الفهرس 
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Abstract
This study was a screening study aimed to screen voice patients with MAPLs and with non-organic voice disorders for the symptoms and signs of LPR, which is one of the extraesophageal symptoms of GERD. The results of this study indicate that 24% of patients with MAPLs versus only 6% of the patients with non-organic voice disorders were suspected to have LPR. These patients were found to have high scores in A-RSI and RFS that screen LPR symptoms and signs, respectively. The suspicion of LPR could not depend on one tool only because of the lack of gold-standard diagnostic measures for LPR. A combination of different procedures to confirm the clinical suspicion of GER/LPR is needed, including the patient’s symptoms, the laryngeal findings (by videoendolaryngoscopy), and reflux testing measures such as dual probe (pharyngeal and esophageal) 24-pH monitoring and esophagogastroscopy.
This study found no relationship between symptoms and signs of LPR as assessed by A-RSI and the RFS respectively, and neither the MAPLs nor the non-organic voice disorders. There is no relationship between the onset of the voice complaints among the participated patients in each of the two groups (MAPLs, and non-organic voice disorders). Moreover, there was no correlation between the scores of the A-RSI and the RFS and the severity of the dysphonia (assessed by the modified GRBAS scale) among patients with MAPLs. While dysphonia severity in patients with non-organic voice disorders was indirectly related to the signs of LPR only as indicated by scores of RFS.
Among the studied patients with MAPLs, the main symptoms of reflux were dysphonia, difficulty in swallowing solid, breathing difficulties, a sensation of a lump, and stomach acid coming up. While, in patients with non-organic voice disorders, the presenting symptoms of most of them was dysphonia, however, the severity of this dysphonia was found to be indirectly related to the LPR signs.
By our knowledge this study was the first to study the relationship between the RSI and the RFS among patients with voice disorders. The current study found that among the studied patients with either MAPLs or non-organic voice disorders, there was no correlation between the scores of the A-RSI and the scores of the RFS. This indicates no relationship between the symptoms of LPR that patients with MAPLs and/or non-organic voice disorders had, and the signs of LPR recorded in each of the 2 groups. This could be due to 1) the results of the A-RSI could be biased as some patients may somatize more than others for the same complaints, 2) the bad eating habits used daily by the Egyptians including eating a high carbohydrate diet, species, and fatty food, together with obesity, all these factors could lead to symptoms of GERD and LPR and could lead to differences in the final value of the A-RSI and 3) some LPR signs causing clinical symptoms are not described in the RFS scale, such as hypertrophy of the lingual tonsils and vocal fold keratosis.
from the previous, this study could not answer whether LPR is a contributing factor in such voice disorders, or it was just a coincidence. There is a need for a comprehensive assessment of LPR among the voice patients in comparison to a control group of normal population with either no voice or LPR symptoms and signs is a need to decide where the presence of LPR among patients with voice disorders is a contribution or just a coincidence.