Laryngopharyngeal reflux is caused due to retrograde flow of gastric contents into laryngopharynx.
This condition is related to GERD (Gastric oesophageal reflux disease). In fact it is a common extra oesophageal manifestation of GERD.
To help in the diagnosis of laryngopharyngeal reflux two score charts have been devised:
1. Reflux symptom index
2. Reflux finding score.
Reflux symptom index: Suspected patients are given a questionnaire to answer. It contains about 9 questions. Patient is supposed to award scores according to their symptoms.
Reflux symptom index chart:
Within last month how did the following problems affect you ?
1. Hoarseness of voice / voice problems : scores 0 - 5. 0 = No problem 5 = severe problem
2. Clearing your throat: Scores 0 - 5
3. Excess throat mucous / post nasal drip: scores 0 - 5
4. Difficulty in swallowing food / liquids / pills: scores 0-5
5. Cough after eating / lying down: scores 0-5
6. Breathing difficulty / choking: scores 0-5
7. Annoying cough: Scores 0-5
8. Sticky sensation in throat / lump in throat: Scores 0-5
9. Heart burn / chest pain: scores 0-5
Reflux symptom index score of more than 13 indicates laryngopharyngeal reflux.
Reflux finding score:
This scoring is prepared by the surgeon after performing a laryngeal examination.
1. Subglottic oedema: 0 - absent, 2 - present.
2. Ventricular obliteration: 2 - partial, 4 - complete
3. Erythema / Hyperemia: 2 - arytenoids involved, 4 - diffuse
4. Vocal fold oedema: 1 - mild, 2 - moderate, 3 - severe, 4 - polypoidal
5. Diffuse laryngeal oedema: 1 - mild, 2 - moderate, 3 - severe, 4 - obstruction
6. Posterior commissure hypertrophy: 1 - mild, 2 - moderate, 3 - severe and 4 - obstruction.
7. Granuloma / Granulation: 0 - absent, 2 - present
8. Thick mucous: 0 - absent, 2 - present.
A score of 7 indicates possible presence of laryngopharyngeal reflux.
Detection of pepsin in the throat sputum of patients indicates the presence of laryngopharyngeal reflux.
It is 100% sensitive, and 90% specific.
1. Cessation of smoking
2. Decreased fat intake
3. Avoiding going to bed within three hours after eating
4. Elevation of head during sleep