Diagnosis of laryngopharyngeal reflux disease with digital imaging MARY ES BEAVER, MD, C. RICHARD STASNEY, MD, ERIK WEITZEL, MD, MIICHAEL G. STEWART, MD, MPH, DONALD T. DONOVAN, MD, ROBERT B. PARKE, Jr, MD, and MARGARITA RODRIGUEZ, MD, Houston, Texas OBJECTIVE: The study goal was to assess the use of digital laryngeal videostroboscopy (LVS) in the de- tection of objective improvement of the larynx after 6 weeks of proton pump inhibitor (PPI) therapy and to evaluate a clinical grading scale for findings of laryngopharyngeal reflux disease (LPRD). STUDY DESIGN AND SETTING: We conducted a pro- spective analysis of digital LVS examinations from a tertiary referral center for laryngology by 3 inde- pendent blinded examiners. RESULTS: The mean score on the Laryngopharyn- geal Reflux Disease Index for experimental patients was significantly higher than that for control pa- tients (9.50 versus 2.92, P < 0.001), and posttreat- ment scores were significantly lower than pretreat- ment scores (7.35 versus 9.50, P < 0.001). Useful items on the grading scale for assessing the pres- ence of LPRD and improvement in LPRD included supraglottic edema and erythema, glottic edema and erythema, and subglottic edema and ery- thema. Nonuseful items included the presence of pachydermia, granulomas, nodules, leukoplakia, and polyps. CONCLUSION: Objective improvement of signs of LPRD can be detected after 6 weeks of PPI therapy using digital LVS. The Laryngopharyngeal Reflux Disease Index is a useful valid clinical tool for following treatment response to PPI therapy. (Otolaryngol Head Neck Surg 2003;128:103-8.) L aryngopharyngeal reflux disease (LPRD) is ex- tremely common in the patient with voice disor- ders. 1 Diagnosis of this disorder is difficult; 24- hour dual pH probe is highly specific for reflux, but as a screening tool, it has been criticized for its lack of sensitivity. 2,3 In addition, a small amount of pharyngeal reflux occurs in the normal popula- tion, so the interpretation of results remains con- troversial. 4-6 Patient history and symptom profile combined with clinical examination remain the most sensitive method of diagnosis of LPRD. A reflux symptom index appears to reliably and nu- merically demonstrate symptom improvement after treatment. 7 Physical examination findings of LPRD may be subtle and not detectable on the average otolaryngologist’s flexible fiberop- tic endoscopy; superior diagnostic equipment and storage media exist and can increase the sensitivity of physical examination. Laryngov- ideostroboscopy (LVS) is currently recom- mended for use in the dynamic evaluation of laryngeal disorders. 8-10 Digital LVS further im- proves resolution and image extraction and is particularly useful in the detection of subtle findings of chronic inflammation caused by LPRD. However, no standard grading scale cur- rently exists for the diagnosis of LPRD with LVS. In addition, an initial therapeutic trial of a high-dose proton pump inhibitor (PPI) has been advocated as a first step in diagnosis and treat- ment of the patient suspected to have LPRD, but no recommendation exists for length of the ther- apeutic trial. This study was designed to assess whether independent blinded examiners could diagnose LPRD based on single digital images extracted from LVS examinations and whether they could detect clinical objective improve- ment after 6 weeks of high-dose PPI therapy. Also, a clinical grading scale was designed for LVS and evaluated both its usefulness as a clinical tool for following LPRD and the use- fulness of each individual item of the scale in detecting LPRD. From the Texas Voice Center (Drs Beaver, Stasney, and Rodriguez), The Bobby R. Alford Department of Otorhi- nolaryngology and Communicative Sciences (Drs Weitzel, Stewart, Donovan, and Parke), and The University of Texas Health Science Center at Houston (Dr. Beaver). Presented at the Annual Meeting of the American Academy of Otolaryngology-Head and Neck Surgery, Denver, CO, September 9-12, 2001. Reprint requests: Mary Es Beaver, MD, 6550 Fannin St, Suite 2001, Houston, TX 77030; e-mail, beavlodge2@ hotmail.com. Copyright © 2003 by the American Academy of Otolaryn- gology–Head and Neck Surgery Foundation, Inc. 0194-5998/2003/$30.00 + 0 doi:10.1067/mhn.2003.10 103