Clinical-endoscopic features and clinicopathological correlations of laryngopharyngeal reflux in young adult men: an observational cross-sectional study

Abstract

Aim. To determine clinical and morphological manifestations of laryngopharyngeal reflux (LPR) in young adult men using validated diagnostic instruments (RSI, RSS-12, RSA) in a single-center, cross-sectional comparative study.

Materials and methods. The study was conducted at the Medical Educational and Scientific Center “University Clinic” of Zaporizhzhia State Medical and Pharmaceutical University between July 2024 and June 2025. Two groups of young men were formed: the main LPR group (MG, n = 91) and a conditionally healthy control group (CG, n = 64). Comprehensive diagnostics included medical history, general clinical examination, standardized questionnaires, and videoendoscopy. Endoscopic verification was performed using MedStar UE 3000 and KARL STORZ systems, applying the Reflux Sign Assessment (RSA) scale (threshold > 14). Symptoms severity was assessed using the Reflux Symptom Index (RSI) (threshold ≥ 13) and Reflux Symptom Score-12 (RSS-12) (threshold ≥ 11), including the quality of life (QoL) subscale. Psycho-emotional status was evaluated using the Hospital Anxiety and Depression Scale (HADS).

Results. The mean RSA endoscopic score was significantly higher in the MG compared with the CG (20.64 ± 9.49 vs 6.28 ± 3.32; p < 0.01). The most frequent complaints were throat dryness (52.74 %) and burning (64.84 %), which are not captured by standardized questionnaires and emerged only through detailed history taking. Videoendoscopy revealed variable pharyngeal and laryngeal mucosal changes; due to neuro-reflex and sensory mechanisms in LPR pathogenesis, findings ranged from minimal or absent to pronounced. Questionnaire data showed markedly higher scores in the MG compared to the CG: RSI – more than threefold higher, RSS-12 – approximately sevenfold higher, and QoL – 4.7-fold higher.

Conclusions. Among patients with LPR, reflux-associated laryngitis was most prevalent (78.02 %), followed by pharyngitis (52.74 %), chronic cough (56.04 %), and dysphonia (49.45 %). The “globus” symptom complex was reported by one-third of patients (34.07 %). Less common morphological alterations were detected in 14.28 % of cases, including laryngeal granulomas (5.49 %), edematous-polypoid laryngitis (3.30 %), and squamous papillomas of the oropharynx (5.49 %). Digital and visual endoscopic visualization of the laryngopharyngeal complex of patients with LPR demonstrated changes ranging from mild-to-moderate to markedly expressed (maximum RSA = 56, minimum = 7), indicating distinct clinical phenotypes, the absence of a single pathogenetic mechanism, and the necessity of individualized diagnostic and therapeutic strategies. The range of total scores in the RSI questionnaire survey of patients with LPR was 13–44 points, and in the RSS-12 questionnaire survey, it was 16–175 points.