Diagnosis of laryngopharyngeal reflux

Laryngopharyngeal reflux is of great interest to otolaryngologists, speech and language therapists, and gastroenterologists. This is a brief review of recent publications in the diagnosis of laryngopharyngeal reflux.

Otolaryngologic signs and symptoms can be found in 4 to 10% of patients with gastroesophageal reflux and those presenting for ear, nose, and throat evaluations. Laryngeal signs are not pathognomonic for laryngopharyngeal reflux because many of these signs can be found in healthy volunteers. A combination of signs and symptoms should be sought before suspecting this diagnosis. Most investigators consider pH monitoring the best currently available instrument to diagnose gastroesophageal reflux, even though it is not considered to be 100% sensitive and specific. Studies in normal volunteers indicate that a minimal number of reflux episodes reach the hypopharynx. The correlation between laryngeal signs and symptoms and pH-documented reflux is less than perfect, whereas the combination of pH testing and signs and symptoms is better in detecting patients with a favorable response to acid-suppressing therapy. Using an empiric trial of high-dose proton pump inhibitors over a prolonged period of time to diagnose laryngopharyngeal reflux is supported mainly by uncontrolled studies. To date, double-blind, placebo-controlled studies suggest that empiric trials of proton pump inhibitors may not have high accuracy for the diagnosis of laryngopharyngeal reflux.

Multidisciplinary trials are needed to establish the optimal combination of sign and symptom scores, reflux monitoring results, and empiric treatment trials for the most accurate diagnosis of laryngopharyngeal reflux.