Question

Gold standard test for diagnosis of laryngopharyngeal reflux?

• A. 24-hour double-probe pH monitoring
• B. Flexible endoscopy
• C. Barium swallow
• D. Laryngoscopy

Hint:

Look for the test that objectively measures acid reaching the pharynx.

Answer 1

The Correct Option is A

Step 1: Laryngopharyngeal reflux (LPR) is retrograde flow of gastric contents up to the larynx and pharynx, producing hoarseness, throat clearing, globus and cough.
Step 2: Diagnosis requires objective documentation of acid reaching the upper aerodigestive tract. The most sensitive and specific method is dual-probe (double-probe) ambulatory pH monitoring, with one sensor in the distal oesophagus and one at the upper oesophageal sphincter / pharynx.
Step 3: The 24-hour recording quantifies the number and timing of pharyngeal acid events, which is why double-probe 24-hour pH monitoring is regarded as the gold standard. So option 1 is correct.
Step 4: Flexible endoscopy and laryngoscopy show only indirect signs (oedema, erythema, posterior commissure hypertrophy) that are non-specific. Barium swallow assesses anatomy and gross reflux but is insensitive for LPR.
Conclusion: The answer is option 1 (24-hour double-probe pH monitoring).