Abstract :
[en] Objective : Patients with laryngopharyngeal reflux (LPR) frequently reported voice-related symptoms that can lead to the development of communicative disability. The aim of this study is i) to explore the subjective and objective speech modifications in LPR disease, ii) to assess the usefulness of acoustic parameters as treatment outcomes in general and hoarseness LPR population, and iii) to better understand the pathophysiological mechanisms underlying the development of voice disorder.
Study Design : a prospective case series
Material and methods: from september 2013 to july 2015, forty one patients with a reflux finding score (RFS) > 7 and a reflux symptom index (RSI) > 13 were enrolled and treated with pantoprazole 20 mg twice daily and diet behavioral changes for three months. The following data were assessed at baseline and after three months post-therapy: RSI, RFS, Voice Handicap Index, GRBASI. Acoustic parameters were measured by selecting the most stable interval of vowel /a/ using Multi-Dimensional Voice Program (MDVP). Study of correlations between acoustic measurements and laryngoscopic signs was conducted in hoarseness patients. Statistical analysis was performed with Statistical Package for the Social Sciences (SPSS) for Windows.
Results : LPR was associated with significant voice disorders caracterized by an impairment of each categories of GRBASI, VHI and some acoustic measurements. Clinically significant improvement in RSI, RFS, VHI, and GRBASI score was found after treatment period (p <.05). Jitter, percent jitter, RAP, shimmer, percent shimmer, APQ had improved significantly at 3 months of treatment in the entire cohort (p <.05). Correlation analysis revealed a significant correlation between breathing and jitter, percent jitter, RAP, shimmer and percent shimmer. When we divided cohort into two groups of patients according to the presence of hoarseness, Shim, Shdb and APQ significantly improve only in hoarse patients but no positive correlation was found between the acoustic parameters and laryngoscopic signs.
Conclusion : Acoustic parameter could help to a better understanding of voice disorders due to microalterations of the mucosal change secondary to acidic reflux, and can be used as outcomes of treatment efficacy in hoarse patients. There is a need for high quality trials with larger cohorts and objective acoustic methodological approach to confirm the place of each acoustic parameter in the follow-up of LPR disease.
