Evaluating the Role of Hoarseness in Diagnosing LPR: A Study of VHI and RSI Scores

Abstract Background The Reflux Symptom Index (RSI) is commonly used to assess laryngopharyngeal reflux (LPR). However, hoarseness—a symptom included in the RSI—may be elevated due to non-reflux-related voice disorders, potentially leading to diagnostic inaccuracy. To evaluate the influence of hoarseness, measured by the Voice Handicap Index (VHI), on RSI scores, independent of gastroesophageal reflux disease (GERD), and to assess whether this affects the clinical diagnosis of LPR. Methods This retrospective study included 239 patients with voice disorders. RSI and VHI scores were recorded. Univariate linear regression and multivariate generalized linear modeling were performed to assess the relationship between VHI, GERD, and RSI scores. Results Univariate analysis showed that each 1-unit increase in VHI score corresponded to a 0.348-unit increase in RSI score (B: 0.348, SE: 0.056, p<0.001). Multivariate analysis demonstrated that VHI independently predicted RSI scores regardless of GERD status (p<0.001). Notably, 41.5% of patients without GERD had RSI scores ≥13. Conclusion Hoarseness-related voice handicap significantly elevates RSI scores independent of reflux. Clinicians should interpret elevated RSI values with caution in patients with voice disorders to avoid misdiagnosis and overtreatment of LPR.