Pharyngolaryngeal Reflux Research Articles

Analysis of clinical characteristics of children with adenoid hypertrophy and pharyngolaryngeal reflux

Objectives: To explore the clinical characteristics of children with adenoid hypertrophy (AH) and laryngopharyngeal reflux (LPR) by detecting the expression of pepsin in adenoids as a standard for AH with LPR. Methods: A total of 190 children who were admitted for surgical treatment due to AH were included in the study. The main clinical symptoms of the patients were recorded, and the degree of adenoid hypertrophy was evaluated. Before the surgery, Reflux Symptom Index (RSI) and Reflux Finding Score (RFS) were used to evaluate the reflux symptoms. After the surgery, pepsin immunohistochemical staining was performed on the adenoid tissue, and according to the staining results, the patients were divided into study group (pepsin staining positive) and control group (pepsin staining negative). SPSS 19.0 software was used for statistical analysis. Quantitative data conforming to normal distribution between the two groups were tested by two-independent sample t test, and quantitative data with skewed distribution were tested by Mann-Whitney U test. Results: The positive rate of pepsin staining in the 190 AH patients was 78.4% (149/190). The study group had higher levels of preoperative symptoms such as erythema and/or congestion of the pharynx(2.1±0.7 vs. 1.8±0.6,t=2.23), vocal cord edema[1.0(0, 1.0) vs. 1.0(0, 1.0), Z=2.00], diffuse laryngeal edema[0(0, 1.0) vs. 0(0, 0), Z=2.48], posterior commissure hypertrophy[(1.4±0.6 vs. 1.1±0.5), t=2.63], and a higher total score on the RFS scale than the control group(6.2±2.7 vs. 5.0±2.6, t=2.47), with statistical differences (P<0.05). The sensitivity and specificity of RFS score in diagnosing AH with LPR were 24.8% and 80.5%, respectively. When RFS>5 was used as the positive threshold, the sensitivity and specificity of RFS score in diagnosing AH with LPR were 61.1% and 58.5%, respectively. There was a statistical difference in the number of positive cases of RFS score between the study group and the control group(91 vs. 17,χ2=5.04,P=0.032). Conclusions: LPR is common in AH children. Children with AH and LPR have specific performance in electronic laryngoscopy, such as erythema with edema in the pharynx, posterior commissure hypertrophy, and vocal cord edema.

Inducible laryngeal obstruction: detection and management

Inducible laryngeal obstruction (ILO) is a phenomenon of paradoxical upper airway closure during breathing causing respiratory distress and a noisy breathing. It most often appears during maximal exertion but can also be induced by inhalation of irritants, pharyngolaryngeal reflux or stressful situations. It can sometimes be confused with an acute asthma attack. The gold standard investigation is a videolaryngoscopy during ergometry which can confirm the diagnosis, allowing appropriate treatment. The aim of this article is to describe the pathophysiology of ILO and to discuss paraclinical examinations and treatment options.

Скрининговый способ диагностики фаринголарингеального рефлюкса

Pharyngolaryngeal reflux (PLR) can cause the upper respiratory tract pathology. To diagnose PLR based on complaints is rather difficult, due to the absence of typical manifestations of reflux syndrome in some cases of the disease. The use of daily impedance pH monitoring of the esophagus is not always possible due to the invasiveness and unavailability of the method. The aim of the study was to develop an affordable non-invasive method for diagnosing PLR. The study group consisted of 48 patients with PLR proven by the results of impedance pH-monitoring. The control group consisted of 20 healthy patients. The “Pharyngolaryngeal reflux index” questionnaire was developed based on the analysis of patient complaints. The questionnaire was assessed using ROC analysis. Patients who scored 5.5 points according to the results of the questionnaire with a probability of 93.2% have PLR. Thus, a method for the diagnosis of PLR has been developed, including the simultaneous comparison of the laryngoscopic signs of PLR with the highest diagnostic sensitivity (hyperemia, edema, maceration of the interarytenoid mucosa) and “Pharyngolaryngeal reflux index” questionnaire results, which allows diagnosing of PLR.

Pharyngolaryngeal reflux – a new clinical entity?

In the past, pharyngolaryngeal reflux was considered a com­pli­cation of the gastroesophageal reflux disease. The gas­tro­esophageal reflux disease is a clinical entity be­long­ing to gastroenterology and it represents all the symp­toms due to reflux of the gastric content in the eso­pha­gus, whether or not accompanied by lesions of the eso­pha­geal mu­co­sa, being diagnosed and managed by the gastro­en­te­ro­logist. The pharyngolaryngeal reflux, known in the specialty literature as „the silent reflux“, is considered a distinct clinical entity, diagnosed and managed by the oto­la­ryn­go­lo­gist due to its specific symptoms caused by the as­cen­sion of the gastric content to the pharyngolaryngeal level, causing laryngeal mucosal lesions. The authors are focusing on establishing a diagnosis and treatment al­go­rithm for pharyngolaryngeal reflux, reviewing the sym­p­to­ma­to­logy and the impact of this pathology on the nor­mal anatomy and physiology of vocal tract structures, spe­ci­fi­cally on the differences between pharyngolaryngeal reflux and gastroesophageal reflux disease (GERD).

Динамика акустических параметров голоса у больных после антирефлюксных операций

The article is devoted to the influence of pharyngolaryngeal reflux on the voice acoustic parameters in patients before and after the antireflux surgery (fundoplication). The study involved 12 patients aged 33 to 64 years with a confirmed impedance–pH monitoring diagnosis of gastroesophageal reflux disease. The control group included 10 patients aged 18 to 33 years. These subjects did not have any upper respiratory diseases (including pharyngolaryngeal reflux) and gastrointestinal tract diseases. Computer voice analysis was used to objectively evaluate the voice acoustic parameters. In patients before fundoplication, a statistically significant increase in Jitter and Shimmer parameters was observed in 100% of cases compared with the control group (p ≤ 0,05). In the late postoperative period, 6 months after surgery, the analysis of acoustic parameters of voice in the study group revealed: Jitter and Shimmer indicators in 100% of cases significantly decreased compared to the preoperative values (p ≤ 0,05), which indicates an improvement in voice function. Jitter and Shimmer were the most diagnostically significant parameters.

Use OF NBI for the assessment of clinical signs of rhino-pharyngo-laryngeal reflux in pediatric age: Preliminary results

ObjectivesLaryngopharyngeal reflux (LPR) is a complex problem in pediatric population: diagnosis and clinical presentation are still controversial.Classic white light endoscopy shows some pathognomonic signs of LPR in children, such as thickening of pharyngo-laryngeal mucus, the cobblestoning aspect of pharyngeal mucosa, arytenoid edema/hyperemia, nodular thickening/true vocal cord edema, hypertrophy of the posterior commissure, subglottic edema.The NBI (Narrow Band Imaging) technology, generally used in oncology, allows to study neoangiogenesis and hypervascularization of the mucosa, common aspects in both chronic inflammation and neoplastic transformation. The aim of our study was to evaluate the added value of this technology in identifying the main laryngopharyngeal reflux sign in a pediatric population. MethodsWe evaluated at the Otolaryngology Unit of the “Fondazione Policlinico A. Gemelli” hospital and the Airway Surgery Unit of the “Bambino Gesù” Children's Hospital 35 patients aged from 2 months to 16 years divided into two groups in the period between November 2017 and May 2018. Group A included patients with clinical suspicion of LPR after gastroenterologist evaluation and Group B included patients who underwent an endoscopic evaluation for the assessment of recurrent respiratory symptoms such as stridor, recurrent croup, wheezing and persistent cough. We performed an endoscopic evaluation by white light and NBI for each patient, comparing the results of both methods to evaluate signs of pharyngo-laryngeal reflux and to calculate the value of reflux finding score (RFS). ResultsThe analysis of the data showed: for Group A an average value of RFS with white light of 11,84 (range 8–17, standard deviation 2,52 ± 0,57) and with NBI of 13,63 (range 10–17, standard deviation 2,13 ± 0,49); for Group B the analysis of the data showed an average value of RFS with white light of 10,06 (range 8–14, standard deviation 2,32 ± 0,58) and with NBI of 12,50 (range 9–18, standard deviation 2,63 ± 0,65). The comparison between the two methods resulted significant.Furthermore evaluation by NBI allowed to highlight other signs of pharyngo-laryngeal reflux, characteristic of pediatric age and not included in RFS, in particular cobblestone aspect of the hypopharingeal mucosa, phlogosis of the tonsillar crypts and adenoid surface, hyperemia and hypervascularization of subglottic and tracheal mucosa. ConclusionAlthough still preliminary our results represent an interesting starting point for further studies, because they underline the potentiality of NBI endoscopy in LPR evaluation and how this technology could improve the identification of reflux signs.

Eosinophilic esophagitis: an underdiagnosed cause of dysphagia and food impaction to be recognized by otolaryngologists.

Eosinophilic esophagitis (EoE) is arecently recognised pathologic entity whose prevalence has risen significantly since first being described in 1993. Defined as achronic, local immune-mediated disease with predominant eosinophil infiltration, it is nowadays the leading cause of dysphagia and food bolus impaction in children and young adults. Genetic and environmental risk factors, and especially food antigens, trigger the disease and are in the focus of investigation as avoidance can cure three quarters of patients. The most common antigen involved is milk, followed by egg and gluten. These patients frequently come undiagnosed to the otolaryngologist with complaints of dysphagia and recurrent non-sharp food impactions, although pharyngolaryngeal reflux symptoms and other airway complaints could also be afirst sign. Delayed diagnosis and treatment can produce fibrostenosis of the esophagus that greatly impairs patients' quality of life.In-office transnasal esophagoscopy with esophageal biopsy offers aunique opportunity to promptly diagnose and follow-up these patients, without causing the morbidity of repeated sedations and reducing exploration overload in gastroenterology departments. The search for food-antigen triggers, response evaluation to swallowed steroids, or proton pump inhibitors (PPIs) make multiple endoscopies and biopsies necessary every 6to 8weeks.There are three first-line interchangeable treatments with the same recommendation: PPIs, dietary allergen elimination and topical swallowed steroids. The choice should be discussed with the patient on an individual basis.The objective of this article is to raise awareness of this condition, update otolaryngologists with the new EoE consensus, and highlight the need for biopsy in patients with dysphagia to rule out EoE.

Reflux Laryngitis: Correlation between the Symptoms Findings and Indirect Laryngoscopy.

Introduction The indirect laryngoscopy has an important role in the characterization of reflux laryngitis. Although many findings are nonspecific, some strongly suggest that the inflammation is the cause of reflux. Objective The aim of this study was to evaluate the correlation between reflux symptoms and the findings of indirect laryngoscopy. Methods We evaluated 27 patients with symptoms of pharyngolaryngeal reflux disease. Results Laryngoscopy demonstrated in all patients the presence of hypertrophy of the posterior commissure and laryngeal edema. The most frequent symptoms were the presence of dry cough and foreign body sensation. Conclusion There was a correlation between the findings at laryngoscopy and symptoms of reflux.

PH values in the pharynx of the patients presenting with compromised nasal breathing of inflammatory and non-inflammatory genesis concomitant with gastroesophageal reflux disease

The objective of the present study was to estimate the influence of gastroesophageal reflux disease (GERD) on the pH values in the pharynx and nose. It included 87 patients at the age varying from 18 to 81 years admitted to the Irkutsk-based Railway Clinical Hospital and allocated to four groups. Group 1 was comprised of 25 patients presenting with gastroesophageal reflux disease and chronic rhinosinusitis (CRS), group 2 consisted of 29 patients with CRS in the absence of GERD, group 3 included 22 patients with nasal septum deformations (NSD) and GERD, group 4 included 11 patients with NSD and motor rhinitis without GERD. The control group was formed from 10 volunteers. pH was measured by the contact method with the use ofEkokhim indicator paper. Gastroesophageal reflux disease was diagnosed following the recommendations of the Montreal consensus. It was shown that pH values in the pharynx of the patients with compromised nasal breathing of any origin in combination with GERD were lower than in the absence of GERD and in the healthy volunteers. The study groups did not differ in terms of pH values in the nasal cavity. It is concluded that pH values 4 or lower may serve as the criterion for pharyngo-laryngeal reflux (PLR) concomitant with HERD while pH 5 occurs more frequently in the patients with compromised nasal breathing of any etiology, regardless of the presence or absence of GERD.Disordered nasal breathing of any genesis in the patients presenting with gastroesophageal reflux disease was associated with the feeling of the lump in the throat, congestion of the respiratory tract and the nose, pain in the ears, cardialgia, and irregular heartbeat. It isrecommended to use pH measurements as a criterion for diagnostics of pharyngo-laryngeal reflux in the patients presenting with gastroesophageal reflux disease.

Laringitis graves asociadas a reflujo gastroesofágico

There is a strong association between gastroesophageal reflux and pharyngolaryngeal reflux as factors leading to respiratory disease, manifested as dysphonia, wheezing, coughing, recurrent laryngitis, bronchial obstruction, laryngospasm and apparent life-threatening events (ALTEs). These manifestations can be mild or severe and may sometimes put the patient's life at risk. We present two cases of patients with severe laryngitis who required endotracheal intubation, one of which underwent tracheostomy. The diagnostic methods and their limitations and the patients outcomes are described.

Gastroesophageal reflux disease and pharyngo-laryngeal reflux in the patients presenting with obstructive sleep apnea syndrome

Gastroesophageal reflux disease and pharyngo-laryngeal reflux in the patients presenting with obstructive sleep apnea syndrome

The Role of the Larynx in Chronic Cough

Cough lasting more than 8 weeks is considered chronic. If the classic causes of chronic cough have been discarded, vagus nerve sensory disturbances are currently considered the most important etiological cause. Patients with chronic cough of laryngeal origin have associated symptoms such as globus, dysphagia, dysphonia, dyspnoea and/or stridor. These patients are more likely to have paradoxical vocal fold movement. There is a higher cough reflex sensibility and neuropathic laryngeal response, mainly caused by viral infection or reflux. The cough associated with reflux has 2 mechanisms: Exposure to acid in the distal oesophagus (gastroesophageal reflux) and microaspiration of oesophageal contents into the larynx and tracheo-bronchial tree (pharyngo-laryngeal reflux). Laryngeal neuropathy hypersensitivity responds well to speech therapy as a treatment for refractory chronic cough. Because chronic cough is a sign of laryngeal sensory, neuropathy can improve with neuroleptic drugs such as amitriptyline and gabapentin.

Pharyngolaryngeal Reflux Simulating Vocal Fold Paralysis Hoarseness following Total Thyroidectomy

Objectives: Systemic multifocal fibrosclerosis is a syndrome characterized by the presence of fibrosis in various locations, most often retroperitoneal, mediastinal, and thyroid (Riedel thyroiditis). The fibrosis in the thyroid tissue can extend to the laryngeal cartilages and muscles, leading to respiratory distress. A thyroidectomy is, in these cases, an intervention to consider. Recognize potential “rare” causes of hoarseness following thyroid surgery. Method: Hoarseness case study. A 69 year old man presented to the ear, nose, and throat (ENT) consultation with a history of hoarseness and aspiration following total thyroidectomy for Riedel’s thyroiditis. Physical examination revealed exuberant pharyngolaryngeal reflux with consequent edema and redundancy of arytenoid mucosa with simetric mobility of the vocal folds. Results: Worsening dysphonia after total thyroidectomy, particularly in the context of Riedel thyroiditis, leads to suspicion of iatrogenic vocal fold paresis. The vocal fold preserved mobility, associated with signs of exuberant pharyngolaryngeal reflux with extensive mucosal damage, reveals an unsuspected cause of hoarseness. The authors postulate that post-operatory changes in esophagic sphincter pressure may have triggered reflux. Conclusions: Rare causes of hoarseness following thyroid surgery should be considered in order to promptly establish a correct treatment plan.

Participación laríngea en la tos crónica

Cough lasting more than 8 weeks is considered chronic. If the classic causes of chronic cough have been discarded, vagus nerve sensory disturbances are currently considered the most important etiological cause. Patients with chronic cough of laryngeal origin have associated symptoms such as globus, dysphagia, dysphonia, dyspnoea and/or stridor. These patients are more likely to have paradoxical vocal fold movement. There is a higher cough reflex sensibility and neuropathic laryngeal response, mainly caused by viral infection or reflux. The cough associated with reflux has 2 mechanisms: Exposure to acid in the distal oesophagus (gastroesophageal reflux) and microaspiration of oesophageal contents into the larynx and tracheo-bronchial tree (pharyngo-laryngeal reflux). Laryngeal neuropathy hypersensitivity responds well to speech therapy as a treatment for refractory chronic cough. Because chronic cough is a sign of laryngeal sensory, neuropathy can improve with neuroleptic drugs such as amitriptyline and gabapentin.

Ribosomal therapy in patients with pharyngolaryngeal reflux

Conclusions: Our data confirm the induction of specific and nonspecific immune responses of the upper respiratory tract mucosa and the consequent improvement of its physiology, through an oral ribosomal therapy in patients with pharyngolaryngeal reflux disease (PLRD). Objectives: The aim of this study was to investigate the efficiency and applicability of oral ribosomal immunotherapy in adult patients with PLRD. Methods: One hundred adult patients with PLRD were enrolled. The patients were equally divided, at random, into two groups (A and B): group A patients underwent ribosomal prophylaxis with Immucytal® (one tablet daily, 8 days a month for 3 months), while group B received a placebo (same dosage for the same period). At the beginning, at the end, and 6 months after the beginning of the therapy, all patients underwent medical history, ENT examination, nasal-pharynx-laryngoscopy with optic fiber, plasma levels of immunoglobulins class E, A, G, M, subjective assessment of symptoms on a 10 cm visual analog scale (VAS), reflux symptoms index, and reflux finding score. Results: At the end and 6 months after the beginning of the treatment, all the patients in group A presented a significant (p < 0.05) improvement of almost all the different items analyzed.

Experimental model of smoking and simulation of reflux with acid and pepsin in rats

PURPOSE: To develop experimental models to evaluate the effects of hydrochloric acid associated with the pepsin instilled in the mucosa of the upper esophagus and the esophagogastric junction of young male rats Wistar, simulating injury caused by gastroesophageal reflux on the mucosa of aero-digestive tract in humans as well as the action of the risk exposure of mucosa to cigarette smoke. METHODS: Fifty young male Wistar rats divided in 5 groups with 10 animals each one, respectively simulating pharyngo-laryngeal reflux and gastroesophageal reflux, pharyngo-laryngeal reflux and smoking, smoking only, gastroesophageal reflux and control group. RESULTS: The histopathologic studies no recorded neoplasias, only mild changes and no significant alterations. The hemo-oximetry (carboxyhemoglobin and methemoglobim) and CO2 concentration confirm that the animals were submitted to high intensity of exposure to carcinogens in tobacco and its derivatives. CONCLUSION: The experimental models were highly efficient, practical, easy to use and economical and can be employed in other similar studies to determine the harmful effects by smoking and reflux.

Pharyngolaryngeal reflux in patients who underwent cervical esophago-gastrostomy following esophagectomy

Pharyngolaryngeal reflux has been generally accepted as a cause for pharyngolaryngitis, hoarseness, aspiration pneumonia, chronic cough, and nocturnal asthma. Although patients who have undergone gastric conduit reconstruction after esophagectomy are at a high risk to pharyngolaryngeal reflux disease (PLRD), PLRD after esophagectomy is still unknown. The aim of this study is to investigate the correlation between reflux pharyngolaryngitis and acid reflux into the hypopharynx and into the cervical esophagus in patients who have undergone cervical esophagogastrostomy. We enrolled 62 patients who received follow-up endoscopy and 24-h pH monitoring after cervical esophagogastrostomy. These included 26 at 1 month after surgery and 36 at 1 year or more after surgery. We investigated: (i) the correlation between the extent of reflux pharyngolaryngitis and that of reflux esophagitis based on endoscopic findings; and (ii) the correlation between the extent of reflux pharyngolaryngitis and that of acid exposure -'% time pH < 4' measured by 24-h pH monitoring - in the hypopharynx and in the cervical esophagus, and of acidity in the gastric conduit. There was no difference in acid exposure between the hypopharynx and the cervical esophagus according to time after surgery. However, the acidity in the gastric conduit was significantly more at one year or more after surgery compared with acidity at 1 month after surgery (P= 0.001). There was a significant correlation between acid exposure in the hypopharynx and that in the cervical esophagus (P < 0.001), although acid exposure in the hypopharynx was significantly less than that in the cervical esophagus (P < 0.001). A significant correlation between reflux pharyngolaryngitis and reflux esophagitis was observed (P < 0.001). There was a significant correlation between reflux pharyngolaryngitis and acid exposure in the hypopharynx (P= 0.021), and also that in the proximal esophagus (P= 0.001). The correlation between the extent of reflux pharyngolaryngitis and the acidity in the gastric conduit was not observed. These findings are consistent with pharyngolaryngitis being caused by gastro-esophago-pharyngolaryngeal reflux in patients after cervical esophagogastrostomy, despite the upper esophageal sphincter strongly preventing acid reflux from the cervical esophagus into the hypopharynx.

The prevalence of laryngeal pathology in a treatment‐seeking population with dysphonia

This article describes the prevalence of laryngeal pathology in a treatment-seeking population with dysphonia in the Flemish part of Belgium. Retrospective investigation. During a period of 5 years (2004-2008), data were collected from 882 patients who consulted with dysphonia at the ear, nose, and throat department of the University Hospital in Ghent (Belgium). Laryngeal pathology was diagnosed using videostroboscopy. Ages ranged from 4 years to 90 years. Functional voice disorders were most frequently diagnosed (30%), followed by vocal fold nodule (15%), and pharyngolaryngeal reflux (9%). The role of age, gender, and occupation was investigated. Pathologies were significantly more common in females than in males, representing 63.8% and 36.2% of the population, respectively. Professional voice users accounted for 41% of the workforce population, with teachers as main subgroup. In professional voice users, functional dysphonia occurred in 41%, vocal fold nodules in 15%, and pharyngolaryngeal reflux in 11%. Our data were compared with data from other countries. Functional voice disorders were overall the most common cause of voice disorders (except in childhood), followed by vocal fold nodules and pharyngolaryngeal reflux. Professional voice users accounted for almost one half of the active population, with functional voice disorders as the main cause of dysphonia.

Endoscopic classification for reflux pharyngolaryngitis

The quality of life in patients who have undergone surgery for esophageal cancer is frequently disturbed by postoperative gastroesophageal reflux disease or pharyngolaryngeal reflux disease. Recently, there have been many reports on gastroesophageal reflux disease after esophagectomy, and only a few on pharyngolaryngeal reflux disease. There is not yet any convenient endoscopic classification of reflux pharyngolaryngitis. We designed a new classification for reflux pharyngolaryngitis based on endoscopic findings. Our new classification consists of the five grades from 0 to IV based on (i) the extent and severity of erythema and/or edema in the pharynx and the larynx, and (ii) the extent and severity of granulation or scarring stenosis in the vocal cords. Ninety-three patients after cervical esophagogastrostomy after esophagectomy (the CEG group) and 28 patients after intrathoracic esophagogastrostomy (the TEG group) were reviewed in this study. We investigated the relation between the severity of reflux pharyngolaryngitis and clinical symptoms in these patients, and the correlation between this new classification of reflux pharyngolaryngitis and the Los Angeles classification of reflux esophagitis. Reflux esophagitis was more severe in the TEG group than in the CEG group, while there was no difference in the grading of reflux pharyngolaryngitis between the two groups. The pharyngolaryngeal symptoms and F-scale scores were not correlated with the severity of reflux pharyngolaryngitis in each group. The grading of reflux pharyngolaryngitis and that of reflux esophagitis was correlated in each group (P<0.001 in the CEG group and P=0.002 in the TEG group). We proposed a new endoscopic classification of reflux pharyngolaryngitis. The new classification of reflux pharyngolaryngitis correlated fairly well with the Los Angeles classification of reflux esophagitis, although this classification did not correlate with the clinical symptoms in patients who underwent esophagectomy. Follow-up attention including upper endoscopy should be paid to reflux pharyngolaryngitis in patients after esophagogastrostomy as well as reflux esophagitis, because there is often a lack in symptoms regardless of high incidence of pharyngolaryngitis.

Pharyngolaryngeal reflux: Findings and response to the therapeutic trial

Problem: Pharyngolaryngeal reflux (PLR), associated with gastroesophageal reflux (GERD), is a common clinical entity. Although double-probe pH monitoring is currently considered the gold standard for diagnosis, several authors agree that a therapeutic trial is a reasonable initial diagnostic tool for most patients. Methods: Thirty-eight patients were enrolled in the study; 87% completed 12 weeks of treatment. Patients were evaluated at the beginning of the study, and once again every 4 weeks after being started on a high dosage of proton pump inhibitor (PPI). All patients underwent clinical interview, including Reflux Symptom Index (RSI), as well as laryngoscopy with grading of Reflux Finding Scale (RFS). Biopsies were obtained from 12 patients; 12 arytenoid samples and 10 postcricoid area samples were evaluated. Results: The mean pretreatment RSI was 22.62,,b8.82, improving to 8.54,,b7.48 by 12 weeks of treatment ( P < 0.001). The pretreatment mean RFS was 12.57,,b2.34, improving to 9.58,,b2.55 by the end of the study ( P < 0.001). The concordance rate between observers for the RFS was only moderate (Kappa = 0.448). The histologic findings included basal epithelial hyperplasia, edema, chronic inflammation, vascular congestion, and epithelial papillomatosis. The model obtained by logistic regression associated a positive response to the therapeutic trial with esophagogastric symptoms of GERD, subglottic edema, and total RFS score. Conclusion: Clinical manifestations of PLR improved by the fourth week of treatment; the improvement continued up to the twelfth week of treatment. Endoscopic findings showed a more delayed response by the eighth week of treatment. The therapeutic trial should be the initial diagnostic tool for most patients. The RFS should be validated in our population. Significance: Double-probe pH monitoring is not readily available, a therapeutic trial is therefore a good initial diagnostic tool for most patients. We describe histologic findings of PLR, which are seldom described in the literature. We report findings of RSI and RFS in a different population. Support: None reported.