Objective Assessment of Laryngopharyngeal Reflux in Laryngeal Contact Granuloma

OBJECTIVE: To determine the prevalence and characteristics of objectively confirmed laryngopharyngeal reflux (LPR) in patients with laryngeal contact granuloma (LCG) using 24-h hypopharyngeal-esophageal multichannel intraluminal impedance-pH (HEMII-pH) monitoring, and to compare patient and disease features by reflux status. METHODS: This retrospective study included patients diagnosed with LCG who underwent 24-h HEMII-pH monitoring. Reflux episodes were classified by acidity (acid, weakly acidic, weakly alkaline) and posture (upright, recumbent). Clinical characteristics, reflux episode profiles, lesion laterality, and Reflux Symptom Index (RSI) scores were compared between reflux-positive and reflux-negative patients. RESULTS: Among 41 patients, 25 (61.0%) were reflux-positive and 16 (39.0%) were reflux-negative, with no hypopharyngeal reflux event detected. The pH-based classification of reflux events identified a predominance of weakly acidic (46.2%) and weakly alkaline (44.3%) episodes; acidic events were uncommon (9.5%). Most reflux events occurred during upright periods (94.8%), with only 5.2% during recumbent position. Among unilateral lesions, a higher proportion of hypopharyngeal reflux-positive cases involved the left side (76.2% left, 23.8% right), while reflux-negative cases showed no lateral preference (60.0% left, 40.0% right). Symptom screening with the RSI had limited discrimination for hypopharyngeal reflux status (sensitivity 50.0%, specificity 46.7%, PPV 60.0%, NPV 36.8%). CONCLUSION: Our findings highlight the limitations of symptom-based diagnosis and empiric acid suppression in patients with LCG. Pre-treatment 24-h HEMII-pH monitoring can provide a more evidence-based initial approach than routine empiric therapy and supports individualized behavioral interventions.