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Position Statement: Laryngopharyngeal Reflux

Position Statement: Laryngopharyngeal Reflux

Laryngopharyngeal reflux (LPR) occurs when gastric contents (acid and enzymes such as pepsin) flow in a retrograde fashion and contact the tissues of the upper aerodigestive tract.  LPR may be associated with chronic sore throat, hoarseness, frequent throat clearing, cough, globus sensation, refractory asthma, laryngeal ulcers and granulomas, subglottic stenosis, carcinoma, OSA, and sinonasal disease among other conditions.  Only about 1/3 of patients suspected of having LPR experience classic gastroesophageal reflux (GERD) symptoms including heartburn and regurgitation. Diagnosis and treatment of LPR are within the scope of practice of Otolaryngology - Head & Neck Surgery.  This may include endoscopy, imaging and pharyngoesophageal testing. Initial empiric treatment with medication is often the first line of treatment, as response to medication may be diagnostic. When possible, lifestyle and behavioral changes should be encouraged. Surgery to control reflux may be necessary in some patients with LPR. 

References

Magliulo G, Iannella G, Polimeni A, De Vincentiis M, Meccariello G, Gulotta G, Pasquariello B, Montevecchi F, De Vito A, D'Agostino G, Gobbi R, Cammaroto G, Vicini C. Laryngopharyngeal reflux in obstructive sleep apnoea patients: Literature review and meta-analysis. Am J Otolaryngol. 2018 Nov-Dec;39(6):776-780. doi: 10.1016/j.amjoto.2018.09.006. Epub 2018 Sep 12
Cohen JT, Bach KK, Postma GN, Koufman JA. Clinical manifestations of laryngopharyngeal reflux. Ear Nose Throat J. 2002 Sep;81(9 Suppl 2):19-23.

Khan AM, Hashmi SR, Elahi F, Tariq M, Ingrams DR. Laryngopharyngeal reflux: A literature review. Surgeon. 2006 Aug;4(4):221-5.
Martinucci I, de Bortoli N, Savarino E. et al. Optimal treatment of laryngopharyngeal reflux disease. Ther Adv Chronic Dis. 2013 Nov; 4(6): 287–301. doi: 10.1177/2040622313503485

Altman KW, Stephens RM, Lyttle CS, Weiss, KB. Changing Impact of Gastroesophageal Reflux in Medical and Otolaryngology Practice. Laryngoscope. 2005 July; 115 (7): 145-1153. doi.org/10.1097/01.MLG.0000165464.75164.E5

Gooi Z, Ishman SL, Bock JM, Blumin JH, Akst LM. Changing patterns in reflux care: 10-year comparison of ABEA members. Ann Otol Rhinol Laryngol. 2015;124:940–6.

Koufman JA et al. Laryngopharyngeal reflux: position statement of the committee on speech, voice and swallowing disorders of the American Academy of Otolaryngology-Head and Neck Surgery. Otolaryngol Head Neck Surg. 2002;217(1):32–5

Adopted: 3/6/2006
Reaffirmed: 9/28/2013
Updated: 8/11/2020

Important Disclaimer Notice (Updated 7/31/14)

Position statements are approved by the American Academy of Otolaryngology—Head and Neck Surgery or Foundation (AAO-HNS/F) Boards of Directors and are typically generated from AAO-HNS/F committees. Once approved by the Academy or Foundation Board of Directors, they become official position statements and are added to the existing position statement library. In no sense do they represent a standard of care. The applicability of position statements, as guidance for a procedure, must be determined by the responsible physician in light of all the circumstances presented by the individual patient. Adherence to these clinical position statements will not ensure successful treatment in every situation. As with all AAO-HNS/F guidance, this position statement should not be deemed inclusive of all proper treatment decisions or methods of care, nor exclusive of other treatment decisions or methods of care reasonably directed to obtaining the same results. Position statements are not intended to and should not be treated as legal, medical, or business advice.