Reflux Laryngitis (cont.)

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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.

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.

Medically reviewed by Martin E Zipser, MD; American Board of Surgery

REFERENCE: Reflux Laryngitis

Medically Reviewed by a Doctor on 4/14/2015

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