More Aggressive Identification Attempts May Prevent Overdiagnosis of Laryngopharyngeal Reflux

Is laryngopharyngeal reflux (LPR) overdiagnosed in complaints of hoarseness, and how effective are videoendoscopic laryngeal findings in determining etiology?

Background: LPR is increasingly cited as a primary underlying etiology of hoarseness in adults. Many patients who present with its symptoms and laryngoscopic findings are often empirically treated prior to objective reflux confirmation. The authors sought to determine laryngeal pathology incidence in dysphonic patients previously diagnosed with LPR as the etiology of their hoarseness.

Study design: Prospective, nonintervention study of data collected from 21 consecutive patients seeking consultation at a tertiary laryngology practice between March and December 2012.

Setting: New York University Voice Center, Department of Otolaryngology–Head and Neck Surgery, New York University School of Medicine, New York City.

Synopsis: Patient history and examination findings were reviewed and the suspected diagnosis selected as either: 1) benign vocal fold lesions such as cysts, nodules, or polyps; 2) neoplastic lesions such as leukoplakia, cancerous lesions, or papillomas; 3) glottal incompetence; 4) vocal fold paresis or paralysis; 5) vocal fold scar or sulcus; 6) functional disorders/muscle tension dysphonia (MTD); 7) miscellaneous neurologic disorders such as spasmodic dysphonia or tremor; or 8) LPR. The average duration of hoarseness at the time of presentation was 10 months, with a range of one to 36 months. The majority of patients received a trial of proton pump inhibitor (PPI) therapy prior to referral. The most common concurrent symptoms were throat clearing, excess mucus, globus, and coughing. The most common findings were benign mucosal lesions, paresis/paralysis, and neoplastic lesions. Three laryngologists not involved in the patients’ care were asked to provide a diagnosis based on review of laryngostroboscopic video recordings. Benign lesions, paresis/paralysis, and neoplasms were again the most commonly cited findings. Limitations included a small patient sampling, a single time point for collecting data, and unknown methods for previous laryngeal visualization.

Bottom line: More aggressive attempts at identification of an underlying laryngeal disorder at the time of initial presentation may identify those patients with an alternate diagnosis upfront, avoiding unnecessary treatment and a delay in appropriate treatment.

Citation: Rafil B, Taliercio S, Achlatis S, Ruiz R, Amin MR, Branski RC. Incidence of underlying laryngeal pathology in patients initially diagnosed with laryngopharyngeal reflux. Laryngoscope. 2014;124:1420-1424.