Introduction: The present study aimed to develop a new tool for the evaluation of singers with self-reported symptoms suggestive of laryngopharyngeal reflux (LPR) (the SVHI-12-LPR), by correlating RSI with SVHI in a population sample of 163 subjects (both professional and amateur singers), evaluated also by videolaryngostroboscopy. This study was a cross-sectional, double-observational study. Methods: RSI and SVHI were administered to 159 singers (amateurs, singing students, and professional singers). All subjects underwent videolaryngostroboscopy to objectively identify four subgroups: normal subjects (41.5%), subjects with organic lesions occupying the glottic space (17.6%), subjects with functional dysphonia (18.2%), and subjects presenting solely signs suggestive of LPR (22.6%). Using the validated RSI threshold, 33.9% of participants presented an RSI total score >13, suggestive of LPR. Results: Subjects with a suspected diagnosis of LPR at videolaryngostroboscopy presented a mean RSI significantly higher than other subgroups (p < 0.001). Moreover, the SVHI-36 score did not statistically differ between pathological subgroups. A significant positive relationship was observed between RSI and SVHI total score (Spearman’s rank correlation coefficient [ρ] = 0.474, p < 0.001). 12 SVHI items (items 1, 2, 4, 5, 6, 7, 12, 20, 24, 25, 26, 30) showed a significant association with RSI pathology classification. Statistical analysis demonstrated for the 12 selected items (SVHI-12-LPR) acceptable specificity (0.691) and sensibility (0.833) for the suspected diagnosis of LPR with a cut-off of 15. Conclusions: From the SVHI-36, 12 items were extracted that correlated with the specific impact that LPR has on the singer’s voice (SVHI-12-LPR), as evaluated by RSI and videolaryngostroboscopy. Such questionnaire represents a new tool that could be applied to singers with symptoms suggestive of LPR to select which patients would benefit from a further phoniatric and videolaryngostroboscopic evaluation.

1.
Lechien
JR
,
Schindler
A
,
Hamdan
AL
,
Bobin
F
,
Barillari
MR
,
Harmegnies
B
.
The development of new clinical instruments in laryngopharyngeal reflux disease: the international project of young otolaryngologists of the International Federation of Oto-rhino-laryngological Societies
.
Eur Ann Otorhinolaryngol Head Neck Dis
.
2018
135
5S
S85
91
.
2.
Lechien
JR
,
Saussez
S
,
Schindler
A
,
Karkos
PD
,
Hamdan
AL
,
Harmegnies
B
.
Clinical outcomes of laryngopharyngeal reflux treatment: a systematic review and meta-analysis
.
Laryngoscope
.
2019
;
129
(
5
):
1174
87
.
3.
Koufman
JA
.
Laryngopharyngeal reflux 2002: a new paradigm of airway disease
.
Ear Nose Throat J
.
2002
81
9 Suppl 2
2
6
.
4.
Lechien
JR
,
Saussez
S
,
Nacci
A
,
Barillari
MR
,
Rodriguez
A
,
Le Bon
SD
.
Association between laryngopharyngeal reflux and benign vocal folds lesions: a systematic review
.
Laryngoscope
.
2019
129
9
E329
41
.
5.
Parsons
JP
,
Mastronarde
JG
.
Gastroesophageal reflux disease and asthma
.
Curr Opin Pulm Med
.
2010
;
16
(
1
):
60
3
.
6.
Elhennawi
DM
,
Ahmed
MR
,
Abou-Halawa
AS
.
Correlation of obstructive sleep apnoea and laryngopharyngeal reflux: phmetry study
.
Clin Otolaryngol
.
2016
;
41
(
6
):
758
61
.
7.
Ren
JJ
,
Zhao
Y
,
Wang
J
,
Ren
X
,
Xu
Y
,
Tang
W
.
PepsinA as a marker of laryngopharyngeal reflux detected in chronic rhinosinusitis patients
.
Otolaryngol Head Neck Surg
.
2017
;
156
(
5
):
893
900
.
8.
Salihefendic
N
,
Zildzic
M
,
Cabric
E
.
Laryngopharyngeal reflux disease: lprd
.
Med Arch
.
2017
;
71
(
3
):
215
8
.
9.
Magliulo
G
,
Iannella
G
,
Polimeni
A
,
De Vincentiis
M
,
Meccariello
G
,
Gulotta
G
.
Laryngopharyngeal reflux in obstructive sleep apnoea patients: literature review and meta-analysis
.
Am J Otolaryngol
.
2018
;
39
(
6
):
776
80
.
10.
Milstein
CF
,
Charbel
S
,
Hicks
DM
,
Abelson
TI
,
Richter
JE
,
Vaezi
MF
.
Prevalence of laryngeal irritation signs associated with reflux in asymptomatic volunteers: impact of endoscopic technique (rigid vs. flexible laryngoscope)
.
Laryngoscope
.
2005
;
115
(
12
):
2256
61
.
11.
Kamolz
T
,
Velanovich
V
.
Psychological and emotional aspects of gastroesophageal reflux disease
.
Dis Esophagus
.
2002
;
15
(
3
):
199
203
.
12.
Sataloff
RT
.
Professional singers: the science and art of clinical care
.
Am J Otolaryngol
.
1981
;
2
(
3
):
251
66
.
13.
Hočevar-Boltežar
I
,
Šereg-Bahar
M
,
Kravos
A
,
Mumović
G
,
Mitrović
S
.
Is an occupation with vocal load a risk factor for laryngopharyngeal reflux: a prospective, multicentre, multivariate comparative study
.
Clin Otolaryngol
.
2012
;
37
(
5
):
362
8
.
14.
Lane
H
,
Tranel
B
.
The Lombard sign and the role of hearing in speech
.
J Speech Hear Res
.
1971
;
14
(
4
):
677
709
.
15.
Cammarota
G
,
Masala
G
,
Cianci
R
,
Palli
D
,
Capaccio
P
,
Schindler
A
.
Reflux symptoms in professional opera choristers
.
Gastroenterology
.
2007
;
132
(
3
):
890
8
.
16.
Franco
RA
,
Andrus
JG
.
Common diagnoses and treatments in professional voice users
.
Otolaryngol Clin North Am
.
2007
;
40
(
5
):
1025
61, vii
.
17.
Pregun
I
,
Bakucz
T
,
Banai
J
,
Molnar
L
,
Pavlik
G
,
Altorjay
I
.
Gastroesophageal reflux disease: work-related disease
.
Dig Dis
.
2009
;
27
(
1
):
38
44
.
18.
Lundy
DS
,
Casiano
RR
,
Sullivan
PA
,
Roy
S
,
Xue
JW
,
Evans
J
.
Incidence of abnormal laryngeal findings in asymptomatic singing students
.
Otolaryngol Head Neck Surg
.
1999
;
121
(
1
):
69
77
.
19.
Myint
C
,
Moore
JE
,
Hu
A
,
Jaworek
AJ
,
Sataloff
RT
.
A comparison of initial and subsequent follow-up strobovideolaryngoscopic examinations in singers
.
J Voice
.
2016
;
30
(
4
):
472
7
.
20.
Robotti
C
,
Schindler
A
,
Lechien
JR
,
Di Sabatino
A
,
Capobianco
S
,
Schindler
A
.
Prevalence of laryngopharyngeal reflux symptoms, dysphonia, and vocal tract Discomfort in amateur choir singers
.
J Voice
.
2021
S0892
1997(21)00214-9
.
21.
Nacci
A
,
Baracca
G
,
Romeo
SO
,
Cavaliere
MD
,
Barillari
MR
,
Berrettini
S
.
Endoscopic and phoniatric evaluation in singing students
.
J Voice
.
2019
;
33
(
2
):
135
42
.
22.
Nacci
A
,
Bastiani
L
,
Barillari
MR
,
Martinelli
M
,
Lechien
JR
,
Simoni
F
.
Reflux symptom index (RSI) and singing voice handicap index (SVHI) in singing students: a pilot study
.
J Voice
.
2022
36
2
288.e25
34
.
23.
Belafsky
PC
,
Postma
GN
,
Koufman
JA
.
Validity and reliability of the reflux symptom index (RSI)
.
J Voice
.
2002
;
16
(
2
):
274
7
.
24.
Schindler
A
,
Mozzanica
F
,
Ginocchio
D
,
Peri
A
,
Bottero
A
,
Ottaviani
F
.
Reliability and clinical validity of the Italian reflux symptom index
.
J Voice
.
2010
;
24
(
3
):
354
8
.
25.
Cohen
SM
,
Jacobson
BH
,
Garrett
CG
,
Noordzij
JP
,
Stewart
MG
,
Attia
A
.
Creation and validation of the singing voice handicap index
.
Ann Otol Rhinol Laryngol
.
2007
;
116
(
6
):
402
6
.
26.
Baracca
G
,
Cantarella
G
,
Forti
S
,
Pignataro
L
,
Fussi
F
.
Validation of the Italian version of the singing voice handicap index
.
Eur Arch Otorhinolaryngol
.
2014
;
271
(
4
):
817
23
.
27.
Hirano
M
,
Bless
DM
.
Videostroboscopic examination of the larynx
San Diego, CA
Singular Publishing Group
1993
.
28.
Bartholomew
D
,
Knott
M
.
Latent variable models and factor analysis
London
Edward Arnold
1999
.
29.
Kline
R
.
Principles and practice of structural equation modeling
3rd ed.
New York
Guilford Publications
2010
.
30.
Steiger
JH
.
Understanding the limitations of global fit assessment in structural equation modeling
.
Pers Individ Dif
.
2007
;
42
(
5
):
893
8
.
31.
Lechien
JR
,
Khalife
M
,
Huet
K
,
Finck
C
,
Bousard
L
,
Delvaux
V
.
Perceptual, aerodynamic, and acoustic characteristics of voice changes in patients with laryngopharyngeal reflux disease
.
Ear Nose Throat J
.
2019
98
6
E44
50
.
32.
Jin
bJ
,
Lee
YS
,
Jeong
SW
,
Jeong
JH
,
Lee
SH
,
Tae
K
.
Change of acoustic parameters before and after treatment in laryngopharyngeal reflux patients
.
Laryngoscope
.
2008
;
118
(
5
):
938
41
.
33.
Lechien
JR
,
Finck
C
,
Huet
K
,
Khalife
M
,
Fourneau
AF
,
Delvaux
V
.
Impact of laryngopharyngeal reflux on subjective, aerodynamic, and acoustic voice assessments of responder and nonresponder patients
.
J Voice
.
2019
;
33
(
6
):
929
39
.
34.
Mozzanica
F
,
Robotti
C
,
Lechien
JR
,
Pizzorni
N
,
Pirola
F
,
Mengucci
A
.
Vocal tract Discomfort and dysphonia in patients undergoing empiric therapeutic trial with proton pump inhibitor for suspected laryngopharyngeal reflux
.
J Voice
.
2020
;
34
(
2
):
280
8
.
35.
Xu
X
,
Huang
X
,
Tan
J
,
Stevenson
H
,
Zhuang
P
,
Li
X
.
The effects of hard voice onset on objective voice function in patients with laryngopharyngeal reflux [published online ahead of print, 2022 mar 31]
.
J Voice
.
2022
S0892-1997
22
00066
2
.
You do not currently have access to this content.