THE ROLE OF VOICE THERAPY IN REDUCING VOICE-RELATED SYMPTOMS IN LARYNGOPHARYNGEAL REFLUX EVALUATED BY REFLUX SYMPTOM INDEX, VOICE HANDICAP INDEX, AND LARYNGOVIDEOSTROBOSCOPY

Patients with laryngopharyngeal reflux frequently experience refractory voice- related symptoms that are nonresponsive to antireflux therapy. New options, such as voice therapy, are alternative treatments for laryngopharyngeal reflux. To evaluate the effect of voice therapy in addition to medical antireflux treatment in a patient with laryngopharyngeal reflux with persistent voice-related symptoms with the use of subjective assessment by the Reflux Symptom Index and the Voice Handicap Index and objective evaluation of the vocal cords by laryngovideostroboscopy. A 48-year-old woman with laryngopharyngeal reflux presented with hoarseness and a sensation of lump in her throat for the previous 6 months. The patient had taken a proton-pump inhibitor twice a day and undergone lifestyle modification for 6 months, but there was no significant improvement. Voice therapy along with antireflux therapy and lifestyle modification was then conducted. Evaluation by subjective and objective assessments showed a significant improvement after the comprehensive treatment strategy. After voice therapy and the use of a proton-pump inhibitor, the Reflux Symptom Index decreased from 19 to 10, and the Voice Handicap Index lowered in functional (from 3 to 0) and physical (from 8 to 6) subscales. The stroboscopic findings showed significant improvement in mucosal wave (from 10% to 60%), amplitude (from 20% to 40%), open-closed phase, phase symmetry, and periodicity. Voice therapy should be considered as an adjuvant treatment to antireflux therapy and lifestyle modification in patients with laryngopharyngeal reflux presenting with refractory voice-related symptoms.