Revisiting the Clinical Practices in Laryngopharyngeal Reflux Disease; Measures that Decrease the Duration of Treatment

The techniques used in the diagnosis of gastroesophageal reflux disease (GERD) have insufficient specificity and sensitivity in diagnosing laryngopharyngeal reflux (LPR). The purpose of this study was to evaluate the role of esophagogastroduodenoscopy (EGD) and laryngological examination in the diagnosis of LPR. A total of 684 diagnosed GERD and suspected LPR patients were prospectively scored by the reflux finding score (RFS) which was suggested by Koufman. A total of 484 patients with GERD who had RFS ≥ 7 were accepted as having LPR. 248 patients with GERD plus LPR on whom an endoscopic examination was performed were evaluated. As a control group, results from 82 patients with GERD who had RFS <7 were available for comparison. The GERD symptom score (RSS) was counted according to the existence of symptoms (heartburn/regurgitation) and frequency, duration, and severity. The reflux symptom index (RSI) suggested by Belafsky et al. was also evaluated. The relationship between esophageal endoscopic findings, RSS, RFS and RSI was investigated. Mean age was 46 ± 12 (19-80). The mean values of RSS, RFS, and RSI were 18.9 ± 7.7, 10 ± 2.2, 16.6 ± 11.9, respectively. Erosive esophagitis was detected in 75 cases (30%). Hiatus hernia was observed in 32 patients (13%). There was no correlation between RSS and RFS, RSI. The severity of esophagitis did not correlate with the severity of the laryngeal findings. LPR should be suspected when the history and laryngoscopy findings are suggestive of the diagnosis. EGD has no role in the diagnosis of LPR.

Aim- To determine the correlation of reported symptom improvement in laryngopharyngeal reux with physical ndings in endoscopic laryngeal examination following treatment with proton pump inhibitor. This study included the pa Methodology- tients presenting with the symptoms of laryngopharyngeal reux. All patient were evaluated with detailed history, ENT examination &amp; self administered RSI questionnaire. RFS assessed by endoscopic laryngeal examination. RSI and RFS assessed post treatment with proton pump inhibitor and lifestyle modication. 72 Resultpatients with laryngopharyngeal reux disease were studied for correlation of pre &amp; post treatment RSI and RFS. The mean pretreatment symptom index of 18.15 was reduced to 6.28. The mean reux nding score in the pretreatment group was 12.18 reduced to 5 in the post treatment group (p value &lt;0.0001). A signicant correlation was found in improvement in RSI with improvement in RFS (Spearman rank Correlation coefcient0.501). RSI and RFS can be used as diagnostic tools in the assessment of patie Conclusion- nt with laryngopharyngeal reux (LPR) and assessing clinical improvement of such patient of LPR post treatment

Objective: To evaluate the correlation between the reflux symptom index (RSI) and the reflux finding score (RFS) in the patients with voice-related problems and to investigate the reliability of RFS. Methods: Fifty-four patients presenting with the complaint of voice abnormality were included in the study. Patients were asked to complete an RSI score sheet, and they were examined by rigid laryngostroboscopy. Laryngostroboscopic examinations of the patients were evaluated and rated with RFS by three different otolaryngologists blinded to patient information in two different sessions to evaluate intra-rater and inter-rater reliability. The correlations between RSI and RFS, for both total RFS and individual variables from RFS, were investigated. Results: Sixty-three percent were female and 37% were male, with a mean±SD age of 39.09±14.43 years. RSI ranged from 4 to 31, and RFS ranged from 8 to 22. All three raters demonstrated highly consistent intra-rater and inter-rater reliability for both total RFS and individual variables from RFS. There was a highly significant statistical correlation between RSI and total RFS (r=0.696; p=0.0001). Individual variables from RFS, except the posterior commissure hypertrophy, also demonstrated a significant positive correlation with RSI scores (p<0.05). Conclusion: RFS is a simple scale that could easily be administered with high intra-rater and inter-rater reliability for the evaluation of laryngopharyngeal reflux. RSI is highly correlated with both total RFS and all the individual variables from RFS, except posterior commissure hypertrophy. (JAREM 2015; 5: 68-74)

Smoking is known to increase laryngeal inflammation and laryngopharyngeal reflux (LPR), which cause laryngeal irritation. Thus, the aim of this study is to evaluate the changes in the symptoms and the findings of laryngeal irritation in smokers after a smoking cessation period. The reflux symptom index (RSI) and the reflux finding score (RFS) were used for evaluating the symptoms and findings of laryngeal irritation in smokers. Endoscopic examination of the laryngeal structures for RFS and symptom inquiry for RSI were performed at the beginning of the study and after a 2 months of cigarette cessation period. This study was carried out in 24 volunteers (14 female and 10 male), between the ages of 24 and 62 years. When we compared the results of RSI and RFS that were performed before and after the cigarette cession period, we found that there was a significant improvement both in RSI and in RFS (P < .001 and P < .001, respectively). Also, there was significant correlation between the cigarette smoking period and RFS score that was determined at the beginning of the study (P = .006, r = .54). A significant improvement was found both in RSI and in RFS after smoking cessation period, which might be the evidence of improvement in laryngeal irritation possibly caused by inflammation due to smoking and LPR. A significant positive correlation was found between smoking period and RFS, especially with vocal fold edema and posterior commissure hypertrophy.

Introduction: Laryngopharyngeal reflux is defined as the reflux of gastric content into the larynx and pharynx with symptoms like foreign body sensation in the throat, cough, heartburn, difficulty in swallowing, and hoarseness. Objective of this study was to find the effect of proton pump inhibitor on quality of life in patients having laryngopharyngeal reflux disease. Method: A Prospective study was conducted in Department of Ear Nose Throat (ENT) at Devdaha Medical College, Butwal between March 2023 to May 2023. Patients with suspected laryngopharyngeal reflux were evaluated using Reflux Symptom Index (RSI) and Reflux Finding Score (RFS) and treated with proton pump inhibitors (PPIs). Pre and post therapeutic RSI and RFS were compared. Result: A total of 75 patients were included over a period of 3 months. Mean total score of RSI and RFS before therapy was 1.51±2.102 and 0.99±1.297 and after therapy RSI and RFS was 0.87±1.383 and 0.44±0.773 (p&lt;0.005) respectively. Conclusion: RFS and RSI are convenient and helpful in diagnosing LPR. Its use may prevent the unnecessary costs of invasive laboratory studies and imaging and time consuming examinations.

To study the prevalence of Laryngopharyngeal reflux in individuals having throat complaints by applying the Reflux Symptom Index and Reflux finding score as a prognostic tool after anti reflux therapy. Materials and Methods: A Cross-sectional study of 75 patients of age 18years and above with clinical diagnosis of Laryngopharyngeal reflux was conducted in ENT. Cases were examined with detailed history and thorough examination with indirect laryngoscopy and Hopkins 70 degree endoscope. Symptoms and findings of patients were assessed by Belafsky Reflux Symptom Index and Reflux Finding Score. Patients presenting Belafsky Reflux Symptom Index > 13 and also Reflux Finding Score > 7 were classified as having Laryngopharyngeal reflux. After 6weeks of treatment, patients were reassessed and Reflux Symptom Index and Reflux finding score were calculated. Results: The mean age of the study subjects was 37.12 ± 12.39years. Most common symptom reported based on RSI questionnaire was excessive throat mucus (81.33%) followed by clearing of throat (75%) and coughing on lying down and heartburn. Based on the Laryngoscopy, about 57.33% had thick endolarygeal mucus, 56% had diffuse erythema, 45.33% had granulations and 29.33% had subglottic edema. Based on the reflux symptom scores, we found 53.33% and 80% of patients based on reflux findings score to have Laryngopharyngeal Reflux. The mean Reflux Symptom Index scores were 16.25 ± 5.53 and 10.73 ± 4.40 and also the mean Reflux Finding scores were 13.81 ± 2.42 and 6.61 ± 2.16 respectively before and after the treatment which was statistically significant.

Several trials on the predictors of response to proton pump inhibitor (PPI) treatment of laryngopharyngeal reflux (LPR) have shown conflicting results. Furthermore, the influence of age in disease severity and response to PPI therapy is unclear. To assess the difference in disease severity and response to PPI therapy according to age in patients with LPR. Prospective multicenter study at 3 tertiary medical centers of 264 consecutive patients with LPR who were referred to the otolaryngology clinic from November 2010 to February 2012. Participants were prescribed 15 mg of lansoprazole (PPI) twice daily for 3 months. Reflux Symptom Index (RSI), Reflux Finding Score (RFS), and laryngopharyngeal reflux-health-related quality of life (LPR-HRQOL) were collected at baseline and at 1 and 3 months postbaseline. After 3 months, 35 patients were lost to follow-up and excluded; the remaining 229 patients included 135 men and 94 women. The oldest group (60-79 years; n = 111) showed higher baseline RSI (P < .001) and LPR-HRQOL (P < .001) scores than the 18- to 39-year-old (n = 35) and 40- to 59-year-old (n = 83) groups. However, baseline RFS scores showed no significant difference among age groups (P = .44). Within each age group, the RSI, RFS, and LPR-HRQOL improved significantly with PPI therapy (all P < .001); however, no significant difference in improvement of RSI (P = .59), RFS (P = .50), or LPR-HRQOL (P = .09) was seen among the groups. At 3-month follow-up, significantly more responders, defined as those whose RSI score improved by more than 50%, were found in the 18- to 39-year-old and 40- to 59-year-old groups (86% and 75%, respectively) than in the oldest group (57%) (P = .002), but there was no significant difference in proportion of responders among age groups at 1-month follow-up (P = .69). In patients with LPR, age seems to affect the subjective symptoms and resulting impact on quality of life but not the laryngeal findings. Furthermore, older patients are more likely not to respond to PPI therapy than younger patients.

Laryngopharyngeal reflux (LPR) is defined as an extraesophageal reflux of gastroduodenal contents to the laryngopharynx, affecting the upper aerodigestive tract. There is currently no standardized treatment protocol for LPR. The use of proton pump inhibitors (PPIs) is widely established in common practice and derives from the standard approach of using PPIs to treat patients with gastroesophageal reflux disease (GERD). However, as PPIs may not be effective on all types of reflux, the aim of our study was to evaluate the effectiveness of dietary changes and mucosal protectants, alone or in combination, in LPR treatment. This multicenter randomized controlled trial included 48 patients divided into three groups: dietary modifications only, mucosal protectors only, and a combination of both. The patients' responses were assessed over 1 month using the Reflux Symptom Index (RSI) and Reflux Finding Score (RFS), along with measurements of salivary and nasal pepsin concentration and rhinomanometry. Significant improvements were observed in RSI and RFS scores across all groups. The group receiving combined dietary modifications and mucosal protectors showed the most substantial benefits. Additionally, a notable reduction in salivary and nasal pepsin concentrations and nasal resistances was observed, particularly in patients combining dietary modifications and mucosal protectors. The study showed that combined dietary modifications and mucosal protects strategies effectively manage LPR symptoms, offering a potential therapeutic approach.

Predictive Value of Laryngeal Mucosa Pepsin in Therapeutic Response of Laryngopharyngeal Reflux

Complex Diagnosis of Clinical Forms of Laryngitis Caused by Laryngopharyngeal Reflux Disease (LPRD).

Laryngopharyngeal reflux (LPR) is a condition of reverse flow of gastric and duodenal fluid that reaches the aerodigestive tract, causing inflammation in the upper respiratory tract. Reflux Symptoms Index (RSI) and Reflux Finding Score (RFS) have been used as instruments to determine the symptoms and signs in LPR patients. This study aims to find out the characteristics of patients with LPR. A retrospective descriptive study was performed using medical records as a source of information to obtain the characteristics of patients with LPR in ENT Outpatient Clinic Dr. Soetomo General Academic Hospital Surabaya. The study population is all patients that has been diagnosed with LPR based on RSI &gt;13 and RFS &gt;7 in the period 2018-2019. Our finding shows the total patients diagnosed with LPR were 58. There were 45 patients diagnosed solitarily according to the results of the RSI score, while the RFS was 34 patients. The total patients diagnosed according to both of RSI and RFS were 21 patients. In this study, 67.24% patients with LPR were female, while the male patients were 32.76%. Most patients with LPR belonged to 50 – 59 years (25.86%). The distribution of occupation shows the highest number of patients is unemployed (43.10%). The most frequent and severe complaints from LPR patients were throat clearing, sensation of something sticking in throat or lump, and excess throat mucus or postnasal drip. The laryngoscopy findings compiled on the RFS showed that the most common signs in LPR patients were subglottic edema, thick endolaryngeal mucus, and posterior commissure hypertrophy.

Reflux Symptom Index and Reflux Finding Score in Otolaryngologic Practice

Objective: To investigate the effect of gastroesophageal reflux disease (GERD) on the clinical characteristics of patients with laryngopharyngeal reflux disease(LPRD). Methods: The data of 141 patients with symptoms of LPRD, who were admitted to the Department of Pharyngology, Laryngology& Phonosurgery at the Sixth Medical Center of the PLA General Hospital from November 2020 to October 2021, were retrospectively analyzed.There were 118 males and 23 females, aged 28-75 (56.72±10.04) years old. The included patients underwent simultaneous 24-hour hypopharyngeal and esophageal multichannel intraluminal impedance pH monitoring (24h-HEMII-pH), salivary pepsin test at multiple times, Reflux Symptom Index (RSI), and Reflux Finding Score (RFS). One laryngopharyngeal reflux event on 24 h-HEMII-pH monitoring results was used as a diagnostic criterion for LPRD. And the duration of lower esophageal pH<4.0>4.0% at 24 h or DeMeester score>14.7 were used as diagnostic criteria for GERD. Among them, patients with both positive LPRD and GERD were classified as L&G group, patients with positive LPRD and negative GERD were classified as IL group, patients with negative LPRD and positive GERD were classified as IG group, and patients with both negative LPRD and GERD were classified as N group. The differences in the clinical characteristics of reflux and salivary pepsin assay in each group were statistically analyzed. SPSS 23.0 software was applied for statistical analysis. Results: According to the 24 h-HEMII-pH results, 116 (82.3%) patients were diagnosed with LPRD and 45 (31.9%) with GERD, including 82 (58.2%) in the IL group, 34 (24.1%) in the L&G group, 11 (7.8%) in the IG group, and 14 (9.9%) in the N group. Based on the salivary pepsin test, a total of 106 patients had positive results, and the L&G group had a significantly higher rate of positive total salivary pepsin test (94.1%) and positive morning test (70.6%) than the IL group (75.6%, 26.8%), IG group (63.6%, 27.3%) and N group (35.7%, 28.6%), with chi-square values of 19.01 and 20.81, both with P<0.001. The patients in the L&G group had a significantly higher RSI score (14.0) than the IL group (7.0), IG group (1.0) and N group (0), H=52.26,P<0.001. The difference in RFS between the L&G and IL groups was not statistically significant (Z=-0.92,P>0.05). Conclusion: Combined with GERD, LPRD patients have more obvious clinical symptoms and higher positive rate of pepsin test in saliva.

The objective is to assess the differences in the severity of symptoms, signs, voice quality, and quality of life before and after treatment according to age in suspected laryngopharyngeal reflux (LPR) patients. The design used in this paper is prospective multi-center study. Eighty clinically diagnosed LPR patients with a reflux finding score (RFS) >7 and a reflux symptom index (RSI) >13 were treated with pantoprazole and diet recommendations for 3 months. Patients were subdivided into three groups according their age: group 1 (18-39years, N=21), group 2 (40-59years, N=31), and group 3 (≥60years, N=28). RSI, RFS, Voice Handicap Index (VHI), Short Form 36 questionnaire (SF36), aerodynamic, and acoustic measurements were evaluated at baseline and after treatment. The response to the empiric treatment was also assessed. Significant improvements in RSI, RFS, and VHI were found in all patient groups. The elderly patients showed a significantly lower RSI score than younger subjects (p=0.035) without RFS difference among groups. At baseline, the SF36 score was better in group 3 with respect to social functioning (p=0.049). At the 3-month follow-up, we found significant improvement of acoustic parameters only in the younger age groups (group 1 and group 2). The rate of resistant patients to the empiric treatment was higher in the younger group than in the elderly patient group (42.9 versus 28.6%). Age appears to reduce the subjective LPR symptom perception, leading to a lower rate of uncured patients. The utilization of acoustic parameters as an indicator of treatment effectiveness seems less useful for elderly subjects, probably due to an overlap between an aging voice and LPR.

To evaluate the effect of laryngopharyngeal reflux (LPR) and antireflux treatment on peak nasal inspiratory airflow (PNIF). Prospective observational study was conducted. Tertiary otorhinolaryngology clinic. Adults with LPR and healthy controls. PNIF measurements were performed on 60 patients who applied with complaints suggestive of LPR having higher Reflux Symptom Index (RSI) (>13) and Reflux Finding Scores (RFS) scores (>7). Proton pump inhibitor (PPI) treatment was started and PNIF measurements were repeated two months later. A total of 100 patients without any history of LPR and sinonasal disease were included in the study. A statistically significant increase was observed in PNIF values after proton pump inhibitor treatment. The mean PNIF values of the LPR patients were 133.83±27.99 L/min and 149.92±23.23 L/min before and after treatment, respectively. The mean PNIF value in the control group was 145.0±25.92 L/min. PNIF values were significantly lower in the LPR relative to the control group (P<.05). Laryngopharyngeal reflux decreases PNIF. This negative effect on PNIF disappears after antireflux medication. The results of the study indicate that PNIF measurements may be an appropriate method for clinical diagnosis of LPR and evaluation of treatment results.