Laryngopharyngeal Reflux: Paradigms for Evaluation,Diagnosis,and Treatment

Abstract

Objectives:

Describe current otolaryngologic paradigms for diagnosis and treatment of laryngopharyngeal reflux (LPR) and analyze differences between laryngologists and non-laryngologists.

Methods:

American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) and American Bronchoesophageal Association (ABEA) members were invited to complete a 23-question online survey regarding evaluation, diagnosis, and treatment of LPR in 2012. Subgroup analysis was performed to identify differences between respondents who completed laryngology fellowships (LL) and those who did not (NL).

Results:

Of 159 respondents, 40 completed laryngology fellowships. NL respondents had been practicing longer than LL (19.6 vs. 11.4 years, P = 0.0001). Video-documentation of laryngopharyngeal exams was almost universal in the LL group (97% vs 38%, P < 0.0001); similarly, use of rigid (100%, P = 0.002) and flexible distal-chip technologies (94%, P = 0.004) were far more common in the LL group. Diagnostic criteria were otherwise similar between the groups, with symptoms of heartburn, globus, and throat clearing thought most suggestive of LPR. Adjunctive tests most commonly used were barium esophagram, dual-probe pH testing with impedance, and esophagoscopy, although most ordered no initial testing. NL used dual pH probe with impedance more often than LL (P = 0.004). LL were significantly more likely to perform transnasal esophagoscopy in their office (P < 0.0001), to prescribe twice-daily proton pump inhibitors with concurrent H2-blocker medication initially (P = 0.004), and to treat for longer than 4 weeks (P = 0.0003).

Conclusions:

Otolaryngologists are in broad agreement on symptoms and physical features of LPR; however, significant differences exist between laryngologists and non-laryngologists on the use of adjunctive testing and treatment strategy.