Do Laryngologists and General Otolaryngologists Manage Laryngopharyngeal Reflux Differently?

Jerome R Lechien; Jacqueline Allen; Francois Mouawad; Tareck Ayad; Maria Rosaria Barillari; Kathy Huet; Lise Crevier-Buchman; Stéphane Hans; Petros D Karkos; Young-Gyu Eun; Francois Bobin; Sven Saussez; Lee M Akst

doi:10.1002/lary.28484

Do Laryngologists and General Otolaryngologists Manage Laryngopharyngeal Reflux Differently?

Laryngoscope. 2020 Oct;130(10):E539-E547. doi: 10.1002/lary.28484. Epub 2020 Jan 8.

Authors

Jerome R Lechien^{1

2

3}, Jacqueline Allen⁴, Francois Mouawad⁵, Tareck Ayad^{1

6}, Maria Rosaria Barillari⁷, Kathy Huet^{1

8}, Lise Crevier-Buchman^{1

9}, Stéphane Hans^{1

9}, Petros D Karkos^{1

10}, Young-Gyu Eun^{1

11}, Francois Bobin^{1

12}, Sven Saussez^{1

2

3}, Lee M Akst^{1

13}

Affiliations

¹ Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies, Paris, France.
² Department of Anatomy and Experimental Oncology, Mons School of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium.
³ Department of Otorhinolaryngology and Head and Neck Surgery, CHU Saint-Pierre, Faculty of Medicine, University Libre de Bruxelles, Brussels, Belgium.
⁴ Department of Surgery, University of Auckland, Grafton, Auckland, New Zealand.
⁵ Department of Otorhinolaryngology and Head and Neck Surgery, CHRU de Lille, Lille, France.
⁶ Division of Otolaryngology-Head and Neck Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, Québec, Canada.
⁷ Division of Phoniatrics and Audiology, Department of Mental and Physical Health and Preventive Medicine, University of Naples SUN, Naples, Italy.
⁸ Laboratory of Phonetics, Faculty of Psychology, Research Institute for Language Sciences and Technology, University of Mons, Mons, Belgium.
⁹ Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, Paris, France.
¹⁰ Department of Otorhinolaryngology and Head and Neck Surgery, Thessaloniki Medical School, Thessaloniki, Greece.
¹¹ Department of Otorhinolaryngology and Head and Neck Surgery, Kyung Hee University School of Medicine, Seoul, Korea.
¹² Polyclinique Elsan de Poitiers, Poitiers, France.
¹³ Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, U.S.A.

PMID: 31913520
DOI: 10.1002/lary.28484

Abstract

Objective: To investigate current practices of laryngologists and non-laryngologists in management of Laryngopharyngeal Reflux (LPR).

Methods: An online survey was sent to members of otolaryngology societies about LPR, and subgroup analysis was performed between laryngologists and non-laryngologists. This survey was conducted by the LPR Study Group of Young Otolaryngologists of the International Federation of Otolaryngological Societies.

Results: A total of 535 otolaryngologists completed the survey. Among them, 127 were laryngologists and 408 were non-laryngologists. Collectively, symptoms most commonly attributed to LPR are cough after lying down/meal, throat clearing, and acid brash; most common findings are thought to be arytenoid erythema and posterior commissure hypertrophy. Respectively, 12.5% and 5% of non-laryngologists and laryngologists believe that ≥50% of LPR patients suffer from heartburn (P = .010). Non-laryngologists are more aware about some extra-laryngeal findings associated with LPR (eg, pharyngeal erythema) than laryngologists. Neither laryngologists nor non-laryngologists associated development of benign lesions of the vocal folds with reflux. The management of LPR substantially differs between groups, with laryngologists indicating increased awareness of (impedance)-pH monitoring as well as the prevalence and treatment of nonacid/mixed LPR. Conversely, non-laryngologists are much more likely to include gastroenterology referral in their management of presumed LPR. Respectively, 44.8% and 27.6% of non-laryngologists and laryngologists believe themselves not sufficiently knowledgeable about LPR.

Conclusions: Significant differences exist between laryngologists and non-laryngologists in diagnosis and treatment of LPR. Overall only one-third of responders believe themselves to be sufficiently educated about LPR.

Level of evidence: 4 Laryngoscope, 130:E539-E547, 2020.

Keywords: Laryngopharyngeal; laryngologist; management; reflux; survey; treatment.

MeSH terms

Humans
Laryngopharyngeal Reflux / diagnosis*
Laryngopharyngeal Reflux / therapy*
Otolaryngologists*
Practice Patterns, Physicians' / statistics & numerical data*
Surveys and Questionnaires