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Highlights
In Brief
Reflux Laryngitis is a voice disorder which results from irritation and swelling of parts of the voice box due to the backflow of stomach fluids into the voice box area or laryngopharyngeal reflux.
Stomach fluids contain acids and enzymes that help digest food in the stomach, but cause problems elsewhere in the food pipe [esophagus, throat, and voice box].
Frequent Complaints
People with reflux laryngitis do not always complain of heartburn, which is a typical complaint in backflow of stomach fluids to the esophagus causing inflammation in the esophagus or GERD/gastroesophageal reflux disease. Instead, they usually complain of hoarseness, frequent throat clearing, sensation of lump in the throat (globus pharyngeus), cough or sore throat.
Key Investigation Pathways
Physicians determine whether a voice disorder is backflow of stomach fluids to the voice box or laryngopharyngeal reflux by:
| Primary Investigation |
Part I. Inspection of the Voice Box
Test design: Office examination of the throat and voice box while the patient talks, sniffs, coughs
Instrument used: Special scope for the voice box that allows the physician to view the voice at work (rigid laryngoscope or flexible laryngoscope)
Looking for: Swelling, redness, signs of irritation of the voice box, increased mucous production |
Part II. Treatment Trial
Test design: Patient takes medicines which reduce stomach fluid backflow and/or acid level + "reflux precautions" diet and lifestyle changes
Looking for: Improvement of hoarseness and/or throat symptoms after sufficient time and dose of medicine + "reflux precautions" diet and lifestyle changes |
| Confirmatory Testing, if necessary |
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Key Confirmatory Test: Prolonged 2-site measurement of acid level or double-probe pH monitoring)
Test Design: Record the amount of acid throughout a usual-routine day for the patient sites monitored for acid level:
- Back of throat (hypopharynx)
- Within the food pipe (esophagus)
Instrument used: Double-probe pH monitor
Looking for: Abnormal levels of acid, number of times throughout the day wherein backflow of stomach acid occurs
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Overlapping Compliants
Patients with reflux laryngitis have complaints similar to other voice disorders, making it an easily missed voice disorder.
Role of Medical Treatment
First line of treatment for reflux laryngitis involves using medicines that reduce or neutralize stomach acid secretion, plus "reflux precautions" which involve dietary and lifestyle modifications.
Role of Surgery in Treatment
In most cases wherein reflux has been clearly demonstrated, surgical treatment is indicated when there is no improvement of the voice disorder, the voice box swelling and irritation, and/or throat pain despite adequate anti-reflux treatment and precautions, and other conditions causing voice dysfunction have been eliminated.
In some cases, surgery may be indicated earlier in the treatment management.
Elements of Successful Treatment
For treatment to be successful, the following are necessary:
- patient takes the proper amount of medicine
- patient takes the medicine regularly
- patient takes the medicine for the proper period of time
- patient follows physician advice to prevent backflow of stomach fluids ("reflux precautions")
- patient goes for follow-up check-ups with the physician
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