Using RSI and RFS scores to differentiate between reflux-related and other causes of chronic laryngitis

Abstract Objective: To establish if the Reflux Symptom Index (RFI) and the Reflux Finding Score (RFC) can help establish the differential diagnosis in patients with distinct causes of chronic laryngopharyngitis. Methods: A group of 102 adult patients with chronic laryngopharyngitis (Group A – 37 patients with allergic rhinitis; Group B – 22 patients with Obstructive Sleep Apnea (OSA); Group C -43 patients with Laryngopharyngeal Reflux (LPR)) were prospectively studied. Chronic laryngitis was diagnosed based on suggestive symptoms and videolaryngoscopic signs (RSI ≥ 13 and RFS ≥7). Allergies were confirmed by a positive serum RAST, OSA was diagnosed with a positive polysomnography, and LPR with a positive impedance-PH study. Discriminant function analysis was used to determine if the combination of RSI and RFS scores could differentiate between groups. Results: Patients with respiratory allergies and those with LPR showed similar and significantly higher RSI scores when compared to that of patients with OSA (p < 0.001); Patients with OSA and those with LPR showed similar and significantly higher RFS scores when compared to that of patients with Respiratory Allergies (OSA vs. Allergies p < 0.001; LPR vs. Allergies p < 0.002). The combination of both scores held a higher probability of diagnosing OSA (72.73%) and Allergies (64.86%) than diagnosing LPR (51.16%). Conclusions: RSI and RFS are not specific for reflux laryngitis and are more likely to induce a false diagnosis if not used with diligence.

摘要 目的：探讨反流症状指数（Reflux Symptom Index，RFI）与反流体征评分（Reflux Finding Score，RFC）能否用于不同病因慢性喉咽炎患者的鉴别诊断。
方法：前瞻性纳入102例慢性喉咽炎成年患者，分为3组：A组37例合并变应性鼻炎，B组22例合并阻塞性睡眠呼吸暂停（Obstructive Sleep Apnea，OSA），C组43例合并喉咽反流（Laryngopharyngeal Reflux，LPR）。慢性喉咽炎的诊断依据典型症状与电子喉镜征象（RSI≥13分、RFS≥7分）。变应性鼻炎经血清放射变应原吸附试验（RAST）阳性确诊，OSA经多导睡眠监测阳性确诊，LPR经阻抗-pH监测阳性确诊。采用判别函数分析评估RSI与RFS联合评分对各组患者的区分效能。
结果：与OSA组患者相比，变应性鼻炎组与LPR组患者的RSI评分均显著升高且二者相近（p<0.001）；与变应性鼻炎组患者相比，OSA组与LPR组患者的RFS评分均显著升高且二者相近（OSA vs. 变应性鼻炎组 p<0.001；LPR vs. 变应性鼻炎组 p<0.002）。两项评分联合对OSA的诊断准确率为72.73%，对变应性鼻炎的诊断准确率为64.86%，均高于对LPR的诊断准确率（51.16%）。
结论：RSI与RFS并非反流性喉炎的特异性诊断指标，若未谨慎应用，极易导致误诊。