Survey of current perspectives on laryngopharyngeal reflux among Canadian otolaryngologists.

OBJECTIVE

Laryngopharyngeal reflux (LPR) -- gastroesophageal reflux above the upper esophageal sphincter -- is a common problem encountered by otolaryngologists. Despite consensus guidelines, the presentation, diagnosis, and treatment remain controversial. We surveyed Canadian otolaryngologists to assess current perspectives.

METHODS

Web-based questionnaires were e-mailed to 135 otolaryngologists. Respondents were categorized by subspecialty as head and neck (H&N) or non-H&N (rhinology, otology, laryngology, facial plastics, general and pediatric otolaryngology). Data were analyzed to determine differences in proportions between groups.

RESULTS

The response rate was 48 of 135 otolaryngologists. Symptoms considered to be strongly or moderately associated with LPR included globus sensation, excessive throat clearing, sore or burning throat, hoarseness, chronic cough, and dysphonia. The laryngoscopic signs considered strongly associated with LPR were edema, intra-arytenoid changes, and granulomata. The majority of otolaryngologists in both the H&N (12 of 15) and non-H&N groups (27 of 32) use flexible laryngoscopy for investigation and diagnosis of LPR. Proton pump inhibitors in addition to lifestyle modifications are recommended by both groups as first- and second-line therapy for an initial course of 6 to 12 weeks, with long-term therapy extended for 4 to 12 months.

CONCLUSIONS

Canadian otolaryngologists do correlate specific signs and symptoms with LPR patients. This is consistent across subspecialties within the field. Flexible fibre-optic laryngoscopy is the preferred diagnostic tool. Although evidence based on randomized controlled trials has yet to demonstrate a reproducible, statistically significant improvement in LPR from medical therapy, first-line pharmacologic treatment (in addition to lifestyle changes) is generally provided as a proton pump inhibitor, with the duration of therapy being somewhat variable and less than that recommended by the current literature.