Laryngopharyngeal Reflux

  • Lauren Sowa
  • Holly Schmidt
  • Mark E. GerberEmail author


In the pediatric population, reflux of gastric contents into and above the esophagus impacts different age groups in a variety of ways. It has been estimated that up to 10% of patient visits to an otolaryngologist are for reflux-related issues (Johnston et al. Ann N Y Acad Sci 1381(1):5–13; 2016). Vague symptoms have led to difficulty in research among the involved specialties including gastroenterology, otolaryngology, and speech pathology. This chapter aims to clarify definitions of laryngopharyngeal reflux (LPR) and its contribution to other aerodigestive pathologies from the perspective of both the otolaryngologist and speech pathologist.


Laryngopharyngeal reflux Pediatric laryngopharyngeal reflux Gastroesophageal reflex Laryngomalacia Laryngeal stenosis 


  1. 1.
    Johnston N, Ondrey F, Rosen R, Hurley BP, Gould J, Allen J, et al. Airway reflux. Ann N Y Acad Sci. 2016;1381(1):5–13.PubMedCrossRefGoogle Scholar
  2. 2.
    Rosen R, Vandenplas Y, Singendonk M, Cabana M, DiLorenzo C, Gottrand F, et al. Pediatric gastroesophageal reflux clinical practice guidelines. J Pediatr Gastroenterol Nutr. 2018;66(3):516–54.PubMedPubMedCentralCrossRefGoogle Scholar
  3. 3.
    Venkatesan NN, Pine HS, Underbrink M. Laryngopharyngeal reflux disease in children. Pediatr Clin N Am. 2013;60(4):865–78.CrossRefGoogle Scholar
  4. 4.
    Koufman JA, Aviv JE, Casiano RR, Shaw GY. Laryngopharyngeal reflux: position statement of the committee on speech, voice, and swallowing disorders of the American Academy of Otolaryngology-Head and Neck Surgery. Otolaryngol Head Neck Surg. 2002;127(1):32–5.PubMedCrossRefGoogle Scholar
  5. 5.
    Carr MM, Nguyen A, Poje C, Pizzuto M, Nagy M, Brodsky L. Correlation of findings on direct laryngoscopy and bronchoscopy with presence of extraesophageal reflux disease. Laryngoscope. 2000;110(9):1560–2.PubMedCrossRefGoogle Scholar
  6. 6.
    Koufman JA. The otolaryngologic manifestations of gastroesophageal reflux disease (Gerd): a clinical investigation of 225 patients using ambulatory 24-hour ph monitoring and an experimental investigation of the role of acid and pepsin in the development of laryngeal. Laryngoscope. 1991;101(4. Pt 2 Suppl 53):1–78.PubMedPubMedCentralCrossRefGoogle Scholar
  7. 7.
    Johnston N, Dettmar PW, Bishwokarma B, Lively MO, Koufman JA. Activity/stability of human pepsin: implications for reflux attributed laryngeal disease. Laryngoscope. 2007;117(6):1036–9.PubMedCrossRefGoogle Scholar
  8. 8.
    Samuels TL, Johnston N. Pepsin as a causal agent of inflammation during nonacidic reflux. Otolaryngol – Head Neck Surg. 2009;141(5):559–63.PubMedCrossRefGoogle Scholar
  9. 9.
    Farhath S, He Z, Nakhla T, Saslow J, Soundar S, Camacho J, et al. Pepsin, a marker of gastric contents, is increased in tracheal aspirates from preterm infants who develop bronchopulmonary dysplasia. Pediatrics. 2008;121(2):e253–9.PubMedCrossRefGoogle Scholar
  10. 10.
    Duncan DR, Amirault J, Johnston N, Mitchell P, Larson K, Rosen RL. Gastroesophageal reflux burden, even in children that aspirate, does not increase pediatric hospitalization. J Pediatr Gastroenterol Nutr. 2016;63(2):210–7.PubMedPubMedCentralCrossRefGoogle Scholar
  11. 11.
    Rosen R, Johnston N, Hart K, Khatwa U, Nurko S. The presence of pepsin in the lung and its relationship to pathologic gastro-esophageal reflux. Neurogastroenterol Motil. 2012;24(2):129–33, e84-5.PubMedCrossRefGoogle Scholar
  12. 12.
    Suskind DL, Thompson DM, Gulati M, Huddleston P, Liu DC, Baroody FM. Improved infant swallowing after gastroesophageal reflux disease treatment: a function of improved laryngeal sensation? Laryngoscope. 2006;116(8):1397–403.PubMedCrossRefGoogle Scholar
  13. 13.
    Thompson DM. Laryngopharyngeal sensory testing and assessment of airway protection in pediatric patients. American Journal of Medicine. 2003;115(Suppl 3A):166S–8S.PubMedCrossRefGoogle Scholar
  14. 14.
    Orenstein SR. An overview of reflux-associated disorders in infants: apnea, laryngospasm, and aspiration. Am J Med. 2001;111(Suppl 8A):60s–3S.PubMedCrossRefGoogle Scholar
  15. 15.
    Arvedson J, Rogers B, Buck G, Smart P, Msall M. Silent aspiration prominent in children with dysphagia. Int J Pediatr Otorhinolaryngol. 1994;28(2–3):173–81.PubMedCrossRefGoogle Scholar
  16. 16.
    Dupont C. Gastroesophageal reflux (GER) in the preterm baby. In: Gastroesophageal reflux in children. Cham: Springer International Publishing; 2017. p. 111–24.CrossRefGoogle Scholar
  17. 17.
    Gaffney KF. Infant exposure to environmental tobacco smoke. J Nurs Scholarsh. 2001;33:343.PubMedCrossRefGoogle Scholar
  18. 18.
    Orenstein SR, McGowan JD. Efficacy of conservative therapy as taught in the primary care setting for symptoms suggesting infant gastroesophageal reflux. J Pediatr. 2008;152:310.PubMedCrossRefGoogle Scholar
  19. 19.
    Pavić I, Babić I, Čepin Bogović J, Hojsak I. The importance of combined 24-hour multichannel intraluminal impedance-pH monitoring in the evaluation of children with suspected laryngopharyngeal reflux. Clin Otolaryngol. 2017;42(3):544–9.PubMedCrossRefGoogle Scholar
  20. 20.
    Jetté ME, Gaumnitz EA, Birchall MA, Welham NV, Thibeault SL. Correlation between reflux and multichannel intraluminal impedance pH monitoring in untreated volunteers. Laryngoscope. 2014;124(10):2345–51.PubMedPubMedCentralCrossRefGoogle Scholar
  21. 21.
    Belafsky PC, Postma GN, Koufman JA. The validity and reliability of the reflux finding score (RFS). Laryngoscope. 2001;111(8):1313–7.PubMedCrossRefGoogle Scholar
  22. 22.
    Rosen R, Mitchell PD, Amirault J, Amin M, Watters K, Rahbar R. The edematous and erythematous airway does not denote pathologic gastroesophageal reflux. J Pediatr. 2017;183:127–31.PubMedCrossRefGoogle Scholar
  23. 23.
    Ida JB, Thompson DM. Questioning the utility of laryngoscopy in the evaluation of pediatric gastroesophageal reflux. J Pediatr. 2017;183:9–11.PubMedCrossRefGoogle Scholar
  24. 24.
    Singendonk MMJ, Pullens B, van Heteren JAA, de Gier HHW, Hoeve HLJ, König AM, et al. Reliability of the reflux finding score for infants in flexible versus rigid laryngoscopy. Int J Pediatr Otorhinolaryngol. 2016;86:37–42.PubMedCrossRefGoogle Scholar
  25. 25.
    McMurray JS, Gerber M, Rudolph C, Stern Y, Willging JP, Walner D, et al. Role of laryngoscopy, dual pH probe monitoring, and laryngeal mucosal biopsy in the diagnosis of pharyngoesophageal reflux. Ann Otol Rhinol Laryngol. 2001;110(4):299–304.PubMedCrossRefGoogle Scholar
  26. 26.
    Carr MM, Nagy ML, Pizzuto MP, Poje CP, Brodsky LS. Correlation of findings at direct laryngoscopy and bronchoscopy with gastroesophageal reflux disease in children: a prospective study. Arch Otolaryngol – Head Neck Surg. 2001;127(4):369.PubMedCrossRefGoogle Scholar
  27. 27.
    Meyers WF, Roberts CC, Johnson DG, Herbst JJ. Value of tests for evaluation of gastroesophageal reflux in children. J Pediatr Surg. 1985;20(5):515–20.PubMedCrossRefGoogle Scholar
  28. 28.
    Rosbe KW, Kenna MA, Auerbach AD. Extraesophageal reflux in pediatric patients with upper respiratory symptoms. Arch Otolaryngol – Head Neck Surg. 2003;129(11):1213–20.PubMedCrossRefGoogle Scholar
  29. 29.
    Rabinowitz SS, Piecuch S, Jibaly R, Goldsmith A, Schwarz SM. Optimizing the diagnosis of gastroesophageal reflux in children with otolaryngologic symptoms. Int J Pediatr Otorhinolaryngol. 2003;67(6):621–6.PubMedCrossRefGoogle Scholar
  30. 30.
    Bauman NM, Bishop WP, Sandler AD, Smith RJ. Value of pH probe testing in pediatric patients with extraesophageal manifestations of gastroesophageal reflux disease: a retrospective review. Ann Otol Rhinol Laryngol Suppl. 2000;184:18–24.PubMedCrossRefGoogle Scholar
  31. 31.
    Wenzl TG. Evaluation of gastroesophageal reflux events in children using multichannel intraluminal electrical impedance. Am J Med. 2003;115:161S.PubMedCrossRefGoogle Scholar
  32. 32.
    Little JP, Matthews BL, Glock MS, Koufman JA, Reboussin DM, Loughlin CJ, et al. Extraesophageal pediatric reflux: 24-hour double-probe pH monitoring of 222 children. Ann Otol Rhinol Laryngol. 1997;169:1.Google Scholar
  33. 33.
    Mahajan L, Wyllie R, Oliva L, Balsells F, Steffen R, Kay M. Reproducibility of 24-hour intraesophageal pH monitoring in pediatric patients. Pediatrics. 1998;101:260.PubMedCrossRefGoogle Scholar
  34. 34.
    Vandenplas Y, Helven R, Goyvaerts H, Sacre L. Reproducibility of continuous 24 hour oesophageal pH monitoring in infants and children. Gut. 1990;31:374.PubMedPubMedCentralCrossRefGoogle Scholar
  35. 35.
    Castell DO, Vela M. Combined multichannel intraluminal impedance and ph-metry: an evolving technique to measure type and proximal extent of gastroesophageal reflux. Am J Med. 2002;111:157S.CrossRefGoogle Scholar
  36. 36.
    Wenzl TG, Moroder C, Trachterna M, Thomson M, Silny J, Heimann G, et al. Esophageal pH monitoring and impedance measurement: a comparison of two diagnostic tests for gastroesophageal reflux. J Pediatr Gastroenterol Nutr. 2002;34:519.PubMedCrossRefGoogle Scholar
  37. 37.
    Wenzl TG, Silny J, Schenke S, Peschgens T, Heimann G, Skopnik H. Gastroesophageal reflux and respiratory phenomena in infants: status of intraluminal impedance technique. J Pediatr Gastroenterol Nutr. 1999;28:423.PubMedCrossRefGoogle Scholar
  38. 38.
    Pilic D, Fröhlich T, Nöh F, Pappas A, Schmidt-Choudhury A, Köhler H, et al. Detection of gastroesophageal reflux in children using combined multichannel intraluminal impedance and pH measurement: data from the German pediatric impedance group. J Pediatr. 2011;158:650.PubMedCrossRefGoogle Scholar
  39. 39.
    Nicolai T. Association of apnea and nonacid gastroesophageal reflux in infants: investigations with the intraluminal impedance technique. Pediatr Pulmonol. 2001;31:144.CrossRefGoogle Scholar
  40. 40.
    Rosen R, Amirault J, Giligan E, Khatwa U, Nurko S. Intraesophageal pressure recording improves the detection of cough during multichannel intraluminal impedance testing in children. J Pediatr Gastroenterol Nutr. 2014;58:22.PubMedPubMedCentralCrossRefGoogle Scholar
  41. 41.
    Holbrook JT, Wise RA, Gold BD, Blake K, Brown ED, Castro M, et al. Lansoprazole for children with poorly controlled asthma a randomized controlled trial. JAMA – J Am Med Assoc. 2012;307:373.CrossRefGoogle Scholar
  42. 42.
    AB C, TJ L, Gaffney J, FL C. LA G. gastro-oesophageal reflux treatment for prolonged non-specific cough in children and adults. Cochrane Database Syst Rev. 2011;16:1150.Google Scholar
  43. 43.
    Reilly S, Skuse D. Characteristics and management of feeding problems of young children with cerebral palsy. Dev Med Child Neurol. 1992;34:379.PubMedCrossRefGoogle Scholar
  44. 44.
    Arvedson JC, Brodsky L. Pediatric swallowing and feeding : assessment and management. San Diego: Singular Thomson Learning; 2002. 644 p.Google Scholar
  45. 45.
    Matthews BL, Little JP, Mcguirt WF, Koufman JA. Reflux in infants with laryngomalacia: results of 24-hour double-probe pH monitoring. Otolaryngol Head Neck Surg. 1999;120(6):860–4.PubMedCrossRefGoogle Scholar
  46. 46.
    Hartl TT, Chadha NK. A systematic review of laryngomalacia and acid reflux. Otolaryngol Head Neck Surg (United States). 2012;147:619.CrossRefGoogle Scholar
  47. 47.
    Roger G, Denoyelle F, Triglia JM, Garabedian EN. Severe laryngomalacia: srgical indications and results in 115 patients. Laryngoscope. 1995;105:1111.PubMedCrossRefGoogle Scholar
  48. 48.
    Nussbaum E, Maggi JC. Laryngomalacia in children. Chest. 1990;98:942.PubMedCrossRefGoogle Scholar
  49. 49.
    Don McClurg FL, Evans DA. Laser Laryngoplasty for Laryngomalacia. Laryngoscope. 1994;104:247.CrossRefGoogle Scholar
  50. 50.
    Belmont JR, Grundfast K. Congenital laryngeal stridor (laryngomalacia) etiologic factors and associated disorders. Ann Otol Rhinol Laryngol. 1984;93:430.PubMedCrossRefGoogle Scholar
  51. 51.
    Thompson DM. Abnormal sensorimotor integrative function of the larynx in congenital laryngomalacia: a new theory of etiology. Laryngoscope. 2007;117:1.PubMedCrossRefGoogle Scholar
  52. 52.
    Halstead LA. Gastroesophageal reflux: a critical factor in pediatric subglottic stenosis. Otolaryngol Head Neck Surg. 1999;120:683.PubMedCrossRefGoogle Scholar
  53. 53.
    Yellon RF, Coticchia J, Dixit S. Esophageal biopsy for the diagnosis of gastroesophageal reflux-associated otolaryngologic problems in children. Am J Med. 2000;108:131S.PubMedCrossRefGoogle Scholar
  54. 54.
    Mitzner R, Brodsky L. Multilevel esophageal biopsy in children with airway manifestations of extraesophageal reflux disease. Ann Otol Rhinol Laryngol. 2007;116:571.PubMedCrossRefGoogle Scholar
  55. 55.
    Carr MM, Abu-Shamma U, Brodsky LS. Predictive value of laryngeal pseudosulcus for gastroesophageal reflux in pediatric patients. Int J Pediatr Otorhinolaryngol. 2005;69:1109.PubMedCrossRefGoogle Scholar
  56. 56.
    Giannoni C, Sulek M, Friedman EM. Duncan 3rd NO. gastroesophageal reflux association with laryngomalacia: a prospective study. Int J Pediatr Otorhinolaryngol. 1998;43:11.PubMedCrossRefGoogle Scholar
  57. 57.
    Little FB, Koufman JA, Kohut RI, Marshall RB. Effect of gastric acid on the pathogenesis of subglottic stenosis. Ann Otol Rhinol Laryngol. 1985;94:516.PubMedCrossRefGoogle Scholar
  58. 58.
    Holinger LD. Chronic cough in infants and children. Laryngoscope. 1986;96:316.PubMedCrossRefGoogle Scholar
  59. 59.
    Thomson F, Masters IB, Chang AB. Persistent cough in children and the overuse of medications. J Paediatr Child Health. 2002;38:578.PubMedCrossRefGoogle Scholar
  60. 60.
    Chang AB, Cox NC, Faoagali J, Cleghorn GJ, Beem C, Ee LC, et al. Cough and reflux esophagitis in children: their co-existence and airway cellularity. BMC Pediatr. 2006;6:4.PubMedPubMedCentralCrossRefGoogle Scholar
  61. 61.
    Vandenplas Y, Sacré-Smits L. Continuous 24-hour esophageal pH monitoring in 285 asymptomatic infants 0-15 months old. J Pediatr Gastroenterol Nutr. 1987;6:220.PubMedCrossRefGoogle Scholar
  62. 62.
    Orenstein SR, Lynn Magill H, Brooks P. Thickening of infant feedings for therapy of gastroesophageal reflux. J Pediatr. 1987;110:181.PubMedCrossRefGoogle Scholar
  63. 63.
    Karkos PD, Wilson JA. Empiric treatment of laryngopharyngeal reflux with proton pump inhibitors: a systematic review. Laryngoscope. 2006;116(1):144–8.PubMedCrossRefGoogle Scholar
  64. 64.
    Wo JM, Koopman J, Harrell SP, Parker K, Winstead W, Lentsch E. Double-blind, placebo-controlled trial with single-dose pantoprazole for laryngopharyngeal reflux. Am J Gastroenterol. 2006;101(9):1972–8; quiz 2169.PubMedCrossRefGoogle Scholar
  65. 65.
    Rosh JR, Hassall E. Therapy with gastric acidity inhibitors increases the risk of acute gastroenteritis and community-acquired pneumonia in children. J Pediatr Gastroenterol Nutr. 2006;43:545.PubMedCrossRefGoogle Scholar
  66. 66.
    Francis DO, Rymer JA, Slaughter JC, Choksi Y, Jiramongkolchai P, Ogbeide E, et al. High economic burden of caring for patients with suspected extraesophageal reflux. Am J Gastroenterol. 2013;108:905.PubMedCrossRefGoogle Scholar
  67. 67.
    Ulualp SO, Toohill RJ. Laryngopharyngeal reflux: state of the art diagnosis and treatment. Otolaryngol Clin N Am. 2000;33:785.CrossRefGoogle Scholar
  68. 68.
    Iqbal M, Batch AJ, Moorthy K, Cooper BT, Spychal RT. Outcome of surgical fundoplication for extra-oesophageal symptoms of reflux. Surg Endosc Other Interv Tech. 2009;8:9684.Google Scholar
  69. 69.
    Corvaglia L, Ferlini M, Rotatori R, Paoletti V, Alessandroni R, Cocchi G, et al. Starch thickening of human milk is ineffective in reducing the gastroesophageal reflux in preterm infants: a crossover study using intraluminal impedance. J Pediatr. 2006;148:265.PubMedCrossRefGoogle Scholar
  70. 70.
    Corvaglia L, Aceti A, Mariani E, Legnani E, Ferlini M, Raffaeli G, et al. Lack of efficacy of a starch-thickened preterm formula on gastro-oesophageal reflux in preterm infants: a pilot study. J Matern Neonatal Med. 2012;25:2735.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of Surgery, Section of Otolaryngology-Head and Neck SurgeryThe University of Chicago MedicineChicagoUSA
  2. 2.Department of Pediatric Speech PathologyLurie Children’s Hospital of ChicagoChicagoUSA
  3. 3.Otolaryngology Head and Neck SurgeryPhoenix Children’s HospitalPhoenixUSA

Personalised recommendations