Munevver Celik1, Ibrahim Ercan. 1. Department of Neurology, Sisli Etfal Education and Research Hospital, Istanbul, Turkey. fmclk@yahoo.com
Abstract
PURPOSE OF REVIEW: Recent publications have seemed to clarify the controversies that existed in the diagnosis of laryngopharyngeal reflux and have shed light on the therapy. The present article reviews recent publications in the diagnosis and management of laryngopharyngeal reflux. RECENT FINDINGS: In laryngopharyngeal reflux, laryngeal pathology results from small amounts of acid causing damage to laryngeal tissues and producing localized symptoms. None of these symptoms is pathognomonic. The new outcome assessment tool, the quality-of-life instrument, provides a self-assessment tool. Detection of pepsin in throat sputum by immunoassay provides a sensitive method to detect laryngopharyngeal reflux, although further evaluation is needed. A meta-analysis of upper-probe measurements has clarified that acid exposure time is very reliable in differentiating normal subjects from patients with laryngopharyngeal reflux. Long-term aggressive acid suppression with proton-pump inhibitors is necessary to treat laryngopharyngeal reflux. Pre-therapy abnormalities of the arytenoids and vocal cords appear to be associated with better symptom response. SUMMARY: Recent studies have revealed useful information on the diagnosis of laryngopharyngeal reflux, although further clarification is needed. Treatment protocols should be further evaluated by double-blinded, placebo-controlled multidisciplinary studies.
PURPOSE OF REVIEW: Recent publications have seemed to clarify the controversies that existed in the diagnosis of laryngopharyngeal reflux and have shed light on the therapy. The present article reviews recent publications in the diagnosis and management of laryngopharyngeal reflux. RECENT FINDINGS: In laryngopharyngeal reflux, laryngeal pathology results from small amounts of acid causing damage to laryngeal tissues and producing localized symptoms. None of these symptoms is pathognomonic. The new outcome assessment tool, the quality-of-life instrument, provides a self-assessment tool. Detection of pepsin in throat sputum by immunoassay provides a sensitive method to detect laryngopharyngeal reflux, although further evaluation is needed. A meta-analysis of upper-probe measurements has clarified that acid exposure time is very reliable in differentiating normal subjects from patients with laryngopharyngeal reflux. Long-term aggressive acid suppression with proton-pump inhibitors is necessary to treat laryngopharyngeal reflux. Pre-therapy abnormalities of the arytenoids and vocal cords appear to be associated with better symptom response. SUMMARY: Recent studies have revealed useful information on the diagnosis of laryngopharyngeal reflux, although further clarification is needed. Treatment protocols should be further evaluated by double-blinded, placebo-controlled multidisciplinary studies.