Reflux laryngitis produces: [PGI Dee 10)
a. There are lots of controversies regarding the reflux laryngitis secondary to reflux gastrointestinal disease. But now some studies document that there is a clear relation between the two.
b. Reflux laryngitis may have the following sequlae: - Bronchospasm
- Chemical pneumonitis
- Refractory subglottic stenosis
- Refractory contact ulcer
Peptic laryngeal granuloma
- Acid laryngitis (Heart burn, burning pharyngeal discomfort, nocturnal chocking due to interarytenoid pachydermia)
- Laryngeal Carcinoma (According to recent reports laryngeal reflux is the cause of laryngeal carcinoma in patients who are life time non-smokers).
Here classical GERD symptoms are absent. Patients have more of daytime/upright reflux without the nocturnal/supine reflux of GERD.ln laryngopharyngeal reflux esophageal motility and lower esophageal sphincter is normal, while upper esophageal sphincter is abnormal. The traditional diagnostic tests for GERD are not useful in LPR.
Symptom Chronic or Intermittent dysphonia, vocal strain, foreign body sensation, excessive throat mucus, Postnasal discharge and cough. Laryngeal findings: Interarytenoid bunching, Posterior laryngitis and subglottic edema (Pseudosulcus)
Sequelae of Laryngopharyngeal Reflux
- Subglottic stenosis
- Carcinoma larynx
- Contact ulcer/granuloma
- Cricoarytenoid joint fixity
- Vocal nodule/polyp
- Sudden infant deaths
- Laryngomalacia (Association)
Treatment is in similar lines as GERD, but we need to give proton pump inhibitors at a higher dose and for a longer duration (at least 6-8 months).