Interferência do refluxo laringofaríngeo (RLF) na produção vocal: revisão narrativa

Abstract

Introduction: The human voice is an essential element for communication and the expression of subjectivity, relying on the harmonic and biomechanical interaction of the vocal apparatus. The balance of this system can be destabilized by Laryngopharyngeal Reflux (LPR), a condition characterized by the retrograde flow of gastroduodenal content into the larynx and pharynx. Due to the direct action of hydrochloric acid and pepsin, inflammatory processes, cellular dehiscence, and tissue remodeling occur in the vocal mucosa, altering its vibration patterns and causing deviations such as hoarseness, roughness, and vocal fatigue. Objective: To analyze the influence of LPR on voice production through a narrative literature review. Methodology: An active search was conducted in the PubMed database between February and May 2026 using combined descriptors (AND) correlated to voice, dysphonia, and LPR. Full-text scientific articles in English or Portuguese published between 2015 and 2025 were included, resulting in a final sample of 13 studies analyzed through a critical-discursive approach. Results and Discussion: There was robust consensus that LPR deteriorates the viscoelasticity of the vocal folds and alters objective short-term acoustic parameters, generating reproducible elevations in jitter and shimmer. Symptoms such as chronic throat-clearing and dry throat act harmfully through compensatory overloads. However, marked inconsistencies exist in the literature: studies with voice professionals fail to demonstrate a direct linear statistical association between visual laryngeal findings and voice disorders. Furthermore, it was detected that the Reflux Symptom Index (RSI) generates significant false-positives due to the diagnostic overlap of hoarseness. In the therapeutic field, behavioral speech therapy interventions showed robust and superior efficacy in recovering voice quality compared to isolated treatment with Proton Pump Inhibitors (PPIs). Conclusion: LPR significantly influences voice production by modifying the myoelastic properties of the larynx. However, the absence of a direct linear causal relationship demands caution in clinical diagnosis and reinforces the indispensability of behavioral speech therapy over exclusive pharmacological approaches.