Hypervigilance and Anxiety are Elevated Among Patients With Laryngeal Symptoms With and Without Laryngopharyngeal Reflux

Review article: Diagnosis and management of laryngopharyngeal reflux

“…14 Finally, there is growing evidence that patients with diagnostically proven LPR have non-gastroenterology (GI)-associated mechanisms of symptoms including enhanced laryngeal-specific hypervigilance and anxiety as well as hyper-responsive laryngeal behaviours, which suggests the need for multipronged treatment strategies that do not solely target acid reflux. 10,14,18 There is a critical need to, and fortunately growing evidence to support, a move towards more precise and available methods to identify true LPR as well as integrative management approaches.…”

“…Further, an enhanced brain–larynx interaction can coexist with true LPR, just as patients with GERD or oesophageal motility disorders can have concomitant oesophageal hypersensitivity 94 . For example, in one study, researchers evaluated the Oesophageal Hypervigilance and Anxiety Scale (EHAS) in patients with chronic laryngeal symptoms and identified similarly elevated EHAS scores across patient groups with or without objective GERD 18 . Similarly, Wong et al 95 identified increased oesophageal hypervigilance and symptom‐specific anxiety in patients with both GERD and LPR symptoms, LPR predominant and GERD predominant symptoms when compared to controls, and once again, reflux burden did not differ across groups.…”

“…Despite guideline and practice updates suggesting up‐front reflux testing, this is not always clinically practical, and diagnostic criteria and thresholds for interpreting reflux testing in the context of LPR are lacking 14 . Finally, there is growing evidence that patients with diagnostically proven LPR have non‐gastroenterology (GI)‐associated mechanisms of symptoms including enhanced laryngeal‐specific hypervigilance and anxiety as well as hyper‐responsive laryngeal behaviours, which suggests the need for multipronged treatment strategies that do not solely target acid reflux 10,14,18 …”

Update on extraesophageal manifestations of gastroesophageal reflux

“…Among these, growing evidence in recent years explored the potential relationship between cognitive-behavioral mechanisms and laryngeal symptoms related to LPR. In a 2022 single center observation study of 77 patients with and without LPR on ambulatory pH monitoring, >79% of patients in both groups endorsed increased hypervigilance and anxiety, suggesting that cognitive-affective processes may contribute to laryngeal symptoms regardless of reflux physiology [7 ▪▪ ]. Another study of 269 patients found that esophageal hypervigilance and anxiety positively correlated with LPR symptom severity, and were higher among patients with LPR symptoms, both compared to controls and to those with GERD symptoms alone [8 ▪▪ ].…”

“…Other treatment options targeting nonreflux mechanisms of symptoms may include voice therapy for vocal cord dysfunction, swallow therapy for oropharyngeal dysphagia, management of allergies or postnasal drip, and intervention of other underlying otolaryngologic pathologies. In particular, as mentioned earlier, a growing body of evidence supports cognitive-affective process and altered brain-throat axis as potential contributors to and, therefore, potential therapeutic targets for chronic laryngeal symptoms [7 ▪▪ ]. Recently, the Laryngeal Cognitive-Affective Tool (LCAT) was developed to evaluate laryngeal hypervigilance and symptom-specific anxiety in patient presenting with possible LPR symptoms [37 ▪ ].…”