Background: Pharyngeal pH monitoring and laryngoscopy are used to diagnose gastroesophageal-pharyngeal reflux as a cause of respiratory symptoms. Though their use seems intuitive, their ultimate role remains to be defined.
Methods: We studied 10 asymptomatic subjects and 76 patients with respiratory symptoms. Patients and subjects were queried regarding their symptoms and their frequency scored. Each underwent direct laryngoscopy using the Reflux Finding Score (RFS) to grade laryngeal injury, esophageal manometry and 24-hour esophago-pharyngeal pH monitoring. The patients were RFS+ if the score was >7, and PR+ if they had >1 episode of pharyngeal reflux detected during pH monitoring.
Results: The most common symptoms reported by patients were hoarseness (87%), cough (53%), and heartburn (50%). Subjects had a significantly lower RFS (2.1 vs. 9.6, p<.01) and fewer episodes of PR (0.2 vs. 3.4, p<.01), than patients. No subject had more than one episode of PR. Fifty patients (66%) were RFS+ and 26 (34%)were RFS-. Thirty-two patients (42%) were PR+ and 44 (58%) were PR-. Fifteen patients had a normal RFS and no pharyngeal reflux (Group I=RFS-,PR-). Forty patients had discordance between the laryngoscopy findings and the pH monitoring (Group II=RFS PR+ or RFS+PR-). Twenty-one patients had both an abnormal RFS and pharyngeal reflux (Group III=RFS+PR+). The heartburn score in Group I was 1.3; Group II, 0.9; and Group III, 1.8 (p<.05 for Group II vs. Group III). The mean distal esophageal acid exposure (% time pH<4) was 3% in Group I, 3.3% in Group II, and 5.9% in Group III (p<.05 for Group II vs. Group III).
Conclusions: An abnormal PR or RFS differentiates normal subjects from patients with laryngeal symptoms. Agreement between PR and RFS helps establish or refute the diagnosis of gastroesophageal reflux as a cause of laryngeal symptoms. Patients who are RFS+ and PR - may have laryngeal injury from another source; whereas patients who are RFS- and PR+ may not have acid enter the larynx, despite pharyngeal reflux. Patients who are RFS+ and PR+ have more severe gastroesophageal reflux disease. Laryngoscopy and pharyngeal pH monitoring should be considered complimentary studies in establishing the diagnosis of laryngeal injury induced by gastroesophageal reflux.