Iranian Journal of Otorhinolaryngology

Iranian Journal of Otorhinolaryngology

Usefulness of Reflux Symptom Index and Reflux Finding Score in the diagnosis of Laryngopharyngeal Reflux Disease

Document Type : Original

Authors
1 Department of ENT, Teerthanker Mahaveer Medical College and Research Center, Moradabad, India.
2 Department of Otolaryngology, Tamralipto Government Medical College & Hospital, Tamluk, India.
10.22038/ijorl.2026.93713.4111
Abstract
Introduction:
Laryngopharyngeal reflux disease (LPRD) is a common condition with an estimated prevalence between 8-30% in the general population. The complaints of LPRD are non-specific and may overlap with many other common conditions leading to misdiagnosis.Reflux Symptom Index (RSI) is a 9-item patient response based questionnaire developed to diagnose LPRD. Similarly, Reflux Finding Score (RFS) is an 8-item based scoring system created to diagnose LPRD based on endoscopic findings during laryngoscopy.The aim of our study was to evaluate the usefulness of the two scoring systems in identifying patients with LPRD.

Materials and Methods:

Patients with features suggestive of LPRD were considered for participation as per strict inclusion and exclusion criteria. The RSI and RFS was calculated in each case and result was analyzed for statistical significance.

Results:
Total of 150 patients were identified with 37.38 years as mean age of presentation. M:F ratio was 1:1.88. 111 cases (74%) had RSI score above 13 suggestive of LPRD with mean RSI of 19.58. 84 cases (56%) had RFS above 7 suggestive of LPRD with mean RFS of 7.29. There was a positive correlation between RSI score and RFS.

Conclusion:
There was positive correlation between RSI score and RFS in our study (p<0.0001) and the correlation was stronger with RSI scores above 13. This corroborates with the findings of most studies although some authors have inferred otherwise. Using both RSI score and RFS may be useful and complimentary to each other for the correct diagnosis of LPRD.
Keywords
Subjects

1.                   Salihefendic N, Zildzic M, Cabric E. Laryngopharyngeal reflux disease – LPRD. Med Arch. 2017;71(3):215-218.
2.                   Mishra P, Agrawal D, Chauhan K, Kaushik M. Prevalence of laryngopharyngeal reflux disease in Indian population. Indian J Otolaryngol Head Neck Surg. 2022;74(Suppl 2):1877-1881. doi:10. 1007/s 12070-020-01882-1.
3.                   Watkinson JC, Clarke RW, editors. Scott-Brown's Otorhinolaryngology and Head and Neck Surgery. 8th ed. Boca Raton (FL): CRC Press; 2018.
4.                   Mukherjee Y, Chatterji P. Effect of laryngopharyngeal reflux disease on middle ear function: a case-control study. Indian J Otolaryngol Head Neck Surg. 2024;76(2):1979-1983. doi:10. 1007/ s12070-024-04487-0.
5.                   Groome M, Cotton JP, Borland M, McLeod S, Johnston DA, Dillon JF. Prevalence of laryngopharyngeal reflux in a population with gastroesophageal reflux. Laryngoscope. 2007; 117(8):1424-1428. doi:10.1097/MLG.0b013e31806865cf.
6.                   Belafsky PC, Postma GN, Koufman JA. Validity and reliability of the reflux symptom index (RSI). J Voice. 2002;16(2):274-277. doi: 10.1016/ S0892-1997(02)00097-8.
7.                   Belafsky PC, Postma GN, Koufman JA. The validity and reliability of the reflux finding score (RFS). Laryngoscope. 2001;111(8):1313-1317. doi: 10. 1097/ 00005537-200108000-00001.
8.                   Koufman JA. The otolaryngologic manifestations of gastroesophageal reflux disease (GERD): a clinical investigation of 225 patients using ambulatory 24-hour pH monitoring and an experimental investigation of the role of acid and pepsin in the development of laryngeal injury. Laryngoscope. 1991;101(4 Pt 2 Suppl 53):1-78. doi:10.1002/lary.1991.101.s53.1.
9.                   Mesallam TA, Stemple JG, Sobeih TM, Elluru RG. Reflux symptom index versus reflux finding score. Ann Otol Rhinol Laryngol. 2007;116(6):436-440. doi:10.1177/000348940711600608.
10.                Fraser AG. Review article: gastro-oesophageal reflux and laryngeal symptoms. Aliment Pharmacol Ther. 1994;8(3):265-272. doi:10.1111/j.1365-2036. 1994. tb00287.x.
11.                Mallikarjunappa AM, Deshpande GA. Comparison of reflux symptom index (RSI) with reflux finding score (RFS) and its effectiveness in diagnosis of laryngopharyngeal reflux disease (LPRD). Indian J Otolaryngol Head Neck Surg. 2022;74(Suppl 2):1809-1813. doi:10.1007/s12070-020-01814-z.
12.                Guo Z, Wu H, Jiang J, Zhang C. Pepsin in saliva as a diagnostic marker for gastroesophageal reflux disease: a meta-analysis. Med Sci Monit. 2018;24:9509-9516. doi:10.12659/MSM.913978.
13.                Soni A, Gupta A, Jotdar A, et al. Does reflux symptom index and reflux finding score have clinical utility in the diagnosis of laryngopharyngeal reflux disease? Egypt J Otolaryngol. 2024;40:116. doi:10.1186/s43163-024-00686-2.
14.                Bhargava A, Faiz SM, Srivastava MR, Shakeel M, Singh NJ. Role of proton pump inhibitors in laryngopharyngeal reflux: clinical evaluation in a North Indian population. Indian J Otolaryngol Head Neck Surg. 2019;71(3):371-377.
15.                Satish D, Datta H, Manjula BV, Poojari BA, Molluru BR. Correlation between reflux symptom index and reflux finding score in patients with laryngopharyngeal reflux: our experience. J Adv Clin Res Insights. 2016;3:13-17. doi:10. 15713/ ins.jcri.96.
16.                Karakaya NE, Akbulut S, Altıntaş H, Demir MG, Demir N, Berk D. The reflux finding score: reliability and correlation to the reflux symptom index. J Acad Res Med. 2015;5(2):68-74. doi:10. 5152/jarem.2015.698.
17.                Nunes HS, Pinto JA, Zavanela AR, Cavallini AF, Freitas GS, Garcia FE. Comparison between the reflux finding score and the reflux symptom index in the practice of otorhinolaryngology. Int Arch Otorhinolaryngol. 2016;20(3):218-221. doi: 10. 1055/ s-0036-1579557.
18.                Sirajuddin SHP, Veluswamy S, Duraisamy R. Reflux symptom index (RSI) and reflux finding score (RFS) in management of laryngopharyngeal reflux in Indian scenario. Int J Clin Exp Otolaryngol. 2020;6(2):108-113.
19.                Branski RC, Bhattacharyya N, Shapiro J. The reliability of the assessment of endoscopic laryngeal findings associated with laryngopharyngeal reflux disease. Laryngoscope. 2002;112(6):1019-1024. doi:10.1097/00005537-200206000-00016.
 
 
 

Articles in Press, Corrected Proof
Available Online from 26 August 2026