Visual Findings and Reported Symptoms Do Not Correlate With Laryngopharyngeal Reflux, Underscoring the Need for Confirmatory Diagnostics

ABSTRACT Objective To assess the correlation between hypopharyngeal acid exposure, symptom questionnaires, and pharyngeal findings in patients with suspected laryngopharyngeal reflux (LPR) and to provide normative data for hypopharyngeal acid reflux in healthy Finnish subjects. Methods The study included 50 healthy controls and 70 symptomatic patients aged 18–76 years. All participants underwent 24‐h dual‐probe pH monitoring with the proximal sensor positioned above the cricopharyngeal muscle. Participants completed the Finnish version of the reflux symptom index (RSI) and a newly developed reflux symptom questionnaire (RSQ). Three specialists assessed laryngeal findings by evaluating videolaryngoscopies for possible visible reflux‐related findings and applying the reflux finding score (RFS). Statistical analyses examined correlations between objective acid reflux measurements, reported symptoms, and clinical findings. Results No significant correlation was found between the number of acid reflux episodes and reported symptoms or endoscopic findings. Elevated reflux symptoms (RSI, RSQ) and finding scores (RFS) did not reliably identify those with objective acid reflux. Most healthy and symptomatic participants (83%) had no hypopharyngeal acid reflux events (pH < 4) during monitoring. There was a significant difference between groups when comparing the proportions with two or more reflux episodes with pH < 4. Conclusion LPR diagnosis should not rely solely on reported symptoms or visual findings; objective reflux testing is essential. This study challenges the notion that patient‐reported symptoms and pharyngeal and laryngeal visual findings justify acid suppressant use. More than one hypopharyngeal acid reflux event in 24 h should be regarded as pathological. Advanced diagnostic techniques are required to capture nonacidic events. The postprandial period should not be excluded from assessment. Optimal sensor placement above the upper esophageal sphincter is necessary for accurate diagnosis.