Laryngopharyngeal reflux current developments and therapeutic strategies

Laryngopharyngeal reflux (LPR) is reflux of gastric contents proximal to the upper esophageal sphincter and leading to a variety of symptoms including cough, dysphonia, globus, and sore throat. There is currently no diagnostic gold standard for LPR which often leads to over or under diagnosis and complicates therapeutic approach to this group of patients. This uncertainty has led to a high economic burden of the disease. The goal of this review was to present current recommendations in the diagnosis and treatment of LPR to aid in clinical decision making. There has been emerging research regarding the role of laryngeal hypersensitivity, mediated through neuronal hyperresponsiveness, autonomic dysfunction and symptom hypervigilance. Diagnosis remains a challenge, but novel biomarkers show promise. Therapeutics involve the consideration of acid suppression with an increasing emphasis on neuromodulators and external compression devices. There remains a great need for further research on both diagnostic and therapeutics to develop a gold standard for this disease.