Laryngeal Recalibration Therapy Improves Laryngopharyngeal Symptoms in Patients With Suspected Laryngopharyngeal Reflux Disease

Erin Walsh; Amanda J Krause; Madeline Greytak; Alexander M Kaizer; Philip A Weissbrod; Kelli Liu; Tiffany Taft; Rena Yadlapati

doi:10.14309/ajg.0000000000002839

Laryngeal Recalibration Therapy Improves Laryngopharyngeal Symptoms in Patients With Suspected Laryngopharyngeal Reflux Disease

Am J Gastroenterol. 2024 May 21. doi: 10.14309/ajg.0000000000002839. Online ahead of print.

Authors

Erin Walsh¹, Amanda J Krause², Madeline Greytak², Alexander M Kaizer³, Philip A Weissbrod¹, Kelli Liu², Tiffany Taft⁴, Rena Yadlapati²

Affiliations

¹ Department of Otolaryngology, University of California San Diego, La Jolla, California, USA.
² Department of Medicine, Division of Gastroenterology and Hepatology, University of California San Diego, La Jolla, California, USA.
³ Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado-Anschutz Medical Campus, Aurora, Colorado, USA.
⁴ The Rome Foundation Research Institute, Chapel Hill, North Carolina, USA.

PMID: 38656937
DOI: 10.14309/ajg.0000000000002839

Abstract

Introduction: Laryngopharyngeal symptoms such as cough, throat clearing, voice change, paradoxic vocal fold movement, or laryngospasm are hyper-responsive behaviors resulting from local irritation (e.g., refluxate) and heightened sympathetic tone. Laryngeal recalibration therapy (LRT) guided by a speech-language pathologist (SLP) provides mechanical desensitization and cognitive recalibration to suppress hyper-responsive laryngeal patterns. The aim of this study was to assess symptom response to LRT among patients with chronic laryngopharyngeal symptoms undergoing evaluation of gastroesophageal reflux disease (GERD).

Methods: Adults with chronic laryngopharyngeal symptoms referred for evaluation of GERD to a single center were prospectively followed. Inclusion criteria included ≥2 SLP-directed LRT sessions. Data from endoscopy, ambulatory reflux monitoring, and patient-reported outcomes were collected when available. The primary outcome was symptom response.

Results: Sixty-five participants completed LRT: mean age 55.4 years (SD 17.2), 46 (71%) female, mean body mass index 25.6 kg/m 2 (6.8), and mean of 3.7 (1.9) LRT sessions. Overall, 55 participants (85%) met criteria for symptom response. Specifically, symptom response was similar between those with isolated laryngopharyngeal symptoms (13/15, 87%) and concomitant laryngopharyngeal/esophageal symptoms (42/50, 84%). Among participants who underwent reflux monitoring, symptom response was similar between those with proven, inconclusive for, and no GERD (18/21 [86%], 8/9 [89%], 10/13 [77%]).

Discussion: Eighty-five percent of patients with chronic laryngopharyngeal symptoms referred for GERD evaluation who underwent LRT-experienced laryngeal symptom response. Rates of symptom response were maintained across patients with or without proven GERD and patients with or without concomitant esophageal reflux symptoms. SLP-directed LRT is an effective approach to incorporate into multidisciplinary management of chronic laryngopharyngeal symptoms/laryngopharyngeal reflux disease.

Abstract

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