The Silent Reflux: Unmasking Atypical GERD Presentations and Diagnostic Delays in ENT Clinics

Frank Monroe¹, Sarah Klein², William Brooks³, Natalie Chen⁴

Abstract

Background: Gastroesophageal reflux disease (GERD) often manifests with classic heartburn symptoms, yet atypical presentations such as chronic cough, laryngitis, or globus sensation lead to frequent misdiagnosis in ENT settings. This study aims to determine the prevalence, diagnostic delay, and outcomes of atypical gastroesophageal reflux disease (GERD) among patients initially presenting to otolaryngology clinics.
Methods: A retrospective cohort study was conducted across four academic hospitals in the USA from 2020 to 2023. Records of 1,216 patients presenting to ENT clinics with chronic throat symptoms were reviewed. Atypical GERD diagnosis was confirmed through pH impedance testing and symptom-response to proton pump inhibitor (PPI) therapy. Time to diagnosis, number of prior referrals, and symptom improvement after treatment were analysed.
Results: Among 1,216 patients, 376 (30.9%) were ultimately diagnosed with atypical GERD. The average time to correct diagnosis was 14.3 weeks (SD ± 7.2), with 2.1 prior referrals per patient. The most common misdiagnoses included postnasal drip (34.6%) and vocal strain (22.1%). PPI response rate was 81.2% at 8 weeks. Patients diagnosed earlier (<8 weeks) had significantly higher symptom resolution (89.4% vs. 72.1%, p = 0.002). Multivariate analysis showed that symptom overlap and lack of early GI consultation were significant predictors of delay (p < 0.01).
Conclusion: Atypical GERD remains a frequent and underrecognized diagnosis in ENT practice, with substantial diagnostic delays contributing to unnecessary referrals and prolonged morbidity. Incorporating early reflux screening protocols in ENT clinics could streamline diagnosis and improve patient outcomes.