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The epithelium plays a critical role in the maintenance of laryngeal health. This is evident in that laryngeal disease may result when the integrity of the epithelium is compromised by insults such as laryngopharyngeal reflux. In this article, we will review the structure and function of the laryngeal epithelium and summarize the impact of laryngopharyngeal reflux on the epithelium. Research investigating the ramifications of reflux on the epithelium has improved our understanding of laryngeal disease associated with laryngopharyngeal reflux. It further highlights the need for continued research on the laryngeal epithelium in health and disease.

Much controversy continues to exist regarding almost every facet of layrngopharyngeal reflux (LPR), including the method of its clinical evaluation, the interpretation of the available data, and its ultimate diagnosis and treatment. In this article, the author reviews some of the controversies associated with the diagnosis and management of LPR from the perspective of a laryngologist. The author conducted a literature review to identify recent key articles regarding the diagnosis and treatment of LPR. Special attention was taken to identify clinical practice guidelines and review articles that summarize the scientific validity of the literature on LPR. The results show that evidence in the current literature is inconsistent, although most clinicians agree that extraesophageal reflux is associated with manifestations of symptoms in the larynx and pharynx. Questions remain about the true prevalence of LPR and its causation.

Voice disorders in the pediatric population are common, but have been understudied. Inflammation, trauma, and neurologic and congenital anomalies all can result in childhood dysphonia. Laryngopharyngeal reflux, an extraesophageal variation of gastroesophageal reflux, has been associated with laryngeal symptoms of dysphonia, globus sensation, throat clearing, and chronic cough in children. This article reviews the current evaluation and treatment techniques of reflux and the effects of laryngopharyngeal reflux on voice quality in children. A case study illustrates the importance of treating laryngeal inflammation to achieve an accurate diagnosis.

Gastroesophageal reflux disease (GERD) is a commonly diagnosed condition often associated with the typical symptoms of heartburn and regurgitation, although it may present with atypical symptoms such as chest pain, hoarseness, chronic cough, and asthma. In most cases, the patient's reduced quality of life drives clinical care and diagnostic testing. Because of its widespread impact on voice and swallowing function as well as its social implications, it is important that speech-language pathologists (SLPs) understand the nature of GERD and its consequences. The purpose of this article is to summarize the nature of GERD and GERD-related complications such as GERD-related peptic stricture, Barrett's esophagus and adenocarcinoma, and laryngeal manifestations of GERD from a gastroenterologist's perspective. It is critical that SLPs who work with a multidisciplinary team understand terminology, diagnostic tools, and treatment to ensure best practice.

Extraesophageal reflux (EER) has been implicated in a variety of different otorhinolaryngologic disorders including otitis media, chronic sinusitis, globus pharyngeus, laryngeal neoplasia, and many benign laryngeal disorders. New technologies such as multichannel intraluminal impedance studies have revolutionized our ability to detect the prevalence of EER, and the role of biomarker detection in diagnosing ongoing EER is evolving. Gastric refluxate contains not only hydrochloric acid, but also bile salts and digestive enzymes such as pepsin. Analysis of pepsin levels in both tissues and secretions is emerging as a useful adjunct in the diagnosis of EER and work to evaluate the role of pepsin in the promotion of laryngeal inflammation and neoplasia is ongoing. This review discusses the recent literature regarding the diagnosis and treatment of EER, and describes the controversies that can perhaps be further elucidated by ongoing clinical and translational research.