Extralaryngeal Manifestations of Laryngopharyngeal Reflux Disease

Extralaryngeal manifestations of laryngopharyngeal reflux are widely recognised, although evidence to support mechanistic pathways is still lacking. Evidence to support reflux contribution to the following disorders is accumulating: otitis media, sinusitis, obstructive sleep apnea, dental erosions, subglottic and tracheal stenosis, inflammatory lung disease and lung transplant rejection. Acid likely only plays a small part in symptom generation and therefore proton pump inhibitor therapy will not provide sustained relief for many, and should no longer be considered as a diagnostic trial. Multifaceted management including behavioural modifications, barrier protection, antiinflammatory approaches and occasionally surgery are more effective.