Review article: Diagnosis and management of laryngopharyngeal reflux

Abstract

Background: Laryngopharyngeal reflux has classically referred to gastroesophageal reflux leading to chronic laryngeal symptoms such as throat clearing, dysphonia, cough, globus sensation, sore throat or mucus in the throat. Current lack of clear diagnostic criteria significantly impairs practitioners' ability to identify and manage laryngopharyngeal reflux.

Aims: To discuss current evidence-based diagnostic and management strategies in patients with laryngopharyngeal reflux.

Methods: We selected studies primarily based on current guidelines for gastroesophageal reflux disease and laryngopharyngeal reflux, and through PubMed searches.

Results: We assess the current diagnostic modalities that can be used to determine if laryngopharyngeal reflux is the cause of a patient's laryngeal symptoms, as well as review some of the common treatments that have been used for these patients. In addition, we note that the lack of a clear diagnostic gold-standard, as well as specific diagnostic criteria, significantly limit clinicians' ability to determine adequate therapies for these patients. Finally, we identify areas of future research that are needed to better manage these patients.

Conclusions: Patients with chronic laryngeal symptoms are complex due to the heterogenous nature of symptom pathology, inconsistent definitions and variable response to therapies. Further outcomes data are critically needed to help elucidate ideal diagnostic workup and therapeutic management for these challenging patients.

Keywords: GERD or GORD; acidity (oesophageal); diagnostic tests; oesophagus.

Figure 1:. The Brain-Larynx Interaction

A diagram outlining the brain-larynx interaction, demonstrating how laryngeal thoughts, laryngeal feelings and laryngeal behaviours are all intertwined and can lead to exacerbations of symptoms.

Figure 2:. Therapeutic Approaches for Chronic Laryngeal Symptoms

A diagram outlining the therapeutic approaches for managing patients with chronic laryngeal symptoms.