Persistent Hoarseness Associated with Laryngopharyngeal Reflux and Suspected Ortner’s Syndrome: A Case Report
DOI:
https://doi.org/10.37287/ijghr.v8i4.2185Keywords:
cardiovocal syndrome, hoarseness, laryngopharyngeal reflux, ortner’s syndrome, recurrent laryngeal nerve palsyAbstract
Laryngopharyngeal reflux (LPR) is an extraesophageal inflammatory disorder caused by the retrograde flow of gastric contents into the laryngopharyngeal region, leading to chronic irritation of the upper airway mucosa. Persistent hoarseness is a common symptom; however, dysphonia may also reflect rare cardiovascular causes such as Ortner’s syndrome (cardiovocal syndrome), which results from recurrent laryngeal nerve dysfunction secondary to cardiovascular pathology. Diagnostic differentiation between these entities can be challenging due to overlapping clinical features. We report a 70-year-old woman with two months of persistent hoarseness following coronary artery stenting after myocardial infarction. She also experienced nocturnal cough, globus sensation, intermittent choking, and dysphagia. Flexible laryngoscopy showed bilateral vocal fold hyperemia and edema, posterior commissure hypertrophy, and partial glottic narrowing. The Reflux Symptom Index (RSI) score was 22 and the Reflux Finding Score (RFS) was 17, supporting LPR. Coronary angiography revealed total occlusion of the right coronary artery. Given her significant cardiovascular history, recurrent laryngeal nerve involvement due to suspected Ortner’s syndrome was also considered. This case highlights overlapping manifestations of LPR and cardiovocal syndrome, complicating diagnosis. Comprehensive multidisciplinary evaluation is essential, particularly in elderly patients with cardiovascular disease, to avoid attributing persistent hoarseness solely to reflux and to identify potential cardiogenic causes of dysphonia.
References
Barrett, C. M., Patel, D., & Vaezi, M. F. (2020). Laryngopharyngeal reflux and atypical gastroesophageal reflux disease. Gastrointestinal Endoscopy Clinics, 30(2), 361–376.
Brown, J., Matz, O., Sutton, A. E., & Shermetaro, C. (2025). Laryngopharyngeal reflux. In StatPearls StatPearls Publishing.
Chen, C., & Liao, D.-M. (2024). Common laryngopharyngeal reflux: a review. Tungs’ Medical Journal, 18(Suppl 1), S18–S22.
Chen, G., & Lechien, J. R. (2025). Voice Quality Changes After Laryngopharyngeal Reflux Disease Treatment: A Systematic
Cuff, C., & Yadlapati, R. (2025). Laryngopharyngeal Reflux: Historical Perspectives, Current Diagnostics and Therapies, and Remaining Challenges. Acta Gastroenterologica Latinoamericana, 55(4), 292.
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.
Han, H., Lyu, Q., & Zhao, J. (2022). Laryngopharyngeal Reflux in Hypertrophic Laryngeal Diseases. Ear, Nose & Throat Journal, 101(4), NP158–NP163.
Krause, A. J., Walsh, E. H., Weissbrod, P. A., Taft, T. H., & Yadlapati, R. (2022). An update on current treatment strategies for laryngopharyngeal reflux symptoms. Annals of the New York Academy of Sciences, 1510(1), 5–17.
Krause, A. J., & Yadlapati, R. (2024). Review article: Diagnosis and management of laryngopharyngeal reflux. Alimentary Pharmacology & Therapeutics, 59(5), 616–631.
Lechien, J. R. (2026). Differential and additional diagnoses of laryngopharyngeal reflux disease: a case series. Journal of Voice. https://www.sciencedirect.com/science/article/pii/S089219972600038X
Lechien, J. R., Akst, L. M., Hamdan, A. L., Schindler, A., Karkos, P. D., Barillari, M. R., Calvo‐Henriquez, C., Crevier‐Buchman, L., Finck, C., Eun, Y., Saussez, S., & Vaezi, M. F. (2019). Evaluation and Management of Laryngopharyngeal Reflux Disease: State of the Art Review. Otolaryngology–Head and Neck Surgery, 160(5), 762–782.
Lechien, J. R., Akst, L. M., Saussez, S., Crevier‐Buchman, L., Hans, S., Barillari, M. R., Calvo‐Henriquez, C., Bock, J. M., & Carroll, T. L. (2021). Involvement of Laryngopharyngeal Reflux in Select Nonfunctional Laryngeal Diseases: A Systematic Review. Otolaryngology–Head and Neck Surgery, 164(1), 37–48.
Lechien, J. R., Hans, S., Bobin, F., Calvo-Henriquez, C., Saussez, S., & Karkos, P. D. (2021). Atypical clinical presentation of laryngopharyngeal reflux: a 5-year case series. Journal of Clinical Medicine, 10(11), 2439.
Lechien, J. R., Saussez, S., Schindler, A., Karkos, P. D., Hamdan, A. L., Harmegnies, B., De Marrez, L. G., Finck, C., Journe, F., Paesmans, M., & Vaezi, M. F. (2019). Clinical outcomes of laryngopharyngeal reflux treatment: A systematic review and meta‐analysis. The Laryngoscope, 129(5), 1174–1187. https://doi.org/10.1002/lary.27591
Runggaldier, D., Hente, J., Brockmann-Bauser, M., Pohl, D., & Bohlender, J. E. (2021). Current possibilities and challenges in the diagnosis of laryngopharyngeal reflux. Hno, 69(11), 861.
Runggaldier, D., van Schie, B., Marti, S., & Bohlender, J. E. (2023). Current possibilities and challenges in the treatment of laryngopharyngeal reflux. Hno, 71(5), 294.
Salihefendic, N., Zildzic, M., & Cabric, E. (2017). Laryngopharyngeal reflux disease–LPRD. Medical Archives, 71(3), 215.Samuels, T. L., Aoun, J., Husain, I., Figueredo, E., Richards, D., & Johnston, N. (2024). Advances in laryngopharyngeal reflux: Etiology, diagnosis, and management. Annals of the New York Academy of Sciences, 1541(1), 53–62. https://doi.org/10.1111/nyas.15242
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Indonesian Journal of Global Health Research
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
