Laryngopharyngeal Symptoms and Laryngopharyngeal Reflux Disease: Interdisciplinary Considerations and Management.

backgroundThe San Diego Consensus for Laryngopharyngeal Symptoms (LPS) and Laryngopharyngeal Reflux Disease (LRPD) describes a broad-based multidisciplinary management paradigm that focuses on mechanisms underlying symptoms to improve treatment outcomes. PURPOSE: This review expands on the San Diego Consensus framework to discuss multidisciplinary management of LPS and LPRD. LPS manifest as persistent or disproportionate symptoms despite minimal or inconsistent evidence of reflux exposure. Emerging evidence suggests that hyperresponsiveness, hypervigilance, and symptom-specific anxiety are more strongly associated with LPS than objective reflux metrics and may contribute to symptom persistence through heightened attention to perceived irritation and protective behavioral responses. Repeated peripheral sensory input may further contribute to central sensitization and lower perceptive thresholds. While these behavioral and neurophysiological processes may be partially improved by reducing reflux exposure, behavioral therapies that address the multidimensional nature of LPS may provide additional benefit. Laryngeal Recalibration Therapy addresses LPS by retraining maladaptive laryngeal behaviors, enhancing vagal tone via heart rate variability biofeedback, and cognitive reframing to reduce symptom amplification. Meta-therapy, a clinical dialogue approach used in speech-language pathology to facilitate behavioral change, alongside psychological interventions such as mindfulness meditation, cognitive-behavioral therapy, and gut-directed hypnotherapy, may further target cognitive-affective processes that shape perception. Behavioral interventions can be combined with neuromodulators, particularly delta ligands such as gabapentin in patients with chronic cough, and tricyclic antidepressants or selective serotonin reuptake inhibitors in select cases. Effective management relies on multidisciplinary collaboration, integration of reflux-directed and behavioral therapies, and patient-centered education that supports adaptive symptom interpretation.