Impact of pH Monitoring on Laryngopharyngeal Reflux Treatment

Abstract

OBJECTIVES: Treatment of laryngopharyngeal reflux (LPR) often suffers from poor patient compliance and hence poor symptom improvement. The aim of this study was to determine whether 24-hour oropharyngeal pH monitoring was associated with higher rates of treatment compliance and symptom improvement compared with empirical treatment for LPR. STUDY DESIGN: Retrospective, case-control study. SETTING: Tertiary care center. SUBJECTS AND METHODS: Charts were reviewed from 170 consecutive adult patients diagnosed with LPR from January 2008 to March 2010. After clinical diagnosis, all patients were offered the option of empiric treatment with a proton pump inhibitor versus treatment based on a 24-hour oropharyngeal pH study using the Dx-pH system (Restech, San Diego, California). Treatment compliance and pretreatment and posttreatment reflux symptom index (RSI) scores were compared for the 2 groups. Only consecutive patients with complete data were included. RESULTS: One-hundred and seventy patients were included in 2 groups. Group I consisted of 73 patients who underwent pH monitoring. Group II consisted of 70 patients treated empirically. Compliance with medication therapy (68.5% vs 50.0%, P = .019) and lifestyle modification (82.2 vs 25.7%, P = .0001) were greater among patients in group I. Symptom improvement was greater among patients in group I following treatment compared with patients in group II, with a significantly greater reduction in RSI (36.6% vs 24.4%, P = .023). CONCLUSION: Among our patient population, treatment of LPR based on pH monitoring resulted in greater compliance, as well as greater symptom improvement, compared with empirical therapy alone.