Symptoms of Laryngopharyngeal Reflux: Is It Really Reflux?

Objective: 1) Report the accuracy of subjective Reflux Symptom Index scores (RSI) and objective Reflux Finding Scores (RFS) in identifying patients with laryngopharyngeal reflux (LPR) using ambulatory pH monitoring as confirmation. 2) Present clinical recommendations for the use of subjective and objective tools in the diagnosis of LPR. Method: Retrospective chart review of 300 adult outpatients from January 3, 2009 to December 30, 2010 in a tertiary care setting. Patients with a diagnosis of LPR based on abnormal RSI and positive findings on laryngeal endoscopic examination using RFS were tested for confirmation with a 24-hour oropharyngeal pH study using the Restech Dx-pH system. Results: Among 300 consecutive patients with an RSI score >5, 58.6% were confirmed to have reflux after undergoing 24-hour oropharyngeal pH-monitoring. Of these 300 patients, 146 had an RFS score >5. Among patients with a RSI >5 and a RFS 5 and RFS>5 the positive predictive value (PPV) increased to 71.9% (105 of 146). Therefore, when combined, an RSI>5 and RFS>5 yields significantly higher PPV than RSI alone. Conclusion: Patients with clinical signs and symptoms of LPR based on RSI alone do not demonstrate significant positive predictive value when confirmed with oropharyngeal pH testing, but predictive value is increased greatly when RSI and RSF are combined.