Abstract
This chapter reviews the evidence linking laryngopharyngeal reflux (LPR) and chronic rhinosinusitis (CRS). Epidemiologically, LPR is more common in patients with CRS than those without. In addition, patients diagnosed with gastroesophageal reflux have a 2.36 times greater risk for developing CRS than control. There seems to be significant overlap in nasal symptoms between both entities as captured by the sinonasal outcomes test. Direct contact of acid and pepsin from LPR with sinonasal tissues may initiate or potentiate chronic inflammation seen in CRS. Reflux may also trigger an autonomic response in sinonasal tissue, resulting in increased mucous production and nasal congestion. In addition, presence of reflux in CRS may offer prognostic information about symptom control. Nasopharyngeal reflux was more prevalent in patients with refractory CRS after endoscopic sinus surgery than in control groups with well-controlled CRS or no CRS. Treatment of LPR with a proton pump inhibitor (PPI) has been effective in treating postnasal drip and reducing nasal resistance. Based on aggregative quality of evidence level B, benefit outweighs harm for PPI treatment of postnasal drip and nasal congestion in patients with CRS and comorbid LPR.
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