Signs and symptoms of laryngopharyngeal reflux and its relation to complaints and vocal quality
Sinais e sintomas de refluxo laringofaríngeo e sua relação com queixas e qualidade vocal
Gabriela Ricci; Aline Epiphanio Wolf; Aline Pires Barbosa; Felipe Moreti; Ingrid Gielow; Mara Behlau
Abstract
Purpose: To verify the association between laryngopharyngeal reflux (LPR) with age, gender, vocal deviation and voice complaints. Methods: The study included patients between 18 and 70 years old, referred to the Otorhinolaryngology service for complaints of voice or reflux, of both sexes. Endolaryngeal findings were classified using the Reflux Finding Score (RFS) scale. The presence or absence of vocal and reflux complaints was verified and correlated with the RFS classification. On the same date, they were submitted to sustained vowel voice recording and chained speech. The auditory-perceptual assessment was performed by a speech therapist, classifying the general degree of vocal deviation based on the GRBASI scale. Results: Ninety-seven patients were evaluated, with a mean age of 42.6 years, 62.3% female, and mean RFS scores of 6.26 points. Among the patients, 48 subjects had vocal complaints, 34 women with a mean age of 44.9 years and an average RFS score of 6.94 points. The other 49 individuals had no vocal complaints, and of these 27 were women, with a mean age of 41.2 years and a mean RFS score of 5.5 points. The variables “reflux complaint”, “vocal complaint” and age were the ones that most correlated with the RFS scale scores. Conclusion: There is a relationship among reflux complaints, laryngeal findings and vocal complaint
Keywords
Resumo
Objetivo: Verificar a associação entre Refluxo laringofaríngeo (RLF) com idade, sexo, desvio vocal e queixas de voz. Método: Participaram do estudo pacientes entre 18 e 70 anos, encaminhados ao serviço de otorrinolaringologia por queixas de voz ou refluxo, de ambos os sexos. Os achados endolaríngeos foram classificados utilizando a escala Reflux Finding Score (RFS). A presença ou não de queixas vocais e de refluxo foi verificada e correlacionada com a classificação RFS. Na mesma data, os pacientes foram submetidos à gravação de voz de vogal sustentada e fala encadeada. A avaliação perceptivo-auditiva foi realizada por uma fonoaudióloga, classificando o grau geral do desvio vocal com base na escala GRBASI. Resultados: Foram avaliados 97 pacientes, com média de idade de 42,6 anos, sendo 62,3% do sexo feminino e média dos escores da escala RFS igual a 6,26 pontos. Do total de pacientes, 48 indivíduos apresentavam queixas vocais, sendo 34 mulheres com idade média de 44,9 anos e escore RFS médio de 6,94 pontos. Os outros 49 indivíduos não apresentavam queixas vocais, e desses 27 eram mulheres, com idade média de 41,2 anos e média de escore RFS igual a 5,5 pontos. As variáveis “queixa de refluxo”, “queixa vocal” e idade foram as que mais se correlacionaram com os escores da escala RFS. Conclusão: Há relação entre queixas de refluxo, achados laríngeos e queixa vocal.
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Referencias
1 Behlau M, Azevedo R, Pontes P. Conceito de Voz Normal e Classificação das Disfonias. In: Behlau M (org. ). Voz - O Livro do Especialista. V1. Rio de Janeiro: Revinter, 2001. [ Links ]
2 Koufman J, Sataloff RT, Toohill T. Laryngopharyngeal reflux: consensus conference report. J Voice. 1996. 10(3):215-6. DOI: 10. 1016/s0892-1997(96)80001-4. PMid: 8865091. [ Links ]
3 Vaezi MF, Hicks DM, Abelson TI, Richter JE. Laryngeal signs and symptoms and gastroesophageal reflux disease (GERD): a critical assessment of cause and effect association. Clin Gastroenterol Hepatol. 2003. 1:333-44. DOI: 10.1053/s1542-3565(03)00177-0. PMid: 15017651. [ Links ]
4 Hicks DM, Ours TM, Abelson TI, Vaezi MF, Richter JE. The prevalence of hypopharynx findings associated with gastroesophageal reflux in normal volunteers. J Voice. 2002. 16:564-579. DOI: 10.1016/s0892-1997(02)00132-7. PMid: 12512644. [ Links ]
5 Mozzanica M, Robotti C, Lechien JR, Pizzorni N, Pirola F, Mengucci A, Dell'Era A, Ottaviani F, Schindler A. Vocal Tract Discomfort and Dysphonia in Patients Undergoing Empiric Therapeutic Trial with Proton Pump Inhibitor for Suspected Laryngopharyngeal Reflux. J Voice. 2020;34(2):280-288. https://doi. org/10.1016/j.jvoice.2018.11.002. [ Links ]
6 Sidhwa F, Moore A, Alligood E, Fisichella PM. Diagnosis and Treatment of the Extraesophageal Manifestations of Gastroesophageal Reflux Disease. Ann Surg. 2017. 265(1):63-7. DOI: 10.1097/SLA.0000000000001907. PMid: 27455157. [ Links ]
7 Moraes-Filho JP, Chinzon D, Eisig JN, Hashimoto CL, Zaterka S. Prevalence of heartburn and gastroesophageal reflux disease in the urban Brazilian population. Arq Gastroenterol. 2005. 42(2):122-7. http://dx.doi.org/10.1590/S0004-28032005000200011. [ Links ]
8 Hawkshaw MJ, Pebdani P, Sataloff RT. Reflux Laryngitis: an update, 2009-2012. J Voice. 2013. 4:486-94. DOI: 10.1016/j.jvoice.2013.03.001. PMid: 23769008. [ Links ]
9 Vaezi MF, Hicks DM, Abelson TI, Richter JE. Laryngeal signs and symptoms and gastroesophageal reflux disease (GERD): a critical assessment of cause and effect association. Clin Gastroenterol Hepatol. 2003. 1:333-44. DOI: 10.1053/s1542-3565(03)00177-0. PMid: 15017651. [ Links ]
10 Koufman JA. 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. 1991. 101(53):1-78. DOI: 10.1002/lary.1991.101.s53.1. PMid: 1895864. [ Links ]
11 Koufman JA, Ami MR, Panetti M. Prevalence of reflux in 113 consecutive patients with laryngeal and voice disorders. Otolaryngol Head Neck Surg. 2000. 123(4):385-8. DOI: 10.1067/mhn.2000.109935. PMid: 11020172. [ Links ]
12 Koufman JA, Aviv JE, Casiano RR, Shaw GY. Refluxo laringofaríngeo: declaração de posição do comitê sobre transtornos de fala, voz e deglutição da Academia Americana de Otorrinolaringologia - Cirurgia de Cabeça e Pescoço. Otolaryngol Head Neck Surg. 2002. 127-132. DOI: 10.1067/mhn.2002.125760. PMid: 12161727. [ Links ]
13 Park JO, Shim MR, Hwang YS. Combination of voice therapy and antireflux therapy rapidly recovers voice-related symptoms in laryngopharyngeal reflux patients. Otolaryngol Head Neck Surg. 2012. 146:92-97. DOI: 10.1177/0194599811422014. PMid: 21908799. [ Links ]
14 Koufman JA, Amin MR, Panetti, M. Prevalence of reflux in 113 consecutive patients with laryngeal and voice disorders. Otolaryngol. Head Neck Surg. 2000. 123(4):385-8. DOI: 10.1067/mhn.2000.109935. PMid: 11020172. [ Links ]
15 Aguero GC, Lemme EMO, Alvariz Â, Carvalho BB, Schechter RB, Abrahão LJ. Prevalência de queixas supra-esofágicas em pacientes com doenças do refluxo erosiva e não-erosiva. Arq Gastroenterol. 2007. 44(1):39-43. http://dx.doi. org/10.1590/S0004-28032007000100009. [ Links ]
16 Koufman JA. 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. 1991. 101:1-78. DOI: 10.1002/lary.1991.101.s53.1. PMid: 1895864. [ Links ]
17 Sidhwa F, Moore A, Alligood E, Fisichella PM. Diagnosis and Treatment of the Extraesophageal Manifestations of Gastroesophageal Reflux Disease. Ann Surg. 2017. 265(1):63-7. DOI: 10.1097/SLA.0000000000001907. PMid: 27455157. [ Links ]
18 Lechien JR, Schindler A, De Marrez LG, Hamdan AL, Karkos PD, Harmegnies B, Barillari MR, Finck C, Saussez S. Instruments evaluating the clinical findings of laryngopharyngeal reflux: a systematic review Laryngoscope. 2019. 129(3):720-736. DOI: 10.1002/lary.27537. PMid: 30291719. [ Links ]
19 Belafsky PC, Postma GN, Koufman JA. The validity and reliability of the reflux finding score (RFS). Laryngoscope. 2001. 111:1313-17. DOI: 10.1097/00005537-200108000-00001. [ Links ]
20 Pilotto A, Maggi S, Noale M, Franceschi M, Parisi G, Crepaldi G. Association of upper gastrointestinal symptoms with functional and clinical characteristics in elderly. World J Gastroenterol. 2011;17(25):3020-3026. doi: 10.3748/wjg.v17.i25.3020. PMid: 21799648. [ Links ]
21 Mendelsohn AH. The Effects of Reflux on the Elderly: The Problems with Medications and Interventions. Otolaryngol Clin North Am. 2018. 51(4):779-787. DOI: 10.1016/j.otc.2018.03.007. PMid: 29699708. [ Links ]
22 Ferriolli E, Oliveira RB, Matsuda MN, Braga FJ, Dantas RO. Aging, esophageal motility, and gastroesophageal reflux disease. J Am Geriatr Soc. 1998. 46:1534-7. doi: 10.3205/000145. PMid: 21863136. [ Links ]
23 Thomas JP, Zubiauir FM. Over-diagnosis of laryngopharyngeal reflux as the cause of hoarseness. Eur Arch Otorhinolaryngol. 2013. 270(3):995-9. DOI: 10.1007/s00405-012-2244-8. PMid: 23143641. [ Links ]
24 Lechien JR, Finck C, Huet K, Fourneau AF, Khalife M, Delvaux V, Piccaluga M, Harmegnies B, Saussez S. Voice Quality as Therapeutic Outcome in Laryngopharyngeal Reflux Disease: A Prospective Cohort Study. J Voice. 2020;34(1):112-120. https://doi.org/10.1016/j.jvoice.2018.08.018. [ Links ]
25 Qadeer MA, Swofer J, Milstein C, Hicks DM, Ponsky J, Richter JE, Abelson TI, Vaezi MF. Correlation between symptoms and laryngeal signs in laryngopharyngeal reflux. Laryngoscope. 2005. 115(11):1947-52. DOI: 10.1097/01.mlg.0000176547.90094.ac. PMid: 16319603. [ Links ]
Submitted date:
04/04/2019
Accepted date:
27/10/2019
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