In Reply We thank James and Ong and Sataloff for dedicating their time to comment on our article. We are honored by their attention, overall complimentary perspective, and will make our best effort to respond to their comments.
James and Ong mentioned that in our study the presence of laryngopharyngeal reflux disease (LPR) was formally examined only in singing children, whereas in the nonsinging group only the presence of reflux symptoms was described. We would like to clarify that both groups were evaluated in exactly the same way for LPR and reflux symptoms. However, owing to limitations caused by the uncertain nature of LPR diagnosis and no agreement across specialists on diagnostic criteria, this matter was just an additional observation in our study and was not included in the results (LPR was discounted from the voice disorders in our research).1 Sataloff noted that there may be an association between singing training and the increased incidence of LPR owing to increased intra-abdominal pressure. We entirely agree and we noted this relationship in our practice.
Porebska I, Clarós P, Clarós-Pujol A. Association of Singing With the Development of Pediatric Voice Disorders—Reply. JAMA Otolaryngol Head Neck Surg. Published online August 01, 2019. doi:10.1001/jamaoto.2019.1799
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