• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.15 no.2
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• pp.81-86
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• 2004

Background and Objectives : In general, ambulatory 24-hour pH monitoring is considered the current gold standard for larynogopharyngeal reflux(LPR). There is no validated instrument whose purpose is to document the physical finding and severity of laryngopharyngeal reflux. The purposes of this study are to revaluate the validity and reliability of the reflux finding score(RFS) and to quantify laryngoscopic findings using reflux finding score. Material and Methods : Thirty-three LPR patients confirmed by dual-probe pH monitoring and thirty patients of control were selected. The RFS was documented for each patient with telescopic laryngoscopy before treatment. For test-retest intraobserver reliability assessment, a blinded laryngologists determined the RFS on two separate occasions. To evaluate interobserver reliability assessment, the RFS was determined by t재 different blinded laryngologists. Results : The mean age of the cohort with pH-documented LPR was 45.8 years and the mean RFS was 11.4. The mean age of cotrol subjects was 52 years and the mean RFS was 5.4. The mean RFS for laryngologist no. 1 was 10.8 at the initial screening and 10.9 at the repeat evaluation. The mean FRS for laryngologist no.2 was 11.1 at the intial test and 10.9 at the repeat evaluation. The correlation coefficient for interobserver variability was 0.93 and intraobserver variability was 0.94. Conclusion : The RFS demonstrates excellent inter-and introaobserver reproducibility and is helpful for quantifying laryngeal finding in LPR. We can be 95% certain that an individual with a RFS greater than 7 has LPR.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.18 no.2
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• pp.96-101
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• 2007

Laryngopharyngeal reflux (LPR) is the retrograde movement of gastric contents into the larynx, pharynx, and upper aero-digestive tract. LPR differs from gastroesophageal reflux in that it is often not associated with heartburn and regurgitation symptoms. Otolaryngological manifestations of acid reflux include a wide range of pharyngeal and laryngeal symptoms. Belafsky et al. developed a useful self-administered tool, the reflux symptom index (RSI), for assessing the degree of LPR symptoms. Patients are asked to use a 0 to 5 point scale to grade the following symptoms: 1) hoarseness or voice problems; 2) throat clearing; 3) excess throat mucus or postnasal drip ; 4) difficulty swallowing; 5) coughing after eating or lying down; 6) breathing difficulties ; 7) troublesome or annoying cough; 8) sensation of something sticking or a lump in the throat; 9) heartburn, chest pain, indigestion or stomach acid coming up. A RSI score greater than 13 is considered abnormal. As there is no validated instrument to document the physical findings and severity of LPR, Belafsky et al. developed an eight-item clinical severity scale for judging laryngoscopic finding, the reflux finding score (RFS). They rated eight LPR-associated findings on a scale from 0 to 4 : subglottic edema, ventricular obliteration, erythema/hyperemia, vocal-fold edema, diffuse laryngeal edema, posterior commissure hypertrophy, granuloma/granulation tissue, and thick endolaryngeal mucus. A RFS score of greater than 7 was found to suggest LPR-associated laryngitis. Although both indices (RSI and RFS) are widely used, there is some controversy about their validity (sensitivity and specificity) and reliability (intra-rater and inter-rater) in LPR diagnosis and treatment. We discuss the validity and reliability of RSI and RFS with literature review.

• Korean Journal of Bronchoesophagology
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• v.15 no.1
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• pp.41-49
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• 2009

Background and Objectives : Proton pump inhibitors(PPIs) improve the symptoms of laryngopharyngeal reflux(LPR). But there is little reports about the changes of each items in reflux symptom index (RSI) and reflux finding score (RFS) after PPIstreatment. The purpose of this study is to analyze the changes of pre- and post-treatment score in each RSI and RFS items after 8 weeks medication with proton pump inhibitors in laryngopharyngeal reflux patients. Methods : Prospective study. Among the patients who had visited the department of otolaryngology from January 2007 to December 2008, 91 patients who had shown scores greater than 13 on the RSI and/or 7 on the RFS were studied. All patients received PPIs once daily before breakfast for 8 weeks. RSI and RFS were assessed at initial, four weeks and eight weeks after medication. Result: All RSI items were improved (p < 0.05). The globus sense followed by throat clearing, heartburns and hoarseness showed high initial RSI score than other items. And globus sense, throat clearing, hoarseness and heartburn were improved significantly more than others items. But only posterior commissure hypertrophy of RFS was improved significantly more than others items. Conclusion: Empiric PPIs therapy reduced the RSI scores and more effective for symptoms such as globus sense, throat clearing, hoarseness and heartburn among suspected LPR patients. In RFS, only posterior commissure hypertrophy has improved significantly. However, the changes of each categories of RFS were minimal (average: 0.16), therefore clinical significance is restricted in RFS.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.16 no.1
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• pp.15-18
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• 2005

Background and Objectives : To determine the changes of reflux symptoms and laryngoscopic findings of patients with laryngopharyngeal reflux (LPR) on the duration of proton pump inhibitor medication. Materials and Methods : From Feb 2003 to Nov 2004, 58 patients who were diagnosed with LPR by 24-hour double-probe pH monitoring were enrolled. All patients were treated with proton pump inhibitor and followed up for 8 weeks at least. The response of symptoms and laryngoscopic findings of patients were assessed with reflux symptom index (RSI) and reflux finding score (RFS) before treatment and 2, 4, 8, 12, 16, 20 weeks after treatment. Results : The symptoms of patients with LPR were improved significantly at 2, 4, 8 weeks of treatment. The laryngoscopic findings of patients with LPR were improved significantly at 4 and 12 weeks of treatment. There was no correlation between improvement of reflux symptoms and laryngoscopic findings. Conclusions : The laryngoscopic findings of LPR patients were improved more slowly than reflux symptoms. Based on our results, anti-reflux therapy might be continued at least for 3 months until the improvement of laryngoscopic findings.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.19 no.2
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• pp.136-141
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• 2008

Background and Objectives: Laryngopharyngeal reflux (LPR) is a very common disease among outpatients of department of otorhinolaryngology. Although there are several diagnostic tools for LPR disease and ambulatory 24-hour double-probe pH monitoring is gold standard method, empirical diagnosis by reflux symptom index and reflux finding score (RFS) are mainly used. So we analyzed the relationship between ambulatory 24-hour double-probe pH monitoring and RFS in patients with LPR. Subjective and Method: Fifty patients with LPR symptoms and abnormal RFS and ambulatory 24-hour double probe monitoring were enrolled. Each items and sum of laryngeal reflux score were compared the results of ambulatory 24-hour double-probe pH monitoring in upper (UES) and lower (LES) esophageal sphincter. Results: There were no significant correlation between the results of ambulatory 24-hour double-probe pH monitoring in UES (pH<4 and pH<5) and each item and sum of RFS. However, supine time and reflux number of UES (pH<5) were showed the partial correlations with diffuse laryngeal edema and thick endolaryngeal mucus (p=0.03, p=0.01). Although there were no relationship between the results of ambulatory 24-hour double-probe pH monitoring in LES and sum of RFS, the significant correlations presented between granuloma and total time (p=0.008), upright time (p=0.008, reflux number (p=0.049) of LES. Conclusion: Although granuloma among items of RFS showed significantly correlation with the results of ambulatory 24-hour double-probe pH monitoring in LES, there were no significant correlation between the results of ambulatory 24-hour double-probe pH monitoring in UES and LES and items and sum of RFS.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.14 no.1
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• pp.26-29
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• 2003

Background and Objectives : Gastric acid reflux has been suggested to have an association with sleep apnea(SA). This study's aim is to evaluate the relationship between reflux laryngitis and SA through the fact that the treatment of reflux laryngitis may impact the snoring and SA related symptoms in selective individuals. Methods : Population consist of 24 males and 10 female aged 34 to 66 years(mean age 50 years) confirmed by Reflux Finding Score(RFS) of PC Belafsky. Thirty four patients with reflux laryngitis and associated symptoms of SA were treated with proton pump inhibitor(Rabeprazole sodium 10mg/day) for 60 days. The degree of snoring and apnea related symptoms were evaluated using questionnaires, and palatine tonsillar hypertropy(PTH) and RFS were compared preoperatively and postoperatively. Results : After antireflux treatment for 60 days, the snoring(p=0.039), daytime sleepiness(p=0.002), and concentration(p=0.011) were significantly improved(p<0.05) and RFS was significantly decreased(p=0.000), but morning headache(p=0.057) and sleep apnea(p=0.083) were not significantly improved(p>0.05) and PTH was not significantly decreased(p=0.328). Conclusion : Treatment of reflux laryngitis significantly impacted the snoring, daytime sleepiness, and concentration in selective individuals. These results suggest some close relationship between reflux laryngitis and SA, and the treatment of reflux laryngitis may be some effective in those with both disorders.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.23 no.2
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• pp.124-128
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• 2012

Background and Objectives : There are many diagnostic modalities to evaluate laryngopharyngeal reflux. However, ideal diagnostic methods have not been established yet. The purpose of this study is to evaluate the effectiveness of Water-Siphon test as a diagnostic test of laryngopharyngeal reflux. Subjects and Methods : From November 2006 to September 2007, we performed esophagography with Water-Siphon test and questionnaire, physical examination for 227 patients with laryngopharyngeal reflux symptoms. The results of Water-Siphon test were classified according to the degree of reflux, the number of reflux, the retention time and analyzed about the relationship with the reflux symptom index (RSI), reflux finding score (RFS). Results : The degree of reflux was related with pseudosulcus, thick endolaryngeal mucus. The number of reflux was related with thick endolaryngeal mucus. A positive predictive value of Water-Siphon test was 82.7% and sensitivity was 91.5%. Conclusion : Water-Siphon test is a reliable diagnostic test for laryngopharyngeal reflux.

• Journal of Acupuncture Research
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• v.40 no.3
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• pp.188-200
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• 2023

Laryngopharyngeal reflux (LPR) disease is a condition in which the stomach contents return to the larynx and pharynx via the esophagus, causing mucosal injury. While conventional treatments, such as proton pump inhibitors, have limitations, acupuncture has been shown to reduce LPR symptoms. However, its effectiveness has not been systematically assessed. This study aimed to systematically evaluate the effectiveness of acupuncture in treating LPR. We review 10 electronic databases with a consistent search strategy, and 2 independent reviewers screened the articles based on the inclusion and exclusion criteria. This study selected and analyzed 7 randomized controlled trials after the screening to assess primary outcomes, including reflux symptom index and reflux finding score, and secondary outcomes, including upper and lower esophageal sphincter pressure. The results revealed the statistically significant effectiveness of acupuncture in combination with conventional treatment in reducing LPR symptoms compared with conventional treatment alone. The most commonly used acupuncture points were CV22, ST36, and LR3. However, the meta-analysis demonstrated low reliability, as assessed using the GRADE Tool. Further research is needed to improve the evidence and draw clear conclusions regarding the clinical use of acupuncture for treating LPR.

• Korean Journal of Head & Neck Oncology
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• v.33 no.2
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• pp.23-27
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• 2017

Background and Objectives: Gastric acid reflux is known to be the most important cause of contact granuloma. Therefore, anti-gastric acid reflux medication has been used as the first line treatment although there are other treatment methods such as surgery or steroid injections. Actually, the role of surgery in the treatment of contact granuloma has not been established clearly. The purpose of this study was to evaluate the effectiveness of surgical treatment for contact granuloma. Materials and Methods: We retrospectively reviewed the medical records of 14 patients who were diagnosed with contact granuloma and treated with surgery from 2011 to July 2016 at Hanyang University hospital. Results: Of 14 patients, 9 (64.3%) were male and 5 (27.4%) were female. The mean age was 53.8 (${\pm}6.1$) years. The main symptoms were voice change followed by globus, dyspnea, and asymptomatic. Mean Reflux Finding Score (RFS) before surgery was 13.5 and mead Reflux Symptom Index (RSI) was 10.4. The causes of surgery were inadequate response to proton pump inhibitor (PPI) in 4 cases, airway obstruction with large granuloma in 8 cases, and differential diagnosis in 2 cases. Of 14 patients, recurrence occurred in 8 (53.3%) patients after surgery. In 8 recurrent cases, 5 patients showed complete remission and 3 patients showed partial remission with PPI medication. Conclusion: The role of surgery in the treatment of contact granuloma might be limited due to high recurrence rate.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.28 no.2
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• pp.123-127
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• 2017

Background and Objectives : Contact granuloma is granulation tissue that occurs mainly in the vocal process of arytenoid cartilage. Among several etiological factors, gastric acid reflux is known to be an important cause. The aim of this study was to evaluate clinical characteristics of contact granuloma and analyze the effectiveness of proton pump inhibitor in the treatment of contact granuloma. Materials and Methods : We retrospectively reviewed the medical records of 40 patients who were treated with proton pump inhibitor (PPI) for contact granuloma from January 2011 to December 2015. Reflux finding score (RFS), reflux symptom index (RSI) and size of granuloma were evaluated before and after treatment serially to assess the effectiveness of proton pump inhibitor. Results : Of 40 patients, 25 patients (62.5%) and 10 patients (25%) showed improvement and partial improvement of granuloma, respectively. Five patients showed no response. The mean times of partial improvement and improvement were $2.08{\pm}2.23$ months and $4.60{\pm}2.77$ months, respectively and mean duration of PPI treatment was $6.8{\pm}5.2$ months. Conclusion : Proton pump inhibitors is effective in the treatment of contact granuloma.