Belafsky Reflux Finding Score

The Belafsky Reflux Finding Score¹² is an endoscopic scoring system used to quantify the findings seen in laryngopharyngeal reflux (LPR).
It was initially developed by Belafsky et al to both document the findings and severity of LPR and to monitor for treament response.
The Belafsky Reflux Finding Score ranges from 0-26 and assigns points based on the following 8 features:
1. Subglottic edema
2. Ventricular obliteration
3. Erythema/hyperemia
4. Vocal fold edema
5. Diffuse laryngeal edema
6. Posterior commissure hypertrophy
7. Granuloma/granulation tissue
8. Endolaryngeal mucous
Mnemonic: Vocal Fold PHLEGM Sucks
1. V – Ventricular obliteration
2. F - Fold (vocal fold) edema
3. PH - Posterior commissure hypertrophy
4. L – Laryngeal edema (diffuse)
5. E – Erythema/hyperemia
6. G – Granuloma/granulation tissue
7. M – Mucous (endolaryngeal)
8. S - Subglottic edema

Feature	Grading
Subglottic Edema	0 – absent 2 – present
Ventricular Obliteration	2 – partial 4 – complete
Laryngeal Erythema/hyperemia	2 – arytenoids only 4 – diffuse erythema
Vocal fold edema	1 – mild 2 – moderate 3 – severe 4 – polypoid
Diffuse laryngeal edema	1 – mild 2 – moderate 3 – severe 4 – obstructive
Posterior commissure hypertrophy	1 – mild 2 – moderate 3 – severe 4 – obstructive
Granuloma/granulation tissue	0 – absent 2 – present
Thick endolaryngeal mucous	0 – absent 2 – present

Belafsky, Peter C., Gregory N. Postma, and James A. Koufman. “The validity and reliability of the reflux finding score (RFS).” The laryngoscope 111.8 (2001): 1313-1317. ↩
Belafsky, Peter C., et al. “Symptoms and findings of laryngopharyngeal reflux.” Ear, Nose and Throat Journal 81.9 (2002): S10-S10. ↩

Last updated October 07, 2022