title: Efficacy of anti-reflux surgery on refractory laryngopharyngeal reflux disease in professional voice users: a pilot study.
abstract: OBJECTIVE
  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).
  
  
  METHODS
  Retrospective medical record review.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania; Department of Otolaryngology, Eastern Virginia Medical School, Norfolk, Virginia.
authors.forename: Brittany
authors.initials: B
authors.lastname: Weber
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania; Voice and Swallowing Center, ENT and Allergy Associates, Lake Success, New York.
authors.forename: Joel E
authors.initials: JE
authors.lastname: Portnoy
authors.affiliation: Department of Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania.
authors.forename: Andres
authors.initials: A
authors.lastname: Castellanos
authors.affiliation: Drexel University College of Medicine, Philadelphia, Pennsylvania.
authors.forename: Mary J
authors.initials: MJ
authors.lastname: Hawkshaw
authors.affiliation: Department of Mathematics, St. Joseph's University, Philadelphia, Pennsylvania.
authors.forename: Deborah
authors.initials: D
authors.lastname: Lurie
authors.affiliation: Thomas Jefferson University, Philadelphia, Pennsylvania; Division of Gastroenterology, Albert Einstein Medical Center, Philadelphia, Pennsylvania.
authors.forename: Philip O
authors.initials: PO
authors.lastname: Katz
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania. Electronic address: RTSataloff@PhillyENT.com.
authors.forename: Robert T
authors.initials: RT
authors.lastname: Sataloff
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D005260:Female; D018662:Fundoplication; D006801:Humans; D006863:Hydrogen-Ion Concentration; D057045:Laryngopharyngeal Reflux / Q000150:complications / Q000188:drug therapy / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009784:Occupational Diseases / Q000188:drug therapy / Q000209:etiology / Q000601:surgery*; D010865:Pilot Projects; D011182:Postoperative Care; D011300:Preoperative Care; D054328:Proton Pump Inhibitors / Q000008:administration & dosage; D012189:Retrospective Studies; D013812:Therapeutics; D014831:Voice; D014832:Voice Disorders / Q000188:drug therapy / Q000209:etiology / Q000601:surgery*; D055815:Young Adult
chemical_list: D054328:Proton Pump Inhibitors
keywords: Fundoplication; Laryngopharyngeal reflux; Nissen; Professional voice; Proton pump inhibitor; Reflux; Reflux finding score; Super-high-dose proton pump inhibitor; pH impedance