Laryngitis

Michael F. Vaezi, MD, PhD, MSC(EPI)
Vanderbilt University Medical Center, Nashville, TN

Definition/Key Clinical Features
Best Tests
Best Therapy
Best References


Definition/Key Clinical Features

• May be caused by gastroesophageal reflux disease (GERD)
• Two laryngeal findings may be specific for GERD-induced laryngeal injury
• Vocal cord lesions
• Arytenoid medial wall erythema and edema
• Many normal subjects have at least one abnormal finding in the larynx
• Often called reflux laryngitis or laryngopharyngeal reflux
• Range of symptoms
• Hoarseness
• Throat clearing
• Dysphagia
• Increased phlegm
• Globus sensation

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Best Tests

• No consensus on diagnostic procedures
• No reliable method to prove that laryngeal signs and symptoms result from GERD
• 24-hour esophageal pH monitoring can be used
• Half of patients with laryngoscopic signs of GERD have abnormal esophageal acid exposure
• May reflect overdiagnosis of GERD as the cause of laryngeal pathology
• May reflect lack of sensitivity of the pH probes in diagnosing acid-related disease

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Best Therapy*

• Lack of consensus on current treatment protocol
• Open-label studies suggest proton pump inhibitor (PPI) as first line of therapy
• PPI b.i.d. for 2 to 3 mo
• Taper to q.d.
• Consider H2 blocker or p.r.n. PPI
• If PPI ineffective, perform 24 hr pH/impedance study on medication
• If normal results, reflux unlikely to be cause of symptoms
• Evaluate for another cause
• If abnormal results, intensify antireflux therapy
• Conduct studies off therapy to confirm abnormal acid reflux for possible laparoscopic fundoplication

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Best References

Ormseth EJ, Wong RK. Reflux laryngitis: pathophysiology, diagnosis, and management. Am J Gastroenterol 1999;94:2812. [PMID 10520826]

Qadeer MA, Phillips CO, Lopez AR, et al. Proton pump inhibitor therapy for suspected GERD-related chronic laryngitis: a meta-analysis of randomized controlled trials. Am J Gastroenterol 2006;101:2646. [PMID 17037995]

The author has received research funding from AstraZeneca, TAP Pharmaceutical Products Inc., and Respiratory Technology Corporation; participates in the speaker’s bureau of AstraZeneca and TAP Pharmaceutical Products Inc.; and is a consultant for AstraZeneca and Santarus, Inc.

* To obtain additional drug information, click on the DrugInfo tab in the left column, or click on the following link: http://search.medscape.com/drug-reference-search?queryText=

February 2011