INTRODUCTION Endoscopic radiofrequency therapy for gastro-esophageal reflux disease (GERD) has been proven to be successful. 1 STRETTA is the only radiofrequency device licensed for this indication in the UK and is approved by The National Institute for Health and Care Excellence (NICE) for cases refractory to medical therapy. 2 STRETTA improves the quality of life and reduces the need for anti-reflux medication in a select group of patients, 3 namely those with uncomplicated GERD. Complicated GERD is defined as the presence of stenotic disease, ulcerative esophagitis, scarring of the gastro-esophageal junction (GEJ), a recurrent hiatus hernia of > 2.5 cm, a dilated crura of > 2.5 cm, Barrett's metaplasia, wrap migration, and gastric volvulus. 4 At our center, STRETTA is not performed on patients with complicated GERD. STRETTA has also been shown to be cost-effective in some studies. 5 For refractory GERD in patients with a history of previous gastric surgery, STRETTA is effective; however, it has been reported only in a few studies. A retrospective study of 6 patients with a history of previous Roux-en-Y gastric bypass showed that STRETTA led to resolution of the symptoms in

Muscle Tension Dysphonia (MTD) is a syndrome involving abnormal vocal cord behaviour due to increased tension of laryngeal musculature. It has a complex etiology, but gastroesophageal reflux disease (GERD) is implicated in up to half of cases. The authors present the first reported case of MTD being successfully treated using STRETTA, an endoscopic radio-frequency therapy, licenced for GERD. Since 2016, a 60- year-old female had symptoms of laryngo-pharyngeal reflux. These included dysphonia, cough, sore throat, and persistent throat clearing. She underwent flexible nasendoscopy demonstrating significant posterior laryngeal edema, and anterior-posterior constriction on phonation, suggestive of MTD. Despite anti-reflux medication, her symptoms persisted. Repeat flexible nasendoscopy demonstrated bilateral Reinke's edema. Her symptoms failed to improve despite incision and drainage of the Reinke’s edema. An EGD demonstrated reflux esophagitis, and a blunt angle of His. She underwent STRETTA and reports significant improvement of symptoms. Repeat nasoendoscopy showed convalescence of the Reinke’s edema. Existing evidence suggests that management of MTD with proton pump inhibitor (PPI) improves reflux symptoms such as chronic cough and heartburn but has a limited effect on measures of voice such as voice range profile, perceptual evaluation, and acoustic analysis. Given that the present patient found subjective improvement in voice quality, it is possible STRETTA may be preferable to PPI in treating MTD with regard to voice, but further assessment of voice quality pre- and post-STRETTA is needed. In LPR refractory to PPI, there is evidence that Laparoscopic Nissen Fundoplication (LNF) is successful; however, the cost-effectiveness of endoscopic anti-reflux procedures such as STRETTA is superior to operative management such as LNF. Therefore, STRETTA may well be more beneficial than both PPI and LNF in the treatment of MTD with LPR.