Laryngopharyngeal reflux (LPR) went unrecognized as a clinical entity until 1968 when the first reports linking LPR with the development of vocal process granulomas (contact ulcer) appeared in the otolaryngology literature. Since that time, LPR has been reported to be associated with a host of laryngeal conditions, including muscle tension (functional) dysphonia, subglottic stenosis, laryngospasm, pachydermia, leukoplakia, and vocal cord carcinoma.
The most common symptoms associated with LPR are hoarseness, dysphagia, globus pharyngeus, chronic throat clearing and cough, and excessive throat mucus. Common laryngeal findings of LPR are localized or diffuse laryngeal edema, opalescence and/or hypertrophy of the posterior commissure, erythema, granulation, and, sometimes, granuloma formation. Classic posterior laryngitis (red arytenoids and piled-up interarytenoid mucosa) is not seen in most patients with LPR. Instead, laryngeal edema, not erythema, is by far the most common laryngeal finding.
The first reports of the use of ambulatory 24-hour pH monitoring in otolaryngologic patients with hoarseness and other throat symptoms appeared in the 1980s. Wiener et al reported the use of simultaneous monitoring of the pH in the distal esophagus and in the pharynx by placement of a second pH probe in the hypopharynx behind the laryngeal inlet. This diagnostic technique was used to document the presence of extraesophageal reflux (ie, true LPR). This test is the current gold standard for diagnosis of LPR.
Although LPR is now a widely recognized clinical entity, the incidence of this disease process remains unknown. The purpose of this study was to investigate the prevalence of reflux disease in a consecutive series of patients with laryngeal and voice disorders with ambulatory 24-hour double-probe pH testing.
Read more: Prevalence of reflux in 113 consecutive patients with laryngeal and voice disorders
JAMIE A. KOUFMAN, MD, FACS, MILAN R. AMIN, MD, and MARGUERITE PANETTI, MA,Winston-Salem, North Carolina, and Philadelphia, Pennsylvania