Laryngopharyngeal reflux symptoms improve before changes in physical findings

Background Patients with laryngopharyngeal reflux (LPR) undergoing treatmen t appear to have improvement in symptoms before the complete resolution of the laryngeal findings. Objective: To determine whether patients with LPR e xperience an improvement in symptoms before the complete resolution of the laryngeal findings. Methodology: Forty consecutive patients with LPR docume nted by double-probe pH monitoring were evaluated prospectively, Symptom re sponse to therapy with proton pump inhibitors was assessed at 2, 4, and 6 m onths of treatment with a self-administered reflux symptom index (RSI). In addition, transnasal fiberoptic laryngoscopy (Tn) was performed and a reflu x finding score (RFS) was determined for each patient at each visit. Result s: The mean RSI at entry was 19.3 (+/- 8.9 standard deviation) and it impro ved to 13.9 (+/- 8.8) at 2 months of treatment (P < .05), No further signif icant improvement was noted at 4 months (13.1 +/- 9.8) or 6 months (12.2 +/ - 8.1) of treatment. The RFS at entry was 11.5 (+/- 5.2), and it improved t o 9.4 (+/- 4.7) at 2 months, 7.3 (+/- 5.5) at 4 months, and 6.1 (+/- 5.2) a fter 6 months of treatment (P < .05 with trend). Conclusions: Symptoms of L PR improve over 2 months of therapy. No significant improvement in symptoms occurs after 2 months, This preliminary report demonstrates that the physi cal findings of LPR resolve more slowly than the symptoms and this continue s throughout at least 6 months of treatment. These data imply that the phys ical findings of LPR are not always associated with patient symptoms, and t hat treatment should continue for a minimum of 6 months or until complete r esolution of the physical findings.