Reflux-induced laryngitis (laryngopharyngeal reflux)

Gastroesophageal reflux disease (GERD) has been increasingly associated with ear, nose, and throat (ENT) signs and symptoms. This condition, often referred to as laryngopharyngeal reflux (LPR) has become increasingly prevalent. However, the cause and effect relationship between GERD and laryngeal signs or symptoms is far from established. Many patients diagnosed initially with GERD as the cause of laryngeal signs do not symptomatically or laryngoscopically respond to aggressive acid suppression and do not have abnormal esophageal acid exposure by pH monitoring. This has resulted in frustration on the part of both gastroenterologists and ENT physicians and confusion on the part of patients. The current recommendations for the management of LPR patients call for initial empiric therapy with twice daily proton-pump inhibitors (PPIs) for 2 to 4 months. In those unresponsive to such therapy, diagnostic testing with prolonged pH monitoring may be indicated. However, in the majority of such patients, the reason for lack of response to PPI therapy may be irritation of the larynx by causes other than GERD. Surgical fundoplication in this group of patients has lower efficacy than in those with typical symptoms of GERD and is reserved for those with improvement on acid-suppressive therapy.