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# Laryngopharyngeal reflux

[Stomach](https://durgical.com/en/anatomy/stomach/) contents rising up to the throat and voice box. It causes hoarseness, throat clearing and a lump-in-the-throat feeling, often without heartburn.

Updated Nov 5, 2026

On this page

- The basics What it is
- Who gets it
- Causes
- Risk factors
- Classification
- Why it happens
- In ENT

- Clinical Symptoms and signs
- Red flags
- Diagnosis
- Differential diagnosis
- Complications
- Prognosis

- Treatment Treatment

- Study Test yourself

- Connections Connections

## What it is

Backflow of gastric contents (acid, pepsin and bile) past the upper oesophageal sphincter into the larynx and [pharynx](https://durgical.com/en/anatomy/pharynx/), whose lining is far more sensitive than the oesophagus. Many patients have no heartburn, so it is also called silent reflux.

See it in 3D

- [Vocal folds](https://durgical.com/en/anatomy/vocal-fold/)
- [Arytenoid cartilages](https://durgical.com/en/anatomy/arytenoid-cartilage/)
- [Pharynx](https://durgical.com/en/anatomy/pharynx/)
- [Epiglottis](https://durgical.com/en/anatomy/epiglottis/)

## +4

- [Esophagus](https://durgical.com/en/anatomy/esophagus-abdominal-part/)
- [Cricoid cartilage](https://durgical.com/en/anatomy/cricoid-cartilage/)
- [Thyroid cartilage](https://durgical.com/en/anatomy/thyroid-cartilage/)
- [Pharyngeal constrictors](https://durgical.com/en/anatomy/superior-pharyngeal-constrictor/)

## Who gets it

A frequent reason for consultation in otolaryngology and voice clinics, often in adults with GERD, obesity or smoking. It is probably overdiagnosed because its symptoms and laryngoscopy signs are not specific.

## Causes

- Failure of the upper and lower oesophageal sphincters and of oesophageal clearance
- Direct injury to laryngeal mucosa by pepsin and acid
- Reflex cough and throat clearing triggered by acid in the distal oesophagus

## Risk factors

- Gastro-oesophageal reflux disease and hiatus hernia
- Obesity
- Smoking and alcohol
- Large, fatty or late meals, coffee and carbonated drinks
- Voice overuse

## Classification

- Acid, weakly acid or non-acid reflux on impedance testing
- With or without typical GERD symptoms
- Severity scored with the Reflux Symptom Index (symptoms) and the Reflux Finding Score (laryngoscopy)

## Symptoms and signs

- Hoarseness that varies through the day
- Frequent throat clearing and excess throat mucus
- Chronic cough
- Globus: a feeling of a lump in the throat
- Sore throat and mild difficulty swallowing
- Heartburn in only some patients

## Red flags

- Hoarseness lasting more than about three to four weeks, especially in smokers (laryngoscopy to rule out cancer)
- Progressive dysphagia, pain on swallowing or weight loss
- Coughing up blood, stridor or a neck mass
- Persistent ear pain on one side with throat symptoms

## Diagnosis

**Clinical**
Typical symptoms with a Reflux Symptom Index above 13, and laryngoscopy showing posterior laryngitis: redness and swelling of the arytenoids, interarytenoid thickening, subglottic oedema (pseudosulcus) and thick mucus; a Reflux Finding Score above 7 supports it. An empirical treatment trial with improvement supports the diagnosis.

**Tests**
24-hour multichannel intraluminal impedance-pH monitoring with a pharyngeal sensor when the diagnosis is doubtful or before surgery; salivary pepsin testing in some centres; upper endoscopy for dysphagia, alarm features or long-standing GERD.

**Imaging**
Videolaryngoscopy or videostroboscopy documents the larynx. A barium swallow may show hiatus hernia or dysmotility.

## Differential diagnosis

- [Vocal fold](https://durgical.com/en/anatomy/vocal-fold/) nodules, polyps and other benign lesions
- Laryngeal cancer
- Postnasal drip from rhinitis or chronic rhinosinusitis
- Asthma and other causes of chronic cough
- Eosinophilic oesophagitis and oesophageal dysmotility

## Treatment

**Lifestyle**
Lifestyle measures first: weight loss, stopping smoking, limiting alcohol, coffee and fatty foods, avoiding meals two to three hours before bedtime, and raising the head of the bed.

**Medical**
Proton pump inhibitors (omeprazole, esomeprazole) usually twice daily for an empirical trial of about two to three months, then tapered to the lowest dose that controls symptoms.

**Medical**
Alginates after meals and at bedtime, alone or with a proton pump inhibitor, form a barrier against reflux.

**Surgical**
Laparoscopic fundoplication for proven reflux that does not respond to medical treatment, after impedance-pH testing.

**Follow-up**
Re-evaluation with laryngoscopy if symptoms persist, and referral to otolaryngology or gastroenterology to look for another cause.

## Complications

- Chronic laryngitis and voice disorders
- Contact granuloma of the vocal process
- Subglottic stenosis and laryngospasm
- Worsening of asthma and chronic cough
- A possible contribution to laryngeal cancer (debated)

## Prognosis

Usually good with lifestyle measures and medical treatment, but improvement of laryngeal signs takes months and symptoms often recur. Persistent symptoms despite treatment call for a review of the diagnosis.

## Test yourself

Think of the answer, then tap the question to see it.

## Why is laryngopharyngeal reflux called silent reflux?

Because many patients have no heartburn; they present with hoarseness, throat clearing, cough or globus.

## Which laryngoscopy findings are typical?

Posterior laryngitis: arytenoid redness and swelling, interarytenoid thickening and pseudosulcus.

## Which test detects non-acid reflux reaching the pharynx?

24-hour multichannel intraluminal impedance-pH monitoring with a pharyngeal sensor.

## What must be done for a smoker with hoarseness lasting more than a few weeks?

Laryngoscopy to exclude laryngeal cancer before attributing it to reflux.

[Add to my cards (4)](https://durgical.app/estudiar/?add=/en/conditions/laryngopharyngeal-reflux/)

## Why it happens

- [Benign lesions of the larynx](https://durgical.com/en/general-pathology/benign-lesions-of-the-larynx/)

## In ENT

- [Laryngitis and other laryngeal inflammation: acute, chronic, TB, perichondritis and congenital webs](https://durgical.com/en/ent/laryngitis-and-other-laryngeal-inflammation-acute-chronic-tb-perichondritis-and/)
- [Voice and speech disorders: muscle tension, spasmodic dysphonia, puberphonia and voice care](https://durgical.com/en/ent/voice-and-speech-disorders-muscle-tension-spasmodic-dysphonia-puberphonia-and-vo/)
- [Chronic pharyngitis and other non-acute sore throats](https://durgical.com/en/ent/chronic-pharyngitis-and-other-non-acute-sore-throats/)

## Connections

## Related conditions 9

- [Gastro-oesophageal reflux disease (GERD)](https://durgical.com/en/conditions/gastro-oesophageal-reflux-disease/)
- [Vocal fold nodules, polyps and laryngitis](https://durgical.com/en/conditions/vocal-fold-nodules-polyps-and-laryngitis/)
- [Laryngeal cancer](https://durgical.com/en/conditions/laryngeal-cancer/)
- [Eosinophilic oesophagitis](https://durgical.com/en/conditions/eosinophilic-oesophagitis/)
- [Barrett oesophagus](https://durgical.com/en/conditions/barrett-oesophagus/)
- [Asthma](https://durgical.com/en/conditions/asthma/)
- [Chronic rhinosinusitis and nasal polyps](https://durgical.com/en/conditions/chronic-rhinosinusitis-and-nasal-polyps/)
- [Obesity](https://durgical.com/en/conditions/obesity/)
- [Tobacco use disorder](https://durgical.com/en/conditions/tobacco-use-disorder/)

Educational information, not medical advice. For any symptom, see a health professional.

Sources: [Laryngopharyngeal Reflux](https://www.ncbi.nlm.nih.gov/books/NBK519548/) (StatPearls (NCBI Bookshelf), 2025).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/conditions/laryngopharyngeal-reflux/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/laryngopharyngeal-reflux/