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Comparative Evaluation of RSI, RSS, RFS, and RSA for Screening Laryngopharyngeal Reflux.

Bolin Zhang1, Qian Nie1, Shufang Zhang1

  • 1Department of Otolaryngology Head and Neck Surgery, The First Affiliated Hospital of Bengbu Medical University, Bengbu 233000, China.

Journal of Voice : Official Journal of the Voice Foundation
|December 3, 2025
PubMed
Summary
This summary is machine-generated.

The reflux symptom score (RSS) is the most effective screening tool for laryngopharyngeal reflux (LPR) among the evaluated questionnaires. This study found RSS demonstrated superior sensitivity and specificity for LPR detection compared to RSI, RFS, and RSA.

Keywords:
DiagnosisLaryngopharyngeal refluxRSSSaliva pepsin

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Area of Science:

  • Otolaryngology
  • Gastroenterology
  • Diagnostic Medicine

Background:

  • Laryngopharyngeal reflux (LPR) is a condition where stomach contents reflux into the throat.
  • Accurate screening tools are essential for early LPR diagnosis and management.
  • Current screening methods include symptom indices and physical examination scores.

Purpose of the Study:

  • To assess the diagnostic utility of four screening tools for LPR: reflux symptom index (RSI), reflux symptom score (RSS), reflux finding score (RFS), and reflux sign assessment (RSA).
  • To compare the effectiveness of these tools against saliva pepsin measurements as a diagnostic standard for LPR.

Main Methods:

  • Fifty patients suspected of having LPR completed RSI, RSS, RFS, and RSA questionnaires.
  • Saliva pepsin levels were measured in participants under fasting and post-dinner conditions.
  • Weighted Cohen's kappa statistics were used to analyze the agreement between questionnaire results and saliva pepsin test outcomes.

Main Results:

  • The reflux symptom score (RSS) showed the highest consistency with saliva pepsin testing (kappa = 0.504, P < 0.01).
  • RSS demonstrated the highest sensitivity (92.68%) and an optimal area under the curve (AUC = 0.741, P = 0.025).
  • While RFS had good specificity (77.78%), RSS offered a better overall performance for LPR screening.

Conclusions:

  • The reflux symptom score (RSS) questionnaire exhibits superior screening value for laryngopharyngeal reflux (LPR) compared to RSI, RFS, and RSA.
  • RSS is recommended as a more effective tool for initial LPR screening in clinical practice.
  • Further research may explore combining RSS with other diagnostic methods for enhanced LPR diagnosis.