Reflux Finding Score Research Articles

Characteristics and Management of Laryngopharyngeal Reflux in The Elderly : A Case Report

Laryngopharyngeal reflux is a condition resulting from the retrograde flow of stomach acid through the distal esophagus into the laryngopharyngeal area. The prevalence of laryngo-pharyngeal reflux in the elderly population remains uncertain. Therefore, the symptoms, findings, and therapy for laryngopharyngeal reflux in the elderly require further investigation. To analyze the characteristics and management of laryngopharyngeal reflux in the elderly. A case of laryngopharyngeal reflux in a 70-year-old woman who frequently experiences sudden choking sensations is presented in this report. Other symptoms include hoarseness, a sensation of throat obstruction, and chest burning. We explored literature on laryngopharyngeal reflux in the elderly through PubMed, PMC, and Google Scholar databases to discuss the case. Laryngopharyngeal reflux in the elderly has a lower reflux symptoms index but a higher reflux finding score. Mental health factors significantly influence laryngopharyngeal reflux incidence in the elderly. Therefore, besides pharmaco-logical therapy, additional non-pharmacological therapies need to be considered to ensure effective laryngopharyngeal reflux treatment. Elderly patients diagnosed with laryngopharyngeal reflux have different presentations and management of the disease compared with younger patients.

Association between laryngopharyngeal reflux clinical scores and esophageal multichannel intraluminal impedance pH monitoring interpretation according to Lyon Consensus 2.0.

Laryngopharyngeal reflux remains a diagnostic challenge due to the lack of a definitive diagnostic tool. Esophageal multichannel intraluminal impedance (MII) pH monitoring has been proven reliable for detecting gastric reflux. This study aims to evaluate the association between clinical scores and MII/pH monitoring according to the Lyon Consensus 2.0. Patients with laryngo-pharyngeal symptoms (LPS) who had a reflux symptom index (RSI) ≥13 or reflux finding score (RFS) ≥7 underwent MII/pH monitoring. The findings were analyzed in comparison with clinical scores. A total of 100 patients meeting the inclusion criteria were recruited for this study. MII/pH monitoring revealed a median acid exposure time (AET) of 1.9% (interquartile range [IQR] = 0.2, 4.9), with 22% of patients recording an AET above 6%. The median number of reflux episodes was 29.5 episodes per day (IQR = 19.0, 43.8), with 7% experiencing more than 80 episodes per day. Gas reflux was identified as the most prevalent type. Based on the Lyon Consensus 2.0, 25 patients exhibited conclusive pathological reflux, while 75 patients showed no conclusive evidence of pathological reflux. No significant differences were found in RSI and RFS between these groups. Only gas reflux episodes showed a significant correlation with RSI (r = 0.255, P = 0.011). RSI and RFS among patients with LPS showed no statistically significant differences in identifying pathological reflux or no conclusive evidence of pathological reflux. This finding suggests that the pathophysiology underlying LPS may not be solely attributable to reflux.

Does reflux symptom index and reflux finding score have clinical utility in the diagnosis of laryngopharyngeal reflux disease?

BackgroundReflux symptom index(RSI) and reflux finding score (RFS) are widely used scoring systems used to diagnose laryngopharyngeal reflux disease(LPRD). However many patients do visit the outpatient department with minimal symptoms not sufficient to fit the criteria described by Belafsky et al. for diagnosing LPRD. Most of these patients are provisionally diagnosed and treated for LPRD. Reflux symptom index(RSI) and reflux finding score (RFS) are widely used scoring systems used to diagnose(LPRD) (Belafsky PC et al., J Voice 16(2):274–7, 2002, Belafsky PC et al, Laryngoscope 111(8):1313–7, 2001).RSI has nine questions that the patient must grade from 0 to 5. An abnormal score is greater than 13. Laryngopharyngeal reflux (LPR) may or may not be diagnosed using the RSI and RFS especially when patients present with minimum symptoms not sufficient to score more than 13 and 7 respectively. These patients may miss the diagnosis and have to be treated empirically. Pepsin’s presence in the saliva is indicative of reflux as pepsin is a gastric enzyme (NICE advice on Peptest for diagnosing gastro-oesophageal reflux, 2015, Wood JM et al., J Laryngol Otol 125(12):1218–24, 2011). Patients with minimum symptoms may be missed if diagnosis relies only on RSI AND RFS. The present study aims to see the correlation of pepsin-proven LPRD and RSI and RFS.MethodsThis is a prospective study, 49 patients with symptoms suggestive of LPRD who tested positive for the pepsin test were further analysed for RSI and RFS. A cut-off value of > 25 ng/mL was considered diagnostic of LPRD (Dhillon VK et al., Curr Gastroenterol Rep 18(8):44, 2016).ResultThe average RSI and RFS were respectively 10 and 4. The mean age of the patients in the study was 39 years and the mean weight was 60 kg. The association between RSI and PEPSIN detection is considered to be not statistically significant. Chi-squared equals 0.086 with 1 degree of freedom. The two-tailed P value equals 0.7698. Chi-squared equals 0.233 with 1 degree of freedom. The two-tailed P value equals 0.6295. The association between RFS and PEPSIN detection is considered to be not statistically significant.In terms of correlation analysis, neither the RSI nor the RFS had Pearson’s correlation coefficient that was statistically significant.ConclusionSince salivary pepsin detection and the RSI do not have any significant correlation, the RSI is not a valid diagnostic method for LPR and should not be used exclusively.Level of evidence4.

Role of reflux symptom index score in diagnosis of laryngopharyngeal reflux

Background: The retrograde flow of gastric contents to the upper aero digestive tract is known as laryngo pharyngeal reflux disease (LPRD). Diet and lifestyle play a huge role in the pathophysiology of LPR. Methods: A hospital based cross sectional study in the Department of ENT, KMCT, Kozhikode. 291 Patients were selected from those who presented to the OPD with throat symptoms who scored >10 in a questionnaire (Reflux symptom Index) that was provided and were advised to undergo video laryngoscopy and their reflux finding score (RSI)was calculated. LPRD prevalence, RSI/Reflux Findings Score (RFS) correlations, and clinical/ laryngoscopic (video laryngoscopy) associations were analyzed. Results: LPRD prevalence was 68.7%, higher in females (60.1%) and the 41-50 age group (31.3%). Increased spicy food/caffeine intake and shorter dinner-bedtime intervals were significantly associated. Heartburn/indigestion was the most common symptom, with RSI mean 12.94±2.26. Erythema/hyperaemia was the most frequent laryngeal finding, with RFS mean 8.47±2.40. RSI and RFS scores significantly correlated. Conclusions: This study demonstrates a high LPRD prevalence among patients with throat symptoms, particularly in females aged 41-50 and influenced by dietary/lifestyle factors. RSI effectively identified LPRD in this resource-constrained setting, highlighting its diagnostic value. These findings provide valuable insights for managing and further investigating LPRD.

The Impact of a Twice-daily Versus Once-daily Proton Pump Inhibitor Dosing Regimen on Laryngopharyngeal Reflux Symptoms: A Prospective Randomized Controlled Trial.

Proton pump inhibitors (PPIs) play a crucial role in managing laryngopharyngeal reflux (LPR), but the optimal dosing regimen remains unclear. We aim to compare the effectiveness of the same total PPI dose administered twice daily versus once daily in LPR patients. We conducted a prospective randomized controlled trial at a tertiary referral hospital, enrolling a total of 132 patients aged 19 to 79 with LPR. These patients were randomly assigned to receive either a 10 mg twice daily (BID) or a 20 mg once daily (QD) dose of ilaprazole for 12 weeks. The Reflux Symptom Index (RSI) and Reflux Finding Score (RFS) were assessed at 8 weeks and 16 weeks. The primary endpoint was the RSI response, defined as a reduction of 50% or more in the total RSI score from baseline. We also analyzed the efficacy of the dosing regimens and the impact of dosing and duration on treatment outcomes. The BID group did not display a higher response rate for RSI than the QD group. The changes in total RSI scores at the 8-week and 16- week visits showed no significant differences between the 2 groups. Total RFS alterations were also comparable between both groups. Each dosing regimen demonstrated significant decreases in RSI and RFS. Both BID and QD PPI dosing regimens improved subjective symptom scores and objective laryngoscopic findings. There was no significant difference in RSI improvement between the 2 dosing regimens, indicating that either dosing regimen could be considered a viable treatment option.

Efficacy and safety of fexuprazan in patients with symptoms and signs of laryngopharyngeal reflux disease: a randomized clinical trial.

Laryngopharyngeal reflux disease (LPRD) is mainly treated with proton pump inhibitors (PPI) such as esomeprazole, which have shortcomings like delayed absorption and increased osteoporosis. Fexuprazan is a novel potent potassium-competitive acid blocker that inhibits gastric acid secretion with rapid onset and long duration of action. To assess the efficacy and safety of fexuprazan compared to esomeprazole in patients with LPRD. This prospective, randomized, double-blinded, multicenter, active-controlled trial was conducted in nine otolaryngologic clinics. Patients with reflux symptom index (RSI) ≥ 13 and reflux finding score (RFS) ≥ 7 were randomly assigned to the fexuprazan or esomeprazole groups, and received fexuprazan 40-mg or esomeprazole 40-mg once daily for 8weeks. The outcomes were (1) mean change, change rate, and valid rate in RSI, RFS, and LPR-related questionnaires; and (2) adverse events. A total of 136 patients (fexuprazan n = 68, esomeprazole n = 68) were followed up for ≥ 1month. Each parameter significantly improved after 4 and 8weeks in each group, with no significant differences between the two groups. For those with severe symptoms (RSI ≥ 18), the fexuprazan group (n = 32) showed more improvement in the mean change and change rate in the RSI than esomeprazole group (n = 31) after 4weeks (p = .036 and .045, respectively). This phenomenon was especially observed in hoarseness and troublesome cough. Fexuprazan improved symptoms and signs without no serious adverse events in patients with LPRD. In patients with severe symptoms, fexuprazan resulted in a faster symptom improvement than PPI. KCT0007251, https://cris.nih.go.kr/cris/search/detailSearch.do?seq=22100 .

Analysis of 1782 Pediatric Hoarseness Cases: A Clinical Retrospect Study

ObjectiveThis study aims to clarify the clinical characteristics of pediatric voice disorders. MethodsThe clinical data of 1,782 pediatric patients presenting with voice disorders were retrospectively analyzed. These cases were categorized into four age-based cohorts: 0–3 years, 4–7 years, 8–11 years, and 12–15 years. Variables such as gender disparities, laryngoscopic manifestation, disease types, and acoustic parameters were thoroughly examined. ResultsA total of 1,782 children with acoustic hoarseness were included in this study, comprising 1,325 males and 457 females. When the sex ratio among the children in each group was compared, males were found to outnumber females. A notable male predominance was observed across all age groups.Laryngoscopic results revealed that the most prevalent condition was vocal cord nodules (1,363 cases, 76.48%), followed by vocal cord polyps (271 cases, 15.20%). Other diseases included laryngeal papillomas, vocal fold movement impairment, vocal cord cysts, functional dysphonia, leukoplakia of the vocal cords, and benign laryngeal tumors such as laryngeal amyloidosis and subglottic granular cell tumors. Among these, adenoid hypertrophy was presented in 382 children (21.44%). Additionally, the Reflux Finding Score (RFS) was conducted, and 799 cases (44.83%) were found to have a score above 7.The distribution of various diseases across different age groups indicated that children with vocal cord nodules (637 cases, 46.74%), vocal cord polyps (109 cases, 40.22%), and laryngeal papillomas (35, 36.84%) were predominantly found in the 4–7 years age group. Pediatric acute laryngitis (3 cases, 75%) and vocal fold movement impairment (8 cases, 36.36%) were more common in the 0–3 years age group. Functional dysphonia (4 cases, 66.67%) and vocal cord leukoplakia (4 cases, 80%) were mainly observed in the 12–15 years age group, while vocal cord cysts were predominantly seen in the 8–11 years age group (4 cases, 57.14%).A comparative analysis of acoustic parameters among 153 children showed statistically significant differences in jitter, fundamental frequency (F0), voice handicap index (VHI), reflux symptom index (RSI), and reflux finding score (RFS) across different pathologies. ConclusionThis study highlighted that vocal cord nodules, vocal cord polyps, and laryngeal papillomas were the primary causes of pediatric hoarseness, although the possibility of tumors and rare diseases cannot be disregarded. There was a noticeable gender bias towards males, and functional dysphonia was significantly more prevalent in older children.

Reflux Finding Score and Reflux Symptom Index Potential Indicators for Diagnosis and Management of Laryngopharyngeal Reflux Disease.

Retrograde movement of gastric contents into the pharynx is termed Laryngopharyngeal Reflux (LPR). It represents an extraesophageal manifestation associated with gastroesophageal reflux disease (GERD). The objective of the study is to investigate the clinical profile of LPR and its response to treatment. Three hundred consecutive patients who presented to the ENT outpatient department with a clinical profile of LPR were selected. The patients' symptoms were assessed using the Reflux Symptom Index (RSI), followed by an endoscopic examination of the larynx and scoring using the Reflux Finding Score (RFS). Patients were started on LPR treatment if they had an RSI score of 13 and an RFS of more than 7. The patients were then started on medication and monitored for three months. The most common symptom in our research sample (52%) was a foreign body sensation in the throat. On endoscopic examination of the larynx, the most common sign was hyperemia/erythema of laryngeal tissue, especially bilateral arytenoids. Most of our patients responded favorably to a combination of pantoprazole (40mg) and domperidone (30mg) for 4 weeks. This was measured by the reduction in RSI and RFS scores. LPR is a frequently encountered clinical entity, and otorhinolaryngologists should consider it when treating patients with chronic symptoms such as throat pain and voice changes. Appropriate LPR diagnosis and care can help prevent unnecessary prescriptions for antibiotics and surgical interventions in these patients.

A Cross Sectional Study on the Prevalence Risk Factors and Clinical Presention of Laryngopharyngeal Reflux Disease at a Tertiary Care Hospital

Background: Laryngopharyngeal reflux disease is an extraesophageal variant of gastro-esophageal reflux disease. It is a disease with high prevalence which is usually under reported or misdiagnosed due to lack of definite diagnosis. It can affect the quality of life of the patients. Hence, it is important to identify the risk factors associated with the disease.Methods: This was a hospital based cross sectional study conducted in a tertiary care hospital of Kerala for aperiod of one year. All patients with more than 18 years of age presented with throat and voice symptoms for more than six weeks were included in our study. A questionnaire based on Reflux Symptom Index (RSI) put forward by Belafsky were distributed to the patients and the responses were collected. Out of patients who responded, those who had an RSI score > 13 were diagnosed to be suffering from LPRD. Additional questions were included in the questionnaire to assess the risk factors. All patients having RSI >13 underwent flexible endoscopic examination to establish Reflux Finding Score (RFS) put forward by Belafsky et al. Patients having a score of 7or higher were classified as having LPRD.Conclusion: In our study we found the prevalence of laryngopharyngeal reflux to be 20.89%.The most common symptoms among the LPRD positive patients in our studygroup were sensation of lump in throat and heart burn,chest pain, indigestion or stomach acid coming up.

Validity and Reliability of the Reflux Sign Assessment-10 (RSA-10).

To develop and validate the Reflux Sign Assessment-10 (RSA-10) for documenting the physical findings of laryngopharyngeal reflux disease (LPRD). Patients with LPRD at the hypopharyngeal-esophageal multichannel intraluminal impedance-pH monitoring and asymptomatic individuals were consecutively recruited from two European hospitals. Three experienced otolaryngologists rated RSA-10 in patients and controls for assessing internal validity. RSA-10 was rated within a 7-day period to assess test-retest reliability. Internal consistency was measured using Cronbach's α in patients and controls. Convergent validity was evaluated through a correlation analysis between RSA-10 and Reflux Finding Score (RFS). Interrater reliability was evaluated by comparing the RSA-10 evaluations of the three otolaryngologists through Fleiss kappa. Pre- to posttreatment change of RSA-10 was evaluated to assess responsiveness to change. The RSA-10 thresholds were examined by receiver operating characteristic analysis. Fifty-five patients completed the pre- to posttreatment evaluations from January 2020 to December 2023. A total of 115 asymptomatic individuals completed the study. RSA-10 reported high internal consistency reliability (α = 0.822) and test-retest reliability (rs = 0.725). The RSA-10 scores of patients were significantly higher than those of controls (p = 0.001), suggesting high internal validity. RSA-10 was significantly correlated with the RFS (rs = 0.771). The interrater reliability was adequate for sub- and total RSA-10 scores (k = 0.708). RSA-10 significantly improved from baseline to 3-month posttreatment (p = 0.001). An RSA-10 > 13 may be suggestive of LPRD. Both RSA-10 > 13 and Reflux Symptom Score-12 > 11 were associated with a sensitivity of 92.7% and a specificity of 97.3%. The RSA-10 is a reliable and valid clinical instrument for documenting the most prevalent laryngeal and extra-laryngeal findings associated with LPRD. 3 Laryngoscope, 134:3981-3988, 2024.

Conservative Management of Early Grade Unilateral Reinke's Edema with Laryngopharyngeal Reflux

Reinke's edema is described as fluid-filled vocal folds in the Reinke's space. Unilateral cases are uncommon and might caused by gastrointestinal reflux. We report a 61-year-old man with complaints of hoarseness since one year ago, which was getting worse for the past two months. Examination of the reflux symptom index (RSI) obtained a score of 23 and reflux finding score (RFS) score of 11. Examination of the flexible fiber laryngoscopy showed that the right vocal fold size was thicker than the contralateral side, greyish in color, soft, and did not bleed easily. The patient was then given conservative therapy with proton pump inhibitors (PPIs), corticosteroids, and mucolytics, accompanied by lifestyle modifications. Clinical improvement was found at four weeks of evaluation. In conclusion, the response to conservative therapy and elimination of risk factors for early-stage Reinke's edema contributes well to disease recovery, particularly those caused by laryngopharyngeal reflux.

Effect of Laryngopharyngeal Reflux and Potassium-Competitive Acid Blocker (P-CAB) on the Microbiological Comprise of the Laryngopharynx.

To probe the microbiota composition progressing from healthy individuals to those with laryngopharyngeal reflux disease (LPRD) and subsequently undergoing potassium-competitive acid inhibitor (P-CAB) therapy. Prospective case-control study. Academic Medical Center. Forty patients with LPRD and 51 patients without LPRD were recruited. An 8-week P-CAB therapy was initiated (post-T-LPRD), and 39 had return visits. In total, 130 laryngopharyngeal saliva samples were collected and sequenced by targeting the V3-V4 region of the 16S ribosomal RNA (rRNA) gene using an Illumina MiSeq. Amplicon sequence variants (ASVs) and clinical indices were analyzed. Alpha and beta diversities were compared among the non-LPRD, LPRD, and post-T-LPRD groups, and the Observed_ASVs were not significantly different. At the same time, the Shannon and Simpson indices, unweighted Unifrac, weighted Unifrac, and binary Jaccard distance were significantly different between non-LPRD and LPRD groups. In addition, significant differences were found in the abundance of Streptococcus, Prevotella, and Prevotellaceae in the LPRD versus non-LPRD groups, and Neisseria, Leptotrichia, and Allprevotella in the LPRD versus post-T-LPRD groups. The genera model was used to distinguish patients with LPRD from those without, and a better receiver operating characteristiccurve was formed after combining the clinical indices of reflux symptom index, reflux finding score, and pepsin, with an area under the curve of 0.960. Laryngopharyngeal microbial communities changed after laryngopharyngeal reflux and were modified further after P-CAB treatment, which provides a potential diagnostic value for LPRD, especially when combined with clinical indices.

Tonghua Liyan granules in the treatment of Laryngopharyngeal reflux disease with stagnation of phlegm and qi syndrome: a randomized, double-blind, placebo-controlled study.

Background: Laryngopharyngeal reflux disease (LPRD) is an extraesophageal syndromic manifestation of gastroesophageal reflux disease (GERD). Despite the increasing incidence of and concern about LPRD, treatment with proton pump inhibitors (PPIs) is unsatisfactory. Here, LPRD was treated with Tonghua Liyan (THLY) granules in combination with PPIs to evaluate treatment efficacy and possible adverse reactions. Methods: Seventy-six LPRD patients with stagnation of phlegm and qi syndrome (SPQS) were randomly divided into an experimental group and a control group. The experimental group received THLY granules combined with rabeprazole capsules. The control group received THLY granule placebo combined with rabeprazole capsules. A parallel, randomized, double-blind, placebo-controlled clinical trial was conducted with these two groups. The treatment cycle was 8weeks. The reflux symptom index (RSI), clinical symptom score, salivary pepsin content, reflux finding score (RFS) and gastroesophageal reflux disease questionnaire (GerdQ) were used to evaluate clinical efficacy. The final efficacy rate was evaluated according to the RSI and clinical symptom score. Results: Compared with those at baseline, all the indicators in the experimental group and control group significantly improved (p < 0.01). In terms of the RSI, clinical symptom score, and RFS, the experimental group had a higher degree of improvement (p < 0.05), and the overall efficacy rate was higher (p < 0.05). In terms of the salivary pepsin concentration and GerdQ, there was no significant difference between the test group and the control group (p > 0.05). Both groups of safety indicators showed no abnormalities and did not cause any allergic reactions in the body. Conclusion: Compared with PPIs alone, THLY granules combined with PPIs are more effective in the treatment of LPRD patients with SPQS in terms of symptoms and signs. This combination treatment, because of its higher clinical efficacy and lack of obvious adverse reactions, is worthy of clinical promotion and further in-depth study. Clinical Trial Registration: www.chictr.org.cn, identifier ChiCTR2100046614.

Impact of Laryngopharyngeal Reflux in Patients with Voice Disorders.

The aim of this study is to evaluate the presence of laryngopharyngeal reflux in patients with voice disorders thereby aiding in the early management and improving the quality of life. Cross Sectional study. This cross sectional study was carried out in a tertiary care hospital, patients with history of voice change for more than 3 weeks were included, and divided into 4 groups depending upon the level of voice use. Patients were asked to fill Koufmann Reflux Symptom Index questionnaire followed by video laryngoscopy and findings were plotted according to Reflux Finding Score. Based on the scoring, impact of LPRD in patient with voice disorders was analysed. Among the 90 study participants, 74 (82.2%) were found to have LPRD. The mean age was 42.76 ± 10.33 years. Majority (43.2%) belong to the age group of 41-50 years, with female predominance (70.3%). Majority (41.9%) of them were level IV voice users. 59.5% were positive Koufman reflex symptom index, 67.6% were positive Reflex finding score. Hoarseness (58.1%) the most common symptom. Laryngopharyngeal reflux disease has to be considered in patients presenting with hoarseness of voice for more than three weeks. Simple and highly reproducible scores like Reflux Symptom Index and Reflux Finding Score proven useful and valuable tools in diagnosing LPRD thereby aiding in early diagnosis and prompt management and improves the patient's quality of life. Level 1.

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.

Characterization of Laryngopharyngeal Reflux in the Elderly Population

Laryngopharyngeal reflux (LPR) often is not diagnosed due to its presentation without heartburn. The aim of this study was to analyze the signs and symptoms of elderly patients undergoing treatment for LPR using subjective as well as objective measures including strobovideolaryngoscopies, 24-hour pH studies, and manometry to highlight appropriate considerations for diagnosis and treatment. This was a retrospective review of patients with laryngopharyngeal reflux who were seen from January 2010 to February 2021 in the practice of the senior author (Robert T. Sataloff) who had undergone 24-hour pH testing, and for whom all data were available. Patients aged 60 years and older were considered elderly and compared to patients younger than 40 and between the ages of 40 and 59. However, patients in their 60s, 70s, and 80s were evaluated and compared separately. Objective reflux findings, 24-hour pH studies, and manometry were compared between groups. Two hundred and eighty-eight patients being treated for LPR were included, 100 of whom were over the age of 60. While 94.1% of patients younger than 40 had a chief complaint of hoarseness, 71% percent of those aged 60 and older complained of hoarseness. Patients aged 60 and older were more likely to present with no voice complaint as their age increased (P = 0.001). Lower esophageal sphincter residual pressure was 12.15 ± 6.28 in elderly patients compared to 4.90 ± 3.38 in patients younger than 40 (P < 0.001). Upper esophageal sphincter (UES) basal pressure was decreased in elderly patients at 83.84 ± 50.53 compared to 105.92 ± 51.49 in patients younger than 60 or younger (P = 0.029). Older patients in their 70s and 80s also had lower UES basal pressures at 75.79 ± 47.66 and 63.45 ± 14.50 (P = 0.003). Additionally, while 71.4% of patients younger than 40 had normal esophageal motility (Chicago classification v4), only 40% of elderly patients had normal esophageal motility (P < 0.001). More severe ventricular obliteration also was present in elderly patients compared to non-elderly patients (P = 0.032), and thick endolaryngeal mucus was less likely to be present in elderly patients (P = 0.007). Reflux finding score differed between age groups with patients aged less than 40 scoring 14.78 ± 2.5, 40-59 year olds scoring 15.83 ± 2.13 and patients 60 and older scoring 15.48 ± 2.43 (P = 0.018). Elderly patients diagnosed with LPR have different presentations of the disease compared with younger patients.

Types of Epiglottic Collapse in Breathing Sleep Disorder and Their Impact in Clinical Practice.

Introduction Obstructive sleep apnea (OSA) is a severe form of sleep-disordered breathing (SDB) that is strongly correlated with comorbidities, in which epiglottic collapse (EC) and other contributing factors are involved. Objectives To evaluate the occurrence of EC in OSA patients through drug-induced sleep endoscopy (DISE) and to determine the factors contributing to EC. Methods A retrospective study of 37 adult patients using medical history. Patients were assessed for laryngopharyngeal reflux (LPR) and lingual tonsil hypertrophy (LTH) using reflux symptom index and reflux finding score (RFS); for OSA using polysomnography, and for airway collapse through DISE. An independent t -test was performed to evaluate risk factors, including the involvement of three other airway structures. Results Most EC patients exhibited trap door epiglottic collapse (TDEC) (56.8%) or pushed epiglottic collapse (PEC) (29.7%). Lingual tonsil hypertrophy, RFS, and respiratory effort-related arousal (RERA) were associated with epiglottic subtypes. Laryngopharyngeal reflux patients confirmed by RFS (t(25) = -1.32, p = 0.197) tended to suffer PEC; LTH was significantly associated (X2(1) = 2.5, p = 0.012) with PEC (odds ratio [OR] value = 44) in grades II and III LTH patients; 11 of 16 TDEC patients had grade I LTH. Pushed epiglottic collapse was more prevalent among multilevel airway obstruction patients. A single additional collapse site was found only in TDEC patients. Conclusion Laryngopharyngeal reflux causes repetitive acid stress toward lingual tonsils causing LTH, resulting in PEC with grade II or III LTH. Trap door epiglottic collapse requires one additional structural collapse, while at least two additional collapse sites were necessary to develop PEC. Respiratory effort-related arousal values may indicate EC.

The prevalence of gastroesophageal reflux disease and laryngopharyngeal reflux in patients with dysphagia after radiotherapy for nasopharyngeal carcinoma.

The prevalence of gastroesophageal reflux disease (GERD) and laryngopharyngeal reflux (LPR) in post-irradiated patients with nasopharyngeal carcinoma (NPC) is unknown. In a cross-sectional study, 31 NPC and 12 control patients completed questionnaires for GERD/LPR before esophageal manometry and 24-h pH monitoring. The DeMeester score and reflux finding score (RFS) were used to define GERD and LPR, respectively. Risk factors were identified. 51.6% of NPC and 8.3% of control patients, and 77.4% of NPC and 33% of control patients, were GERD-positive and LPR-positive, respectively. The GERD/LPR questionnaire failed to identify either condition in patients with NPC. No parameter differences in esophageal manometry or pneumonia incidence were noted between GERD/LPR-positive and GERD/LPR-negative patients. Post radiotherapy duration, high BMI, lack of chemotherapy, and dysphagia were positive risk factors for GERD/LPR. A high prevalence of GERD/LPR in patients with post-irradiated NPC exists, but reflux symptoms are inadequate for diagnosis.

Effect of Laryngopharyngeal Reflux Disease on Middle Ear Function: A Case-Control Study.

To identify the effect of acid reflux on the middle ear function in patients with laryngopharyngeal reflux disease (LPRD) with no pre-existing otologic complaints. Patients presenting with complaints suggestive of LPRD were identified and Reflux Symptom Index (RSI) and Reflux Finding Score (RFS) were calculated. 73 individuals with RSI ≥ 13 and RFS ≥ 7 was diagnosed with LPRD and chosen as cases. An equal number of healthy controls who had no symptoms of LPRD, matched for age and sex were chosen. Pure tone audiometry (PTA) and Impedance Audiometry were done in both the groups to assess middle ear function and the findings were compared. PTA values indicated hearing impairment among 61.64% of cases as compared to 17.81% controls (p value < 0.001). Result of Impedance Audiometry also revealed that 54.8% cases of LPRD had deranged middle ear function compared to 6.85% of controls (p value < 0.001). Laryngopharyngeal reflux disease can have silent manifestations in the ear in the form of altered middle ear function. This can lead to a wide spectrum of dysfunctions in the form of serous otitis media, retraction pockets and squamosal variant of chronic otitis media, which has its own set of complications. Hence, early management of LPRD can reduce possibility of middle ear disease.

Reflux Symptom Index and Reflux Finding Score in the Diagnosis of Laryngopharyngeal Reflux and Its Improvement with Treatment

Reflux Symptom Index and Reflux Finding Score in the Diagnosis of Laryngopharyngeal Reflux and Its Improvement with Treatment