The Relation Between Endoscopic and Subjective Laryngopharyngeal Reflux Signs, Vocal Tract Discomfort, Voice Handicap, and Voice Disorder Type: Same Yet Different?

Julia Lukaschyk; Jakob Abel; Meike Brockmann-Bauser; Jacob Friedrich Clausen; Rudolf Reiter; Julian Wessel; Anna-Katharina Rohlfs

doi:10.1016/j.jvoice.2023.11.021

The Relation Between Endoscopic and Subjective Laryngopharyngeal Reflux Signs, Vocal Tract Discomfort, Voice Handicap, and Voice Disorder Type: Same Yet Different?

J Voice. 2024 Jan 4:S0892-1997(23)00381-8. doi: 10.1016/j.jvoice.2023.11.021. Online ahead of print.

Authors

Julia Lukaschyk¹, Jakob Abel², Meike Brockmann-Bauser³, Jacob Friedrich Clausen⁴, Rudolf Reiter⁵, Julian Wessel⁶, Anna-Katharina Rohlfs⁷

Affiliations

¹ ENT, Phoniatrics and Pedaudiology - Klosterstern, Hamburg, Germany. Electronic address: j.lukaschyk@googlemail.com.
² Department of Otorhinolaryngology, Head and Neck Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany.
³ Department of Phoniatrics and Speech Pathology, Clinic for Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
⁴ Department of Otorhinolaryngology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
⁵ Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Hospital, Ulm, Germany.
⁶ ENT, Phoniatrics and Pedaudiology - Klosterstern, Hamburg, Germany.
⁷ ENT, Phoniatrics and Pedaudiology - Klosterstern, Hamburg, Germany; Department of Otorhinolaryngology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

PMID: 38182496
DOI: 10.1016/j.jvoice.2023.11.021

Abstract

Objectives: This study aimed to investigate the relation between subjective voice-related symptoms and endoscopic findings in patients with different etiology of voice disorder and vocally healthy subjects with and without laryngopharyngeal reflux (LPR).

Study design: Retrospective cross-sectional study.

Methods: The study involved 149 participants (106 female, 43 male) including 125 with various voice disorders (functional, structural, and neurogenic) and 24 vocally healthy individuals. For self-rating the German versions of the Voice Handicap Index (VHI), Vocal Tract Discomfort (VTD) Scale, and Reflux Symptom Index (RSI) were applied, while endoscopic evaluations utilized the Reflux Finding Score (RFS) and Reflux Sign Assessment (RSA). Statistical analyses incorporated ANOVA with Bonferroni posthoc tests to identify group variations. Correlations between VTD Scale, VHI, RSI, RFS, and RSA were evaluated using Pearson's correlation coefficient. To examine test sensitivity and specificity for the VTD Scale and RSA, we performed a receiver operating characteristics analysis. Youden's-Index was applied to determine the cut-off-value with best discriminatory abilities. The diagnosis of LPR was assumed when the criteria of RFS > 7 AND RSI > 13 was met.

Results: Significant differences for all voice diagnosis groups and vocally healthy individuals for RFS and all three self-rating questionnaires were found. Moreover, there was significant correlation between VTD Scale and VHI and RSI as well as RSI and RFS, which was moderate, negative in the group of persons with LPR. However, there was no significant difference for RSA results between the vocally healthy or any diagnosis group.

Conclusion: Thus, the RFS may be more suitable to predict reflux and voice-related symptoms. The VTD Scale is a useful instrument in screening voice disorders but also LPR and can therefore be used as a tool for decision-making when transferring to a specialist.

Keywords: Laryngopharyngeal reflux; Reflux Finding Score (RFS); Reflux Sign Assessment (RSA); Vocal Tract Discomfort Scale (VTD); Voice Handicap Index (VHI).