Laryngopharyngeal reflux (LPR) is common in otolaryngologic practice. The prevalence of reflux in patients with voice disorders may be as high as 50%. reflux symptoms include hoarseness, cough, vocal fatigue, globus, excessive throat clearing, dysphonia, and mild dysphagia. We have developed a nine-item, 45-point scale to document the severity of patient symptoms of LPR. The laryngeal physical findings of uncomplicated LPR include edema, posterior glottic erythema, and mucosal hypertrophy. We have recently validated a weighted, eight-item, 26-point LPR physical finding score to document laryngeal reflux findings.
Even though LPR is common, its diagnosis may be difficult, because its symptoms are nonspecific and the laryngeal findings are not always associated with symptom severity. The purpose of this investigation was to evaluate the association between the symptoms and physical findings of patients with LPR.
The improvement of patient symptoms with LPR occurs over 2 months of therapy with twice-daily proton pump inhibitors (PPI). The resolution of laryngeal findings, however, takes longer and continues throughout at least 6 months of treatment. The results of our investigation suggest that the initial treatment of most patients with uncomplicated LPR should include twice-daily PPI therapy and behavioral modification. The percentage of relative drug resistance with twice-daily PPI may be as high as 40%, and a low threshold for increasing the dosage to three or four times a day, or changing to a different PPI, should be maintained.10 Patient symptoms can be expected to improve by 2 months, although therapy should continue at least until the resolution of laryngeal findings which may take up to 6 months or longer.
Peter C. Belafsky, MD, PhD; Gregory N. Postma, MD; Jamie A. Koufman, MD