CHALLENGES IN DIAGNOSING SILENT GASTROESOPHAGEAL REFLUX IN CHRONIC LARYNGITIS PATIENTS: ROLE OF PH MONITORING

Abstract

Silent gastroesophageal reflux (GER) is increasingly recognized as an elusive contributor to chronic laryngitis, yet remains underdiagnosed in the absence of classic reflux symptoms. We conducted a prospective cross‐sectional study in 120 adults (mean age 45 ± 12 years; 50 % female) presenting with persistent hoarseness, throat clearing, or cough for ≥3 months but without heartburn or regurgitation. Participants completed the Reflux Symptom Index and underwent flexible laryngoscopy scored via the Reflux Finding Score, followed by 24-hour dual-channel pH monitoring at the distal esophagus and hypopharynx; a subset of 50 patients also received multichannel intraluminal impedance-pH monitoring. Pathological distal acid exposure (defined as ≥4 % time pH <4) was detected in 58.3 % of patients, and 40 % demonstrated symptom association probability > 95 %. Distal and hypopharyngeal acid exposures correlated strongly with symptom and laryngeal findings (Pearson r = 0.60–0.65), and multivariate logistic regression identified elevated symptom scores (OR 1.10–1.15) and acid exposure metrics (OR 1.20–1.25; all p < 0.001) as independent predictors of pathological reflux. Impedance-pH monitoring revealed that 42 % of reflux events were weakly acidic or non-acidic, paralleling the finding that only 60 % of patients achieved complete symptom relief with empirical proton pump inhibitor therapy. These data underscore the incremental diagnostic and therapeutic value of ambulatory pH-based assessments in patients with refractory laryngeal symptoms, supporting the integration of objective reflux quantification into otolaryngology workflows. Future work should refine normative thresholds for laryngopharyngeal monitoring, validate tolerable wireless technologies, and assess the impact of pH-guided interventions on long-term voice outcomes and healthcare utilization.