Voice Therapy Improves Reflux Symptoms in Patients with Voice Complaints

What are the effects of voice therapy on Reflux Symptom Index (RSI) and Voice Handicap Index (VHI-10) scores in patients with voice complaints not responsive to antireflux medications?

Bottom line
Patient RSI and VHI-10 scores improved following voice therapy.

Background: Dysphonia is frequently attributed to laryngopharyngeal reflux disease (LPRD) and treated accordingly despite an unclear relationship between objective esophagopharyngeal reflux and voice symptoms. Antireflux therapies are widely used to treat the majority of patients with voice disorders but have demonstrated mixed results.

Study design: Retrospective cohort study of 18 patients, from January 2012–January 2013.

Setting: Department of Otolaryngology–Head and Neck Surgery, University of California, San Francisco.

Synopsis: Mean patient age was 49.9 ± 14.5 years, and 16 were female. The majority primarily complained of dysphonia, with two experiencing chronic cough complaints and one experiencing throat clearing. At the initial visit, the median RSI score was 18.5 and median VHI-10 score was 25.5. Overall, patients completed a median of four voice therapy sessions. Median time from initial visit to follow-up visit with a laryngologist was five months. Between the initial and follow-up visit, the RSI score decreased by a median of 7.0 points. Fourteen patients had an improvement in RSI score. The majority of patients had an improvement in globus, hoarseness, throat clearing, and mucus. A minority of patients reported improvement in chest pain or heartburn and cough. Between the initial and follow-up visit the VHI-10 score decreased by a median of 6.0 points. Eleven patients had an improvement in VHI-10 score. The median VHI-10 score at follow-up was significantly lower compared to the initial visit. Eleven patients had an overall improvement in RSI score. There was significant inverse correlation between the number of voice therapy sessions per month and the change in RSI score.

Citation: Schneider SL, Clary MS, Fink DS, et al. Voice therapy associated with a decrease in the reflux symptoms index in patients with voice complaints. Laryngoscope. 2019;129:1169–1173.