Medical Care
Medication therapies directed mainly against the causative agents vary on a case-by-case basis. With GERD, H2-receptor antagonists, proton pump inhibitors, and prokinetics are the main classes of drugs used. A study failed to provide evidence to support treatment with esomeprazole 40 mg twice a day for 16 weeks compared with placebo for chronic posterior laryngitis (CPL). [12]
A study by Mirić et al suggested that in patients with GERD and chronic laryngitis, gas diffusion capacity should be controlled, even when lung function is normal. The study included 30 children with chronic or recurrent laryngitis who tested positive for GERD. Increases in reflux indexes correlated with decreases in values for single-breath diffusing capacity of the lung for carbon monoxide (DLCO); ie, the odds for a significant reduction in the DLCO increased by 3.9% and 5.5% for each unit change in the Johnson-DeMeester and Boix-Ochoa scores, respectively. [13]
Supportive measures include the following:
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Hydration with about 2 liters of fluid intake per day
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Steam inhalation or room humidifier
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Avoidance of pollutant or irritative/toxic substances
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Identification and avoidance of environmental and occupational sensitizers: Limitation of exposure or change in the work environment if noxious fumes and organic solvents are responsible; avoidance of cigarette smoking, even secondhand smoke
Surgical Care
From a therapeutic standpoint, the following procedures may be indicated:
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Reduction of stenosis is indicated if infiltrative processes or conditions, such as amyloidosis, Wegener granulomatosis, rheumatoid arthritis, or systemic lupus erythematous, have significantly narrowed the lumen of the larynx. Aggressive surgical intervention may be required.
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Exophytic mass removal by surgical means
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Laser vaporization
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Laparoscopic antireflux surgery, using the Nissen fundoplication technique, has shown appreciable results in the treatment of GERD.
Consultations
Consultations with the following specialists may be necessary:
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Allergists, particularly when chronic inflammation of the larynx is suspected to be secondary to allergens and/or pollutants (after excluding other potential causes)
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Gastroenterologists
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Pulmonologists, particularly because Wegener granulomatosis, systemic lupus erythematous, rheumatoid arthritis, and asthma affect not only the larynx but also the lungs
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Otolaryngologists
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Speech therapists, especially when assessing and/or rehabilitating voice and swallowing (eg, after laryngeal surgery)
Diet
If swallowing difficulties exist, then the patient must be fed according to recommendations of a speech pathologist after appropriate swallowing evaluation.
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With GERD, avoidance of fat, alcohol, and caffeine should be practiced.
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Foods thought to play a role in the allergic pathogenesis of the chronic laryngitis must be avoided.
Activity
If GERD is present, any habits or activities that cause acid reflux from the stomach to the esophagus (eg, lying down in bed after a rich meal, movements that may increase intra-abdominal pressure) must be avoided. Elevating the head of the bed is also beneficial. After treatable medical and surgical causes of chronic laryngitis have been resolved, voice rehabilitation under the guidance of a speech therapist is the major tool.
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Illustration of the larynx.
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Illustration of the glottic and supraglottic larynx.
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Illustration of the larynx, posterior view.
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Illustration of the larynx, nasopharyngeal view.
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Illustration of the intrinsic muscles of the larynx, sagittal view.
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Illustration of the intrinsic muscles of the larynx, sagittal view.
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Illustration of the extrinsic muscle insertions of the larynx.
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Illustration of the intrinsic muscles of the larynx, superior view.
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Illustration of the intrinsic muscles of the larynx.
