Correlation between symptoms and laryngeal signs in laryngopharyngeal reflux

Laryngopharyngeal reflux (LPR) is diagnosed by the presence of laryngeal signs and symptoms. Some studies have noted that signs and symptoms may be nonspecific and may have poor correlation. However, many such studies were either observational or had short-term follow-up. Therefore, we conducted subgroup analysis of a prospective concurrent controlled study with a 1 year follow-up to study the correlation between signs and symptoms.

Prospective study.

Seventy-two patients with suspected gastroesophageal reflux disease related laryngeal symptoms/signs received a 4 month trial of aggressive acid-suppressive therapy. Four month symptomatic nonresponders (<50% improvement) with continued laryngeal inflammation and normalized esophageal acid exposure were then offered laparoscopic Nissen fundoplication. The primary outcome was laryngeal symptom-sign correlation at 1 year postsurgery.

Twenty-five of 72 (35%) patients remained unresponsive after 4 months of aggressive acid suppressive therapy. Ten (40%) patients agreed to undergo surgical fundoplication (mean age = 50, male = 4). The most common laryngeal symptoms were sore throat (40%), hoarseness (30%), and cough (20%), whereas the most common signs were medial arytenoid wall erythema/edema (60%), interarytenoid erythema (50%), and arytenoid complex erythema/edema (50%). At 1 year postfundoplication, laryngeal symptoms improved in only 1 of 10 (10%) patient, whereas signs improved in 8 of 10 (80%) patients.

There appears to be poor correlation between signs and symptoms of LPR, particularly when monitoring therapeutic outcomes. In patients unresponsive to twice-daily proton-pump inhibitor therapy for 4 months, further aggressive therapy is unlikely to bring additional symptomatic benefit.