. Treatment of laryngopharyngeal reflux disease: A systematic review. World J Clin Cases. 2019 Oct;7(19):2995–3011. doi:10.12998/wjcc.v7.i19.2995
Koufman JA. The Otolaryngologic Manifestations of Gastroesophageal Reflux Disease (GERD): A Clinical Investigation of 225 Patients Using Ambulatory 24-Hour pH Monitoring and an Experimental Investigation of the Role of Acid and Pepsin in the Development of Laryngeal Injury. Laryngoscope. 1991;101(S53):1–78. doi: 10.1002/lary.1991.101.s53.1
Sh E, Kudabayeva HI, Agzamova RT, Sarculova JN. Prevalence Of Gastroezofageal Reflux Diseas In The Adult Population The City Of Aktobe. Orenburg Med Vestnik. 2014. 1(5):41–2.
Ford CN. Evaluation and management of laryngopharyngeal reflux. JAMA. 2005 Sep;294(12):1534–40. doi: 10.1001/jama.294.12.1534
Francis DO, Rymer JA, Slaughter JC, et al. High Economic Burden of Caring for Patients With Suspected Extraesophageal Reflux. Am. J. Gastroenterol. 2013 Jun;108(6):905-11. doi: 10.1038/ajg.2013.69.
Maronian NC, Azadeh H, Waugh P, Hillel A. Association of laryngopharyngeal reflux disease and subglottic stenosis. Ann Otol Rhinol Laryngol. 2001 Jul;110(7 Pt 1):606-12.
doi: 10.1177/000348940111000703.
Li Y, Xu G, Zhou B, et al. Effects of acids, pepsin, bile acids, and trypsin on laryngopharyngeal reflux diseases: physiopathology and therapeutic targets. Eur Arch Otorhinolaryngol. 2022 Jun;279(6):2743-2752. doi: 10.1007/s00405-021-07201-w.
Tavaluc R, Tan-Geller M. Reinke’s Edema. Otolaryngol Clin North Am. 2019 Aug;52(4):627-635. doi: 10.1016/j.otc.2019.03.006.
Lechien JR, Saussez S, Nacci A, et al. Association between laryngopharyngeal reflux and benign vocal folds lesions: A systematic review. Laryngoscope. 2019;129(9):E329–41 Laryngoscope. 2019 Sep;129(9):E329-E341. doi: 10.1002/lary.27932.
Han H, Lyu Q, Zhao J. Laryngopharyngeal Reflux in Hypertrophic Laryngeal Diseases. Ear Nose Throat J. 2022 May;101(4):NP158-NP163. doi: 10.1177/0145561320953232.
Zhang J, Wang X, Wang J, et al. Optimal Timing of the Salivary Pepsin Test for the Diagnosis of Laryngopharyngeal Reflux. Laryngoscope. 2023 Jul;133(7):1706-1711. doi: 10.1002/lary.30408.
Elhennawi DM, Ahmed MR, Abou-halawa AS. Correlation of obstructive sleep apnoea and laryngopharyngeal reflux: phmetry study. Clin Otolaryngol. 2016 Dec;41(6):758-761.
doi: 10.1111/coa.12640.
Mayo-Yáñez M, Viña-Vázquez S, Lechien JR, Chiesa-Estomba CM, Calvo-Henríquez C, González-Torres L. Involvement of Laryngopharyngeal Reflux in Ocular Diseases: A State-of-the-Art Review. J Voice. 2023 Jul;37(4):586-597. doi:10.1016/j.jvoice.2021.03.010.
Casciaro S, Gelardi M, Giancaspro R, Quaranta VN, Porro G, Sterlicchio B, et al. Dental Disorders and Salivary Changes in Patients with Laryngopharyngeal Reflux. Diagnostics (Basel). 2022 Jan; 12(153): 1-10. doi: 10.3390/diagnostics12010153
Lechien JR, Hans S, Bobin F, Calvo-Henriquez C, Saussez S, Karkos PD. Atypical Clinical Presentation of Laryngopharyngeal Reflux: A 5-Year Case Series. J Clin Med. 2021 Jun; 10(11): 2439. doi: 10.3390/jcm10112439
Snow G, Dhar SI, Akst LM. How to Understand and Treat Laryngopharyngeal Reflux. Gastroenterol Clin North Am. 2021 Dec;50(4):871-884. doi: 10.1016/j.gtc.2021.08.002.
Lechien JR, Allen JE, Barillari MR, et al. Management of Laryngopharyngeal Reflux Around the World: An International Study. Laryngoscope. 2021 May;131(5):E1589-E1597. doi: 10.1002/lary.29270.
Belafsky PC, Postma GN, Koufman JA. The validity and reliability of the reflux finding score (RFS). Laryngoscope. 2001 Aug;111(8):1313-7. doi: 10.1097/00005537-200108000-00001.
Belafsky PC, Postma GN, Koufman JA. Validity and Reliability of the Reflux Symptom Index (RSI). J Voice. 2002 Jun;16(2):274-7. doi: 10.1016/s0892-1997(02)00097-8.
Nukusbekova G, Toguzbayeva D, Hashimli R, Oguz H, Taukeleva S. Reflux Symptom Index: Translation to the Kazakh Language and Validation. J Voice. 2022 Aug 3:S0892-1997(22)00205-3. doi: 10.1016/j.jvoice.2022.07.004.
Zeleník K, Hránková V, Vrtková A, Staníková L, Komínek P, Formánek M. Diagnostic Value of the PeptestTM in Detecting Laryngopharyngeal Reflux. J Clin Med. 2021 Jul 5;10(13):2996. doi: 10.3390/jcm10132996.
Powell J, Cocks HC. Mucosal changes in laryngopharyngeal reflux—prevalence, sensitivity, specificity and assessment. Laryngoscope. 2013 Apr;123(4):985-91. doi:10.1002/lary.23693.
Sataloff RT, Hawkshaw MJ, Johnson JL, Ruel B, Wilhelm A, Lurie D. Prevalence of abnormal laryngeal findings in healthy singing teachers. J Voice. 2012 Sep;26(5):577-83. doi: 10.1016/j.jvoice.2012.01.002.
Park W, Hicks DM, Khandwala F et al. Laryngopharyngeal reflux: prospective cohort study evaluating optimal dose of proton-pump inhibitor therapy and pretherapy predictors of response. Laryngoscope. 2005 Jul;115(7):1230-8. doi:10.1097/01.MLG.0000163746.81766.45.
Salgado S, Borges LF, Cai JX, Lo WK, Carroll TL, Chan WW. Symptoms classically attributed to laryngopharyngeal reflux correlate poorly with pharyngeal reflux events on multichannel intraluminal impedance testing. Dis Esophagus. 2022 Dec 31;36(1):doac041. doi: 10.1093/dote/doac041.
Levine RL, Fromm REJ, Mojtahedzadeh M, Baghaie AA, Opekun ARJ. Equivalence of litmus paper and intragastric pH probes for intragastric pH monitoring in the intensive care unit. Crit Care Med. 1994 Jun;22(6):945-8. doi: 10.1097/00003246-199406000-00011.
Gluvajić D, Šereg‐Bahar M, Jerin A, Janša R, Hočevar‐Boltežar I. The Impact of Laryngopharyngeal Reflux on Occurrence and Clinical Course of Recurrent Respiratory Papillomatosis. Laryngoscope. 2022 Mar;132(3):619-625. doi: 10.1002/lary.29793.
Kowalik K, Krzeski A. The role of pepsin in the laryngopharyngeal reflux. Otolaryngol Pol. 2017 Dec 30;71(6):7-13. doi: 10.5604/01.3001.0010.7194.
Boogers LS, Chen BSJ, Coerts MJ, Rinkel RNPM, Hannema SE. Mobile Phone Applications Voice Tools and Voice Pitch Analyzer Validated With LingWAVES to Measure Voice Frequency. J Voice. 2022 Nov 9:S0892-1997(22)00318-6. doi: 10.1016/j.jvoice.2022.10.013
Oguz H, Tarhan E, Korkmaz M, et al. Acoustic analysis findings in objective laryngopharyngeal reflux patients. J Voice. 2007 Mar;21(2):203-10. doi:10.1016/j.jvoice.2005.10.005.
Lovato A, Bonora C, Genovese E, Amato C, Maiolino L, de Filippis C. A panel of jitter/shimmer may identify functional dysphonia at risk of failure after speech therapy. Am J Otolaryngol. 2020 Jul-Aug;41(4):102455. doi: 10.1016/j.amjoto.2020.102455.
Jin bBong J, Lee YS, Jeong SW, Jeong JH, Lee SH, Tae K. Change of acoustic parameters before and after treatment in laryngopharyngeal reflux patients. Laryngoscope. 2008 May;118(5):938-41. doi: 10.1097/MLG.0b013e3181651c3a.
Wuyts FL, De Bodt MS, Molenberghs G, et al. The dysphonia severity index: an objective measure of vocal quality based on a multiparameter approach. J Speech Lang Hear Res. 2000 Jun;43(3):796-809. doi: 10.1044/jslhr.4303.796.
Lechien JR, Finck C, Costa de Araujo P, et al. Voice outcomes of laryngopharyngeal reflux treatment: a systematic review of 1483 patients. Eur Arch Otorhinolaryngol. 2017 Jan;274(1):1-23. doi: 10.1007/s00405-016-3984-7.
Li L, Ren QY, Mai YP. Therapeutic effect of acid-suppressing therapy combined with voice therapy in patients with voice-related symptoms caused by laryngopharyngeal reflux. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2018 Nov;32(22):1714-1718.
doi: 10.13201/j.issn.1001-1781.2018.22.008.
Lechien JR, Schindler A, Robotti C, Lejeune L, Finck C. Laryngopharyngeal reflux disease in singers: Pathophysiology, clinical findings and perspectives of a new patient-reported outcome instrument. Eur Ann Otorhinolaryngol Head Neck Dis. 2019 Jun;136(3S):S39-S43.
doi: 10.1016/j.anorl.2018.08.008.
Sataloff RT, Hawkshaw MJ, Gupta R. Laryngopharyngeal reflux and voice disorders: an overview on disease mechanisms, treatments, and research advances. Discov Med. 2010 Sep;10(52):213-24.
Takahashi M, Katayama Y, Suzuki K, et al. Significance of PPI-test in the diagnosis of GERD. Nihon Rinsho. 2004 Aug;62(8):1465-74.
Jin X, Zhou X, Fan Z, Qin Y, Zhan J. Meta-analysis of Proton Pump Inhibitors in the Treatment of Pharyngeal Reflux Disease. Comput Math Methods Med. 2022 Jul; 2022: 9105814. doi: 10.1155/2022/9105814.
Liu X, Jiang Y, Luo H, Liu H. Proton pump inhibitors for the treatment of laryngopharyngeal reflux disease: A protocol for systematic review and meta-analysis. Medicine (Baltimore). 2020 Dec 4;99(49):e23297.doi: 10.1097/MD.0000000000023297.
Moayyedi P, Eikelboom JW, Bosch J, et al. Safety of Proton Pump Inhibitors Based on a Large, Multi-Year, Randomized Trial of Patients Receiving Rivaroxaban or Aspirin. Gastroenterology. 2019 Sep;157(3):682-691.e2. doi: 10.1053/j.gastro.2019.05.056.
Lechien JR, Saussez S, Schindler A, et al. Clinical outcomes of laryngopharyngeal reflux treatment: A systematic review and meta-analysis. Laryngoscope. 2019 May;129(5):1174-1187. doi: 10.1002/lary.27591.
Campanholo M de AT, Caparroz F de A, Vidigal T de A Kenchian CH, et al. Assessment of Laryngopharyngeal Reflux and Obstructive Sleep Apnea: A Population-Based Study. Laryngoscope. 2022 Sep;132(9):1877-1882. doi: 10.1002/lary.30061.
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