Laryngopharyngeal Reflux Symptoms Research Articles

The effect of laryngopharyngeal reflux on arousal in patients with obstructive sleep apnea

Background Laryngopharyngeal reflux (LPR) may be associated with the severity of obstructive sleep apnea (OSA). However, it is unknown whether LPR may be associated with arousal. Objective To clarify the effect of LPR on arousal in OSA. Methods This study included 120 OSA patients. The correlations between LPR scores and arousal index (ArI) were analyzed. Finally, to further clarify the effect of LPR on ArI, we analyzed the correlations between respiratory event-related arousal index (BERAI), leg-movement-related arousal index (LMRAI), snore-related arousal index (SRAI), spontaneous arousal index (SAI), and RSI score. Results Partial correlation analysis showed that the RSI score was positively correlated with ArI (p = .000), mainly correlated with BERAI and SAI (r = 0.422, p = .000; r = 0.212, p = .020). While controlling for apnea-hypopnea index (AHI), the RSI score was still positively correlated with ArI (p = .002), mainly correlated with BERAI and SAI (r = 0.252, p = .006; r = 0.200, p = .029). Conclusions and significance The effect of LPR symptoms on arousal in OSA exists. The more severe the LPR was, the more frequent the arousal in OSA patients was. Thereinto, respiratory event-related arousal and spontaneous arousal were the most obvious.

Developing a Vocal Manual Therapy Intervention for the Treatment of Laryngopharyngeal Reflux in Professional Voice Users: A Pilot Study of Two Elite Singers

Laryngopharyngeal reflux (LPR) can be extremely debilitating for singers. This pilot study describes a vocal manual therapy intervention that may have a potential to address LPR symptoms. It is a preliminary study, suggesting that they study provides a foundation for future work investigating nonpharmacological intervention strategies for singers with LPR.

The Reflux Symptom Index (RSI) as a Diagnostic Tool for Laryngopharyngeal Reflux (LPR)

Laryngopharyngeal reflux (LPR) is the backflow of gastric contents into the laryngopharynx, where the gastric contents will come into contact with the upper aerodigestive tract tissue. These clinical entities are known to profoundly affect the patient's quality of life, altering sleep and daily activities and reducing the effectiveness of the speaker's communicator. The Reflux Symptom Index (RSI) was developed in 2001 for the purpose of diagnosing laryngopharyngeal reflux. The RSI is a validated nine-item instrument that focuses on LPR symptoms, including hoarseness, frequent clearing of the throat, globus, cough, and dysphagia. A score of more than 13 was considered abnormal and reflected LPR, and improvement at an RSI > 5 points was considered clinically significant.

Clinical assessment of laryngo-pharyngeal reflux disease by reflux symptom index and reflux finding score in a tertiary care hospital, Madhya Pradesh

Background: Laryngopharyngeal reflux (LPR) or LPR disease (LPRD) is a commonly diagnosed clinical entity caused by the back-flow of gastric contents into the laryngo-pharynx. Diagnosis was made by a set of non-specific clinical symptoms, endoscopic laryngeal examination signs, reflux symptom index (RSI), and reflux finding score (RFS). Aims and Objectives: The aims and objectives of the present study were to establish the diagnosis and treatment of LPR by assessment of the RSI and RFS and also evaluate the impact of proton pump inhibitor (PPI) therapy on LPR. Materials and Methods: A total of 60 clinically suspected patients attending the ENT outpatient department presenting LPRD signs and symptoms were enrolled in the present study. LPR symptoms were assessed using the RSI, and LPR signs were assessed by laryngoscopic examination of the larynx using the RFS. Patient having an RSI score of ≥13 and an RFS of >7 was included in the present study and it was also considered for starting LPR treatment. We have again calculated the both the score (RSI and RFS) after 3 months of successful PPI therapy and compared them with the initial scores. Results: Out of total 60 patients, 50 (83.4%) had RSI score >13 and RFS >7 indicating severe LPRD. Most common symptoms were troublesome/annoying cough (95%), sensation of something sticking in throat (95%), heartburn(95%), frequent throat clearing (91%), and excess throat mucous (87.9%), whereas the most common sign noted on laryngoscopic examination were arytenoids erythema (86.66%), partial ventricular obliteration (83.33%), vocal cord edema (56.7%), posterior commissure hypertrophy (51.7%), and diffuse laryngeal edema (50%). Majority of the patients significantly responded on 3 months PPI therapy. Reduction of clinical signs, symptoms of LPR and also observed significant reduction of RSI and RFS score after successful PPI therapy. Conclusions: In the present study, most of the patients suffering from severe LPRD who presented in our hospital RSI and RFS scored that were clinically significant in current study. After 3 months of proton-pump inhibitor therapy, there was a significant reduction in clinical signs and symptoms of LPR as well as RSI/RFS scores, indicating that PPI therapy was the mainstay of LPRD treatment in the current era.

Finding relief for the self-conscious esophagus: laparoscopic anti-reflux surgery and the esophageal hypersensitivity and anxiety scale.

Measures of mood and effective coping strategies have notable correlations with quality of life and treatment responses. There is evidence that patients with previously diagnosed anxiety disorders have less improvement in patient-reported outcome measures (PROMs) after laparoscopic anti-reflux surgery (LARS) and that objective pathology does not correlate well with symptom severity. We were interested in investigating whether anxiety and hypervigilance, as measured preoperatively with the esophageal hypervigilance anxiety scale (EHAS), is associated with the improvement in GERD-specific PROMs and EHAS scores 6months after LARS. We performed a retrospective cohort study of 102 adult patients (31% men, average age 64) who underwent LARS. In the preoperative evaluation, baseline gastroesophageal reflux disease-health-related quality of life (GERD-HRQL), laryngopharyngeal reflux symptom index (LPR-RSI) and EHAS scores were collected in addition to the standard reflux workup, including endoscopy, manometry, barium swallow, and pH study. For all three surveys, a higher score represents worse symptom severity. At 6months postoperatively, 70 patients completed repeat GERD-HRQL, LPR-RSI, and EHAS surveys. We then analyzed for surgical and patient-related factors associated with improvement in the 6-month postoperative GERD-HRQL and LPR-RSI scores. There was a statistically significant decrease in the GERD-HRQL (25 vs. 2, p < 0.001), LPR-RSI (17 vs. 3, p < 0.001) and EHAS (34 vs. 15, p < 0.001) 6months after LARS. On multivariable linear regression, a higher baseline EHAS score was independently associated with a greater improvement in GERD-HRQL (β 0.35, p < 0.001) and LPR-RSI (β 0.19, p = 0.03) 6-months after LARS. Additionally, the degree of improvement in EHAS, GERD-HRQL, and LPR-RSI was not influenced by the type of LARS performed or by the severity of disease. These findings are consistent with literature suggesting that measures of psychoemotional health correlate better with symptom intensity than objective pathology. We found that patients with a higher EHAS score have greater symptom severity and lower quality of life at baseline. Novel findings to this study are that patients with a higher preoperative EHAS, a measure of psychoemotional health, actually benefitted more from surgery and not less, which has been the traditional view in the literature. Future studies are warranted to establish directionality and explore the role of preoperative cognitive behavioral therapy with LARS for patients with significant symptoms of hypervigilance and anxiety.

Assessment of Laryngopharyngeal Reflux and Obstructive Sleep Apnea: A Population-Based Study.

To evaluate the presence of laryngopharyngeal reflux (LPR) and the potential association between presence of LPR symptoms and obstructive sleep apnea (OSA) in a representative sample from a population-based study. Cross-sectional study. Participants of the follow-up of the Epidemiological Sleep Study were evaluated. Sleep was assessed through questionnaires and polysomnography. The presence of LPR was based on the questionnaire Reflux Score Index (RSI), and scores higher than 13 were suggestive of LPR. A general linear model test was used for comparison of continuous data and Pearson's chi-square test was used to compare categorical variables. Predictors of LPR were obtained by regression analysis. 701 were enrolled (54.8% female, 45.2% male; mean age, 50.2± 13.3 years). The mean apnea-hypopnea index score was 17 ± 18.3 events/hr, and the mean RSI score was 7.0 ± 8.1. LPR was found in 17% of the volunteers, whereas OSA was present in 38.5% of the sample. Specifically, in those patients with OSA, the prevalence of LPR was 45.4%; however, there was no statistically significant association between LPR and the presence of OSA. The severity of OSA was not associated with RSI score. The presence of LPR was associated with older age, smoking, excessive daytime sleepiness and worse quality of life and sleep scores questionnaires. Age, smoking, but not body mass index, were associated with LPR. There was not statistically significant association of LPR with OSA. Individuals with symptoms of LPR had greater drowsiness and worse quality of life and sleep. 3 Laryngoscope, 132:1877-1882, 2022.

Laryngopharyngeal reflux: is laparoscopic fundoplication an effective treatment?

Laryngopharyngeal reflux (LPR) is difficult to diagnose and treat owing to uncertainty relating to the underlying pathology. The initial management of LPR includes lifestyle modifications and oral medications. In patients who have failed to respond to proton pump inhibitor (PPI) therapy, anti-reflux surgery is considered; laparoscopic fundoplication is the surgery of choice. The primary aim of this review is to identify whether fundoplication is effective in improving signs and symptoms of LPR. The secondary aim is to identify whether patients who have had a poor response to PPIs are likely to have symptom improvement with surgery. The objective of the study is to establish the effect of laparoscopic fundoplication on the reflux symptom index score (RSI). PubMed, Embase, Medline and Cochrane databases were used to search according to the PRISMA guidelines. Original articles assessing the efficacy of fundoplication in relieving symptoms of LPR were included. For each study, the efficacy endpoints and safety outcomes were recorded. Nine studies from 844 initial records met the inclusion criteria: one prospective case control study, one retrospective case-control study, four prospective case series and three retrospective case series involving 287 fundoplications. All nine studies found fundoplication to be effective in improving symptoms of LPR (p < 0.05). Current evidence suggests laparoscopic fundoplication is an effective treatment for LPR and should be considered if medical management is unsuccessful.

Magnesium alginate versus proton pump inhibitors for the treatment of laryngopharyngeal reflux: a non-inferiority randomized controlled trial

PurposeProton pump inhibitors (PPIs) are commonly prescribed for laryngopharyngeal reflux (LPR), but their efficacy remains debated. Alginates is an option for the treatment of LPR with few adverse effects. The study aimed to investigate the non-inferiority of an alginate suspension (Gastrotuss®) compared to PPIs (Omeprazole) in reducing LPR symptoms and signs.MethodsA non-inferiority randomized controlled trial was conducted. Fifty patients with laryngopharyngeal symptoms (Reflux Symptom Index -RSI- ≥ 13) and signs (Reflux Finding Score -RFS- ≥ 7) were randomized in two treatment groups: (A) Gastrotuss® (20 ml, three daily doses) and, (B) Omeprazole (20 mg, once daily). The RSI and the RFS were assessed at baseline and after 2 months of treatment.ResultsGroups had similar RSI and RFS scores at baseline. From pre- to 2-month posttreatment, the mean RSI significantly decreased (p = 0.001) in alginate and PPI group (p = 0.003). The difference between groups in the RSI change was not significant (95%CI: − 4.2–6.7, p = 0.639). The mean RFS significantly decreased in alginate (p = 0.006) and PPI groups (p = 0.006). The difference between groups in the mean change RFS was not significant (95%CI: − 0.8; 1.4, p = 0.608).ConclusionAfter 2 months of treatment, LPR symptoms and signs are significantly reduced irrespective of the treatment. Alginate was non-inferior to PPIs and may represent an alternative treatment to PPIs for the treatment of LPR.

Клинические аспекты ларингофарингеального рефлюкса

Laryngopharyngeal reflux (LPR) as the cause of symptoms in the absence of symptomatic gastroesophageal reflux disease (GERD) is often questioned. But it is worth remembering that GERD is a whole complex of symptoms that occur when the mucous membrane is damaged. We aimed to study the clinical symptoms of LPR without esophageal symptoms. The study included 66 women and 34 men with complaints typical of LPR, aged 18 to 70. The study included patients with typical LPR complaints without esophageal symptoms who rated them at more than 13 points according to the RSI questionnaire. 91 patients (95%) complained of hoarseness; 93 (97%), of a sore throat; 88 (92%), of excessive mucus coughing up or its running off from the nose; 36 (38%), of difficulty swallowing; 43 (45%), of coughing after eating or after lying down; 68 (71%), of shortness of breath or episodes of suffocation; 64 (67%), of excruciating or hacking cough; 84 (88%), of feeling of something sticky in the throat or a lump in the throat. In addition to the typical symptoms of LPR, patients may experience difficulty in nasal breathing; sneezing in the absence of respiratory allergies; burning and bitterness in the mouth; bad breath due to the formation of tonsilloliths; complaints from the ear not recorded by objective methods of research. 23% of patients with LPR suffer from carcinophobia. We concluded that LPR affects the larynx and all parts of the pharynx. The appointment of omeprazole 20 mg 30 minutes before meals in the morning 1 time per day for 6 weeks significantly reduces the symptoms of LPR. A new questionnaire is required for the early detection of LPR symptoms by a questionnaire method.

Vocal deviation in individuals with suggestive signs and symptoms of laryngopharyngeal reflux.

Verify and compare vocal deviation in quality, vocal symptoms and reflux symptom index in patients with clinical diagnosis of laryngopharyngeal reflux (LPR). 100 individuals of both genders participated in this prospective study, aged between 18 and 60 years old, who presented signs of LPR in the nasofibrolaryngological exam. Participants answered the Reflux Symptom Index (RSI) questionnaire to determine the reflux index and the Voice Symptom Scale (VoiSS). Their voices were recorded for the auditory-perceptual assessment. Three speech therapists with voice experience were contacted and the most reliable one was maintained. 100 examined voices, 34 were classified as adapted and 66 as deviated. The predominant vocal quality type was rough and a slight degree of deviation. The average score on VoiSS and RSI of individuals with deviated voice is significantly higher than the adapted voice group on both protocols (p<0.01). The symptom reported with most frequency and intensity, in both analyses, was throat clearing. There were statistically significant differences once analyzed the vocal quality types by pairs: rough-adapted (p=0.0021) and tense-adapted (p=0.0075) on VoiSS, and rough-adapted (p=0.001) on RSI. Individuals with deviated voice reported higher occurrence of LPR related vocal signals and symptoms measured by VoiSS and RSI. The numerous theories about the disease do not make possible a single conclusion on the subject. Further studies are needed in the area to assist the professional in the diagnosis and treatment of the RLF patient.

Changes in laryngopharyngeal reflux after uvulopalatopharyngoplasty for obstructive sleep apnea: An observational study.

PurposeTo estimate laryngopharyngeal reflux (LPR) changes after uvulopalatopharyngoplasty (UPPP) for obstructive sleep apnea (OSA) using the reflux symptom index (RSI) and reflux finding score (RFS) questionnaires.MethodsA total of 91 participants were recruited and divided into three groups: control (n = 27), OSA mild to moderate (n = 29), and OSA severe (n = 35) groups according to polysomnography. All participants completed the preoperative RSI, and underwent blinded evaluation on videolaryngoscopy using the RFS questionnaire. Thirty‐four OSA patients who underwent UPPP surgery completed postoperative polysomnography and questionnaires again after a 6‐month follow‐up.ResultsThe RSI score and RFS were higher in patients with OSA than in those without OSA. Patients with severe OSA also had a higher RSI score and RFS than those with mild to moderate OSA. Apnea and hypopnea index degree and percentage of recording time for <90% oxygen saturation showed positive correlation with LPR symptoms. But the lowest blood oxygen saturation during the recording time was negatively correlated with LPR symptoms. The mean RSI score and RFS before UPPP surgery were 15.88 ± 4.85 and 13.18 ± 4.80, after surgery decreasing to 9.53 ± 4.16 and 8.65 ± 4.87, respectively (P <.05). In 25 patients where surgery was successful, RSI scores, RFSs and individual RSI variables decreased after surgery.ConclusionsLPR symptoms are common among OSA patients, and the coexistence of OSA and LPR cannot be ignored. Successful UPPP surgery potentially reduces LPR symptoms and improves laryngoscopic signs by alleviating sleep respiratory disorders. Level of Evidence: 3.

An update on current treatment strategies for laryngopharyngeal reflux symptoms.

Laryngopharyngeal reflux (LPR) is a syndrome caused by reflux of gastric contents into the pharynx or larynx, which leads to symptoms of throat clearing, hoarseness, pain, globus sensation, cough, excess mucus production in the throat, and dysphonia. LPR is a challenging condition, as there is currently no gold standard for diagnosis or treatment, and thus this presents a burden to the healthcare system. Strategies for treatment of LPR are numerous. Medical therapies include proton pump inhibitors, which are first line, H2 receptor antagonists, alginates, and baclofen. Other noninvasive treatment options include lifestyle therapy and the external upper esophageal sphincter compression device. Endoscopic and surgical options include antireflux surgery, magnetic sphincter augmentation, and transoral incisionless fundoplication. Functional laryngeal disorders and laryngeal hypersensitivity can present as LPR symptoms with or without gastroesophageal reflux disease. Though there are minimal studies in this area, neuromodulators and behavioral interventions are potential treatment options. Given the complexity of these patients and numerous available treatment options, we propose a treatment algorithm to help clinicians diagnose and triage patients into an appropriate therapy.

Acacia pycnantha and gum arabic an alternative to antacids and proton pump inhibitors in the management of gastroesophageal and laryngopharyngeal reflux

ABSTRACT A case report is presented where a patient with long-term gastroesophageal reflux and recently diagnosed laryngopharyngeal reflux (LPR) underwent an 8-week treatment with proton pump inhibitors (PPIs). On discontinuation of the PPIs, symptoms of LPR remained and the patient’s reflux symptoms returned with increased severity. Consumption of acacia gum exudates from Acacia pycnantha resolved the LPR. Acacia pycnantha or gum arabic were both found to reduced reflux symptoms to a manageable level. An evaluation of the therapeutic effect of acacia gums using questionnaires to evaluate reflux symptoms, quality of life and global refluxogenic scores was undertaken. It was found acacia gums can be taken after the evening meal in the same way as antacids to manage reflux symptoms but with more sustained overnight relief.

Bolus transit of upper esophageal sphincter on high-resolution impedance manometry study correlate with the laryngopharyngeal reflux symptoms

Laryngopharyngeal reflux symptom is a troublesome upper esophageal problem, and reflux symptom index (RSI) is commonly applied for the assessment of clinical severity. We investigated the relationship between the upper esophageal sphincter impedance integral (UESII) and RSI scores in this study. Totally 158 subjects with high-resolution esophageal impedance manometry (HRIM) with RSI questionnaire assessment were recruited. There are 57 (36.08%), 74 (46.84%), 21 (13.29%), and 6 (3.79%) patients were categorized as normal, ineffective esophageal motility disorder, absent contractility, and achalasia by HRIM examination, respectively. Subjects with RSI > 13 were noted to have lower UESII than others with RSI ≦ 13 (7363.14 ± 1085.58 vs. 11,833.75 ± 918.77 Ω s cm; P < 0.005). The ROC analysis yielded a UESII cutoff of < 2900 Ω s cm for the best prediction of subjects with RSI > 13 (P = 0.002). Both female gender and UESII cutoff of < 2900 Ω s cm were significant predictors of RSI > 13 in logistic regression analysis (OR = 3.84 and 2.83; P = 0.001 and 0.01; respectively). Lower UESII on HRIM study, indicating poor bolus transit of UES during saline swallows, is significantly associated with prominent laryngopharyngeal reflux symptoms scored by RSI score.

Impaired Proximal Esophageal Contractility Predicts Pharyngeal Reflux in Patients With Laryngopharyngeal Reflux Symptoms.

OBJECTIVES:The pathophysiology of laryngopharyngeal reflux (LPR) remains incompletely understood. Proximal esophageal motor dysfunction may impair bolus clearance, increasing the risk of pharyngeal refluxate exposure. We aimed to evaluate the association of proximal esophageal contractility with objective reflux metrics.METHODS:We evaluated adults with LPR symptoms undergoing high-resolution manometry (HRM) and combined hypopharyngeal-esophageal multichannel intraluminal impedance-pH testing at a tertiary center between March 2018 and August 2019. Routine parameters per Chicago classification were obtained on HRM. Proximal esophageal contractility was evaluated using proximal contractile integral (PCI), which quantifies contractile pressure >20 mm Hg for the region spanning the distal margin of the upper esophageal sphincter and transition zone. Univariate (Kendall correlation and Student t test) and multivariable (general linear regression and logistic regression) analyses were performed.RESULTS:We enrolled 138 patients (66.7% women, mean age 57.1 years) in this study. Lower PCI was associated with an elevated risk of increased pharyngeal reflux (adjusted odds ratio 0.83 per 100 mm Hg-s-cm change in PCI, 95% confidence interval: 0.69–0.98), with a trend toward increased bolus exposure time and total reflux events, after multivariable adjustment. The relationship between PCI and pharyngeal reflux was strongest among participants without a primary motility disorder on HRM (adjusted odds ratio 0.63, 95% confidence interval: 0.42–0.85, P interaction = 0.04). Among continuously expressed reflux parameters, lower PCI was significantly associated with more distal acid reflux events (β = −0.0094, P = 0.03) and total reflux events (β = −0.0172, P = 0.05), after adjusting for confounders.DISCUSSION:Reduced proximal esophageal contractility as assessed by decreased PCI on HRM independently predicted increased pharyngeal reflux in patients with LPR symptoms, particularly among those without a coexisting motility disorder.

Laryngopharyngeal reflux: is laparoscopic fundoplication an effective treatment?

Laryngopharyngeal reflux (LPR) is difficult to diagnose and treat owing to uncertainty relating to the underlying pathology. The initial management of LPR includes lifestyle modifications and oral medications. In patients who have failed to respond to proton pump inhibitor (PPI) therapy, anti-reflux surgery is considered; laparoscopic fundoplication is the surgery of choice. The primary aim of this review is to identify whether fundoplication is effective in improving signs and symptoms of LPR. The secondary aim is to identify whether patients who have had a poor response to PPIs are likely to have symptom improvement with surgery. The objective of the study is to establish the effect of laparoscopic fundoplication on the reflux symptom index score (RSI). PubMed, Embase, Medline and Cochrane databases were used to search according to the PRISMA guidelines. Original articles assessing the efficacy of fundoplication in relieving symptoms of LPR were included. For each study, the efficacy endpoints and safety outcomes were recorded. Nine studies from 844 initial records met the inclusion criteria: one prospective case control study, one retrospective case-control study, four prospective case series and three retrospective case series involving 287 fundoplications. All nine studies found fundoplication to be effective in improving symptoms of LPR (p < 0.05). Current evidence suggests laparoscopic fundoplication is an effective treatment for LPR and should be considered if medical management is unsuccessful.

Özofageal inlet patch: Hastaların demografik ve endoskopik karakteristikleri ve litaratürün gözden geçirilmesi

Background and Aims: An esophageal inlet patch is crucial in swallowing difficulty, laryngopharyngeal reflux symptoms, and rarely in the etiology of proximal esophagus adenocarcinoma. We aimed to evaluate the endoscopic and demographic features of patients with esophageal inlet patch during endoscopic evaluation and compare them with those of the literature. Material and Method: Between January 2017 and January 2021, we evaluated the age, gender ratio, inlet patch size, and number along with the other endoscopic findings in patients with proximal esophageal inlet patch. Results: Overall, 53 patients (women, 36 (68%); mean age, 46.3 ± 15.8 years; range, 19–83 years) were included the study. Only 13 patients (24.5%) had specific symptoms of esophageal inlet patch. The median esophageal inlet patch size was 7.0 mm in women (range, 4–30), while it was 8 mm (range, 5–20) in men. The median inlet patch number was 1 in both sexes (range, 1–3 in women, 1–2 in men). Forceps biopsy was possible in 30 (56.6%) patients. We found no additional esophageal pathology in 45 (84.9%) patients, normal lower esophageal sphincter in 39 (73.5%), incompetent lower esophageal sphincter in 14 (26.4%), hiatal diaphragmatic hernia in 1 (1.8%), and endoscopic antral gastritis in 29 (55.7%) patients. Twelve (54.5%) of 22 endoscopic biopsies were positive for Helicobacter pylori. We detected esophageal inlet patch in the distal esophagus in 2 (3.7%) patients. Conclusion: Esophageal inlet patch was more common in women, unrelated to gastroesophageal reflux disease, and most patients were asymptomatic, with a median size of 8 mm (range, 4–30), with no gender difference. Moreover, inlet patch size was not associated with presence of symptoms. Evidence of malignancy in the biopsied inlet patches was not observed.

Prevalence of Laryngopharyngeal Reflux Symptoms, Dysphonia, and Vocal Tract Discomfort in Amateur Choir Singers

IntroductionVocal tract discomfort (VTD), dysphonia, and laryngopharyngeal reflux (LPR) symptoms are complaints frequently reported by amateur singers. There are two aims of this study. The first is to evaluate the prevalence of these symptoms using validated questionnaires. The second is to correlate singing-related variables with the questionnaire responses. MethodsA total of 392 amateur choir singers (ACS) and 514 control subjects completed an online survey divided into four parts: (1) clinical and demographic characteristics, (2) training in singing and singing experience, (3) history of gastroesophageal reflux disease and LPR symptoms, (4) validated questionnaires. Specifically, the reflux symptom index (RSI), the vocal tract discomfort scale (VTDS), and the voice symptom scale (VoiSS) were included to analyze the actual burden related to LPR symptoms, VTD, and dysphonia. ResultsACS demonstrated a healthier lifestyle and a lower prevalence of gastroesophageal reflux disease symptoms in comparison with control subjects. ACS scored significantly higher in VTDS and VoiSS than control subjects, while no differences in the RSI results were found. Significant correlations among the questionnaires’ results were demonstrated. Occasional professional singing was the variable influencing VTDS and VoiSS results the most. ConclusionACS do not evidently manifest a higher impairment connected to LPR (RSI score), while they do report higher levels of voice (VoiSS score) and vocal tract (VTDS score) impairments, in comparison with control subjects. The relevant correlations among the PRO measures suggest that LPR symptoms, VTD, and dysphonia are related to each other. Given the relevant repercussion on the severity of VTD and dysphonia, providers should specifically ask about occasional professional singing when treating amateur singers.

Response of Laryngopharyngeal Symptoms to Transoral Incisionless Fundoplication in Patients with Refractory Proven Gastroesophageal Reflux.

Patients with laryngopharyngeal reflux (LPR) symptoms may not respond to proton pump inhibitors (PPI) if they have an alternative laryngeal diagnosis or high-volume reflux. Transoral incisionless fundoplication (TIF) or TIF with concomitant hiatal hernia repair (cTIF) are effective in decreasing symptoms of gastroesophageal reflux disease (GERD) but are not well studied in patients with LPR symptoms. This prospective multicenter study assessed the patient-reported and clinical outcomes after TIF/cTIF in patients with LPR symptoms and proven GERD. Patients with refractory LPR symptoms (reflux symptom index [RSI] > 13) and with erosive esophagitis, Barrett's esophagus, and/or pathologic acid reflux by distal esophageal pH testing were evaluated before and after a minimum of 6 months after TIF/cTIF. The primary outcome was normalization of RSI. Secondary outcomes were >50% improvement in GERD-Health-Related Quality of Life (GERD-HRQL), normalization of esophageal acid exposure time, discontinuation of PPI, and patient satisfaction. Forty-nine patients had TIF (n = 26) or cTIF (n = 23) with at least 6 months follow-up. Mean pre- and post TIF/cTIF RSI were 23.6 and 5.9 (mean difference: 17.7, P < .001). Post TIF/cTIF, 90% of patients had improved GERD-HQRL score, 85% normalized RSI, 75% normalized esophageal acid exposure time, and 80% discontinued PPI. No serious procedure-related adverse events occurred. Patient satisfaction was 4% prior to TIF/cTIF and 73% after TIF/cTIF (P < .001). In patients with objective evidence of GERD, TIF, or cTIF are safe and effective in controlling LPR symptoms as measured by normalization of RSI and improvement in patient satisfaction after TIF/cTIF. Level 4.

Anatomical and physiological characteristics in patients with Laryngopharyngeal Reflux Symptoms: A case-control study utilizing high-resolution impedance manometry

This study aimed to explore the anatomical and physiological characteristics of patients with laryngopharyngeal reflux (LPR) symptoms, such as hoarseness, throat clearing, throat pain, globus, and chronic cough, with the novel high-resolution impedance manometry (HRIM). Consecutive patients exhibited at least one LPR symptom for ≥4 weeks after 2-month proton-pump inhibitor treatment were enrolled during November 2014 and March 2018 from single tertiary medical center. All patients completed validated symptom questionnaires, esophagogastroduodenoscopy, and HRIM. Healthy volunteers were also recruited for comparison of esophageal parameters on HRIM. Eighty-nine LPR patients and 63 healthy volunteers were analyzed. Compared with healthy volunteers, LPR patients had significantly shorter upper and lower esophageal sphincters (UES and LES), a shorter intraabdominal esophagus (all P<0.01), higher 4-s integrated relaxation pressures (IRP-4s) (P=0.011) of the LES. After adjusted for age, sex, body weight, body height and alcohol consumption, multiple regression analysis showed that age, LES IRP-4s and the UES length were independent risk factors for LPR symptoms (OR 1.056, 95% CI 1.019-1.094; OR 1.107, 95% CI 1.004-1.222; OR 0.432, 95% CI 0.254-0.736, respectively). In subgroup analysis, patients with moderate LPR symptoms had lower IRP-4s (6.64±4.55 vs. 8.69±5.10, P=0.049) and more failed peristalsis (27.33±29.26 vs. 11.36±21.20, P=0.004) than those with mild LPR symptoms. Our study suggests that esophageal structural factors and LES IRP-4s may contribute to the occurrence of LPR symptoms. Patients with moderate LPR symptoms were more likely to present with failed peristalsis.