Hoarseness: Is It Really Laryngopharyngeal Reflux?


  • Seth M. Cohen MD, MPH,

    Corresponding author
    1. Duke Voice Care Center, Division of Otolaryngology–Head and Neck Surgery, Duke University Medical Center, Durham, North Carolina, U.S.A.
    • Dr. Seth Cohen, DUMC Box 3805, Durham, NC 27710
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  • C Gaelyn Garrett MD

    1. Vanderbilt Voice Center, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A.
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  • Work was completed at both the Duke Voice Care Center and Vanderbilt Voice Center.


Objective/Hypothesis: This study will test the hypothesis that proton pump inhibitor (PPI) use is prevalent among patients referred for hoarseness and will assess the ultimate diagnosis and factors associated with patients' voice outcomes.

Study Design: Retrospective review of patients in a tertiary care voice clinic.

Methods: Patients with a primary diagnosis of hoarseness, who were taking or had taken PPIs in the previous 2 months and referred to a tertiary care voice clinic, were identified. The dosage and length of PPI administration, patient report of gastroesophageal reflux (GER), presence of findings suggesting muscle tension dysphonia (MTD), patient demographics, diagnosis, chronicity of symptoms, interventions, follow-up, and outcome were determined.

Results: Of 299 patients, 264 met the inclusion criteria. The mean age was 47.2 years, with a range of 18 to 89 years, with 26.7% male and 73.3% female. Among patients referred for voice problems, 148 (56.1%) had previously tried PPIs or were currently on PPI treatment; 44 (29.7%) stopped taking their PPI because of continued hoarseness, and 104 (70.3%) had persistent hoarseness and associated throat complaints despite continued PPI treatment. Among patients who quit taking their PPI because of continued voice complaints, 79.5% did not have traditional GER symptoms of heartburn or regurgitation. The most common treatment after referral was voice therapy, with an overall voice therapy response rate of 62.7%.

Conclusions: PPI use is prevalent among patients referred because of persistent hoarseness. Whether patients have GER or MTD may influence patients' voice outcomes in response to PPI treatment.