Prevalence of Esophageal Dysmotility and Reflux in Muscle Tension Dysphonia Patients

Laryngopharyngeal reflux (LPR) contributes to muscle tension dysphonia (MTD); however, symptoms overlap with esophageal dysmotility. Study aims were to determine the prevalence of esophageal disorders among MTD patients and correlate pathologies to patient-reported outcome measures (PROMs).

Retrospective chart review of MTD patients diagnosed by laryngologists who underwent barium esophagram for suspected LPR. Demographics, Voice Handicap Index 10 (VHI-10), Voice Related Quality of Life (V-RQOL), and imaging were reviewed. The Kruskal-Wallis test was used to compare VHI-10 and V-RQOL across groups. The Wilcoxon rank-sum test was applied to compare scores including their subitems, between dysmotility only and reflux only groups.

A total of 128 patients with MTD underwent barium esophagram. The average age was 61 years; 70% were female. Esophageal findings included dysmotility only (31%), reflux only (24%), both (12%), and neither (33%). The reflux-only group reported significantly worse voice-related outcomes on PROMS compared to dysmotility only. Reflux-only patients had higher total VHI-10 (p = 0.04) and were more likely to report difficulty being heard (p = 0.01), understood in noisy environments (p = 0.02), restricted socially (p < 0.01), and left out of conversations (p = 0.03). V-RQOL items like speaking loudly (p = 0.04), using phone (p = 0.04), performing work duties (p = 0.03), and feeling less outgoing (p = 0.02) were also more negatively impacted in reflux-only.

Esophageal dysmotility is prevalent in MTD patients and may mimic LPR. Patients with reflux may have more negative impacts on V-RQOL. Although esophagrams can be used as a screening tool, further studies can help elucidate the connection between esophageal dysmotility and laryngeal function.