title: Symptom overlap between laryngopharyngeal reflux and glottic insufficiency in vocal fold atrophy patients.
abstract: OBJECTIVE
  To determine in true vocal fold (TVF) atrophy patients if symptoms of throat clearing and mucus sensation, attributed to laryngopharyngeal reflux (LPR), are due to glottic insufficiency. Is the TVF atrophy population being prescribed proton pump inhibitors unnecessarily?
  
  
  METHODS
  A retrospective review of patients with TVF atrophy but no other underlying laryngeal pathology seen at a tertiary voice center from July 2009 to May 2012 was conducted. Patient demographics, symptoms, LPR diagnosis, interventions, and pre-intervention and post-intervention Voice Handicap Index-10 (VHI) and Reflux Symptom Index (RSI) scores were recorded.
  
  
  RESULTS
  Twenty-six patients met inclusion criteria, and 85% were treated for LPR. Throat clearing and mucus sensation (85%), dysphonia (54%), and globus sensation (46%) were recorded. Interventions included LPR medical management (65%), vocal fold augmentation (23%), and voice therapy (12%). Reflux Symptom Index scores improved in all groups. Voice Handicap Index-10 and RSI scores normalized in patients treated with augmentation. Globus was never present in patients who received augmentation.
  
  
  CONCLUSIONS
  Throat clearing and mucus sensation may be due to underlying glottic insufficiency and changes of the aging larynx rather than LPR. High VHI and RSI scores normalized with TVF augmentation. Further work is needed to evaluate symptom presentation and risk versus benefit of treatment options, especially if it avoids unnecessary proton pump inhibitor trials.
authors.affiliation: Department of Otolaryngology, Tufts Medical Center, Boston, Massachusetts, USA.
authors.forename: Anju K
authors.initials: AK
authors.lastname: Patel
authors.forename: Nicholas R
authors.initials: NR
authors.lastname: Mildenhall
authors.forename: William
authors.initials: W
authors.lastname: Kim
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Carroll
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001284:Atrophy / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D003937:Diagnosis, Differential; D055154:Dysphonia / Q000209:etiology / Q000628:therapy; D005260:Female; D006801:Humans; D057045:Laryngopharyngeal Reflux / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D012189:Retrospective Studies; D064706:Vocal Cord Dysfunction / Q000150:complications* / Q000175:diagnosis; D014827:Vocal Cords / Q000473:pathology* / Q000601:surgery; D014834:Voice Training
chemical_list: D054328:Proton Pump Inhibitors
keywords: dysphonia; glottic insufficiency; laryngopharyngeal reflux; presbylarynx; proton pump inhibitors; vocal fold atrophy