Journal of voice : official journal of the Voice Foundation · 2026
Differential and Additional Diagnoses of Laryngopharyngeal Reflux Disease: A Case Series.
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Lechien Jérôme R
Аннотация
OBJECTIVE: To investigate conditions that may mimic or aggravate laryngopharyngeal reflux disease (LPRD) symptoms in patients with confirmed LPRD who experience recalcitrant symptoms despite adequate treatment.
STUDY DESIGN: Retrospective case series with prospective data.
SETTING: University medical center.
METHODS: Patients with LPRD undergoing 24-hour hypopharyngeal-esophageal multichannel intraluminal impedance-pH monitoring were prospectively followed at the European Reflux Clinic and Elsan Hospital from 2017 to 2024. Symptoms and findings were assessed from pre to post treatment with the reflux symptom score (RSS) and reflux sign assessment. Differential/additional diagnoses were screened in patients with recalcitrant symptoms despite receiving adequate treatment. The data of symptom evolution after management of the potential differential diagnoses were reviewed.
RESULTS: A total of 143 patients with recalcitrant laryngopharyngeal symptoms were included. The mean age was 52.4 ± 15.6 years. One hundred and thirty differential diagnoses were documented in 107 patients. No additional diagnosis was found in 36 cases (25.2%). Inhaled steroid laryngitis (N = 18, 12.6%), allergy (N = 17, 11.9%), lactose intolerance (N = 15, 10.5%), and chronic rhinosinusitis (N = 11, 7.7%) were the most prevalent additional diagnoses to LPRD. The RSS significantly decreased when the differential diagnoses of LPR symptoms were treated. The proportion of therapeutic responses to LPRD treatment, initially at 47.9%, significantly increased to 80.6% following the initiation of treatment for the differential diagnoses (P = 0.001) CONCLUSION: The use of a standardized protocol documenting the digestive and otolaryngological conditions mimicking or aggravating LPRD symptoms may help to identify 74.8% of the differential diagnoses. Further studies are needed to establish the causality or association relationships between these conditions and the LPRD.
STUDY DESIGN: Retrospective case series with prospective data.
SETTING: University medical center.
METHODS: Patients with LPRD undergoing 24-hour hypopharyngeal-esophageal multichannel intraluminal impedance-pH monitoring were prospectively followed at the European Reflux Clinic and Elsan Hospital from 2017 to 2024. Symptoms and findings were assessed from pre to post treatment with the reflux symptom score (RSS) and reflux sign assessment. Differential/additional diagnoses were screened in patients with recalcitrant symptoms despite receiving adequate treatment. The data of symptom evolution after management of the potential differential diagnoses were reviewed.
RESULTS: A total of 143 patients with recalcitrant laryngopharyngeal symptoms were included. The mean age was 52.4 ± 15.6 years. One hundred and thirty differential diagnoses were documented in 107 patients. No additional diagnosis was found in 36 cases (25.2%). Inhaled steroid laryngitis (N = 18, 12.6%), allergy (N = 17, 11.9%), lactose intolerance (N = 15, 10.5%), and chronic rhinosinusitis (N = 11, 7.7%) were the most prevalent additional diagnoses to LPRD. The RSS significantly decreased when the differential diagnoses of LPR symptoms were treated. The proportion of therapeutic responses to LPRD treatment, initially at 47.9%, significantly increased to 80.6% following the initiation of treatment for the differential diagnoses (P = 0.001) CONCLUSION: The use of a standardized protocol documenting the digestive and otolaryngological conditions mimicking or aggravating LPRD symptoms may help to identify 74.8% of the differential diagnoses. Further studies are needed to establish the causality or association relationships between these conditions and the LPRD.