Diagnosis
Laryngopharyngeal reflux disease
A variant of gastroesophageal acid reflux going past esophagus into hypopharynx causing irritation and inflammation to laryngeal tissue (laryngitis). Characterized by symptoms such as hoarseness, excessive throat clearing, globus pharyngeus, cough, postnasal drip.
Also known as: Extra-esophageal reflux disease, Extraesophageal reflux disease, Reflux Laryngitis, Silent reflux disease, Supra-esophageal reflux disease
Etiology
Cause/pathophysiology [dkb]
Gastroesophageal acid reflux (anatomical defect in the upper esophageal sphincter)
Acidic damage to the larynx/pharynx
In some cases, gastric contents may even reach the nasal cavities and/or ears via the Eustachian tubes, which can exacerbate rhinitis, sinusitis, or otitis media [eeg]
Risk factors [dkb]
Diet heavy in acidic or fatty foods
Caffeine
Alcohol
Large meals before going to sleep
Obesity
Smoking
Complications [dkb][igi]
Chronic cough
Recurrent laryngitis
Oral cavity disorders/ulcers
Recurrent bronchopulmonary injury/infections, such as pneumonia
Laryngopharyngeal reflux is associated with laryngeal cancer
Epidemiology
Prevalence per 100.000 [ymv][uug][uwf][wzq][g2n]
Incidence per 100.000 [ymv][uug][uwf][wzq][g2n]
Symptoms & findings
Symptoms
Cough, Dysphagia, Globus sensation, Halitosis, Heartburn, Hoarseness, Mucus, Odynophagia, Sore throat, Wheezing
Clinical findings
Vocal cord erythema, Vocal cord swelling
Anamneses
None listed.
Localized findings
Approach
Fiberoptic laryngoscopy:
Erythema, edema, lymphoid hyperplasia of the posterior larynx, ulcerations, subglottic or posterior glottic stenosis, vocal cord polyps, granuloma, leucoplakia, and cancer
24-hour pH monitoring
Multichannel intraluminal impedance pH monitoring
Pepsin Saliva Measurement
Barium enema
Esophageal manometry
Spectrophotometric measurement of bile reflux
Mucosal biopsy [pie][1cc]
Treatment
Lifestyle changes: [pie][rys]
Dietary: avoid sweet, spicy, and fried foods, avoid food before bedtime
Behavioral: reduce stress
Lifestyle habits: stop smoking and drinking, reduce weight, exercise
Medical treatment: PPI (acid suppression), H2-receptor antagonists, prokinetic
agents, mucosal cytoprotectants, tricyclic antidepressants, gabapentin, and pregabalin
Surgical treatment: Nissen fundoplication
Differential diagnoses
Achalasia, Acute laryngitis, Allergic rhinosinusitis, Bacterial tonsillitis, Croup, Epiglottitis, Esophageal spasm, Esophageal stricture, Gastroesophageal reflux disease, Myasthenia gravis, Pharyngitis, Reinkes edema
References
[1] Brown J, Shermetaro C. Laryngopharyngeal Reflux. [Updated 2022 Dec 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519548/
[2] Crapko M, Kerschner JE, Syring M, Johnston N. Role of extra-esophageal reflux in chronic otitis media with effusion. Laryngoscope. 2007 Aug;117(8):1419-23.
[3] Tamin S, Saraswati I, Hermani B, Timan IS, Bardosono S. The relationship between laryngopharyngeal reflux based on pepsin value and clinical characteristics of laryngeal cancer patients. J Nat Sc Biol Med 2019;10:S88-91.
[4] Lien HC, Lee PH, Wang CC. Diagnosis of Laryngopharyngeal Reflux: Past, Present, and Future-A Mini-Review. Diagnostics (Basel). 2023 May 7;13(9):1643.
[5] Massawe WA, Nkya A, Abraham ZS, Babu KM, Moshi N, Kahinga AA, Ntunaguzi D, Massawe ER. Laryngopharyngeal reflux disease, prevalence and clinical characteristics in ENT department of a tertiary hospital Tanzania. World J Otorhinolaryngol Head Neck Surg. 2020 Aug 26;7(1):28-33.
[6] George BR, Ajayan PV, Samad S. Prevalence and symptomatology of laryngopharyngeal reflux disease in a medical college hospital in Kerala. J Evid Based Med Healthc 2021;8(27):2467- 2471.
[7] Durazzo M, Lupi G, Cicerchia F, Ferro A, Barutta F, Beccuti G, Gruden G, Pellicano R. Extra-Esophageal Presentation of Gastroesophageal Reflux Disease: 2020 Update. J Clin Med. 2020 Aug 7;9(8):2559.
[8] Jaspersen D, Kulig M, Labenz J, Leodolter A, Lind T, Meyer-Sabellek W, Vieth M, Willich SN, Lindner D, Stolte M, Malfertheiner P. Prevalence of extra-oesophageal manifestations in gastro-oesophageal reflux disease: an analysis based on the ProGERD Study. Aliment Pharmacol Ther. 2003 Jun 15;17(12):1515-20.
[9] Kuo CL. Laryngopharyngeal reflux: An update. Arch Otorhinolaryngol Head Neck Surg. 2019;3(1):1.
[10] Jiang A, Liang M, Su Z, Chai L, Lei W, Wang Z, Wang A, Wen W, Chen M. Immunohistochemical detection of pepsin in laryngeal mucosa for diagnosing laryngopharyngeal reflux. Laryngoscope. 2011 Jul;121(7):1426-30.
[11] Martinucci I, de Bortoli N, Savarino E, Nacci A, Romeo SO, Bellini M, Savarino V, Fattori B, Marchi S. Optimal treatment of laryngopharyngeal reflux disease. Ther Adv Chronic Dis. 2013 Nov;4(6):287-301.
[12] Lechien JR. Pediatric Laryngopharyngeal Reflux: An Evidence-Based Review. Children (Basel). 2023 Mar 18;10(3):583.
[13] Lechien JR, Finck C, Huet K, Khalife M, Fourneau AF, Delvaux V, Piccaluga M, Harmegnies B, Saussez S. Impact of age on laryngopharyngeal reflux disease presentation: a multi-center prospective study. Eur Arch Otorhinolaryngol. 2017 Oct;274(10):3687-3696.