Laryngopharyngeal Reflux and Voice Disorders: An Overview on Disease Mechanisms, Treatments, and Research Advances

It may take several months for this to happen. Attempts to improve vocal hygiene should be undertaken. The person should drink plenty of liquids to prevent a dry throat. Caffeine, alcohol, antihistamines, and menthol containing cough drops all have a drying effect and should be avoided.

Laryngopharyngeal reflux is defined as the reflux of gastric content into larynx and pharynx. A large number of data suggest the growing prevalence of laryngopharyngeal symptoms in patients with gastroesophageal reflux disease. However, laryngopharyngeal reflux is a multifactorial syndrome and gastroesophageal reflux disease is not the only cause involved in its pathogenesis. Current critical issues in diagnosing laryngopharyngeal reflux are many nonspecific laryngeal symptoms and signs, and poor sensitivity and specificity of all currently available diagnostic tests. Although it is a pragmatic clinical strategy to start with empiric trials of proton pump inhibitors, many patients with suspected laryngopharyngeal reflux have persistent symptoms despite maximal acid suppression therapy.

Consequently, individuals who engage in singing as a primary professional activity, frequently display higher reflux symptom scores [2, 3, 7, 8]. In addition to the actions of the LES, a wide range of other physiological processes relating to gastrointestinal function may be affected, potentially resulting in hyperacidity and esophageal dysmotility [6]. Performance-related stress and anxiety exert a disproportionate effect on singers [9-13]. Additionally, external influences such as irregular eating habits (e.g., eating late at night or following rehearsals or performances), or inconsistent sleep schedules, may further exacerbate these underlying vulnerabilities, potentially placing singers at increased risk for LPR. The diagnostic work-up of patients presenting with symptoms of laryngopharyngeal reflux begins with a thorough history and a meticulous physical examination.

Although these symptoms were previously thought to constitute the spectrum of GERD, laryngopharyngeal reflux (LPR) is today thought to be a distinct entity and should be managed differently. When reflux disease involves the larynx or pharynx, it is referred to as laryngopharyngeal reflux (LPR) or extraesophageal reflux, rather than gastroesophageal reflux disease (GERD).

lpr acid reflux vocal

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Objective voice analysis quantifies voice quality, pulmonary function, valvular efficiency of the vocal folds, and harmonic spectral characteristics. The neuromuscular function can be measured by laryngeal electromyography (EMG). These aspects of the physical examination and tests of voice function are discussed elsewhere (Sataloff, 2005). LPR has been associated with numerous laryngeal conditions, including muscle tension dysphonia, Reinke’s edema, globus pharyngeus, laryngeal hyperirritability, laryngospasm, delayed wound healing, posterior laryngitis, diffuse laryngitis, laryngeal pyogenic granuloma, glottic and subglottic stenosis, cricoarytenoid joint ankylosis, carcinoma, and other conditions (Sataloff et al., 2006a; Chen et al., 1998).

Diet and lifestyle modifications are effective interventions for GERD, despite the fact that few robust data have been published (Table 1) [De Groot et al. 2009; Kaltenbach et al. 2006]. According to treatment used in a UK district general hospital, dietary and behavior modification has also been supposed to be very effective in the management of LPR [Pearson et al. 2011]. First agreement analysis and day-to-day comparison of pharyngeal pH monitoring with pH/impedance monitoring in patients with suspected laryngopharyngeal reflux. 38.

Weight loss, smoking cessation, alcohol avoidance, meal habit modifications, and head elevation during sleep need to be strongly suggested to patients. As to the medical therapy, currently, the treatment is focused on increasing the pH of the refluxate, thus it is recommended to start with PPIs twice daily for a period of 8-12 weeks.

EMPIRIC THERAPY AND ADDITIONAL STUDIES

The stomach lining is designed to cope with these juices but sometimes they travel upwards from the stomach into the gullet (oesophagus) which was not designed to accommodate powerful digestive juices and the oesphageal lining becomes irritated causing symptoms of indigestion (heartburn). This process is referred to as gastro-oesophageal reflux (GOR). Despite many articles exploring signs and symptoms of reflux including those cited above and other recent literature (Close, 2002; Tauber et al., 2002; Vaezi, 2002; Book et al., 2002; Branski et al., 2002; Noordzi and Khidr, 2002; Marambaia et al., 2002; Siupsinskiene and Adamonis, 2003; Vaezi, 2003; Issing, 2003; Maronian et al., 2003; Burati et al., 2003; Wang et al., 2004; Ahmad and Batch, 2004; Grillo et al., 2004; Hill et al., 2004), evidence confirming the diagnostic significance of various complaints and findings is scarce and contradictory. This problem is due to various problems including the lack of a standard definition of “normal” in populations being studied.

lpr acid reflux vocal
lpr acid reflux vocal

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