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ORL 2005;67:185–191

Extraesophageal Reflux and Upper Aerodigestive Tract Diseases

Jecker P.a · Orloff L.A.b · Mann W.J.a
aDepartment of Otolaryngology, Mainz Medical School, Mainz, Germany; bDivision of Otolaryngology/Head and Neck Surgery, University of California, San Diego, Calif., USA
email Corresponding Author

 goto top of outline Key Words

  • Extraesophageal reflux
  • Head and neck diseases
  • Gastroesophageal reflux
  • pH monitoring
  • Reflux therapy

 goto top of outline Abstract

Reflux disease can cause multiple disorders not only of the esophagus but also of the upper aerodigestive tract. In the last decade, an association between reflux disease and multiple head and neck diseases was described, including those of the larynx and pharynx as well as those of the nose, the sinuses and the middle ear. The present article summarizes these different diseases and possible pathomechanisms are explained. In particular, there is a need to differentiate between the classical gastroesophageal reflux disease (GERD) and the extraesophageal manifestation of the reflux disease, called extraesophageal reflux (EER). Both diseases are characterized by different symptoms and can cause different disorders. To differentiate between GERD and EER, double-probe pH monitoring is mandatory. At last, some aspects of reflux therapy are explained.

Copyright © 2005 S. Karger AG, Basel

 goto top of outline References
  1. Shaw GY: Application of ambulatory 24-hour multiprobe pH monitoring in the presence of extraesophageal manifestations of gastroesophageal reflux. Ann Otol Rhinol Laryngol Suppl 2000;184:15–17.
  2. Koufman JA, Belafsky PC, Bach KK, Daniel E, Postma GN: Prevalence of esophagitis in patients with pH-documented laryngopharyngeal reflux. Laryngoscope 2002;112:1606–1609.
  3. Noordzij JP, Khidr A, Desper E, Meek RB, Reibel JF, Levine PA: Correlation of pH probe-measured laryngopharyngeal reflux with symptoms and signs of reflux laryngitis. Laryngoscope 2002;112:2192–2195.
  4. Powitzky E: Extraesophageal reflux: The role in laryngeal disease. Curr Opin Otolaryngol Head Neck Surg 2002;10:485–491.

    External Resources

  5. Postma GN: Ambulatory pH monitoring methodology. Ann Otol Rhinol Laryngol Suppl 2000;184:10–14.
  6. Little JP, Matthews BL, Glock MS, Koufman JA, Reboussin DM, Loughlin CJ, McGuirt WF Jr: Extraesophageal pediatric reflux: 24-hour double-probe pH monitoring of 222 children. Ann Otol Rhinol Laryngol Suppl 1997;169: 1–16.
  7. Yellon RF, Goldberg H: Update on gastroesophageal reflux disease in pediatric airway disorders. Am J Med 2001;111(suppl 8A):78S–84S.
  8. Johnson LF, Demeester TR: Twenty-four-hour pH monitoring of the distal esophagus. A quantitative measure of gastroesophageal reflux. Am J Gastroenterol 1974;62:325–332.
  9. Smit CF, Tan J, Devriese PP, Mathus-Vliegen LM, Brandsen M, Schouwenburg PF: Ambulatory pH measurements at the upper esophageal sphincter. Laryngoscope 1998;108:299–302.
  10. Vincent DAJ, Garrett JD, Radionoff SL, Reussner LA, Stasney CR: The proximal probe in esophageal pH monitoring: Development of a normative database. J Voice 2000;14:247–254.
  11. Zalesska-Krecicka M, Krecicki T, Iwanczak B, Blitek A, Horobiowska M: Laryngeal manifestations of gastroesophageal reflux disease in children. Acta Otolaryngol 2002;122:306–310.
  12. Ulualp SO, Toohill RJ, Hoffmann R, Shaker R: Pharyngeal pH monitoring in patients with posterior laryngitis. Otolaryngol Head Neck Surg 1999;120:672–677.
  13. Ylitalo R, Lindestad PA, Ramel S: Symptoms, laryngeal findings, and 24-hour pH monitoring in patients with suspected gastroesophago-pharyngeal reflux. Laryngoscope 2001;111:1735–1741.
  14. Bouchard S, Lallier M, Yazbeck S, Bensoussan A: The otolaryngologic manifestations of gastroesophageal reflux: When is a pH study indicated? J Pediatr Surg 1999;34:1053–1056.
  15. Hickson C, Simpson CB, Falcon R: Laryngeal pseudosulcus as a predictor of laryngopharyngeal reflux. Laryngoscope 2001;111:1742–1745.
  16. Kuhn J, Toohill RJ, Ulualp SO, Kulpa J, Hofmann C, Arndorfer R, Shaker R: Pharyngeal acid reflux events in patients with vocal cord nodules. Laryngoscope 1998;108:1146–1149.
  17. Glanz H, Kleinsasser O: Chronic laryngitis and carcinoma (author’s transl). Arch Otorhinolaryngol 1976;212:57–75.
  18. Galli J, Cammarota G, Calo L, Agostino S, D’Ugo D, Cianci R, Almadori G: The role of acid and alkaline reflux in laryngeal squamous cell carcinoma. Laryngoscope 2002;112:1861–1865.
  19. El-Serag HB, Hepworth EJ, Lee P, Sonnenberg A: Gastroesophageal reflux disease is a risk factor for laryngeal and pharyngeal cancer. Am J Gastroenterol 2001;96:2013–2018.
  20. Koufman JA, Burke AJ: The etiology and pathogenesis of laryngeal carcinoma. Otolaryngol Clin North Am 1997;30:1–19.
  21. Loughlin CJ, Koufman JA: Paroxysmal laryngospasm secondary to gastroesophageal reflux. Laryngoscope 1996;106:1502–1505.
  22. Maceri DR, Zim S: Laryngospasm: An atypical manifestation of severe gastroesophageal reflux disease (GERD). Laryngoscope 2001;111:1976–1979.
  23. Ludviksdottir D, Bjornsson E, Janson C, Boman G: Habitual coughing and its associations with asthma, anxiety, and gastroesophageal reflux. Chest 1996;109:1262–1268.
  24. Harding SM, Richter JE, Guzzo MR, Schan CA, Alexander RW, Bradley LA: Asthma and gastroesophageal reflux: Acid suppressive therapy improves asthma outcome. Am J Med 1996;100:395–405.
  25. Valipour A, Makker HK, Hardy R, Emegbo S, Toma T, Spiro SG: Symptomatic gastroesophageal reflux in subjects with a breathing sleep disorder. Chest 2002;121:1748–1753.
  26. Ing AJ, Ngu MC, Breslin AB: Obstructive sleep apnea and gastroesophageal reflux. Am J Med 2000;108(suppl 4a):120S–125S.
  27. Senior BA, Khan M, Schwimmer C, Rosenthal L, Benninger M: Gastroesophageal reflux and obstructive sleep apnea. Laryngoscope 2001;111:2144–2146.
  28. Koufman JA: The otolaryngologic manifestations of gastroesophageal reflux disease (GERD): A clinical investigation of 225 patients using ambulatory 24-hour pH monitoring and an experimental investigation of the role of acid and pepsin in the development of laryngeal injury. Laryngoscope 1991;101(4 Pt 2 Suppl 53):1–78.
  29. Woo P, Noordzij P, Ross JA: Association of esophageal reflux and globus symptom: Comparison of laryngoscopy and 24-hour pH manometry. Otolaryngol Head Neck Surg 1996;115:502–507.
  30. Poelmans J, Tack J, Feenstra L: Prospective study on the incidence of chronic ear complaints related to gastroesophageal reflux and on the outcome of antireflux therapy. Ann Otol Rhinol Laryngol 2002;111:933–938.
  31. Tasker A, Dettmar PW, Panetti M, Koufman JA, Birchall JP, Pearson JP: Reflux of gastric juice and glue ear in children. Lancet 2002;359:493.
  32. White DR, Heavner SB, Hardy SM, Prazma J: Gastroesophageal reflux and eustachian tube dysfunction in an animal model. Laryngoscope 2002;112:955–961.
  33. Bothwell MR, Parsons DS, Talbot A, Barbero GJ, Wilder B: Outcome of reflux therapy on pediatric chronic sinusitis. Otolaryngol Head Neck Surg 1999;121:255–262.
  34. Chambers DW, Davis WE, Cook PR, Nishioka GJ, Rudman DT: Long-term outcome analysis of functional endoscopic sinus surgery: Correlation of symptoms with endoscopic examination findings and potential prognostic variables. Laryngoscope 1997;107:504–510.
  35. DiBaise JK, Olusola BF, Huerter JV, Quigley EM: Role of GERD in chronic resistant sinusitis: A prospective, open label, pilot trial. Am J Gastroenterol 2002;97:843–850.
  36. Ulualp SO, Toohill RJ, Hoffmann R, Shaker R: Possible relationship of gastroesophagopharyngeal acid reflux with pathogenesis of chronic sinusitis. Am J Rhinol 1999;13:197–202.
  37. Koufman J, Sataloff RT, Toohill R: Laryngopharyngeal reflux: Consensus conference report. J Voice 1996;10:215–216.
  38. Peghini PL, Katz PO, Bracy NA, Castell DO: Nocturnal recovery of gastric acid secretion with twice-daily dosing of proton pump inhibitors. Am J Gastroenterol 1998;93:763–767.

 goto top of outline Author Contacts

Peter Jecker, MD, PhD
Department of Otolaryngology
Mainz Medical School, Langenbeckstrasse 1
DE–55101 Mainz (Germany)
Tel. +49 6131 17 7361, Fax +49 6131 17 6637, E-Mail

 goto top of outline Article Information

Received: May 21, 2004
Accepted: June 17, 2004
Published online: July 7, 2005
Number of Print Pages : 7
Number of Figures : 1, Number of Tables : 1, Number of References : 38

 goto top of outline Publication Details

ORL (Journal for Oto-Rhino-Laryngology and Ist Related Specialties)

Vol. 67, No. 4, Year 2005 (Cover Date: 2005)

Journal Editor: O'Malley, B.W., Jr. (Philadelphia, Pa.)
ISSN: 0301–1569 (print), 1423–0275 (Online)

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