Opinion statement
Gastroesophageal reflux disease (GERD) has been increasingly associated with ear, nose, and throat (ENT) signs and symptoms. This condition, often referred to as laryngopharyngeal reflux (LPR) has become increasingly prevalent. However, the cause and effect relationship between GERD and laryngeal signs or symptoms is far from established. Many patients diagnosed initially with GERD as the cause of laryngeal signs do not symptomatically or laryngoscopically respond to aggressive acid suppression and do not have abnormal esophageal acid exposure by pH monitoring. This has resulted in frustration on the part of both gastroenterologists and ENT physicians and confusion on the part of patients. The current recommendations for the management of LPR patients call for initial empiric therapy with twice daily proton-pump inhibitors (PPIs) for 2 to 4 months. In those unresponsive to such therapy, diagnostic testing with prolonged pH monitoring may be indicated. However, in the majority of such patients, the reason for lack of response to PPI therapy may be irritation of the larynx by causes other than GERD. Surgical fundoplication in this group of patients has lower efficacy than in those with typical symptoms of GERD and is reserved for those with improvement on acid-suppressive therapy.
Similar content being viewed by others
References and Recommended Reading
Koufman JA: The otolaryngologic manifestation of gastroesophageal reflux disease. Laryngoscope 1991, 101:1–78. An extensive thesis investigating the role of acid reflux in LPR.
Vaezi MF, Hicks DM, Abelson TI, Richter JE: Laryngeal signs and symptoms and gastroesophageal reflux disease (GERD): a critical assessment of cause and effect association. Clin Gastroenterol Hepatol 2003, 1:333–344. A concise, recent review of the role of GERD in patients with chronic laryngeal signs and symptoms and the controversies surrounding this area.
Koufman JA, Weiner GJ, Wallace CW, Castell DO: Reflux laryngitis and its sequela. J Voice 1988, 2:78–79.
McNally PR, Maydonovitch CL, Prosek RA, et al.: Evaluation of gastroesophageal reflux as a cause of idiopathic hoarseness. Dig Dis Sci 1989, 34:1900–1904.
Irwin RS, Rosen MJ, Braman SS: Cough: a comprehensive review. Arch Intern Med 1977, 137:1186–1191.
Irwin RS, Corrao WM, Pratter MR: Chronic persistent cough in the adult: the spectrum and frequency of causes and successful outcome of specific therapy. Am Rev Respir Dis 1981, 123:413–417.
Irwin RS, Madison JM: Anatomical diagnostic protocol in evaluating chronic cough with specific reference to gastroesophageal reflux disease. Am J Med 2000, 108(Suppl 4a):126S-130S.
Curren JA, Barry MK, Callanan V, Gormely PK: A prospective study of acid reflux and globus pharyngeus using a modified symptom index. Clin Otolaryngol Allied Sci 1995, 20:552–554.
Ott DJ, Ledbetter MS, Koufman JA, Chen MYM: Globus pharyngeus: radiographic evaluation and 24-hour pH monitoring of the pharynx and esophagus in 22 patients. Radiology 1994, 191:95–97.
Feeland AP, Ardran GM, Emrys-Roberts E: Globus hystericus and reflux esophagitis. J Laryngol Otol 1974, 88:1025–1031.
Ward PH, Hanson DG: Reflux as an etiological factor of carcinoma of the laryngopharynx. Laryngoscope 1998, 98:1195–1199.
Freije JE: Carcinoma of the larynx in patients with gastroesophageal reflux. Am J Otolaryngol 1996, 17:386–390.
Morrison MD: Is chronic gastroesophageal reflux a causative factor in glottic carcinoma? Otolaryngol Head Neck Surg 1988, 99:370–373.
Gaynor EB: Gastroesophageal reflux as an etiologic factor in laryngeal complications of intubation. Laryngoscope 1988, 98:972–979.
Little FB, Kohut RI, Koufman JA, Marshall RB: Effect of gastric acid on the pathogenesis of subglottic stenosis. Ann Otol Rhinol Laryngol 1985, 94:516–519.
Delahunty JE, Cherry J: Experimentally produced vocal cord granulomas. Laryngoscope 1968, 78:1941–1947.
Adhami T, Goldblum JR, Richter JE, Vaezi MF: The role of gastric and duodenal agents in laryngeal injury: an experimental canine model. Am J Gastroenterol 2004, 99:2098–2106.
Metz DC, Childs ML, Ruiz C, Weinstein GS: Pilot study of the oral omeprazole test for reflux laryngitis. Otolaryngol Head Neck Surg 1997, 116:41–46.
Hanson DG, Kamel PL, Kahrilas PJ: Outcomes of antireflux therapy for the treatment of chronic laryngitis. Ann Otol Rhinol Laryngol 1995, 104:550–555.
Kamel PL, Hanson D, Kahrilas PJ: Omeprazole for the treatment of posterior laryngitis. Am J Med 1994, 96:321–326.
Shaw GY, Searl JP: Laryngeal manifestations of gastroesophageal reflux before and after treatment with omeprazole. South Med J 1997, 90:1115–1122.
Wo JM, Grist WJ, Gussack G, et al.: Empiric trial of high-dose omeprazole in patients with posterior laryngitis: A prospective study. Am J Gastroenterol 1997, 92:2160–2165.
Park W, Hicks DM, Khandwala F, et al.: Laryngopharyngeal reflux: prospective cohort study evaluating optimal dose of proton-pump inhibitor therapy and pretherapy predictors of response. Laryngoscope 2005, 115:1230–1238. A most recent, large-scale, open-label study evaluating optimal dosing of PPI therapy and pretherapy predictors of response.
Ahmed TF, Vaezi MF: Chronic laryngitis associated with GERD: a large-scale prospective assessment of differences in practice patterns between gastroenterologists and ENT physicians [abstract]. Gastroenterology 2005, 128:M19769.
Hicks DM, Ours TM, Abelson TI, et al.: The prevalence of hypopharynx findings associated with gastroesophageal reflux in normal volunteers. J Voice 2002, 16:564–579.
Williams RB, Szczesniak MM, Maclean JC, et al.: Predictors of outcome in an open label, therapeutic trial of high-dose omeprazole in laryngitis. Am J Gastroenterol 2004, 99:777–785.
Havas T, Huang S, Levy M, et al.: Posterior pharyngolaryngitis: Double blind randomised placebo controlled trial of proton pump inhibitor therapy. Aust J Otolaryngol 1999, 3:243–246.
El-Serag H, Lee P, Buchner A: Lansoprazole treatment of patients with chronic idiopathic laryngitis: a placebo controlled trial. Am J Gastroenterol 2001, 96:979–983.
Eherer AJ, Habermann W, Hammer HF, et al.: Effect of pantoprazole on the course of reflux associated laryngitis: a placebo-controlled double-blind crossover trial. Scand J Gastroenterol 2003, 38:462–467.
Noordzij JP, Khidr A, Evans BA, et al.: Evaluation of omeprazole in the treatment of reflux laryngitis: a prospective, placebo-controlled, randomized, doubleblind study. Laryngoscope 2001, 111:2147–2151.
Steward DL, Wilson KM, Kelly DH, et al.: Proton pump inhibitor therapy for chronic laryngo-pharyngitis: a randomized placebo-control trial. Arch Otolarynol Head Neck Surg 2004, 131:343–350.
Vaezi MF, Richter JE, Stasney CR, et al.: Treatment of chronic posterior laryngitis with esomeprazole. Laryngoscope 2005, In press. The largest double-blind, placebo-controlled trial evaluating the role of aggressive acid suppression in patients suspected of having LPR.
So JBY, Zeite SM, Rattner DW: Outcome of atypical symptoms attributed to gastroesophageal reflux treated by laparoscopic fundoplication. Surgery 1998, 124:28–32. An evaluation of surgical outcome in patients with atypical symptoms of GERD.
Larrain A, Carrasco E, Galleguillos F, et al.: Medical and surgical treatment of nonallergic asthma associated with gastroesophageal reflux. Chest 1991, 99:1330–1335.
Klaus A, Swain JM, Hinder RA: Laparoscopic antireflux surgery for supraesophageal complications of gastroesophageal reflux disease. Am J Med 2001, 111:202S-206S.
Swoger J, Ponsky J, Hicks DM, et al.: Surgical fundoplication in laryngopharyngeal reflux (LPR) unresponsive to aggressive acid suppression: a prospective concurrent controlled study. Clin Gastroenterol Hepatol 2005, In press. A concurrent controlled study evaluating surgical fundoplication outcome in patients with LPR who are unresponsive to twice-daily PPI therapy.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Vaezi, M.F. Reflux-induced laryngitis (laryngopharyngeal reflux). Curr Treat Options Gastro 9, 69–74 (2006). https://doi.org/10.1007/s11938-006-0025-4
Issue Date:
DOI: https://doi.org/10.1007/s11938-006-0025-4