Vocal fatigue is a prevalent but significantly underestimated hidden burden among patients with laryngopharyngeal reflux.

OBJECTIVES

To investigate the characteristics of vocal fatigue in patients with laryngopharyngeal reflux (LPR) and evaluate the correlation between vocal fatigue and both subjective and objective reflux assessment indices.

METHODS

A cross-sectional case-control study was conducted at the Department of Otolaryngology, Fuyang People's Hospital. Patients presenting with LPR symptoms (experimental group) and healthy volunteers (control group) were enrolled. All participants completed the Vocal Fatigue Index (VFI), Reflux Symptom Index (RSI), and Reflux Finding Score (RFS). A subset of participants underwent 24-h multichannel intraluminal impedance-pH (MII-pH). LPR was diagnosed based on the occurrence of at least one LPR episode. Objective acoustic analysis was also performed across all subjects.

RESULTS

The study included 58 patients in the experimental group and 34 in the control group. Based on MII-pH monitoring, the LPR positivity rates were 72.5% in the experimental group and 16% in the control group. Total VFI scores and all three subscale factors were significantly higher in the experimental group (p < 0.001). Notably, VFI Factor 2 demonstrated the most significant variance, with scores approximately sevenfold higher than those of the control group. Proximal esophageal MNBI values were significantly negatively correlated with VFI Factor 2. Furthermore, VFI Factor 2 showed a significant positive correlation with AET, while VFI Factor 1 correlated significantly with total reflux episodes. Spearman's rank correlation analysis showed a strong positive correlation between RSI and VFI total scores (ρ = 0.72, P < 0.001). By contrast, the correlation between RFS and VFI total scores was significantly weaker (ρ = 0.35, P < 0.05). Acoustic analysis revealed significantly elevated jitter, shimmer, and noise-to-harmonic ratio, alongside a significantly shortened maximum phonation time in the experimental group.

CONCLUSIONS

Vocal fatigue is a prevalent but frequently underestimated burden in LPR patients. The significant correlation between VFI scores and MNBI suggests that the VFI may serve as a sensitive, non-invasive indicator for auxiliary LPR assessment. Further longitudinal studies are needed to confirm its value in monitoring mucosal recovery.