Correlation between Reflux and multichannel intraluminal impedance pH monitoring in untreated volunteers.
OBJECTIVE
Although probable causative agents have been identified (e.g., refluxate components, tobacco smoke), the definitive mechanism for inflammation-related laryngeal mucosal damage remains elusive. Multichannel intraluminal impedance combined with pH monitoring (MII/pH) has emerged as a sensitive tool for diagnosis and characterization of gastroesophageal reflux disease with laryngopharyngeal manifestations. To determine the relationship between laryngeal signs and MII/pH, we examined correlations between Reflux Finding Score (RFS) ratings of videostroboscopic laryngeal examinations and findings from MII/pH.


METHODS
Correlational study.


METHODS
Healthy, untreated volunteers (n = 142) underwent reflux diagnosis using data acquired from MII/pH testing. Eight trained clinicians performed RFS ratings of corresponding laryngeal examinations. Averaged RFS ratings were compared to MII/pH data using Pearson correlation coefficients. The relationship between RFS and MII/pH findings and demographic/clinical information (age, sex, smoking status, reflux) was assessed using general linear modeling. Rater reliability was evaluated.


RESULTS
Posterior commissure hypertrophy was negatively correlated with minutes of nonacid refluxate (R = -0.21, P = .0115). General linear modeling revealed that 28% to 40% of the variance in ratings of ventricular obliteration, erythema/hyperemia, vocal fold edema, diffuse laryngeal edema, posterior commissure hypertrophy, and granulation/granuloma could be explained by main and interaction effects of age, sex, smoking status, and reflux. Intra- and inter-rater reliability for RFS were poor-fair.


CONCLUSIONS
These results support the theory that the RFS is not specific for reflux in healthy, untreated volunteers, suggesting there may be alternate explanations for inflammatory clinical signs commonly ascribed to reflux in this population.
Department of Surgery, Department of Communication Sciences and Disorders (), University of Wisconsin-Madison, Madison, Wisconsin, U.S.A.
Marie E
ME
Jetté
Eric A
EA
Gaumnitz
Martin A
MA
Birchall
Nathan V
NV
Welham
Susan L
SL
Thibeault
D000328:Adult; D000368:Aged; D017097:Electric Impedance; D050782:Esophageal pH Monitoring; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis* / Q000378:metabolism / Q000503:physiopathology; D064368:Healthy Volunteers; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007828:Laryngoscopy; D007830:Larynx / Q000378:metabolism / Q000503:physiopathology*; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011379:Prognosis; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D055815:Young Adult
Impedance monitoring; Reflux Finding Score; gastroesophageal reflux; laryngopharyngeal reflux; laryngopharyngeal reflux diagnosis; pH monitoring