Evaluation of the Reflux Symptom Index and the Endolaryngeal Findings Scale after Treatment in Individuals with Laryngopharyngeal Reflux
Introduction Laryngopharyngeal reflux (LPR) is a prevalent condition in outpatients visiting the otorhinolaryngological clinic, with many controversies regarding its diagnosis and follow-up. Therefore, there is a need for clinical instruments that can diagnose individuals and monitor the results of their treatment.
Objective To evaluate the applicability of the scores translated and adapted to Brazilian Portuguese: Reflux Symptom Index (RSI) and Endolaryngeal Reflux Findings Scale (ERFS), as instruments for post-treatment follow-up of LPR.
Method A total of 35 individuals with atypical symptoms of gastroesophageal reflux disease and with an objective diagnosis of LPR, confirmed by high digestive endoscopy and 24-hour esophageal pH-metry dual probe test were submitted to the RSI and ERFS questionnaires, used in the pre- and post-treatment of 90 days with a Proton Pump Inhibitor.
Result The evaluation of RSI and ERFS in the pre- and post-treatment showed a reduction in the results of the two scores, with a higher drop in the RSI (p < 0.001) than in the ERFS (p = 0.014). Although there was an improvement in the values in 23.9% of the individuals in the ERFS, there was no change in the category (p = 0.057), different from the RSI (p < 0.001), where there was a 67.4% improvement in values, as well as change in category (score went from positive to negative). There was a correlation between RSI and ERFS, moderate in the pretreatment and strong in the post-treatment.
Conclusion The RSI and ERFS scores, when translated and adapted for Brazilian Portuguese and applied simultaneously, can be considered a good tool for post-treatment LPR follow-up.
Paper presented at: 48th ABORL-CCF Congress; October 31st to November 3rd, 2018, João Pessoa, state of Paraíba, Brazil.
Received: 28 June 2019
Accepted: 15 December 2019
04 May 2020 (online)
© 2020. Fundação Otorrinolaringologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)
Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil
- 1 Koufman JA. Reintroducing otolaryngologists to esophageal disease. Ear Nose Throat J 2001; 80 (07) 428
- 2 Moraes-Filho J, Cecconello I, Gama-Rodrigues J. et al; Brazilian Consensus Group. Brazilian consensus on gastroesophageal reflux disease: proposals for assessment, classification, and management. Am J Gastroenterol 2002; 97 (02) 241-248
- 3 Eckley CA, Costa HO. Salivary pH and Volume before and after treatment of LPR. Otolaryngol Head Neck Surg 2006; 135: 196
- 4 Groome M, Cotton JP, Borland M, McLeod S, Johnston DA, Dillon JF. Prevalence of laryngopharyngeal reflux in a population with gastroesophageal reflux. Laryngoscope 2007; 117 (08) 1424-1428
- 5 Ali Mel-S. Laryngopharyngeal reflux: diagnosis and treatment of a controversial disease. Curr Opin Allergy Clin Immunol 2008; 8 (01) 28-33
- 6 Gupta R, Sataloff RT. Laryngopharyngeal reflux: current concepts and questions. Curr Opin Otolaryngol Head Neck Surg 2009; 17 (03) 143-148
- 7 Hammer HF. Reflux-associated laryngitis and laryngopharyngeal reflux: a gastroenterologist's point of view. Dig Dis 2009; 27 (01) 14-17
- 8 Belafsky PC, Postma GN, Koufman JA. Validity and reliability of the reflux symptom index (RSI). J Voice 2002; 16 (02) 274-277
- 9 Belafsky PC, Rees CJ. Laryngopharyngeal reflux: the value of otolaryngology examination. Curr Gastroenterol Rep 2008; 10 (03) 278-282
- 10 Prado AA, Saliture TB, Silva AS, Eckley CA. Tradução para o português brasileiro e adaptação cultural do reflux finding score. Braz J Otorhilaryngol 2013; 79: 47-53
- 11 Saliture TB. Tradução e adaptação cultural do reflux symptoms index para o português brasileiro e avaliação de suas propriedades psicométricas [dissertation]. São Paulo: Faculdade de Ciências Médicas da Santa Casa de São Paulo;; 2015: 97
- 12 Schindler A, Mozzanica F, Ginocchio D, Peri A, Bottero A, Ottaviani F. Reliability and clinical validity of the Italian Reflux Symptom Index. J Voice 2010; 24 (03) 354-358
- 13 Printza A, Kyrgidis A, Oikonomidou E, Triaridis S. Assessing laryngopharyngeal reflux symptoms with the Reflux Symptom Index: validation and prevalence in the Greek population. Otolaryngol Head Neck Surg 2011; 145 (06) 974-980
- 14 Farahat M, Malki KH, Mesallam TA. Development of the Arabic version of Reflux Symptom Index. J Voice 2012; 26 (06) 814.e15-814.e19
- 15 Hill RK, Simpson CB, Velazquez R, Larson N. Pachydermia is not diagnostic of active laryngopharyngeal reflux disease. Laryngoscope 2004; 114 (09) 1557-1561
- 16 Habermann W, Schmid C, Neumann K, Devaney T, Hammer HF. Reflux symptom index and reflux finding score in otolaryngologic practice. J Voice 2012; 26 (03) e123-e127
- 17 Belafsky PC, Postma GN, Koufman JA. The validity and reliability of the reflux finding score (RFS). Laryngoscope 2001; 111 (08) 1313-1317
- 18 Iglesia FV, Gonzáles SF, Gomez MC. Reflujo faringolaríngeo: correlación entre los síntomas y los signos mediante cuestionarios de valoración clínica y fibroendoscópica: Es suficiente para realizar el diagnostic. Acta Otorrinolaringol Esp 2007; 58: 421-425
- 19 Lee YS, Choi SH, Son YI, Park YH, Kim SY, Nam SY. Prospective, observational study using rabeprazole in 455 patients with laryngopharyngeal reflux disease. Eur Arch Otorhinolaryngol 2011; 268 (06) 863-869
- 20 Lundell LRJ, Dent J, Bennett JR. et al. Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification. Gut 1999; 45 (02) 172-180
- 21 Toros SZ, Toros AB, Yüksel OD, Ozel L, Akkaynak C, Naiboglu B. Association of laryngopharyngeal manifestations and gastroesophageal reflux. Eur Arch Otorhinolaryngol 2009; 266 (03) 403-409
- 22 Mahieu HF, Smit CF. Diagnosis and management of laryngopharyngeal reflux disease. Curr Opin Otolaryngol Head Neck Surg 2006; 14 (03) 133-137
- 23 Marambaia O, Andrade NA, Varela DG, Juncal MC. Refluxo laringofaringeano: estudo prospectivo correlacionando achados laringoscópicos precoces com a phmanometria de 24 horas de 2 canais. Braz J Otorhilaryngol 2002; 68: 527-531
- 24 de Bortoli N, Nacci A, Savarino E. et al. How many cases of laryngopharyngeal reflux suspected by laryngoscopy are gastroesophageal reflux disease-related?. World J Gastroenterol 2012; 18 (32) 4363-4370
- 25 Joniau S, Bradshaw A, Esterman A, Carney AS. Reflux and laryngitis: a systematic review. Otolaryngol Head Neck Surg 2007; 136 (05) 686-692
- 26 Waxman J, Yalamanchali S, Valle ES, Pott T, Friedman M. Effects of proton pump inhitor therapy for laryngopharyngeal reflux on posttreatment symptons and hypopharyngeal pH. Otolaryngol Head Neck Surg 2014; 150 (06) 1010-1017
- 27 Park KH, Choi SM, Kwon SU, Yoon SW, Kim SU. Diagnosis of laryngopharyngeal reflux among globus patients. Otolaryngol Head Neck Surg 2006; 134 (01) 81-85
- 28 Reichel O, Dressel H, Wiederänders K, Issing WJ. Double-blind, placebo-controlled trial with esomeprazole for symptoms and signs associated with laryngopharyngeal reflux. Otolaryngol Head Neck Surg 2008; 139 (03) 414-420
- 29 Lee JS, Jung AR, Park JM, Park MJ, Lee YC, Eun YG. Comparison of Characteristics According to Reflux Type in Patients With Laryngopharyngeal Reflux. Clin Exp Otorhinolaryngol 2018; 11 (02) 141-145
- 30 Francis DO, Patel DA, Sharda R. et al. Patient-Reported Outcome Measures Related to Laryngopharyngeal Reflux: A Systematic Review of Instrument Development and Validation. Otolaryngol Head Neck Surg 2016; 155 (06) 923-935
- 31 Lechien JR, Bobin F, Muls V. et al. Validity and reliability of the reflux symptom score. Laryngoscope 2019; 00: 1-10
- 32 Chang BA, MacNeil SD, Morrison MD, Lee PK. The Reliability of the Reflux Finding Score Among General Otolaryngologists. J Voice 2015; 29 (05) 572-577
- 33 Lechien JR, Schindler A, De Marrez LG. et al. Instruments evaluating the clinical findings of laryngopharyngeal reflux: A systematic review. Laryngoscope 2019; 129 (03) 720-736
- 34 DelGaudio JM, Naseri I, Wise JC. Proximal pharyngeal reflux correlates with increasing severity of lingual tonsil hypertrophy. Otolaryngol Head Neck Surg 2008; 138 (04) 473-478
- 35 Beaver ME, Stasney CR, Weitzel E. et al. Diagnosis of laryngopharyngeal reflux disease with digital imaging. Otolaryngol Head Neck Surg 2003; 128 (01) 103-108