Associations among Self-Reported Laryngopharyngeal Reflux, Allergic Symptoms, and Type of Dysphonia

Dysphonia is defined as a change in voice timber, pitch, or loudness. Precipitating factors may be occupational or health-related, such as allergy and laryngopharyngeal reflux (LPR).

To investigate the association between combined LPR, and allergic rhinitis (AR), and type of dysphonia, that is, functional versus non-functional.

A retrospective chart review of all patients with dysphonia who presented to the Voice Unit at a tertiary referral center between November 2018 and February 2022 was conducted. Patients must have previously filled out the Reflux Symptom Index (RSI) and AR questionnaires to be recruited. Based on laryngeal examination, the etiology of dysphonia was stratified as functional versus non-functional (referred to as structural/neurologic).

A total of 137 patients were included, 65 (47.4%) of whom had a structural voice disorder, 22 (16.1%) had neurologic voice disorders, and 50 (36.5%) had a functional voice disorder. Seventy-eight patients (56.1%) had a positive RSI ≥ 13, suggestive of LPR. In these patients, dysphonia was functional in 31, structural-in 34, and neurologic in 13 ( p  = 0.568). Sixty-eight patients (48.9%) had a positive AR score ≥ 1, suggestive of allergy, 62% of whom had functional dysphonia, 46.2% had structural dysphonia, and 31.8% had neurologic dysphonia ( p  = 0.046). Twenty-five of the 50 patients (50%) with functional dysphonia had RSI ≥ 13 and AR ≥ 1 versus 29.3% (19/65) of the structural subgroup and 31.8% (7/22) of the neurologic subgroup ( p  = 0.063). After adjusting for smoking, patients with both reflux and allergy had 2.913 (95%CI = 1.32-6.442) times the odds having functional dysphonia compared with those having either or none ( p  = 0.008).

Patients with dysphonia and history of LPR and allergy are more likely to have a functional underlying etiology.