Clinical utility of 24 hour pharyngeal pH monitoring for hoarseness

Abstract

Objective: To evaluate the contribution of 24 hour pharyngeal pH monitoring of patient presenting with symptoms of hoarseness, globus, throat clearing, and sore throat. Study Design: Retrospective case study. Setting: Tertiary laryngology practice. Materials and Methods: Results of 167 pharyngeal pH studies performed for complaints of hoarseness, globus, and throat clearing in an outpatient private practice setting from 5/09-12/09 were analyzed for pharyngeal reflux pattern and severity. Patient records were reviewed for chief complaint, symptom duration, ten item Voice Handicap Index (VHI-10) and Reflux Symptom Index (RSI) scores. Nonparametric testing was used to compare symptom duration, VHI-10 scores, and RSI scores between those patients with and without abnormal pharyngeal pH studies. Results: 71 studies (43%) were normal with zero events below pH 5.5. 32 studies (19%), or 33% of all positive studies showed supine pharyngeal reflux only. 46 studies or 48% of all positive studies showed combination upright daytime reflux events and supine reflux. 18 studies or 19% of all positive studies had only upright events. There was no significant difference in presenting symptoms, symptom duration, or severity scores in the patients that had negative vs. positive pharyngeal pH studies. Conclusion: 24 hour pharyngeal pH study eliminates the diagnosis of reflux in a significant percentage of patients with hoarseness. Severity or duration of symptoms of hoarseness, globus, or throat clearing does not reliably predict presence of reflux.

Characteristics of upright versus supine reflux pattern in patients with laryngopharyngeal reflux

“…These findings confirm the hypothesis of having laryngopharyngeal reflux episodes occurring mainly in the upright position. Although using the same diagnostic technology for LPR, these findings contradict with the findings of the previously mentioned studies of Scott et al 13 and Beaver et al 14 …”

“…11 , 12 Recently, a study by Scott et al 13 reported that LPR occurred exclusively in the supine position. In another earlier study by Beaver et al 14 LPR was found to be more frequently reported in the supine position than upright position. Interestingly the above two studies used the recent technology of 24 h oropharyngeal pH monitoring in diagnosing patients with LPR.…”

Supraesophageal Reflux: Correlation of Position and Occurrence of Acid Reflux–Effect of Head-of-Bed Elevation on Supine Reflux

“…23 Utilizing this newer technology, Beaver et al also described similar findings among 95 subjects with documented SER, 60% occurring primarily in the supine position. 24 This study also reveals that SERD, as measured by a pharyngeal pH monitor, can be corrected in the majority of patients by elevating the head of bed by 6 inches. This finding has important clinical implications due to the limited utility of acid-suppressing medications in treating SERD as well as recent increased concern regarding the safety of long-term PPI use.…”

Machine Learning Aided Diagnosis of Diseases Without Clinical Gold Standard: A New Score for Laryngopharyngeal Reflux Disease Based on pH Monitoring

“…The Restech Dx-pH monitoring technique has become a useful tool for diagnosing LPRD. Besides its easy operation, high sensitivity and good patient tolerance, the probe can detect gas reflux which is a difference mechanism between LPRD and GERD [20], [25], [26]. The Ryan score, proposed by Dr. DeMeester, has played a significant role in the detection of severe LPR diseases.…”

“…The long-term pH test, which reflects the changes of H+ in the oesophagus and/or airway, provides objective monitoring of the reflux occurrences. Compared with traditional double-probe oesophageal pH monitoring, the Restech Dx-pH monitoring system provides an accurate probe positioning (0.5-1 cm below the uvula) and could detect more extraoesophageal reflux [20]- [26]. In the analysis of 24-hour pH data, the Ryan score proposed by Dr. DeMeester has played a significant role in the detection of some LPRD, especially in the evaluation of operation indications and surgical efficacy for LPR patients [21].…”