There is not enough evidence that anti-reflux therapies are effective in treating hoarseness

Hopkins C, Yousaf U, Pedersen M

Published Online:

January 21, 2009

Hoarseness is a common disorder. A recent study suggested that up to 55% of patients with hoarseness have acid reflux (where stomach acid flows back up into the oesophagus), which affects their throat and voice box. Anti-reflux therapy includes drugs, lifestyle changes and sometimes surgery. These treatments are often used for patients with hoarseness, where no other cause has been found by examination. This review found no randomised controlled trials of patients with hoarseness treated by anti-reflux therapy. Some studies were found, however, where patients had hoarseness among other symptoms of acid reflux. These studies suggested a significant response of such symptoms to placebo therapy. More good quality studies are needed to test the effectiveness of anti-reflux therapies in patients with hoarseness.

Abstract (click to read)

Background:

Acid reflux is a common problem, and is thought to occur in 4% to 10% of patients presenting to ENT clinics. A recent study of reflux and voice disorders suggests that up to 55% of patients with hoarseness (dysphonia) have laryngopharyngeal reflux. Anti-reflux therapy is often used empirically in treating patients with hoarseness, where no other cause has been identified by examination.

Objectives:

The aim of the review was to assess the effectiveness of anti-reflux therapy for patients with hoarseness, in the absence of other identifiable causes, whether or not a definitive diagnosis of laryngopharyngeal and gastro-oesophageal reflux has been made. This was assessed by evaluation of prospective randomised controlled studies that were identified by a systematic review of the literature. Both medical and surgical treatments were evaluated.

Search strategy:

The Cochrane ENT Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (Cochrane Library Issue 3, 2005), MEDLINE (1966 to 2005), EMBASE (1974 to 2005) and conference proceedings were searched with prespecified terms. The date of the last search was September 2005.

Selection criteria:

Randomised controlled trials recruiting patients with hoarseness in the absence of other identifiable causes, such as malignancy, cord palsy or nodules, whether or not a definitive diagnosis of laryngopharyngeal and gastro-oesophageal reflux has been made.

Data collection and analysis:

Three reviewers examined the search results and identified studies before deciding which would be included in the review.

Main results:

302 potential studies were identified by the search strategy. No trials were identified which met our inclusion criteria. Six randomised controlled trials were identified in which some, but not all patients presented with hoarseness, and were treated with proton pump inhibition. As we could not determine with certainty whether all these patients had hoarseness among the other laryngeal symptoms, these were excluded. However, these studies suggest a significant placebo response, which is comparable to the benefit derived from anti-reflux therapy in some studies. As no trials met our criteria, we are unable to reach any firm conclusions regarding the effectiveness of anti-reflux treatment for hoarseness.

Authors' conclusions:

There is a need for high quality randomised controlled trials to evaluate the effectiveness of anti-reflux therapy for patients with hoarseness which may be due to laryngopharyngeal and gastro-oesophageal reflux.

This record should be cited as:

Hopkins C, Yousaf U, Pedersen M. Acid reflux treatment for hoarseness. Cochrane Database of Systematic Reviews 2006, Issue 1. Art. No.: CD005054. DOI: 10.1002/14651858.CD005054.pub2

Assessed as up to date:

November 16, 2005

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Primary Review Group:

Ear, Nose and Throat Disorders Group

Health topics:

Ear, nose, & throat > Larynx > Hoarseness

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

There is not enough evidence that anti-reflux therapies are effective in treating hoarseness

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