Journal of voice : official journal of the Voice Foundation · 2026
Sex- and Age-Based Diagnostic Thresholds for Reflux Questionnaires and Clinical Instruments.
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Muscato Catherine, Lechien Jerome R
Аннотация
OBJECTIVE: To investigate the influence of gender and age on the diagnostic accuracy of patient-reported outcome measures and find instruments dedicated to the clinical diagnosis of laryngopharyngeal reflux disease (LPRD).
METHODS: A total of 538 patients with LPRD at the hypopharyngeal-esophageal multichannel intraluminal impedance-pH monitoring and 287 asymptomatic controls were recruited. The reflux symptom score (RSS), reflux symptom score-12 (RSS-12), reflux sign assessment (RSA), and reflux sign assessment-10 (RSA-10) were collected at baseline for all groups. Thresholds were calculated with receiver operating characteristic analysis according to age- and gender-stratified groups.
RESULTS: Among LPRD patients, younger individuals (18-39 years; n = 140) reported predominantly acidic pharyngeal reflux patterns and higher rates of esophagitis, gastritis, and H. pylori infections. Depending on age and gender, RSS, RSS-12, RSA, and RSA-10 reported variable performance and thresholds for suspecting the LPRD diagnosis. RSS demonstrated superior diagnostic performance for patients aged 18-59 years (area under the curve [AUC] = 0.986-0.995), while RSS-12 performed better in elderly patients (AUC = 0.988). Sex-based analyses revealed females required higher RSA diagnostic thresholds (>19,>21,>18) than males (>17,>20,>17) across all age groups. RSS/RSA-10 was optimal for younger males, RSS-12/RSA-10 for younger females; RSS/RSA for middle-aged females, RSS-12/RSA for middle-aged males; RSS/RSA-10 for elderly males, RSS-12/RSA-10 for elderly females.
CONCLUSION: Age-specific thresholds were established for reflux questionnaires, with RSS optimal for 18-59-year patients, RSS-12 for the elderly, and females requiring higher diagnostic thresholds across all instruments. These new thresholds fit into the development of precision medicine in the management of LPRD.
METHODS: A total of 538 patients with LPRD at the hypopharyngeal-esophageal multichannel intraluminal impedance-pH monitoring and 287 asymptomatic controls were recruited. The reflux symptom score (RSS), reflux symptom score-12 (RSS-12), reflux sign assessment (RSA), and reflux sign assessment-10 (RSA-10) were collected at baseline for all groups. Thresholds were calculated with receiver operating characteristic analysis according to age- and gender-stratified groups.
RESULTS: Among LPRD patients, younger individuals (18-39 years; n = 140) reported predominantly acidic pharyngeal reflux patterns and higher rates of esophagitis, gastritis, and H. pylori infections. Depending on age and gender, RSS, RSS-12, RSA, and RSA-10 reported variable performance and thresholds for suspecting the LPRD diagnosis. RSS demonstrated superior diagnostic performance for patients aged 18-59 years (area under the curve [AUC] = 0.986-0.995), while RSS-12 performed better in elderly patients (AUC = 0.988). Sex-based analyses revealed females required higher RSA diagnostic thresholds (>19,>21,>18) than males (>17,>20,>17) across all age groups. RSS/RSA-10 was optimal for younger males, RSS-12/RSA-10 for younger females; RSS/RSA for middle-aged females, RSS-12/RSA for middle-aged males; RSS/RSA-10 for elderly males, RSS-12/RSA-10 for elderly females.
CONCLUSION: Age-specific thresholds were established for reflux questionnaires, with RSS optimal for 18-59-year patients, RSS-12 for the elderly, and females requiring higher diagnostic thresholds across all instruments. These new thresholds fit into the development of precision medicine in the management of LPRD.