Is dysphonia due to allergic laryngitis being misdiagnosed as  laryngopharyngeal reflux?
OBJECTIVE
Voice problems affect up to 30% of the population at some time during their life, and in particular it affects those who use their voice professionally. Patients who commonly present with dysphonia are often found to have symptoms of both allergy and reflux. Clinical examination of the larynx often makes it difficult to differentiate between the main causative factors of dysphonia, as the clinical findings on nasendoscopy between reflux and allergy are similar. Laryngopharyngeal reflux (LPR), an entity of gastro-oesophageal reflux, is a common diagnosis made in the voice out-patient clinic. Few studies have been able to successfully correlate management of LPR and outcome of dysphonia. Allergy or more specifically allergic rhinitis is said to affect approximately 24% of the population, but few studies have investigated its role in dysphonia.


METHODS
Prospective observational study.


METHODS
University teaching hospital otolaryngology department.


METHODS
Fifteen new patients with primary voice disorder were investigated for possible LPR and allergy from April 2007 to October 2007. All patients were tested using the validated reflux symptom index (RSI), reflux finding score (RFS) to diagnose LPR, and both skin prick tests (SPT) and nasal nitric oxide (NO) levels to diagnose the presence of allergy.


METHODS
Prevalence of symptoms of reflux and allergy in patients presenting with primary voice disorders, and also whether dysphonia thought to be caused by LPR could actually be due to allergy.


RESULTS
No positive correlation or statistical significance was found between reflux and allergy. From our sample 20% (three patients) were diagnosed with LPR and 67% (ten patients) with allergy. The three patients diagnosed with LPR also had concomitant allergy.


CONCLUSIONS
In our patient cohort, three times as many patients demonstrated allergy compared with LPR. This has led us to question if some patients with allergic laryngitis are being misdiagnosed with LPR and thereby being over-treated with proton pump inhibitors (PPIs).
Randhawa
Premjit S
PS
Department of Otolaryngology, Royal National Throat Nose and Ear Hospital, 330 Grays Inn Road, London, WC1X 8DA, UK. prandhawa13@hotmail.com
Mansuri
Shaji
S
Rubin
John S
JS
D000328:Adult; D015331:Cohort Studies; D003937:Diagnosis, Differential; D055154:Dysphonia / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D006967:Hypersensitivity / Q000150:complications* / Q000453:epidemiology; D007827:Laryngitis / Q000150:complications* / Q000453:epidemiology; D057045:Laryngopharyngeal Reflux / Q000175:diagnosis* / Q000453:epidemiology; D008297:Male; D015995:Prevalence; D011446:Prospective Studies; D012720:Severity of Illness Index; D014832:Voice Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology