Impact of laryngopharyngeal reflux on subjective and objective voice assessments: A prospective study

Abstract

BackgroundLaryngopharyngeal reflux is a prevalent, not well-understood disease affecting a high proportion of patients who seek laryngology consultation. The objective of this prospective case series is to explore the subjective and objective voice modifications in Laryngopharyngeal reflux (LPR), especially the usefulness of acoustic parameters as treatment outcomes, and to better understand the pathophysiological mechanisms underlying the development of voice disorder.MethodsForty-one patients with a reflux finding score (RFS) > 7 and a reflux symptom index (RSI) > 13 were enrolled and treated with pantoprazole 20 mg twice daily for three months. RSI, RFS, Voice Handicap Index (VHI), and Grade, Roughness, Breathiness, Asthenia, Strain and Instability (GRBASI) were assessed at baseline and after three months post-therapy. Acoustic parameters were measured by selecting the most stable interval of the vowel /a/. A study of correlations between acoustic measurements and laryngoscopic signs was conducted in patients with roughness. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS).ResultsSignificant improvement in RSI, RFS, VHI, jitter, percent jitter, relative average perturbation (RAP), shimmer, percent shimmer, and amplitude perturbation quotient (APQ) was found at 3 months of treatment (p < .05). A correlation analysis revealed significant correlations between the grade of dysphonia, breathiness, asthenia, instability and jitter, percent jitter, RAP, shimmer, percent shimmer and APQ. In dividing our cohort into two groups of patients according to the presence of roughness, shimmer, percent shimmer and APQ significantly improved in patients with roughness, but no positive correlation was found between acoustic parameters and laryngoscopic signs.ConclusionAcoustic parameters can help to better understand voice disorders in LPR and can be used as treatment outcomes in patients with roughness.

Validity and reliability of the reflux symptom score

“…Because LPR‐related symptoms are associated with QoL impairments, we wanted to include in the RSS a QoL assessment related to the underlying symptoms. Our analysis confirmed the impact of reflux on patient QoL and identified some symptoms that were associated with significant QoL impairment, such as throat pain, heartburn, throat clearing, globus sensation, and excess throat mucus.…”

“…Six impedance segments were placed along the esophagus zones (Z1 to Z6) and centered at 19,17,11,9,7, and 5 cm above the lower esophageal sphincter (LES). The last two impedance segments were placed 1 and 2 cm above the upper esophageal sphincter in the hypopharyngeal cavity.…”

“…The majority of symptoms are nonspecific, including globus sensation, cough, throat clearing, hoarseness, and throat pain . In addition, fiberoptic examination usually identifies nonspecific laryngeal and extralaryngeal findings; the most common are posterior commissure hypertrophy, laryngeal and pharyngeal erythema, and retrocricoid hypertrophy . The nonspecificity of both symptoms and findings makes the clinical diagnosis uncertain, and follow‐up can be difficult.…”

Change of signs, symptoms and voice quality evaluations throughout a 3‐ to 6‐month empirical treatment for laryngopharyngeal reflux disease

“…To improve the management of LPR patients, Belafsky et al developed RSI and RFS, two reliable scales that are widely used for LPR diagnosis and follow‐up throughout the world . Many studies found that total scores of RSI and RFS improved from baseline to 3 or 6 months post‐treatment, but a few trials were really interested in the evolution of individual symptoms and signs along the empirical therapeutic course. Moreover, we often see in our clinical practice that many patients need over 3 months of treatment to completely be cured.…”

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

“…Seven studies were excluded due to overlapping patient populations. 78,[87][88][89][90][91][92] Two placebo RCTs included in previous meta-analysis 93 were excluded because focusing on patients with chronic cough attributed a posteriori to LPR. 94,95 The degree of agreement between investigators was high because only three articles have been discussed about the inclusion.…”