Voice Outcomes in Patients With Laryngopharyngeal Reflux: A Systematic Review and Meta-Analysis.

Abstract

Laryngopharyngeal reflux (LPR) commonly causes voice disturbances, yet treatment efficacy remains debated. This review synthesizes evidence on voice outcomes in patients with LPR. A Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA)-guided systematic review (2000-2024) identified eight studies evaluating pharmacological, behavioral, and diagnostic approaches. Random-effects meta-analyses were conducted to assess effect sizes (ES), heterogeneity (I²), and subgroup differences. Behavioral interventions (e.g., Lee Silverman Voice Treatment {LSVT}, voice therapy) demonstrated robust efficacy (ES=0.60, 95% CI: 0.45-0.76, I²=0%), whereas proton pump inhibitors (PPIs) showed negligible effects (ES = -0.15). Adjunctive rikkunshito significantly improved outcomes in refractory LPR cases (ES=0.82). Diagnostic methods based on acoustic analysis or the Voice Handicap Index (VHI) yielded more reliable outcomes (ES=0.56) than those based on clinical symptoms or the Reflux Symptom Index (RSI) (ES=0.32, I²=94.45%). Long-term benefits beyond six months were inconsistent (ES=0.25, I²=97.47%). Behavioral therapies outperform pharmacological treatments in managing LPR-related voice dysfunction, though diagnostic precision and long-term adherence remain critical. Future studies should prioritize standardized diagnostic protocols and investigate multimodal therapeutic strategies.