Voice therapy associated with a decrease in the reflux symptoms index in patients with voice complaints

Sarah L. Schneider, Matthew S. Clary, Daniel Steven Fink, Sean X. Wang, Farshad N. Chowdhury, Rena Yadlapati, Marie E. Jetté, Mark S. Courey

Research output: Contribution to journalArticlepeer-review

16 Scopus citations


Objectives/Hypothesis: Patients with muscle tension dysphonia often demonstrate an elevation in Reflux Symptom Index (RSI) and 10-item Voice Handicap Index (VHI-10) scores, and may be erroneously diagnosed with laryngopharyngeal reflux disease. In this study we assessed the effects of voice therapy on RSI and VHI-10 scores in patients with voice complaints not responsive to antireflux medications. Study Design: Retrospective cohort study. Methods: A study of patients was conducted at a single tertiary-care center over 1 year (January 2012–January 2013). Patients were included if they had dysphonia not responsive to proton pump inhibition, did not have neurologic or neoplastic disease, and participated in at least three voice-therapy sessions in the absence of antireflux therapy. Primary analysis assessed change in RSI scores between the initial and follow-up visits with a laryngologist. Results: A total of 18 patients were included (mean age = 49.9 ± 14.5 years, 89% female, 83% with a primary complaint of dysphonia). From initial to follow-up visit, the median RSI score (18.5 [interquartile range {IQR}, 9.5–22.8] vs. 10.5 [IQR, 4.5–14]; P =.02) and median VHI-10 score (25.5 [IQR, 11.3–30.0] vs. 13.5 [IQR, 9.5–20.8]; P =.03) significantly decreased. A significant inverse correlation was found between the number of voice therapy sessions/month and change in RSI score (r = −0.4; P =.05). Conclusions: In this study of patients with muscle tension dysphonia or vocal hyperfunction not responsive to antireflux therapy, RSI and VHI-10 scores improved following voice therapy. Results suggest that self-reported symptoms typically attributed to laryngopharyngeal reflux disease may actually be secondary to inefficient voice use patterns or anxiety about dysphonia that are responsive to voice therapy. Level of Evidence: 4 Laryngoscope, 129:1169–1173, 2019.

Original languageEnglish
Pages (from-to)1169-1173
Number of pages5
Issue number5
StatePublished - May 2019


  • Muscle tension dysphonia
  • laryngopharyngeal reflux
  • reflux symptom index


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