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Objectives: To investigate usefulness, feasibility, and patient satisfaction of an electronic pre-consultation medical history tool (EPMH) in laryngopharyngeal reflux (LPR) work-up., Methods: Seventy-five patients with LPR were invited to complete electronic medical history assessment prior to laryngology consultation. EPMH collected the following parameters: demographic and epidemiological data, medication, medical and surgical histories, diet habits, stress and symptom findings. Stress and symptoms were assessed with perceived stress scale and reflux symptom score. Duration of consultation, acceptance, and satisfaction of patients (feasibility, usefulness, effectiveness, understanding of questions) were evaluated through a 9-item patient-reported outcome questionnaire., Results: Seventy patients completed the evaluation (93% participation rate). The mean age of cohort was 51.2 ± 15.6 years old. There were 35 females and 35 males. Patients who refused to participate (N = 5) were > 65 years old. The consultation duration was significantly lower in patients who used the EPMH (11.3 ± 2.7 min) compared with a control group (18.1 ± 5.1 min; p = 0.001). Ninety percent of patients were satisfied about EPMH easiness and usefulness, while 97.1% thought that EPMH may improve the disease management. Patients would recommend similar approach for otolaryngological or other specialty consultations in 98.6% and 92.8% of cases, respectively., Conclusion: The use of EPMH is associated with adequate usefulness, feasibility, and satisfaction outcomes in patients with LPR. This software is a preliminary step in the development of an AI-based diagnostic decision support tool to help laryngologists in their daily practice. Future randomized controlled studies are needed to investigate the gain of similar approaches on the traditional consultation format., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: To study the management of laryngopharyngeal reflux (LPR) among the subspecialties of practicing otolaryngology-head and neck surgeons and their trainees., Methods: A survey was sent to over 8000 otolaryngologists (OTOHNS) over 65 countries, utilizing membership lists of participating otolaryngological societies. The outcomes were answers to questions regarding LPR knowledge and practice patterns, and included queries about its definition, prevalence, clinical presentation, diagnosis, and treatment., Results: Of the 824 respondents, 658 practiced in one specific otolaryngologic subspecialty. The symptoms and findings thought to be the most related to LPR varied significantly between subspecialists. Extra-laryngeal findings were considered less by laryngologists while more experienced OTOHNS did not often consider digestive complaints. Compared with colleagues, otologists, rhinologists and laryngologists were less aware of the involvement of LPR in otological, rhinological and laryngological disorders, respectively. Irrespective of subspecialty, OTOHNS consider symptoms and signs and a positive response to empirical therapeutic trial to establish a LPR diagnosis. Awareness regarding the usefulness of impedance pH-studies is low in all groups. The therapeutic approach significantly varies between groups, although all were in agreement for the treatment duration. The management of non-responder patients demonstrated significant differences among laryngologists who performed additional examinations. The majority of participants (37.1%) admitted to being less than knowledgeable about LPR management., Conclusions: LPR knowledge and management vary significantly across otolaryngology subspecialties. International guidelines on LPR management appear necessary to improve knowledge and management of LPR across all subspecialties of otolaryngology.

Objective: To investigate worldwide practices of otolaryngologists in the management of laryngopharyngeal reflux (LPR)., Methods: An online survey was sent on the management of LPR to members of many otolaryngological societies. The following aspects were evaluated: LPR definition, prevalence, clinical presentation, diagnosis, and treatment., Results: A total of 824 otolaryngologists participated, spread over 65 countries. The symptoms most usually attributed to LPR are cough after lying down/meal, throat clearing and globus sensation while LPR-related findings are arytenoid erythema and posterior commissure hypertrophy. Irrespective to geography, otolaryngologists indicate lack of familiarity with impedance pH monitoring, which they attribute to lack of knowledge in result interpretation. The most common therapeutic regimens significantly vary between world regions, with a higher use of H2 blocker in North America and a lower use of alginate in South America. The duration of treatment also significantly varies between different regions, with West Asia/Africa and East Asia/Oceania otolaryngologists prescribing medication for a shorter period than the others. Only 21.1% of respondents are aware about the existence of nonacid LPR. Overall, only 43.2% of otolaryngologists believe themselves sufficiently knowledgeable about LPR., Conclusions: LPR knowledge and management significantly vary across the world. International guidelines on LPR definition, diagnosis, and treatment are needed to improve knowledge and management around the world., Level of Evidence: N.A. Laryngoscope, 131:E1589-E1597, 2021., (© 2020 American Laryngological, Rhinological and Otological Society Inc, "The Triological Society" and American Laryngological Association (ALA).)

Objective: To develop and validate the Reflux Sign Assessment‐10 (RSA‐10) for documenting the physical findings of laryngopharyngeal reflux disease (LPRD). Methods: Patients with LPRD at the hypopharyngeal‐esophageal multichannel intraluminal impedance‐pH monitoring and asymptomatic individuals were consecutively recruited from two European hospitals. Three experienced otolaryngologists rated RSA‐10 in patients and controls for assessing internal validity. RSA‐10 was rated within a 7‐day period to assess test‐retest reliability. Internal consistency was measured using Cronbach's α in patients and controls. Convergent validity was evaluated through a correlation analysis between RSA‐10 and Reflux Finding Score (RFS). Interrater reliability was evaluated by comparing the RSA‐10 evaluations of the three otolaryngologists through Fleiss kappa. Pre‐ to posttreatment change of RSA‐10 was evaluated to assess responsiveness to change. The RSA‐10 thresholds were examined by receiver operating characteristic analysis. Results: Fifty‐five patients completed the pre‐ to posttreatment evaluations from January 2020 to December 2023. A total of 115 asymptomatic individuals completed the study. RSA‐10 reported high internal consistency reliability (α = 0.822) and test‐retest reliability (rs = 0.725). The RSA‐10 scores of patients were significantly higher than those of controls (p = 0.001), suggesting high internal validity. RSA‐10 was significantly correlated with the RFS (rs = 0.771). The interrater reliability was adequate for sub‐ and total RSA‐10 scores (k = 0.708). RSA‐10 significantly improved from baseline to 3‐month posttreatment (p = 0.001). An RSA‐10 > 13 may be suggestive of LPRD. Both RSA‐10 > 13 and Reflux Symptom Score‐12 > 11 were associated with a sensitivity of 92.7% and a specificity of 97.3%. Conclusion: The RSA‐10 is a reliable and valid clinical instrument for documenting the most prevalent laryngeal and extra‐laryngeal findings associated with LPRD. Level of Evidence: 3 Laryngoscope, 134:3981–3988, 2024 [ABSTRACT FROM AUTHOR]

Objective: To investigate the effectiveness of platelet‐rich plasma (PRP) injection into the olfactory clefts of coronavirus disease 2019 (COVID‐19) patients with persistent olfactory dysfunction (OD). Study Design: Controlled study. Setting: Multicenter study. Methods: From March 2022 to November 2022, COVID‐19 patients with persistent OD were recruited from three European hospitals to undergo PRP injections into the olfactory clefts. Olfactory function was evaluated at baseline and 10 weeks postinjection with the Olfactory Disorder Questionnaire (ODQ) and threshold, discrimination, and identification (TDI) test. Data were compared with a control group of untreated patients. Results: Eighty‐one patients who underwent PRP injection and 78 controls were included. Sixty‐five PRP patients (80.3%) experienced subjective smell improvement after a mean duration of 3.4 ± 1.9 weeks. The parosmia, life quality statement, and ODQ sub‐ and total scores significantly decreased from pre‐ to 10‐week postinjection in the PRP group. The TDI sub‐ and total scores significantly increased 10 weeks postinjection. In controls, the ODQ score did not change over time, while the discrimination, identification, and total TDI scores significantly increase after 10 weeks of follow‐up. The 10‐week TDI and ODQ scores were significantly better in the PRP group compared with the controls. Conclusion: Patients who underwent PRP injection reported better 10‐week subjective and objective smell outcomes than controls. Future randomized‐controlled studies using saline injection into the olfactory cleft of controls are needed to determine the superiority of PRP over placebo. [ABSTRACT FROM AUTHOR]

Objective: To investigate the association between laryngopharyngeal reflux (LPR), gastroesophageal reflux disease (GERD) and recalcitrant chronic rhinosinusitis (CRS). Data Sources: PubMed, Cochrane Library and Scopus. Review Methods: Three investigators searched the specified databases for studies investigating the relationship between LPR, GERD and recalcitrant CRS with or without polyposis. The following outcomes were investigated with PRISMA criteria: age; gender; reflux and CRS diagnosis; association outcomes and potential treatment outcomes. The authors performed a bias analysis of papers and provided recommendations for future studies. Results: A total of 17 studies investigated the association between reflux and recalcitrant CRS. According to pharyngeal pH monitoring, 54% of patients with recalcitrant CRS reported hypo or nasopharyngeal acid reflux events. The number of hypo‐ and nasopharyngeal acid reflux events was significantly higher in patients compared to healthy individuals in 4 and 2 studies, respectively. Only one study did not report intergroup differences. The proportion of GERD was significantly higher in CRS patients compared to controls, with a prevalence ranging from 32% to 91% of cases. No author considered nonacid reflux events. There was significant heterogeneity in the inclusion criteria; definition of reflux and association outcomes, limiting the ability to draw clear conclusions. Pepsin was found in sinonasal secretions more frequently in CRS patients than controls. Conclusion: Laryngopharyngeal reflux and GERD may be contributing factors of CRS therapeutic resistance, but future studies are needed to confirm the association considering nonacid reflux events. [ABSTRACT FROM AUTHOR]

Objective: To investigate the clinical patterns and disease evolution of laryngopharyngeal reflux (LPR) patients. Methods: Patients with LPR diagnosed by hypopharyngeal‐esophageal impedance‐pH monitoring were prospectively followed in three medical centers. Symptoms and findings were assessed with reflux symptom score (RSS) and reflux sign assessment (RSA). Patients were treated with 3‐to 9‐month diet and combination of proton pump inhibitors, alginate or magaldrate. Patients were followed for 3 years to determine the clinical evolution of symptoms over time. LPR that did not recur was defined as acute. Recurrent LPR consisted of reflux with one or several recurrences yearly despite successful treatment. Chronic LPR was reflux with a chronic course of symptoms. Predictive indicators of clinical evolution were investigated. Results: One hundred forty patients and 82 healthy individuals completed the evaluations. Among patients, 41 (29.3%), 57 (40.7%), and 42 (30.0%) had acute, recurrent, or chronic LPR respectively. Baseline quality of life‐RSS (QoL‐RSS) and RSS total scores were significantly higher in chronic LPR patients. The post‐treatment decrease of QoL‐RSS and RSS of acute LPR patients were significantly faster as compared to recurrent and chronic patients. QoL‐RSS >5 reported adequate sensitivity (94.2) and specificity (75.3). QoL‐RSS thresholds defined acute (QoL‐RSS = 6–25), recurrent (QoL‐RSS = 26–38), and chronic (QoL‐RSS > 38) LPR. Conclusion: Baseline QoL‐RSS may predict the clinical course of LPR patients: acute, recurrent, or chronic. A novel classification system that groups patients according to the longevity, severity, and therapeutic response of symptoms was proposed: the International Federation of Otorhinolaryngological Societies Classification of LPR. Level of Evidence: 3 Laryngoscope, 133:1073–1080, 2023 [ABSTRACT FROM AUTHOR]

Objective: To evaluate the evolution of voice quality in patients after type I‐VI transoral CO2 laser cordectomy (TLC) by using validated voice outcome measures over a 12‐month period. Study Design: Prospective uncontrolled study. Setting: Monocenter study. Methods: Patients with laryngeal carcinoma who were eligible for type I‐IV TLC were prospectively recruited from a tertiary medical center. The following outcomes were assessed throughout the 12‐month posttreatment period: Voice Handicap Index (VHI), GRBAS (grade of dysphonia, roughness, breathiness, asthenia, strain), maximal phonation time, fundamental frequency (F0), F0 standard deviation, percentage jitter, percentage shimmer, noise‐to‐harmonic ratio, and speech fluency. Analyses were performed considering 2 groups of cordectomies: type I‐III vs IV‐VI. Results: A total of 131 patients completed the evaluations, totaling 76 type I‐III and 55 type IV‐VI cordectomies. In type IV‐VI, breathiness and maximal phonation time significantly worsened from pretreatment to 1 month posttreatment (P <.05). In the type I‐III cordectomy group, VHI, shimmer, roughness, breathiness, and strain significantly improved from pretreatment to 3 months posttreatment, while VHI, F0 standard deviation, shimmer, jitter, grade of dysphonia, roughness, breathiness, and strain improved from baseline to 6 months. Assessments at 12 months posttreatment revealed significant improvements for VHI, shimmer, jitter, noise‐to‐harmonic ratio, grade of dysphonia, roughness, breathiness, and strain. In the type IV‐VI group, VHI significantly improved from baseline to 3, 6, and 12 months posttreatment. Strain improved at 6 and 12 months while roughness improved from baseline to 12 months. Maximal phonation time significantly worsened over the 12‐month evaluation period. Conclusion: The effect of TLC on voice quality depends on its type. VHI was identified as the most indicative tool of voice changes irrespective of TLC type. [ABSTRACT FROM AUTHOR]

Objective: To psychophysically evaluate olfaction in patients with laryngopharyngeal reflux (LPR). Study Design: Prospective controlled study. Setting: Tertiary medical center. Methods: From January 2021 to January 2022, patients with LPR diagnosed with hypopharyngeal‐esophageal multichannel intraluminal impedance‐pH monitoring underwent psychophysical evaluation of the sense of smell. Reflux symptoms and findings were assessed with the Reflux Symptom Score (RSS) and Reflux Sign Assessment (RSA). Nasal symptoms were assessed through the Sino‐Nasal Outcome Test 22 (SNOT‐22). From pre‐ to posttreatment, patients underwent identification Sniffin' Sticks test and olfactory cleft examination. Clinical outcomes were compared between LPR patients and healthy individuals. Results: In total, 107 patients and 76 healthy individuals completed the evaluations. LPR patients reported significant higher RSS, RSA, and SNOT‐22 scores. Psychophysical olfactory evaluations were significantly lower in reflux patients compared with controls, while there were no significant differences in olfactory cleft score. RSS and RSA significantly improved from baseline to 3 months posttreatment. SNOT‐22, olfactory cleft endoscopy scale, and psychophysical olfactory evaluations did not change throughout treatment. Patients with higher number of acid pharyngeal reflux events reported lower psychophysical olfactory scores (P =.025). Conclusion: LPR disease was associated with low odor identification results in patients without olfactory cleft abnormalities. The sense of smell did not improve after 3‐month therapy. Future controlled studies using threshold, discrimination, and identification testing are needed. [ABSTRACT FROM AUTHOR]

Objective: To investigate the prevalence and recovery of olfactory dysfunction (OD) in COVID‐19 patients 24 months after the infection. Methods: From 22 March 2020 to 5 June 2022, 251 COVID‐19 patients were followed in three European medical centres. Olfactory function was assessed with subjective patient‐reported outcome questionnaires and odour identification tests at baseline, 6, 12, 18 and 24 months postinfection. The predictive values of epidemiological and clinical data were investigated with multivariate analysis. Results: One hundred and seventy‐one patients completed the evaluations. The odour identification test revealed that 123 patients (50.8%) had OD at baseline. The prevalence of persistent psychophysical abnormalities at 6, 12, 18 and 24 months post‐COVID‐19 was 24.2%, 17.9%, 5.8% and 2.9%, respectively (p = 0.001). Parosmia occurred in 40 patients (23.4%) and lasted 60 ± 119 days. At 2 years, 51 patients (29.8%) self reported that their olfaction was unnormalised. Older patients had better odour identification evaluations at baseline (p < 0.001) but those with OD reported lower odour identification test scores at the end of the follow‐up. Parosmia occurred more frequently in young patients. The olfactory training was significantly associated with higher values of Sniffin' Sticks tests at 18 months postinfection (rs = 0.678; p < 0.001). Conclusion: Two years post‐COVID‐19, 29.8% of patients reported persistent OD, but only 2.9% had abnormal identification psychophysical evaluations. [ABSTRACT FROM AUTHOR]

In this paper, we described technique of platelet rich plasma injection into the olfactory cleft in a 22-year-old female with 24-month post–COVID-19 anosmia. The technique starts with the blood extraction and the isolation of PRP through a 10-min centrifugation. The supernatant was injected in nasal regions after a local anesthesia through a 0° rigid optic. Several points of.2–.5 mL were performed in the nasal septum in regard of the head of the middle turbine and in the head of the middle turbine in both sides. The baseline threshold, discrimination, and identification scores were 1, 8, and 0, and the Olfactory Disorder Questionnaire score was 51, respectively. The injection of PRP in olfactory cleft was done without complication and mild pain. The patient perception of recovery of smell sense occurred at 3-week post-injection. From this time, the smell sense progressively improved to the 2-month consultation. At 2-month post-injection, the TDI scores reached 16, 16, and 16 (48), while the Olfactory Disorder Questionnaire was 73. The injection of PRP into the olfactory cleft appears to be a safe and easiness new approach that may improve the recovery of smell sense. Future controlled studies are needed. [ABSTRACT FROM AUTHOR]

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