Comparison of Voice Therapy and Antireflex Therapy in LPR

Temple University

Status and phase: Withdrawn; Phase 4

Conditions: Laryngopharyngeal Reflux

Treatments: Drug: Omeprazole, Lansoprazole, Esomeprazole, Rantidine; Other: Combination of anti-reflux medication and voice therapy; Behavioral: Voice therapy

Study type: Interventional

Funder types: Other

Identifiers

NCT02530879

22455

Details and patient eligibility

About

This study will be a prospective, randomized, unblinded but controlled trial. Patients presenting to the Otolaryngology clinic who are diagnosed with laryngopharyngeal reflux disorder related dysphonia and meet inclusion criteria will be eligible to enroll in the study. Subjects will be randomized to one of three treatment arms, voice therapy, anti-reflux therapy, or a combination of voice therapy and anti-reflux therapy. Reflux symptom index (RSI) scores, reflux finding scores (RFS), voice handicap index-10 (VHI-10) scores, and consensus auditory perceptual evaluation-voice (CAPE-V) scores will be compared prior to initiation of therapy as well as at 1, 2, and 3 months following initiation of treatment.

Full description

Hoarseness is one of the most common presenting complaints in otolaryngology. The differential diagnosis for hoarseness is board, but a large percentage has been attributed to laryngopharyngeal reflux (LPR). LPR refers to the symptomatic effects of regurgitated gastric contents into the pharynx and larynx.1-3 1,2 Although dual-probe 24 hour pH monitoring is the gold standard in the diagnosis of LPR, it is not always performed due to inconvenience and cost. Patients are commonly treated based on history and physical examination findings alone. The literature on the efficacy of anti-reflux therapy and LPR is controversial. Karkos et al performed a systematic review on the use of empiric treatment of proton pump inhibitors (PPI) in patients suspected of having LPR and found no statistically significant difference between patients treated with PPI and those treated with placebo in reference to symptom severity or frequency of presumed reflux events. 2 Commonly patients are started on empiric therapy with anti-reflux medications and lifestyle modifications. Laryngoscopy is performed on all patients presenting with dysphonia. While a variety of findings have been characterized as consistent with reflux a study performed by Hicks et al, found that 86% of normal volunteers had findings consistent with reflux on flexible laryngoscopy.5 This calls into question the sensitivity and specificity of laryngoscopy in the diagnosis of LPR. Park et al performed a study comparing the effectiveness of anti-reflux therapy alone versus a combination of voice therapy with PPI in the treatment of presumed LPR-related dysphonia, and found combination therapy to be superior to anti-reflux therapy alone. 3 Because there are no studies comparing voice therapy directly with anti-reflux therapy, one cannot determine whether the improvements are due to augmentation of anti-reflux therapy with voice therapy, or if voice therapy alone is superior in the treatment of LPR-related dysphonia. There are currently no studies comparing the effectiveness of voice therapy alone, anti-reflux therapy alone, and combination therapy. Patients who present with dysphonia may be over treated with anti-reflux medications. These medications are not without side effects. It is hypothesized that a subset of patients who are thought to have reflux related dysphonia are misusing their voice and can be successfully treated with voice therapy alone. This study will be a prospective, randomized, unblinded but controlled trial. Patients presenting to the Otolaryngology clinic who are diagnosed with LPR-related dysphonia who meet inclusion criteria will be eligible to enroll in the study and will be randomized to one of the three treatment arms. Reflux symptom index (RSI) scores, reflux finding scores (RFS), voice handicap index-10 (VHI-10) scores, and consensus auditory perceptual evaluation-voice (CAPE-V) scores will be compared prior to initiation of therapy as well as at 1, 2, and 3 months following initiation of treatment.

Sex: All

Ages: 18+ years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

• 18 years of age and older
• Hoarseness
• Reflux symptom index score >13
• Reflux finding score >7
• English speaking

Exclusion criteria

• Evidence of other laryngeal pathology
• Esophageal dysmotility
• Gastroesophageal reflux
• Currently on anti-reflux medications
• Presence of a neurologic condition
• Active smoking
• Currently pregnant
• Individuals unable to consent for themselves
• Recent upper respiratory infection lasting more than 1 month
• Prior treatment for laryngopharyngeal reflux.

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Factorial Assignment

Masking: None (Open label)

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0 participants in 3 patient groups

Voice therapy

Experimental group

Description:

Evaluation is completed over two, one-hour sessions. Once the evaluation is complete, the subject will begin weekly, individual voice therapy for 55 minute sessions per week with a second year graduate student under the direct supervision of the clinical faculty member.Treatment sessions will include a counseling component and an active exercise program.

Treatment:

Behavioral: Voice therapy

Antireflux medication

Active Comparator group

Description:

Intervention includes treatment with one of the following: 1. Omeprazole- Dose range oral, 20mg once a day, up to 40mg twice a day 2. Lansoprazole-Dose range 15mg per day- 30mg twice a day 3. Esomeprazole- Dose range oral, 20mg once a day, up to 40mg twice a day 4. Rantidine-Dose range: 150 mg twice a day or 300 mg once a day. 5. Rantidine may be used in combination with any of the above

Treatment:

Drug: Omeprazole, Lansoprazole, Esomeprazole, Rantidine

Voice therapy and Anti-reflux therapy

Experimental group

Description:

Subjects will receive both anti-reflux medication as detailed above and voice therapy as detailed above.

Treatment:

Other: Combination of anti-reflux medication and voice therapy