Sensitivity and specificity of reflux-attributed laryngeal lesions: experimental and clinical evidence.

In patients with signs and symptoms of laryngeal disorders, laryngoscopic examination and ambulatory pH monitoring often implicate gastroesophageal reflux disease (GERD). Experimental evidence highlights the importance of acidic reflux in laryngeal disorders. However, many patients with laryngeal signs that appear to be reflux related do not respond to aggressive acid suppression. This has resulted in controversy about the exact nature of the relation between GERD and ear, nose, and throat (ENT) signs and symptoms. Use of a combination of laryngoscopic examination and 24-hour ambulatory pH testing may improve the ability to identify those patients who would most benefit from acid suppression. Currently, however, these tests lack specificity, and the relationship remains unproved. This important task will require data from large-scale, randomized, controlled studies. Until we have determined these specific laryngeal signs from both a gastroenterology and an ENT perspective, we will be forced to use empiric therapy to identify those patients whose laryngeal signs and symptoms are due to GERD. Based on present data, we recommend aggressive acid suppression with twice-daily dosing of proton pump inhibitors for >or=4 months in these patients.