Behavioral Intervention for Laryngopharyngeal Reflux and Upper Airway Disorders: A Systematic Review for Nonphysician...

Treatment for voice and upper airway disorders often includes a behavioral program to reduce laryngopharyngeal reflux (LPR), a recognized irritant for voice and upper airway diagnoses. The purpose of this systematic review was to develop an evidence-based behavioral guideline for nonphysician voice professionals who counsel clients on optimal vocal hygiene, which could include nonmedical management of LPR.

A systematic review was conducted and is reported following the Preferred Reporting Items for Systematic Review and Meta-analyses guideline. The search was limited to human intervention studies that targeted the reduction in LPR symptoms published in English. Databases included Medline through the Ovid platform, EMBASE, and Web of Science.

Database searches yielded 1621 items, 1162 after removal of duplicates. The authors screened 1162 at the title and abstract stage, eliminating 1098. Including citation review sources, 71 sources were retrieved for full-text review. After elimination of noneligible sources, data were extracted from 21. Evidence was identified to support the most commonly advised dietary and behavioral methods to reduce LPR, except for chocolate and carbonated beverages. Acacia gum, alkaline water, and a body positioning device were unexpected evidence-supported recommendations.

Most commonly recommended dietary and behavioral interventions to reduce LPR have evidence to support their use; however, most investigations combined approaches, making it difficult to understand the clinical impact of each individual recommendation. A combination approach appears to be best when nonphysician voice care professionals advise students and clients on behavioral management of LPR symptoms.