Using the reflux symptom index to quantify throat symptom burden in LPR-screened-negative patients before and during...

This study aimed to quantify throat symptom burden using the Reflux Symptom Index (RSI) in laryngopharyngeal reflux (LPR)-screened-negative patients before and during SARS-CoV-2 infection in the Omicron-dominant period, and to identify factors independently associated with RSI score increase during infection.

This prospective follow-up study enrolled 428 LPR-screened-negative participants with SARS-CoV-2 infection during the Omicron-dominant period (December 2022-March 2023) in China. RSI questionnaires were administered at two time points: pre-infection baseline and follow-up. The second questionnaire was completed ≥4 weeks after infection onset, and participants retrospectively recalled acute symptoms experienced during the first 2 weeks of illness. Paired-samples t-tests, McNemar's test, and multivariable linear regression were used for analysis.

Mean age was 37.59 ± 11.56 years; 64.7% were female. Mean total RSI score increased significantly from 5.04 ± 5.98 at baseline to 9.68 ± 7.48 during infection (mean ΔRSI = +4.64; p < 0.001). The proportion with RSI > 13 rose from 9.1 to 25.9% (p < 0.001). The most common symptoms during infection were troublesome cough (79.2%), throat clearing (76.9%), and excess throat mucus (72.4%). Multivariable linear regression identified three factors independently associated with greater RSI increase: stuffy/runny nose (β = 3.30, 95% CI 1.99-4.60, p < 0.001), fatigue (β = 2.53, 95% CI 0.83-4.23, p = 0.004), and muscle pains (β = 1.96, 95% CI 0.59-3.32, p = 0.005).

SARS-CoV-2 infection during the Omicron-dominant period significantly worsened throat symptoms in LPR-screened-negative patients. Patients presenting with concurrent fatigue, nasal congestion, and muscle pain showed higher RSI increases and may warrant closer clinical attention.