Essential Guide To Laryngopharyngeal Reflux Treatment For SLPs

Laryngopharyngeal reflux (LPR) is when stomach acid backflows into the throat and vocal folds.

It can lead to chronic laryngitis/cough and voice disorders (Brown & Shermetaro, 2022). In fact, LPR is present in up to 50% of voice disorders (Belafsky, 2002).

How can speech therapy help in the treatment and management of LPR? In this article you’ll learn:

• Laryngopharyngeal reflux treatment ideas for a healthier voice
• Symptoms of LPR
• How to assess LPR (with a free assessment template!)

For bestselling assessment templates, patient handouts, and worksheets, see The Evaluation Pack and Voice & Resonance Pack!

What Is Laryngopharyngeal Reflux (LPR)?

Laryngopharyngeal reflux is a backflow of stomach acid that moves up through the esophagus and into the pharynx and larynx. It’s a common inflammatory disease and can be acute or chronic (Cui et al., 2024).

This disorder is often misdiagnosed because patients may not present with the more well-known symptoms seen in gastroesophageal reflux disease (GERD; Lechien et al., 2020).

LPR can lead to issues in the larynx and pharynx, including:

• Edema of the pharynx, larynx, false, and true vocal folds
• Thickening of mucus
• Subglottic edema (swelling below the vocal cords)
• Pseudosulcus vocalis (a groove that forms on the free edge of the true vocal fold due to subglottic edema)
• Drying of mucosa/tissues 
• Laryngeal granuloma and vocal cord polyps (Cui et al., 2024; Brown & Shermetaro, 2022)

If left untreated, LPR can also lead to dysphonia and vocal fold abnormalities (Lechien et al., 2020).

Symptoms Of LPR

Common symptoms of LPR include:

• Vocal hoarseness
• Globus sensation or ‘lump’ feeling in the throat
• Frequent throat clearing
• Sore throat
• Excessive mucus in the throat
• Nasal drainage (Cui et al., 2024)
• Coughing after eating/lying down or an annoying cough

Some patients also complain of heartburn or regurgitation. 

The symptoms of LPR are variable, which can complicate detection and diagnosis. As a result, LPR is often overdiagnosed, underdiagnosed, or misdiagnosed as allergies (Lechien et al., 2020). 

How Is LPR Diagnosed?

To be diagnosed with LPR, your patient will need to see a specialist such as an otolaryngologist/laryngologist. The doctor will complete a physical assessment, ask about symptoms, and may complete an instrumental assessment such as a laryngoscopy.

The diagnostic gold standard for testing LPR is the HEMII-pH (hypopharyngeal-esophageal intraluminal impedance-pH monitoring), which is performed by a gastroenterologist.

Speech Therapy LPR Assessment

If you suspect LPR is impacting your patient’s voice, complete a thorough voice assessment and the Reflux Symptom Index (RSI). You’ll find the RDI below, plus a link to a free PDF version.

Reflux Symptom Index (RDI)

The RSI is an assessment tool for patients reporting LPR-like symptoms. It’s a patient-reported outcome measure that can broadly assess the severity of a patient’s LPR (Belsafsky et al., 2002).

“Within the last month, how did the following problems affect you?” 

0 = No Problem to 5 = Severe Problem.

1. Hoarseness or a problem with your voice. 
2. Clearing your throat. 
3. Excess throat mucus or postnasal drip.  
4. Difficulty swallowing food, liquids, or pills.  
5. Coughing after you eat or after lying down. 
6. Breathing difficulties or choking episodes. 
7. Troublesome or annoying cough. 
8. Sensations of something sticking in your throat or a lump in your throat.  
9. Heartburn, chest pain, indigestion, or stomach acid coming up.

(Belsafsky et al., 2002)

A score greater than 13 on the RSI indicates the presence of GERD and/or LPR.

If you suspect our patient may have underlying LPR and/or they score above 13 on the RSI, refer them to an otolaryngologist and/or gastroenterologist. Click for a free RDI PDF offered by Stanford University.

Speech Therapy Laryngopharyngeal Reflux Treatment

1. Breathing and relaxation exercises. Breathing and relaxation exercises have been shown to decrease cough and the severity of LPR symptoms (Huestis et al., 2020). 
2. Voice exercises. Your patient may also benefit from vocal exercises, including relaxation. 
3. Vocal hygiene. If your patient developed maladaptive vocal behaviors due to LPR, educate on vocal hygiene. See our Vocal Hygiene checklist for a patient handout. 
4. Avoid acid reflux. Educate patients on how to avoid triggers for acid reflux (Huestis et al., 2020).  
5. Multidisciplinary care. LPR is a complex disorder, and a multidisciplinary approach is best. Consult with an otolaryngologist and/or gastroenterologist to determine if your patient would benefit from medications to address their LPR.

More Speech Therapy Materials

For evidence-based speech therapy treatment protocols, check out the *new* Adult Speech Therapy Protocols Pack.

For a complete guide to assessment, treatment, and documentation, take The Adult Speech Therapy Roadmap Course (eligible for 1.55 ASHA CEUs). Perfect for interns, new graduates, and clinicians transitioning from pediatrics.

References

• Belafsky, P. C., Postma, G. N., & Koufman, J. A. (2002). Validity and reliability of the reflux symptom index (RSI). Journal of voice: official journal of the Voice Foundation, 16(2), 274–277. https://doi.org/10.1016/s0892-1997(02)00097-8
• Brewer, C., Aparo, M. (2021) The Adult Speech Therapy Starter Pack. Harmony Road Design Publishing.
• Brown J, Shermetaro C. Laryngopharyngeal Reflux. [Updated 2022 Dec 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519548/
• Cui, N., Dai, T., Liu, Y., Wang, Y. Y., Lin, J. Y., Zheng, Q. F., Zhu, D. D., & Zhu, X. W. (2024). Laryngopharyngeal reflux disease: Updated examination of mechanisms, pathophysiology, treatment, and association with gastroesophageal reflux disease. World journal of gastroenterology, 30(16), 2209–2219. https://doi.org/10.3748/wjg.v30.i16.2209
• Huestis, M. J., Keefe, K. R., Kahn, C. I., Tracy, L. F., & Levi, J. R. (2020). Alternatives to Acid Suppression Treatment for Laryngopharyngeal Reflux. The Annals of otology, rhinology, and laryngology, 129(10), 1030–1039. https://doi.org/10.1177/0003489420922870
• Lechien, J. R., Saussez, S., Harmegnies, B., Finck, C., & Burns, J. A. (2017). Laryngopharyngeal Reflux and Voice Disorders: A Multifactorial Model of Etiology and Pathophysiology. Journal of voice : official journal of the Voice Foundation, 31(6), 733–752. https://doi.org/10.1016/j.jvoice.2017.03.015
• Lechien, J. R., Saussez, S., Muls, V., Barillari, M. R., Chiesa-Estomba, C. M., Hans, S., & Karkos, P. D. (2020). Laryngopharyngeal Reflux: A State-of-the-Art Algorithm Management for Primary Care Physicians. Journal of clinical medicine, 9(11), 3618. https://doi.org/10.3390/jcm9113618