Otolaryngologic Manifestations of Gastroesophageal Reflux

Gastroesophageal reflux disease (GERD) is a common problem that has been linked to multiple extraesophageal manifestations relevant to the otolaryngologist. Finding evidence for a causal relationship between reflux and manifestations of otolaryngologic disease is often difficult, however, due in part to the non-specific nature of extraesophageal symptoms and the lack of pathognomonic endoscopic or laryngoscopic signs. This poses an even greater challenge in pediatrics given the inherent unreliability when obtaining subjectively reported data from younger aged children. Numerous studies have drawn a correlation between GERD and specific extraesophageal symptoms such as otitis media, sinusitis, chronic cough, and various laryngeal findings; however, determining a clear causative relationship has proven to be much more difficult. Further studies must be done to elucidate the true pathophysiologic mechanisms behind these disease processes. Diagnosis of GERD is challenging and is typically over-diagnosed among otolaryngologists based on laryngoscopic findings. This method has been proven to be both inconsistent and non-specific when evaluating for the presence of GERD. Impedance monitoring is supplanting pH probes as the new gold standard; the clinical utility of impedance testing among patients with extraesophageal symptoms remains unclear however and there are practical limitations in performing these studies in children. The accuracy of diagnostic tests (laryngoscopy, endoscopy, and pH- or pH-impedance monitoring) for patients with suspected extraesophageal manifestations of gastroesophageal reflux disease remains suboptimal at this time. Management options for GERD include lifestyle changes, pharmacologic therapy, and surgical intervention. H2 blockers and proton pump inhibitors are effective treatment options in children but must be used judiciously given their potential side-effect profiles. Surgical options remain for those cases which are refractory to medical management. Multidisciplinary approaches and close collaboration between otolaryngologists and gastroenterologists is recommended to ensure application of best practice guidelines and for continued improvements in this area.