Background: Laryngeal symptoms including cough, throat clearing, or dysphonia are hyper-responsive behaviors that result from local irritation (e.g., refluxate) and heightened sympathetic tone. Laryngeal recalibration therapy provided by a speech-language pathologist (SLP) desensitizes and suppresses hyper-responsive behaviors. Thus, laryngeal recalibration therapy may be effective in patients with laryngeal symptoms and gastroesophageal reflux disease (GERD). The aims of this pilot study were to examine symptom response to laryngeal recalibration therapy in a cohort of patients undergoing evaluation & management of laryngopharyngeal reflux (LPR).

Methods: This prospective single center study included adults with chronic laryngeal symptoms referred for evaluation of LPR. Inclusion criteria included two or more SLP directed laryngeal recalibration therapy sessions which included heart rate variability biofeedback, vocal conditioning, and/or muscle tension aversion. Participants continued their acid suppression therapy (proton pump inhibitor or H2 blocker) while undergoing therapy. Data from endoscopy, ambulatory reflux monitoring off acid suppression, and patient reported outcomes were collected when available. The primary outcome was symptom response within participants.

Results: In total 31 participants completed therapy: mean age 48.8 years (SD 17.6), 19 (61%) female, mean body mass index 25.3 kg/m² (SD 6.2). Twenty (65%) presented with concomitant laryngeal & esophageal symptoms and 11 (35%) presented with isolated laryngeal symptoms. Participants underwent a mean of 3.9 laryngeal recalibration therapy sessions (Table).
Following therapy 74% of participants reported improvement in laryngeal symptoms (Figure). Specifically, 10/11 (91%) with isolated laryngeal symptoms reported improvement in laryngeal symptoms compared to 13/20 (65%) with concomitant laryngeal & esophageal symptoms. Among participants that underwent ambulatory reflux monitoring, a similar proportion of those with proven GERD derived symptom relief compared those with unproven GERD (73% vs 80%, respectively). Among participants with complete pre- and post-therapy questionnaire data there was a reduction in mean RSI (24.2 to 21.4, p=0.14) and mean VHI (20.7 to 17.3, p=0.06).

Conclusion: In this pilot study, 74% of patients with chronic laryngeal symptoms referred for LPR evaluation that underwent laryngeal recalibration therapy experienced improvement in laryngeal symptoms, with nearly all patients (91%) with isolated laryngeal symptoms deriving symptom relief following laryngeal recalibration therapy. Symptom response was similar among those with proven and unproven GERD. SLP directed laryngeal recalibration therapy may be an effective approach to incorporate into multi-disciplinary management of chronic laryngeal symptoms/LPR.

Philip Weissbrod

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