Otolaryngologic manifestations of gastroesophageal reflux

The exact incidence of gastroesophageal reflux (GER) is unknown, although it is estimated that at least 25% of patients with GER have head and neck symptoms alone. These symptoms may consist of one or more of the following: excess salivation, hoarseness, "post-nasal drip," voice change, persistent coughing, food sticking in the throat, globus hystericus, otalgia, throat clearing, neck pain, sore throats, the sensation of a lump in the throat, choking spells, and bronchospasm. Carcinoma of the larynx and upper aerodigestive tract may be a consequence of chronic reflux. GER, especially when the classic symptoms of reflux are absent, is frequently overlooked as a cause of these problems. This article reviews the symptoms and pathophysiology of these conditions. The diagnostic and therapeutic modalities available to us in managing these patients are also discussed.