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 (Tn) 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.