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Reflux Laryngitis: Highlights
Reflux laryngitis is a voice disorder that results from
irritation and swelling of parts of the voice box due to the
backflow of stomach fluids into the voice box area. This backflow is
called 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].
People with reflux laryngitis usually complain of hoarseness,
frequent throat clearing, sensation of lump in the throat (globus
pharyngeus), cough, or sore throat. These patients do not
commonly experience heartburn, which is a typical complaint in
backflow of stomach fluids to the esophagus causing inflammation in
the esophagus, also known as gastroesophageal reflux disease
(GERD).
Key Investigation Pathways
Physicians determine whether a voice disorder is backflow of
stomach fluids to the voice box or laryngopharyngeal reflux using
the methods in the table below.
| 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 |
| Confirmatory Testing, if necessary |
Key confirmatory test: Prolonged two-site
measurement of acid level or double-probe
pH monitoring)
Test design: Record the
amount of acid throughout a usual/routine day for acid level
in the following sites:
- 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 |
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. In addition,lifestyle modifications, termed
reflux precautions, are recommended.
Role of Surgery in Treatment
In most cases of clearly demonstrated reflux, 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 patient must do the
following:
- Take the proper amount of medicine
- Take the medicine regularly
- Take the medicine for the proper period of time
- Follow physician advice to prevent backflow of stomach fluids
(reflux
precautions)
- Go for follow-up check-ups with the physician
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