Laryngeal Recalibration Therapy Improves Laryngopharyngeal Symptoms in Patients with Suspected Laryngopharyngeal Reflux Disease.

BACKGROUND 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. This study aimed to assess symptom response to LRT among patients with chronic laryngopharyngeal symptoms 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 25.6kg/m2 (6.8), mean of 3.7 (1.9) LRT sessions. Overall, 55 (85%) participants 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 that 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%)). CONCLUSION 85% of patients with chronic laryngopharyngeal symptoms referred for GERD evaluation that underwent LRT experienced laryngeal symptom response. Rates of symptom response were maintained across patients with or without proven GERD as well as patients with or without concomitant esophageal reflux symptoms. SLP directed LRT is an effective approach to incorporate into multi-disciplinary management of chronic laryngopharyngeal symptoms/laryngopharyngeal reflux disease.