Laryngology
Reflux Laryngitis (LPR)
ENT presentations of laryngopharyngeal reflux, diagnostic algorithm, and treatment options.
What is reflux laryngitis (LPR) and how is it recognised?
Laryngopharyngeal reflux (LPR) is the back-flow of gastric contents (acid + pepsin) past the oesophagus to the larynx. It differs from classic gastroesophageal reflux (GERD) — instead of heartburn, the typical features are globus sensation, chronic cough, morning hoarseness, frequent throat clearing, and postnasal drip sensation. Diagnosis combines clinical suspicion + RFS (Reflux Finding Score) + RSI (Reflux Symptom Index); 24-hour pH-impedance monitoring is added if needed. Treatment: PPI (proton pump inhibitor) for 8–12 weeks + lifestyle modification (no late dinner, head elevation, weight loss, trigger-food elimination). H2-blockers, alginates, and rarely anti-reflux surgery (Nissen fundoplication) are options for refractory cases.
Lifestyle modification — the foundation of treatment
PPI alone is not enough; without lifestyle modification, recurrence exceeds 50%. Core rules: finish eating at least 3 hours before bed; raise the head 15–20 cm (raise the head of the bed itself, not just a wedge pillow); lose weight (BMI <25); stop smoking; limit alcohol and caffeine; eliminate trigger foods (spicy, acidic, chocolate, mint products, onion, garlic).
Trigger foods vary by individual; a 2–3 week food diary reveals which foods provoke symptoms.
Frequently Asked Questions
- Safe for most. Long-term use has been associated with small effects on bone density, B12 absorption, and gut flora; a "step-down" approach (to the lowest effective dose) is preferred after 12 months.
- First check adherence: PPI should be taken once daily on empty stomach (30 min before breakfast). Twice-daily dosing or a different PPI class is tried; for refractory cases, 24-hour pH-impedance monitoring + anti-reflux surgery if indicated.
- Untreated LPR leaves cords oedematous and granulomatous; chronic cases raise risk of subglottic stenosis or laryngeal cancer. Early treatment prevents permanent damage.
- Reflux is not only from obesity; hiatal hernia, lax lower oesophageal sphincter, and gastric motility disorders all cause it. Endoscopy clarifies diagnosis.
- Yes. In children, LPR may present as recurrent otitis media, chronic cough, hoarseness, or feeding difficulty. Joint paediatric-gastroenterologist + ENT evaluation.
References
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