Diagnosis and management of laryngopharyngeal reflux disease

Laryngopharyngeal reflux remains a controversial subject for both diagnosis as well as treatment. Nevertheless, there is increasing clinical and experimental evidence to suggest that it is associated with many nonspecific otolaryngological symptoms.

Twenty-four hour dual probe pH tests fail to prove or exclude laryngopharyngeal reflux because of insufficient specificity and sensitivity. Therefore, the diagnosis is usually based on a combination of diagnostic signs and symptoms, which cannot be explained by pathology other than laryngopharyngeal reflux. Many signs of laryngopharyngeal reflux, however, are also found in individuals without symptoms. Treatment should consist of high-dose proton-pump inhibitor medication twice daily.

Laryngopharyngeal reflux disease is a diagnosis by exclusion, and resolution of symptoms following a 4-month trial of high-dose proton pump inhibitor twice daily is, for all practical purposes, considered proof of the initial diagnosis. Nonresponse does not exclude the diagnosis of laryngopharyngeal reflux disease, however, since proton-pump inhibitors will only reduce the acid component of the refluxate.