• 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.

• Phonetics and Speech Sciences
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• v.7 no.2
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• pp.47-54
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• 2015

The objectives of this study are to research the frequency of depression symptom in patients with voice disorders and to investigate parameters associated with depression from voice evaluation. A hundred ninety six patients(106 males and 90 females) who had been diagnosed with voice disorders first in their lifetime were selected. All the patients were examined by laryngeal stroboscopy. For depression and voice study, personal interview, acoustic and aerodynamic analysis, voice handicap index(VHI), reflux symptom index(RSI), and beck depression index(BDI) were done respectively. Mild to severe BDI were seen in 26.2%(52 patients) of the whole patients. A BDI mean score of female patients was $8.8{\pm}7.5$ which was higher than that of male patients($5.6{\pm}6.6$), the difference observed being statistically significant(p<0.001). In the acoustic analysis, the score of sent_duration parameter was increasing in the patients with depression, which was significantly higher than the score of the patients without depression(p<0.05). In the addition, the scores of VHI and RSI were higher in the patients with depression(p<0.001). Our findings suggest that the prevalence of depression in patients with voice disorders is related to female, speaking velocity, and self-questionnaire. This result can be used for psychologically based approach to therapy.

• 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.28 no.1
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• pp.43-47
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• 2017

Laryngopharyngeal reflux disease (LPRD) is common in laryngologic practice. In Korea, up to 1 out of every 5 patients who visit otorhinolaryngology clinic is supposed to have LPRD with symptoms and physical findings. Major symptoms of LPRD include hoarseness, cough, reflux symptom and mild dysphagia. Even though LPRD is common, its diagnosis may be difficult, because its symptoms are nonspecific and the laryngeal findings are not always associated with symptom severity. In Recent study, 66.4% of Patient who has LPRD also associated with esophageal motility disorders. Esophageal achalasia is a disease of unknown etiology characterized by an absence of peristalsis in the body of esophagus and nonrelaxing hypertension of the lower esophageal sphincter. Common cause is loss of ganglion cells in Auerbachs plexus. The classic triad of symptoms in achalasia includes dysphagia, regurgitation and weight loss. LPRD and esophageal achalasia have similar symptoms but have different treatment of choice. The Differentiation diagnosis of theses disease is important and should be established by history, radiologic examination and endoscopic examination. We recently assessed a 59-year-old female patient who complained of an epigastric pain, dysphagia and chronic cough. LPRD was initially diagnosed on Laryngoscopic examination and Reflux Symptom Index, but patient was not relieved of any symptoms after treatment of Proton Pump Inhibitor for 3 months. After high resolution manometry, esophageal achalasia was finally diagnosed. We report this case regarding the diagnosis and treatment with review of literatures because we have to think about esophageal motility disorders as a differential diagnosis in laryngology.

• 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.

• The Journal of Internal Korean Medicine
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• v.38 no.5
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• pp.650-657
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• 2017

Objective: This study was performed to report the effect of traditional Korean medicine as a treatment for laryngopharyngeal reflux (LPR) combined with depressive and anxiety disorder. Methods: We treated this patient with traditional Korean medicine and measured symptom severity using the reflux symptom index (RSI), Beck depression inventory (BDI), and Beck anxiety inventory (BAI). Results: After 3 weeks of treatment, most symptoms had decreased. The RSI score dropped from 21 to 8, BDI from 27 to 14, and BAI from 29 to 15. Conclusions: Traditional Korean medicine may be effective as a treatment for LPR combined with depressive and anxiety disorder, and a correlation may exist between LPR and psychological factors. However, more rigorous studies are required to identify exactly what treatment is most efficient for relieving LPR combined with depressive and anxiety disorder and whether LPR and psychological factors are clearly correlated.

• The Journal of Internal Korean Medicine
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• v.42 no.5
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• pp.800-807
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• 2021

Objectives: This study investigated the efficacy of Korean medical treatment for reflux esophagitis. Methods: We used Korean medical treatment (herbal medicines, acupuncture, herbal acupuncture, and therapy) to treat a hospitalized patient with reflux esophagitis. To evaluate the treatment, we measured the symptoms using the Reflux Symptom Index (RSI) and the Visual Analogue Scale (VAS) for heartburn, acid reflux, chest pain, foreign body sensations in the throat, chronic cough, hoarseness, and bronchial asthma. The generic health status was evaluated using the European Quality of Life Five-Dimension (EQ-5d) Scale. Results: The RSI and EQ-5d scores improved following treatment, but the VAS scores showed that only heartburn, acid reflux, and chest pain symptoms were relieved. Conclusions: This study suggests that Korean medicine may be effective for treating reflux esophagitis.

• Korean Journal of Otorhinolaryngology-Head and Neck Surgery
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• v.61 no.12
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• pp.692-696
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• 2018

Background and Objectives This study investigated the relationship between reflux symptom index (RSI) and psychiatric problems such as depression, somatization, and anxiety. Subjects and Method We prospectively analyzed 231 patients with symptoms with laryngopharyngeal reflux (LPR) using the RSI and the reflux finding score. Results Seventy nine patients (34.2%) were diagnosed with LPR. A significant correlation was detected between the RSI and depression ($18.4{\pm}8.3$ vs. $12.3{\pm}7.0$, p<0.001), anxiety ($19.5{\pm}8.5$ vs. $13.0{\pm}7.3$, p<0.001), and somatization ($19.2{\pm}9.1$ vs. $13.6{\pm}7.5$, p<0.001). A multivariate analysis confirmed a significant association between heartburn and depression [odds ratio (OR): 1.241, 95% confidence interval (CI): 1.003-1.537, p=0.047], choking and anxiety (OR: 1.747, 95% CI: 1.297-2.352, p<0.001), and choking and somatization (OR: 1.707, 95% CI: 1.248-2.336, p=0.001). Conclusion Our preliminary results suggest that patients with high RSI may need to be carefully evaluated for psychiatric problems.