Laryngologists v. Non-Laryngologist Treatment of Laryngopharyngeal Reflux

by Natasha Mirza, MD •

What are the differences in diagnosis and treatment of laryngopharyngeal reflux (LPR) between laryngologists and non-laryngologists?

Background: LPR is recognized as the extraesophageal manifestation of reflux. With improved technology and knowledge about the harmful effects of proton pump inhibitor therapy, there is a need to characterize current patterns in the diagnosis and treatment of LPR and to examine differences between subspecialists—those who have completed laryngology fellowships (LF)—and other otolaryngologists who have not (NL) in approaches to LPR diagnosis, testing, and treatment.

Study design: Online survey of the American Academy of Otolaryngology-Head and Neck Surgery and American Broncho-Esophagological Association members; a subgroup analysis was performed to identify differences between LF and NL respondents.

Setting: Membership survey.

Synopsis: The survey sought to collect information regarding the evaluation, diagnosis, and treatment of LPR. Of the 159 respondents, approximately 30% held positions in academics and approximately 25% were fellowship trained but had been practicing for a shorter time. The most frequently noted symptoms of LPR among all respondents were throat clearing (87%), globus sensation (82%), persistent cough (76%), and heartburn/dyspepsia (73%). Among laryngoscopic findings arytenoid edema (80%), posterior commissure hypertrophy (77%), arytenoid erythema (76%), and pachydermia larynges (68%) were most common. Video documentation of laryngopharyngeal exams was 97% in those with laryngology fellowships, compared with 38% in respondents without the fellowship (P < .0001). The adjunctive tests most commonly used were barium esophagram and dual-probe pH testing with impedance, and LF respondents used the latter more often (P = .004). This test was selected as the most sensitive and specific for diagnosis of LPR.

Reasons cited for not incorporating technology in validating the diagnosis of LPR were insufficient time to perform validation, belief that it does not contribute meaningfully to the diagnosis, and cost concerns. The majority of respondents treated LPR empirically with once- or twice-daily proton pump inhibitors, but LF respondents were significantly more likely to use longer empiric treatment and twice-daily proton pump inhibitor therapy initially (P = .004).

Bottom line: There is broad agreement among all otolaryngologists regarding the symptoms and physical signs related to LPR; however, significant differences exist between laryngologists and non-laryngologists on the use of adjunctive testing and treatment strategies.

Citation: Gooi Z, Ishman SL, Bock JM, Blumin JH, Akst LM. Laryngopharyngeal reflux: paradigms for evaluation, diagnosis, and treatment. Ann Otol Rhinol Laryngol. 2014;123:677-685.

Reviewed by Natasha Mirza, MD