the term laryngopharyngeal reflux disease ( reflux laryngitis ) was adopted in 2002 by the american academy of otolaryngology and head and neck surgery and refers to clinical manifestations of gastric reflux on the upper airways.1 
 2 this supraesophageal form of gastroesophageal reflux disease ( gerd ) was named in 1994 by koufman and cummins,3 not with the intention to designate the origin of reflux , but to call attention to the predominance of symptoms and changes in the laryngopharyngeal segment.4 
  estimates regarding the acid reflux causing posterior laryngitis vary widely , reaching up to 80% of cases , according to some authors.5 
 6 
 7 this causal relationship has been fed by the technological development of devices that are able to measure the acidity both on proximal and distal esophagus and the pharynx8 
 9 
 10 
 11 
 12 
 13 
 14 
 15 and also the optical fibers , widely used in clinical practice , which greatly facilitate the visualization of the larynx.16 in this sense , indirect laryngoscopy has an important role in the characterization of the reflux laryngitis . although many findings are nonspecific , some suggest that the etiology of the inflammation is the reflux , such as thickness , redness , and swelling concentrated in the posterior parts of the larynx ( posterior laryngitis ) . a symptom scale ( reflux symptom index [ rsi ] ) was developed by belafsky and collaborators to facilitate the suspect diagnosis and the clinical follow - up in pharyngolaryngitis . patients score themselves on a scale from 0 to 5 of nine symptoms often described of the disease ( table 1).17 values above 13 are considered abnormal . source : belafsky et al.19 
  in the same way , they developed a scale related to the symptoms of reflux pharyngolaryngitis , belafsky and collaborators created a score related to the findings of laryngoscopy ( reflux finding score [ rfs ] ) . it consists of scores from 0 to 4 determined by the examiner of eight laryngoscopic findings : subglottic edema , ventricular obliteration , erythema / hyperemia , vocal fold edema , diffuse laryngeal edema , posterior commissure hypertrophy , granuloma / granulation tissue , and thick endolaryngeal mucus ( 8 findings ) ( table 2 ) . the score , which ranges from 0 ( normal ) to 26 ( worst possibility ) , indicates reflux pharyngolaryngitis if greater than 7.18 
 19 
  source : belafsky et al.17 
  the aim of this work is to analyze if there is a correlation between clinical symptoms of reflux pharyngolaryngitis ( using the rsi ) and the findings of indirect laryngoscopy ( using the rfs ) and thus detect the signs of indirect laryngoscopy that best correlate to the main symptoms of reflux laryngitis . a survey was conducted of patients with symptoms of reflux pharyngolaryngitis at the hospital gaffree guinle from august 2008 to december 2008 . the following patients were excluded from the study : smokers ; people with asthma , chronic obstructive pulmonary disease , or previous treatment with proton pump inhibitors , antacids , or h1 inhibitors ; those with organic laryngeal disorders , previous radiotherapy , or head and neck surgeries ; and psychiatric patients.20 the project was approved by the ethics committee on research ( number 02/2008 ) . we applied a symptom score ( table 1 ) developed by belafsky to facilitate the clinical diagnosis and follow - up on drfl ( laryngopharyngeal reflux disease ) . it is scored by the patient on a scale from 0 to 5 of nine symptoms often described in the disease . belafsky and colleagues also created a score related to the findings of laryngoscopy ( table 2 ) . the score , which ranges from 0 ( normal ) to 26 ( worst possibility ) , indicates drfl when greater than 7.19 the indirect laryngoscopy exam was performed with a rigid 70-degree fiber karl storz brand scope ( germany ) , always by the same examiner . from the 405 patients with symptoms of reflux , 27 fulfilled the criteria of this survey . the laryngoscopy results revealed that almost all patients had posterior commissure hypertrophy ( n  =  25 ; fig . 1 ) and laryngeal diffuse edema ( n  =  21 ) . the average score of reflux symptoms was 17.9 ( ranging from 3 to 34 , standard deviation [ sd ] 8.82 ) and the findings regarding indirect laryngoscopy was 5.7 ( ranging from 1 to 14 , sd 3.82 ) . the most frequently found symptom was the presence of dry cough episodes , foreign body sensation in the throat , and clearing the throat . the patients with clinical and laryngoscopic findings highly suggestive of drfl received complementary therapy for the disease itself ( antireflux therapy and suggestions for lifestyle changes).21 
 
 presence of the posterior commissure hypertrophy . the transversal study was used , and the criteria evaluated were mean age and sex , for symptoms of drfl ( rsi ) , and indirect laryngoscopy findings ( rfs ) . the pearson correlation coefficient for parametric variables was used to assess the degree of correlation , and to reject the null hypothesis , p    0.05 was used . the software used was spss ( statistical package for the social science ) , ibm , united states , for evaluation v.14 for windows xp , microsoft , united states . analyzing the sum of symptoms of reflux ( rfi ) and correlating these findings to indirect laryngoscopy ( rsi ) , a pearson correlation coefficient of 0.7 ( strongly positive ) was found , which was statistically significant ( p    5 ) . correlating the main symptoms ( episodes of dry cough , foreign body sensation in the throat , feeling of cleanliness , and roughness of throat ) with the main findings on indirect laryngoscopy , a statistically significant correlation was found only between the variables hoarseness versus subglottic edema , hoarseness versus posterior commissure hypertrophy , and foreign body sensation versus posterior commissure hypertrophy ( bold in the table 3 ) . one of the difficulties of the present study was to obtain a larger sample of patients , especially with the indiscriminate use of antireflux medications , culminating in incomplete and improper treatment of this disease . another problem ( or solution ) was the exclusion of any patient who had used any tobacco in the years before the study , helping us select the the symptoms most frequently found were the presence of dry cough episodes , foreign body sensation in the throat , and throat clearing . however , the presence of foreign body sensation in the throat ( globus pharyngeus ) showed a positive correlation to the posterior third edema ( posterior commissure ) , as well as the presence of dysphonia ( hoarseness ) . this region of the larynx is anatomically more prone to chronic aggression , especially after the adoption of the supine position . some authors also reported dysphonia as a major symptom that is more common in the morning because of vocal cord edema caused by night reflux episodes , improving during the day.22 a weak positive correlation ( pearson correlation coefficient close to 0 ) was found between hoarseness and vocal fold edema , accepting the null correlation . laryngoscopy findings demonstrated that almost all patients had the presence of laryngeal edema associated with posterior commissure hypertrophy . the diagnosis of reflux disease as the cause of pharyngolaryngitis is not simple . despite the evidence that favors the association , in addition , endoscopy is less efficient in the diagnosis of drfl , because these changes are found in fewer than 20% of patients with this disease . vzquez de la iglesia et al applied similar selection criteria and exclusion surveys and found a similar population ( mostly women and patients with a mean age of 58.32),23 recommending a therapy test ( empirical treatment ) in patients with symptoms highly suggestive of drfl ( score greater than 13 ) and also suspicious laryngoscopic findings ( score greater than 7 ) , with proton pump inhibitors in full dose for 4 months . correlating both scores , the researchers came to the conclusion that the laryngoscopic findings are most useful for diagnosis and patients ' symptoms are most useful for follow - up and evolution of medical treatment . even after 60 years of research , both the diagnosis and treatment of gerd and extraesophageal reflux have been the target of several studies due to their controversial nature . the gold standard of ph monitoring on diagnosis has been questioned by some authors , who have stated that in addition to the test not having 100% sensitivity , the electrodes in the digestive tract interfere with the eating habits of the patients , which affects the results and consequently the diagnosis.24 other studies must establish a consensus on the diagnosis and treatment of patients with pharyngolaryngeal reflux disease to improve the quality of life in these patients.25 after analyzing the data presented , we conclude that there was a strong positive correlation between the findings of indirect laryngoscopy and symptoms of reflux among patients who participated in the study in question ; the most common symptoms were episodes of dry cough , foreign body sensation in the throat , and throat clearing . furthermore , there was a statistically significant correlation between the symptoms of hoarseness and foreign body sensation with the finding of posterior commissure hypertrophy in indirect laryngoscopy .
introduction  the indirect laryngoscopy has an important role in the characterization of reflux laryngitis . 
 although many findings are nonspecific , some strongly suggest that the inflammation is the cause of reflux . 
 objective  the aim of this study was to evaluate the correlation between reflux symptoms and the findings of indirect laryngoscopy . 
 methods  we evaluated 27 patients with symptoms of pharyngolaryngeal reflux disease . 
 results  laryngoscopy demonstrated in all patients the presence of hypertrophy of the posterior commissure and laryngeal edema . 
 the most frequent symptoms were the presence of dry cough and foreign body sensation . 
 conclusion  there was a correlation between the findings at laryngoscopy and symptoms of reflux .