Laryngeal complications of GERD.

Anatomic proximity of the larynx and hypopharynx make these structures particularly susceptible to acid and bile exposure due to gastroesophageal reflux disease (GERD). There is an increasingly expansive list of signs and symptoms that can occur on the larynx and upper airway as a consequence of GERD. A high index of suspicion must be maintained to property diagnose and manage the laryngeal complications of GERD. Reflux of gastric contents into the laryngopharynx is best demonstrated by a dual- or triple-sensor pH probe study. Alternatively, an empiric trial of proton pump therapy as a diagnostic test has sensitivity/specificity that is comparable to pH studies. This approach provides both diagnostic and therapeutic advantage. Following improvement of symptoms, reduction of the medication should be attempted, with the target of either withdrawing therapy or using the lowest dose to control symptoms. Surgical intervention for laryngeal complications is predictably better in patients who have responded to proton pump inhibitor (PPI) therapy.