Skip to main content

Advertisement

Log in

Voice outcomes of laryngopharyngeal reflux treatment: a systematic review of 1483 patients

  • Review Article
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

The aim of this study is to explore voice quality modifications in laryngopharyngeal reflux (LPR) disease and to understand better the pathophysiological mechanisms underlying the development of communicative disability. Biological Abstracts, BioMed Central, Cochrane database, PubMed and Scopus were assessed for subject headings using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) recommendations. Relevant studies published between January 1990 and December 2015 describing the evaluation of voice quality in LPR disease were retrieved. Issues of clinical relevance, such as LPR diagnosis method, treatment efficacy and outcomes, were evaluated for each study. We determined the grade of recommendation for each publication according to the Oxford Centre for Evidence-Based Medicine evidence levels. The search identified 145 publications, of which 25 studies met the inclusion criteria for a total of 1483 LPR patients. Data were extracted by 2 independent physicians who identified 16 trials with a IIb evidence level, 7 trials with a IIa evidence level and 2 RCTs with a Ib evidence level where 4 patient-based instruments and 5 clinician-based instruments were used. The main voice assessment outcomes reported were hoarseness assessments by physicians or patients, followed by acoustic parameters; 15 and 14 articles, respectively, demonstrated significant improvements in subjective and objective voice assessments after treatment. The methodology used to measure acoustic parameters (i.e. sustained vowel duration, the sample portion choice for measurement, etc.) varied from one study to another. The majority of studies indicated that voice quality assessments (especially acoustic parameters) remain an interesting outcome to measure the effectiveness of treatment, but further studies using standardised and transparent methodology to measure acoustic parameters are necessary to confirm the place of each tool in the LPR disease evaluation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. 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):32–35

    Article  PubMed  Google Scholar 

  2. Rees LE, Pazmany L, Gutowska-Owsiak D et al (2008) The mucosal immune response to laryngopharyngeal reflux. Am J Respir Crit Care Med 177(11):1187–1193

  3. Sen P, Georgalas C, Bhattacharyya AK (2006) A systematic review of the role of proton pump inhibitors for symptoms of laryngopharyngeal reflux. Clin Otolaryngol 31(1):20–24

    Article  CAS  PubMed  Google Scholar 

  4. Koufman JA (1991) The otolaryngologic manifestations of gastroesophageal reflux disease (GERD): a clinical investigation of 225 patients using ambulatory 24-h pH monitoring and an experimental investigation of the role of acid and pepsin in the development of laryngeal injury. Laryngoscope. 101(4 Pt 2 Suppl 53):1–78

  5. Poelmans J, Feenstra L, Tack J (2006) Determinants of long-term outcome of patients with reflux-related ear, nose, and throat symptoms. Dig Dis Sci 51(2):282–288

    Article  PubMed  Google Scholar 

  6. Printza A, Kyrgidis A, Oikonomidou E, Triaridis S (2011) Assessing laryngopharyngeal reflux symptoms with the Reflux Symptom Index: validation and prevalence in the Greek population. Otolaryngol Head Neck Surg 145(6):974–980

    Article  PubMed  Google Scholar 

  7. Koufman JA, Amin MR, Panetti M (2000) Prevalence of reflux in 113 consecutive patients with laryngeal and voice disorders. Otolaryngol Head Neck Surg 123(4):385–388

    Article  CAS  PubMed  Google Scholar 

  8. Belafsky PC, Postma GN, Koufman JA (2002) Validity and reliability of the reflux symptom index (RSI). J Voice 16(2):274–277

    Article  PubMed  Google Scholar 

  9. Pearson JP, Parikh S, Orlando RC et al (2011) Review article: reflux and its consequences–the laryngeal, pulmonary and oesophageal manifestations. Conference held in conjunction with the 9th International Symposium on Human Pepsin (ISHP) Kingston-upon-Hull, UK, 21–23 April 2010. Aliment Pharmacol Ther 33(Suppl 1):1–71

    PubMed  Google Scholar 

  10. Hanson DG, Conley D, Jiang J, Kahrilas P (2000) Role of esophageal pH recording in management of chronic laryngitis: an overview. Ann Otol Rhinol Laryngol Suppl 184:4–9

    Article  CAS  PubMed  Google Scholar 

  11. Ford CN (2005) Evaluation and management of laryngopharyngeal reflux. JAMA 294(12):1534–1540

  12. Sataloff RT, Castell DO, Katz PO, Sataloff DM (2006) Reflux laryngitis and related disorders, 3rd edn. Plural Publishing Inc, San Diego

    Google Scholar 

  13. Pribuisiene R, Uloza V, Kupcinskas L, Jonaitis L (2006) Perceptual and acoustic characteristics of voice changes in reflux laryngitis patients. J Voice 20(1):128–136

    Article  PubMed  Google Scholar 

  14. Lechien JR, Khalife M, Delvaux V et al (2014) Pathophysiology, assessment and treatment of laryngopharyngeal reflux. Rev Laryngol Otol Rhinol (Bord) 135(4–5):163–170

    CAS  Google Scholar 

  15. Sansone RA, Sansone LA (2012) Hoarseness: a sign of self-induced vomiting? Innov Clin Neurosci 9(10):37–41

    PubMed  PubMed Central  Google Scholar 

  16. Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009) Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA Statement. PLoS Med 6(6):e1000097. doi:10.1371/journal.pmed1000097)

    Google Scholar 

  17. Belafsky PC, Postma GN, Koufman JA (2001) The validity and reliability of the reflux finding score (RFS). Laryngoscope 111(8):1313–1317

    Article  CAS  PubMed  Google Scholar 

  18. Vincent DA Jr, Garrett JD, Radionoff SL, Reussner LA, Stasney CR (2000) The proximal probe in esophageal pH monitoring: development of a normative database. J Voice 14(2):247–254

    Article  PubMed  Google Scholar 

  19. Sataloff RT, Hawkshaw MJ, Gupta R (2010) Laryngopharyngeal reflux and voice disorders: an overview on disease mechanisms, treatments, and research advances. Discov Med 10(52):213–224

    PubMed  Google Scholar 

  20. Gupta R, Sataloff RT (2009) Laryngopharyngeal reflux: current concepts and questions. Curr Opin Otolaryngol Head Neck Surg 17(3):143–148

    Article  PubMed  Google Scholar 

  21. Howick J, Chalmers I, Glasziou P et al. The 2011 Oxford CEBM Levels of Evidence. Oxford Centre for Evidence Based Medicine

  22. Systematic and literature review resources 2011. http://distillercer.com/resources. Accessed July 2015

  23. Shaw GY, Searl JP (1997) Laryngeal manifestations of gastroesophageal reflux before and after treatment with omeprazole. South Med J 90(11):1115–1122

    Article  CAS  PubMed  Google Scholar 

  24. Hamdan AL, Sharara AI, Younes A, Fuleihan N (2001) Effect of aggressive therapy on laryngeal symptoms and voice characteristics in patients with gastroesophageal reflux. Acta Otolaryngol 121(7):868–872

    Article  CAS  PubMed  Google Scholar 

  25. Siupsinskiene N, Adamonis K, Toohill RJ (2007) Quality of life in laryngopharyngeal reflux patients. Laryngoscope. 117(3):480–484

    Article  PubMed  Google Scholar 

  26. Ogut F, Ersin S, Engin EZ et al (2007) The effect of laparoscopic Nissen fundoplication on laryngeal findings and voice quality. Surg Endosc 21(4):549–554

    Article  CAS  PubMed  Google Scholar 

  27. Beech TJ, Campbell G, McDermott AL, Batch AJ (2013) The effect of anti-reflux treatment on subjective voice measurements of patients with laryngopharyngeal reflux. J Laryngol Otol 127(6):590–594

    Article  CAS  PubMed  Google Scholar 

  28. Sahin M, Vardar R, Ersin S et al (2015) The effect of antireflux surgery on laryngeal symptoms, findings and voice parameters. Eur Arch Otorhinolaryngol 272(11):3375–3383

    Article  PubMed  Google Scholar 

  29. Ayazi S, Pearson J, Hashemi M (2012) Gastroesophageal reflux and voice changes: objective assessment of voice quality and impact of antireflux therapy. J Clin Gastroenterol 46(2):119–123

    Article  PubMed  Google Scholar 

  30. Kumar R, Bhat JS (2008) Aerodynamic Analysis Of Voice In Persons With Laryngopharyngeal Reflux. Online J Health Allied Scs 7(4):5

    Google Scholar 

  31. Ross JA, Noordzji JP, Woo P (1998) Voice disorders in patients with suspected laryngo-pharyngeal reflux disease. J Voice 12(1):84–88

    Article  CAS  PubMed  Google Scholar 

  32. Oguz H, Tarhan E, Korkmaz M et al (2007) Acoustic analysis findings in objective laryngopharyngeal reflux patients. J Voice 21(2):203–210

    Article  PubMed  Google Scholar 

  33. Akyildiz S, Ogut F, Varis A, Kirazli T, Bor S (2012) Impact of laryngeal findings on acoustic parameters of patients with laryngopharyngeal reflux. ORL J Otorhinolaryngol Relat Spec 74(4):215–219

    Article  PubMed  Google Scholar 

  34. Siupsinskiene N, Adamonis K (2003) Diagnostic test with omeprazole in patients with posterior laryngitis. Medicina (Kaunas). 39(1):47–55

    PubMed  Google Scholar 

  35. Vashani K, Murugesh M, Hattiangadi G et al (2010) Effectiveness of voice therapy in reflux-related voice disorders. Dis Esophagus 23(1):27–32

    Article  CAS  PubMed  Google Scholar 

  36. Habermann W, Schmid C, Neumann K, Devaney T, Hammer HF (2012) Reflux symptom index and reflux finding score in otolaryngologic practice. J Voice 26(3):e123–e127

    Article  PubMed  Google Scholar 

  37. Noordzij JP, Khidr A, Evans BA et al (2001) Evaluation of omeprazole in the treatment of reflux laryngitis: a prospective, placebo-controlled, randomized, double-blind study. Laryngoscope. 111(12):2147–2151

    Article  CAS  PubMed  Google Scholar 

  38. Lechien JR, Huet K, Khalife M et al (2015) Impact of laryngopharyngeal reflux on subjective and objective voice assessments: a prospective study. 122e annual meeting of the french society of oto-rhino-laryngology and head and neck surgery, Paris

  39. Sereg-Bahar M, Jerin A, Jansa R, Stabuc B, Hocevar-Boltezar I (2015) Pepsin and bile acids in saliva in patients with laryngopharyngeal reflux—a prospective comparative study. Clin Otolaryngol 40(3):234–239

    Article  CAS  PubMed  Google Scholar 

  40. Park JO, Shim MR, Hwang YS et al (2012) Combination of voice therapy and antireflux therapy rapidly recovers voice-related symptoms in laryngopharyngeal reflux patients. Otolaryngol Head Neck Surg 146(1):92–97

    Article  PubMed  Google Scholar 

  41. Oyer SL, Anderson LC, Halum SL (2009) Influence of anxiety and depression on the predictive value of the Reflux Symptom Index. Ann Otol Rhinol Laryngol 118(10):687–692

    Article  PubMed  Google Scholar 

  42. Elam JC, Ishman SL, Dunbar KB, Clarke JO, Gourin CG (2010) The relationship between depressive symptoms and Voice Handicap Index scores in laryngopharyngeal reflux. Laryngoscope 120(9):1900–1903

    Article  PubMed  Google Scholar 

  43. Waring JP, Lacayo L, Hunter J, Katz E, Suwak B (1995) Chronic cough and hoarseness in patients with severe gastroesophageal reflux disease. Diagnosis and response to therapy. Dig Dis Sci 40(5):1093–1097

    Article  CAS  PubMed  Google Scholar 

  44. Williams RB, Szczesniak MM, Maclean JC, Brake HM, Cole IE, Cook IJ (2004) Predictors of outcome in an open label, therapeutic trial of high-dose omeprazole in laryngitis. Am J Gastroenterol 99(5):777–785

    Article  CAS  PubMed  Google Scholar 

  45. Sala E, Salminen P, Simberg S, Koskenvuo J, Ovaska J (2008) Laryngopharyngeal reflux disease treated with laparoscopic fundoplication. Dig Dis Sci 53(9):2397–2404

    Article  PubMed  Google Scholar 

  46. Millet B, Dejonckere PH (1998) What determines the differences in perceptual rating of dysphonia between experienced raters? Folia Phoniatr Logop 50(6):305–310

    Article  CAS  PubMed  Google Scholar 

  47. Paecher G, Holinger P (1947) CONTACT ULCER OF THE LARYNX II. the role of vocal reeducation. Arch Otolaryngol 46(5):617–623

    Article  Google Scholar 

  48. Koufman JA (1995) Gastroesophageal reflux and voice disorders. In: Rubin JS, Sataloff RT, Korovin GS, Gould WJ (eds) Diagnosis and treatment of voice disorders. Igaku-Shoin, New-York and Tokyo, pp 161–175

    Google Scholar 

  49. Carding PN (2000) Evaluating voice therapy: measuring the effectiveness of treatment. Whurr Publishers, Philadelphia

    Google Scholar 

  50. Hirano M (1981) Clinical Examination of Voice. Springer, New York, pp 56–64

    Google Scholar 

  51. Dejonckere PH, Remacle M, Fresnel-Elbaz E, Woisard V, Crevier-Buchman L, Millet B (1996) Differentiated perceptual evaluation of pathological voice quality: reliability and correlations with acoustic measurements. Rev Laryngol Otol Rhinol (Bord) 117(3):219–224

  52. Jin bJ, Lee YS, Jeong SW, Jeong JH, Lee SH, Tae K (2008) Change of acoustic parameters before and after treatment in laryngopharyngeal reflux patients. Laryngoscope 118(5):938–941

  53. Selby JC, Gilbert HR, Lerman JW (2003) Perceptual and acoustic evaluation of individuals with laryngopharyngeal reflux pre- and post-treatment. J Voice 17(4):557–570

    Article  PubMed  Google Scholar 

  54. Naiboglu B, Durmus R, Tek A, Toros SZ, Egeli E (2011) Do the laryngopharyngeal symptoms and signs ameliorate by empiric treatment in patients with suspected laryngopharyngeal reflux? Auris Nasus Larynx 38(5):622–627

    Article  PubMed  Google Scholar 

  55. Wo JM, Koopman J, Harrell SP, Parker K, Winstead W, Lentsch E (2006) Double-blind, placebo-controlled trial with single-dose pantoprazole for laryngopharyngeal reflux. Am J Gastroenterol 101(9):1972–1978 (quiz 2169)

  56. Titze IR (1995) workshop on acoustic voice analysis: summary statement. National Center for Voice and Speech, Iowa City

    Google Scholar 

  57. Baken RJ (1987) Vocal fundamental frequency. In: Baken RJ, ed. Clinical measurement of speech and voice. Boston, MA: college-Hill Pess, pp 125–196

  58. Murray T (1978) Speaking fundamental frequency characteristics associated with voice pathologies. J Speech Hear Disord. 43(3):374–379

    Article  CAS  PubMed  Google Scholar 

  59. Reijonen P, Lehikoinen-Söderlund S, Rihkanen H (2002) Results of fascial augmentation in unilateral vocal fold paralysis. Ann Otol Rhinol Laryngol. 111(6):523–529

    Article  PubMed  Google Scholar 

  60. Dejonckere PH, Remacle M, Fresnel-Elbaz E, Woisard V, Crevier-Buchman L, Millet B. Differentiated perceptual evaluation of pathological voice quality: reliability and correlations with acoustic measurements. Rev Laryngol Otol Rhinol (Bord) 117(3):219–224

  61. Beckett RL (1969) Pitch perturbation as a function of subjective vocal constriction. Folia Phoniatr (Basel) 21(6):416–425

    Article  CAS  Google Scholar 

  62. Hickson C, Simpson CB, Falcon R (2001) Laryngeal pseudosulcus as a predictor of laryngopharyngeal reflux. Laryngoscope 111(10):1742–1745

    Article  CAS  PubMed  Google Scholar 

  63. Yoshikawa H, Furuta K, Ueno M, Egawa M et al (2012) Oral symptoms including dental erosion in gastroesophageal reflux disease are associated with decreased salivary flow volume and swallowing function. J Gastroenterol 47(4):412–420

    Article  PubMed  Google Scholar 

  64. Zhu H, Xu W, Li Y, Cheng L (2014) Observation of clinicopathological characteristics of vocal fold leukoplakia and laryngopharyngeal reflux. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 49(5):368–373

    PubMed  Google Scholar 

  65. Ogut F, Ersin S, Engin EZ et al (2007) The effect of laparoscopic Nissen fundoplication on laryngeal findings and voice quality. Surg Endosc 21(4):549–554

    Article  CAS  PubMed  Google Scholar 

  66. Alberts et al, eds (2008) Cell junction, cell adhesion and the extracellular matrix. In: Molecular biology of the Cell. Garland Science, New York and London, pp 1131–1204

  67. Hahn MS, Kobler JB, Starcher BC, Zeitels SM, Langer R (2006) Quantitative and comparative studies of the vocal fold extracellular matrix. I: elastic fibers and hyaluronic acid. Ann Otol Rhinol Laryngol 115:156–164

    Article  PubMed  Google Scholar 

  68. Lechien JR, Delvaux V, Huet K et al (2015) Phonetic approaches of laryngopharyngeal reflux disease: a prospective study. Sixth clinical phonetics day, Montpellier

    Google Scholar 

  69. Maryn Y, Roy N, De Bodt M, Van Cauwenberge P, Corthals P (2009) Acoustic measurement of overall voice quality: a meta-analysis. J Acoust Soc Am 126(5):2619–2634

    Article  PubMed  Google Scholar 

  70. Fass R, Noelck N, Willis MR et al (2010) The effect of esomeprazole 20 mg twice daily on acoustic and perception parameters of the voice in laryngopharyngeal reflux. Neurogastroenterol Motil 22(2):134–141

    Article  CAS  PubMed  Google Scholar 

  71. Qua CS, Wong CH, Gopala K, Goh KL (2007) Gastro-oesophageal reflux disease in chronic laryngitis: prevalence and response to acid-suppressive therapy. Aliment Pharmacol Ther 25(3):287–295

    Article  CAS  PubMed  Google Scholar 

  72. Sinn DH, Kim JH, Kim S et al (2008) Response rate and predictors of response in a short-term empirical trial of high-dose rabeprazole in patients with globus. Aliment Pharmacol Ther 27(12):1275–1281

    Article  CAS  PubMed  Google Scholar 

  73. de Bortoli N, Nacci A, Savarino E et al (2012) How many cases of laryngopharyngeal reflux suspected by laryngoscopy are gastroesophageal reflux disease-related? World J Gastroenterol 18(32):4363–4370

    Article  PubMed  PubMed Central  Google Scholar 

  74. Koufman JA (2002) Laryngopharyngeal reflux is different from classic gastroesophageal reflux disease. Ear Nose Throat J 81(9 Suppl 2):7–9

    PubMed  Google Scholar 

  75. Cesari U, Galli J, Ricciardiello F, Cavaliere M, Galli V (2004) Dysphonia and laryngopharyngeal reflux. Acta Otorhinolaryngol Ital 24(1):13–19

    CAS  PubMed  Google Scholar 

  76. Hirano M (1981) The structure and control of the vocal fold as a vibrator. In: Clinical examination of voice. Springer-Verlag, Wien New York, pp 4–7

  77. Jiang J (2006) Physiology of voice production:how does voice work? In: Benninger MS, Murry T (eds) The Performer’s Voice. Plural Publishing, San Diego, pp 23–32

    Google Scholar 

  78. Finck C (2008) Implantation d’acide hyaluronique estérifié lors de la microchirurgie des lésions cordales bénignes. Université de Liège, thèse de doctorat

  79. Wan Y, Yan Y, Ma F, Wang L, Lu P, Maytag A, Jiang JJ (2014) LPR: how different diagnostic tools shape the outcomes of treatment. J Voice 28(3):362–368

    Article  PubMed  Google Scholar 

  80. Guo H, Ma H, Wang J (2015) Proton pump inhibitor therapy for the treatment of laryngopharyngeal reflux: a meta-analysis of randomized controlled trials. J Clin Gastroenterol, 16

  81. Koufman JA (2011) Low-acid diet for recalcitrant laryngopharyngeal reflux: therapeutic benefits and their implications. Ann Otol Rhinol Laryngol 120(5):281–287

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors thank American Journal Expert for the proofreading the article.

Funding

This study was funded by A.R.C. grant convention from Communauté Française de Belgique (ARC N°AUWB-2012-12/17-UMONS).

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jérôme R. Lechien.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Additional information

B. Harmegnies and S. Saussez contributed equally to this work and should be regarded as joint last authors.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lechien, J.R., Finck, C., Costa de Araujo, P. et al. Voice outcomes of laryngopharyngeal reflux treatment: a systematic review of 1483 patients. Eur Arch Otorhinolaryngol 274, 1–23 (2017). https://doi.org/10.1007/s00405-016-3984-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00405-016-3984-7

Keywords

Navigation