Otolaryngologic Manifestations of GERD

What Are They?

These manifestations of GERD can result from reflux of gastric contents with subsequent contact injury of the pharynx and larynx. The most common site is the larynx. Several reports on documented gastric reflux to the upper esophagus or pharynx (back of the throat) in patients with these conditions have found that what is interesting is a lot of these patients will often have minimal esophageal symptoms, such as heartburn, and usually these patients do not have any endoscopic evidence of inflammation (esophagitis).

 

Laryngitis, or hoarseness of voice - substantial evidence suggests a relationship between acid reflux and laryngitis, including contact ulceration and even small granuloma formation on the vocal cords. Affected patients complain of chronic hoarseness, cough, a feeling of a lump in the throat (globus sensation), frequent throat clearing, or sore throat, without identifiable allergic or infectious causes.

 

Treatment

Anti-secretory therapy for gastroesophageal reflux disease (GERD) with lifestyle modification is important as well as proton pump inhibitors, such as Prilosec, Prevacid, Aciphex, Nexium, Protonix. Note that it is very important that these medications be taken 30 minutes before breakfast and supper. It will take anywhere from six to eight weeks before one sees an objective response.

 

Laryngeal and tracheal stenosis – the most common cause of these stenoses in adults is prolonged endotracheal intubation when a patient is on a ventilator. But this can also happen in patients who have reflux of gastric contents in the back of the throat. These patients will present with difficulty breathing. This is treated as one treats gastroesophageal reflux disease (GERD).

 

Laryngeal cancer is the worst potential risk of reflux laryngitis. It is the development of squamous cell cancer of the larynx. The larynx is the most common site of head-and-neck squamous cell carcinoma, accounting for 26 percent of cases. The overwhelming majority of these cases can be linked to cigarette smoking. Excessive alcohol consumption may be a potential factor.

 

Reflux laryngitis also has been invoked as a pathogenesis of some causes of laryngeal cancer. A report in 1983 described cases of this. Subsequently two series described a total of about 40 patients who were lifetime non-smokers but had chronic reflux and developed laryngeal squamous cell cancer.

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