Trends in laryngopharyngeal reflux: a British ENT survey

Abstract

There is a lot of scepticism surrounding laryngopharyngeal reflux (LPR). Symptoms such as globus pharyngeus, constant throat clearing, chronic cough, idiopathic hoarseness, catarrh and choking episodes may be reflux-related. The aim of this survey was to highlight current treatment trends in LPR. Questionnaires were emailed to 260 members of the British Academy of Otolaryngology-Head and Neck surgery (BAO-HNS). Survey recipients were asked about type, duration and dose of antireflux treatment and length of follow-up appointments, if any. Finally, they were asked about awareness of any reflux symptom and reflux sign questionnaires. Survey response rate was 60%. The vast majority of the otolaryngologists surveyed believe in laryngopharyngeal reflux (90%) and more than 50% prescribe proton pump inhibitors (PPIs). The preferred duration of treatment is 2 months (37%). Only a minority will prescribe PPIs for 6 months or more. Most otolaryngologists will give the standard GORD dose (70%) (once daily) and only a few (20%) will prescribe more aggressive and prolonged doses. The commonest symptoms for which proton pump inhibitors are prescribed are globus (73%), followed by choking episodes (66%) and chronic cough (62%). If LPR is suspected, most of the otolaryngologists will follow-up the patients (61%) and approximately one third (31%) will discharge them back to the general practitioners. Only eight-percent 8% will refer to gastroenterologists. The three commonest laryngoscopic signs that makes them suspect LPR are erythema of the arytenoids (86%) or the vocal cords (57%) and granulomas (42%). The majority of the otolaryngologists (94%) do not use popular questionnaires such as the RFS or RSI. Despite the controversy surrounding laryngopharyngeal reflux, our results suggest that the majority of the otolaryngologists surveyed believe in LPR and attempt to treat it. Interesting findings are: the duration of treatment, the doses used, the length of follow-ups or the lack of, and the fact that the majority does not request any specific diagnostic tests. “symptoms and signs” questionnaires are rarely used.

Appendix

Do you “believe” in Laryngopharyngeal Reflux

• Yes

• No

• I am not familiar with this term

How often do you prescribe antireflux treatment (including Proton Pump inhibitors-PPIs) in outpatients?

• Never

• <10% of cases

• 10–49%

• >50% of cases

If you suspect Laryngopharyngeal Reflux, what is your next action?

• Refer back to the GP with advice

• Refer to a gastroenterologist and/or order investigations

• Start them on antireflux treatment and follow them up

What is the commonest symptom (apart from indigestion) you prescribe PPIs for? You can tick one, or more from the following:

• Feeling of something stuck in the throat (globus pharyngeus)

• Frequent throat clearing

• Halitosis, bitter taste in the mouth

• Hoarseness

• Chronic cough

• Catarrh

• Dysphagia

• Choking episodes, esp when lying down

• Wheezing and “asthma-like” symptoms

What is the sign or signs on Fibreoptic Laryngoscopy that makes you suspect LPR?

• Erythema of arytenoids

• Erytthema of vocal cords

• Diffuse laryngeal oedema

• Vocal cord oedema

• Infraglottic oedema

• Laryngeal granulomas

• Thick laryngeal mucous

How long do you prescribe PPIs for?

• 1/12

• 2/12

• 3/12

• 6/12

• >6/12

Do you give PPIs once or twice daily?

• Once

• Twice

Do you advice your patients about life-style modifications, i.e. smoking, spicy food, late meals, etc.?

• Yes

• No

Do you give PPIs at night or daytime or both?

• Night

• Daytime

• Both

Are you familiar with the reflux finding score and Reflux Symptom Index?

• Yes

• No