key: cord-0976571-9ur2mgfd
authors: Lechien, Jerome R.; Bartaire, Emmanuel; Bobin, Francois; Hans, Stephane; Saussez, Sven
title: The association between laryngopharyngeal reflux and COVID‐19 is still not demonstrated
date: 2020-06-09
journal: J Med Virol
DOI: 10.1002/jmv.26080
sha: b9c2878e45a43be420bbf989b3dc99222bb2228d
doc_id: 976571
cord_uid: 9ur2mgfd

We read with interest the paper entitled «The impact of laryngopharyngeal reflux disease on 95 hospitalized patients with COVID-19 in Wuhan, China: A retrospective study.»1 The authors retrospectively reported that hospitalized patients with laryngopharyngeal reflux (LPR) had poorer clinical outcomes compared with those without LPR according to Reflux Symptom Index (RSI). The LPR diagnosis was based on RSI>13, which is the threshold used by Belafsky et al. to suspect LPR.2 This article is protected by copyright. All rights reserved.

The association between laryngopharyngeal reflux and COVID-19 is still not demonstrated First, the use of RSI > 13 as diagnosis approach is particularly problematic. RSI includes many nonspecific symptoms (eg, hoarseness, cough, throat clearing, sticky mucus, etc) that are usually encountered in many common inflammatory diseases of the upper aerodigestive tract, including allergy, 3 rhinitis or chronic rhinosinusitis, 4 and pharyngolaryngitis. 5 The RSI is not designed to make the LPR diagnosis but to suspect the LPR diagnosis when use in combination with laryngeal finding score, such as reflux finding score (sensitive approach). 5, 6 The use of objective approach, such as hypopharyngeal-esophageal multichannel intraluminal impedance-pH monitoring (HEMII-pH) is required to confirm the LPR diagnosis. 5 It is unconceivable to state that patients have LPR if they did not have objective testing. In case of inability to use HEMII-pH, authors would consider fiberoptic findings (eg, posterior commissure hypertrophy, laryngeal erythema or arytenoid granulation tissue) or noninvasive objective approach such as pepsin saliva measurement to increase the accuracy of the diagnosis approach. 5 The use of objective diagnosis approach of LPR would make sense regarding the non-specificity of the RSI symptoms, which are commonly found in both diseases. Thus, the ear, nose, and throat symptoms are frequently observed in patients with COVID-19. 6 Regarding a recent European study, a significant number of patients F I G U R E 1 Main symptoms associated with COVID-19 infection. According to this study that included 1420 patients, 7 the otolaryngological symptoms were prevalent. Cough, rhinorrhea, postnasal drip are all symptoms that may be associated with overall inflammation of the upper aerodigestive tract mucosa, leading to similar LPR-associated symptoms. COVID-19, coronavirus disease 2019; LPR, laryngopharyngeal reflux

The impact of laryngopharyngeal reflux disease on 95 hospitalized patients with COVID-19 in Wuhan, China: A retrospective study

Validity and reliability of the reflux symptom index (RSI)

Factors confusing the diagnosis of laryngopharyngeal reflux: the role of allergic rhinitis and inter-rater variability of laryngeal findings

The Impact of laryngopharyngeal reflux on patient-reported measures of chronic rhinosinusitis

Evaluation and management of laryngopharyngeal reflux disease: state of the art review. Otolaryngol Head Neck Surg

Laryngopharyngeal reflux symptoms improve before changes in physical findings

Clinical and epidemiological characteristics of 1420 European patients with mild-tomoderate coronavirus disease 2019

Patients with acid, high-fat and low-protein diet have higher laryngopharyngeal reflux episodes at the impedance-pH monitoring

Association between laryngopharyngeal reflux disease and autonomic nerve dysfunction

Saliva: potential diagnostic value and transmission of 2019-nCoV