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Efficacy of Anti-Reflux Surgery on Refractory Laryngopharyngeal Reflux Disease in Professional Voice Users: A Pilot Study
Journal article

Efficacy of Anti-Reflux Surgery on Refractory Laryngopharyngeal Reflux Disease in Professional Voice Users: A Pilot Study

Brittany Weber, Joel E. Portnoy, Andres Castellanos, Mary J. Hawkshaw, Deborah Lurie, Philip O. Katz and Robert T. Sataloff
Journal of voice, v 28(4), pp 492-500
Jul 2014
DOI: https://doi.org/10.1016/j.jvoice.2013.12.009
PMID: 24629640
Featured in Collection :   UN Sustainable Development Goals @ Drexel

Abstract

Fundoplication Laryngopharyngeal reflux Nissen pH impedance Professional voice Proton pump inhibitor Reflux Reflux finding score Super-high-dose proton pump inhibitor
Laryngopharyngeal reflux (LPR) is a pervasive disorder that may cause hoarseness, throat clearing, and other symptoms. These symptoms are particularly problematic in professional voice users. Proton pump inhibitors (PPIs) are the mainstay of current medical management for LPR but may be insufficient in managing some patients' symptoms. Laparoscopic Nissen fundoplication (LNF) is well established for treatment of gastroesophageal reflux disease with a high success rate, but its role in the treatment of LPR remains uncertain. This study was designed to investigate the effectiveness of anti-reflux surgery in managing disease refractory to medical reflux therapy (twice of more per day PPIs). Retrospective medical record review. This study examined 25 professional voice users, age ranging from 14 to 75 years, diagnosed with refractory LPR treated twice daily or more with PPIs. Reflux finding scores (RFS) were graded by blinded raters and compared for initial, preoperative, postoperative, and final visits. Twenty-four-hour pH-impedance study scores were obtained pre- and postoperatively. Sixty percent of patients were on no-reflux medications postoperatively and an additional 24% were on less medication. RFS was not significantly different between pre- and postoperative evaluations with good inter- and intrarater reliability; postoperative examinations occurred on less or no pharmaceutical reflux treatment. Twenty-four-hour pH-impedance testing revealed significant reductions in reflux and a nearly significant reduction in total acid. Ninety percent of positive symptom indices preoperatively were negative postoperatively. Seventy-six percent of patients on BID dosing of PPIs and 86% of those receiving super-high-dose PPI administration who underwent LNF were satisfied with the results for their LPR disease. LNF should be considered as a treatment option for professional voice users with LPR with symptoms refractory to standard or super-high-dose medical management. LNF may decrease or eliminate the need for postoperative PPI usage. The RFS may not be sensitive enough to monitor changes in LPR severity. Patients, especially those on super-high-dose medication administration, are satisfied with the improvement in LPR symptoms after anti-reflux surgery.

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10 Record Views
10 citations in Web of Science
20 citations in Scopus

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UN Sustainable Development Goals (SDGs)

This publication has contributed to the advancement of the following goals:

#3 Good Health and Well-Being

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Collaboration types
Domestic collaboration
Web of Science research areas
Audiology & Speech-language Pathology
Otorhinolaryngology
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