Reflux Laryngitis (cont.)
John P. Cunha, DO, FACOEP
John P. Cunha, DO, FACOEP
John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.
In this Article
What types of medications are used to treat reflux?
There are several different types of medications available over the counter (OTC) or by prescription. The acid-blocking drugs [famotidine (Pepcid), cimetidine (Tagamet), nizatidine (Axid), ranitidine (Zantac)] are known as H2-blockers. These are available without a prescription. However, their strength may be inadequate.
If conservative therapy and medical therapy fail, surgery may be necessary. Traditionally, the fundoplication procedure, which serves to strengthen the muscular valve (lower esophageal sphincter), required significant surgical work and hospital stay. Recently, the surgery has been performed using a viewing tube instrument (endoscopic fundoplication). This has shortened both hospital stay and recovery.
What are the difficulties in diagnosing reflux laryngitis?
In some patients it appears clear that the laryngeal symptoms - hoarseness, cough, sore throat - are due to reflux, for example, in patients with marked heartburn and regurgitation of acid.
In most patients with laryngeal symptoms - those with milder heartburn and no regurgitation who comprise the majority of patients in whom reflux laryngitis is considered - it is not as clear. Examination of the larynx may reveal redness and swelling, but these signs can be caused by many diseases of the larynx as well as reflux.
There are difficulties with using symptoms to diagnose reflux. For example, cough may occur when there is reflux into the esophagus. Refluxed liquid does not need to reach the larynx. There are no well-accepted acid tests to demonstrate that acid is reaching the larynx.
Finally, it is unclear whether or not refluxed liquid from the stomach that is not acid can cause reflux laryngitis, and there is no way of testing whether or not non-acid liquid is reaching the larynx. Many physicians use a trial of potent acid-suppression with PPIs to try to prove that acid reflux is the cause of the laryngeal symptoms. The problem with a trial of PPIs is that some symptoms such as cough and throat clearing can be caused by habit, and the PPIs may have a placebo effect. Thus, a response to PPIs may not be proof that reflux is the cause of symptoms.
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