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Laryngopharyngeal reflux

Laryngopharyngeal reflux is caused due to retrograde flow of gastric contents into laryngopharynx.

This condition is related to GERD (Gastric oesophageal reflux disease).  In fact it is a common extra oesophageal manifestation of GERD.

Clinical manifestations:

  • Voice change
  • Excessive throat clearing
  • Copious amount of mucous
  • Feeling of lump in the throat
  • Difficulty in swallowing
  • Heart  burn
  • Chronic cough
  • Vague discomfort in the throat

To help in the diagnosis of laryngopharyngeal reflux two score charts have been devised:

1. Reflux symptom index

2. Reflux finding score.

Reflux symptom index:  Suspected patients are given a questionnaire to answer.  It contains about 9 questions.  Patient is supposed to award scores according to their symptoms.

Reflux symptom index chart:

Within last month how did the following problems affect you ?

1. Hoarseness of voice / voice problems :  scores 0 - 5.  0 = No problem  5 = severe problem

2. Clearing your throat:  Scores 0 - 5

3. Excess throat mucous / post nasal drip: scores 0 - 5

4. Difficulty in swallowing food / liquids / pills: scores 0-5

5. Cough after eating / lying down: scores 0-5

6. Breathing difficulty / choking: scores 0-5

7. Annoying cough: Scores 0-5

8. Sticky sensation in throat / lump in throat: Scores 0-5

9. Heart burn / chest pain: scores 0-5

Reflux symptom index score of more than 13 indicates laryngopharyngeal reflux.

Reflux finding score:

This scoring is prepared by the surgeon after performing a laryngeal examination. 

1. Subglottic oedema: 0 - absent, 2 - present.

2. Ventricular obliteration: 2 - partial, 4 - complete

3. Erythema / Hyperemia: 2 - arytenoids involved, 4 - diffuse

4. Vocal fold oedema: 1 - mild, 2 - moderate, 3 - severe, 4 - polypoidal

5. Diffuse laryngeal oedema: 1 - mild, 2 - moderate, 3 - severe, 4 - obstruction

6. Posterior commissure hypertrophy: 1 - mild, 2 - moderate, 3 - severe and 4 - obstruction.

7. Granuloma / Granulation: 0 - absent, 2 - present

8. Thick mucous: 0 - absent, 2 - present.

A score of 7 indicates possible presence of laryngopharyngeal reflux.

Pepsin Immunoassay:

Detection of pepsin in the throat sputum of patients indicates the presence of laryngopharyngeal reflux.

It is 100% sensitive, and 90% specific.

Management:

1. Cessation of smoking

2. Decreased fat intake

3. Avoiding going to bed within three hours after eating

4. Elevation of head during sleep