Aim We have applied a new method for the quantitative assessment of voice to investigate the effect of anti-reflux surgery (ARS) on voice quality. Methods 59 asymptomatic volunteers were examined with the laryngograph, providing normal values for percentage irregularity of voice frequency (%CFx) and amplitude (%CAx). The values were distributed normally; values greater than the 95th percentile were regarded as abnormal. 16 patients due to undergo ARS underwent laryngograph studies pre-operatively and four weeks post-operatively. All subjects completed a standardised symptom questionnaire and read a standardised phonetically balanced text whilst laryngograph measurements of impedance across the larynx and vocal cord contact were obtained by means of electrodes applied to the neck. All ARS patients also underwent 24-hours pH and motility studies pre-operatively and underwent laparoscopic 360 or 180 fundoplication. Abnormal preoperative CFx & CAx values were found in 6/16 patients which comprised the study population. Results: There was a significant reduction in irregularity of both frequency (P=0.002) and amplitude (P=0.004) post-surgery (Table 1). 24 pH studies were abnormal (Demeester score > 14.7) in the distal oesophagus in 4/6 and proximally in 1/6 (16%). Pre-operative voice/laryngeal symptoms were absent in 5/6 (83.4%), and present in 1/6 patient which resolved after ARS. Conclusion: We have demonstrated that after ARS there is significant reduction in irregularity of voice frequency and amplitude. This objective improvement in voice quality may represent correction of laryngeal sequel of GORD that are rarely identified by symptoms, and which may occur in the presence of normal proximal pH studies in the majority of patients.
Comparision of Pre and Post Operative Changes