Reflux and Voice Disorders: Have We Established Causality?

被引：12
作者：
Todd Schneider G. [1 ]
Vaezi M.F. [2 ]
Francis D.O. [1 ,3 ]
机构：
[1] Department of Otolaryngology, Vanderbilt Voice Center, Bill Wilkerson Center, Vanderbilt University Medical Center, Medical Center East, Suite 7302, 1215, 21st Avenue South, Nashville, 37232, TN
[2] Division of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, Nashville, TN
[3] Center for Surgical Quality and Outcomes Research, Center for Population Sciences, and Evidence-based Practice Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN
来源：
Current Otorhinolaryngology Reports | 2016年 / 4卷 / 3期
关键词：
Causality; Dysphonia; Fundoplication; Gastroesophageal reflux; Laryngopharyngeal reflux; Proton pump inhibitors;
D O I：
10.1007/s40136-016-0121-5
中图分类号：
学科分类号：
摘要：
Purpose of Review: A trend of attributing abnormal voice changes to reflux has gained momentum among medical professionals over the last few decades. Evidence supporting the connection between reflux and voice and the use of anti-reflux medication in patients with dysphonia is conflicting and deserves careful examination. In the current health care environment, it is important that medical decisions be based on science rather than anecdote and practice patterns. The goal of this review is to investigate the evidence linking reflux and voice changes. Specifically, this association will be examined in the context of the Bradford Hill criteria to determine what evidence exists for a causal relationship between this exposure (reflux) and outcome (voice change). Summary: Using the Bradford Hill criteria as a rubric, the evidence toward causality between reflux and voice is insufficient. The most compelling data derived from animal studies show biological plausibility, since an acidic environment does induce mucosal changes. However, evidence from human studies is largely associative. To date, neither clinical trials nor comparative observational studies have been able to demonstrate a strong dose–response relationship between reflux and voice disorders, temporality (reflux precedes dysphonia), consistent treatment effects, or strength of association between anti-reflux treatment and improved voice among patients with presumed laryngopharyngeal reflux (LPR). Nonetheless, a relationship does exist between LPR and voice and it deserves careful consideration. However, the strength and nature of that association remain unclear. © 2016, Springer Science+Business Media New York.
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收藏
页码：157 / 167
页数：10
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