Hoarseness misattributed to reflux: sources and patterns of error.

Area of Science:

• Otolaryngology
• Speech-Language Pathology

Background:

• Gastroesophageal reflux disease (GERD) is often implicated in voice disorders.
• Misattribution of hoarseness to reflux can delay accurate diagnosis and treatment.

Purpose of the Study:

• To identify voice disorders misdiagnosed as reflux.
• To determine the sources of misattribution in patients with hoarseness.

Main Methods:

• Retrospective chart review of 381 new patients with hoarseness.
• Analysis of 26 patients diagnosed solely with reflux seeking a second opinion.
• Exclusion of patients referred for further workup.

Main Results:

• Reflux alone was not the cause of hoarseness in any patient.
• Diagnoses included phonotraumatic lesions (42%), neurologic disorders (34%), age-related changes (19%), and infection (4%).
• Dynamic laryngeal examination with stroboscopy identified 85% of abnormalities, while flexible laryngoscopy identified only 15%.

Conclusions:

• Patients with hoarseness and no clear cause after initial evaluation, or those unresponsive to reflux treatment, may require advanced laryngeal investigation.
• Continued empiric reflux treatment or evaluation may be inappropriate for persistent dysphonia.
• Consider differential diagnosis beyond reflux for unexplained hoarseness.