Laryngopharyngeal reflux symptoms improve before changes in physical findings

Background: Patients with laryngopharyngeal reflux (LPR) undergoing treatment appear to have improvement in symptoms before the complete resolution of the laryngeal findings. Objective: To determine whether patients with LPR experience an improvement in symptoms before the complete resolution of the laryngeal findings. Methodology: Forty consecutive patients with LPR documented by double-probe pH monitoring were evaluated prospectively. Symptom response to therapy with proton pump inhibitors was assessed at 2, 4, and 6 months of treatment with a self. administered reflux symptom index (RSI). In addition, transnasal fiberoptic laryngoscopy (TFL) was performed and a reflux finding score (RFS) was determined for each patient at each visit. Results: The mean RSI at entry was 19.3 (± 8.9 standard deviation) and it improved to 13.9 (± 8.8) at 2 months of treatment (P <.05). No further significant improvement was noted at 4 months (13.1 ± 9.8) or 6 months (12.2 ± 8.1) of treatment. The RFS at entry was 11.5 (± 5.2), and it improved to 9.4 (± 4.7) at 2 months, 7.3 (± 5.5) at 4 months, and 6.1 (± 5.2) after 6 months of treatment (P <.05 with trend). Conclusions: Symptoms of LPR improve over 2 months of therapy. No significant improvement in symptoms occurs after 2 months. This preliminary report demonstrates that the physical findings of LPR resolve more slowly than the symptoms and this continues throughout at least 6 months of treatment. These data imply that the physical findings of LPR are not always associated with patient symptoms, and that treatment should continue for a minimum of 6 months or until complete resolution of the physical findings.