Voice outcomes of laryngopharyngeal reflux treatment: a systematic review of 1483 patients

Abstract

The aim of this study is to explore voice quality modifications in laryngopharyngeal reflux (LPR) disease and to understand better the pathophysiological mechanisms underlying the development of communicative disability. Biological Abstracts, BioMed Central, Cochrane database, PubMed and Scopus were assessed for subject headings using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) recommendations. Relevant studies published between January 1990 and December 2015 describing the evaluation of voice quality in LPR disease were retrieved. Issues of clinical relevance, such as LPR diagnosis method, treatment efficacy and outcomes, were evaluated for each study. We determined the grade of recommendation for each publication according to the Oxford Centre for Evidence-Based Medicine evidence levels. The search identified 145 publications, of which 25 studies met the inclusion criteria for a total of 1483 LPR patients. Data were extracted by 2 independent physicians who identified 16 trials with a IIb evidence level, 7 trials with a IIa evidence level and 2 RCTs with a Ib evidence level where 4 patient-based instruments and 5 clinician-based instruments were used. The main voice assessment outcomes reported were hoarseness assessments by physicians or patients, followed by acoustic parameters; 15 and 14 articles, respectively, demonstrated significant improvements in subjective and objective voice assessments after treatment. The methodology used to measure acoustic parameters (i.e. sustained vowel duration, the sample portion choice for measurement, etc.) varied from one study to another. The majority of studies indicated that voice quality assessments (especially acoustic parameters) remain an interesting outcome to measure the effectiveness of treatment, but further studies using standardised and transparent methodology to measure acoustic parameters are necessary to confirm the place of each tool in the LPR disease evaluation.

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

“…Since that time, many case‐controlled studies have supported the association between LPR and chronic laryngitis, hoarseness, and the development of benign laryngeal lesions . Prospectively, the real impact of empirical treatment on voice quality remains unclear yielding some controversial conclusions regarding the usefulness of voice quality as treatment outcome …”

“…Another controversy concerns the evolution of voice quality throughout the treatment period. Indeed, since the first works of Koufman in the early 1990s, only some twenty trials have studied the development of voice impairments related to LPR and the use of voice quality assessments as outcome measures . Some of these studies reported significant improvement in voice quality after medical treatment, while others found mixed results .…”

“…Some of these studies reported significant improvement in voice quality after medical treatment, while others found mixed results . As shown in a previous literature review, most of these studies focused on the evolution of voice quality throughout the first 3 months, but none studied voice quality after the first 3 months of treatment, especially throughout the empirical treatment …”

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

“…Another difference among the therapeutic schemes is duration of the empiric trial. The improvement of both signs and symptoms may take time, especially in patients with a long history of LPR . To date, most researches support a period of 2 to 6 months of treatment to get substantial therapeutic benefit .…”

Effect of diabetes mellitus on voice: a systematic review

“…Gastro‐oesophageal reflux disorder (GORD) leads to reflux of stomach contents into the oesophagus; when this reflux affects the oesophagus, upper oesophageal sphincter and up to the level of the throat, it is called laryngopharyngeal reflux (LPR). LPR leads to macroscopic and microscopic changes in the vocal fold mucosa that could lead to voice problems . LPR can have a negative influence on a person's voice quality as well as the overall quality of life .…”