Laryngopharyngeal Reflux: Inter-rater Reliability of Reflux Finding Score in Clinical Practice

Abstract

Introduction
 Laryngopharyngeal reflux (LPR) is a clinical entity, caused due to retrograde flow of gastric content into the larynx. It imposes great diagnostic challenge to clinicians because of lack of specific symptoms, signs and validated tool. Reflux Finding Score (RFS) has been proposed for clinical diagnosis of LPR. Inter observer reliability of RFS tool was found out using two independent observers
 Materials and Methods 
 In this Cross sectional study, ninety LPR subjects were subjected to 90° rigid endoscopic examination of larynx and RFS scores were calculated by two observers. Inter observer reliability of RFS was calculated using Kappa value.
 Results 
 Most commonly observed laryngeal findings were erythema/hyperemia, posterior commissure hypertrophy, and vocal fold edema. Subglottic edema, thick endolaryngeal mucus and erythema had fair agreement.
 Conclusion
 There was a poor agreement between observers for total RFS score. The variables like subglottic edema, erythema/hyperemia, and thick endolaryngeal mucus showed fair agreement between the raters. The findings of diffuse laryngeal edema and posterior commissure hypertrophy showed poor inter rater reliability.

Usefulness of The Reflux Symptom Index in the Management of Laryngopharyngeal Reflux

“…14 Various studies have found that the RFS as a clinical tool for diagnosis of LPR should be viewed with limited utility as it exhibits low inter-rater reliability. 15 Thus, it becomes all the more necessary that the RSI be assessed extensively for symptomatic betterment of the patient.…”