The reflux symptom index - A clinical tool for the diagnosis of laryngopharyngeal reflux

Background: Laryngopharyngeal reflux (LPR) refers to the backflow of stomach contents into the throat. Patients with LPR suffer from hoarseness, throat discomfort, dysphonia, chronic cough, chronic throat clearing and dysphagia. In 2001 Koufman et al. published the self-administered nine-item reflux symptom index (RSI) to assist clinicians in detecting and documenting the presence of LPR. This instrument appears to be valid and highly reproducible. Objective: To develop the Hebrew version of the Reflux Symptom Index (RSI). Methods: Validation of the Hebrew questionnaire included translation of the original instrument from English to Hebrew by three independent translators and retranslation back from Hebrew to English by three other translators. In the United States, patients completed the original and back-translated questionnaires. Scores correlation of the two instruments was performed using correlation coefficient analysis. Validation of the questionnaire was performed by measuring the association between the mean RSI score and the reflux findings upon flexible endoscopy. A control group of 9 patients with no clinical signs of reflux was chosen for our outpatient clinic. Results: A total of 14 patients in the United States completed the original and the back-translated questionnaires. The correlation coefficient (r) was 0.92 (p<0.001). In the second part of the study, 21 consistent Israeli patients that were referred to our voice center because of voice problems were requested to complete the questionnaire. History and endoscopic examinations did not reveal tumors, paralysis, functional voice problems or smoking. The mean age was 53 years (range 37-69 years). There were 14 women in the study group. Twenty patients had RSI higher then 10 (considered positive to the presence of reflux disease). Examination of the larynx demonstrated presence of reflux (e.g. edema of the vocal cords, posterior commissure hypertrophy, arythenoids edema, subglottic edema) in 19 cases (90.5% of patients). All the patients in the control group had a RSI lower then 10. Conclusions: The Hebrew RSI is an easy self-administered and reliable instrument that can help the clinician detect patients suffering from LPR and monitor their treatment.