Aggravation of Reflux Finding Score (RFS) after thyroidectomy

Laryngopharyngeal reflux (LPR) has been suggested as a possible cause of post-thyroidectomy syndrome. However, the pathophysiology and relationship between thyroidectomy and LPR have not been well investigated. We aimed to evaluate the correlation between thyroidectomy and LPR by assessing changes in LPR-related symptoms and laryngoscopic findings before and after thyroidectomy. Ninety-five patients who underwent thyroidectomy with or without central neck dissection were included. The reflux finding score (RFS) and reflux symptom index (RSI) were investigated one day before surgery and two, four, six, and twelve months after surgery. The RFS scores increased significantly after thyroidectomy and decreased to the preoperative level 12 months after surgery. The RSI scores increased after surgery and decreased gradually by 12 months postoperatively, although it was not statistically significant. The RSI and RFS scores improved with the administration of proton pump inhibitors. In conclusion, LPR-related laryngoscopic findings were exacerbated after uncomplicated thyroidectomy. Further studies using pH-monitoring and esophageal manometry are required to investigate the possible deterioration of LPR itself and the UES pressure after thyroidectomy.

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Empirical treatment with pantoprazole as a diagnostic tool for symptomatic adult laryngopharyngeal reflux

The Journal of Laryngology & Otology ◽

10.1017/s0022215111000120 ◽

2011 ◽

Vol 125 (5) ◽

pp. 502-508 ◽

Cited By ~ 24

Author(s):

M Masaany ◽

M B Marina ◽

W P Sharifa Ezat ◽

A Sani

Keyword(s):

Predictive Value ◽

Laryngopharyngeal Reflux ◽

Ph Monitoring ◽

Reflux Symptom ◽

Empirical Treatment ◽

Double Blind Study ◽

Reflux Finding Score ◽

Reflux Symptom Index ◽

Double Blind ◽

Symptom Index

AbstractObjective:To determine the sensitivity and specificity of intensive empirical treatment with pantoprazole in diagnosing laryngopharyngeal reflux in adults.Study design:This was a prospective, double-blind study.Subjects and methods:Fifty-five patients with either a Reflux Symptom Index of more than 13 or a Reflux Finding Score of more than 7 were enrolled. All patients underwent 24-hour, double-probe pH monitoring before commencing pantoprazole 40 mg twice daily; both investigators and patients were blinded to pH monitoring results. The Reflux Symptom Index and Reflux Finding Score were reassessed during the second, third and fourth month of follow up.Results:The sensitivity of empirical pantoprazole treatment in diagnosing laryngopharyngeal reflux was 92.5 per cent. The specificity was 14.2 per cent, the positive predictive value 86 per cent and the negative predictive value 25 per cent. There was significant reduction in the total Reflux Symptom Index and Reflux Finding Score after the second, third and fourth month of treatment. There was no correlation between laryngopharyngeal reflux and body mass index.Conclusion:Our results suggest that intensive empirical treatment with proton pump inhibitors is effective in diagnosing laryngopharyngeal reflux.

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The application of 24-hour pharyngeal pH-monitoring and Reflux Finding Score and Reflux Symptom Index questionnaires in the diagnostics of laryngopharyngeal reflux

Gastroenterology Review ◽

10.5114/pg.2019.90253 ◽

2019 ◽

Vol 14 (4) ◽

pp. 274-282

Author(s):

Elżbieta Włodarczyk ◽

Beata Miaśkiewicz ◽

Danuta Raj-Koziak ◽

Agata Szkiełkowska ◽

Piotr Skarżyński ◽

...

Keyword(s):

Laryngopharyngeal Reflux ◽

Ph Monitoring ◽

Reflux Symptom ◽

Reflux Finding Score ◽

Reflux Symptom Index ◽

Symptom Index

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Association between Laryngeal Pepsin Levels and the Presence of Vocal Fold Polyps

Otolaryngology ◽

10.1177/0194599816676471 ◽

2016 ◽

Vol 156 (1) ◽

pp. 144-151 ◽

Cited By ~ 15

Author(s):

Lu Wang ◽

Jia-Jie Tan ◽

Ting Wu ◽

Rui Zhang ◽

Jia-Nuan Wu ◽

...

Keyword(s):

Vocal Fold ◽

Laryngopharyngeal Reflux ◽

Ph Monitoring ◽

Reflux Symptom ◽

Healthy Controls ◽

Reflux Finding Score ◽

Reflux Symptom Index ◽

Symptom Index ◽

Predictive Values ◽

Laryngeal Mucosa

Objective To determine whether pepsin, the main component of refluxed gastric contents, is significantly associated with vocal fold polyps and to evaluate the diagnostic value of pepsin in vocal fold polyps’ tissues. Study Design Cross-sectional study. Setting Nanfang Hospital of Southern Medical University. Subjects and Methods The study included 32 patients with vocal fold polyps and 16 healthy controls between 2011 and 2012. Reflux symptom index and reflux finding score assessments, 24-hour combined multichannel intraluminal impedance and pH monitoring, and biopsy of the vocal fold polyp tissues or posterior laryngeal mucosa (healthy controls) for immunohistochemical pepsin staining were performed. Results The expression of pepsin was significantly higher in patients with vocal fold polyps than in controls (28/32, 75% vs 5/16, 31.25%; P < .001). The pepsin levels were significantly positively correlated with upright position pharyngeal acid reflux and esophageal reflux parameters adjusted by age. Based on pepsin staining data, the sensitivity and negative predictive values of 24-hour pH monitoring, the reflux symptom index, and the reflux finding score were 70% to 84.62%, whereas their specificity and positive predictive values were relatively low (20%-31.58%). Conclusion Pepsin reflux may be a risk factor for vocal fold polyps formation. In addition, pepsin immunohistochemical analysis of polyp biopsy samples appears to be a more sensitive and effective test for diagnosing laryngopharyngeal reflux than the reflux symptom index, the reflux finding score, and 24-hour pH monitoring in a clinical setting.

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Deteksi pepsin pada penderita refluks laringofaring yang didiagnosis berdasarkan reflux symptom index dan reflux finding score

Oto Rhino Laryngologica Indonesiana ◽

10.32637/orli.v41i2.48 ◽

2011 ◽

Vol 41 (2) ◽

pp. 121

Author(s):

Yunida Andriani ◽

Muhammad Amsyar Akil ◽

Masyita Gaffar ◽

Abdul Qadar Punagi

Keyword(s):

Gold Standard ◽

Laryngopharyngeal Reflux ◽

Ph Monitoring ◽

Reflux Symptom ◽

Diagnostic Tools ◽

Reflux Finding Score ◽

Reflux Symptom Index ◽

Symptom Index ◽

Double Probe ◽

Contact Ulcer

Background: It is estimated that more than 50% of patients with voice disorders who come fortreatment are caused by laryngopharyngeal reflux (LPR). LPR has been implicated in the etiology ofmany laryngeal disorders including subglottic stenosis, laryngeal carcinoma, laryngeal contact ulcer,laryngospasm and vocal nodule on the vocal cords. Ambulatory 24 hour double-probe (pharyngeal andesophageal) pH monitoring is the gold standard examination for diagnosing LPR, but it is still far fromideal criteria.The assessment of pepsin in airway secretions could be used as a sensitive diagnosticmarker of LPR because pepsin is not synthesized by any type of airway cells. Purpose: The aim ofthis study was to detect the presence of pepsin on laryingopharyngeal reflux patients which diagnosedbased on reflux symptom index (RSI) dan reflux finding score (RFS) at Wahidin Sudirohusodo Hospital,Makassar. Methods: This is a comparative quantitative study. We performed RSI and RFS examinationson 51 samples, followed by saliva pepsin detection using ELISA method on 48 samples, then analyzed withSpearman’s Rho test. Result: RSI score >13 was found in 48 samples (94,12%) and RFS score >7 wasin 51 samples (100%). Pepsin was detected on all sputum samples, however there was no significant relationship betwen RSI and RFS scoring with the level of pepsin in saliva (p>0.01). Conclusion: Pepsin was detected on saliva of patients with laringopharyngeal reflux who was diagnosed based on RSI andRFS. We concluded that RSI and RFS can be used as diagnostic tools for LPR. Keywords: laringopharyngeal reflux, reflux symptom index, reflux finding score, pepsin Abstrak : Latar belakang: Diperkirakan lebih dari 50% pasien dengan gangguan suara yang datang berobatke dokter THT diakibatkan oleh refluks laringofaring (RLF). Diduga RLF berperan pada patogenesissejumlah kelainan pada laring, termasuk stenosis subglotik, karsinoma laring, laryngeal contact ulcers,laringospasme dan vokal nodul pada pita suara. Pemeriksaan ambulatory 24 hour double-probe pHmonitoring merupakan gold standard untuk mendiagnosis RLF, namun pemeriksaan ini masih jauh darikriteria ideal. Menentukan adanya pepsin pada sekret saluran napas merupakan petanda diagnostik yangsensitif untuk RLF karena pepsin tidak dihasilkan oleh sel apapun dalam saluran napas. Tujuan: Penelitianini bertujuan mendeteksi keberadaan pepsin pada penderita refluks laringofaring yang didiagnosisberdasarkan refluks symptom index (RSI) dan reflux finding score (RFS). Metode: Jenis penelitian iniadalah komparatif kuantitatif. Dilakukan pemeriksaan RSI dan RFS pada 51 percontoh dan dilanjutkandengan pemeriksaan pepsin saliva menggunakan metode ELISA pada 48 percontoh lalu dilakukan ujiSpearman’s Rho. Hasil: Skor RSI >13 sebanyak 48 percontoh (94,12%) dan skor RFS >7 sebanyak 51percontoh (100%). Pepsin terdeteksi pada saliva semua percontoh. Tidak ada hubungan yang bermaknaantara skoring RSI dan RFS dengan kadar pepsin pada saliva (p>0,01). Kesimpulan: RSI dan RFS dapatdigunakan dalam menegakkan diagnosis RLF. Kata kunci: refluks laringofaring, reflux symptom index, reflux finding score, pepsin

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Evaluation of Oropharyngeal pH-Monitoring in the Assessment of Laryngopharyngeal Reflux

Journal of Clinical Medicine ◽

10.3390/jcm10112409 ◽

2021 ◽

Vol 10 (11) ◽

pp. 2409

Author(s):

Lukas Horvath ◽

Patricia Hagmann ◽

Emanuel Burri ◽

Marcel Kraft

Keyword(s):

Cohort Study ◽

Diagnostic Tests ◽

Retrospective Cohort ◽

Laryngopharyngeal Reflux ◽

Ph Monitoring ◽

Reflux Finding Score ◽

Reflux Symptom Index ◽

Symptom Index ◽

Transnasal Esophagoscopy ◽

Sensitivity Specificity

Background: Laryngopharyngeal reflux (LPR) is a prevalent disorder. The aim of the present retrospective cohort study was to evaluate oropharyngeal pH-monitoring using a novel scoring system for LPR. Methods: In a total of 180 consecutive patients with possible LPR, reflux symptom index (RSI), reflux finding score (RFS), oropharyngeal pH-monitoring and transnasal esophagoscopy were carried out for further investigation. Results: In our series, 99 (55%) patients had severe LPR, 29 (16%) cases presented with moderate and 23 (13%) with mild severity, 9 (5%) subjects revealed neutral values, and 7 (4%) individuals were alkaline, while 13 (7%) patients had no LPR. In detecting LPR, the sensitivity, specificity and accuracy of oropharyngeal pH-monitoring was 95%, 93% and 94%, respectively. Conclusion: Oropharyngeal pH-monitoring is a reliable tool in the assessment of LPR, but the pH graphs have to be precisely analyzed and interpreted in context with other validated diagnostic tests.

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Correlation between Ambulatory 24 Hour Dual Probe pH Monitoring and Reflux Finding Score, Reflux Symptom Index in the Laryngopharyngeal Reflux

Korean Journal of Otorhinolaryngology - Head and Neck Surgery ◽

10.3342/kjorl-hns.2013.56.11.706 ◽

2013 ◽

Vol 56 (11) ◽

pp. 706 ◽

Cited By ~ 5

Author(s):

Jae Ho Oh ◽

Yong Bae Ji ◽

Chang Myeon Song ◽

Jin Hyuk Jung ◽

Bong Joon Jin ◽

...

Keyword(s):

Laryngopharyngeal Reflux ◽

Ph Monitoring ◽

Reflux Symptom ◽

Reflux Finding Score ◽

Reflux Symptom Index ◽

Symptom Index ◽

Dual Probe

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Smoking Cessation Improves the Symptoms and the Findings of Laryngeal Irritation

Ear Nose & Throat Journal ◽

10.1177/0145561319881559 ◽

2019 ◽

Vol 99 (2) ◽

pp. 124-127

Author(s):

A. Secil Kayalı Dinc ◽

Melih Cayonu ◽

Tijen Sengezer ◽

M. Melih Sahin

Keyword(s):

Smoking Cessation ◽

Vocal Fold ◽

Laryngopharyngeal Reflux ◽

Endoscopic Examination ◽

Reflux Finding Score ◽

Reflux Symptom Index ◽

Posterior Commissure ◽

Symptom Index ◽

Before And After ◽

Cigarette Cessation

Smoking is known to increase laryngeal inflammation and laryngopharyngeal reflux (LPR), which cause laryngeal irritation. Thus, the aim of this study is to evaluate the changes in the symptoms and the findings of laryngeal irritation in smokers after a smoking cessation period. The reflux symptom index (RSI) and the reflux finding score (RFS) were used for evaluating the symptoms and findings of laryngeal irritation in smokers. Endoscopic examination of the laryngeal structures for RFS and symptom inquiry for RSI were performed at the beginning of the study and after a 2 months of cigarette cessation period. This study was carried out in 24 volunteers (14 female and 10 male), between the ages of 24 and 62 years. When we compared the results of RSI and RFS that were performed before and after the cigarette cession period, we found that there was a significant improvement both in RSI and in RFS ( P < .001 and P < .001, respectively). Also, there was significant correlation between the cigarette smoking period and RFS score that was determined at the beginning of the study ( P = .006, r = .54). A significant improvement was found both in RSI and in RFS after smoking cessation period, which might be the evidence of improvement in laryngeal irritation possibly caused by inflammation due to smoking and LPR. A significant positive correlation was found between smoking period and RFS, especially with vocal fold edema and posterior commissure hypertrophy.

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