Is it always Laryngopharyngeal Reflux? How Voice Disorders Can Manifest as LPR

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Abstract

Introduction. Laryngopharyngeal reflux (LPR) manifests with a constellation of common throat symptoms and inconclusive signs on laryngoscopic exam. It is a diagnosis, often made clinically, that can lead to prescriptions of proton pump inhibitors that are unnecessary and potentially harmful. Glottic insufficiency (GI) and the accompanying hyperfunctional laryngeal behaviors can also present with similar, common throat complaints that may or may not include a qualitative change to the voice.

Methods. This is a reflection article. It is written to summarize, explain, and support with evidence the opinion of the author on the topic of how symptoms of voice disorders can easily be mistaken for symptoms of LPR. The offered reflection is based on his experience, research and the available literature.

Reflection. This article intends to explore the similarities between GI and LPR, how to ultimately differentiate them and how to approach treatment with a broader differential diagnosis.

Conclusion. LPR and GI can present with identical, vague throat, and voice symptoms. Empiric medication trials, behavioral interventions and objective laryngovideostroboscopy, impedance-based reflux, and esophageal motility testing may all be needed, sometimes in a trial and error fashion, to correctly diagnose and treat a patient’s symptoms.

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Authors

Thomas L. Carroll Department of Otolaryngology-Head and Neck Surgery; Harvard Medical School; Boston; Massachusetts; United States. / Division of Otolaryngology; Department of Surgery; Brigham and Women's Hospital; Boston; Massachusetts; United States

https://orcid.org/0000-0001-5666-2482

Keywords

Laryngopharyngeal reflux

otolaryngology

proton pump inhibitors

alginates

vocal fold augmentation

glottic insufficiency

vocal fold injection

injection laryngoplasty

unilateral vocal fold paralysis

References

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Carroll TL. Is it always Laryngopharyngeal Reflux? How Voice Disorders Can Manifest as LPR. Rev. Investig. Innov. Cienc. Salud [Internet]. 2023 Nov. 30 [cited 2024 Nov. 8];5(2):243-5. Available from: https://riics.info/index.php/RCMC/article/view/262