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Incidence of underlying laryngeal pathology in patients initially diagnosed with laryngopharyngeal reflux

Authors

  • Benjamin Rafii MD,

    1. New York University Voice Center, Department of Otolaryngology–Head and Neck Surgery, New York University School of Medicine, New York, New York, U.S.A
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  • Salvatore Taliercio MD,

    1. New York University Voice Center, Department of Otolaryngology–Head and Neck Surgery, New York University School of Medicine, New York, New York, U.S.A
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  • Stratos Achlatis MD,

    1. New York University Voice Center, Department of Otolaryngology–Head and Neck Surgery, New York University School of Medicine, New York, New York, U.S.A
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  • Ryan Ruiz BA,

    1. New York University Voice Center, Department of Otolaryngology–Head and Neck Surgery, New York University School of Medicine, New York, New York, U.S.A
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  • Milan R. Amin MD,

    1. New York University Voice Center, Department of Otolaryngology–Head and Neck Surgery, New York University School of Medicine, New York, New York, U.S.A
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  • Ryan C. Branski PhD

    Corresponding author
    1. New York University Voice Center, Department of Otolaryngology–Head and Neck Surgery, New York University School of Medicine, New York, New York, U.S.A
    • Send correspondence to Ryan C. Branski, PhD, New York University Voice Center, Department of Otolaryngology–Head and Neck Surgery, 345 East 37th Street, Suite 306, New York, NY 10016. E-mail: ryan.branski@nyumc.org

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  • Portions of data contained in the current manuscript were accepted for a poster presentation at the American Laryngological Association Annual Meeting at the Combined Otolaryngologic Spring Meetings, Orlando, Florida, U.S.A., April 10–11, 2013.

  • The authors have no funding, financial relationships, or conflicts of interest to disclose.

Abstract

Objectives/Hypothesis

To characterize the videoendoscopic laryngeal findings in patients with a prior established diagnosis of laryngopharyngeal reflux disease (LPR) as the sole etiology for their chief complaint of hoarseness. We hypothesized that many, if not all, of these patients would present with discrete laryngeal pathology, divergent from LPR.

Study Design

Prospective, nonintervention.

Methods

Patients presenting to a tertiary laryngology practice with an established diagnosis of LPR as the sole etiology of their hoarseness were included. All subjects completed the Voice Handicap Index and Reflux Symptom Index, in addition to a questionnaire regarding their reflux diagnosis and prior treatment. Laryngoscopic examinations were reviewed by the laryngologist caring for the patients. Reliability of findings was assessed by interpretation of videoendoscopic findings by three outside laryngologists not involved in the care of the patients.

Results

Laryngeal pathology distinct from LPR was identified in all 21 patients felt to be causative of the chief complaint of dysphonia. Specifically, the most common findings were benign mucosal lesions and vocal fold paresis (29% each), followed by muscle tension dysphonia (14%). Two patients were found to have vocal fold leukoplakia, of which one was confirmed to be a microinvasive carcinoma upon removal.

Conclusion

LPR may be overdiagnosed; other etiologies must be considered for patients with hoarseness who fail empiric LPR treatment.

Level of Evidence

4. Laryngoscope, 124:1420–1424, 2014

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