The relationship between symptoms of laryngopharyngeal reflux (LPR) and objective reflux measurements obtained through multichannel intraluminal impedance-pH (MII-pH) monitoring remains unclear. The aim of this study was to investigate the relationship between LPR symptoms and objective reflux episodes and possible associations between fibreoptic ENT findings, eosinophil counts, and serum IgE levels with reflux episodes detected by MII-pH. In this prospective study, MII-pH monitoring, fiberoptic laryngoscopy, nasal swabs for eosinophils, total serum IgE levels, and symptom assessment (Reflux Symptom Index, RSI) were performed in all children with suspected LPR. The Reflux Findings Score (RFS) was determined based on the laryngoscopy findings. A total of 113 patients (mean age, 8 years) with LPR symptoms were included in the study. The number of reflux episodes was highest in children with chronic cough and recurrent broncho-obstruction. Secondary outcomes showed positive correlations between reflux episodes and ENT findings, particularly hypopharyngeal hyperemia, arytenoid hyperemia, and arytenoid erythema ( < 0.01, < 0.001, and < 0.001, respectively). The number of total, acidic, and weakly acidic reflux episodes was significantly positively correlated with RSI and RFS. Proximal total, acidic, and weakly acidic reflux episodes showed significant correlations with eosinophil counts in nasal swabs but negative correlations with serum IgE levels. This study highlights the significant role of weakly acidic reflux in pediatric LPR and its association with respiratory symptoms. Our findings emphasize the importance of objective monitoring techniques in the assessment of LPR and provide insights for refining diagnostic and management strategies.