Over-diagnosis of laryngopharyngeal reflux as the cause of hoarseness
The objectives of this study were: (1) to determine the percentage of patients seen in a private laryngology clinic with voice-related disorders previously diagnosed with and treated for laryngopharyngeal reflux (LPR); (2) to determine how many of those patients are found to have disorders other than LPR as a cause for their voice disorder. A retrospective, chart-review analysis of new patients was conducted from January 2005 through December 2007 in a private laryngology clinic setting. Patients with a previous diagnosis of LPR as the cause of hoarseness, with or without anti-reflux treatment were included. Incomplete charts and patients with additional diagnoses besides LPR where excluded. Patient charts were analyzed in search of different variables including chief complaint, previous medications and final diagnosis among others. 784 consecutive charts were reviewed. Inclusion criteria were met in 105 charts. 82 % had no improvement or felt worse after previous anti-reflux treatment while 18 % had significant or mild improvement. However, all patients remained with some degree of hoarseness. Final diagnosis by the author was diverse though none of the patients had laryngopharyngeal reflux as a final diagnosis and none of them noted worsening of their voice after respective treatment. Only 6 % felt the same after treatment and 9 % could not be found for follow-up. LPR has become an over-diagnosed entity. With a thorough history, vocal capability testing and physical exam, an accurate diagnosis for hoarseness can be made in the vast majority of cases. LPR may not be the cause of voice disorders and should not be assigned as a de facto diagnosis just because the cause of hoarseness is not readily identifiable.
KeywordsHoarseness Reflux Laryngopharyngeal Diagnosis
- 2.Koufman JA (1991) The otolaryngologic manifestations of gastroesophageal reflux disease (GERD): a clinical investigation of 225 patients using ambulatory 24-hour pH monitoring and an experimental investigation of the role of acid and pepsin in the development of laryngeal injury. Laryngoscope 101(S53):1–78Google Scholar
- 5.Koufman JA, Aviv JE, Casiano RR, Shaw GY (2002) Laryngopharyngeal reflux: Position statement of the committee on speech, voice, and swallowing disorders of the American Academy of Otolaryngology-Head and Neck Surgery. Otolaryngol Head Neck Surg 127(1):32–35Google Scholar
- 8.Ulualp SO, Roland PS, Toohill RJ et al (2005) Prevalence of gastroesophagopharyngeal acid reflux events: an evidence-based systematic review. Am J Otolaryngol Head Neck Surg 26:239–244Google Scholar
- 10.Hopkins C, Yousaf U, Pedersen M (2006) Acid reflux treatment for hoarseness. Cochrane Database Syst Rev (1):CD005054Google Scholar