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Objective: To study the profile and the therapeutic response of patients with laryngopharyngeal reflux (LPR) at the hypopharyngeal-esophageal multichannel intraluminal impedance-pH monitoring (HEMII-pH) according to the initial pepsin saliva concentration. Methods: From January 2018 to January 2020, patients with positive LPR diagnosis at the HEMII-pH were consecutively recruited from 3 European Hospitals. Saliva pepsin concentration (Peptest™) was measured during the HEMII-pH testing period and patients were classified into 2 groups: negative versus positive Peptest. The clinical outcomes, that is, gastrointestinal and HEMII-pH findings, reflux symptom score-12 (RSS-12), and 3-month therapeutic response, were compared between groups. Results: A total of 124 patients completed the study. Among them, 30 patients had negative Peptest. Pharyngeal reflux events occurred outside 1-hour post-meal time in 74.0%, after the meals in 20.5% and nighttime in 5.5%. The pepsin saliva level was not significantly associated with the reflux events preceding the sample collection. Patients with positive Peptest had better improvement of RSS-12 digestive and respiratory subscores and oral, pharyngeal, and laryngeal findings compared with patients with negative Peptest. Conclusion: Patients with high saliva pepsin concentration had no stronger gastrointestinal, HEMII-pH, or clinical outcomes compared with those with low or undetectable saliva pepsin concentration. [ABSTRACT FROM AUTHOR]

Objective: To assess the evolution of symptoms and findings of laryngopharyngeal reflux (LPR) patients according to the type of reflux (acid, non‐acid, mixed and gastro‐oesophageal (GERD)). Design: Prospective uncontrolled multicentre study. Methods: One hundred and six patients with LPR have been recruited from 3 European Hospitals. According to the reflux characteristics at the impedance‐pH monitoring (acid, non‐acid, mixed, GERD), patients received a personalised treatment based on the association of diet, pantoprazole, alginate or magaldrate for 3 months. Reflux Symptom Score (RSS) was assessed at baseline, 6 and 12 weeks post‐treatment. Reflux Sign Assessment (RSA) has been used to rate laryngeal and extra‐laryngeal findings at baseline and 12 weeks post‐treatment. Overall success rate and the evolution of symptoms and findings were evaluated according to the LPR types. Results: One hundred and two LPR patients (42 acid, 33 non‐acid, 27 mixed, including 49 with LPR and GERD) completed the study. RSS and RSA total scores significantly improved from baseline to post‐treatment time in acid, mixed and non‐acid groups. The presence of GERD in addition to LPR did not impact the clinical improvement. The 3‐month success rates of treatment ranged from 62% to 64%, and there were no significant differences between groups. The success rate of patients with non‐acid LPR was similar to those of patients with mixed and acid LPR. Conclusion: MII‐pH is useful to specify the type of LPR and the related most adequate therapeutic regimen. Non‐acid or mixed LPR similarly respond to treatment than acid LPR but require a treatment based on alginate or magaldrate covering the non‐acid proximal reflux events. [ABSTRACT FROM AUTHOR]

Objective: To compare symptoms, signs, and acoustical voice quality changes throughout the 6-month course of empirical treatment between laryngopharyngeal reflux (LPR) males and females. Materials and Methods: Forty clinically diagnosed LPR females and 40 males with a reflux finding score (RFS) >7 and a reflux symptom index (RSI) >13 were treated with pantoprazole and diet recommendations during 3 or 6 months according to their evolution. RSI, RFS, and acoustic parameters were assessed at baseline and 3 and 6 months posttreatment. A correlation analysis between videolaryngostroboscopic findings and acoustic measurements was performed. Results: RSI, RFS, and many acoustic measurements (i.e., percent jitter, percent shimmer, phonatory fundamental frequency range, fundamental frequency variation, and peak-to-peak amplitude variation) significantly improved from baseline to 3 months posttreatment in male group. In female group, RSI and RFS total score significantly improved along the 3 first months of treatment. However, some clinical outcomes (i.e., RSI total score, hoarseness, cough, and globus) continued to improve from 3 to 6 months of treatment. We did not identify significant improvement of acoustic measurements in female group. The correlation study did not reveal significant correlation between videolaryngostroboscopic findings and acoustic measurements. Conclusion: This preliminary study suggests the occurrence of gender-related differences in the LPR therapeutic response. Further studies need to clarify whether females require a longer course of therapy than males. [ABSTRACT FROM AUTHOR]

The aim of this study is to explore voice quality modifications in laryngopharyngeal reflux (LPR) disease and to understand better the pathophysiological mechanisms underlying the development of communicative disability. Biological Abstracts, BioMed Central, Cochrane database, PubMed and Scopus were assessed for subject headings using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) recommendations. Relevant studies published between January 1990 and December 2015 describing the evaluation of voice quality in LPR disease were retrieved. Issues of clinical relevance, such as LPR diagnosis method, treatment efficacy and outcomes, were evaluated for each study. We determined the grade of recommendation for each publication according to the Oxford Centre for Evidence-Based Medicine evidence levels. The search identified 145 publications, of which 25 studies met the inclusion criteria for a total of 1483 LPR patients. Data were extracted by 2 independent physicians who identified 16 trials with a IIb evidence level, 7 trials with a IIa evidence level and 2 RCTs with a Ib evidence level where 4 patient-based instruments and 5 clinician-based instruments were used. The main voice assessment outcomes reported were hoarseness assessments by physicians or patients, followed by acoustic parameters; 15 and 14 articles, respectively, demonstrated significant improvements in subjective and objective voice assessments after treatment. The methodology used to measure acoustic parameters (i.e. sustained vowel duration, the sample portion choice for measurement, etc.) varied from one study to another. The majority of studies indicated that voice quality assessments (especially acoustic parameters) remain an interesting outcome to measure the effectiveness of treatment, but further studies using standardised and transparent methodology to measure acoustic parameters are necessary to confirm the place of each tool in the LPR disease evaluation. [ABSTRACT FROM AUTHOR]