The Prevalence of Esophageal Disorders Among Voice Patients With Laryngopharyngeal Reflux—A Retrospective Study *Parastou Azadeh Ranjbar, † Ghiath Alnouri, *Dylan Vance, *Jin Park, *Aishwarya Suresh, ‡ Pankti Acharya, and †,║ Robert T. Sataloff, *Philadelphia, and zStratford, USA, y, and ║ Summary: Objective. The goal of this study was to determine the prevalence of esophageal disorders among voice patients with intractable laryngopharyngeal reflux (LPR) who have undergone 24 pH impedance and esophageal manometry. Methods. A retrospective chart review was performed of patients with LPR-associated dysphonia in the absence of subjective dysphagia who presented between January 1, 2007 and June 30, 2019 and underwent 24 pH impedance and esophageal manometry studies after inadequate response to lifestyle modifications, high dose of Proton Pump Inhibitor (PPIs), H2 blockers, alkaline water, and Gaviscon (GlaxoSmithKline, Warren, NJ, USA). The comorbidities, medications, Strobovideolaryngoscopy findings, 24 pH impedance, and esophageal manometry results were analyzed. Results. The study included 109 patients ages 19 to 80 years old, with a mean age of 51.5 (SD 16.8). About 24.8% of the 109 subjects were found to have peristaltic wave abnormalities indicating esophageal dysmotility (11% with esophageal stasis). Lower esophageal sphincter pressures were normotensive in 56.9% of patients, hypertensive in 24.8%, and hypotensive in 18.4% of patients. In addition, the upper esophageal sphincter pressures were normoten- sive in 57.8% of patients, hypertensive in 36.7%, and hypotensive in 2.8% of patients. About 12.6% had both lower esophageal sphincter and upper esophageal sphincter dysfunction (hypertensive or hypotensive). The average total reflux events in patients exhibiting dysmotility on manometry 101.81, which was significantly higher compared with the mean total of 61.28 in the group of patients without dysmotility (P= 0.0396). In addition, there was a signifi- cantly higher prevalence of total events that were weakly acidic in the group with dysmotility compared with the group without (all patients performed the study on reflux medications, mean of total weakly acidic events 70.2 in dysmotility group vs 44.2 in normal motility group, P= 0.0427).Finally, the average number of total supine reflux events and the total acidic supine events were both significantly higher in the dysmotility group compared with the group without motility problems (P = 0.0199 and P = 0.0213, respectively). Conclusion. Esophageal dysmotility may be a significant cofactor in voice patients with refractory LPR on appropriate reflux medications and lifestyle modifications. Further research is advised. Key Words: LPR-Dysphagia-24-hour pH impedance test-Esophageal dysmotility. INTRODUCTION Laryngopharyngeal reflux (LPR) involves the retrograde flow of gastric contents into the pharyngeal and laryngeal regions. Irritation of the esophagus and injury to the larynx occur often and can lead to erythema, edema and significant macroscopic and microscopic histopathologic changes in the mucosa of the vocal folds, larynx and upper airway. Dysphonia is common in patients with LPR. The purpose of this study was to determine the prevalence of esophageal disorders among voice patients with intractable LPR by evaluatory 24-hour pH impedance and esophageal manom- etry test results. METHODOLOGY Voice patients diagnosed with LPR on strobovideolaryngo- scopy using reflux finding score Reflux Finding Score > 11 who were seen in the office of the primary investigator (RTS) and underwent 24-hour pH impedance and esoph- ageal manometry testing from January 2007 to June 2019 for LPR with inadequate response to lifestyle modifications, high dose of Proton Pump Inhibitor (PPIs), H2 blockers, alkaline water, and Gaviscon (GlaxoSmithKline, Warren, NJ) were included in this study. One hundred nine eligible patients were identified. Patients who complained of dys- phagia at time of the initial visit were excluded. Patients with known esophageal motility disorder prior to our initial evaluation, and patients who had undergone head and neck surgeries, Nissen fundoplication or other antireflux proce- dures or had a history of head or neck radiation therapy also were excluded (Table 1). RESULTS About 64.2% of the patients were female, 34.9% were male, and 0.9% were transgender. The study included patients ages 19 to 80 years old, with a mean age of 51.5 (SD 16.84). Accepted for publication July 6, 2020. From the *Drexel University College of Medicine, Philadelphia, Pennsylvania, USA; yDepartment of Otolaryngology—Head and Neck Surgery, Drexel University College of Medicine; zRowan College of Osteopathic Medicine, Stratford, NJ, USA; and the ║Lankenau Institute for Medical Research. Address correspondence and reprint requests to Robert T. Sataloff, Department of Otolaryngology—Head and Neck Surgery, Drexel University College of Medicine, 219 N. Broad Street, 10th Floor, PHiladelphiia, PA 19107. E-mail: rtsataloff@phillyent.com Journal of Voice, Vol. &&, No. &&, pp. &&-&& 0892-1997 © 2020 The Voice Foundation. Published by Elsevier Inc. All rights reserved. https://doi.org/10.1016/j.jvoice.2020.07.005 ARTICLE IN PRESS