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Comment & Response
September 22/29, 2015

Treating Hoarseness With Proton Pump Inhibitors—Reply

Author Affiliations
  • 1Boston VA Healthcare System, Harvard Medical School, Boston, Massachusetts
JAMA. 2015;314(12):1295-1296. doi:10.1001/jama.2015.10045

In Reply Dr Dion and colleagues address 3 concerns: that empirical PPI therapy for 3 months is not reasonable for the treatment of laryngopharyngeal reflux; that a patient’s history may not determine the etiology of hoarseness (ie, GERD); and that the efficacy of PPIs is questionable. Dion and colleagues also advocate for more timely laryngeal visualization.

Laryngopharyngeal reflux as a cause of hoarseness is a complex diagnostic and therapeutic challenge. Laryngopharyngeal reflux can cause hoarseness, but the relationship between the 2 disorders is elusive, mainly because laryngopharyngeal reflux is difficult to diagnose. Symptoms attributable to laryngopharyngeal reflux are nonspecific and unreliable, and the diagnostic tests available—laryngoscopy and pH monitoring—do not improve the diagnosis. For these reasons, laryngopharyngeal reflux is frequently overdiagnosed.