Is pseudosulcus alone a reliable sign of gastroesophago-pharyngeal reflux?

To investigate if laryngeal pseudosulcus (bilateral infraglottic oedema) is a reliable sign of pharyngeal reflux, the video recordings of 59 patients and 18 controls were examined off-line by two phoniatricians. Eleven video segments were duplicated for calculation of intrarater reliability. The frequency of pseudosulcus was correlated to the results of 24-h double-probe pH monitoring. The intrarater reliability was moderate (K = 0.582; P = 0.005). The sensitivity of pseudosulcus in the diagnosis of pharyngeal reflux among the patients was 30% and among the controls it was 0%. The positive predictive value (PPV) of pseudosulcus for patients with pharyngeal and laryngeal symptoms was 67%, while for the controls it was 0%. The negative predictive value (NPV) of pseudosulcus for patients with pharyngeal or laryngeal symptoms was 32% and for the controls it was 64%. The single finding of pseudosulcus is not a very sensitive predictor of pharyngeal reflux but if the patient has laryngeal symptoms and a pseudsulcus, the probability that the patient has pharyngeal reflux is almost 70%.