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Voice Hoarseness with Reflux as a Suspected Etiology: Incidence, Evaluation, Treatment, and Symptom Outcomes

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Journal of Gastrointestinal Surgery

Abstract

Purpose

To describe the clinical evaluation course, treatments, and outcomes of patients with a primary complaint of hoarseness due to suspected laryngopharyngeal reflux (LPR).

Methods

A retrospective chart review was conducted of patients with a primary complaint of hoarseness with acid reflux as the suspected cause at a single institution between October 2011 and March 2020 who underwent clinical evaluation, treatment, and follow-up. Data collected included diagnostic procedures and treatments received, subjective symptom outcomes, and final diagnosis as determined by the treating physician.

Results

A total of 134 patients met the inclusion criteria. Videostroboscopy was the most performed procedure (n = 59, 44%) followed by endoscopy (n = 38, 28%) and pH monitoring (n = 28, 21%). Three patients were removed for statistical analysis of treatment differences and outcomes due to variant treatment plans. Most patients received sole medical management (n = 86, 66%), 7 patients received only voice therapy (5%), and 10 patients underwent surgical management (8%). Several patients received combined medical management and voice therapy (n = 21, 16%). Final diagnoses included gastroesophageal reflux disease (GERD) (25%), followed by multifactorial causes (17%) and dysphonia with unclear etiology (13%). Among all patients, 82 (61%) reported symptom improvement. Twenty-eight patients were diagnosed with LPR or LPR with GERD (21%), and 22 reported symptom improvement (79%). There was a statistically significant relationship between a final diagnosis with a reflux component and symptom improvement (p = .038). There was no statistically significant difference between treatment types and symptom outcomes both within the total patient population (p = .051) and patients diagnosed with a reflux condition (p = .572).

Conclusion

LPR remains a difficult diagnosis to establish and represents a minority of patients with voice complaints. Despite varying evaluation and treatment modalities, most patients with LPR improved during their treatment and evaluation period without a clear association with any specific type of treatment. Further studies should explore diagnostic criteria for LPR, the necessary and efficient clinical evaluation to establish a diagnosis, and possible beneficial treatments.

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Data Availability

The data supporting this study's findings are available from the corresponding author, SK, upon reasonable request.

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Authors and Affiliations

  1. USF Health Morsani College of Medicine, Tampa, FL, USA

    Sydney R. A. Korsunsky, Diep Nguyen & Rahul Mhaskar

  2. University of South Florida, Tampa, FL, USA

    Leonel Camejo

  3. USF Health Department of Surgery, Tampa, FL, USA

    Khattiya Chharath & Vic Velanovich

  4. USF Health Joy McCann Culverhouse Center for Swallowing Disorders, Tampa, FL, USA

    Joy Gaziano & Joel Richter

Authors
  1. Sydney R. A. Korsunsky
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  2. Leonel Camejo
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  3. Diep Nguyen
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  4. Rahul Mhaskar
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  5. Khattiya Chharath
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  6. Joy Gaziano
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  7. Joel Richter
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  8. Vic Velanovich
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Contributions

Sydney Korsunsky, Leonel Camejo, Diep Nguyen, Rahul Mhaskar, Khattiya Chharath, Joy Gaziano, Joel Richter, and Vic Velanovich made substantial contributions to the conception or design of the work; the acquisition, analysis, or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published; and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Sydney R. A. Korsunsky.

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Conflict of Interest

Sydney Korsunsky, Leonel Camejo, Diep Nguyen, Rahul Mhaskar, Khattiya Chharath, Joy Gaziano, and Joel Richter have no conflicts of interest.

Vic Velanovich is a speaker for Integra Life Sciences and a paid consultant for Innocoll Pharmaceuticals. He sits on the Executive Committee for the Society for Surgery of the Alimentary Tract (SSAT).

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This study was presented at Digestive Diseases Week 2022, May 23, 2022, San Diego, CA.

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Korsunsky, S.R.A., Camejo, L., Nguyen, D. et al. Voice Hoarseness with Reflux as a Suspected Etiology: Incidence, Evaluation, Treatment, and Symptom Outcomes. J Gastrointest Surg 27, 658–665 (2023). https://doi.org/10.1007/s11605-022-05574-9

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