Laryngopharyngeal reflux and its manifestations in the upper airways: A literature review

Abstract

Introduction: Laryngopharyngeal reflux (LPR) presents heterogeneous clinical manifestations and results from the interaction between reflux episodes, defense mechanisms of the aerodigestive tract, inflammation, and changes in sensorineural sensitivity. Its symptoms can affect different structures of the upper airways, making it difficult to recognize and differentiate it from other conditions. Objective: To analyze the main aspects related to LPR, with emphasis on its pathophysiology, clinical manifestations, diagnosis, and treatment. Methods: It is a narrative review of the literature, of a qualitative, descriptive, and interpretative nature. The search was carried out between 1999 and 2026 in the PubMed/MEDLINE, SciELO, LILACS, Virtual Health Library, and Scopus databases, using descriptors related to laryngopharyngeal reflux, upper airways, larynx, pharynx, chronic cough, diagnosis, and treatment, combined by the Boolean operators AND and OR. Studies in Portuguese, English, and Spanish were included, including original articles, reviews, clinical studies, guidelines, and other pertinent publications, available in full text. After screening by titles and abstracts and subsequent full evaluation, 15 scientific papers were selected. The data were organized by thematic similarity and analyzed qualitatively and descriptively, considering pathophysiological aspects, clinical manifestations, otorhinolaryngological repercussions, diagnostic methods, and therapeutic strategies for laryngopharyngeal reflux. No meta-analysis or formal assessment of risk of bias was performed. Results: The studies analyzed demonstrated that LPR can manifest as dysphonia, hoarseness, throat clearing, chronic cough, globus pharyngeus, irritation, and sensation of secretion in the throat. Laryngeal hypersensitivity and reflex mechanisms between the gastrointestinal tract and airways may contribute to the maintenance of symptoms. Possible associations with nasal, rhinosinusal, and otological manifestations have also been described, although these relationships are multifactorial. Videolaryngoscopy was relevant in the evaluation, but its findings are not specific. Treatment may involve lifestyle changes, behavioral measures, medications in selected patients, and a multidisciplinary approach. Conclusion: LPR has a multifactorial nature and nonspecific manifestations, making its diagnosis challenging. Individualized evaluation and careful interpretation of clinical and complementary findings are essential to differentiate reflux from other conditions and to adequately guide treatment.