The relationship of laryngopharyngeal reflux-related signs and symptoms to vocal complaints in professional classical singers

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AIM: To examine the relationship between laryngopharyngeal reflux-related signs, symptoms, and self-reported vocal complaints in professional classical singers. METHODS: This cross-sectional study enrolled 111 classically trained singers. Participants completed a questionnaire on vocal habits and complaints, as well as the validated Reflux Symptom Score (RSS). Data were collected at the phoniatrics departments of the University Hospital Center Zagreb and the University Hospital Center Osijek in 2023. LPR signs were assessed using flexible nasopharyngolaryngoscopy and the Reflux Sign Assessment (RSA). Spearman's rank correlation, multivariable regression, and multivariate analysis of variance were used to examine associations according to RSA and RSS cutoff values. RESULTS: A total of 29 (26.13%) participants exceeded the RSA cutoff value. Fifty-seven (51.35%) exceeded the RSS cutoff. RSA and RSS total scores were weakly but significantly positively correlated. The total RSS score emerged as a significant predictor of higher RSA scores, although the explained variance was modest. Compared with singers who did not exceed the RSA or RSS cutoff values, singers exceeding RSA or RSS cutoff values demonstrated a different pattern of vocal complaints, with more frequent throat clearing, hoarseness, and other vocal disturbances, vocal fatigue, and post-performance deterioration of voice quality. CONCLUSION: LPR-related signs and symptoms were common in professional classical singers, with subjective symptom burden exceeding objective laryngoscopic findings. The weak concordance between signs and symptoms highlights the multifactorial nature of voice complaints in this population. These findings support an integrated approach combining reflux-oriented management with targeted voice therapy rather than reliance on isolated laryngoscopic findings.

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