10/31/2026
As a laryngologist and a silent reflux (LPR) specialist there are a few misconceptions that definitely make the office feel a little more “spooky.”
🎃PPIs are the only way to treat silent reflux
-False! One would argue they aren’t really treating it at all…
Silent reflux or LPR management should take a primarily 3 tiered approach focusing on antireflux diet precautions, antireflux lifestyle changes, and addition of barrier strengthening agents like alginates.
🎃I’m treating my reflux because I take a PPI
-False! PPIs are simply acid suppressing drugs, not anti-reflux drugs. They reduce the acid content of stomach contents but don’t stop those contents from coming out of the stomach (ie reflux!)
🎃 Take a PPI for your hoarseness
-False! For silent reflux with no heartburn, regurgitation, or esophagitis, the AAO-HNS hoarseness guideline recommends against empiric acid-suppressing meds, and the 2026 San Diego Consensus and AGA save empiric PPIs for patients who also have typical heartburn symptoms. In placebo-controlled trials, PPIs mostly failed to improve voice, including the two largest studies, which found no benefit over placebo after 4 months of high-dose therapy. The better first step is a laryngoscopy and, when needed, objective reflux testing, so you get the right diagnosis before starting a pill.
Comment “hoarse” and I’ll send you the entire AAO-HNS guideline on Hoarseness. 👻