Flexible Laryngoscopy: A Comparison of Fiber Optic and Distal Chip Technologies-Part 2: Laryngopharyngeal Reflux

Part 1 of this paper compared fiber optic (FO) and distal chip (DC) flexible technologies in the diagnosis of vocal fold masses and mucosal wave abnormalities. Part 2 of this study was designed to evaluate the usefulness of FO and DC flexible imaging in the diagnosis of laryngopharyngeal reflux (LPR) disease. Thirty-four consecutive patients were examined with either FO or DC flexible stroboscopy followed immediately by rigid stroboscopy. Rigid stroboscopy was considered the "gold-standard" for this study. All stroboscopy segments were evaluated by two laryngologists, an otolaryngologist, a laryngology fellow, and an otolaryngology resident for physical findings of LPR using the Reflux Finding Score (RFS) and Posterior Erythema Grade (PE grade). Both flexible systems underrepresented the physical findings of LPR compared to the rigid examination, but the FO system was frequently more accurate than the DC system. For PE grade, agreement with the rigid endoscope was 95% for the FO system and 73% for the DC system. Total RFSs for both flexible systems were significantly different than RFSs from the corresponding rigid examinations (P = 0.001). Raters who used the RFS more often were more consistent. More severe PE grade scores correlated well with increasing RFSs. The number of patients diagnosed with LPR (RFS > 7) showed that despite differences in the category scores, the FO and DC were almost identical in how much LPR was diagnosed compared with their matched rigid examination. Because both flexible platforms significantly underrepresented reflux signs, we recommend that a rigid laryngeal telescope be used when examining the larynx for signs of LPR. If this is not available, these data suggest that a high-quality FO endoscope may be more accurate than a DC endoscope for most otolaryngologists.