Treatment of Reflux Laryngitis
How is reflux laryngitis treated?
There are two main methods of treating voice disorder from stomach fluid backflow (reflux laryngitis), both of which depend on an accurate identification of the cause of backflow.
- Decrease production and secretion of stomach acid with medicine
- Improve the barrier function of the lower food pipe sphincter (lower esophageal sphincter, LES) through surgery
Current Clinical Recommendation
Effective medical treatment of voice disorders from backflow of
stomach fluid (reflux laryngitis) involves medicines that decrease
stomach acid production . These medicines, called proton pump inhibitors or PPIs, are taken twice daily from three to six months.
Expectation from Effective Treatment
- Improvement of voice disorder
- Improvement of associated complaints (e.g., frequent throat clearing, sensation of lump in throat)
- Improvement in surface appearance of voice box and throat:
- Decreased swelling in throat and voice box
- Decreased redness in throat and voice box
- Decreased mucus production
 Key Information
Some physicians prescribe medications in addition to proton pump
inhibitors (PPIs) to increase the power of a treatment plan. Antacids, H2 blockers, and pro-kinetic (motility-promoting) drugs are all used to varying degrees.
Evaluation of Medical Treatment
After three to six months, the response to medical therapy is checked.
"No-meds" trial: After a period of success on medications,
they are decreased to determine whether the body can suppress the
backflow (reflux) on its own. The outcome of this "test" will influence
the type of further treatment you receive.
- No more backflow: In some patients symptoms
will not return after discontinuing or decreasing medication (proton
pump inhibitors). This has been observed most often in mild cases of
reflux laryngitis.
- Return of backflow after months or years: In some patients the voice disorder and accompanying complaints return.
These patients are placed on another round of proton pump inhibitors.
- Immediate return of voice disorder: Other patients experience an immediate return of the voice disorder as
soon as medications are stopped. In these cases, long-term treatment
with PPIs may be necessary to keep symptoms in check.
Key Information
Fortunately, current studies of patients on high dose PPI therapy
suggest that PPIs can be taken safely by many patients for long periods
of time (such patients show no ill effects even after 10 years), and
PPIs appear to be quite successful at controlling symptoms over the
course of many years.
If Treatment Not Successful
If the three-to-six month treatment trial is not successful, the
patient is re-evaluated. Possible explanations for treatment failure
are given below.
- The cause of the voice disorder may not be due to backflow of stomach fluids as originally suspected.
- There
may be multiple causes for the patient's voice disorder; all will need
to all be identified and managed for meaningful improvement in voice
function.
- The patient has a particularly "tough case" of
reflux which needs a "stepped-up" treatment strategy, which usually
involves two steps:
- Dosage of PPIs are increased or different PPIs are tried until an effective medial treatment regimen is found
- Surgical
treatment is performed to reinforce the lower esophageal sphincter
(LES) to make it function effectively as the main barrier against
backflow of stomach fluid (reflux).
Key Information
Surgery Versus Lifetime Medical Treatment
Surgery
is most likely recommended for younger patients who would need to take
PPIs for the remainder of their lives to counteract reflux laryngitis
or who find the lifestyle changes associated with PPI treatment to be
too demanding.
Current Most Effective Surgical Procedure: Nissen fundoplication
Currently, the most effective surgical treatment for backflow of stomach fluid (reflux) is the Nissen Fundoplication.
Briefly, this surgery tightens the lower food pipe sphincter (lower
esophageal sphincter, LES) so it can perform better as a barrier to
stomach fluid backflow.
Minimally Invasive Surgery
Nissen fundoplication can now be performed through several small holes in the abdomen (laparoscopically) or through a tube inserted down the throat (endoscopically)
– rather than the traditional method of operating through an open
incision in the abdomen. Postsurgical recovery is much faster with
these minimally invasive techniques.
Key Information
- Note: Despite proven success in treating GERD, no conclusive studies have yet
been reported to quantify the success of using fundoplication surgery
to treat stomach fluid backflow to the voice box (laryngopharyngeal reflux, LPR).
- Theoretically
at least, if less acid is able to backflow into the esophagus, less is
then able to travel beyond the upper esophageal sphincter (UES) and
into the voice box (larynx).
- More
studies must be completed to judge the long-term success and
complications of fundiplication for patients with voice disorders due
to stomach fluid backflow.
 Red Flag
Possible Multiple Causes When Patients Do Not Respond to Medical or Surgical Treatment for Reflux
When
both medical and surgical treatments for stomach fluid backflow
(reflux) do not improve the voice disorder and associated complaints –
despite all tests confirming that stomach fluid backflow does occur –
an additional cause of the persisting voice disorder might be present
and must also be investigated and treated.
These many-cause voice disorders (multifactorial voice disorders) contribute to the challenges in the investigation and treatment of voice disorders.
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