Poor consistency between reflux symptom index and laryngopharyngeal pH monitoring in laryngopharyngeal reflux diagnosis in Chinese population

Wang, Junyao; Peng, Tao; Zhao, Lili; Feng, Guijian; Liu, Yulan

doi:10.21037/atm-20-4783

Cited by 10 publications

(7 citation statements)

References 32 publications

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“…This study found that the consistency between the RSS and 24 h MII‐pH was comparatively high (kappa value = 0.663), with a sensitivity of 92.8% and a specificity of 71.4%. However, RSI had a general consistency with 24 h HEMII‐pH (kappa value = 0.213) and a sensitivity of 48.2% but specificity is 80.9%, a result similar to other studies 18,19 . The extra inclusion of ENT, digestive, and respiratory symptoms in the RSS allows for a more comprehensive assessment and make patients a clearer understanding of the frequency and severity of symptoms.…”

Section: Discussionsupporting

confidence: 78%

“…However, RSI had a general consistency with 24 h HEMII-pH (kappa value = 0.213) and a sensitivity of 48.2% but specificity is 80.9%, a result similar to other studies. 18,19 The extra inclusion of ENT, digestive, and respiratory symptoms in the RSS allows for a more comprehensive assessment and make patients a clearer understanding of the frequency and severity of symptoms. The RSS expands the scope of symptom screening and is more sensitive and consistent than the RSI, but as a result, the specificity of the RSS is inevitably less than that of the RSI.…”

Section: Symptom Characteristics In Lpr Patientsmentioning

confidence: 99%

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Comparison of Reflux Symptom Score versus Reflux Symptom Index in screening laryngopharyngeal reflux

et al. 2022

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ObjectivesTo compare the screening value of the Reflux Symptom Score (RSS) and the Reflux Symptom Index (RSI) for laryngopharyngeal reflux (LPR).MethodsAll included patients attending the Department of Otolaryngology at the Sixth Medical Center of the PLA General Hospital from February 2022 to August 2022, completed the RSS and the RSI and underwent 24‐hour hypopharyngeal‐esophageal multichannel intraluminal impedance‐pH (24 h HEMII‐pH) monitoring. The results of 24 h HEMII‐pH were used as a diagnostic criterion for LPR, consistency between two questionnaires (RSS, RSI) and 24 h HEMII‐pH was compared by the weighted Cohen's kappa statistic and the screening value of RSS and RSI for LPR was compared by receiver operating characteristics analysis.ResultsA total of 77 patients, 58 males, and 19 females, were included. The Kappa values of between RSS, RSI, and 24 h HEMII‐pH were 0.663 (p < 0.001) and 0.213 (p < 0.05), respectively. The sensitivity of RSS and RSI were 92.8% and 48.2%, respectively, the specificity was 71.4% and 80.9%. The negative predictive value and positive predictive value of RSI were 36.9%, 87.1%, and that of RSS were 78.9%, 89.6%. The area under curve of the RSS (0.783; 95% CI = 0.53, 0.75) is significantly higher than RSI (0.633; 95% CI = 0.72, 0.90).ConclusionThe RSS has a higher consistency and better screening value for LPR compared to RSI. In addition, the RSS includes more reflux symptoms, which may reduce the number of missed diagnoses in patients with LPR to some extent.Level of Evidence3 Laryngoscope, 133:2104–2109, 2023

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Section: Discussionsupporting

confidence: 78%

Section: Symptom Characteristics In Lpr Patientsmentioning

confidence: 99%

Comparison of Reflux Symptom Score versus Reflux Symptom Index in screening laryngopharyngeal reflux

et al. 2022

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“…Despite RSI being developed as a tool for LPR symptoms [ 63 ], there is a lack of agreement between its score and laryngopharyngeal pH monitoring [ 79 ]. The findings of this study support the fact that symptoms reflected in the RSI are not always associated with LPR [ 80 ] and may be related to other etiologies including LSD.…”

Section: Discussionmentioning

confidence: 99%

Supraglottic Botulinum Toxin Improves Symptoms in Patients with Laryngeal Sensory Dysfunction Manifesting as Abnormal Throat Sensation and/or Chronic Refractory Cough

Novakovic

Sheth

Stewart

et al. 2021

JCM

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Laryngeal sensory dysfunction (LSD) encompasses disorders of the vagal sensory pathways. Common manifestations include chronic refractory cough (CRC) and abnormal throat sensation (ATS). This study examined clinical characteristics and treatment outcomes of LSD using a novel approach of laryngeal supraglottic Onabotulinum toxin Type A injection (BTX). This was a retrospective review of clinical data and treatment outcomes of supraglottic BTX in patients with LSD. Between November 2019 and May 2021, 14 patients underwent 25 injection cycles of supraglottic BTX for treatment of symptoms related to LSD, including ATS and CRC. Primary outcome measures included the Newcastle Laryngeal Hypersensitivity Questionnaire (LHQ), Cough Severity Index (CSI), Reflux Symptom Index (RSI), and Voice Handicap Index-10 (VHI-10) at baseline and within three months of treatment. Pre- and post-treatment data were compared using a linear mixed model. After supraglottic BTX, LHQ scores improved by 2.6. RSI and CSI improved by 8.0 and 5.0, respectively. VHI-10 did not change as a result of treatment. Short-term response to SLN block was significantly associated with longer term response to BTX treatment. These findings suggest that LSD presents clinically as ATS and CRC along with other upper airway symptoms. Supraglottic BTX injection is a safe and effective technique in the treatment of symptoms of LSD.

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“…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. The findings of Vance et al do not corroborate those of Weitzendorfer et al who observed that elevated Dx-pH measurements did not show significant correlation with either pH–impedance monitoring features, RSI, RFS, and saliva pepsin measurements [ 59 ]. However, irrespective to the pH study device, the correlation between pH study, symptoms, and findings remains controversial according to many studies that could not demonstrate an apparent relationship between the intensity of symptoms and the magnitude and patterns of hypopharyngeal reflux events [ 1 , 60 ].…”

Section: Diagnosis Of Reflux and Place Of Ph Studymentioning

confidence: 95%

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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Poor consistency between reflux symptom index and laryngopharyngeal pH monitoring in laryngopharyngeal reflux diagnosis in Chinese population

Cited by 10 publications

References 32 publications

Comparison of Reflux Symptom Score versus Reflux Symptom Index in screening laryngopharyngeal reflux

Comparison of Reflux Symptom Score versus Reflux Symptom Index in screening laryngopharyngeal reflux

Supraglottic Botulinum Toxin Improves Symptoms in Patients with Laryngeal Sensory Dysfunction Manifesting as Abnormal Throat Sensation and/or Chronic Refractory Cough

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

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