Can symptoms patterns distinguish patients with post‐nasal drip, reflux or globus?

Abstract

The Glasgow Edinburgh Throat scale (GETS) was developed to assess severity and therapy outcomes in globus sensation. The Reflux Symptom Index (RSI) was similarly derived to assess the possible spectrum of cervical symptoms due to laryngopharyngeal reflux. Both were physician derived tools with little published data on their factor structure, and nothing published to date on their ability to generate whether or not they capture similar pharyngeal phenomena. Aim. To assess the consistency and factor structure of the two questionnaires. Methods. Subjects completing: both questionnaires 134 catarrh clinic patients; RSI only: 32 chronic chest clinic attenders; GETS only 168 volunteer ophthalmology outpatients. All items of both questionnaires were stored in SPSS. The analysis included Cronbach's α, correlation coefficients, Scree slope plots with derivation of Eigenvalues, principal components analysis using Varimax rotation with Kaiser Normalisation. Results. The GETS was completed by 302 subjects (Cronbach's α = 0.81, confirming good internal consistency of the scale overall. Three factors were identified which accounted for over 70 % of the total variance. Factor 1 was much the strongest (49% of the total variance) and included ‘catarrh’ or post‐nasal drip, globus, can't empty throat, continually want to swallow, irritation. Factor 2 had obstructive items‐ dysphagia, food sticking / throat closing. Factor three was a 2 item pain and swelling component. The RSI was completed by 168 individuals, also with acceptable overall consistency (α = 0.72). The optimum factorisation showed 2 main factors: (i) The first (α = 0.71) included coughing, choking, difficulty swallowing and heartburn/dyspepsia. (ii) The second appeared mostly to reflect post‐nasal drip and included catarrh, throat clearing, globus, and voice disorder (α = 0.62). Finally we performed a combined analysis of all 19 items – 10 GETS and nine RSI – derived from 134 subjects. This showed that heartburn mapped poorly to the overall combined factor structure which, as might be now predicted, showed factors similar to the two component tools – i.e. (i) obstruction / cough; (ii) post‐nasal drip / clearing the throat. Conclusion. The RSI and GETS emerge as reliable tools of symptom intensity: but what do these symptoms actually indicate? Both tools generate principal domains of ‘cough and block’ and ‘globus/drip/throat clearing’. In other words RSI and GETS both appear to identify similar symptom patterns, nor can the place of symptomatic gastro‐oesophageal reflux be clarified from the history. Indeed it appears that there can be little specific aetiological inference from the isolated assessment of post‐nasal or pharyngeal symptoms. References 1 Deary I.J., Wilson J.A. et al. (1995) J Psychosom Res. 39, 203–2132 Belafsky P.C., Postma G.N. & Koufman J.A. (2002) Validity and reliability of the reflux symptom index (RSI). J Voice16, 274–277