Laryngopharyngeal Reflux

5.3.1 List the common symptoms of laryngopharyngeal reflux (LPR).

5.3.2 Describe laryngoscopy findings in LPR. What is sandifer syndrome? 

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5.3.3 What is laryngeal pseudosulcus? What is the significance of this finding? How does it differ from sulcus vergeture?

http://portal.entnet.org/images/COCLIA/2011-2012%20updates/COCLIA%20Media/Laryngopharyngeal%20Reflux/Laryngopharyngeal%20Reflux-Q3-080710_005.jpg

Belafsky PC, Postma GN, Koufman JA. The association between laryngeal pseudosulcus and laryngopharyngeal reflux. Otolaryngol Head Neck Surg. 2002 Jun;126(6):649-52. PMID:12087332

5.3.4 Discuss the role of objective tests in the diagnosis of LPR.

McMurray JS, et al. Role of laryngoscopy, dual pH probe monitoring, and laryngeal mucosal biopsy in the diagnosis of pharyngoesophageal reflux. Ann Otol Rhinol Laryngol. 2001 Apr;110(4):299-304. PMID:11307903

Kwon YS, Oelschlager BK, Merati AL. Evaluation and treatment of laryngopharyngeal reflux symptoms. Thorac Surg Clin. 2011 Nov;21(4):477-87. PMID:22040630

5.3.5 What behavior and lifestyle modifications are recommended in the medical treatment of LPR?

5.3.6 What is the difference between H2 blockers vs. PPI? Which would you prescribe for LPR? PPI should be prescribed at what frequency? What is the evidence for this practice?

5.3.7 Describe your approach to the medical therapy of LPR. How much and how long? Explain persistent symptoms in patients on maximal medical therapy.

Kwon YS, Oelschlager BK, Merati AL. Evaluation and treatment of laryngopharyngeal reflux symptoms. Thorac Surg Clin. 2011 Nov;21(4):477-87. PMID:22040630

5.3.8 Discuss sequelae of chronic LPR.

Maronian NC, Azadeh H, Waugh P, Hillel A. Association of laryngopharyngeal reflux disease and subglottic stenosis. Ann Otol Rhinol Laryngol. 2001 Jul;110(7 Pt 1):606-12. PMID:11465817

Sataloff RT. Gastroesophageal reflux-related chronic laryngitis. Commentary. Arch Otolaryngol Head Neck Surg. 2010 Sep;136(9):914-5. PMID:20855686

5.3.9 Any data on laryngeal cancer and LPR?

Tae K, Jin BJ, Ji YB, Jeong JH, Cho SH, Lee SH. The role of laryngopharyngeal reflux as a risk factor in laryngeal cancer: a preliminary report. Clin Exp Otorhinolaryngol. 2011 Jun;4(2):101-Epub 2011 May 31. PMID:21716948

5.3.10 When should patients be referred for surgery? What procedures are available to treat LPR/GERD?

van der Westhuizen L. et al. Impact of Nissen fundoplication on laryngopharyngeal reflux symptoms. Am Surg. 2011 Jul;77(7):878-82. PMID:21944351

5.3.11 Discuss pediatric manifestations of reflux.

Matthews BL, Little JP, Mcguirt WF Jr, Koufman JA. Reflux in infants with laryngomalacia: results of 24-hour double-probe pH monitoring. Otolaryngol Head Neck Surg. 1999 Jun;120(6):860-4. PMID:10352440