Two recent articles provide some insight into the muddy waters of laryngeal symptoms and reflux which is a much bigger challenge in the adult population than in the pediatric age group.

AJ Krause et al. Clin Gastroenterol Hepatol 2024; 22: 1200-1209. Open Access! Validated Clinical Score to Predict Gastroesophageal Reflux in Patients With Chronic Laryngeal Symptoms: COuGH RefluX

AJ Krause et al. Am J Gastroenterol 2024; 119: 627-634. Diagnostic Yield of Ambulatory Reflux Monitoring Systems for Evaluation of Chronic Laryngeal Symptoms. Thanks to Dr. Benjamin Gold for this reference.

In the first study, there were a total of 856 adults, 304 in the training cohort and 552 in the validation cohort. Key finding: In the validation phase, the COuGH RefluX score had an area under the curve of 0.67 (95% CI, 0.62–0.71), with 79% sensitivity and 81% specificity for proven GERD. Graphical abstract from the first study:

In the second study, the authors retrospectively examined 813 adults with chronic laryngeal symptoms over a 5 year period comparing . The diagnostic yield for prolonged wireless pH testing (n=296) was compared to 24-hour pH-impedance monitoring (n=532) off anti-secretory agents. Key finding: the prolonged wireless pH testing had a yield of 50% compared to 27% for the 24-hr pH-impedance testing.

My take: In the 1st study, the scoring system of cough, obesity, globus sensation, hiatal hernia, regurgitation, and male sex provides a good idea about the likelihood of reflux. In the 2nd study, the authors conclude that prolonged wireless pH testing may be preferrable due to higher diagnostic yield. However, the more proper conclusion is that we still don’t know the best way to determine when reflux causes chronic laryngeal symptoms or even the best way to measure reflux.

Related blog posts:

• AGA Guidance on Extraesophageal Gastroesophageal Reflux
• Current Thinking with Laryngopharyngeal Reflux Symptoms
• Understanding Reflux/Airway Disease and Potential Role of Airway Impedance
• Better to Do a Coin Toss than an ENT Examination to Determine Reflux
• Clinical Practice Update: Extraesophageal Symptoms Attribute to Gastroesophageal Reflux Disease
• Gastroesophageal Reflux Phenotypes and “Where Rome, Lyon, and Montreal Meet”
• Accuracy of ENT diagnosis of Reflux Changes
• Incredible Review of GERD, BRUE, Aspiration, and Gastroparesis