Diagnosis and management of laryngopharyngeal reflux disease

A practical approach for the evaluation and management of laryngopharyngeal reflux is provided.

In the absence of definite diagnostic criteria, laryngopharyngeal reflux disease remains a subjective entity. The development and validation of various assessment instruments (the reflux symptom index and reflux finding score) are beginning to remedy this problem. A diagnosis of laryngopharyngeal reflux disease is usually based on response of symptoms to empirical treatment. Investigative modalities such as pH monitoring and, more recently, impedance studies are generally reserved for treatment failures. In contrast to gastroesophageal reflux disease, laryngopharyngeal reflux disease rarely responds to behavior modification alone, or in combination with low-dose histamine-2 receptor antagonists. Laryngopharyngeal reflux disease usually requires more aggressive and prolonged treatment to achieve regression of both symptoms and laryngeal findings. Surgical intervention may play a useful role in selected patients with persistent acid or nonacid reflux.

Laryngopharyngeal reflux is suspected when the history and laryngoscopy findings are suggestive of the diagnosis. Failure to respond to an empiric treatment suggests the need for confirmatory studies and consideration of alternative diagnoses. pH monitoring and multichannel impedance studies are the most useful modalities for directing further investigations or therapy.