Impact of pH Monitoring on Laryngopharyngeal Reflux Treatment

Abstract

Treatment of laryngopharyngeal reflux (LPR) often suffers from poor patient compliance and hence poor symptom improvement. The aim of this study was to determine whether 24-hour oropharyngeal pH monitoring was associated with higher rates of treatment compliance and symptom improvement compared with empirical treatment for LPR. Retrospective, case-control study. Tertiary care center. Charts were reviewed from 170 consecutive adult patients diagnosed with LPR from January 2008 to March 2010. After clinical diagnosis, all patients were offered the option of empiric treatment with a proton pump inhibitor versus treatment based on a 24-hour oropharyngeal pH study using the Dx-pH system (Restech, San Diego, California). Treatment compliance and pretreatment and posttreatment reflux symptom index (RSI) scores were compared for the 2 groups. Only consecutive patients with complete data were included. One-hundred and seventy patients were included in 2 groups. Group I consisted of 73 patients who underwent pH monitoring. Group II consisted of 70 patients treated empirically. Compliance with medication therapy (68.5% vs 50.0%, P = .019) and lifestyle modification (82.2 vs 25.7%, P = .0001) were greater among patients in group I. Symptom improvement was greater among patients in group I following treatment compared with patients in group II, with a significantly greater reduction in RSI (36.6% vs 24.4%, P = .023). Among our patient population, treatment of LPR based on pH monitoring resulted in greater compliance, as well as greater symptom improvement, compared with empirical therapy alone.