Correlation between Reflux Symptom Index and Reflux Finding Score in Laryngopharyngeal Reflux

Introduction: Laryngopharyngeal reflux is an extra esophageal variant of gastro esophageal reflux disease and is characterized by change in voice, recurrent throat clearing, chronic cough, discomfort in throat, globus. The larynx and pharynx are devoid of the normal acid clearance mechanism even three episodes of reflux per week seems to be associated with a significant disease. Aims: The aim of the study was to evaluate the correlation between the reflux symptom index and reflux finding score in patients with Laryngopharyngeal reflux. Methods: This prospective analytical study was conducted from November 2019 to October 2020 in total of 65 patients presented in department of Otorhinolaryngology, Nepalgunj Medcial College and Teaching Hospital, Nepalgunj. Reflux symptom index questionnaire with nine Questions were answered by patients on a 5 point scale. Reflux symptom index of more than 13 out of total score of 45 was considered to indicate Laryngopharyngeal reflux were as, reflux finding score was based on laryngoscopic findings after evaluating 8 items. Score more than 7 out of 26 was taken as an indicator for presence of Laryngopharyngeal reflux. Results: The reflux symptom index was more than 13 on 22 patients withmean11.85±3.48 and reflux finding score was more than 7 on 11 patients with mean 5.02±3.23 with statistically moderate correlation between reflux symptom index and reflux finding score (p=0.000,r=0.595). Conclusion: There is moderate correlation between the reflux symptom index and reflux finding score. The combined use of these questionnaires and laryngoscopic findings can be more precise, practical and cost effective in the diagnosis of laryngopharyngeal reflux.

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.

Prevalence and Symptomatology of Laryngopharyngeal Reflux Disease in a Medical College Hospital in Kerala

BACKGROUND Laryngopharyngeal reflux is a common clinical condition encountered in Otolaryngology practice. It is one of the major causes of laryngeal inflammation. It presents with a constellation of symptoms making the diagnosis difficult. Reflux Symptom Index and Reflux Finding Score are two tools which aid in diagnosis of Laryngopharyngeal reflux. The main objective of this study was to study the agent, host and environment factors of epidemiology of patients with laryngopharyngeal reflux disease using Reflux Symptom Index and Reflux Finding Score. METHODS A descriptive study was conducted on 100 patients attending the Department of Otorhinolaryngology, Government Medical College and Hospital, Thrissur, Kerala. The study period was for one year from December 2017 to December 2018. Demographic data of the patients was recorded, and patients were evaluated for Laryngopharyngeal reflux disease using Reflux Symptom Index and Reflux Finding Score using 70 degree / flexible nasopharyngolaryngoscopy. The clinical data collected was then tabulated and analysed. RESULTS From the study conducted in 100 patients, 59 % were females and 41 % males. Most common symptom noted was frequent clearing of throat which was present in 88 % cases. Least frequent symptom was choking episode (in 5 %). CONCLUSIONS The prevalence of Laryngopharyngeal Reflux Disease was commonest in the 31 to 40 years age group with mean age was 37.8 ± 2.35 years. The male to female ratio were 1:1.43. The disease was common in labourers and housewives. Risk factors were consumption of tea/coffee, inadequate sleep of less than 6 hrs. Lower socioeconomic group populations were more vulnerable than higher income group. The RSI score was between 13 and 15 in 53 % of the patients. KEYWORDS Laryngopharyngeal Reflux, Reflux Symptom Index, Reflux Finding Score

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

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.

Assessment of Dysphagia as a Risk Factor of Chronic Cough

Background: The aim of the study was to determine the prevalence of dysphagia in patients with chronic cough and its relationship with the long-term persistence of these symptoms. Methods: Thirty consecutive patients. All patients underwent physical examination, ENT assessment, videolaryngoscopy, functional phoniatric assessment at rest and speech, Water-Swallow Test, and Fiberoptic Endoscopic Evaluation of Swallowing disorders with Reflux Finding Score. Reflux Symptom Index questionnaire was performed. The study was approved by the local Ethics Committee Review Board (KB/39/A/2016). Results: The results of the RFS and the RSI questionnaire showed the risk of reflux in participating patients. The patients presented episodes of spillage, double swallows, penetration, aspiration and residue of food at the hypopharynx. The results of functional assessment correlated with the Water-Swallow Test. The correlation between Fiberoptic Endoscopic Evaluation of Swallowing disorders and Water-Swallow Test results was found for aspiration risk, spillage, and retention of saliva. Conclusion: The results of the study showed prevalence of dysphagia in most patients with chronic chough. It seems that phoniatric assessment in those cases should be expanded and the following tests should be performed: assessment of the laryngeal elevation, Water-Swallow Test, and Fiberoptic Endoscopic Evaluation of Swallowing disorders.

Aktuelle Möglichkeiten und Herausforderungen bei der Diagnostik des laryngopharyngealen Refluxes

ZusammenfassungDer laryngopharyngeale Reflux (LPR) ist definiert als ein Zurückfließen von gastralem bzw. gastroduodenalem Sekret in den Larynx- bzw. Pharynxbereich und ist durch ein sehr breites Spektrum an teils unspezifischen Symptomen wie beispielsweise chronischem Husten, zervikalem Globusgefühl oder Hypersekretion von Mukus im Larynx und Pharynx charakterisiert. Aufgrund des Fehlens eines Goldstandards und der heterogenen Studienlage gestaltet sich die Diagnosestellung des LPR jedoch weiterhin schwierig und wird in absehbarer Zeit weiterhin kontrovers diskutiert werden. Insgesamt kann man jedoch davon ausgehen, dass bei suggestiver Anamnese mit erhöhten Scores im Reflux Symptom Index (RSI), entsprechenden endoskopischen Befunden mit pathologischem Reflux Finding Score (RFS) und auffälliger ösophagealer oder oropharyngealer 24-h-pH-Metrie ohne Hinweise auf eine andere Grunderkrankung die Diagnose eines LRP wahrscheinlich ist. In der vorliegenden Übersichtsarbeit sollen die genannten Methoden ebenso wie neuere Werkzeuge bei der Diagnose des LPR kritisch diskutiert werden.