Non-voice-related throat symptoms: comparative analysis of laryngopharyngeal reflux and globus pharyngeus scales R A CATHCART 1 , N STEEN 2 , B G NATESH 1 , K H ALI 3 , J A WILSON 1 1 Department of Otorhinolaryngology, Freeman Hospital, Newcastle upon Tyne, 2 Institute of Health and Society, Newcastle upon Tyne, and 3 Department of Otorhinolaryngology, University Hospitals of Leicester, UK Abstract Background: This study calculated the comparability of two throat symptom assessment scales devised to evaluate either laryngopharyngeal reflux or globus. Setting: United Kingdom hospital out-patient departments. Method: A total of 334 subjects, with and without throat symptoms, completed the Reflux Symptom Index and/ or the Glasgow and Edinburgh Throat Scale. The following were calculated for the resultant data: Cronbach’s α coefficient, principal component analysis, Kaiser normalisation, varimax and oblimin rotation, and eigenvalues. Results: Analysis of data from the Reflux Symptom Index and the Glasgow and Edinburgh Throat Scale revealed clearly similar symptom domains regarding (1) coughing and blockage, and (2) globus or postnasal drip or throat- clearing, as did combined analysis of their amalgamated items. Both instruments had good overall internal consistency (α = 0.75 and 0.81, respectively). The ‘heartburn or reflux’ item in the Reflux Symptom Index mapped poorly to each underlying factor. Discussion: The most commonly used laryngopharyngeal reflux and globus assessment questionnaires appear to detect very similar symptom clusters. The management of throat disorders may previously have been over-reliant on the presenting pattern of throat symptoms. Our findings indicate a need to revisit the traditional clinical classification of throat symptoms. Key words: Factor Analysis; Pharynx; Signs And Symptoms; Outcome Assessment Introduction A number of well validated tools are used to measure poor voice quality. 1 However, laryngologists fre- quently encounter non-voice-related throat symptoms; patients complain of symptoms such as frequent throat-clearing, obstruction, altered sensation and/or discomfort. Over the past 15 years, different symptom scoring tools have been developed in an attempt to assess these non-voice-related symptoms. In 1995, Deary et al. 2 described the Glasgow and Edinburgh Throat Scale, a 10-item questionnaire designed to assess and monitor the response of symp- toms in patients treated for globus pharyngeus (Appendix 1). This questionnaire has been used as an assessment tool in a number of studies. 3 –6 A few years later, an independent North American group 7 reported the validity of a questionnaire asses- sing laryngopharyngeal reflux symptoms in patients presenting with voice disorders. The nine-item Reflux Symptom Index (Appendix 2), validated for patients with supra-oesophageal reflux confirmed by dual- probe pH monitoring, is now a widely used outcome tool. Although Deary’s group have reported extensively on the psychological correlations of globus, most recently in Vietnam war veterans, 8 others remain con- vinced that globus is itself reflux-related. Given this lack of clarity regarding symptom attribution, and a noted overlap of items between two putative ‘disease- specific’ assessment tools, it has been unclear to what extent the Reflux Symptom Index and the Glasgow and Edinburgh Throat Scale assess similar phenomena. The original description of the Glasgow and Edinburgh Throat Scale included a factor analysis with a three-factor solution. In other words, this ques- tionnaire appeared to assess three different sets of symptoms. To date, there has been no factor analysis published for the Reflux Symptom Index. The principal aim of the current study was to employ factor analysis to explore the underlying elements Data from this work were presented in a free paper at the Otorhinolaryngological Research Society Meeting, 21 April 2006, Bath, United Kingdom. Accepted for publication 29 April 2010 First published online 1 October 2010 The Journal of Laryngology & Otology (2011), 125, 59–64. MAIN ARTICLE © JLO (1984) Limited, 2010 doi:10.1017/S0022215110001866