Screening Evaluation for Laryngopharyngeal Reflux Disease
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Screening Evaluation for Laryngopharyngeal Reflux Disease Jerome R. Lechien1,2,3,4 • Marta P. Circiu2 • Stephane Hans2 • Sven Saussez1,3
Received: 27 October 2020 / Accepted: 10 November 2020 Ó Association of Otolaryngologists of India 2020
Dear Editor, We reviewed the article entitled: ‘‘Screening Test for LPRD: History Versus Video Laryngoscopy’’ by Mishra et al. [1]. The authors investigated the best screening test for laryngopharyngeal reflux (LPR) through a comparison between reflux symptom index (RSI) and reflux finding score (RFS). They did not find significant correlation between RSI and RFS and suggested that both have to be used to detect LPR. The question about the best screening test for LPR is important and we congratulate authors for this research. However, we wish to draw attention to many points. First, LPR symptoms are not specific and RSI may be increased in patients with other laryngopharyngeal disorders, i.e. allergy, tobacco consumption, chronic rhinosinusitis or muscle tension dysphonia [2, 3]. In a context where hypopharyngeal impedance-pH monitoring was not used for the diagnosis, it is important to exclude all confounding factors to be sure that the included patients had & Jerome R. Lechien [email protected] 1
Department of Anatomy and Experimental Oncology, UMONS Research Institute for Health Sciences and Technology, Mons School of Medicine, University of Mons (UMons), Mons, Belgium
2
Department of Otorhinolaryngology-Head and Neck Surgery, Foch Hospital, Paris Saclay University, Paris, France
3
Department of Otorhinolaryngology and Head and Neck Surgery, CHU Saint-Pierre, School of Medicine, Universite´ Libre de Bruxelles, Brussels, Belgium
4
Laboratory of Anatomy and Cell Biology, Faculty of Medicine, University of Mons (UMONS), Avenue du Champ de mars, 6, 7000 Mons, Belgium
only LPR. Authors did not specify if they have excluded these differential diagnoses of LPR, leading to a potential inclusion bias. Second, the non-specificity of symptoms involves the use of patient-reported outcome questionnaires that consider the most prevalent symptoms. RSI is well-used around the world but does not include some LPR prevalent symptoms, e.g. throat pain, odynophagia, halitosis or burp/ regurgitations [4]. Moreover, RSI does not consider the symptom frequency because it focuses only on symptom severity, which may bias the assessment of the patient clinical picture. The lack of reliability of RSI was supported in a recent study where it was compared with reflux symptom score that considers both severity and frequency of the most prevalent LPR symptoms [4]. Third, similar comments may be done for RFS that does not consider many prevalent LPR extra-laryngeal signs, including coated tongue, oropharyngeal erythema or tongue tonsil hypertrophy [5]. Some of these findings are particularly prevalent in LPR patients such as anterior pilar erythema (91.0%), pharyngeal sticky mucus (82.8%) or tongue tonsil hypertrophy (73.7%; Fig. 1) [5]. Moreover, RFS was not assessed in a
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