Further Outpatient Care

Continued monitoring of response to treatment and need for dose adjustment is essential. The primary tools include degree of symptom reduction, laryngoscopic improvement, ambulatory 24-hour pH monitoring to assess the degree of acid suppression, and physiologic correlation with symptoms prior to modifying treatment measures.

Patient Education

Educating patients on physiologic abnormalities and events is essential to ensure their full participation to realize the maximum treatment benefits. Emphasize the need for continued pharmacological treatment, lifestyle, and dietary modifications and relation with possible esophageal symptoms.

For patient education resources, see the Heartburn/GERD/Reflux Center, as well as Gastroesophageal Reflux Disease (GERD) FAQs, Reflux Disease (GERD), and Laryngitis.

Cherry J, Margulies SI. Contact ulcer of the larynx. Laryngoscope. 1968 Nov. 78(11):1937-40. [QxMD MEDLINE Link].
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 injury. Laryngoscope. 1991 Apr. 101(4 Pt 2 Suppl 53):1-78. [QxMD MEDLINE Link].
Ford CN. Evaluation and management of laryngopharyngeal reflux. JAMA. 2005 Sep 28. 294(12):1534-40. [QxMD MEDLINE Link].
Milstein CF, Charbel S, Hicks DM, Abelson TI, Richter JE, Vaezi MF. Prevalence of laryngeal irritation signs associated with reflux in asymptomatic volunteers: impact of endoscopic technique (rigid vs. flexible laryngoscope). Laryngoscope. 2005 Dec. 115(12):2256-61. [QxMD MEDLINE Link].
Maronian NC, Azadeh H, Waugh P, Hillel A. Association of laryngopharyngeal reflux disease and subglottic stenosis. Ann Otol Rhinol Laryngol. 2001 Jul. 110(7 Pt 1):606-12. [QxMD MEDLINE Link].
Reavis KM, Morris CD, Gopal DV, Hunter JG, Jobe BA. Laryngopharyngeal reflux symptoms better predict the presence of esophageal adenocarcinoma than typical gastroesophageal reflux symptoms. Ann Surg. 2004 Jun. 239(6):849-56; discussion 856-8. [QxMD MEDLINE Link].
Lin RJ, Sridharan S, Smith LJ, Young VN, Rosen CA. Weaning of proton pump inhibitors in patients with suspected laryngopharyngeal reflux disease. Laryngoscope. 2017 Jul 21. [QxMD MEDLINE Link].
Vaezi MF. Benefit of acid-suppressive therapy in chronic laryngitis: the devil is in the details. Clin Gastroenterol Hepatol. 2010 Sep. 8(9):741-2. [QxMD MEDLINE Link].
Burton LK Jr, Murray JA, Thompson DM. Ear, nose, and throat manifestations of gastroesophageal reflux disease. Complaints can be telltale signs. Postgrad Med. 2005 Feb. 117(2):39-45. [QxMD MEDLINE Link].
Gill GA, Johnston N, Buda A, Pignatelli M, Pearson J, Dettmar PW. Laryngeal epithelial defenses against laryngopharyngeal reflux: investigations of E-cadherin, carbonic anhydrase isoenzyme III, and pepsin. Ann Otol Rhinol Laryngol. 2005 Dec. 114(12):913-21. [QxMD MEDLINE Link].
Eckley CA, Sardinha LR, Rizzo LV. Salivary concentration of epidermal growth factor in adults with reflux laryngitis before and after treatment. Ann Otol Rhinol Laryngol. 2013 Jul. 122 (7):440-4. [QxMD MEDLINE Link].
Andersson O, Moller RY, Finizia C, Ruth M. A more than 10-year prospective, follow-up study of esophageal and pharyngeal acid exposure, symptoms and laryngeal findings in healthy, asymptomatic volunteers. Scand J Gastroenterol. 2009. 44(1):23-31. [QxMD MEDLINE Link].
Altman KW, Stephens RM, Lyttle CS, Weiss KB. Changing impact of gastroesophageal reflux in medical and otolaryngology practice. Laryngoscope. 2005 Jul. 115(7):1145-53. [QxMD MEDLINE Link].
Martins RH, do Amaral HA, Tavares EL, Martins MG, Goncalves TM, Dias NH. Voice Disorders: Etiology and Diagnosis. J Voice. 2015 Nov 4. [QxMD MEDLINE Link].
Kang JW, Park JM, Lee YC, Eun YG. The association between laryngopharyngeal reflux and insomnia. Eur Arch Otorhinolaryngol. 2022 Feb 7. [QxMD MEDLINE Link].
Ahmed TF, Khandwala F, Abelson TI, et al. Chronic laryngitis associated with gastroesophageal reflux: prospective assessment of differences in practice patterns between gastroenterologists and ENT physicians. Am J Gastroenterol. 2006 Mar. 101(3):470-8. [QxMD MEDLINE Link].
Belafsky PC, Postma GN, Koufman JA. The association between laryngeal pseudosulcus and laryngopharyngeal reflux. Otolaryngol Head Neck Surg. 2002 Jun. 126(6):649-52. [QxMD MEDLINE Link].
Malhotra A, Freston JW, Aziz K. Use of pH-impedance testing to evaluate patients with suspected extraesophageal manifestations of gastroesophageal reflux disease. J Clin Gastroenterol. 2008 Mar. 42(3):271-8. [QxMD MEDLINE Link].
Zalvan CH, Hu S, Greenberg B, Geliebter J. A Comparison of Alkaline Water and Mediterranean Diet vs Proton Pump Inhibition for Treatment of Laryngopharyngeal Reflux. JAMA Otolaryngol Head Neck Surg. 2017 Sep 7. [QxMD MEDLINE Link].
Lechien JR, Huet K, Finck C, et al. Clinical and Acoustical Voice Quality Evolutions Throughout Empirical Treatment for Laryngopharyngeal Reflux Disease According to Gender: A Preliminary Study. Folia Phoniatr Logop. 2019 May 27. 1-10. [QxMD MEDLINE Link].
Lechien JR, Carroll TL, Nowak G, et al. Impact of Acid, Weakly Acid and Alkaline Laryngopharyngeal Reflux on Voice Quality. J Voice. 2021 Oct 23. [QxMD MEDLINE Link].
So JB, Zeitels SM, Rattner DW. Outcomes of atypical symptoms attributed to gastroesophageal reflux treated by laparoscopic fundoplication. Surgery. 1998 Jul. 124(1):28-32. [QxMD MEDLINE Link].
Salminen P, Karvonen J, Ovaska J. Long-term outcomes after laparoscopic Nissen fundoplication for reflux laryngitis. Dig Surg. 2010. 27(6):509-14. [QxMD MEDLINE Link].
Lechien JR, Finck C, Huet K, et al. Impact of age on laryngopharyngeal reflux disease presentation: a multi-center prospective study. Eur Arch Otorhinolaryngol. 2017 Jul 17. [QxMD MEDLINE Link].
US Food and Drug Administration. FDA Requests Removal of All Ranitidine Products (Zantac) from the Market. FDA. Available at https://www.fda.gov/news-events/press-announcements/fda-requests-removal-all-ranitidine-products-zantac-market. Apr 1, 2020; Accessed: May 7, 2020.

Media Gallery

The RSI documents the presence and degree of nine laryngopharyngeal reflux (LPR) symptoms both before and after treatment; maximum score: 45.
The reflux finding score (RFS) documents the presence and degree of eight laryngopharyngeal reflux (LPR) findings during fiberoptic laryngoscopy; maximum score: 26.

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Table 2. shows key features of the 7 studies that evaluated efficacy of antireflux medical treatment. These studies were published from 1991-1997 and reported on 346 adult patients with otherwise unexplained posterior laryngitis suspected to be caused by GERD who received antireflux medical treatment in an uncontrolled nonblinded clinical trial. Outcomes Reported by Trials of Antireflux Medical Treatment of Reflux Laryngitis

Table 2. shows key features of the 7 studies that evaluated efficacy of antireflux medical treatment. These studies were published from 1991-1997 and reported on 346 adult patients with otherwise unexplained posterior laryngitis suspected to be caused by GERD who received antireflux medical treatment in an uncontrolled nonblinded clinical trial. Outcomes Reported by Trials of Antireflux Medical Treatment of Reflux Laryngitis

Author	n	Pharmacologic Intervention	Treatment Duration wk	Symptom Improvement		Laryngoscopic Improvement	Follow-up wk	Repeat Treatment
Author	n	Pharmacologic Intervention	Treatment Duration wk	Laryngeal	Esophageal	Laryngoscopic Improvement	Follow-up wk	Repeat Treatment
Koufman	33	Ranitidine 300-600 mg/d or Famotidine 80 mg/d	24	85%	…	85%	44	50%
Kamel	16	Omeprazole 40 mg/d	6-24	79%	96%	56%	6	Majority
Hanson	182	Step-wise treatment Famotidine 20 mg/d, Omeprazole 20-40 mg/d	6-12	96%	…	96%	>6-12	79%
Shaw	68	Omeprazole 20 mg bid	12	Significantly improved	40%	Significantly improved	None	…
Wo	21	Omeprazole 40 mg/d	8	40%	48%	50%	8	38%
Metz	10	Omeprazole 20 mg bid	4	60%	100%	…	…	…
Hanson	16	Omeprazole 20 mg/d	6-9	Significantly improved acoustic parameters	…	…	…	…

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Author

Pamela A Mudd, MD, MBA Attending Physician in Pediatric Otolaryngology, Children's National Medical Center

Pamela A Mudd, MD, MBA is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Physicians

Disclosure: Nothing to disclose.

Coauthor(s)

Bardia Amirlak, MD Assistant Professor of Plastic Surgery, Director of Residency Cosmetic Clinic, Director of Plastic Surgery Global Health Program, University of Texas Southwestern Medical Center at Dallas; Chief of Hand and Peripheral Nerve Surgery, Dallas Veterans Affairs Medical Center

Bardia Amirlak, MD is a member of the following medical societies: American College of Surgeons, American Society of Plastic Surgeons, American Society of Reconstructive Transplantation, Kleinert Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Robert M Kellman, MD Professor and Chair, Department of Otolaryngology and Communication Sciences, State University of New York Upstate Medical University

Robert M Kellman, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Head and Neck Society, American Rhinologic Society, Triological Society, American Neurotology Society, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, Medical Society of the State of New York

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA Professor of Otolaryngology, Dentistry, and Engineering, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cerescan; Ryte; Neosoma; MI10<br/>Received income in an amount equal to or greater than $250 from: Neosoma; Cyberionix (CYBX)<br/>Received ownership interest from Cerescan for consulting for: Neosoma, MI10.

Additional Contributors

Clark A Rosen, MD Director, University of Pittsburgh Voice Center; Professor, Department of Otolaryngology and Communication Science and Disorders, University of Pittsburgh School of Medicine

Clark A Rosen, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, Pennsylvania Medical Society

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Merz North America Inc<br/>Received consulting fee from Merz North America Inc for consulting; Received consulting fee from Merz North America Inc for speaking and teaching.

Reza Shaker, MD

Reza Shaker, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Federation for Medical Research, American Gastroenterological Association, American Neurogastroenterology and Motility Society, American Physiological Society, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Ramin Soraya, MD Chair, Department of Science, West Coast University, Dallas

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors, Ann L Edmunds, MD, PharmD, to the development and writing of this article.

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