Clinical utility of 24 hour pharyngeal pH monitoring for hoarseness

Abstract

Objective: To evaluate the contribution of 24 hour pharyngeal pH monitoring of patient presenting with symptoms of hoarseness, globus, throat clearing, and sore throat. Study Design: Retrospective case study. Setting: Tertiary laryngology practice. Materials and Methods: Results of 167 pharyngeal pH studies performed for complaints of hoarseness, globus, and throat clearing in an outpatient private practice setting from 5/09-12/09 were analyzed for pharyngeal reflux pattern and severity. Patient records were reviewed for chief complaint, symptom duration, ten item Voice Handicap Index (VHI-10) and Reflux Symptom Index (RSI) scores. Nonparametric testing was used to compare symptom duration, VHI-10 scores, and RSI scores between those patients with and without abnormal pharyngeal pH studies. Results: 71 studies (43%) were normal with zero events below pH 5.5. 32 studies (19%), or 33% of all positive studies showed supine pharyngeal reflux only. 46 studies or 48% of all positive studies showed combination upright daytime reflux events and supine reflux. 18 studies or 19% of all positive studies had only upright events. There was no significant difference in presenting symptoms, symptom duration, or severity scores in the patients that had negative vs. positive pharyngeal pH studies. Conclusion: 24 hour pharyngeal pH study eliminates the diagnosis of reflux in a significant percentage of patients with hoarseness. Severity or duration of symptoms of hoarseness, globus, or throat clearing does not reliably predict presence of reflux.