Efficacy of anti-reflux surgery on refractory laryngopharyngeal reflux disease in professional voice users: a pilot study

Abstract

Objectives: Laryngopharyngeal reflux (LPR) is a pervasive disorder that may cause hoarseness, throat clearing, and other symptoms. These symptoms are particularly problematic in professional voice users. Proton pump inhibitors (PPIs) are the mainstay of current medical management for LPR but may be insufficient in managing some patients' symptoms. Laparoscopic Nissen fundoplication (LNF) is well established for treatment of gastroesophageal reflux disease with a high success rate, but its role in the treatment of LPR remains uncertain. This study was designed to investigate the effectiveness of anti-reflux surgery in managing disease refractory to medical reflux therapy (twice of more per day PPIs).

Study design: Retrospective medical record review.

Methods: This study examined 25 professional voice users, age ranging from 14 to 75 years, diagnosed with refractory LPR treated twice daily or more with PPIs. Reflux finding scores (RFS) were graded by blinded raters and compared for initial, preoperative, postoperative, and final visits. Twenty-four-hour pH-impedance study scores were obtained pre- and postoperatively.

Results: Sixty percent of patients were on no-reflux medications postoperatively and an additional 24% were on less medication. RFS was not significantly different between pre- and postoperative evaluations with good inter- and intrarater reliability; postoperative examinations occurred on less or no pharmaceutical reflux treatment. Twenty-four-hour pH-impedance testing revealed significant reductions in reflux and a nearly significant reduction in total acid. Ninety percent of positive symptom indices preoperatively were negative postoperatively. Seventy-six percent of patients on BID dosing of PPIs and 86% of those receiving super-high-dose PPI administration who underwent LNF were satisfied with the results for their LPR disease.

Conclusion: LNF should be considered as a treatment option for professional voice users with LPR with symptoms refractory to standard or super-high-dose medical management. LNF may decrease or eliminate the need for postoperative PPI usage. The RFS may not be sensitive enough to monitor changes in LPR severity. Patients, especially those on super-high-dose medication administration, are satisfied with the improvement in LPR symptoms after anti-reflux surgery.

Keywords: Fundoplication; Laryngopharyngeal reflux; Nissen; Professional voice; Proton pump inhibitor; Reflux; Reflux finding score; Super-high-dose proton pump inhibitor; pH impedance.