[en] [en] OBJECTIVE: To investigate the usefulness of voice quality assessment as a treatment outcome in responder and nonresponder patients with laryngopharyngeal reflux (LPR).
MATERIAL AND METHODS: Eighty clinically diagnosed LPR patients with reflux finding score (RFS) > 7 and reflux symptom index (RSI) > 13 were treated with pantoprazole, lifestyle changes, and diet recommendations for three months. RSI; RFS; Voice Handicap Index; blinded Grade, Roughness, Breathiness, Asthenia, Strain, and Instability; aerodynamic and acoustic measurements were assessed at baseline and after treatment. These data were analyzed and compared with regard to the clinical evolution of patients (responder versus nonresponder). Patients who significantly improved RSI ≤ 13 and RFS ≤ 7 after treatment were considered as responder. Nonresponders were defined as patients with RSI > 13 and/or RFS > 7 at the end of treatment. Studies of correlation between the adherence to the diet regimen and the evolution of both signs and symptoms and between videolaryngostroboscopic signs; blinded Grade, Roughness, Breathiness, Asthenia, Strain, and Instability; and acoustic measurements were conducted.
RESULTS: Significant improvements in RSI, RFS, Voice Handicap Index, perceptual voice quality (dysphonia and roughness), and some fundamental frequency and intensity perturbation cues (phonatory fundamental frequency range, percent jitter, pitch perturbation quotient, relative average perturbation, percent shimmer, smoothed amplitude perturbation quotient, amplitude perturbation quotient, and peak-to-peak amplitude variation) were mainly identified after treatment in responder patients. The clinical and voice quality improvements of nonresponder patients were lower; highlighting a similar evolution of symptoms, signs, and voice quality. The correlation analysis revealed significant relationships between the adherence to lifestyle changes and diet recommendations and the improvement of symptoms and substantial correlations between breathiness and fundamental frequency perturbation parameters.
CONCLUSION: Voice quality assessments can be used as indicators of the treatment effectiveness in patients with LPR. Voice quality improvement seems to be consistently associated with clinical improvement.
Disciplines :
Otolaryngology
Author, co-author :
Lechien, Jérôme R; Laboratory of Anatomy and Cell Biology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium, Laboratory of Phonetics, Faculty of Psychology, Research Institute for Language sciences and Technology, University of Mons (UMons), Mons, Belgium, Department of Otorhinolaryngology and Head and Neck Surgery, RHMS Baudour, EpiCURA Hospital, Baudour, Belgium. Electronic address: jerome.lechien@umons.ac.be
Finck, Camille ; Université de Liège - ULiège > Département des sciences cliniques > Phoniatrie
Huet, Kathy ; Laboratory of Phonetics, Faculty of Psychology, Research Institute for Language sciences and Technology, University of Mons (UMons), Mons, Belgium
Khalife, Mohamad; Department of Otorhinolaryngology and Head and Neck Surgery, RHMS Baudour, EpiCURA Hospital, Baudour, Belgium
Fourneau, Anne-Françoise; Department of Otorhinolaryngology and Head and Neck Surgery, RHMS Baudour, EpiCURA Hospital, Baudour, Belgium
Delvaux, Véronique; Laboratory of Phonetics, Faculty of Psychology, Research Institute for Language sciences and Technology, University of Mons (UMons), Mons, Belgium
Piccaluga, Myriam; Laboratory of Phonetics, Faculty of Psychology, Research Institute for Language sciences and Technology, University of Mons (UMons), Mons, Belgium
Harmegnies, Bernard; Laboratory of Phonetics, Faculty of Psychology, Research Institute for Language sciences and Technology, University of Mons (UMons), Mons, Belgium
Saussez, Sven; Laboratory of Anatomy and Cell Biology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium, Department of Otorhinolaryngology and Head and Neck Surgery, RHMS Baudour, EpiCURA Hospital, Baudour, Belgium
Language :
English
Title :
Impact of Laryngopharyngeal Reflux on Subjective, Aerodynamic, and Acoustic Voice Assessments of Responder and Nonresponder Patients.
American Journal Expert for the proofreading of the manuscript. This research has been subsidized by the ARC No. AUWB-2012-12/17-UMONS convention from Communauté Française de Belgique.
Koufman, JA, Aviv, JE, Casiano, RR, et al. Laryngopharyngeal reflux: position statement of the committee on speech, voice, and swallowing disorders of the American Academy of Otolaryngology-Head and Neck Surgery. Otolaryngol Head Neck Surg 127 (2002), 32–35.
Sen, P, Georgalas, C, Bhattacharyya, AK, A systematic review of the role of proton pump inhibitors for symptoms of laryngopharyngeal reflux. Clin Otolaryngol 31 (2006), 20–24 discussion 24.
Jin, BJ, Lee, YS, Jeong, SW, et al. Change of acoustic parameters before and after treatment in laryngopharyngeal reflux patients. Laryngoscope 118 (2008), 938–941.
Poelmans, J, Feenstra, L, Tack, J, Determinants of long-term outcome of patients with reflux-related ear, nose, and throat symptoms. Dig Dis Sci 51 (2006), 282–288.
Lee, YS, Choi, SH, Son, YI, et al. Prospective, observational study using rabeprazole in 455 patients with laryngopharyngeal reflux disease. Eur Arch Otorhinolaryngol 268 (2011), 863–869.
Koufman, JA, The otolaryngologic manifestations of gastroesophageal reflux disease (GERD): a clinical investigation of 225 patients using ambulatory 24-hour pH monitoring and an experimental investigation of the role of acid and pepsin in the development of laryngeal injury. Laryngoscope 101:4 Pt 2 suppl 53 (1991), 1–78.
Lee, JS, Lee, YC, Kim, SW, et al. Changes in the quality of life of patients with laryngopharyngeal reflux after treatment. J Voice 28 (2014), 487–491.
Shaw, GY, Searl, JP, Laryngeal manifestations of gastroesophageal reflux before and after treatment with omeprazole. South Med J 90 (1997), 1115–1122.
Lechien, JR, Finck, C, Costa de Araujo, P, et al. Voice outcomes of laryngopharyngeal reflux treatment: a systematic review of 1483 patients. Eur Arch Otorhinolaryngol 274 (2017), 1–23.
Fass, R, Noelck, N, Willis, MR, et al. The effect of esomeprazole 20 mg twice daily on acoustic and perception parameters of the voice in laryngopharyngeal reflux. Neurogastroenterol Motil 22 (2010), 134–141 e44-5.
Hamdan, AL, Sharara, AI, Younes, A, et al. Effect of aggressive therapy on laryngeal symptoms and voice characteristics in patients with gastroesophageal reflux. Acta Otolaryngol 121 (2001), 868–872.
Park, JO, Shim, MR, Hwang, YS, et al. Combination of voice therapy and antireflux therapy rapidly recovers voice-related symptoms in laryngopharyngeal reflux patients. Otolaryngol Head Neck Surg 146 (2012), 92–97.
Sataloff, RT, Hawkshaw, MJ, Gupta, R, Laryngopharyngeal reflux and voice disorders: an overview on disease mechanisms, treatments, and research advances. Discov Med 10 (2010), 213–224.
Noordzij, JP, Khidr, A, Desper, E, et al. Correlation of pH probe-measured laryngopharyngeal reflux with symptoms and signs of reflux laryngitis. Laryngoscope 112 (2002), 2192–2195.
Belafsky, PC, Postma, GN, Koufman, JA, The validity and reliability of the reflux finding score (RFS). Laryngoscope 111 (2001), 1313–1317.
Belafsky, PC, Postma, GN, Koufman, JA, Validity and reliability of the reflux symptom index (RSI). J Voice 16 (2002), 274–277.
Ford, CN, Evaluation and management of laryngopharyngeal reflux. JAMA 294 (2005), 1534–1540.
Koufman, JA, Low-acid diet for recalcitrant laryngopharyngeal reflux: therapeutic benefits and their implications. Ann Otol Rhinol Laryngol 120 (2011), 281–287.
DelGaudio, JM, Naseri, I, Wise, JC, Proximal pharyngeal reflux correlates with increasing severity of lingual tonsil hypertrophy. Otolaryngol Head Neck Surg 138 (2008), 473–478.
Lechien, JR, Finck, C, Khalife, M, et al. Change of signs, symptoms and voice quality evaluations throughout a 3 to 6-months empirical treatment for laryngopharyngeal reflux disease. Clin Otolaryngol, 2018.
Wan, Y, Yan, Y, Ma, F, et al. LPR: how different diagnostic tools shape the outcomes of treatment. J Voice 28 (2014), 362–368.
Harris, MS, Rotenberg, BW, Roth, K, et al. Factors associated with lingual tonsil hypertrophy in Canadian adults. J Otolaryngol Head Neck Surg, 46, 2017, 32.
Sereg-Bahar, M, Jansa, R, Hocevar-Boltezar, I, Voice disorders and gastroesophageal reflux. Logoped Phoniatr Vocol 30 (2005), 120–124.
Lechien, JR, Finck, C, Huet, K, et al. Impact of age on laryngopharyngeal reflux disease presentation: a multi-center prospective study. Eur Arch Otorhinolaryngol, 2017.
Siupsinskiene, N, Adamonis, K, Toohill, RJ, Quality of life in laryngopharyngeal reflux patients. Laryngoscope 117 (2007), 480–484.
Selby, JC, Gilbert, HR, Lerman, JW, Perceptual and acoustic evaluation of individuals with laryngopharyngeal reflux pre- and post-treatment. J Voice 17 (2003), 557–570.
Lechien, JR, Delvaux, V, Huet, K, et al. Phonetic Approaches of laryngopharyngeal reflux disease: a prospective study. J Voice 31 (2017), 119.e11–119.e20.
Millet, B, Dejonckere, PH, What determines the differences in perceptual rating of dysphonia between experienced raters. Folia Phoniatr Logop 50 (1998), 305–310.
Lechien, JR, Saussez, S, Harmegnies, B, et al. Laryngopharyngeal reflux and voice disorders: a multifactorial model of etiology and pathophysiology. J Voice 31 (2017), 733–752.