A Study of the Diagnostic Value of the Sign and Symptom Questionnaires for Laryngopharyngeal Reflux Disease

Abstract

ObjectiveTo investigate the diagnostic value of symptom questionnaires, sign questionnaires, and the combination of 2 questionnaires for laryngopharyngeal reflux disease (LPRD).Study DesignProspective, single‐centered.SettingSeventy‐seven patients who were hospitalized in the Department of Otolaryngology–Head and Neck Surgery from October 2022 to April 2023 were included.MethodsIncluded patients completed the RSS, RSI, RSA, and RFS questionnaires and underwent 24‐hour hypopharyngeal‐esophageal multichannel intraluminal impedance‐pH monitoring (HEMII‐pH). The RSS, RSI, RSA, RFS, RSS+RSA, RSS+RFS, RSI+RSA, RSI+RFS, and RSI+RFS diagnostic value were compared using Cohen's k test and receiver operating characteristic analysis.ResultsBased on the 24 hours HEMII‐pH results, 52 patients had LPRD, and 25 patients did not have LPRD. The Kappa values of RSS, RSI, RSA, RFS, RSS+RSA,2 RSS+RFS, RSI+RSA, and RSI+RFS with the 24 hours HEMII‐pH monitoring results were 0.565, 0.442, 0.318, 0.431, 0.517, 0.631, 0.451, and 0.461, respectively. The RSS+RFS questionnaire had the highest AUC of 0.836 (95% confidence interval [CI] 0.762‐0.909) and the RSA questionnaire had the lowest AUC (AUC = 0.665, 95% CI 0.560‐0.790). The sensitivity of RSS was the highest (98%), the specificities of RSS+RFS and RSI+RFS were the highest (96%), and the specificity of RSS was the lowest (52%). RSS+RFS had a sensitivity of 75%, second only to RSS and RFS (76%).ConclusionAmong the 8 methods, the RSS combined with the RFS had the highest concordance with 24 hours HEMII‐pH monitoring results and AUC values when screening for LPRD.

Validity and Reliability of the Reflux Sign Assessment‐10 (RSA‐10)

“…Indeed, we observed that practitioners often had difficulty distinguishing closely related findings, such as posterior commissure hypertrophy and retrocricoid edema, leading us to combine these items. The low interrater reliability of some clinical instruments 9,10,[26][27][28] is probably related to the use of subjective scoring systems (e.g., "mild," "moderate," or "severe"), which are based on the experience of practitioners, and, consequently, subjective. It has been demonstrated that some LPRD findings require more than 3 months of treatment to improve.…”

“…Laryngeal signs include erythema at the epiglottic petiole (7) or extended to the larynx (8), hypertrophy with (8) or without (7) erythema of the ventricles, posterior commissure hypertrophy (7), and endolaryngeal mucus (9). The granulation of the posterior commissure, the retrocricoid edema, and the posterior commissure hypertrophy were merged into one item (10). Nasal crusts 11), and Mulberry inferior turbinate (12) are atypical findings.…”

“…8,9 Moreover, RFS was tested on patients with acid reflux event only, and treated with acid suppression, while most LPRD patients have weakly acid or alkaline reflux events. 1 Concerning RSA, despite better reliability than RFS, 7,10 the full version of RSA is still time-consuming with 17 items. 7 The aim of this study was to develop and validate the Reflux Sign Assessment-10 (RSA-10), a shortened version of RSA focusing on the most common laryngeal and extra-laryngeal findings associated with LPRD.…”

Integrative effects of transcutaneous auricular vagus nerve stimulation on esophageal motility and pharyngeal symptoms via vagal mechanisms in patients with laryngopharyngeal reflux disease

“…Thus there are some simplified approaches for monitoring and quantifying the symptoms, such as Reflux Symptom Index (RSI), Reflux Finding Score, CarlssonDent, ReQuest, GerdQ, etc. ( Zhang et al, 2023 ).…”