Hoarseness and Laryngopharyngeal Reflux: A Prospective Study

Pullarat, Ahamed Nauphal

doi:10.9790/0853-1604014150

Cited by 3 publications

(4 citation statements)

References 21 publications

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“…Of these references, 53 met our inclusion criteria (specifically, studies using ENT signs for LPRD diagnosis and as therapeutic outcomes). A total of 4,735 suspected or confirmed LPR patients were included within these articles . A detailed description of included studies and characteristics (i.e., the number of patients, assessed signs, and treatment) is displayed in Table .…”

Section: Resultsmentioning

confidence: 99%

Instruments evaluating the clinical findings of laryngopharyngeal reflux: A systematic review

Lechien

Schindler

Marrez³

et al. 2018

The Laryngoscope

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Objectives To identify the instruments for evaluating the clinical findings (ICFs) of laryngopharyngeal reflux (LPR) designed for use with regard to diagnosis and treatment effectiveness. Methods The PubMed, Scopus, and Cochrane databases were used to search for subject headings following Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) recommendations. Three investigators retrieved relevant studies published between 1990 and 2018 describing the evolution of laryngopharyngeal findings throughout LPR treatment. Issues of clinical relevance, that is, LPR diagnosis, treatments, and signs assessed for diagnosis or as therapeutic outcomes, were assessed. The investigators also evaluated the psychometric properties (conceptual model, content validity, consistency, reliability, concordance, convergent validity, known‐groups validity, responsiveness to change, and interpretability) of the ICF. The risk of bias was assessed with the tool of the Clarity Group and Evidence Partners. Results The search identified 1,227 publications with a total of 4,735 LPR patients; of these studies, 53 met the inclusion criteria. Of these 53 studies, we identified 10 unvalidated and six validated ICFs. None of the validated ICFs included all the psychometric properties. The main identified deficiencies related to ICF psychometric validation included variable construct validity, disparate and uncertain reliabilities, and a lack of interpretability. The lack of consideration of certain LPR laryngeal and extralaryngeal signs is the main weakness of ICFs, biasing content, and construct validities. Conclusion The low specificity of LPR signs, the lack of consideration of many findings, and the absence of a gold standard for diagnosis constitute barriers to the further validation of these ICFs. Additional studies are needed to develop complete and reliable ICFs. Laryngoscope, 129:720–736, 2019

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Section: Resultsmentioning

confidence: 99%

Instruments evaluating the clinical findings of laryngopharyngeal reflux: A systematic review

Lechien

Schindler

Marrez³

et al. 2018

The Laryngoscope

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“…Of the 72 qualified articles, we found 15 placebo RCTs, 13 prospective controlled trials (with or without randomization), 40 prospective uncontrolled studies, and four retrospective case series (Supporting Supporting information Table 1). The ELs are described in Figure . Seven studies were excluded due to overlapping patient populations …”

Section: Resultsmentioning

confidence: 99%

“…Thus, a few authors consider the occurrence of a/multiple pharyngolaryngeal drop(s) with a pH below 4 or 5 for the diagnosis, whereas others used composite criteria involving the use of Ryan score or other. In trials that based the diagnosis on both signs and symptoms, more than 40% of the included studies did not provide information about the exclusion criterias or did not exclude some major cofounding factors such as smoking or alcoholism, representing a selection bias according to our analysis with TARB . Overall, four main different medical regimens were identified with a duration ranging from 4 to 54 weeks: PPIs alone once a day (N = 18), twice a day (N = 45), or three times a day (N = 2); PPIs in association with other drugs including gastroprokinetic (N = 5), H 2 receptor antagonists (N = 1), rikkunshito (N = 1); PPIs combined with speech therapy (N = 2); Other drugs or diet or placebo alone (especially in controlled studies, N = 6). …”

Section: Resultsmentioning

confidence: 99%

“…26,43,[84][85][86] In trials that based the diagnosis on both signs and symptoms, more than 40% of the included studies did not provide information about the exclusion criterias 37,39,[45][46][47][48][49][50]52,53,[55][56][57][58]62,75,76,85,86 or did not exclude some major cofounding factors such as smoking or alcoholism, representing a selection bias according to our analysis with TARB. 3,21,31,33,[40][41][42]50,59,72,82,83 Overall, four main different medical regimens were identified with a duration ranging from 4 to 54 weeks:…”

Section: Overview Of Clinical and Epidemiological Characteristics In mentioning

confidence: 99%

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Clinical outcomes of laryngopharyngeal reflux treatment: A systematic review and meta‐analysis

et al. 2018

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Objectives To investigate the therapeutic benefit of proton pump inhibitors (PPIs) over placebo in patients with laryngopharyngeal reflux (LPR) and to analyze the epidemiological factors of heterogeneity in the literature. Methods An electronic literature search was conducted to identify articles published between 1990 and 2018 about clinical trials describing the efficiency of medical treatment(s) on LPR. First, a meta‐analysis of placebo randomized controlled trials (RCTs) comparing PPIs versus placebo was conducted according to diet. The heterogeneity, response to PPIs, and evolution of clinical scores were analyzed for aggregate results. Second, a systematic review of diagnosis methods, clinical outcome of treatment, and therapeutic regimens was performed using the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses statement. Results The search identified 1,140 relevant publications, of which 72 studies met the inclusion criteria for a total of 5,781 patients. Ten RCTs were included in the meta‐analysis. The combined relative risk was 1.31 in favor of PPIs and increased to 1.42 when patients did not receive diet recommendations. Randomized controlled trials were characterized by a significant heterogeneity due to discrepancies in clinical therapeutic outcomes, diagnosis methods (lack of gold standard diagnostic tools), and therapeutic scheme. The epidemiological analysis of all articles supports the existence of these discrepancies in the entire literature. In particular, many symptoms and signs commonly encountered in LPR are not assessed in the treatment effectiveness. The lack of diagnosis precision and variability of inclusion criteria particularly create bias in all reported and included articles. Conclusion This meta‐analysis supports a mild superiority of PPIs over placebo and the importance of diet as additional treatment but demonstrates the heterogeneity between studies, limiting the elaboration of clear conclusions. International recommendations are proposed for the development of future trials. Laryngoscope, 129:1174–1187, 2019

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Treatment of laryngopharyngeal reflux disease: A systematic review

Lechien¹,

Mouawad²,

Barillari³

et al. 2019

WJCC

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BACKGROUNGFor a long time, laryngopharyngeal reflux disease (LPRD) has been treated by proton pump inhibitors (PPIs) with an uncertain success rate.AIMTo shed light the current therapeutic strategies used for LPRD in order to analysis the rationale in the LPRD treatment.METHODSThree authors conducted a PubMed search to identify papers published between January 1990 and February 2019 about the treatment of LPRD. Clinical prospective or retrospective studies had to explore the impact of medical treatment(s) on the clinical presentation of suspected or confirmed LPRD. The criteria for considering studies for the review were based on the population, intervention, comparison, and outcome framework.RESULTSThe search identified 1355 relevant papers, of which 76 studies met the inclusion criteria, accounting for 6457 patients. A total of 64 studies consisted of empirical therapeutic trials and 12 were studies where authors formally identified LPRD with pH-monitoring or multichannel intraluminal impedance-pH monitoring (MII-pH). The main therapeutic scheme consisted of once or twice daily PPIs for a duration ranged from 4 to 24 wk. The most used PPIs were omeprazole, esomeprazole, rabeprazole, lansoprazole and pantoprazole with a success rate ranging from 18% to 87%. Other composite treatments have been prescribed including PPIs, alginate, prokinetics, and H2 Receptor antagonists.CONCLUSIONRegarding the development of MII-pH and the identification of LPRD subtypes (acid, nonacid, mixed), future studies are needed to improve the LPRD treatment considering all subtypes of reflux.

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Hoarseness and Laryngopharyngeal Reflux: A Prospective Study

Cited by 3 publications

References 21 publications

Instruments evaluating the clinical findings of laryngopharyngeal reflux: A systematic review

Instruments evaluating the clinical findings of laryngopharyngeal reflux: A systematic review

Clinical outcomes of laryngopharyngeal reflux treatment: A systematic review and meta‐analysis

Treatment of laryngopharyngeal reflux disease: A systematic review

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