Purpose: To determine whether the patients with refractory posterior laryngitis respond to treatment with omeprazole.
Patients and methods: Sixteen consecutive patients with persistent posterior laryngitis despite prior therapy with H2 blockers were recruited from outpatient university otolaryngology and gastroenterology practices. Patients received 6 to 24 weeks of omeprazole 40 mg qhs, which was increased to 40 mg twice a day for 6 weeks in four patients with continuing symptoms. Laryngoscopy, esophagoscopy, and esophageal/laryngeal symptom questionnaire were completed at entry to the study. Laryngoscopy and the questionnaire were repeated at the conclusion of the study. A follow-up questionnaire was completed at 6 weeks.
Results: Laryngoscopy scores improved from 4.44 to 1.94 (nonblinded otolaryngologist) and 4.31 to 1.88 (blinded otolaryngologist) (P < 0.05). Laryngeal and esophageal symptom indices improved from 13.94 and 9.00 to 3.00 and 0.38, respectively (P < 0.05). Symptom indices increased to 7.00 and 7.33, respectively, after the discontinuation of therapy (P < 0.05 compared with the conclusion of the study). One patient intolerant of omeprazole underwent fundoplication and was asymptomatic 6 weeks after surgery. Only 3 patients had esophagitis at entry.
Conclusions: The signs and symptoms of posterior laryngitis improve with the administration of omeprazole and symptoms recur after discontinuation of therapy, suggesting that reflux is the underlying etiology. Patients with refractory symptoms, but intolerant of omeprazole, may benefit from antireflux surgery. Laryngoscopic findings of posterior laryngitis are often subtle, and many patients with posterior laryngitis do not have esophagitis.