Diagnosing Laryngopharyngeal Reflux: A Comparison between 24-hour pH-Impedance Testing and Pharyngeal Probe (Restech) Testing, with Introduction of the Sataloff Score

Vance, Dylan; Park, Jin; Alnouri, Ghiath; Turner, Ralph R.; Daggumati, Srihari; Ferster, Ashley P. O’Connell; Ahmad, Asyia S.; Lyons, Karen M.; Ross, Justin; Russell, Karissa; Wu, Wei; Sataloff, Robert T.

doi:10.1016/j.jvoice.2021.04.002

Cited by 13 publications

(9 citation statements)

References 22 publications

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“…The comparison between HEMII-pH and oropharyngeal pH monitoring revealed that oropharyngeal pH monitoring detected more percentage time/total pharyngeal reflux events in supine and upright positions and longer event times than HEMII-pH; whereas HEMII-pH testing was able to detect more events of pH<4 than oropharyngeal pH monitoring [79 ▪ ]. Moreover, oropharyngeal pH monitoring correlated better with total patient symptom scores including cough, heartburn, burping, and throat clearing, than HEMII-pH [79 ▪ ]. In practice, the main weakness of oropharyngeal pH monitoring is the lack of information about esophageal findings and GERD.…”

Section: Diagnosis Of Reflux and Place Of Ph Studymentioning

confidence: 90%

“…The accuracy of Ryan score was however controversial because the score does not consider events with pH >7, which are frequent in LPR patients. Vance et al [79 ▪ ] compared both diagnostic approaches in 77 patients who benefited from HEMII-pH and oropharyngeal pH monitoring throughout the same 24-h period. The comparison between HEMII-pH and oropharyngeal pH monitoring revealed that oropharyngeal pH monitoring detected more percentage time/total pharyngeal reflux events in supine and upright positions and longer event times than HEMII-pH; whereas HEMII-pH testing was able to detect more events of pH<4 than oropharyngeal pH monitoring [79 ▪ ].…”

Section: Diagnosis Of Reflux and Place Of Ph Studymentioning

confidence: 99%

“…Vance et al [79 ▪ ] compared both diagnostic approaches in 77 patients who benefited from HEMII-pH and oropharyngeal pH monitoring throughout the same 24-h period. The comparison between HEMII-pH and oropharyngeal pH monitoring revealed that oropharyngeal pH monitoring detected more percentage time/total pharyngeal reflux events in supine and upright positions and longer event times than HEMII-pH; whereas HEMII-pH testing was able to detect more events of pH<4 than oropharyngeal pH monitoring [79 ▪ ]. Moreover, oropharyngeal pH monitoring correlated better with total patient symptom scores including cough, heartburn, burping, and throat clearing, than HEMII-pH [79 ▪ ].…”

Section: Diagnosis Of Reflux and Place Of Ph Studymentioning

confidence: 99%

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The role of pH-impedance monitoring in swallowing disorders

Bobin¹,

Lechien

2022

Current Opinion in Otolaryngology &Amp; Head &Amp; Neck Surgery

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Purpose of reviewTo review the current evidence about the usefulness and the place of pH study in the management of patients with swallowing disorders.Recent findingsGastroesophageal reflux disease (GERD) and laryngopharyngeal reflux (LPR) are found in approximately 30% of patients with esophageal or oropharyngeal dysphagia. Patients with suspected GERD may benefit from gastrointestinal endoscopy and proton pump inhibitors according to guidelines. The diagnosis of LPR in patients with oropharyngeal dysphagia is more controversial because there are no gold standard and diagnostic guidelines. The clinical diagnosis based on empirical therapeutic trial is a reasonable first-line strategy, but many dysphagic patients should not respond to treatment. These patients require hypopharyngeal-esophageal multichannel intraluminal impedance-pH monitoring (HEMII-pH), which is the most effective examination providing important information on GERD and LPR features. At the HEMII-pH, GERD patients often report upright (daytime) and supine (nighttime) liquid acid esophageal events with significant esophageal distal acid exposure time. LPR patients have more frequently upright (daytime) gaseous weakly acid or nonacid pharyngeal reflux events without distal esophageal acid exposure abnormalities in many times. The features of reflux at the HEMII-pH may indicate a personalized treatment for dysphagic patients combining proton pump inhibitors, alginate/magaldrate or gastroprokinetic in cases of esophageal dysmotility.SummaryGERD and LPR are prevalent causes of dysphagia. The large number of reflux patients who do not respond to empirical treatment makes important the awareness of otolaryngologists about pH-impedance monitoring indication, features, and interpretation.

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Section: Diagnosis Of Reflux and Place Of Ph Studymentioning

confidence: 90%

Section: Diagnosis Of Reflux and Place Of Ph Studymentioning

confidence: 99%

Section: Diagnosis Of Reflux and Place Of Ph Studymentioning

confidence: 99%

See 1 more Smart Citation

The role of pH-impedance monitoring in swallowing disorders

Bobin¹,

Lechien

2022

Current Opinion in Otolaryngology &Amp; Head &Amp; Neck Surgery

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“…At alkaline pH, the bile salts and some potential other enzymes may injury the laryngopharyngeal mucosa. Interestingly, Vance et al compared the diagnostic utility of HEMII-pH study versus oropharyngeal pH monitoring in patients who benefited from both examinations throughout the same 24-h period [ 58 ]. These authors reported that oropharyngeal pH monitoring (Restech ® ) detected more percent time/total HREs in supine and upright positions and longer event times compared with HEMII-pH.…”

Section: Diagnosis Of Reflux and Place Of Ph Studymentioning

confidence: 99%

“…These authors reported that oropharyngeal pH monitoring (Restech ® ) detected more percent time/total HREs in supine and upright positions and longer event times compared with HEMII-pH. Moreover, HEMII-pH testing was able to detect more HREs of pH < 4 than oropharyngeal pH monitoring [ 58 ]. Vance et al observed that oropharyngeal pH monitoring correlated better with total patient symptom scores including cough, heartburn, burping, and throat clearing compared with HEMII-pH.…”

Section: Diagnosis Of Reflux and Place Of Ph Studymentioning

confidence: 99%

Clinical Update Findings about pH-Impedance Monitoring Features in Laryngopharyngeal Reflux Patients

Lechien

2022

JCM

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Purpose: The diagnosis of laryngopharyngeal reflux (LPR) is commonly based on non-specific symptoms and findings and a positive response to an empirical therapeutic trial. The therapeutic response is, however, unpredictable, and many patients need pH-impedance monitoring to confirm the diagnosis. Methods: A review of the recent literature was conducted in PubMED, Scopus, and Embase about the pH-study features of LPR patients. A summary of last evidence was proposed. Results: The awareness of otolaryngologists about indications and interpretation of pH-impedance monitoring is low. The hypopharyngeal-esophageal multichannel intraluminal impedance-pH monitoring (HEMII-pH) is the most reliable examination determining the type and composition of hypopharyngeal reflux events (HRE) and the LPR features. The use of HEMII-pH is important to confirm the diagnosis in selected patients because non-specificity of symptoms and findings. There are no international consensus guidelines for the LPR diagnosis at the HEMII-pH. However, most studies supported the occurrence of >1 acid/weakly acid/nonacid HRE as diagnostic threshold. HREs are more frequently gaseous, weakly/nonacid compared with reflux events of gastroesophageal reflux. HREs occurred as daytime and upright, which does not support the value of double proton pump inhibitors or bedtime alginate. Oropharyngeal pH-monitoring is another approach reporting different sensitivity and specificity outcomes from HEMII-pH. The use of Ryan score for the LPR diagnosis at the oropharyngeal pH monitoring may be controversial regarding the low consideration of alkaline HREs. Conclusions: The awareness of otolaryngologists about HEMII-pH indication, features, and interpretation is an important issue regarding the high prevalence of LPR in outpatients consulting in otolaryngology. The HEMII-pH findings may indicate a more personalized treatment considering type and occurrence time of HREs.

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