A patient presents with cough, saying she feels as if there’s something stuck in her throat and sometimes her throat burns. These symptoms are consistent with laryngopharyngeal reflux (LPR) and, after taking a careful history and a detailed symptom profile, her otolaryngologist decides to put her on a proton pump inhibitor (PPI), the No. 1 medication indicated for LPR.
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June 2013At a six-week follow-up, the patient’s symptoms haven’t diminished. She thought she was getting relief in the first month, but at the time of her appointment she is experiencing the same suite of irritating symptoms. What is the best course of action now?
This problem—how best to proceed with LPR patients who don’t respond to treatment—is a tricky one. The issue has been discussed, dissected and argued about by otolaryngologists. The jury is out on this issue, and there’s no good published evidence basis for creating practice guidelines.