otohns.net Conference Coverage AAO-HNSF & OTO Expo 2000

otohns.net Conference Coverage
Annual Meeting of the AAO-HNSF and Oto Expo
Washington, D.C - 2000

"Reflux"
Dr. Blake Simpson with otohns.net Laryngology Advisory Board Member, Albert Merati, MD
Audio/Video Link
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Dr. Blake Simpson: "Al, I want to ask you a little bit about gastroesophageal reflux disease (GERD) or what a lot of people are now terming laryngopharyngeal reflux disease (LPR). What kind of symptoms are your patients coming in with? What are they typically presenting with when you're giving the diagnosis of laryngopharyngeal reflux?"

Dr. Albert Merati: "In a laryngology practice, it's a bit skewed but the basic otolaryngologic symptoms are very common. Probably the most common is throat clearing, cough, and what we used to call globus hystericus - which is not a great term - but rather globus pharyngeus is probably a better term, and hoarseness. It's been well shown in our literature that these symptoms can be highly correlated with the presence of reflux. The greatest lesson, I think, that we can share with people who don't see as much of this is not to call it "atypical reflux" but because it's so common, it's really not atypical, it's typical. It's supraesophageal manifestations of reflux."

Dr. Blake Simpson: "Are there any clues on physical examination that you can use in determining when you suspect somebody might have laryngopharyngeal reflux?"

Dr. Albert Merati: "The ones that most people are familiar with are pretty tried and true, posterior laryngitis with a relatively normal looking anterior larynx and pharynx, interarytenoid irregularity, what Dr. Kaufman calls the sort of the double fold."

Dr. Blake Simpson: “Pseudo-sulcus.”

Dr. Albert Merati: "Pseudo-sulcus, in terms of just inferior to the cord, seeing a second fullness or some other subtle signs. Dr. Hanson from Northwestern has recently showed a nice study that these are objectively demonstrateable using some video techniques. Am I really seeing red in the larynx? Yes, you are, and it is real, it is a describable, and follow-able physical exam finding throughout treatment."

Dr. Blake Simpson: "Do you treat most of your patients empirically for laryngopharyngeal reflux? In other words, if you suspect it, do you treat them with either H2 blockers or proton pump inhibitors, and secondly, if they don't respond, do you get a PH probe?"

Dr. Albert Merati: "That's a good question - it often depends on where the patient has come from. Many times they've come from a gastroenterologist and it depends on the prior work-up; some seen in de-novo and therefore futher testing depends on a higher level suspicion for carcinoma or other problems.”