empiric therapy in otolaryngologic manifestations of gastroesophageal reflux disease

the review of literature shows that a strong relationship exists between the symptoms of otolaryngologic diseases and gastroesophageal reflux disease (gerd). it is commonly observed that an extended physical examination is needed to determine the occurrence of gerd. this non-randomized,prospective quasi-experimental study was performed to clinically verify the relationship between otolaryngologic symptoms and gerd and to show that a search for gerd is necessary under conditions that patients do not respond to initial routine treatment for otolaryngologic symptoms. extended physical examination of patients who had been referred to an ear, nose and throat (ent)hospital revealed that gerd-related laryngeal signs were present in 55 patients. otolaryngologic symptoms detected in decreasing order of occurrence were posterior nasal drip, chronic pharyngitis, chronic cough, hoarseness, ear pain, chronic throat clearing and pruritus in the ear. furthermore, 66% of the patients had gastrointestinal symptoms that included heartburn, dysphagia, odynophagia, aspiration, globus hystericus, dyspepsia and foreign body sensation. signs observed during the physical examination were posterior pharyngitis, granular pharyngitis, inflamed arytenoids, contact granuloma, and pachyderma laryngitis. we administered proton pump inhibitor to all patients and recommended to change their life style. the follow up program was a 6-month period. only 53 patients showed up for the follow up. the overall response rate to the therapeutic regimen was 83%. in treating otolaryngologic patients, especially those who are resistant to routine treatments, a careful extended physical examination including an indirect laryngoscopy for diagnosis of gerd is recommended.